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Psychiatry/Behavior

Stuff I should know

QuestionAnswer
What diagnoses are considered Axis I? Clinical disorders/ mental disorders, including substance abuse, anxiety d/o, mood d/o, eating d/o, psychotic d/o, dissociative d/o
What diagnoses are considered Axis II? Personality d/o and mental retardation
What diagnoses are considered Axis III? General medical condition/ physical disorder
What diagnoses are considered Axis IV? Psychosocial and environmental situations that contribute to the d/o
What criteria are considered Axis V? GAF score
Positive symptoms of schizophrenia (4)? Hallucinations, delusions, bizarre/ disorganized behavior, thought disorder/ disorganized thinking/ thought blocking/ neologisms
Negative symptoms of schizophrenia (7)? Flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech
Types of schizophrenia (5)? Paranoid, disorganized, catatonic, undifferentiated, residual
Schizophrenia with persecutory/grandiose delusions and auditory hallucinations is classified as which type of schizophrenia? Paranoid schizophrenia
Schizophrenia with disorganized speech/behavior and flat/inappropriate affect is classified as which type of schizophrenia? Disorganized schizophrenia
Schizophrenia with motor immobility/ excess motor activity without purpose, extreme negativism/ mutism, echolalia/ echopraxia (mimicking behavior) is classified as which type of schizophrenia? Catatonic schizophrenia
Schizophrenia with only delusions and hallucinations is classified as which type of schizophrenia? Undifferentiated schizophrenia
Schizophrenia with predominantly negative symptoms (flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech) is classified as which type of schizophrenia? Residual schizophrenia
Characteristics of paranoid schizophrenia? Persecutory/grandiose delusions and auditory hallucinations
Characteristics of disorganized schizophrenia? Disorganized speech/behavior and flat/inappropriate affect
Characteristics of Catatonic schizophrenia? Motor immobility/ excess motor activity without purpose, extreme negativism/ mutism, echolalia/ echopraxia (mimicking behavior)
Characteristics of undifferentiated schizophrenia? Delusions and hallucinations, without paranoid, disorganized, and catatonic symptoms
Characteristics of residual schizophrenia? Predominantly negative symptoms (flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech
Drug class: Haloperidol First generation/typical antipsychotic; dopamine antagonist
Drug class: Chlorpromazine First generation/typical antipsychotic; dopamine antagonist
Drug class: Thoridazine First generation/typical antipsychotic; dopamine antagonist
Best treatment for positive symptoms of schizophrenia? First generation/typical antipsychotics; dopamine antagonists: Haloperidol, Chlorpromazine, Thoridazine
Common side effects of first generation/typical antipsychotics (4)? Extrapyramidal symptoms (akinesia, akathisia), parkinsonian-like symptoms, neuroleptic malignant syndrome (fever, sweating, tachycardia, tachypnea, fluctuating BP, tremor, rigidity, catatonia), tardive dyskinesia (involuntary movements)
Drug class: Risperidone Second generation/atypical antipsychotics; serotonin + dopamine antagonists
Drug class: Olanzapine Second generation/atypical antipsychotics; serotonin + dopamine antagonists
Drug class: Aripiprazole Second generation/atypical antipsychotics; serotonin + dopamine antagonists
Drug class: Ziprasidone Second generation/atypical antipsychotics; serotonin + dopamine antagonists
Drug class: Quetiapine Second generation/atypical antipsychotics; serotonin + dopamine antagonists
Best treatment for negative symptoms of schizophrenia? Second generation/atypical antipsychotics; serotonin + dopamine antagonists: Risperidone, Olanzapine, Aripiprazole, Ziprasidone, Quetiapine
Drug class: Clozapine/Clozaril Second generation/atypical antipsychotics; serotonin + dopamine antagonists
Worrisome side effect of Clozapine/Clozaril? Agranulocytosis- check blood work: leukopenia + neutropenia
Criteria for schizoaffective disorder? Major depressive/manic/mixed episode + criteria for schizophrenia
Time period required for schizophrenia diagnosis? Minimum of 2 symptoms (delusion/ hallucination/ disorganized speech/ disorganized behavior/ negative sx) present within a month and persist for 6 months minimum.
