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What are the 4 criteria for adjustment disorder?
- Identifiable psychosocial stressor/s
- Maladaptive reaction to stressor/s
- Occurrence w/in 3mo of onset of stressor/s
- Symptoms do not meet criteria for other disorders
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Describe panic disorder.
Characterized by recurrent attacks of intense anxiety, often w/ marked physical symptoms (e.g. tachycardia, hyperventilation, diaphorism); associated with agoraphobia, depression, GAD, and substance abuse.
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Considerations involved w/ switching between MAOIs and SSRIs?
The two combined can cause serotonin syndrome, so switching from MAOI must involve a 10+ day washout after cessation; fluoxetine (SSRI) must wait 5wks
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Modafinil
Rx of choice for narcolepsy; non-stimulating stimulant to with low addictive risk
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Differentiate between Bipolar I and II
- I: mania with or without depression
- II: hypomania with depression
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Diagnose alcohol dependence (alcoholism)
- Must have at least 3 of the following:
- continued drinking despite negative consequences
- neglect of activities
- inordinate time drinking OR recovering
- more or longer than intended
- inability to control drinking
- tolerance to effects
- withdrawal symptoms
- drinking to prevent withdrawal
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Differentiate between conversion disorder and hypochondriasis.
- Both often arise in response to significant life stressors, however -
- Conversion Disorder: manifests as voluntary sensorimotor deficits that suggest neurologic or medical origin, but cause cannot be found
- Hypochondriasis: not limited to sensorimotor deficits and associated with multiple doctor visits
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Key epidemiology of ADHD
- Prevalence declines 50% every 5 years until mid-20s
- Persists into adulthood in 30%
- 25% chance of developing antisocial personality disorder
- Impulsivity and hyperactivity decrease over time but inattention does not
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Side effects of risperidone
- increased plasma prolactin (anti-dopaminergic in tuberoinfundibular pathway) similar to typical antipsychotics => galactorrhea
- sexual dysfunction
- menstrual irregularities (amenorrhea, infertility)
- weight gain
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Major difference between schizoid and avoidant personality disorder?
- Schizoid: seeks or does not mind isolation
- Avoidant: seeks isolation but craves social interaction
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Difference between schizoid and schizotypal personality disorder?
- Schizoid: do not desire close relationships, aloof personality
- Schizotypal: odd beliefs, magical thinking, etc, and lack close friends
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Difference between postpartum blues, postpartum depression, and postpartum psychosis?
- Blues: immediately following birth, limited in duration, and fewer SIGEMCAPS than depression; no Rx necessary
- Depression: generally in months after childbirth, major depressive episode lasting >5 days; Rx with SSRIs
- Psychosis: requires presence of auditory or visual hallucinations and frequent suicidal/infanticidal thoughts; Rx with risperidone
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Diagnose generalized anxiety disorder (GAD).
- unrealistic worry about life events >6mo and person is worried most days
- at least six of: easy fatigue, difficulty falling asleep, restlessness, difficulty concentrating, irritability, muscle tension
- significant impairment of daily function
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Differentiate GAD and panic disorder
- GAD: constant worry without panic attacks; Rx with buspirone and relaxation therapy
- Panic Disorder: recurrent attacks followed by worry of more attacks; Rx with alprazolam and fluoxetine
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Rx for GAD
buspirone, relaxation therapy
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Rx for Panic Disorder
Alprazolam, fluoxetine
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Rx for Obsessive-Compulsive Disorder (OCD):
Clomipramine, exposure therapy
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First line of Rx for vaginismus?
- Kegels
- If that fails, try SSRIs
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First line of Rx for premature ejaculation?
Squeeze and stop-and-go
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Bipolar 1 patient presents with worsening depression, weight gain, fatigue, dry skin, deepening voice, and hair loss. WTF?
Hypothyroidism induced by lithium toxicity
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3yo girl presents with development delays after 12mo normal development/growth. In second year, head growth decelerates and parents note weird hand movements, disinterest in play, lack of eye contact, and uncoordinated movements. Diagnosis?
- Rett disease! Development begins regressing at 6mo of age (progressive encephalopathy, etc). Appears almost exclusively in females, can also have seizures and irregular respiratory patterns.
- DO NOT CONFUSE with autism/Aspergers, which are more prevalent in males. These do NOT have changes in head growth and stereotyped behaviors do not include hand wringing.
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Differentiate between adjustment disorder and separation anxiety.
- Adjustment disorder: usually occurs w/in 3mo of stressful event
- Separation anxiety: symptoms can be similar to adjustment, but present for at least 4wk and continue past 3mo
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Patient is in vegetative state, with minimal chance of recovery. She has stated prior to event that she would only like to maintain care if quality of life is returned to near normal. Husband wants to stop care, kids want to continue. What are your steps?
- Try to reconcile differences w/ family meeting
- Continue with patient's wishes since they were clear
- Possibly consult psych/lawyer
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Steps to breaking bad news?
- Give appropriate setting
- Get patient's input (What have you made of your illness so far?)
- Determine level of info desired (Would you like full details?)
- Share info in clear language (no medspeak like "demyelinating disease")
- Respond to feelings/provide support
- Establish plan, summarize, and make contract for future care
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Schizophrenic patient previously well-controlled, now hallucinating and wandering a park brought in to ER. Says meds ran out and can't get ahold of case worker. First step in management?
Contact case manager, ensure support/follow up. Giving script no good, actively hallucinating.
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Difference between dissociative amnesia and dissociative fugue?
- Amnesia: localized memory loss/amnesia of circumstances surrounding an extremely stressful event, often accompanied by nightmares and anxiety about event
- Fugue: identity disturbance requiring sudden and unexpected travel; amnesia begins at onset of events, not consequent to them
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Schizophrenic patient in and out of hospital 3 times in 6mo, currently there 2wks. Typical antipsychotics and risperidone have had diminishing efficacy. Family supportive and ensures medication. What next, clozapine, droperidol, ECT, lamotrigine, or topiramate?
- Clozapine: 30% effective in patients resistant to usual treatment for first 6wks, but carries risk of agranulocytosis, so last drug to try.
- ECT only use after all medications have failed; droperidol is anesthetic/sedative; lamotrigine and topiramate are anticonvulsants with trial efficacy in mania.
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Differentiate between age-associated cognitive decline and any form of dementia.
- Age-associated: allows for memory loss/cognitive decline but DO NOT interfere with ADLs
- Dementia: memory loss/cognitive decline and interference with ADLs
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Differentiate between Alzheimer's and vascular dementia.
- Alzheimer's: gradual onset; more common in women; somatic complaints less common; no focal neurologic signs; loss of insight to disease; scans show atrophy
- Vascular: stepwise onset; more common in men; somatic complaints present; focal neurologic signs present; disease insight retained; scans show infarcts
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