Term
| WHat time period of sx is necessary for a dx of GAD to be made? |
|
Definition
| excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 months |
|
|
Term
| Which sex is more commonly effected by GAD? |
|
Definition
| women 2x more often than men |
|
|
Term
| PET scan of a person with GAD may possibly reveal increased blood flow to what part of the brain? |
|
Definition
| the right parahippocampus in the frontal lobe |
|
|
Term
| What two classes of drugs are effective in the tx of GAD? |
|
Definition
-Benzodiazepines: alprazolam (xanax), diazepam (valium), clonazepam (klonopin), lorazepam (ativan)
-SSRIs: citalopram (celexa), paroxetine (paxil), venlafaxine (effexor), escitalopram (lexapro), and sertraline (zoloft) |
|
|
Term
| What are the two classes of meds used for panic disorders in general> |
|
Definition
|
|
Term
|
Definition
| characterized by recurrent, unexpected panic attacks that occur abruptly and are accompanied by debilitating fear of having additional attacks-- also feeling of impending harm or death, fear of MI or stroke, and fear of going "crazy" |
|
|
Term
| panic disorder is more common in which sex? |
|
Definition
| 2-3x more common in females |
|
|
Term
| What can be infused into a patient with panic disorder to produce anxiety? This infusion causes an elevation in what neurotransmitter level? |
|
Definition
|
|
Term
| What comorbidity, of unknown significance, is seen in 50% of patients with panic DO? |
|
Definition
|
|
Term
| What SSRI and what benzo are specifically implicated for the tx of panic disorder? |
|
Definition
-alprazolam (xanax)
-paroxetine (paxil) |
|
|
Term
| How is the diagnosis of a phobia made? |
|
Definition
| the phobic stimuli must interfere with the patient's daily routine, social, or occupational functioning |
|
|
Term
| what are the five types of specific phobias? |
|
Definition
-animal
-natural environment (storms, heights, water)
-blood-injection injury (fear of invasive procedures)
-situational (bridges, tall buildings, heights, flying, etc)
-other (situations that may lead to choking/vomiting or getting an illness- kids could be loud noises or costumed characters) |
|
|
Term
| What are the three main types of phobias? |
|
Definition
specific (5 subtypes)
social: fear of social situations in which embarrassment or humiliation in front of other people may occur (public speaking, using public restrooms, eating in public)
-agoraphobia (intense anxiety about placing oneself into a situation in which incapacitating problem could occur and no help would be available) |
|
|
Term
| what is the best class of medication to tx social and agoraphobia? specific phobias? |
|
Definition
-social and agoraphobia: SSRIs
-specific: short term benzo's and BB's |
|
|
Term
| in a patient less than 18 years old, how long must a phobia be present for it to be dx? |
|
Definition
|
|
Term
| FOr diagnosis of PTSD, the list of sx that the patient must have at least three of must be present for how long? |
|
Definition
|
|
Term
| When the sx of PTSD have been present for less than one month, what is the dx? |
|
Definition
|
|
Term
| what class of meds is considered first line for tx of PTSD? |
|
Definition
|
|
Term
| Describe the body image of a pt with anorexia nervosa? |
|
Definition
| these pt's have a distorted body image and an intense fear of becoming fat even though they are underweight |
|
|
Term
| what are the three criteria that make the diagnosis for anorexia nervosa? |
|
Definition
1. a self-induced starvation to a significant degree
2. a relentless drive for thinness or a morbid fear of fatness
3. the presence of medical signs and symptoms resulting from starvation |
|
|
Term
| what specific medication is contraindicated in patients with eating disorders because it lowers the seizure threshold? |
|
Definition
|
|
Term
| Name a medication commonly used in anorexic patients to stimulate appetite |
|
Definition
| cyproheptadine (periactin) an h2 receptor blocker that may promote weight gain |
|
|
Term
| what heart condition is a complication of anorexia? |
|
Definition
|
|
Term
| At what percentages below recommended weight for height is it indicated for an anorexic patient to be hospitalized? |
|
Definition
20% below hospitalize to restore nutritional state
30% below- psychiatric hospitalization for 2-6 months |
