Term
|
Definition
| Outward expression of the pt’s inner experience |
|
|
Term
1)The condition is not caused by the direct effects of any drug.
2)The psychiatric disorder is not caused by the effects of a medical condition.
3)There is significant impairment of social functioning, occupational functioning, or both. |
|
Definition
| DSM-IV endorses a criteria-based diagnostic approach that requires the following three conditions to be met for diagnosis. |
|
|
Term
-Clinical disorders and other disorders that may be the focus of clinical attention
-Personality disorders and mental retardation only
-General Medical conditions
-Psychosocial and Environmental Problems
-Global Assessment of functioning scale |
|
Definition
Axis I –
Axis II –
Axis III –
Axis IV –
Axis V – |
|
|
Term
| the person is in persistent danger of hurting themselves or others / Suicidal / may have a complete breakdown in being able to care for themselves / is about to commit suicide and there is an expectation of death |
|
Definition
| 1-10 in the GAF scale means-- |
|
|
Term
| pt has superior function in a wide range of activities, no symptoms (this is what you would want to see in someone getting a pre-employment psych exam) |
|
Definition
| 91-100 on the GAF scale means-- |
|
|
Term
-New-onset mental symptoms, qualitatively different symptoms in a patient with a known or stable mental disorder, and
-Atypical symptoms or those that begin at an atypical age |
|
Definition
| A medical assessment is necessitated by: |
|
|
Term
-New or changed drug dosages, and use of illicit drugs
-Use of intoxicants, including alcohol
-Signs and symptoms (e.g., fever, dyspnea, morning headache, diarrhea); and
-Family and personal history of comorbid medical conditions |
|
Definition
| The medical assessment looks at |
|
|
Term
-Confusion/inattention
-Lateralizing findings on neuro exam
-Incontinence; and
-Meningeal signs. |
|
Definition
| Mental symptoms caused by a physical disorder is most likely indicated by: |
|
|
Term
-Mental symptoms are new
-If these are present:
-- Delirium
-- Headache
-- Recent trauma, or
-- Focal neurologic findings |
|
Definition
| A head CT scan is done if: |
|
|
Term
-Meningeal signs, or
-A normal head CT with:
-- Fever
-- Headache, or
-- Delirium |
|
Definition
| Lumbar puncture is performed in patients with |
|
|
Term
Antidepressants
Antipsychotics
Anxiolytics & sedative/hypnotics |
|
Definition
| 3 categories of psychopharmacotherapy |
|
|
Term
>>Tricyclics and heterocyclics
>>SSRIs – most commonly used
>>Monoamine oxidase inhibitors (MAOIs)
>>Mood stabilizers
>>Miscellaneous medications eg – wellbutrin, effexor |
|
Definition
|
|
Term
|
Definition
| group of clinically distinct entities identified by patterns of mood episodes, which are periods of time in which some mood impairment is present. |
|
|
Term
| change in mood from a premorbid state. |
|
Definition
| Defining feature of mood disorder |
|
|
Term
| major depressive episodes, manic episodes, hypomanic episodes, and mixed episodes |
|
Definition
|
|
Term
Depressive signs and symptoms must be present for the better part of a 2-week period (Table 12-1).
At least one of the symptoms must include:
depressed mood or
anhedonia.
Patients should not exhibit manic signs or symptoms (Table 12-1).
The mood episode is not the result of bereavement. |
|
Definition
| 4 characteristics of Major Depressive Episode |
|
|
Term
Sig: E. Caps (energy capsules)
S: sleep problems
I: interest they have lost
G: guilt; the Wt of the world is on them
E: energy is lacking
C: concentration is decreased
A: appetite is decreased or quite increased
P: psychomotor retardation or agitation
S: suicidal (15% of these pts are suicidal; ideations) |
|
Definition
| Depressive symptoms of mood episode... |
|
|
Term
-Inflated self-esteem or grandiosity
-irritability
-Decreased need for sleep
-Pressured Speech
-Flight of Ideas
-Distractibility
-Impaired judgment, resultin in pursuit of pleasure w/ a high probability of adverse outcomes
-Psychomotor Agitation |
|
Definition
| Mania symptoms of mood episode |
|
|
Term
-an abnormally and persistently elevated, expansive, or irritable mood that lasts at least 1 week.
-At least 3 manic symptoms (four if mood is irritable) are present.
-Patients may exhibit psychotic features or require hospitalization to prevent harm to self or others. |
|
Definition
| Manic episode characterized by |
|
|
Term
-at least 4 continuous days of:
*an abnormally and persistently
elevated,expansive, or irritable
mood
-At least 3 manic symptoms (four if the mood is irritable) must be present.
-Although the patient's mood and functioning are changed from premorbid functioning, social and occupational functioning are not significantly affected and there are no psychotic features.