How to differentiate between schizoaffective disorder and mood disorder with psychotic features? Delusions/ hallucinations last 2 weeks without mood disorder symptoms in schizoaffective disorder
Psychotic disorders (4)? Schizophrenia, schizoaffective, delusional, schizophreniform
Criteria for delusional disorder? Non-bizarre delusions x1 month minimum
Pt presents with non-bizarre delusions for 6 weeks. Likely diagnosis? Delusional disorder
Time frame for brief psychotic disorder vs. full-blown psychotic disorder? Symptoms present for at least 1 day, but less than 1 month
Pt presents with symptoms of schizophrenia (delusion/ hallucination/ disorganized speech/ disorganized behavior/ negative sx) for 3 months. Likely diagnosis? Schizophreniform disorder
Criteria for schizophreniform disorder? Symptoms of schizophrenia (delusion/ hallucination/ disorganized speech/ disorganized behavior/ negative sx) lasting between 1 and 6 months
Somatoform disorders (7)? Somatization, body dysmorphic disorder, conversion disorder, factitious disorder, malingering, hypochondriasis, pain disorder
Description of somatization disorder? Vague physical complaints, often GI/ reproductive/ neuro/ pain not explained by medical condition or substance use. Often worse with increased stress
22 year old female presents with complaints of abdominal pain and nausea. She has seen 4 other doctors for these symptoms and claims none have found a cause for her pain. Likely diagnosis? Somatization disorder
Treatment for somatization disorder? Regularly scheduled visits with health care provider. Mental health referral if willing. Avoid medications
Description of body dysmorphic disorder? Preoccupation with imagined defect in physical appearance or exaggerated distortion of a minor flaw. Pt is self conscious and goes to great lengths to hide/correct perceived flaw. Still unsatisfied after visits to plastic surgeon/dermatologist
16 yo fem describes preoccupation w/ imagined defect in phys. appearance or exaggerated distortion of a minor flaw. Pt is self conscious & goes to great lengths to hide/correct it. Still unsatisfied after visits to plastic surgeon/dermatologist. Dx? Body dysmorphic disorder
Treatment for body dysmorphic disorder? SSRIs
Drug class: Citalopram/Celexa SSRI
Brand name of Citalopram? Celexa
Drug class: Fluoxetine/Prozac? SSRI
Brand name of Fluoxetine? Prozac
Generic name of Celexa? Citalopram
Generic name of Prozac? Fluoxetine
Drug class: Paroxetine/Paxil? SSRI
Brand name of Paroxetine? Paxil
Generic name of Paxil? Paroxetine
Drug class: Escitalopram/Lexapro? SSRI
Brand name of Escitalopram? Lexapro
Generic name of Lexapro? Escitalopram
Drug class: Fluvoxamine/Luvox? SSRI
Drug class: Sertraline/Zoloft? SSRI
Brand name of Sertraline? Zoloft
Generic name of Zoloft? Sertraline
Description of conversion disorder? 1+ neuro complaints unexplained clinically, unintentionally produced. Commonly shifting paralysis, blindness, mutism. Exhibit la belle indifference (not concerned). Worse with stress.
19 yo fem presents w/ 1+ neuro complaints unexplained clinically, unintentionally produced. Commonly shifting paralysis, blindness, mutism. Exhibit la belle indifference (not concerned). Worse with stress. Likely dx? Conversion disorder
40 yo male presents to ER with his gf with short term memory loss. He does not remember her or why he is with her. He is in the middle of a divorce. Likely dx? Conversion disorder
1st line treatment for conversion disorder? Behavioral therapy
Description of factitious disorder? Intentionally faking S&S of medical/psych symptoms, with motivation being to assume the sick role. Provided PMH can not be trusted. Pt becomes angry when confronted with ruse.
