Term
| What is the prevalence of epilepsy? |
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Definition
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Term
| What percent of patients enter long term remission after diagnosis of seizures? |
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Definition
| 70% 15 years after diagnosis |
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Term
| How can you increase the sensitivity of EEG for detecting seizure disorder? |
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Definition
| better sensitivity with repeated EEGs, sleep deprived |
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Term
| What percent of patients with epilepsy can have normal EEGs? |
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Definition
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Term
| What percent of patients without epilepsy will have spike and wave formations indicative of epilepsy? |
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Definition
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Term
| Avoid giving the patient ____ prior to evaluation with EEG. |
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Definition
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Term
| What hormone is elevated 15-20 minutes after a generalized tonic-clonic seizure and then returns to normal after 60 minutes? |
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Definition
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Term
| What are the characteristics of temporal lobe epilepsy? |
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Definition
| may not have defect of consciousness, may be simple partial seizures with psychic phenomena, may experience post-ictal headache and sleepiness |
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Term
| What behavioral symptoms are associated with seizures of the temporal lobe? |
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Definition
| hallucinations, illusions, deja vu, jamais vu, repetative thoughts, epigastric sensations, automatisms, affective/mood changes, amnestic episodes, catatonia cataplexy |
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Term
| What is the prevalence of MDE in people with epilepsy? |
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Definition
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Term
| Why is depression linked to epilepsy? |
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Definition
| left-sided epileptogenic lesions and depression and depressive symptoms may represent an aura preceding an ictal event or a characteristic postictal phase, anticonvulsant medications can cause depression |
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Term
| Is there an increased risk of suicide in patients with temporal lobe epilepsy? |
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Definition
| yes 25 fold increase in suicide risk |
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Term
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Definition
| interictal depressive disorder; characterized by somatoform symptoms (anergia, pain, insomnia), and affective symptoms (irritability, euphoric moods, fear, anxiety) |
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Term
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Definition
| dysthymic-like disorder of epilepsy= disabling anhedonia and irritability |
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Term
| T/F Psychotherapy with education and improved coping skills can reduce seizure frequency. |
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Definition
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Term
| What anti depressants should you not use in epileptics d/t ability to cause seizures? |
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Definition
| TCAs (esp maprotiline, amitryptyline, and clomipramine) and bupropion |
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Term
| T/F There is some evidence that serotonergic and noradrenergic activities of antidepressants may actually be anticonvulsant not proconvulsant. |
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Definition
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Term
| What are teh characteristics of temporal lobe personality? |
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Definition
| hyposexuality, hyperreligiosity, hypergraphia, humorlessness, aggressiveness, viscosity |
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Term
| What's another name for temporal lobe personality? |
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Definition
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Term
| Pseudoseizures are also known as.. |
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Definition
| nonepileptic seizures, psychogenic seizures, hysterical seizures, dissociative seizures |
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Term
| What percent of presenting seizures are pseudoseizures? |
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Definition
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Term
| What happens to pseudoseizures if you don't address them? |
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Definition
| 34-53% resolve spontaneously |
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Term
| What are characteristics of pseudoseizures? |
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Definition
| seldom results in injury, starts and ends gradually, out-of-phase movements of extremeties, pelvic thrusting or side-to-side movements, consciousness preserved, reflexes intake, no amnesia afterwards, no nose rubbing |
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Term
| What percent of patients with pseudoseizures have a history of suicidal ideation or attempt? |
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Definition
| 39% with history of suicidal ideation, 20% attempt |
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Term
| Why do treat pseudoseizures? |
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Definition
| improve quality of life/reduce iatrogenic complications, patient cost, medical system cost |
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Term
| How do you treat pseudoseizures? |
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Definition
| pharmacologically (beta blockers, TCAs with benzos), CBT, group therapy, psychodynamic psychotherapy, hypnosis |
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Term
| What are the different types of somatoform disorders? |
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Definition
| somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, pain disorder |
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Term
| What is the lifetime prevalence of somatization disorder? |
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Definition
2% of women, 0.2% of men
usually begins before age 30, often during teenage years |
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Term
| What is the income/education level of most patients with somatization disorder? |
