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Clinical Medicine Exam 3 - Psychiatry
- mistrust, perceived attack, grudges, autonomy, hostility, resentment, soli- tary, rejection-sensitive,. suspicious of others. must have four of the following: 1.Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
- Reluctant to confide in others
- Reads hidden demeaning or threatening meanings into benign re- marks/events
- Persistently bears grudges
- Perceives attacks on their character/reputation that are not apparent to tohers and is quick to react angrily or counterattack
- Has recurrent suspicions without justification regarding fidelity of spouse/sexual partner: paranoid personality disorder
2. detachment from social relationships and restricted range of emotions
- appears aloof and indifferent, poor relationships. must have four of the following: 1.ither desires nor enjoys close relationships, including being part of a family
2.Almost always chooses solitary activities
3.Has little, if any, interest in having sexual experiences with another person
4.Takes pleasure in few, if any, activities
5.Lacks close friends or confidants other than first degree relatives
6.Appears indifferent to the praise or criticism of others
7.Shows emotional coldness, detachment, or flattened affectivity: schizoid per- sonality
disorder
3. acute discomfort with close relationships AND perceptual distortions, ref- erences
and odd beliefs - solitary, bizarre, poor relationships. must have five of the following: 1.Ideas of references
2.Odd beliefs or magical thinking that influences behavior and is inconsistent with
subcultural norms (superstitions, beliefs in telepathy, bizarre fantasies)
3.Unusual perceptual experiences including bodily illusions
4.Odd thinking and speech (vague, circumstantial, metaphorical)
5.Suspiciousness or paranoid ideation
6.Inappropriate or constricted affect
7.Behavior or appearance that is odd, eccentric, or peculiar
8.Lack of close friends or confidants other than first degree relatives
9.Excessive social anxiety that doesn't diminish with familiarity and tends to be
associated with paranoid fears rather than negative judgments about self: schizotypal personality disorder
4. pattern of disregard for and violation of the rights of others. MUST BE 15 OR
personality disorder
6. pattern of excessive emotionality and attention seeking. must have five of the
following:
1.Uncomfortable in situations which he or she isn't center of attention
2.Interaction w others often characterized by inappropriate sexually seductive or
provocative bx
3.Displays rapidly shifting and shallow expression of emotion
4.Consistently uses physical appearance to draw attention to shelf
5.Style of speech excessively impressionistic and lacking in detail
6.Shows self dramatization, theatricality, exaggerated expression of emotion
7.Suggestible by others or circumstances
8.Considers relationships to be more intimate than they actually are: histrionic
personality disorder
7. pattern of grandiosity, need for admiration, lack of empathy. need five of the
following:
1.Grandiose sense of self importance
2.Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal
love
3.Believes they are special and unique and can only be understood by or should
associate with other special or high status people
4.Requires excessive imagination
5.Has a sense of entitlement
6.Interpersonally exploitative
7.Lacks empathy
8.Is often envious of others or believes others are envious of them
9.Shows arrogant, haughty bx or attitude: narcissistic personality disorder
8. pattern of social inhibition, feelings of inadequacy, hypersensitivity to neg- ative
evaluation. need four of the following:
1.Avoids occupational activities that involve significant interpersonal contact bc of
fears of criticism, disapproval or rejection
2.Unwilling to get involved w people unless certain of being liked
3.Shows restraint w intimate relationships bc of the fear of being shamed or ridiculed
4.Preoccupied with being criticized or rejected in social situations
5.Inhibited in new interpersonal situations because feelings of inadequacy
6.Views self as socially inept, personally unappealing, or inferior
7.Unusually reluctant to take personal risks or to engage in any new activities bc they
may prove embarrassing: avoidant personality disorder
9. excessive need to be taken care of that leads to submissive and clinging behavior
and fears of separation. need five of the following:
1.Difficulty making everyday decisions without an excessive amount of advice and
emotional value
6.Reluctant to delegate tasks or to work with others unless they submit to exactly
their way of doing things
7.Adopts a miserly spending style toward both self and others; money is viewed
as something to be hoarded for future catastrophes
8.Shows rigidity and stubbornness: obsessive compulsive personality disorder (OCPD)
11. list the ten personality disorders that we covered (think clusters): odd/ec- centric
emotional/erratic anxious/fearful
1. paranoid
2. schizoid
3. schizotypal
4. borderline
5. narcissistic
6. histrionic
7. antisocial
8. avoidant
9. dependent
10. OCPD
12. what is the first line treatment for PERSONALITY DISORDERS?: psy-
chotherapy possible pharm adjuncts: antipsychotics, mood stabilizers, SSRIs
13. symptoms of psychosis: pos: delusion, hallucination, disorganized speech,
disorganized bx neg: avolitioin, alogia, anhedonia, asocial, affect flattening `
14. one or more delusions, no other psychosis sxs lasting >1 month. may interpret
things incorrectly but not outright, FIXED FALSE BELIEF: delusional disorder
/ anti-seizure drugs anti mania meds (used to treat mania d/t BPD)