A 29 yo fem presents with her 7 yo son, providing a history of fever, abdominal pain, nausea and vomiting. Child does not appear ill, and all labs return negative. Likely diagnosis? Munchausen by proxy
Treatment for factitious disorder? Psychotherapy + SSRI to reduce impulsive tendencies if acting out
Description of malingering disorder? Deliberate production of physical/psych complaints motivated by external gain (avoid responsibility, punishment, etc.). Vague sx + great impairment/distress + self inflicted. Improve when exposed or objective met.
48 yo male presents 1 week after car accident with multiple bruises, scrapes, complaining of neck and leg pain. He is concerned he has a fracture. Further questioning reveals he is recently unemployed & is filing a lawsuit against the driver. Likely dx? Malingering disorder
Pt presents with c/o intermittent abdominal pain. They are seriously worried about colon cancer, even though previous coloscopies have been negative. They have a hx of anxiety and depression. Likely dx? Hypochondriasis
Description of hypochondriasis? Preoccupation with belief of having/contracting serious illness. Not delusional; mistake normal body sensations as sx of disease. Often hx of anxiety and depression. Fear persists even with negative tests.
Treatment of hypochondriasis? Psychotherapy, regular appts with practitioner, SSRIs for anxiety/depression
Description of pain disorder? Pain in 1+ areas resulting in significant impairment without underlying cause or fully explainable cause, pain is "cause of all problems", abrupt onset, long hx of surgeries, often hx of loss of loved one
A 48 yo female presents with abrupt onset of vague low back pain X2 months, increasing in intensity. She has had 2 exploratory surgeries, and multiple images performed. She is a widow x1 year. Claims pain is cause of all her problems. Likely diagnosis? Pain disorder
Treatment of pain disorder? Psychotherapy + pain control program + rehab. SSRI/TCA. Avoid analgesics and sedatives
Mood disorders (5)? MDD, bipolar I, bipolar II, dysthymia, cyclothymia
Time requirement to diagnose a major depressive EPISODE? 2 weeks
S&S of major depressive episode (2)? Depressed mood or anhedonia not as a result of bereavement
A 55 yo female has been feeling depressed for the past 2 weeks. Her husband recently passed a month ago. No h/o depression. Can she be diagnosed with major depressive episode? No, major depressive episodes can not be a result of bereavement
Time requirement to diagnose manic EPIDOSE? 1 week
S&S of manic episode? Abnormally and persistent elevated, expansive, or irritable mood lasting at least 1 week resulting in severe social/occupational dysfunction. At least 3 manic symptoms must be present
DIGFAST pneumonic For mania; Distractibility, Irresponsible/Indescretion, Grandiosity, Flight of ideas, activity increased, Sleep deficit, talkative/pressured speech
SIGECAPS pneumonic For depression; Sleep changes, Interest loss, Guilty, Energy change/decreased, Concentration decreased, Appetite changes, Psychomotor agitation/anxiety/lethargy, Suicidal ideation
Time requirement to diagnose hypomanic EPISODE? 4 days
S&S of hypomanic episode? 3 manic symptoms, elevated/expansive/irritable mood x 4 days, social/occupational functioning not severely affected
Time requirement to diagnose Mixed EPISODE? 1 week
S&S of mixed episode? Rapidly alternating moods with manic and depressive episode sx. No marked impairment in social/occupational functioning
Subtypes of Major Depressive Disorder (6)? Seasonal affective disorder, melancholia, atypical depression, catatonic depression, psychotic depression, postpartum depression
When is the most dangerous time in the course of treatment for a patient with MDD to commit suicide? After initiating treatment. Their mood may not be improved, but they can have increased energy to undertake a suicide attempt.