|
|
Term
| Describe a bulimic patient |
|
Definition
| employ binge eating as well as vomiting, use of laxatives, and/or diuretics, excessive exercise, or other measures to avoid gaining weight. unlike anorexia- these pts maintain a normal body weight or they may be overweight |
|
|
Term
| What are the 4 criteria necessary to make a dx of bulimia? |
|
Definition
1. episodes of binge eating occur twice a week or more for at least 3 months
2. compensatory behaviors are practiced after binge eating to prevent weight gain
3. weight is not severely lowered
4. pt has morbid fear of fatness, relentless drive for thinness, or both |
|
|
Term
| patients with bulimia who vomit a lot would have hypo/hyper-amylasemia? |
|
Definition
| hyperamylasemia due to hypersecretion from the salivary glands |
|
|
Term
| what is the body weight and BMI definition of obesity? |
|
Definition
| more than 20% over ideal body weight or a BMI greater than 30 |
|
|
Term
| what lipase inhibiting medication is sometimes used for obesity tx? |
|
Definition
|
|
Term
| What are the three basic forms of ADHD (ADD)? |
|
Definition
1. attentional
2. hyperactive/impulsive
3. combined |
|
|
Term
| Major neurologic fxns disturbed by the neurotransmitter imbalance of ADHD (ADD) fall into the category of ________ function |
|
Definition
|
|
Term
| what part of the brain are critical in executive function and have been identified in patients with ADHD (ADD) as being abnormal? |
|
Definition
| frontal cortex and the circuits linking them to the basal ganglia |
|
|
Term
| there are many criteria that need to be met to dx ADHD (ADD), at what age must symptoms be present before to make dx? how many situations must sx be present for dx? |
|
Definition
before age 7
greater than or equal to 2 situations (work, home, school etc) |
|
|
Term
| What two alpha2-adrenergic agonists are indicated for tx of ADHD (ADD)? |
|
Definition
-Guanfacine (Intuniv)
-Clonidine (Kapvay) |
|
|
Term
| What SNRI is inidcated for the tx of ADHD (ADD)? |
|
Definition
-Atomoxetine (Strattera)
*when stimulants can not be tolerated at a dose necessary for efficacy (e.g. bc of anxiety) and atomoxetine is not efficacious alone- the combo of this and a low dose stimulant is often very effective |
|
|
Term
| Name some adverse effects of psychostimulants in the tx of ADD (ADHD) |
|
Definition
| anorexia, sleep disturbances, mild anxiety, and rebound |
|
|
Term
| Name some of the major psychostimulants used in the tx of ADHD (ADD) |
|
Definition
-dextroamphetamine (dexedrine)
-methylphenidate (concerta, methylin, metadate, ritalin, quillivant XR)
-dextroamphetamine/amphetamine mix (adderall)
-dexmethylphenidate (focalin)
-lisdexamfetamine (vyvanse)
-methylphenidate transdermal patch (daytrana) |
|
|
Term
| WHat are the 3 key criteria from the DSM IV for diagnosis of autistic DO? |
|
Definition
1. impairments in social interaction
2. impairments in communication
3. a restricted repetitive range of interests, behaviors, and activities |
|
|
Term
|
Definition
| pervasive and sustained feeling tone that is experienced internally and that influences a person's behavior and perception of the world |
|
|
Term
|
Definition
| the external expression of mood |
|
|
Term
| what neurotransmitter is most commonly associated with depression? |
|
Definition
|
|
Term
| describe levels of dopamine possible in depression and mania |
|
Definition
depression: reduced
mania: increased |
|
|
Term
| describe the different ways depression can present in prepubertal, adolescents, and elderly patients |
|
Definition
-prepubescent: somatic complaints, agitation, single-voice auditory hallucinations, anxiety do's, phobia
-adolescence: substance abuse, antisocial behavior, restlessness, truancy, school difficulties, promiscuity, increased sensitivty to rejection and poor hygiene
-elderly: cognitive deficits, pseudodementia, apathy, and distractability |
|
|
Term
|
Definition
| maladaptive behavioral or emotional symptoms that develop within 3 months after a stressful life event and end within 6 months after the event AND are NOT caused by bereavement |
|
|
Term
| name some life situations that may lead to adjustment disorder in childhood and adulthood |
|
Definition
-adolescents: parental rejection/divorce, school problems, leaving home
