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PANCE Prep Pearls Psychiatry
PANCE Prep Pearls Psychiatry
68
Medical
Graduate
07/29/2018

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Term
>/= 1 delusion lasting >=/ 1 month without other psychotic symptoms
Definition
delusional disorder
Term
>/= 1 psychotic symptom w onset and remission < 1 month
Definition
brief psychotic disorder
Term
meets criteria for schizophrenia but <6 months duration
Definition
schizophreniform disorder
Term
schizophrenia + mood disturbance
Definition
schizoaffective disorder
Term
>/= 6 months duration of illness w 1 month of acute symptoms along w functional decline. at least 1 hallucination, delusion or disorganization speech of >/=2 of an auditory, visual, olfactory, tactile, somatic, gustatory hallucination or persecutory, reference, control, grandiose, nihilism, erotomanic, jealousy, doubles delusion. negative symptoms thought to be caused by a dopamine dysfuntion. flat emotional affect, social withdrawal, avolition (lack of self-motoivation)l. risk factor: family history. management antipsychotics: dopamine receptor antagonists. 2nd gen 1st line: risperidone, olanzapine, quetiapine. 1st gen haloperidol and chlorpromazine better at treating pos symptoms but ass w inc etrapyramidal symptoms
Definition
schizophrenia
Term
depressed mood or anhedonia (loss of pleasure) or loss of interest in activiteis w >/= 5 associated symptoms almost every day for most days for at least 2 weeks: fatigue, insomnia, hypersomnia, guild/worthlessness, thoughts of death or suicide, psychomotor agitation, weight change, dec or inc appetite, dec conc/indecisiveness. somatic: constipation, headach, skin changes, chest or abdomina pain, cough, dyspnea. symptoms cause clinical distress or impairment in social, occupational or other areas of functioning. absence of mania or hypomania. manage w psychotherapy, SSRIs, Electroconvulsive therapy
Definition
major depressive disorder (MDD)/ unipolar depression
Term
>/=1 manic or mixed episode which often cycles w occasional depressive episodes, family history 1st deg relatives strongest risk factor, abnormal and persistently elevated, expansive or irritable mood at least 1 week c marked impairment of social/occuptional function. treat w mood stabilizers 1st line- lithium. 2nd gen antipsychotics or haloperidos or benzodiazepines if psychosis or agitation develops. can also treat w MAOIs, SSRIs, TCAs but antidepressant medications may precipitate mania
Definition
bipolar I disorder
Term
>/= 1 hypomanic episode + >/= 1 major depressive episode. perior of elevated, expansive or irritable modo atleast 4 days that is clearly different from the usual nondepressed mood but does not cause marked impairment, no psychotic features and does not require hospitalization usually. treat w lithium
Definition
bipolar II disorder
Term
chronic depressed mood >2 years in adults. usually milder than major depression. patients usually able to function. pessimism. management: SSRIs first line medical treatment
Definition
Persistent depressive disorder (dysthymia)
Term
similar to bipolar disorder II but less severe. prolonged periods of milder elevations and depressions in mood. hypomanic symptoms that don't meet criteria for hypomania cycling w relatively mild depressive episodes for at least a 2-year period. treat w mood stabilizers and neuroleptics
Definition
cyclothymic disorder
Term
episode of intense fear or discomport, peaks w/i 10 min, lasts <60 min, dizziness tremvling choking feeling parasthesias sweating cts, >/= 4 ymptoms. 1st line benzodiazepines: Lorazepam, Alprozolam
Definition
panic attacks
Term
2-3x MC in women, recurrent unexpected panic attacks, at least 2. for atleast 1 month must have panic attacks often followed by concern about future attacks or worry about impolication or significant behavior changes. at least 4 symptoms. can have agoraphobia. 1st line SSRIs- Paroxetine, Sertraline, Fluoxetine, CBT, acute-benzos
Definition
panic disorder
agoraphobia- anxiety about being in places or situations from which escape may be difficult
Term
excessive anxiety or worry a majority of days >6 month peiod about various aspects of life. 3>/= symptoms- fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturance... manage w antidepressants- SSRIs, SNRIs, Buspar (S/E nausea, rls), benzos, tcas, psychotherapy
Definition
Generalized anxiety disorder
Term
>6 months intense fear of social or performance situations where the person is exposed to the scrutiny of others for fear of embarassment, manage w antidepressants SSRIs (paroxetine, fluoxetine, escitalopram) or SNRIs (Venlafaxine), beta blockers (propranolol, Atenolol), benzos, psychotherapy
Definition
social anxiety disorder (formerly social phobia)
Term
persistent >6 months intense fear.anziety of a specific situation, object, or place- out of proportion to any real danger. everyday activities must be impaired by distress or avoidance of the situation or object
