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FOB Exam 2
FOB exam 2
248
Anatomy
Graduate
03/26/2011

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Term
TCA (6):
Definition
- Amitriptyline
- Imipramine
- Doxepine
- Desipramine
- Nortriptyline
- Protriptyline
Term
TCAs that block reuptake of NE:
Definition
- Desipramine
- Nortriptyline
- Protriptyline
Term
TCAs that block serotonin reuptake:
Definition
AID
- Amitriptyline
- Imipramine
- Doxepin
Term
antidepressants useful in chronic pain:
Definition
TCAs
Term
common side effects of TCAs:
Definition
- sedation
- orthostatic hypotension
- constipation
- urinary hesitancy
- dry mouth
- blurred vision
- weight gain
- arrhythmias
Term
TCA withdrawal syndrome:
Definition
- headache
- malaise
- nausea
- anxiety
Term
SSRIs (6):
Definition
- Fluoxetine
- Sertraline
- Paroxetine
- Fluvoxamine
- Citalopram
- Escitalopram
Term
TCA most likely to cause sleepiness:
Definition
Amitriptyline
Term
TCA likely to cause initial agitation:
Definition
Desipramine
Term
SRRI that may cause initial increase in agitation:
Definition
Fluoxetine
Term
SSRI that may cause sleepiness:
Definition
Paroxetine
Term
first line drugs for unipolar mood disorders like major depression:
Definition
- SSRIs
Term
SSRIs indicated for PTSD: :
Definition
- Paroxetine
- Sertraline
Term
SSRIs indicated for premenstrual dysphoria:
Definition
- Fluoxetine
- Paroxetine
- Sertraline

FPS for premenstrual dysphoria
Term
SSRIs indicated for Generalized Anxiety Disorder:
Definition
- Paroxetine
- Escitalopram

PE relieves GAD.
Term
SSRIs indicated for Panic Disorder:
Definition
- Fluoxetine
- Paroxetine
- Sertraline

FPS for premenstrual dyshporia and panic disorder.
Term
SSRIs indicated for social phobias:
Definition
- sertraline
- paroxetine
(also escitalopram and citalopram)
Term
SSRIs indicated for OCD:
Definition
- Fluoxetine
- Fluvoxamine
- Sertraline
- Paroxetine
Term
SSRIs indicated for bulimia nervosa:
Definition
- fluoxetine
- sertraline
Term
what antidepressant would you use for withdrawal of drugs/alcohol:
Definition
- TCA first choice
- SSRI second choice
Term
MAO-Is inhibit reuptake of ___ , causing ___ of ___ receptors, and others including ___ and __.
Definition
- serotonin
- down-regulation
- dopamine
- norepinephrine
Term
common side effects of SSRIs:
Definition
- initial nausea, loose stools, anxiety, headache, sweating, and insomina usually diminish over time and are sometimes dose dependent
- anxiety/hyper stimulation
- persistent insomeina
- weight gain
- vivid dreams (especially fluoxetine)
- sexual dysfunctions
- side effects lessen with time
Term
Reasons SSRIs have a good safety profile:
Definition
- no cardiac side effects
- few significant drug drug interactions although SSRIs increase TCA blood levels
- low risk in overdose
- low risk in pregnancy
Term
Tolerance to effect aka Poop out effect seen after 6 months in some patients on ____. To overcome this, what should you do?
Definition
- SSRIs
- increase dose for a short period of time to increase the effectiveness, then can go back to original dose
Term
Abrupt withdrawal from high doses of SSRIs may cause ___ __ including __, __, and ___ symptoms.
Definition
- discontinuation syndrome
- somatic
- neurological
- psychological
Term
When pt is getting off SSRIs, taper no more rapidly than ___ per week and monitor for recurrence of depression.
Definition
25%
Term
Serotonin syndrome is caused by taking __ doses or multiple SSRIs or an SSRI with a ___. This can lead to ___ __ and __!
Definition
- large
- MAO-I
- renal failure and death
Term
Symptoms of Serotonin Syndrome:
Definition
- lethargy
- restlessness
- myoclonic jerking
- tremor
- mental confusion
- diaphoresis
- flushing
Term
SNRIs:
Definition
- Buproprion
Term
what antidepressant is used to help with smoking cessation:
Definition
Buproprion
Term
Buproprion is NOT indicated to treat __ ___.
Definition
anxiety disorders
Term
Buproprion is indicated in ___ __ and may be useful in ___. It has a minimal effect on __ __, ___ ___, and ___ ___. Thus it is often given to patients who have decreased libido from SSRI to try to increase libido.
Definition
- major depression
- ADHD
- minimal effects on weight gain, cardiac conduction, and sexual dysfunction
Term
Buproprion is a ___, __, and ___ reuptake inhibitor.
Definition
dopamine
norepinephrine
serotonin
Term
Contraindications for Buproprion:
Definition
- seizure disorders
- eating disorders may lower seizure threshold
Term
Common side effects of Buproprion:
Definition
- headaches
- nausea
- anxiety
- tremors
- insomnia
- increased sweating