**This is the mania w/out the social drawbacks; no occupational problems; they function pretty well** |
|
Definition
| Hypomania episode characterized by... |
|
|
Term
| Major Depressive Disorder |
|
Definition
• Chronic course with relapses
- Premorbid functioning may return
between episodes
- Between 5% and 10% of patients subsequently develop a manic episode
- 2-3 times more common in females than males
- Lifetime prevalence of depressive syndromes is 13-20%
• SUICIDE RATES ARE ESTIMATED AT 15% |
|
|
Term
Seasonal Affective Disorder (SAD)Melancholia
Catatonic Depression
Postpartum Depression |
|
Definition
|
|
Term
| Seasonal Affective Disorder |
|
Definition
• The predominance of fall or winter onset and is likely caused by the lessening daylight hours
• Typically remits in the spring
• Usually in cold, darker areas of the world (ex. Alaska)
• Can be treated by light therapy (Happy Light) |
|
|
Term
|
Definition
• Anhedonia (total loss of feeling of pleasure)
• Psychomotor or agitation
• Anorexia
• Weight loss
• Depressed mood (especially in the AM)
• Feelings of guilt
• Sleep disturbance
• Characterizes about 50% of hospitalized pt w/ major depression
• Severe depressive state
• Will have had energy than drastically lose it
• A true depressed pt will make you feel depressed
• Respond much better to SSRIs than most pt |
|
|
Term
|
Definition
• Motor immobility or stupor
• Purposeless motor activity
• Negativism
• Bizarre mannerisms or posturing
• Echolalia (repeat what you say)
• Echopraxia (mimic your gait and movement)
• Often treated w/ antidepressants and antipsychotics simultaneously
• Respond very well to electrocompulsive therapy
• Just want to sit there and not move
• Blunted Effect |
|
|
Term
• Must occur within first 4 weeks after childbirth
• Sleep loss, due to waking up frequently to check on baby
• May have homicidal and delusional beliefs |
|
Definition
| Characteristics of Postpartum depression |
|
|
Term
|
Definition
Considered first line therapy
o Minimal adverse effects and are safer than other antidepressant classes
o Side effects include GI upset, headache, and sexual dysfunction |
|
|
Term
|
Definition
o Side effects include weight gain, orthostatic hypotension, anticholinergic effects, and somnolence
o Overdosage is more lethal than with other antidepressants
o Mad as a hatter, red as a beet, dry as a bone
o Don’t give more than 2 weeks…can gain enough energy for suicide
o Must dangle feet before standing up after laying down…will fall |
|
|
Term
|
Definition
require a tyramine free diet (no wine, beer, almost all cheese, aged foods, smoked meats) to avoid side effects, such as hypertensive crisis
Precautions:
Use w/ SSRIs can cause Serotonin Syndrome (causes acute mental status changes, restlessness, diaphoresis, tremor, hyperthermia, seizures, occasionally coma & death
Use w/ TCAs can cause delirium and hypertension |
|
|
Term
| Electroconvulsive Therapy |
|
Definition
o Effective in all, but reserved for severely depressed or unresponsive or intolerant of psychiatric meds
o Can be safe in pregnant and elderly…produces a rapid response…relatively few contraindications
o Adv. effects: postictal confusion, somatic complaints (HA, nausea, sore)
o Greatest concern memory loss (often returns to baseline by 6 months) |
|
|
Term
|
Definition
• Lifetime prevalence is about 1%
-Avg. age of onset is 30
o Early onset is correlated with a higher incidence of psychotic symptoms and a poorer prognosis
-1st degree relatives have an increased incidence
-Monozygotic twin concordance rates are about 75%
-one or more manic or mixed episodes, which often cycle with depressive episodes
o Depressive episodes not necessary for dx
-Commonly known as manic depression
-Thought processes are difficult to follow because of racing thoughts, flights of ideas, and easy distraction
-Judgment is quite impaired, resulting in spending sprees, promiscuity, or foolish business investments
-Much higher suicide rate |
|
|
Term
|
Definition
-At least one or more major depressive episodes and at least one hypomaniac episode
-Pt has never experienced a manic episode or a mixed episode
-Hypomaniac symptoms are similar to manic symptoms but are less severe and cause less social impairment
-Hypomania also usually does not present w/ psychotic symptoms, racing thoughts, or excess psychomotor agitation
-Prevalence is estimated at 0.5%; it appears to be slightly more common in females |
|
|
Term
-Lithium, valproic acid, or carbamazepine typically effective
o ithium – monitor plasma levels every 4-8 wks
o Although usually well tolerated, side effects include weight gain, tremor, nausea, increased thirst and urination, drowsiness, hypothyroidism, arrhythmias, and seizures
-Antipsychotics (ie. Haloperidol) or benzodiazepines (ie. Ativan) may be added if agitation or psychotic symptoms are present
-Acute depressive episodes can be Tx w/ SSRIs or SNRIs
-Secondary Tx measures include ECT, MAOIs, and TCAs (caution must be exercised because these drugs can result in rapid cycling between mood states)
-Family, group, supportive, interpersonal, and/or cognitive therapy |
|
Definition
|
|
Term
|
Definition
• Chronic persistent mild depression, manifested by pessimism, brooding, generalized loss of interest, decreased productivity, feelings of inadequacy, and social withdrawal
• No psychotic features
• MDD eventually develops in 10-20%, bipolar may develop in others, and 25% will have lifelong dysthymic symptoms
• 2-3x more common in women; onset in young adulthood |
|
|
Term
|
Definition
-Depressed mood for most of the day, more days than not, for at least 2 years (at least 1 yr in children/adolescent)
-Never been w/o symptoms for >2 months at a time
-No major depressive episode during the first 2 yrs
-At least 2 of the following conditions noted: poor concentration or indecisiveness, hopelessness, poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, lack of self-esteem
-Tx w/ antidepressant...psychotherapist for insight psychotherapy |
|
|
Term
|
Definition
• Maladaptive behavioral or emotional symptoms that develop within 3 months after a stressful live event and end within 6 months of the event
• Symptoms cause significant impairment in functioning
• Symptoms not caused by bereavement
• No history of prior mania or hypomania |
|
|
Term
• Supportive psychotherapy
• Group therapy
• Pharmacotherapy for associated insomnia, anxiety, or depression |
|
Definition
|
|
Term
-proposes that depression is due to a deficiency in one or another of the three monoamines, namely serotonin, noradrenaline, and/or dopamine
-Antidepressant therpy aims to correct these deficiencies |
|
Definition
| Monoamine Hypothesis of Depression: |
|
|
Term