management- exposure/desensitization therapy is treatment of choice. childhood phobias may disappear or lessen w age. short- term benzodiazepines and b-blockers can be used in some patients
Definition
specific phobias
Term
MC in young adults- men combat experience & urban violence, women- rape or assult. exposure to acual or threatened death, serious injury or sexual violence (direct, witness, learn of happening to someone close, repeated exposure to details) and prenece of >/= 1 intrusion symptom: re-experiencing >1 mont as repetitive recollections and dissociative reactions, avoidance of reminders, negative alterations in cognition and mood, arousal and reactivity. manage SSRIs 1st line, trycyclic antidepressants (imipramine), MAOIs, trazodone may be helpful for insomnia, CBT
Definition
posttraumatic stress disorder (PTSD)
Term
similar to PTSD but symptoms last <1 month and symptom onset occurs w/i 1 month of event. manage w counseling/psychotherapy if persistent treat as PTSD
Definition
acute stress disorder
Term
emotional or behavioral rxn to an identifiable stressor or an event that causes a disproportionate respone that would normally be expected w/i 3 months of the stressor and resolves usually w/i 6 months of the stressor. symptoms are 1 or both: marked distress out of proportion to the severity fo stressor, significant impirment in areas of functioning. manage w psychotherapy 1st line, medications in select cases. pts may self-medicate w alcohol or other drugs
Definition
adjustment disorders
Term
presence of>/=2 distinct identities or states of personalities that take control of behavior. gaps in the recall of events may occur everyday. may be associated w history of sexual abuse, PTSD, substance use
Definition
dissociative identity disorder (formerly multiple personality disorder)
Term
loss or impaired sense of self
Definition
dissociation
Term
persistent feelings of detachment or estrangement from oneself (feel out of body) and/or surrounding environment (derealization). reality testing is intact and the symptoms cause distress
Definition
depersonalization/derealization disorder
Term
inability to recall personal/autobiographical info often 2ndary to sexual abuse, stress or trauma- causes significant impairment in funcitoning. neurologic testing must be done to r/o seizures or brain tumor
Definition
dissociative amnesia
Term
abrupt change in geographic location with loss of identity or inability to recall the past. must r/o seizures or brain tumor as cause
Definition
dissociative amnesia
Term
management of dissociative disorders
Definition
psychotherapy
Term
anxiety disorder characterized by a combo of thoughts (obsessions) and behaviors (compulsions) men = women but men often present earlier. obessions are recurrent or persistent thoughts/images that are inappropriate intrusive and unqwanted. can have good/fair insight- know beliefs are not true or poor or absent (completely conviced beliefs are tre). compulsions are repetitive behaviors the person feels driven to perform to reduce/prevent stress from the obsession. 4 major patterns- contamination, pathologic doubt, symmetry/precision, intrusive obsessive thoughts. manage w SSRIs, TCAs, SNRIs, and cognitive behavioral therapy
Definition
Obsessive-compulsive disorder
Term
excessive preoccupation that >/= 1 body part is deformed or an overexaggeration of a minor flaw that treats to feeling ashamed and causes funcitonal impairment. may commit repetitive acts in response to preoccupation. MC in females often begins in teenage eyars. manage w SSRIs, TCAs (clomipramine), psychotherapy
Definition
body dysmorphic disorder
Term
chronic condition w physical symptoms involving >/= 1 part of the body but no physical cause can be found. MC in women. one or more vague somatic symptom that is destressing- SOB, dysmenorrhea, burning in sexual organ, dysphagia, amnesia, vomiting, painful extremities. excessive thoughts, feelings or behaviors related to the somatic symptoms. persistent state of being symptomatic >6mo. with predominant pain is a specifier. manage w regularly scheduled visits to a healthcare provider
Definition
somatic symptom disorder
Term
preoccupation w the fear or belief one has or will contract a serious, undiagnosed disease despire reassurance and medical workups showing no disease. symptoms >/= 6 mo. somatic symptoms usually not present. age 20-30y. frequently get tested. manage w regularly scheduled appointments w their medical provider
Definition
illness anxiety disorder (formerly hypochondriasis)
Term
neurologic dysfunction suggestive of a physical disorder that cannot be explained clinically. symptoms are not intentionally produced or feigned. episodic symptoms that recur during times of stress. motor dysfunction: paralysis, aphonia, mutism, seizures, gait abnormalities, involuntary movements, tics, weakness, swallowing. sensory dysfunction: blindness, anesthesia, paresthesias, visual changes, deafness. pts often have depression, anxiety, schizophrenia or personality disorders. manage w psychotherapy