These subside with time and are dose dependent
Term
Duloxetine is an ____ that is indicated in the following conditions:
Definition
- SSNRI
- depression
- Diabetic neuropathy
- urinary incontinence
- fibromyalgia
Term
Duloxetine Contraindications:
Definition
- MAOIs> dietary restrictions
- hepatic insufficiency
- severe renal impairment
- end stage renal disease (ESRD)
Term
Duloxetine has same side effects as :
Definition
SSRIs
Term
Venlafaxine is an ___ used in treatment of ___, ___, ___, and ___. It also cannot be given with MAO-I and has same side effects as SSRIs.
Definition
- SSNRI
- depression, anxiety, OCD, and pain
Term
Trazodone is a ____. It is a weak inhibitor of ___ and blocks the ___ receptors. It is not really great as an antidepressant, but useful for ___ side effect to use with SSRI.
Definition
- MAO-I
- serotonin reuptake
- 5-HT2
- sedative
Term
Trazodone side effects:
Definition
- sedation
- orthostatic hypotension
- dry mouth
- dizziness
- rare side effect of priapism> immediate medical attention (contrainidcation for use in adolescents)
- use sparingly in elderly due to dizziness
Term
Mertazapine aka ___ enhances ___ and ___ neuro-transmission through blockade of ___ ____ and ___ receptors. It has a __ response rate. Can be used with significant __ componenet. Used as a ___. Causes significant ___ __.
Definition
- Remeron
- serotonergic and noradrenergic neurotrasmission
- blockade of post-synaptic 5-HT2 and 5HT3 receptors
- rapid
- anxiety
- sedative
- weight gain
Term
In ___ of patients, depression fails to remit with the initial antidepressant. Controlled trial studies have shown improved response after augmentation of antidepressants with other ___, __, or ___ __.
Definition
- 2/3
- antidepresants
- lithium
- thyroid hormone
Term
first line depression treatment:
Definition
- monotherapy with SSRI, SSNRI, or SDNRI
Term
second line depression treatment:
Definition
- monotherapy agent of different class
- augmentation for partial responders
Term
third line depression treatment:
Definition
- augmentation
- combination
Term
fourth line depression treatment:
Definition
combinations
Term
Fifth line depression treatments:
Definition
- ECT
- vagus nerve stimulation
- other combinations
Term
anxiety definition:
Definition
- apprehensive anticipation of future danger
- experienced as unpleasant
- with somatic symptoms like muscle tension
Term
fear definition:
Definition
- more appropriate term for real threat of danger
Term
phobia definition:
Definition
persistant, excessive or irrational fear of specific object, activity, or situation
Term
Steps in the normal fear response:
Definition
- Cognitive appraisal: recognize and remember real threat
- Physiological arousal: signal danger, enhance alertness, prepare body for action
- Behavior: fight/flight/freeze
Term
The normal fear response is the neural alarm system for rapid alerting to sources of threat. With the normal fear response there is absense of ___ ___.
Definition
- absense of cortical stimulation
Term
Hypothalamic Pituitary Axis (HPA):
Definition
hypothalamus> CRH(corticotropin releasing hormone)> anterior pituitary> ACTH (adrenocorticotropic hormone)> adrenal cortex> cortisol
Term
GAD symptoms:
Definition
- chronic, excessive, unrealistic worry (health, money, career)
- trembling
- muscle aches
- insomnia
- gastric distress
- dizziness
- irritability
- restlessness
- feeling on edge
- easy fatigueability
- muscle tension
Term
general medical conditions that mimic panic attacks:
Definition
Cardiopulmonary disorders:
- mitral valve prolapse
- silent MI> diabetic females
- recurrent pulmonary emboli
- paroxysmal arterial tachycardia

Hypoglycemia

Pheochromocytoma

Temporal lobe epilepsy

Substance abuse/dependence
Term
endocrine disorders that mimic GAD:
Definition
- hyperthyroidism
- hypoglycemia
Term
Hypoglycemia may look like ___ or ___ __.
Definition
GAD
panic attack
Term
Temporal lobe epilepsy may look like __ attack. It causes behavioral disinhibition. Look for head injury in proximity of onset.
Definition
panic attack
Term
Post-concussion syndrome may look like ___ or ___.
Definition
PTSD
GAD
Term
Organic solvent syndrome may look like ___.
Definition
GAD
Term
Delirium may look like ___ ___ with waxing and waning levels of consciousness.
Definition
anxiety NOS
Term
___ is very useful in treating anxiety, know this!
Definition
Psychotherapy
Term
The psychodynamic theory of anxiety believes that the __ are expressions of underlying ___. This theory utilizes the ___ ___ technique. There are no empirical studies of support.
Definition
- symptoms
- conflict
- free association
Term
Behavior therapy can be used as treatment of anxiety as well. This uses ___ conditioning, ___ conditioning with __ and __ reinforcements and punishing, and ___ ___.
Definition
- classical conditioning
- operant conditions for maintenance of avoidance behaviors
- positive and negative
- observational learning
Term
Cognitive behavior therapy is also useful in treatment of anxiety. This uses systematic desensitization and/or graded exposure.
Definition
Term
For PTSD, Panic Disorder, and Anxiety what type of cognitive behavioral therapy should be used?
Definition
Systematic Desensitization (in vitro only, pt only imagining stressful event)
Term
For OCD and Panic Disorder, ___ __ can be used in which you actually expose the patient to stressor hieararchicaly w/o relaxation training and do NOT allow them to go through with compulsion.
Definition
graded exposure
Term
flooding:
Definition
actual IMMEDIATE exposure (not hierachicical) to exaggerate situation
- good with specific phobias
Term
Implosion:
Definition
- convert immediate exposure exaggerated situation
- specific phobia
Term
participant modeling:
Definition
learning desired behavior through demonstrations and observations