Describe seasonal affective disorder? Depressive symptoms predominating in fall/winter with less daylight; more common in cold climates; improves in spring
Treatment for seasonal affective disorder? Light therapy, SSRIs
S&S of melancholia? Anhedonia, psychomotor retardation/agitation, anorexia, weight loss, depressed mood especially in mornings, guilt, sleep disturbance- early morning awakening, +/- suicidal ideation
Treatment for melancholia? Responds well to antidepressants, ECT
S&S of atypical depression? Overeating, weight gain, oversleeping, reactive mood, leaden paralysis, oversensitive to interpersonal rejection
Treatment for atypical depression? MAOIs or SSRIs
MDD subclass where sx occur during fall/winter? Seasonal affective disorder
MDD subclass characterized by overeating, weight gain, oversleeping, reactive mood, leaden paralysis, oversensitive to interpersonal rejection? Atypical depression
S&S of catatonic depression? Motor immobility/stupor, blurred affect, purposeless motor activity, extreme withdrawal, negativism, bizarre mannerisms/posturing, echolalia, echopraxia, waxy flexibility
MDD subclass characterized by motor immobility/stupor, blurred affect, purposeless motor activity, extreme withdrawal, negativism, bizarre mannerisms/posturing, echolalia, echopraxia, waxy flexibility? Catatonic depression
Treatment for catatonic depression? Antidepressants + antipsychotics
S&S of psychotic depression? Depression with delusions/hallucination
MDD class characterized by depression with delusions/hallucinations? Psychotic depression
Time requirement for onset of postpartum depression? Within 4 weeks of delivery
1st line therapy for MDD? SSRIs
Common side effects of SSRIs? GI upset, headache, sexual dysfunction
Common side effects of TCAs? Weight gain, orthostatic hypotension, anticholinergic effects, somnolence
Drug class of Amitriptyline? TCA
Drug class of Clomipramine? TCA
Drug class of Nortriptyline? TCA
Greatest concern with ECT? Memory loss; usually returns within 6 months
Definition of bipolar I disorder? One or more manic or mixed episodes, often cycle with depressive episodes, DIGFAST, +/- psychotic symptoms
Treatment of bipolar I and II disorder? Lithium, valproic acid, olanzapine, carbamazepine, topiramate, lamotrigine
Treatment for acute mania? Second generation antipsychotics (Risperidone, Aripiprazole, Quetiapine)
Monitoring in Lithium time frame? Plasma levels every 4-6 weeks
Definition of bipolar II disorder? One or more major depressive episodes + one or more hypomanic episodes (less severe manic symptoms that do not cause impairment). No manic or mixed episodes
Dysthymic disorder characteristics? Chronic, persistent, mild depression + pessimism, brooding, generalized loss of interest, decreased productivity, feelings of inadequacy, social withdrawal. No psychotic/ manic/ hypomanic episodes
Timeframe for dysthymic disorder diagnosis? 2 years of depressed mood most of the day, more days than not
Treatment for dysthymic disorder? SSRIs, bupropion, TCAs
Characteristics of cyclothymic disorder? Less severe episodes of depression + hypomania x2 years, moody, erratic, impulsive, somewhat volatile, no manic or mixed episodes
Treatment of cyclothymic disorder? Mood stabilizers and antimanic drugs
Characteristics of adjustment disorder? Maladaptive behavioral/emotional sx that develop within 3 months of a stressful life event, and within 6 months of event. Not caused by bereavement.