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Definition
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Term
| What are the criteria for somatization disorder? |
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Definition
| before age 30, results in treatment being sought or significant impairment; 4 pain symptoms, 2 GI symptoms, 1 sexual symptom, 1 psuedoneurologic symptom; either not explained by medical problem or excess complaints or impairment; not intentionally produced or feigned |
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Term
| What psychosocial factors lead to somatization disorder? |
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Definition
| social communication whose reslut is to avoid obligation, express emotion, symbolize feeling or belief; parental teaching and example |
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Term
| What are the comorbidities of somatization disorder? |
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Definition
| MDE and personality disorder |
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Term
| What is the differential diagnosis of somatization disorder? |
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Definition
| MS, myasthenia gravis, SLE, AIDS, hyperthyroidism, hyperparathyroidism |
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Term
| T/F Majority of patients who also have a psychiatric illness also have somatization disorder. |
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Definition
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Term
| What is the treatment for somatization disorder? |
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Definition
| one primary physician optimal, maybe treat comorbid depression/anxiety, psychotherapy |
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Term
| What are the criteria for conversion disorder? |
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Definition
| one or more symptoms, affecting voluntary motor or sensory function; preceded by stress; not intentionally produced as in factitious disorder or malingering, symptom can not be fully explained by medical condition or as a culturally sanctioned behavior, causes distress or impairment, not better accounted for by another mental d/o |
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Term
| What is La Belle Indifference? |
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Definition
| inappropriately cavalier attitude about what appears to be a major impairment |
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Term
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Definition
| feature of conversion disorder where the patient is assuming symptoms of a deceased loved one |
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Term
| What is the course of conversion disorder? |
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Definition
| approx 25% will have additional episodes with stress |
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Term
| How do you treat conversion disorder? |
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Definition
| support therapy, hypnosis/suggestion, amobarbital or lorazepam |
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Term
| What are the criteria for hypochondriasis? |
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Definition
| preoccupation with fears of having a serious disease, preoccupation persists, belief not of delusional intensity, causes distress or impairment, duration of at least 6 months, not better accounted for by another disorder |
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Term
| What's the difference between hypochondriasis and somatization disorder patients? |
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Definition
| hypochondriacs complain about fewer symptoms than somatization disorder patients |
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Term
| What is the gender prediliction of hypochondriasis? |
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Definition
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Term
| How do you treat hypochondriasis? |
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Definition
| most effective in medical setting focusing on stress reduction and education, regularly scheduled visits from primary physician, avoiding invasive procedures or treating incidental findings; avoid reinforcing illness behavior or use of "the sick role" pharmacotherapy of comorbid anxiety disorders if necessary |
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Term
| What is body dysmorphic disorder? |
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Definition
| obsessed with an imagined defect in appearance; causes distress/impairment; preoccupation is not better accounted for by another mental disorder |
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Term
| Patients with body dysmorphic disorder most often present to what kinds of MDs? |
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Definition
| dermatology and plastic surgery |
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Term
| How old is onset of body dysmorphic disorder? |
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Definition
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Term
| What is the gender predeliction of body dysmorphic disorder? |
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Definition
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Term
| What is the average number of body regions that concern a person with body dysmorphic disorder? |
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Definition
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Term
| What percent of patients with body dysmorphic disorder have experienced psychosis? |
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Definition
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Term
| How do you treat body dysmorphic disorder? |
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Definition
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Term
| T/F Pain disorder is often associated with an actual general medical condition. |
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Definition
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Term
| What is the difference between bodily pain and psychogenic pain? |
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Definition
| psychogenic pain will not vary in intensity or be temporarily relieved with distraction or analgesics |
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Term
| Worst prognosis in pain disorders is associated in patients with... |
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Definition
| preexisting persionality disorders (esp. pronounced passivity), involvement in litigation, use addictive substances, long history of pain |
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Term
| What is the motivation for factitious disorder? |
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Definition
| assume the sick role; external incentives (as in malingering) are absent |
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