(put child in room with dog and other child playing with dog and have kid move closer and closer)
Term
panic attacks are not specific to panic disorder, they also occur with __ __, ___, and ___.
Definition
- social phobia
- OCD
- PTSD
Term
Most pts with panic disorder/attacks have underlying ___.
Definition
depression
Term
Panic disorder definition:
Definition
- Recurrent unexpected panic attacks, followed by one or more of the following:
- anticipation and fear of additional attacks
- worry about implications of attacks
- change in behavior, ususally withdrawal
Term
Panic attacks are __ times more common in ___.
Definition
3 times more common in women
Term
Panic disorder patients are at increased riks of abuse of drugs, such as __ ___ like alcohol or ___ ___ ____.
Definition
CNS depressants
long acting benzodiazepines
Term
Panicogenic substances include:
Definition
- sodium lactate infusion
- 35% carbon dioxide
Term
Panic attacks occur due to disturbances of overall function of ___, ___, or ___ systems.
Definition
- serotonergic
- noradrenergic
- GABAergic
Term
For treatment of panic attacks you should start with an ____, full response may take 3 months. Benzos can be used for temporary fast releif, but have problems with neuroadadaptations.
Definition
SSRI
Term
Benzodiazepines for panic attacks:
Definition
- Alazopam .75-1.5, titrate up to 6 mg
- Clonazepam .5 to 1.5, titrate up to 4 mg
- Iorazepam 1 to 2, titrate up to 6
- Diazepam 4 to 10, titrate up to 10-60 mg

Divided doses except for extended release alprazolam
Term
SSRIs for panic attacks:
Definition
FPS and FCE