• Scale for measuring depression intensity and is not a diagnostic instrument
• Has a subgroup of cognitive-affective items (Cognitive-Affective subscale) and another that includes somatic and performance complaints (Somatic and Performance subscale) |
|
Definition
| Beck Depression Inventory (BDI): |
|
|
Term
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder |
|
Definition
| Cluster A Personality D/o |
|
|
Term
|
Definition
| • Pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent |
|
|
Term
|
Definition
| • Pattern of detachment from social relationships and a restricted range of emotional expression |
|
|
Term
| Schizotypal personality d/o |
|
Definition
| • Pattern of acute discomfort in close relationships, cognitive, or perceptual distortions, and eccentricities of behaviors |
|
|
Term
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder |
|
Definition
| Cluster B personality d/o |
|
|
Term
| Antisocial personality d/o |
|
Definition
| • Pattern of disregard for, and violation of, the rights of others |
|
|
Term
| Borderline personality d/o |
|
Definition
| • Pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity |
|
|
Term
| Histrionic personality d/o |
|
Definition
| • Pattern of excessive emotionality and attention seeking |
|
|
Term
| Narcissistic personality d/o |
|
Definition
| • Pattern of grandiosity, need for admiration, and lack of empathy |
|
|
Term
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder |
|
Definition
| Cluster C Personality d/o |
|
|
Term
|
Definition
| • Pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation |
|
|
Term
| Dependent personality d/o |
|
Definition
| • Pattern of submissive and clinging behavior related to an excessive need to be taken care of |
|
|
Term
| Obsessive-compulsive personality d/o |
|
Definition
| • Pattern of preoccupation with orderliness, perfectionism, and control |
|
|
Term
1. Pattern generally meets the general criteria for a Personality Disorder and traits of several different Personality Disorders are present, but the criteria specific for any Personality Disorders are not met
2. Pattern meets the general criteria for a Personality Disorder, but the individual is considered to have a Personality Disorder that is not included in the classification (ie. Passive-aggressive Personality Disorder) |
|
Definition
| Personality Disorders Not Otherwise Specified (NOS) is a category provided for two situations: |
|
|
Term
• Psychotropic Medications generally are viewed as an adjunctive treatment in the management of personality disorders
• They can be helpful for symptoms in some patients
• Therapy is the major treatment, and pharm is the minor treatment |
|
Definition
| Treatment of Personality Disorders: |
|
|
Term
|
Definition
Behavior: Distrust Suspicion
Experience of Illness: Heightened sense of fear and vulnerability
Behavior: Fear physician may harm, arguments, conflict
Management: Adopt a professional stance, provide clear explanations, be empathetic to fears, avoid direct challenge to paranoid ideation
Prevalence/Age/Gender
Prevalence:
-0.5-2.5% in the general population, 2-10% in psychiatric outpatients, and 10-30% among psychiatric inpatients
-More common in men than women
-Familial pattern has been suggested w/ increasing prevalence among 1* relatives w/ chronic schizoprenia |
|
|
Term
|
Definition
Significant impairment in work and personal relationships
Pt are hostile, stubborn, and defensive…may avoid intimacy
They are rigid and uncompromising, interested primarily in inanimate objects rather that human relations, extremely sensitive to rank, and disinterested in the arts and esthetics |
|
|
Term
1) Suspects without sufficient basis that others are exploiting, harming, or deceiving him or her
(2) Is preoccupied with unjustified doubts about the loyalty of trustworthiness of friends or associates
(3) Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
(4) Reads hidden demeaning or threatening meanings into benign remarks or events
(5) Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights
(6) Perceives attacks on his or her character or reputation that are not apparent to other and is quick to react angrily or to counterattack
(7) Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner. |
|
Definition
| Paranoid personality d/o Indicated by four (or more) of the following |
|
|
Term
|
Definition
Prominent Feature: Social detachment, emotional restriction
Experience of Illness: Anxiety because of forced contact with others
Behavior: Delay seeking care, appear unappreciative
Management: Adopt a professional stance, provide clear explanations, avoid over involvement in personal/social issues
Prevalence/Age/Gender:
-Prevalence not established
-Onset in early childhood
-Unclear if there is a genetic predisposition |
|
|
Term
(1) Neither 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 |
|
Definition
| Schizoid personality d/o indicated by 4 or more of the following-- |
|
|
Term
-Long-term psychotherapy has been useful in selected cases
-Group psychotherapy may be helpful |
|
Definition
| tx of Schizoid personality d/o |
|
|
Term
| Schizotypal personality d/o |
|
Definition
Prominent Feature: Odd beliefs, socially isolative
Experience: Odd interpretations of illness, anxiety because of forced contact with others
Behavior: Delay seeking care, odd beliefs, odd behavior
Management: Adopt a professional stance, provide clear explanations, tolerate odd beliefs and behaviors, avoid over involvement in personal and social issues
Prevalence/Age/Gender:
-Shares a genetic relationship w/ schizophrenia |
|
|
Term
(1) Ideas of reference (excluding delusions of reference)
(2) Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (eg, superstitiousness, belief in clairvoyance, telepathy, or "sixth
sense"; in children and adolescents, bizarre fantasies or preoccupations)
(3) Unusual perceptual experiences, including bodily illusions,
(4) Odd thinking and speech (eg, vague, circumstantial, metaphorical, over-elaborate, or stereotyped)
(5) Suspiciousness or paranoid ideation
(6) Inappropriate or constricted affect
(7) Behavior or appearance that is odd, eccentric, or peculiar,
(8) Lacks close friends or confidants other than first-degree relatives
(9) Excessive social anxiety that does not diminish with familiarity and tends to be
associated with paranoid fears rather than negative judgments about self. |
|
Definition
| Schizotypal personality d/o indicated by 5 or more of the following-- |
|
|
Term
-Psychotherapy
-Antipsychotic medication is useful in patients with pronounced psychotic manifestations |
|
Definition
| Tx of schizotypal personality d/o |
|
|
Term
|
Definition
- Persistent pattern of deceitfulness, impulsivity and disregard for the rights of others