Mood disorder with One or more major depressive episodes + one or more hypomanic episodes (less severe manic symptoms that do not cause impairment). No manic or mixed episodes? Bipolar II disorder
Mood disorder with one or more manic or mixed episodes, often cycle with depressive episodes, DIGFAST, +/- psychotic symptoms? Bipolar I disorder
Mood disorder with chronic, persistent, mild depression + pessimism, brooding, generalized loss of interest, decreased productivity, feelings of inadequacy, social withdrawal for 2 years minimum. No psychotic/ manic/ hypomanic episodes. Dysthymic disorder
Mood disorder with less severe episodes of depression + hypomania x2 years, moody, erratic, impulsive, somewhat volatile, no manic or mixed episodes? Cyclothymic disorder
Mood disorder with maladaptive behavioral/emotional sx that develop within 3 months of a stressful life event, and within 6 months of event. Not caused by bereavement.? Adjustment disorder
Treatment of adjustment disorder? Supportive psychotherapy/ group therapy
Personality disorders are considered which axis of functioning? Axis II
Which personality disorders fall under Cluster A? "Mad"/Psychotic: Schizoid, Schizotypal, and Paranoid
Schizoid disorder is considered which personality disorder cluster? Cluster A; "Mad"
Schizotypal disorder is considered which personality disorder cluster? Cluster A; "Mad"
Paranoid personality disorder is considered which personality disorder cluster? Cluster A; "Mad"
Which personality disorders fall under Cluster B? "Bad"/Mood: Antisocial, Borderline, Histrionic, and Narcissistic
Antisocial disorder is considered which personality disorder cluster? Cluster B; "Bad"
Borderline disorder is considered which personality disorder cluster? Cluster B; "Bad"
Histrionic disorder is considered which personality disorder cluster? Cluster B; "Bad"
Narcissistic disorder is considered which personality disorder cluster? Cluster B; "Bad"
Which personality disorders fall under Cluster C? "Sad"/Anxiety: Avoidant, Dependent, OCD
Avoidant personality disorder is considered which personality disorder cluster? Cluster C; "Sad"
Dependent personality disorder is considered which personality disorder cluster? Cluster C; "Sad"
OCD disorder is considered which personality disorder cluster? Cluster C; "Sad"
Description of paranoid personality disorder? Pervasive distrust, suspicion of others, seem hostile and angry, blame problems on others, begins in early adulthood.
Clinical features of paranoid personality disorder (5)? Suspicion of exploitation/deceit by others, preoccupation and doubts regarding loyalty/trustworthiness/fidelity of others, reluctance to confide in others, misinterpret benign remarks as threatening/demeaning, persistent grudges/ quick to counterattack
Treatment of paranoid personality disorder? Psychotherapy + anti-anxiety or antipsychotics
Clinical features of schizoid personality disorder (5)? No enjoyment from or desire for close relationships, choose solitary activities, little interest in sexual activity with partner, indifferent to praise or criticism, emotional coldness/ detachment/ flattened affect.
Suspicion of exploitation/deceit by others, preoccupation & doubts regarding loyalty/trustworthiness/fidelity of others, reluctance to confide in others, misinterpret benign remarks as threatening/demeaning, persistent grudges/ quick to counterattack. Dx? Paranoid personality disorder
No enjoyment from or desire for close relationships, choose solitary activities, little interest in sexual activity with partner, indifferent to praise or criticism, emotional coldness/ detachment/ flattened affect. Likely diagnosis? Schizoid personality disorder
Treatment for schizoid personality disorder? Group therapy, psychotherapy, +/- antipsychotics/ antidepressants
Clinical features of schizotypal personality disorder (5)? Ideas ofreference(things in the world refer to them), Oddbehavior/thoughts/speech/beliefs/magical thinking inconsistent w/ cultural norms (telepathy, superstitions, etc.), unusual perceptualexperience, suspicious/social anxiety, inapprop/restricted affect
Ideas of reference, Odd behavior/thoughts/speech/beliefs/magical thinking inconsistent w/ cultural norms (telepathy, superstitions, etc.), unusual perceptualexperience, suspicious/social anxiety, inapprop/restricted affect. Dx? Schizotypal personality disorder
Treatment for schizotypal personality disorder? Psychotherapy
Characteristics of antisocial personality disorder? Think criminals: Disregard/violate others rights and feelings, manipulative/deceitful/impulsive/ lack empathy and remorse, can appear charming,irritable and aggressive
Think criminals: Disregard/violate others rights and feelings, manipulative/deceitful/impulsive/ lack empathy and remorse, can appear charming,irritable and aggressive. Likely diagnosis? Antisocial personality disorder
Treatment for antisocial personality disorder? Psychotherapy, SSRIs/ lithium/ Valproate/ carbamazepine/ propranolol