- fluoxetine
- paroxetine
- sertraline
- fluvoxamine
- citalopram
- escitalopram
Term
MAO-I for panic attack:
Definition
phenelzine
Term
_% of men and _% of women have specific phobias.
Definition
5
10
Term
Lifetime prevalence of social phobia is __%. It is more common in women. Social phobia has high comorbidity with __ and __ __.
Definition
2.6%
depression
alcohol abuse
Term
OCD has a lifetime prevalence of ___%, childhood onset is greater than __%. Men and women are ___ affected. There is a ___ component. There is disturbed ___ transmission.
Definition
- 2-3%
- 50%
- equally
- familial
- disturbed serotonergic transmission
Term
With OCD, __ is present. Symptoms cause __ __, are ___ ___, or __ with function.
Definition
- insight is present
- subjective distress
- time consuming
- interfere with function
Term
Risk factor for PTSD:
Definition
childhood sexual abuse
Term
Lifetime prevalence of PTSD:
Definition
1-9%
Term
PTSD characteristics:
Definition
- intense fear
- helplessness
- horror
- difficultly sleeping
- irritability
- poor concentration
- trauma persistently reexperienced
- avoidance behaviors
- emotional numbing
- loss of enjoyment in life
- sense of no future
- feeling detached/emotionally aloof
- chronic hyperarousal
Term
GAD is ___,___, ___ worry (health, money, career). Accompanied by __ __, ___,___, __ __, ___, and ___. It is __ times more common in women. Often a comorbid condition.
Definition
- chronic, unrealistsic, excessive worry
- muscle aches
- trembling
- insomnia
- gastric distress
- dizziness
- irritability
- twice
Term
symptoms of GAD:
Definition
- restlessness
- feeling on edge
- easy fatigability
- trouble concentrating
- irritability
- muscle tension
- sleep disturbances
Term
Tricyclics can also be used for panic disorder, thes include ___, __, ___, ___.
Definition
imipramine 150-200 mg
nortriptyline
desipramine
clomipramine
Term
Agoraphobia should be treated with ___ ___ __, specifically ___ ___ or ___ ___. Medication is/is not helpful with agoraphobia.
Definition
- Cognitive Behavioral Therapy
- Systematic Desensitization
- Graded exposure
- Medication is NOT helpful, but may help with panic disorder if this is comorbid
Term
Specific phobias should be treated with __ ___ __, specifically __ ___ or ___ __ with children. Medication should only be used for __ __ situations like a closed MRI, use ___ 20 mg.
Definition
- cognitive behavioral therapy
- systematic desensitization
- participant modeling with children
- one time
- paroxetine
Term
Social phobias should be treated with an ___, specifically __, __, or ___, but NOT __. ___ (SNRI), ___ (benzo), and the MAOI ___ , or ___may also be used. ___ ___ may also work with these patients.
Definition
- SSRI
- flovoxamine, paroxetine, sertraline
- NOT fluoxetine
- Venlafaxine
- Clonazepam
- Phenelzine
- Gabapentin
- Systematic Desensitization
Term
OCD should be treated with ___ therapy and ___ therapy. __ may be used. The SSRIs that can be used include:
Definition
- behavior therapy
- cognitive therapy
- Clomipramine
- Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Escitalopram, Citalopram
Term
PTSD should be treated with __ ___ __, specifically ___ ___. The SSRIs include __, __, and ___. Imipramine the tricyclic or phenelzine can also be used. Also Cyproheptadine can be used.
Definition
- Cognitive Behavior Therapy
- systematic desensitization
- fluoxetine, paroxetine, sertraline
Term
For GAD treatment, Cognitive Behavior Therapy should be used, specifically __ ___. Medications are equally effective as the therapy. Should start with an ___ or ___, __ as second choice, ___ for fast effect.
Definition
- relaxation techniques
- SSRI or buspirone
- benzodiazepine as second choice
- hydroxyzine for fast effect
Term
Herbals for anxiety, many pts will take these and they can interact with other medications:
Definition
- Valerian root
- Kava Kava
- Passion Flower
- Ashwaghanda root
- B complex vitamins
Term
For GAD, start first on SSRI such as ___ or ___, can also do ___. These may initially increase anxiety, but then get better.
Definition
- paroxetine
- escitalopram
- venlafaxine
Term
The Cochrane review found the ___ extract to be an effective treatment of GAD, but doses are not consistent across manufacturers. This is safe for __ to ___ weeks.
Definition
- Kava
- 1 to 24 hours
Term
Cochrane review found ___ to help with core PTSD symptoms
Definition
SSRIs
Term
Cochrane review developed __ ___ __ __ especially for PTSD, very effective.
Definition
trauma focused cognitive therapy
Term
Fluoxetine is contraindicated for ___ __
Definition
social phobia
Term
FFPSEC for OCD and panic disorder, but just FPS for PTSD but different FPS for social phobia:
Definition
fluoxetine
fluvoxamine
paroxetine
sertraline
escitalopram
citalopram
Term
Cochrane review found that __, ___, and ___ help with GAD.
Definition
- imipramine
- venlafaxine
- paroxetine
Term
Dissociative disorders are disturbances in the organization of __, __, __, or __.
Definition
- identity
- memory
- perception
- consciousness
Term
Dissociative amnesia is the separation of ___ from access to ___.
Definition
- separation of memories from access to consciousness
Term
Dissociative fugue or dissociative identity disorder results from ___ of ___.
Definition
fragmentation of identity
Term
fragmentation of identity causes:
Definition
- dissociative fugue
- dissociative identity disorder
Term
Depersonalization disorder results from __ ___.
Definition
disintegrated perception
Term
Disintegrated perception is characteristic of ____ ___.
Definition
depersonalization disorder
Term
Dissociation of aspects of consciousness results in __ ___ __, ____ ___, and ___ ___.
Definition
- acute stress disorder
- dissociative trance
- possession states
Term
Dissociation disorders are more of a disturbance in ___ of mental contents rather than the contents themselves.
Definition
organization
Term
Memories in dissociative amnesia aren't really bizarre, they are just separated from one another. Specialized- like remembering the people involved but not the event.
Definition
Term