- May present in the context of medicolegal issues, such as disability evaluation, seeking controlled substances or in situations involving aggressive or violent behavior
- Prominent feature:
Disregards rights of others
- Experience:
Anger, entitlement masking fear
- Behavior:
Anger, impulsive behavior, deceit, manipulative behavior
- Management:
Carefully investigate concerns and motives, communicate in a clear and nonpunitive manner, set clear limits |
|
|
Term
Individual is at LEAST 18 yrs old, with onset before age 15
Indicated by three (or more) of following:
1) Failure to conform to social norms w/ respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2) Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3) Impulsivity or failure to plan ahead
4) Irritability & aggressiveness, as indicated by repeated physical fights or assaults
5) Reckless disregard for safety of self or others
6) Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7) Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another |
|
Definition
| Antisocial Personality d/o indicated by 3 or more of the following |
|
|
Term
|
Definition
experiences a feeling of subjective dysphoria, characterized by tension, depression, inability to tolerate boredom and feeling of being victimized
Diminished capacity for intimacy
Poor job performance, always fails in classes, illegal activities, reckless & impulsive behaviors – also have depression & anxiety going along w/ that |
|
|
Term
| alcoholism in the fathers, substance abuse disorders in family environment |
|
Definition
| genetic and biological factors of antisocial personality |
|
|
Term
|
Definition
- Chronic psychiatric disorder characterized by marked impulsivity, instability of mood & interpersonal relationships and suicidal behavior that can complicate medical care
- Characterized by emotional turmoil & chronic suicidality (suicide ideation & attempts)
put off shortcoming on health provider – lives are very chaotic, may have extreme dependency or self mutilation
- Prominent Feature
Instability in interpersonal relationships, self image and affects; marked impulsivity
- Experience: Terrifying fanatasies about illness
- Behavior: fear of rejection & abandonment, self destructive acts, idealization and devaluation of physician |
|
|
Term
|
Definition
| complex syndrome whose central features are instability of mood, impulse control & interpersonal relationships |
|
|
Term
1) Frantic efforts to avoid real or imagined abandonment
2) A pattern of unstable & intense interpersonal relationships characterized by alternating b/w extremes of idealization and devaluation
3) Identify disturbance: markedly and persistently unstable self-image or sense of self
4) Impulsibity in at least two areas that are potentially self-damaging
(ex. spending, sex, substance abuse, reckless driving, binge eating)
5) Recurrent suicidal behavior, gestures or threats or self mutilating behabiour (cutting, making threats)
6) Affective instability due to marked reactivity of mood (ex. intense episodic dysphoria, irritability, or anxiety usually lasting few hours and only rarely more than few days
7) Chronic Feelings of emptiness
8) Inappropriate, intense anger or difficulty controlling anger (ex. freq displays of temper, constant anger, recurrent physical fights)
9) Transient stress-related paranoid ideation or severe dissociative symptoms |
|
Definition
| BPD has 5 or more of the following... |
|
|
Term
|
Definition
Affective instability due to a marked reactivity of mood (ex. intense episodice dysphoria, irritability or anxiety usually lasting a few hours & only rarely more than a few days)
Inappropriate, intense anger or difficulty controlling aner (ex. freq displays of temper, constant anger, recurrent physical fights)
Chronic feelings of emptiness
Mood problems – episodic dysphoria, anger control probs |
|
|
Term
|
Definition
Recurrent suicidal behavior, gestures or threats or self-mutilating behavior
Impulsivity in at least 2 areas that are potentially self-damaging (ex. spending, sex, substance abuse, binge eating)
Pattern of unstable & intense interpersonal relationships characterized by alternating b/w extremes of idealization & devaluation |
|
|
Term
Avoid excessive familiarity
Schedule regular visits
Provide clear, nontechnical explanations
Tolerate angry outbursts; But set limits
Maintain awareness of personal feelings
Consult psychiatrist |
|
Definition
|
|
Term
Psychological trtmnt:
- Long-term psychoanalytic psychotherapy
- Long-term, more reality oriented supportive psychotherapy
Drug Trtmnt:
- Monoamine oxidase inhibitors
- Antidepressant & antianxiety agents
- Antipsychotic drugs |
|
Definition
|
|
Term
Most pts w/ BPD improve w/ time
About 75% will regain close to normal functioning by age 35-40
90% full recovery by the age of 50
1 in 10 pts succeeds in comminting suicide |
|
Definition
|
|
Term
|
Definition
- Prominent Feature: Excessive attention-seeking behavior, emotionality
- Experience: Threatened sense of attractiveness & self-esteem
- Behavior: Overly dramatic, attention-seeking behavior, inability to focus on facts & details, somatization
- Management: Avoid excessive familiarity, show professional concern for feelings, emphasize objective issues
Overblown speech and theatrical – overly dramatic and overly seductive
Prevalence
- Estimated to be 10-15% of psychiatric outpatient and inpatient populations |
|
|
Term
1) Is uncomfortable in situations in which he or she is not the center of attention
2) Interaction w/ others is often characterized by inappropriate sexually seductive or provocative behavior
3) Displays rapidly shifting & shallow experession of emotions
4) Consistently uses physical appearance to draw attention to self
5) Has a style of speech that’s excessively impressionistic and lacking in detail
6) Shows self-dramatization, theatricality and exaggerated expression of emotion
7) Is suggestible, i.e., easily influenced by other or circumstances
8) Considers relationships to be more intimate than they actually are |
|
Definition
| histronic personality indicated by 5 of the following |
|
|
Term
Long-term Psychoanalytic psychotherapy
-TOC and should focus on developing the pt’s insight into the reasons for repetitive difficulties in sustaining love relationships and on promoting autonous self-expression |
|
Definition
|
|
Term
|
Definition
- Prominent feature: Grandiosity, need for admiration, lack of empathy
- Experience of illness: Anxiety caused by doubts of personal adequacy
- Behavior: Demanding, attitude of entitlement, denial of illness, alternating praise
- Management: Validate concerns, give attentive & factual responses to questions, channels pt’s skills into dealing w/ illness
Arrogant, hostile and very demanding