Characteristics of borderline personality disorder? Unstable & unpredictable mood/behavior, poor self image, short/transient psychotic episodes/paranoid ideation, self mutilation, suicide attempts, desperate attempts to avoid abandonment, unstable/intense relationships, unable to be alone
Unstable & unpredictable mood/behavior, poor self image, short/transient psychotic episodes/paranoid ideation, self mutilation, suicide attempts, desperate attempts to avoid abandonment, unstable/intense relationships, unable to be alone.. likely dx? Borderline personality disorder
Treatment for borderline personality disorder? Psychotherapy/ behavioral therapy + antipsychotics for hostility/ SSRIs for mood/ benzodiazepines for anxiety/ anticonvulsants for global functioning
Characteristics of histrionic personality disorder? Overly emotional, dramatic, seductive, attention-seeking behavior, exaggerate thoughts and feelings, superficial + rapid shifting emotions = unable to maintain relationships, easily influenced, need to be center of attention, substance abuse common
Overly emotional, dramatic, seductive, attention-seeking behavior, exaggerate thoughts and feelings, superficial + rapid shifting emotions = unable to maintain relationships, easily influenced, need to be center of attention, substance abuse common... Dx? Histrionic personality disorder
Treatment for histrionic personality disorder? Psychotherapy, Antidepressants/ anxiolytics
Characteristics of narcissistic personality disorder? Inflated self image, pattern of grandiosity, need for admiration, lack of empathy, consider themselves deserving of special treatment, fragile self esteem, fantasize about success, etc., exploitative, take advantage of others
Inflated self image, pattern of grandiosity, need for admiration, lack of empathy, consider themselves deserving of special treatment, fragile self esteem, fantasize about success, etc., exploitative, take advantage of others... likely diagnosis? Narcissistic personality disorder
Treatment for narcissistic personality disorder? Psychotherapy is key, meds for symptoms
Treatment for borderline personality disorder? Psychotherapy/ behavioral therapy + antipsychotics for hostility/ SSRIs for mood/ benzodiazepines for anxiety/ anticonvulsants for global functioning
Characteristics of histrionic personality disorder? Overly emotional, dramatic, seductive, attention-seeking behavior, exaggerate thoughts and feelings, superficial + rapid shifting emotions = unable to maintain relationships, easily influenced, need to be center of attention, substance abuse common
Overly emotional, dramatic, seductive, attention-seeking behavior, exaggerate thoughts and feelings, superficial + rapid shifting emotions = unable to maintain relationships, easily influenced, need to be center of attention, substance abuse common... Dx? Histrionic personality disorder
Treatment for histrionic personality disorder? Psychotherapy, Antidepressants/ anxiolytics
Characteristics of narcissistic personality disorder? Inflated self image, pattern of grandiosity, need for admiration, lack of empathy, consider themselves deserving of special treatment, fragile self esteem, fantasize about success, etc., exploitative, take advantage of others
Inflated self image, pattern of grandiosity, need for admiration, lack of empathy, consider themselves deserving of special treatment, fragile self esteem, fantasize about success, etc., exploitative, take advantage of others... likely diagnosis? Narcissistic personality disorder
Treatment for narcissistic personality disorder? Psychotherapy is key, meds for symptoms- Lithium for mood swings/ SSRIs as adjunct
Characteristics of avoidant personality disorder? Sensitive to rejection, low self esteem, social anxiety/phobia, feel inadequate, avoid situations with potential for criticism, shy but desire companionship, restraint with intimate relationships for fear of rejection
Patient exhibits sensitive to rejection, low self esteem, social anxiety/phobia, feel inadequate, avoid situations with potential for criticism, shy but desire companionship, restraint with intimate relationships for fear of rejection... Likely diagnosis? Avoidant personality disorder
Treatment for avoidant personality disorder? Psychotherapy, Beta-blockers/SSRIs for anxiety/sensitiviy to rejection
Characteristics of dependent personality disorder? Dependent, clingy, submissive behavior, require outside help to make decisions, difficulty disagreeing for fear of disapproval, lack confidence, avoid positions of responsibility, dislike being alone, high risk of depression, fear of alone
Dependent, clingy, submissive behavior, require outside help to make decisions, difficulty disagreeing for fear of disapproval, lack confidence, avoid positions of responsibility, dislike being alone, high risk of depression, fear of alone... likely dx? Dependent personality disorder
Treatment for dependent personality disorder? Psychotherapy, SSRIs for anxiety/depression
Characteristics of OCD?
Created by: mccullough87