With DID and fugue the problem results from fragmentation of identity, so it is a __ ___ problem, meaning the information fails to ___ , not that the information is wrong.
Definition
- information processing
- fails to integrate
Term
Dissociative identity is aka:
Definition
multiple personality disorder
Term
Dissociative fugue example:
Definition
have no recollection of how you got to be where you are
Term
In repression, information is ___ and ___.
Definition
- disguised
- hidden
Term
In dissociation, information is ___ __ in ___ manner.
Definition
discretely stored
untransformed
Term
Retrieval of repressed information requires ___ b/c it is ___. Retrieval of dissociated information is ___.
Definition
- translation
- disguised
- direct
Term
___ information is NOT discretely organized temporarily, but ____ information is for a sharply delimited time.
Definition
Repressed
Disocciated
Term
___ is less tied to trauma. __ is a defense used to deal with physical threats not fantasies.
Definition
Repression less tied to trauma
Dissociation
Term
What Axis I disorders have dissociative symptoms?
Definition
BPAP
- Bipolar disorder
- PTSD
- Acute stress disorder
- Panic Disorder
Term
What Axis II disorders have dissociative symptoms?
Definition
Borderline personality disorder
Term
Dissociative amnesia is the classical functional disorder of ___ memory NOT involving ___ __ or problems in ___ __. It is ___ and may ___ ___.
Definition
- NOT involving procedural memory or problems in memory storage
- reversible
- spontaneously remit
Term
With dissociative amnesia, memory loss is ___ . It has a ___ structure, meaning it is ___ not ___, and there is loss of __ periods of time. Types of events forgotten are ___ and ___ events including disavowed behavior like sexual acting out, suicide attempts, death of a relative, or criminal activity.
Definition
- episodic
- temporal structure
- retrograde not anterograde
- discreet
- traumatic and stressful
Term
Differential for dissociative amnesia:
Definition
- CNS disorders: cerebral infection, cerebral neoplasms, CVA
- Metabolic disorders: uremia, hypertensive encephalopathy, hypoglycemia
- Transient global amnesia
- Anoxia (usually anterograde amnesia)
- head trauma- lack of recall immediately before and after
- ECT: transient loss of recall
- Temporal lobe epilepsy
Term
what Axis I disorders have high co-moribidity with dissociative amnesia?
Definition
ABCD comorbid with dissociative amnesia:
- Alcohol abuse
- Bulemia
- Conversion disorder
- Depression
Term
What Axis II disorders have high co-morbidity with dissociative amnesia?
Definition
- Histrionic PD
- Dependent PD
- Borderline PD
Term
Dissociative fugue characteristics:
Definition
- amnesia for aspects of personal memory
- loss of customary identity
- automatisms of behavior- person doesn't behave like they normally do
- sudden, purposeful travel
- assumption of new or partial identity
- rare
- usually following trauma or bereavement
- alcohol abuse frequently involved
- personality predisposing factor (espcially cluster B)
- spontaneous remission may occur
- hypnosis and psychotherapy
Term
Dissociative identity disorder is the presence of __ or __ __ __ that ___ take control of the person's behavior along with occurence of ___ ___ __.
Definition
- 2 or more distinct personalities
- dissociative amnestic states
Term
DID accounts for __ to __% of psychiatric admissions. It is more common in __. Usually diagnosed in the __ __ or __ __. If left untreated it is __ and ___. Majority of these patients report a history of ___ __ and __ __.
Definition
- 0.5-2.0%
- women
- late adolescents or early adulthood
- chronic and recurrent
- early physical and sexual abuse
Term
Pts with DID are unaware of existence of other personalities but is aware of blackouts or loss of time. May be told about behavioral episodes by others. These patients hear voices that are perceived as ___ head rather than outside of self. These patients use the term __ to refer to self in conversations.
Definition
- INSIDE HEAD
- "we"
Term
Axis I disorders that are comorbid with DID:
Definition
DPS with DID
- depressive disorders
- PTSD
- substance abuse disorders
Term
Axis II disorders that are comorbid with DID:
Definition
- borderline personality disorder
Term
Primary treatment modality for DID is ___. What are some guidelines for this.
Definition
- psychotherapy
- setting consistent boundaries
- focus on gaining mastery
- maintain therapeutic alliance
- be consistent with alters
- abreaction not retraumatization
- correct cognitive errors
Term
Depersonalization disorder is persistent feeling of ___, __, or ___ from oneself or one's body. Usually with the feeling of being an __ __. Reality testing remains intact, but the feeling is uncomfortable and __ ___.
Definition
- unreality, detachment, or estrangement
- outside observer
- ego dystonic
Term
___ as a symptom refers to perception that body or self is strange and unreal. ___ as a symptoms refers to perception that objects in external world seem strange and unreal. Transient and isolation cases of depersonalization are common
Definition
- Depersonalization
- Derealization
Term
when depersonalization is normal:
Definition
- bereavement
- emotional shock
- sensory deprivation
- boredome
- exhaustion
Term
Treatment for depersonalization disorder:
Definition
- tincture of time
- reassureance and support
- brief psychotherapy
- hypnosis is contraindicated
Term
hypnosis is contraindicated for tmt of what disorder?
Definition
depersonalization
Term
Somatoform disorders are disorders in which patients have a __ ___ that cannot be fully explained by ___ ___ or known ___ __, or if there are medical findings, the complaints or impairment ___ __ __.
Definition
- physical symptom
- medical findings or known physiological mechanisms
- exceed the expected
Term
Somatoform disorders are likely caused by ___ of ___ ___ ___ and ___ to more acceptable manner of expression. Example: someone has depression but presents to doctor with headaches.
Definition
- repression of emotional conflicts/anxieety
- conversion
Term
6 Major Somatoform Disorders:
Definition
Some Can Hike But Pedal Unwell.