Similar to histrionic – just out there but don’t feel quite as entitled as narcissistic
Belief in youth and beauty – many plastic surgeriesn – don’t believe in aging gracefully
Prevalence
- 1% in the general population
- 2-16% in psychiatric outpt & inpt samples |
|
|
Term
1) Has a grandiose sense of self-importance (ex. exaggerates achievements & talents, expects to be recognized as superior w/o commensurate achievements)
2) Is preoccupied w/ fantasies of unlimited success, power, brilliance, beauty or ideal love
3) Believes that he or she is “special” and unique and can only be understood by or should associate with, other special or high-status people (or institutions)
4) Requires excessive admiration – like to be admired ALL the time
5) Has sense of entitlement, i.e., unreasonable expectations of expecially favorable treatment or automatic compliance w/ his or her expectations
6) Is interpersonally exploitative, i.e. takes advantage of others to achieve his or her own ends
7) Lacks empathy, is unwilling to recognize or identify w/ the feelings and needs of others
8) Is often envious of others or believes that others are envious of him or her
9) Shows arrogant, haughtly behaviors or attitudes |
|
Definition
| narcissistic have 5 or more of the following |
|
|
Term
|
Definition
- Prominent feature: Social inhibition due to fears of rejection or humiliation
- Experience: Heightened sense of inadequacy, low self-esteem
- Behavior: Witholds information, avoids questioning or disagreeing with physician
- Management: Provide reassurance, validate concerns, encourage reporting symptoms & concerns
People are very sensative to rejection --. Don’t take very well at all or if there is even a chance that they might be rejected don’t do well
See themselves as socially inept
Not good at relationships – so worried that someone will reject them or humiliate them |
|
|
Term
1) Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection
2) Is unwilling to get involved w/ people unless certain of being liked
3) Shows restraint within intimate relationships b/c of the fear of being shamed or ridicules
4) Is preoccupied with being criticized or rejected in social situations
5) Is inhibited in new interpersonal situations b/c of feelings of inadequancy
6) Views self as socially inept, personally unappealing or inferior to others
7) Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing |
|
Definition
| Avoidant personality indicated by 4 of the following |
|
|
Term
- Psychoanalytic psychotherapy
- Assertiveness training – how to assert themselves, make good decisions
- Training in general social skills
- Group therapy - good for them |
|
Definition
| tx for avoidant personality |
|
|
Term
| Obsessive compulsive personality |
|
Definition
- Prominent feature: Preoccupation w/ orderliness, perfection, control
- Experience: Fear of losing control of bodily functions and emotions
- Behavior: Fear of relinquishing control, excessive, questioning and attention to details, anger about disruption of routines
- Management: Complete through history & examinations, provide through explanations, don’t overemphasize uncertainty, encourage pt participation in treatment
Don’t like to have routines changed at all – everything you are doing you have to explain it to them
Prevalence/Age/Gender
- Prevalence is estimated to be 1% in community samples & 5-10% in psychiatric settings
- Particularily in the oldest children of a family – they feel like they have to look after others and be totally in charge & everything in the home done right
- Frequently diagnosed in men |
|
|
Term
1) Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of activity is lost
2) Shows perfectionism that interferes with task completion (ex. is unable to complete a project b/c his or her own overly strict standards are not met)
3) Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships ( not accounted for by obvious economic necessity)
4) Is over conscientious, scrupulous and inflexible about matters or morality, ethics or values (not accounted for by cultural or religious identification) – no black and white only ONE way
5) Is unable to discard worn-out or worthless objects even when they have no sentimental value little hoarders but not as much
6) Is reluctant to delegate tasks or to work w/ others unless they submit to exactly his or her 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 |
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Definition
| Obsessive compulsive personality indicated by 4 of the following |
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Term
-increased heart rate
-Altered respiratory rate
-Sweating – may actually drip sweat from fingers
-Trembling
-Weakness and fatigue
-Dizzy
-Palpitations
-Loss of appetite
-Nausea
-other symptoms that cause pt distress |
|
Definition
| Psychological responses of anxiety d/o |
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Term
|
Definition
characterized by persistent, excessive anxiety over general life events that lasts 6months or more
- The pt has difficulty coping with the anxiety, usually expressed as worry or apprehension (anticipatory fear)
- There is high (50-90%) comorbidity with other psychiatric disorders, such as MDD, specific and social phobias and panic disorder |
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Term
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Definition
very common, w/ lifetime prevalence estimated at 45%
Women twice as often as men |
|
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Term
- restlessness or hypervigilence
- easy fatigability
- Irritability
- Sleep disturbance
- Musce tension
- Difficulty concentrating |
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Definition
| GAD dx criteria include at least 3 of the following |
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Term
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Definition
Age of onset is around age 20, although pts typically report feeling anxious as long as they can remember
Persistant excessive anxiety for at least 6mo
-problems coping with anxiety
-may have other psychiatric disorders w/ this |
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Term
SSRIs & Buspirone are effective
TCAs may also help
Benzodiazepines can be used as an adjunct for short-term management severe symptoms but are not recommended for monotherapy – risk of dependence or abuse
Behaviorally oriented therapy should also be initiated |
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Definition
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Term
|
Definition
defined as a period of extreme anxiety that peaks that 10 min, typically declines within 30min, and rarely lasts longer than 1 hr.