-adults: marital discord, financial probs, loss of job |
|
|
Term
| describe bipolar 1 disorder |
|
Definition
| the occurrence of one or more manic or mixed episodes which often cycle with depressive episodes (depressive episode NOT necessary for dx). aka manic depression |
|
|
Term
|
Definition
| characterized by at least one or more major depressive episodes and at least one hypomanic episode. The patient has NEVER experienced a manic episode or a mixed episode. |
|
|
Term
| Name some of the top first line meds to treat bipolar disorder |
|
Definition
-Lithium (must monitor serum levels- very narrow therapeutic window- about 1 mmol/L)
-Valproic Acid (depakote)
-Carbamezapine (tegretol) |
|
|
Term
| 50% of hospitalized pts with MDD have what subtype? |
|
Definition
| melancholia- either a loss of pleasure in all activities or a lack of reactivity to usually pleasurable stimuli is present. |
|
|
Term
| Described catatonic depression |
|
Definition
| characterized by motor immobility or stupor, blurred affect, purposeless motor activty, extreme withdrawal, negativism, bizarre mannerisms, echolalia, echopraxia, or wavy flexibility |
|
|
Term
| what is the first line class of meds to treat depression |
|
Definition
|
|
Term
| name a good SSRI for elderly pts |
|
Definition
|
|
Term
Describe cyclothymic DO
-how long must sx be present?
-what is the longest amount of time that pt can be absent of sx? |
|
Definition
| recurring periods of relatively less severe depressive episodes and hypomania over a 2-year period, with symptoms free periods lasting for no more than 2 months at any time. Depressive episodes are not severe enough to be classified as MDD and manic or mixed episodes have not occurred. |
|
|
Term
Describe dysthymic disorder
-how long must sx be present?
-what is the longest amount of time a pt can go without sx? |
|
Definition
-chronic persistent mild depression that is manifested by pessimism, brooding, generalized loss of interest, decreased productivity, feelings of inadequacy, and social withdrawal
-There are no psychotic, manic/hypomanic features
-depressed mood for most of the day for more days than not for at least 2 years and pt has not gone without sx for more than 2 years at a time |
|
|
Term
| what personality disorder is described by: extreme sensitivty to rejection (inferiority complex) and they see themselves as unappealing |
|
Definition
|
|
Term
| what personality disorder is described by: enduring pattern of dependent, clinging, and submissive behavior; they cannot make their own decisions without help from others |
|
Definition
|
|
Term
| what personality disorder is described by: pervasive pattern of orderliness and perfectionism and inflexibility, unlike other personality do's these pts have an awareness of their DO and seek tx on their own |
|
Definition
|
|
Term
| what personality disorder is described by: pervasive distrust and suspicion of other, beginning by early adulthood. patients blame their own problems on others and seem hostile and agry |
|
Definition
|
|
Term
| what personality disorder is described by: characterized by a lifelone pattern of voluntary social withdrawal, often perceived as eccentric and reclusive. patients are quiet and unsociable and have constricted affect. they have no desire for close relationships and prefer to be alone |
|
Definition
|
|
Term
| what personality disorder is described by: pervasive pattern of eccentric behavior and peculiar thought patterns beginning in early adulthood, the pt is perceived by others as strange and eccentric |
|
Definition
|
|
Term
| what personality disorder is described by: inability to conform to social norms, pervasive pattern for disregard and violation of the rights and feelings of others. described as extremely manipulative, deceitful, impulsive, and totally lacking empathy or remorse. can seem exceedingly charming and normal on interview |
|
Definition
|
|
Term
| what personality disorder is described by: unstable and unpredicatble mood and affect and behavior as well as poorly established self image. mood swings and impulsivity are common, pts always seems to be in a state of crisis |
|
Definition
|
|
Term
| what personality disorder is described by: pts are overly dramatic, emotional, and seductive; they are excitable, with a high degree of attention seeking behavior and a tendency to exaggerate their thoughts and feelings |