22. list the categories and some examples of anti mania meds: antipsychotics -
quetiapine, seroquel antiepileptics - valproic acid, depakote mood stabilizers - lithium, lithobid
23. hallucinations, delusions, 'deficit' in expressiveness, affect, energy, voli- tion,
disorganized: speech often tangential, circumstantial and derailed ("word salad") with disorganized behavior: schizophrenia "syndrome"
24. describe the schizophrenia timeline: brief psychotic disorder <1 month
schizophreniform 1-6 months schizophrenia >6 months
25. how is brief psychotic disorder different from schizophreniform from
schizophrenia?: brief psychotic - 2 or more POS sxs, return to normal after episode schizophreniform - 2 or more psychosis sxs, interferes with function. basically schizophrenia but hasnt been long enough for diagnosis
26. treatment for schizophrenia timeline disorders?: 1. safety assessment
2. psych consult
3. rule out other causes
4. antipsychotics will improve positive sxs
5. psychosocial management
6. weekly monitoring until stable
administer follow up sheet in practice for each abnormal question in practice: if 2+, refer for developmental pediatrician at autism center
34. what sore and what to do if MCHAT child is high risk?: 8-20. skip follow-up and
refer immediately for diagnostic evaluation
35. autism spectrum disorder treatment: multidisciplinary:
speech therapy, OT, self help skills, social interactions, behavioral management, special education. PHARM TX NOT EFFECTIVE IN ASD
36. sxs MUST be present in multiple settings for at least 6 months. inconsis- tent
developmental level and impaired function children must have 6 of the following, adults must have 5. : oFidgeting oCan't sit when required oInappropriate running, climbing oDoesn't play quietly o"on the go" oSpeaking out of turn oDoesn't wait or take turns oCareless mistakes / inattention to detail oDistracted oDoesn't listen oFails to follow through
oDifficulty organizing oAvoids tasks that require mental effort oLoses things / forgets to do things oDistracted by irrelevant stimuli: ADHD
37. ADHD tx?: age 4-6: parent bhx training first line , methylphenidate if ineffective age
6-12: MEDS alongside parent bhx training and school management age 12-18: MEDS with school management
38. SHORT TERM confusion and changes in cognition; sudden, brief, fluctuat- ing,
rapid improvement when cause is reversed. not alert or oriented: delirium
39. what is important to remember about delirium?: you must evaluate and treat the
UNDERLYING cause of it
40. impairment in memory,, judgement, orientation, cognition, slow decline over
time: neurocognitive disorder (dementia)
41. difference between NC major and minor?: minor - compensated major-
non compensated (cannot live alone or take care of themselves)
42. what are three causes of neurocognitive decline?: degenerative disease,
subcortical dementia, injury related dementia
43. list the three categories of internalizing disorders: anxiety disorders, depres- sive
CBT is therapy of choice. can add pharm adjuncts: antidepressants, antipsychotics anticonvulsants
55. panic attacks, adrenaline based sxs MUST have four (palpitations, sweat- ing, HR,
CP, dyspnea, globus, tingling) lasts longer than 1 month, disruptive: panic disorders
56. cued and predictable panic rxn: phobia
57. phobia tx: CBT
58. unexpected panic rxn, pt tries to avert future attacks by avoidance; disrup- tive:
panic disorder
59. panic disorder tx: SSRI, therapy, gabapentin only as third adjunct
60. tx for chronic panic attacks: first line is therapy. xanax, valium and SSRI
61. tx for infrequent panic attacks: benzos
62. intrusive thoughts cause stress and compulsions discharge the stress
(temporarily). disruptive d/t time spent on rituals: obsessive compulsive disor- ders
63. treatment for OCDs?: CBT first line (though typically not enough) so you would want
to add a high dose SSRI
64. neuro-psych disorder characterized by recurrent distressing thoughts and repetitive
behaviors/mental rituals performed to reduce anxiety: OCD
65. generally subjective to worry not abt any specific thing that cannot
be controlled. >6 mo, usually accompanied by some somatic sxs. suicidal ideation/aggression, social anxiety: GAD
66. GAD tx?: therapy (CBT), SSRIs
67. what is the difference between complicated and un-complicated grief?: -
un-complicated: longer than 6mo for kids, 12 for adults. intense or disabling
68. what makes MDD different than the rest of the depression cluster disor- ders?:
these people live that way, it is their baseline
69. emotional or behavioral sxs in response to an identifiable stressor within 3 mo of
the stressor. NOT criterion A: adjustment disorder
70. sxs>2 wks, 5+ depressive sxs, episodic, possible lifetime prevalence: de- pressive
disorder
71. sxs last 2 years, 2+ depressive sxs: persistent depressive disorder (dys-
thymia)
72. when screening for MDD what should you ask?: SIGECAPS
sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide
73. tx for depressive disorders: first line - SSRI or SNRI
81. maladaptive behaviors of self administration for the purpose of alter-
ing subjective experience, under inappropriate circumstances or in amounts greater than accepted in social culture: substance use disorder
82. what are the five drug classes?: 1. EtOH, benzos, and CNS depressants
2. cocaine and stimulants
3. opioids
4. cannabinoids
5. tobacco
83. treatment for alcohol and benzo dependence: 3-4 day benzo taper with detox
, naltrexone, acamprosate, disulfram
84. treatment for narcotic dependence: NO DETOX - opioid agonists, subax-
one/methadone, opioid antagonists, naltrexone