-may have a definable trigger or may be totally unexpected
--feel like they are having a heart attack, they cannot take a deep breath,
-feel numbness and tingling at lips and fingertips |
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Term
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Definition
| may experience palpitations or tachycardia, sweating, trembling, dyspnea, sensation of chocking, chest discomfort, nausea, depersonalization (feel estranged from self and/or the external world), derealization (people, events, and surroundings appear changed or unreal), fear of losing control, fear of dying, light-headedness, numbness or tingling, chills or hot flashes |
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Term
|
Definition
recurrent, unexpected panic attacks that abruptly occur and are accompanied by debilitating fear of having additional attacks
Etiology:
-evidence points to a biological cause though genetics, and psychosocial factors most likely contribute
-nervous system dysregulation and abnormal activity of NE, serotonin, GABA have been implicated
-chief inhibitor is GABA-a decrease in this is indicated in panic and anxiety attacks |
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Term
|
Definition
the intense fear and physical symptoms may be accompanied by feelings of impending harm or death, fear of having a heart attack or stroke, and or/fears of “going crazy”
Prevalence
occurs in 1-5% of population
-2 to3 times more common in Females
-average age at onset is mid-20s, but it can occur at any age, including childhood |
|
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Term
acute management of anxiety short course of benzodiazepines
-maintenanceSSRIs (as benzos are tapered off)
-TCA
-in general, doses should be
Started low and titrated slowly
-treatment should continue or 8-12 months , bc relapse rates are higher after med is stopped
-mild cases psycotherapy alone
-cognitive, insight-orientated , relaxation training and behavioral therapies shown effective
immediate relief of panic attack could use ativan injection, or pill if it’s coming on slowly |
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Definition
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Term
|
Definition
-results from exposure to or witnessing a physiologic or psych traumatic event that is out of the range of normal human experience
-have to witness an event, cannot witness after effects
Clinical Manifestations:
overwhelming sensations of helplessness, fear, and horror that impair occupational or social functioning
-may have sense of repeatedly reliving the event, have intrusive memories or disturbing dreams of the event, or experience distress when exposed to stimuli that trigger event review |
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Term
• Pt unable to recall important aspect of event
• Avoids activities, places, people that remind them of event
• Attempts to avoid thinking or talking about event
• Has feelings of detachment or estrangement from others
• Shows markedly decreased interest or anhedonia
• Shows restricted range of affect
• Believes that his or her future has been foreshortened bc of event
• Has increased state of arousal characterized by at least 2 of the following: insomnia, irritability, angry outbursts, poor concentration, hypervigilance, exaggerated startle response |
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Definition
| PTSD characterized by at least 3 of the following for more than 1 mo |
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Term
TCA (imipramine, doxepin, amitriptyline)
-SSRI, MAOI, and anticonvulsants (carbamazepine and valproate)
-crisis counseling should be initiated as a preventative measure when feasible
-support groups , family therapy, cognitive or behaviorally oriented therapy |
|
Definition
|
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Term
|
Definition
most common mental disorder in US
-characterized by irrational fear and persistent excessive anxiety when presented w/object or situational event
-immediately have increase in anxiety when confronted |
|
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Term
| common co-morbidities are MDD, substance abuse, other anxiety disorders, and personality disorders |
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Definition
| common co-morbidities of phobias... |
|
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Term
| diagnosis of phobia is made if the response to a phobic stimulus interferes with the patient’s daily routine, social, or occupational functioning |
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Definition
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Term
1. Animal fear of animals or insects; onset in childhood
2. Natural environment fear of natural phenomena (storms, heights, water, lightning)
3. Blood-injection injury fear of invasive procedures is paramount, the phobic trigger is possibility of injury, sight of blood, or contamination by exposure to bodily fluids
4. Situational fear of bridges, flying, driving, confined spaces
5. Other fear of situations that may lead to choking, vomiting, getting an illness; In children, fear may be of loud noises or costumed character |
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Definition
| 5 types of specific phobias |
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Term
|
Definition
-Intense anxiety about placing oneself into a situation in which an incapacitating problem could occur and no help would be available.
-May occur with or without a history of panic disorder, although 50%-70% of patients have co-existing panic disorder.
o Not necessary for that diagnosis |
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Term
|
Definition
Any of the symptoms characteristic of a panic attack may be present.
In addition, the patient may have a potentially incapacitating or embarrassing medical condition, such as a heart condition or a lack of bowel or bladder control.
In extreme cases, symptoms may render the patient unwilling or unable to leave home. |
|
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Term
- For social phobias and agoraphobia, SSRIs (paroxetine, in particular) first-line therapy.
- If these are not successful, benzodiazepines, buspirone, TCAs (imipramine), or MAOIs (phenelzine) may be initiated.
- B-blockers, such as propranolol, have been successfully used to reduce autonomic hyperarousal symptoms and tremor associated with performance situations.
- Insight-oriented therapy should also be initiated.
- Hypnosis may be helpful.
- Specific Phobias can be treated with short-term benzodiazepines and B-blockers;
- however, systemic desensitization, hypnosis, supportive, and insight-oriented psychotherapy are probably more useful.
SSRIs – paxil, fluoxetine Benzos (ativan)
TCA
MAOIs
Propranolol helps treat tremors that go along with these disorders |
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Definition
|
|
Term
• Somatization Disorders
• Conversion disorder
• Hyochondriasis
• Body Dismoprhic Disorder
• Pain disorder. |
|
Definition
|
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Term
|
Definition
-occurs in females more than males and more often in Low SES group
-onset is before 30 years of age, and 50% of pts have co-morbid mental disorder
-pt presents with vague physical complaints involving many organ systems that cannot be explained be general medical condition or substance use.
-visits to healthcare providers are numerous, although no medical disorder is found. |
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Term
-pt has hx of many physical symptoms that began before the age of 30, have persisted over several yrs and cause considerable distress and impairment in function.