|
Definition
|
|
Term
| what personality disorder is described by: pts have an inflated self image, pattern of grandiosity, and need for admiration, they also lack empathy |
|
Definition
|
|
Term
| What is delusional disorder? |
|
Definition
| characterized by the presence of non-bizarre, fixed, and unshakable delusions in the absence of other mood or psychotic symptoms (non-bizarre situations that could occur in real life) |
|
|
Term
| What are the four main types of delusions associated with delusional disorder? |
|
Definition
-erotomanic: someone is obsessed with the pt
-somatic: bodily delusions
-jealous: spouse/partner is cheating on the pt
-persecutory: paranoid delusions |
|
|
Term
| How long must delusions be present for a dx of delusional do? |
|
Definition
| 1 month with no other signs of psychotic DOs |
|
|
Term
| Name and describe the 5 subtypes of schizophrenia |
|
Definition
1. paranoid: presence of delusions of persecution or grandeur, pts are tense, suspicious, and guarded. intelligence remains intact
2. disorganized: marked regression to primitive, disinhibited, and chaotic behavior. incoherence, loosening of associations, flat affect, pronounced thought DO, unkempt, incongruous grimacing/grinning. early onset before 25 yoa
3. catatonic: classic is marked disturbance in motor function called waxy flexibility, purposeless excitement, speech disturbances
4. undifferentiated: prominent delusions, hallucinations, incoherence, or grossly disturbed behavior that does not meet the criteria for the above 3
5. residual: absence of the sx listed for #4, but continuing evidence of the disturbance through two or more residual symptoms (emotional blunting, social withdrawal) |
|
|
Term
specified symptoms of schizophrenia must be for how long of a period and continuous signs of disorder must be present for how long for a diagnosis
` |
|
Definition
|
|
Term
| what is the difference between schizophrenia and schizphreniform disorder? |
|
Definition
| schizophreniform is when symptoms have been present for less than 6 months |
|
|
Term
| when is the diagnosis of schizo affective disorder made? |
|
Definition
| when patients have features of a mood disorder (depression or mania) and schizophrenia (delusions, hallucination, disordered thinking) but does not meet the criteria for either dx alone |
|
|
Term
| what makes the dx of schizo affective |
|
Definition
| an uninterrupted period of illness occurs in which a major depressive episode, a manic episode, or a mixed episode occurs with the symptoms that meet the criterion for schizophrenia. during that same period of illness, delusions of hallucinations occur for at least 2 weeks in the absence of prominent mood symptoms |
|
|
Term
|
Definition
| a less severe form of mania characterized by elevated mood, hyperactivity, and grandiosity. in contrast to mania, these symptoms do not cause significant impairment in the individuals productivity at work, or social and family relationships (its a mild form of mania) |
|
|
Term
| What DOs are classified by pts presenting with vague physical complaints involving many organ systems that cannot be explained by general medical condition or substance use. visits to health care providers are numerous, although no do is ever found |
|
Definition
|
|
Term
| What are the 4 subtypes of somatiform DOs |
|
Definition
body dysmorphic
conversion
hypochondriasis
pain |
|
|
Term
| describe body dysmorphic disorder |
|
Definition
| preoccupation with an imagined defect in physical appearance or an exaggerated distortion of a minor flaw. the most common concerns are facial flaws. the pt goes to great lengths to hide or correct their perceived anomaly. |
|
|
Term
| describe conversion disorder |
|
Definition
| one or more neurologic complaints that cannot be clinically explained- sx are not intentionally produced and may be motor, sensory, seziure activity, or mixed. most common sx are shifting paralysis, blindness, and mutism |
|
|
Term
|
Definition
| preoccupation with the belief of having, or fear of contracting, a serious illness. not of delusional intensity, normal bodily sensations are misinterpreted as manifestations of diseas. fear persists even when medical eval shows no cause |