- Somatization disorder
- Conversion disorder
- Hypochondriasis
- Body dysmorphic disorder
- Psychogenic pain disorder
- Undifferentiated somatoform disorder
Term
DSM IV criteria for somatization disorder:
Definition
44211
- 4 pain symptoms in 4 different locations (fibromyalgia would have more pain locations)
- 2 G.I. symptoms
- 1 sexual symptom (irregular menses)
- 1 pseudoneurological symptom (double vision and blindness)
Term
key features of somatization disorder:
Definition
- begin during teens or early 20s
- total absorption in physical symptoms and health care professionals
- exaggerating and over-dramatizing symptoms
- history of significant interpersonal conflict
Term
Somatization disorder is commonly associated with ___ ___ __. There are often ___ ___. __ and ___ defenses are used.
Definition
- histrionic personality disorder
- iatrogenic complications
- Repression and conversion
Term
Conversion disorder key features:
Definition
- sudden, dramatic appearance of symptom
- usually single prominent symptom
- neurological inconsistencies
- significant interpersonal conflict
- symptom provides partial resolution of conflict
- unusual to have single episode
- in children prsents with family problem
- commonly have a personality disorder
- la belle indifference
- primary reason: money
- secondary reason: time off work or don't have to do something
- want some sort of gain
Term
Defenses used with Conversion disorder:
Definition
- reaction formation
- denial
- displacement
Term
Treatment of conversion disorder:
Definition
- tincture of time
- suggestion (hypnotic, authoritative, caring, lorazepam, sodium amytal interview)
- discover underlying problem and address
Term
Treatment of somatization disorder:
Definition
Minimize iatrogenic complications
Single primary physician
Schedule visits on a non-contingent basis
Assist patient with interpersonal problems
Psychotherapy to develop insight and coping skills
Avoid psychotropics
Term
Hypochondriasis features:
Definition
- triad of disease conviction, fear, and preoccupation
- anxiety/compulsive preoccupation
- fear of particular serious illness
- EPISODIC AND RECURRENT
- exacerbations with identifiable life stress
- may be associated with OCD
- may transfer belief to another disease
Term
Defenses used in Hypochondriasis:
Definition
- repression
- displacement
Term
Body dysmorphic disorder features:
Definition
- complaint is out of proportion
- history of visits to doctors about complaint
- chronic
- repeated visits to plastic surgeons/dermatologists
- secondary depression
Term
Defenses used in body dysmorphic disorder:
Definition
- repression
- distortion
- symbolization
- projection
Term
Treatment of Body Dysmorphic Disorder;
Definition
- serotonergic drugs (chlomipramine, fluoxetine)
- these help to decrease obsessive rumination and depression
- anti-anxiety agents of little use
- psychotherapy good to develop insight, address feelings of inadequacy
Term
Differential diagnosis for body dysmorphic disorder:
Definition
- mood disorders (if symptoms limited to mood episode)
- panic disorder (symptoms circumscsribed to attack)
- GAD (focus of worry not limited to physical symptom)
- pscychotic disorders
Term
Malingering is ___ production of ___ or ___ symptoms in order to accomplish an __ __.
Definition
- voluntary
- physcial or psychological
- external goal
Term
Malingering features:
Definition
- many vague or poorly localized symptoms
- presented in GREAT DETAIL
- easily irritated by skepticism
- history reveals secondary gain issue
- chronic
- associated with antisocial PD
Term
3 external motivators for malingering patients:
Definition
- to avoid difficult situations
- to receive compensation
- retaliate when patient feels guilt or suffers financial loss
Term
Malingering patients usually want one of 6 external gains:
Definition
- avoidance of criminal responsibility, trial/punishment
- avoidance of military service or particulary hazardous duties
- financial gain
- transfer from prison to hospital
- admission to hospital
- drug seeking
Term
Malingering is more common in settings of only men. 1% incidence in mental health patients. 5% in military. 10-20% during interviews with criminal defendents.
Definition
Term
treatment of malingering:
Definition
- monitor as if real
- offer NO TREATMENT
- identify secondary gain
- encourage voluntary release of symptoms
Term
Factitious disorders seek ___ gain, while malingering seeks ___ gain.
Definition
internal
external
Term
With somatoform disorders, pt is ___ of it, with malingering pt is ___ of it. With factitious disorders consciousness is somewhere in between.
Definition
- unconscious
- conscious
Term
Factitious d/o patients may have physical and psychotic symptoms, but mostly physical signs and symptoms.
Definition
Term
Factitious d/o features:
Definition
- travel from hospital to hospital
- dramatic presentation aka "pseudologia fantastia"
- classic symptoms
- gridiron abdomen/multiple surgeries
- health care workers
- narcotics
- "orders" lab tests and procedures
- demanding, difficult
- experts at deception
- increased insistence with suspicions, new symptoms
- threats of litigation with confrontation
- leaves AMA
- several psychotic symptoms inconsistent with known psychotic d/o
- highly suggestible
- symptoms worsen with observation
- factitious mourning- dramatic events of death, no means of corroboration
- Ganser syndrome- be vague and give approximate answers
Term
possible etiology of factitious disorder:
Definition
- extensive tmt for real illness during youth
- abusive past relationships with physician
- grudge against medical professionals
- massochistic tendencies
- history of childhood dperivation abuse neglect
- dependent roles to make up for lost parenting
- sense of mastery and control
Term
What personality disorders may prsent with factitious disorders?
Definition
- Borderline PD
- Dependent PD
Term
Treatment of factitious disorder:
Definition
- nothing known to work
Term
Schizophrenia population prevalence is ___. This condition is __ between males and females. Males are more likely to have ___ ___. Females more likely to have ___ ___.
Definition
- 1%
- equally
- negative symptoms
- better outcomes
Term
schizophrenia onset in males vs females:
Definition
males 10-25 years old
females 25-35 years old or 40-50 years old
Term
Schizophrenia rarely ever has an onset before age 10 or after age 60.
Definition
Term
___ is leading cause of death in schizophrenics due to __. 15% die of this.
Definition
Suicide
overdose
Term
risk factor for schizophrenia:
Definition
smoking
- 3/4 of all schizo patients smoke
- smoking related to decrease in antipsychotic drug induced parkinsonism
- smoking increases metabolism of antipsychotic drugs
- smoking may decrease hallucinations
Term
30-50% of schizophrenics abuse alcohol> poor prognosis
Definition
Term
schizophrenia shows a __% discordance rate among monozygotic twins, so this is ___ ___.
Definition
50% discordance rate
incomplete penetration
Term
Diathesis stress hypothesis:
Definition
genetically predisposed to stressed phenotype> may develop schizophrenia, life events play a roll too
Term
Dopamine theory of schizophrenia:
Definition
- schizophrenia results from too much dopaminergic activity: supported by efficacy of dopamine receptor antagonists (blockers) related to D2 antagonists, drugs that increase dopamine cause psychotic symptoms
- increased levels of homovanillic acid
- likely involves multiple transmitters, especially GABA
Term
Diagnostic criteria for schizophrenia:
Definition
- presence of 2 or more DISORGANIZED FUNCTIONING SYMPTOMS during a 1 MONTH period with PERSISTENCE OVER 6 MONTHS:
- delusions (thoughts)
- hallucinations
- disorganized speech
- disorganized/catatonic behavior (stupor, rigidity, excitement, posturing)
- negative symptoms
Term
negative symptoms of schizophrenia:
Definition
- affective flattening (most commonly seen)
- alogia
- avolution/apathy
- anhedonia/asociality
- attention
Term
positive symptoms of schizophrenia:
Definition
- hallucinations
- delusions
- bizarre behavior
- formal thought disorder
Term
5 subtypes of schizophrenia:
Definition
- Paranoid
- Disorganized
- Catatonic
- Undifferentiated
- Residual
Term
Paranoid schizophrenia has an __ __ and has __ __ functioning and prognosis.
Definition
- older onset
- premorbid functioning and prognosis
Term
Disorganized schizophrenia has __ __ aka __ __ and __ __ __ ___ __ and a __ __.
Definition
- disorganized speech aka word salad
- disorganzied non-goal directed behavior
- flat affect
Term
Catatonic schizophrenia is __ or __ with ____ of voluntary movements. They may have ___ or ___ where they repeat back sounds or movements.
Definition
- stuperous or excited
- pecularities of voluntary movements
- echolalia or echopraxia
Term
echolalia
echopraxia
Definition
repeating back of sounds/movements