-pts symptoms have met following criteria over course of illness:
4 pain symptoms(4 sites on body)
2 GI (n/v , abd pain)
1 sexual or reproductive symptom (cramps)
1 pseudo neuro, such as localized weakness
-sx cannot be explained by medical condition or substance
-if there is known medical condition, complaints and decreased functioning cannot be explained by condition
-pt does not intentionally produce dx |
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Definition
| dx criteria for somatization d/o |
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Term
-regularly scheduled visits with a healthcare provider
-pts are very resistant to seeing a mental healthcare provider
-secondary gain should be minimized and meds avoided (opiods side effects, secondary gain-constipation) |
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Definition
|
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Term
|
Definition
-characterized by 1 or more neuro complaints that cannot be explained clinically
-common
-20-25% incidence
-most commonly diagnosed during adolescence and young adulthood, and is 2 to 5 times more common in female than males |
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Term
|
Definition
-symptoms are not intentionally produced and may be motor, sensory, seizure activity, or mixed.
-most common symptoms are shifting paralysis , blindness, and mutism
-Pt display unexpected lack of concern and indifference to their symptoms (la belle difference)
-symptoms tend to be episodic, lasting days to month and may remit for a period of time only to recur during times of stress |
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Term
1. 1 or more senosory or motor deficits suggesting a neuro or med illness
2. Psychological factors are associated bc the deficit is preceded by conflicts or stressors
3. Symptom is not intentionally produced
4. Deficit cannot be fully explained by medical condition, substance of abuse, or culturally sanctioned response
5. Deficit cause significant distress and impairment in functioning or warrants medical evaluation
6. Symptom is not limited to pain or sexual dysfunction and does not occur exclusively during som.disorder |
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Definition
| dx criteria of conversion d/o |
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Term
-psychotherapy, such as insight-oriented or behavior therapy
Hypnosis, anxioltyics, and relaxation therapy
-some pts have responded to amobarbital interviews (truth serum interviews) to uncover underlying psych factors |
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Definition
| conversion d/o dx criteria |
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Term
|
Definition
- Usually there is an abrupt onset, and pain may increase in intensity over weeks or months.
A long history of medical and surgical attention is common, as this tends to be a chronic (and sometimes disabling) d/o
Psychological factors are deemed to have an important role in the pathogenesis.
Peak onset 30-50 years old; it is 2x as common in women. |
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Term
-Pain reported in one or more areas without any known cause--> significant distress/impaired functioning.
-May describe atypical facial pain, low back pain, headache, pelvic pain, and other chronic pain syndromes.
Medical condition does co-exist pain cannot be fully explained as a result of the condition.
Pts attribute pain as cause of all their problems.
Facial pain– big sign, not many things cause facial pain
Very hard not to judge these pts as malingerer’s |
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Definition
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Term
-Psychotherapy, behavioral therapy (e.g., biofeedback and hypnosis), and pain control programs may be helpful.
-Analgesics and sedatives generally not beneficial and may lead to abuse or dependence, although SSRIs and tricyclics have been used with some positive results |
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Definition
|
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Term
|
Definition
-Characterized by a preoccupation with an imagined defect in physical appearance or an exaggerated distortion of a minor flaw.
-Pts feel self-conscious and fear humiliation; go to great lengths to hide or correct their perceived anomaly.
-Visits to a dermatologist and/or plastic surgeon are common, although the pt is usually still not satisfied with his or her appearance.
-Age of onset is 15-20 years |
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Term
-Serotonin-modulating drugs (fluoxetine, clomipramine) can be efficacious.
-Co-existent psychiatric disorders should be treated appropriately.
People can have other problems (i.e. anorexia) that could be underlying stressors… need to treat everything that’s going on with the condition |
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Definition
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Term
|
Definition
-Pts intentionally fake signs and symptoms of medical or psychiatric symptoms with the 1* motivation being to assume the sick role
-Usually begins in early adulthood and carries a poor prognosis.
-Often pts seek hospital admission under different names and by feigning different illnesses
-When (or if) confronted with their ruse, they usually become angry and abruptly sign out |
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Term
|
Definition
-Obtaining a reliable past medical history is unlikely.
-Patients are usually familiar with the disease process
-true disease processes must be ruled out
-Related disorders include Munchausen's syndrome and Munchausen's syndrome by proxy, which is a form of child abuse |
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Term
-Early recognition is paramount in the management of this disorder so as to avoid unnecessary and/or potentially dangerous procedures.
These people do not care if they “require” operations or not for the condition so it’s very important to avoid unnecessary, life threatening procedures and surgeries
-While no specific psychiatric intervention has been notably effective, psychotherapy (individual, family) is suggested |
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Definition
|
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Term
|
Definition
| deliberate production of physical or psychological symptoms motivated by external gain. Some of these obvious, definable goals are avoiding responsibility, police or legal action, punishment, or dangerous or difficult situations; receiving monetary compensation (e.g., in a lawsuit) or free hospital room and board; and obtaining drugs. |
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Term
|
Definition
-Patients tend to express vague, poorly defined complaints and claim that these symptoms cause great distress and impaired functioning.
-->Patients are uncooperative and refuse to accept a clean bill of health.
-->If you offer CT scan or MRI they might refuse b/c they know they are fine and nothing will show up
-->Their symptoms typically improve when the objective has been met or when the ruse has been exposed. |
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Term
|
Definition
-preoccupation with the belief of having or fear of contracting a serious illness.
-This condition is commonly co-existent with symptoms of anxiety and depression.
-The patient's fear persists even though medical investigation reveals no cause.
-The course, although generally chronic, is episodic and may be exacerbated after a major stressor |
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Term
|
Definition
-Preoccupation with fears of having a serious illness based on misinterpretation of bodily symptoms
-Preoccupation persists despite medical evaluation and reassurance
-Belief is not delusional or limited to a specific concern about appearance
If it was specific concern about appearance-- BDD
-Preoccupation causes distress or impairment in functioning
-Duration of at least 6 mths****
-Preoccupation is not better accounted for by another mental disorder |
|
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Term
-Group and insight-oriented psychotherapy can be helpful, though patients are usually resistant to psychiatric care.