Definition
functional neurologic symptom disorder (conversion disorder)
Term
intentional falsification or exaggeration of signs and symptoms of medical or psychiatric illness for primary gain (motivated by getting sympathy). inner need to be seen as ill or injured but not for concrete personal gain. creation or exaggeration of symptoms of illness, may be willing or eager to undergo surgery repeatedly or painful tests
Definition
factitious disorder. 2 types, factitious disorder imposed on self- presents themselves as ill. factitious disorder imposed on another- presents another as ill, can be a form of premeditated child or elder abuse
Term
an old term that referred to a severe form of factitious disorder characterized by the predominance of physical symptoms, use of aliases, habitual lying
Definition
munchausen syndrome
Term
intentional falsification or exaggeration of signs & symptoms of medical or psychiatric illness, primary motivation is secondary gain
Definition
malingering
Term
abuser often male and often known to the victim (has accessibility). signs may include genital/anal trauma, sexually transmitted diseases, UTIs
Definition
sexual abuse
Term
abuser often female and usually to primary caregiver. signs may include cigarette burns, burns in a stocking globe pattern, lacerations, healed fractures on radiographs, subdural hematoma, multiple bruises or retinal hemorrhages. hyphema or retinal hemorrhages seen in shaken baby syndrome
Definition
physical abuse
Term
failure to provide the basic needs of a child (supervision, food, shelter, affection, education). signs include malnutrition, withdrawal, poor hygiene, failure to thrive
Definition
child neglect
Term
BMI >30 kg/m^2 or body weight >/=20% over their ideal weight. binge eating (~50%)
Definition
obesity
Term
at least weekly for 3 months >/=3 of the following: eating until uncomfortably full, faster than normal, large amounts when not physically huingry, feeling disgusted/depressed/guilty afterwards, eating alone due to embarrassment.
Definition
binge eating disorder
Term
anti-obesity meds
Definition
Orlistat (dec's GI fat digestion), Lorcaserin *serotonin agonist)
Term
refusal to maintain a minimally normal body weight fueling a relentless desire for thinness with a morbid fear of fatness or gaining weight (even though they are underweight). mid teens MC onset, 90% women. frequently in athletes, dancers. exhibits behaviors targeting at maintaining a low weight- restrictive or purging. BMI
Definition
anorexia nervosa
Term
normal weight or overweight. binge eating at least weekly for 3 months. compensatory purging or restricting. teeth pitting or enamel erosion from vomitting, russel's sign
Definition
bulimia nervosa
Term
social detachment with unusual hebaviors: weird, odd, eccentric behavior
Definition
cluster A- schizoid personality disorder, shizotypal personality disorder, paranoid personality disorder
Term
long pattern of voluntary social withdrawal & anhedonic introversion (constricted affect). usually early childhood onset. loner "hermit-like behavior" MC in males. anhedonic: appears indifferent to others, prefers to be alone little enjoyment in colose relationships, sex. cold flatteded affect. treat with psychotherapy
Definition
schizoid personality disorder
Term
odd, eccentric behavior & peculiar thought patterns suggestive of schizophrenia but without psychosis/delusions. usually early adulthood onset. odd in behavior or appearance, inappropriate affect or speech, magical thinking. treat w psychotherapy
Definition
schizotypal personality disorder
Term
pervasive pattern of distrucxt and suspiciousness of others. MC in males. misinterprets the actions of others as malevolent, sees hidden messages, preoccupation with doubt regarding the loyalty of others. treat w psychotherapy
Definition
paranoid personality disorder
Term
Dramatic, wild, erratic, impulsive and emotional
Definition
Cluster B- antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder
Term
behaviors deviating shrply from the norms, values & laws of society (harmful or hostile) may commit criminal acts, may begin in childhood as conduct disorders but must be >/=18y to dx. 3x MC in males. inability to conform to social norms w disregard and violation of the rights of others. drunk driving, manipulative, treat w psychotherapy to establish limits
Definition
antisocial personality disorder
Term
unstable, unpredictable mood & affect. unstable self image & relationships MC in women. often mood swings. black and white thinking. impulsivity in self-damaging behaviors- suicid threats, self mutilation, substance abuse. treat w psychotherapy
Definition
borderline personality disorder
Term
overly emotional, dramatic, seductive, attention-seeking. self-absorbed temper tantrums to be center of attention. often inappropriate sexually provocative seductive w shallow or exaggerated emotions. seeks reassurance and praise often. treat w psychotherapy