seen with catatonic schizophrenia
Term
undifferentiated schizophrenia have very mixed symptoms.
Definition
Term
Residual schizophrenia patients once met the criteria, now there is __ ___ __ or __ that do NOT meet criteria.
Definition
- new odd behaviors or beliefs
Term
Stages of shizophrenia (3):
Definition
- prodromal- weird behavior prior to onset
- active- characteristic behaviors
- residual- behavior that not longer meets initial subtype criteria
Term
good prognosis of schizophrenia indicators:
Definition
- acute onset
- late onset
- short duration
- FHx of mood disorder
- mood symptoms
- married
- good premorbid hx
- positive symptoms- can be treated
Term
Bad prognosis indcators for schizophrenia:
Definition
- no precipitants
- young onset
- long duration
- FHx of schizophrenia
- withdrawn
- autistic
- single
- multiple relapses
- negative symptoms
Term
Schizophrenia is treated with ___ ___ __, which are particularly effective with the __ ___.
Definition
dopamine receptor antagonists (blockers)
positive signs
Term
drugs for tmt of schizophrenia:
Definition
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
Term
Chlorpromazine for tmt of ___. May cause the ___ __, a broad base shuffle, not as severe of lean foward as Parkinsons. This shuffle shows up after long term tmt. Drug tmt of schizophrenia helps __% of patients.
Definition
- schizophrenia
- thorazine shuffle
- 25%
Term
Side effects of cholorpromazine (thorazine) and haloperidol for tmt of schizophrenia:
Definition
- thorazine shuffle (long term tmt)
- akathisia, rigidity, tremor
- tardive dyskinesia> abnormal involuntary movement of tongue/mouth/limbs
- neuroleptic malignant syndrome> medical emergency, mortality of 10-20%
Term
Neuroleptic Malignant Syndrome can be caused by chlorpromazine (thorazine) and/or haloperidol for tmt of schizophrenia. What are the symptoms of this condition?
Definition
- rigidity
- high fever
- delirium
- autonomic instability
- increased liver enzymes and Cr
Term
dopamine receptor blockers used to treat schizo include:
Definition
- chlorpromazine
- haloperidol
Term
Atypical antipsychotics are ___ ___ ___, they improve __ and __ symptoms with less risk for developing __ ___. These are used for __ and control of ___ __ behaviors with schizophrenia.
Definition
- serotonin-dopamine antagonists (blockers)
- positive and negative
- extrapyramidal symptoms
- used for agitation and control of acting out behaviors
Term
Atypial Antipscyhotics(4):
Definition
- Risperidone (Resperadal)
- Olazepine (Zyprexa)
- Quetiapine
- Ziprasidone