-Regularly scheduled appointments with a practitioner are recommended to provide reassurance.
Pharmacotherapy can be used if the patient has a concurrent or underlying anxiety or major depressive disorder.
-->Frequently have underlying depression
CONSTANT REASSURANCE!! |
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Definition
|
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Term
|
Definition
| Physical complaints involving several different systems |
|
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Term
|
Definition
| Sensory or motor deficit is present |
|
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Term
|
Definition
| Preoccupation w/imagined defect in appearance; excessive concern about minor physical anomaly |
|
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Term
|
Definition
| Fears of having a serious illness with misrepresentation of bodily symptoms |
|
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Term
| substance abuse and general medical conditions must be ruled out. In addition, schizoaffective disorders and mood disorders must also be excluded |
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Definition
| what must be r/o to make dx of schizophrenia? |
|
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Term
disorganized
residual
paranoid
undifferentiated
catatonic |
|
Definition
| subtypes of schizophrenia |
|
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Term
| disorganized shizophrenia |
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Definition
| Characterized by disorganized speech or behavior and flat or inappropriate affect |
|
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Term
|
Definition
| Negative symptoms predominate, and there are only minimal positive symptoms |
|
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Term
|
Definition
| The most common form, characterized by persecutory or grandiose delusions or auditory hallucinations. |
|
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Term
| undifferentiated schizophrenia |
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Definition
| Delusions and hallucinations are prominent, but there is absence of paranoid, disorganized, and catatonic symptoms. |
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Term
|
Definition
| A rare subtype, manifested by at least two of the following: motor immobility, excess motor activity that is without purpose, extreme negativism or mutism, peculiarly voluntary movement (bizarre postures, stereotyped movements, grimacing), and echolalia (mimicking sound) or echopraxia (mimicking behavior) |
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Term
-Prodromal phase, precedes the 1st psychotic break, manifested by functional decline, social withdrawal, and irritability.
-->1st phase– stay in their room, won’t go out, cranky
-Psychotic phase delusions, disorganized thought process & content & perceptual distur¬bances
-->Positive symptoms!
-Residual phase generally occurs between psychotic episodes. It is characterized by blunted affect, odd thinking or behavior, and other negative symptoms.
-->Negative symptoms!
-->Have to worry about suicidal thoughts and actions here |
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Definition
| 3 phases of schizophrenia |
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Term
-At least 2 of the following symptoms of psychosis have been present for 1 mth
-->Delusions, Hallucinations, Disorganized speech
-->Disorganized or catatonic behavior, Negative symptoms
-->Only 1 of the above is needed if the delusions are bizarre, the auditory hallucinations involve comments on the pt, or there are 2 or more voices talking to each other
-Has to be significant social and/or occupational dysfunction
-Some symptoms are required to be present for at least 6 mths include only negative symptoms or less intense positive symptoms
-Both schizoaffective d/o and mood disorder with psychotic features need to be excluded
-A substance (either of abuse or medication) or a general medical condition cannot cause the symptoms |
|
Definition
| schizophrenia dx criteria |
|
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Term
-Hospitalization recommended for pts exhibiting suicidal ideation, inability to care for themselves, or pose a threat to self or others
Pharmacotherapy
-->No therapeutic intervention is totally effective
-->Typical neuroleptic & antipsychotic medications with DA antagonist activity (haloperidol, chlorpromazine, thioridazine, loxapine, and fluphenazine) decreasing positive symptoms.
-->Atypical neuroleptics w/ 5-HT and DA antagonist activity (risperidone, clozapine, quetiapine) management of negative symptoms
--> 4- to 6-week medication trial is optimal before concluding nonresponse
-Behavior-oriented therapy targeted toward social skills training (as an adjunct along with group and/or family therapy) may be helpful |
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Definition
|
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Term
|
Definition
Patients must exhibit psychotic symptoms consonant with the acute phase of schizophrenia
-Psychotic symps accompanied by prominent mood symptoms (mania/depression) during part of the illness
-At other points in the illness, the psychotic symptoms are unopposed no mood symptoms are present
-Periods of illness in which there are only psychotic symptoms, and no mood symptoms, must last for at least 2 weeks
-Cannot be due to a substance or general medical condition |
|
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Term
-Antipsychotic agent (haloperidol or risperidone) should be tried initially
-If it is ineffective alone, antidepressants (SSRI is generally tried first) should also be administered |
|
Definition
| tx of schizoaffective d/o |
|
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Term
|
Definition
-Characterized by the presence of nonbizarre delusions (i.e., situations that occur in real life) for at least 1 month.
-Behavior is not obviously odd, and functioning is not significantly impaired |
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Term
erotomanic (belief that another person is in love with the patient)
somatic (delusions of a physical defect or medical condition)
jealous (delusions of sexual partner's infidelity)
persecutory (delusion of mistreatment or persecution)
grandiose (delusions of inflated worth, power, knowledge, or special relationship to a famous person)
-Persecutory is the most common type
-Jealous may be associated with homicide, violence; erotomanic accounts for stalking behavior.
Grandiose – believe they are gods |
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Definition
|
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Term
|
Definition
-May be caused by alcohol, illicit drug use, or medications (anticholinergics, antidepressants, hallucinogens, psychostimulants).
-Can be caused by general medical conditions (central nervous system disease, endocrinopathies, vitamin deficiency states, HIV/AIDS, systemic lupus erythematosus). |
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Term
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Definition
| symptoms are present for at least 1 day but < 1 month, and the patient returns to pre-morbid levels of functioning after the symptoms abate. This is commonly encountered after a catastrophic event. |
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Term
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Definition
| leave a topic & never return to it |
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Term
|
Definition
|
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Term
|
Definition
| rhyme w/ your sentences back to you |
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Term
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Definition
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