|
|
Term
|
Definition
| pain is reported in one or more areas without any identifiable cause and results in significant distress and impairment in functioning. pt views pain as a cause of all of their problems. usually an abrupt onset and pain may continue for weeks |
|
|
Term
| what is another name for factitious DO |
|
Definition
|
|
Term
| what is the primary motivation for a patient with factitious do (maunchausens) |
|
Definition
|
|
Term
| what is the DO when a patient intentionally fakes signs and symptoms of a medical or psychiatric DO in order to assume the sick role |
|
Definition
| factitious DO, aka munchausens |
|
|
Term
| what is the term for the DO in which a pt deliberately produces physical or psychological symptoms motivated by external gain. goals of the pt often include avoiding responsibilty, police or legal action, punishment or board, or obtaining drugs |
|
Definition
|
|
Term
| what does the term pseudocyesis mean |
|
Definition
| signs and symptoms of an intentional false pregnancy, or the pt has themselves convinced that they are pregnant |
|
|
Term
| what is somatization DO (Briquets) |
|
Definition
| it presents with hx of recurrent multiple physical complaints of several years duration |
|
|
Term
| according to exam master, what is the first line SSRI for panic DO? |
|
Definition
|
|
Term
| according to exam master, what is the first line SSRI for social phobia? |
|
Definition
|
|
Term
| according to EM, what is the first line SSRI for post partum depression |
|
Definition
|
|
Term
| what is the best non-pharm tx for OCD |
|
Definition
|
|
Term
| what is the term for : Consideration of objects or ideas as specific items rather than as an abstract representation of a more general concept, as contrasted with abstract thinking (e.g., perceiving a chair and a table as individual useful items and not as members of the general class, furniture). |
|
Definition
|
|
Term
|
Definition
| Agitated or restless movement, usually affecting the legs and accompanied by a sense of discomfort. It is a common side effect of neuroleptic medications. |
|
|
Term
| what is tardive dyskinesia? common sx? |
|
Definition
| a DO that involves involuntary movements, esp of the loewr face. caused by long term use of neuroleptics. common sx are facial grimacing, finger movement, jaw swinging, repetitive chewing, tongue thrusting |
|
|
Term
| list some common signs and symptoms of serotonin syndrome |
|
Definition
| agitation and restlessness, confusion, rapid HR, high BP, dilated pupils, loss of muscle coordination, musc twitching, heavy sweating, diarrhea, HA, shivering, goose bumps |
|
|
Term
| name some life threatening signs and symptoms of serotonin syndrome |
|
Definition
| high fever, seizures, irregular heart beat, unconsciousness |
|
|
Term
| what is the definition of substance abuse |
|
Definition
| substance use that has not met the criteria for dependence but has resulted in impairment |
|
|
Term
| what is substance dependence |
|
Definition
| physical dependence is the physiologic changes that occur with drug use and result in withdrawal symptoms on the termination of use. physiologic dependence refers to the craving or desire for the substance independent of the physiologic withdrawal sx. these two things occur together and is termed substance dependence. |
|
|
Term
| what is substance withdrawal |
|
Definition
| a need to use a substance to relieve or avoid physical symptoms associated with deprivation of it |
|
|
Term
| what is an alcohol deterrent medication that causes nausea when ETOH is consumed? |
|
Definition
|
|
Term
| what medication is used to reverse the effects of opioids? |
|
Definition
|
|
Term
| what is the timeline for the dx of acute reaction to stress |
|
Definition
| sx must persist for a minimum of two days up to 4 weeks within a month of the trauma. |
|
|
Term
| what disorder is diagnosed based on a pattern of behavior that involves violation of the basic right of others or of social norms with at least three acts of the following types: aggression toward people and animals, destruction of property, deceitfulness, and serious violations of rules |
|
Definition
|
|
Term
| what are the 5 stages of grieving? |
|
Definition
| denial, anger, bargaining, depression, acceptance |
|
|