ROQS for schizo.
Term
Side effects of atypical antipsychotics:
Definition
- concerns with Diabetes
- orthostais (especially in elderly)
- seizures
- dehydration
- hyperlactinemia
- cognitive impairement
- weight gain
Term
Partial dopamine agonists can also be used to treat schizophrenia, name one:
Definition
Aripiprazole (Abilify)
Term
Aripiprazole/abilify is a ___ __ __ and is good for treatment of __ and __ and ___schizophrenia symptoms. It has __ side effects and results in __ weight gain thant other atypicalys especially Olanzapine. There is no __ __ with extended treatment and no increased in incidence of ___ .
Definition
- partial dopamine agonist
- positive and negative and depressive
- few
- less
- NO tardive dyskinesia with extended tmt
- no increased incidence of DMII
Term
lifetime incidence of bipolar disorders when considering the full spectrum is ___. While lifetime prevalence when just considering bipolar I and II is ___.
Definition
- 5.5%
- 1.5-2.0%
Term
onset for Bipolar I ranges from ___ to __ __ with rare onset in ___ __ .
Definition
- childhood to 50 years old
- rare onset in old age
Term
Mean age of onset for bipolar disorders:
Definition
30 years old
Term
Are bipolar disorders more prevalent in men or women?
Definition
BIPOLAR DISORDERS HAVE EQUAL PREVALENCE BETWEEN MEN AND WOMEN
Term
Men with bipolar disorders are more likely to have ___ episodes, while women are more likely to have ___ episodes.
Definition
- men
- depressed
Term
Women are more likely to have __ episodes when experiencing ___.
Definition
- mixed
- mania
Term
Women are more likely to be ___ ___, having __ or more manic episodes a year.
Definition
- rapid cyclers
- 4
Term
Bipolar __ is more frequent in divorced and separated males.
Definition
Bipolar I
Term
Bipolar II patients have high levels of conflict in their marriage
Definition
Term
Bipolar __ is more common in persons who did not graduate college, likely effect of early onset on functioning.
Definition
- Bipolar I
Term
If you are first degree relative of a Bipolar proband (first affected family member who seeks medical attention for general disorder), you are __ to ___ __ more likely to have __ ___.
Definition
- 8 to 18 times
- Bipolar I
Term
If one parent has Bipolar d/o, there is a ___ chance of any child having a ___ ___.
Definition
- 25%
- mood disorder
Term
If both parents have bipolar disorder, there is a ___ chance of any child having a __ ___.
Definition
-50-75%
-mood disorder
Term
Alcohol dependence is frequently co-morbid with Bipolar Disorders, with __ __ having somewhat higher risk of alcohol abuse.
Definition
- Bipolar I
Term
Substance abuse may precipitate episodes in Bipolar or may be attempt to self medicate. ___ are primary drug of choice.
Definition
Stimulants
Term
Bipolar __ patients are at a higher risk for attempting and completeing suicid than ___ __ or ___ __ __ patients.
Definition
- Bipolar II
- Bipolar I or Major Depressive Disorder
Term
Bipolar I is a mood disorder in which a complete set of __ ___ occurs during the course of the illness.
Definition
- manic symptoms
Term
Bipolar II is a mood disorder in which __ __ and ___ ___ occur during the course of the illness.
Definition
- depressive
- hypomanic episodes
Term
Is rapid cycling found in bipolar I, II, or both?
Definition
both
Term
Cyclothymic disorder is a disorder in which there are periods of __ and episodes of ___ that do not meet ___ criteria.
Definition
- hypomania
- depression
- MDD
Term
A manic episode is a distinct period of ___ ___, ___, or ___ mood that lasts for at least __ __ with at least __ or more manic symptoms persisting throughout the episode. The manic symptoms include:
Definition
- abnormally elevated, expansive, or irritable mood
- one week
- 3 or more symptoms
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative/pressured speech
- racing thoughts
- distractibility
- increased goal directed activity/psychomotor agitation
- hypersexuality, buying sprees, poor investments
Term
Manic symptoms (7):
Definition
IDMTDIH:
- inflated self-esteem, grandiosity
- decreased need for sleep
- more talkative, pressured speech
- thoughts racing
- distractability
- increased goal directed behavior/psychomotor behavior
- hypersexuality, buying sprees, poor investments
Term
Hypomania is a distinct period of elevated, expansive, or irritable mood lasting throughout __ days that is clearly different from the usual __ mood and includes at least __ manic symptoms. This differs from mania in the ___ or degree of behaviors and is not severe enough to cause marked __ of ___.
Definition
- 4 days
- non-depressed
- 3
- severity
- NO impairment of functioning
Term
Bipolar lifetime suicide attempts of __ to __, and completed suicides of __ to __.
Definition
- 25-50%
- 10-15%
Term
Treatment of bipolar disorder with antidepressants alone may trigger a __ or ___ episode in the the undiagnosed bipolar patient.
Definition
- manic or hypomanic
Term
Antidpressants alone in bipolar patients may contribute to __ ___.
Definition
rapid cycling
Term
Bipolar depression has a younger onset of younger than __ ___ with the presence of __ __ like __ ___. There is often comorbid substance abuse, usually __ __ __ like __. There is often a __ __ of bipolar disorders. There are __ __, greater than __, with ___ duration, less than __ ___, episodes.
Definition
- younger than 25 years
- psychotic symptoms
- extreme anhedonia
- centrally acting depressants like alcohol
- family history
- multiple occurences, greater than 3
- shorter duration, less than months
Term
Since antidepressants may trigger mania in the undiagnosed bipolar patient, it is important to have them come back within the __ __ of starting antidepressants. It is still important to treat the depression, but these have poor interaction in bipolar brain.
Definition
- first week
Term
In Bipolar depression __ __ with __ during depression is common.
Definition
- mixed episodes
- hypomania
Term
Most bipolar depressed patients have __ ___ __. Bipolar depressed should be considered in differential in anyone who presents with ___.
Definition
- seasonal affective disorder
- SAD
Term
Half of all women with bipolar disorders have an episode following child birth.
Definition
Term
Women with postpartum depression, and no prior psychiatric history are at a higher risk for ___ ___.
Definition
bipolar disorders
Term
Lithium carbonate is __ __ used to treat __ __. Response takes __ to __ weeks so may need to initally augment with ___ or ___.
Definition
- mood stabilizer
- bipolar disorders
- 1 to 3 weeks
- benzodiazepine (Clonazepam or Iorazepam)
- atypical antipsychotics
Term
Predictors of positive response in lithium treatment of bipolar disorders:
Definition
- 80% of manic patients respond to lithium
- prior positive response
- pure mania or secondary mania
- FHx of bipolar disorders
- obsessional features
- mania followed by depression
Term
Predictors of negative response to lithium treatment of bipolar disorder:
Definition
- BORDERLINE PERSONALITY FEATURES
- rapid cycling (at least 4 times/year)
- mixed symptoms- usually rapid cycler
- substance abuse
- psychosis
- depression followed by mania
Term
Lithium is effective in __% of manic patients, but is just used __ to prevent depression.
Definition
80%
propylactically
Term
___ and ___ medications are more likely to trigger mania than ___ or ___.
Definition
- Tricyclics and tetracyclics
- SSRIs and buproprion
Term
___ and ___ can augment lithiums effectiveness and will not precipitate mania.
Definition
- Divalproex (Depakote)
- Carbamazide (Tegretol)
Term
Lithium is more effective at prophylaxis for mania,so may need antidpresseant to augment for depressive episodes. Lithium is almost always indicated after __ episode of mania. Lithium maintenance reduces incidence of suicide __ fold. Patients responsive to lithium are __ __ more likely to relapse if lithium discontinued. Lithium may lose effectiveness over several years and may need augmentation with ___.
Definition
- indicated after 2 episodes of mania
- reduces incidence of suicide 6 fold
- 30 times
- anticonvulsants
Term
Adverse effects of lithium:
Definition
- minor effects that diminish over time: thirst, polyuria, tremor (due to increased calcium), diarrhea, weight gain, edema
- hypothyroidism- 5-15% of patients, more in women, monitor TSH every 6 months, managed with thyroid hormone replacement
- increased calcium levels> lethargy, ataxia, dysphoria
- exacerbation of acne, psoriasis, and hair loss
- poor memory
- distractability
- confusion
Term
Lithium is __ in the kidneys and ___ in the __ __ along with sodium and water. If the body becomes sodium deficient and reabsorbs more sodium, more lithium may also be absorbed resulting in ___, thus patients should avoid __ , so less time outside and more fluid intake. Also __ ___ __ should be avoided.
Definition
- excreted
- reabsorbed in the proximal tubule
- toxicity
- dehydration
- sodium depleting diuretics
Term
25% of patients on lithium experience a ___ ___ __ __ __ changes that are generally benign, but EKG should still be checked ___.
Definition
- reversible non-specific T wave changes
- yearly
Term
Lithium Contraindications:
Definition
- Parkinson's disease
- Diabetes
- Seizure disorders
- Renal Disease
- Myasthenia Gravis
Term
Lithium levels should be drawn routinely every __ to __ months, or if noncompliance is suspected or there are indications of toxicity.
Definition
- 2 to 6 months
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