Definition
histrionic personality disorder
Term
grandiose often excessive sense of self-importance but needs praise and admiration. MC in males. inflated self-image: considers themselves special, entitled, requires extra special attention but they have fragile self-steem. treat w psychotherapy
Definition
narcissistic personality disorder
Term
anxious, worried and fearful
Definition
cluster c disorders. avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder
Term
desires relationships but avoids relationships due to inferiority complex, shy and lacks confidence. treat w psychotherapy, beta blockers or SSRIs if needed
Definition
avoidant personality disorder
Term
dependent, submissive behavior (very needy & clingy), constantly needs to be reassured, relies on others for decision-making and emotional support, will not initiate things, intense discomfort when alone, may volunteer for unpleasant tasks. psychotherapy maybe anxiolytics or antidepressants
Definition
dependent personality disorder
Term
perfectionists who require a great deal of order and control- rigit adherence to routine, rules, lists, lacks spontaneity, stubborn. preoccupied w minute details, may find it difficult to finish projects, may void intimacy. manage w psychotherapy and beta blockers for anxiety or ssris for depression
Definition
obsessive-compulsive personality disorder
Term
social interaction difficulties, emotional discomfort or detachment, avoiding eye contact, impaired communication, difficulty understanding metaphors, humor, restricted repetitive stereotyped behaviors and patterns of activities. referral for neuropsychological testing, behvior modification streategies, medications
Definition
autism spectrum disorder
Term
persistent pattern of negative, hostile and defiant behavior towards adults. at least 6 months of the following 3 components: angry/irritable mood and blames others, argumentative/defiant behavior, vindictiveness. manage w psychotherapy. may progress to conduct disorder
Definition
oppositional defiant disorder
Term
persistent pattern of behaviors that deviate sharply from the age-appropriate norms and violate the rights of others. social and academic diffficulty. serious violation of laws, aggressive/cruel to animals. deceitfulness, destruction of property. 40% develop antisocial personality disorder. MC in boys
Definition
conduct disorder
Term
must onset before 12y of age and be present for at least 6 months. must occur inat least 2 setting. at least 6 symtpoms of inattentaveness or hyperactivity/impulsivity. easiloy distracted, misses details, switches from one activity to another, difficulty maintaining focus on one task, forgets things or loses things needed to complete tasks. hyperactivity/impulsivity: fidgets and squirms in seat, constantly in motion, talks nonstop or excessively, impatience
Definition
ADD & ADHD
Term
ADD & ADHD treatment
Definition
stimulants- methylphenidate/ritalin, amphetamine/dextroamphetamine/-adderall, dexmethylphenidate-focalin. nonstimulants- atomoxetine/strattera
Term
treatment for tobacco use/dependence
Definition
nicotine tapering therapy, bupripion/zyban, varenicline/chantix
Term
euphoria and sedation, pupillary constriction, respiratory depression, bradycardia, hypotension. withdrawal: goose bumps, pupil dilation/mydriasis, flu-like symptoms:rhinorrhea, joint pains, myalgias. manage w naloxone (narcan)
Definition
opioid use/dependence. includes heroin, oxycodone, morphine, meperidine, codeine
Term
depression, wernicke's encephalopathy, korsakoff syndrome, treat w flumazenil. inc CNS activity/tremor w withdrawal. delirium tremens-something crawling on them at night 2-5 days later.
Definition
ethanol, benzodiazepines. flumazeil used to treat benzodiazepine intoxication
Term
psychosis, aggression, agitation, treat w denzodiazepines. inc motor activity, sympathetic stimulation, hypertenison, pupillary dilation, withdrawal: hypersomnia, inc appetite, suicide ideation
Definition
stimulatns, cocaine, amphetamines. cocaine intoxication treated w benzodiazepines
Term
euphoria and sedation, drowsiness, treat w narcan, pupillary constriction, respiratory depression, bradycardia, hypotension. withdrawal- rhinorrhea, goosebumps, pupillary dilation, tearing
Definition
opiods and narcotics
Term
nystagmus
Definition
PCP
Term
alcohol dependence treatment
Definition
disulfiram/antabuse, naltrexone
Term
suicide risk factors
Definition
previous attempt or threat is the strongest single predictive factor. females attempt suicide more than males however males complete suicide more often than women
Term
altered emotional state as response to a major loss, resolves within one year
Definition
normal grief
Term
suidice ideation, psychosis, psychomotor deficits due to loss, continued symptoms >1 year
Definition
abnormal grief
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