Behavioral Medicine

  1. Refers to events, objects, or persons in one's environment that are believed to have particular personal significance.
    A delusion of reference
  2. The belief that other people or malevolent entities intend to harm the individual. As in all delusions, the beliefs are unshakable.
    A persecutory delusion
  3. Misinterpretations of actual stimuli
  4. Perpetual disturbances lacking any real basis
  5. A cognitive style of processing that utilizes only information related to actual objects and events and is devoid of abstractions
    Concrete thinking
  6. Characterized by the communication of unnecessary details before finally arriving at the central idea
  7. Communicates the central idea in a clear, concise, logical manner
    Goal-oriented thought process
  8. A form of loosening of associations, each of which involves greater or lesser degrees of loss of the logical progression of thoughts
    Flight of ideas
  9. Manifested by a rapid succession of unrelated or fragmentary thoughts
    Flight of ideas
  10. Persistent repetition of words or ideas
  11. a false belief that is not supported by fact and cannot be challenged successfully by logic or reason
  12. False beliefs that can change in the face of strong evidence
    overvalued ideas
  13. Characterized by discrete episodes of aggression and destructiveness that are out of proportion with the precipitant stressor
    Intermittent explosive disorder
  14. EEG may help clarify the diagnosis, since 55% of patients have EEG abnormalities as well as learning disabilities, a history of ADHD, and abnormal neuropsychological test results
    Intermittent explosive disorder
  15. What are the three dimensions of classifying the symptoms of schizophrenia?
    psychotic, disorganized, and negative
  16. What is the worldwide prevalence of schizophrenia?
  17. What is the mean age at the first psychotic episode for men? for women?
    For men, 21. For women, 27.
  18. Which gender tends to develop schizophrenia later than the other?
    Women develop the illness later than men.
  19. How many patients with schizophrenia will attempt suicide? how many will succeed?
    About 1/3 attempt suicide, and 1 in 10 will eventually succeed.
  20. What are the risk factors for suicide in schizophrenia?
    • Male gender, age less than 30 years, unemployment, chronic course, prior depression, past treatment for depression, history of substance abuse, and recent hospital discharge
    • (P.H.A.R.M. C.U.P)
  21. What is formication?
    The sensation of insects crawling under the skin
  22. Which dimension of schizophrenia includes symptoms that reflect a patient's confusion about the loss of boundaries between him- or herself and the external world?
    The psychotic dimension
  23. Which two symptoms are included in the psychotic dimension of schizophrenia?
    Hallucinations (disturbances in perception), and delusions (disturbances in thought)
  24. Which symptoms are included in the disorganization dimension of schizophrenia?
    Disorganized speech, disorganized or bizarre behavior, and incongruous affect
  25. Associative loosening, illogical thinking, overinclusive thinking, and loss of ability to engage in abstract thinking are types of what?
    Thought disorders, or disorganized speech
  26. What is the name of this abnormal motor behavior seen in schizophrenia: The patient may be immobile, mute, and unresponsive, yet fully conscious.
    Catatonic stupor
  27. What is the name of this abnormal motor behavior seen in schizophrenia: The patient may show uncontrolled and aimless motor activity. Patients sometimes assume bizarre or uncomfortable postures, such as squatting, and maintain them for long periods.
    Catatonic excitement
  28. What is the name of this abnormal motor behavior seen in schizophrenia: The patient may exhibit a repeated movement that is not goal directed, such as back-and-forth rocking.
  29. What is the name of this abnormal motor behavior seen in schizophrenia: The patient may have goal-directed activities that are either odd in appearance or out of context, such as grimacing.
  30. What is the name of this abnormal motor behavior seen in schizophrenia: The patient may imitate movements and gestures of another person.
  31. What is the name of this abnormal motor behavior seen in schizophrenia: The patient may carry out simple commands in a robot-like fashion.
    Automatic obedience
  32. What is the name of this abnormal motor behavior seen in schizophrenia: The patient may refuse to cooperate with simple requests for no apparent reason.
  33. What is incongruity of affect?
    The third component of the disorganized dimension of schizophrenia: patients may smile inappropriately when speaking of neutral or sad topics or giggle for no apparent reason.
  34. The DSM IV-TR lists three negative symptoms as characteristic of schizophrenia. What are they? What is another negative symptom common in schizophrenia?
    Alogia, affective blunting, and avolition. Anhedonia is another common symptom.
  35. In schizophrenia, what do negative symptoms reflect?
    A deficiency of mental functioning that is normally present.
  36. Characterized by a diminution in the amount of spontaneous speech or a tendency to produce speech that is empty or impoverished in content when the amount is adequate
  37. A reduced intensity of emotional expression and response. It is manifested by unchanging facial expression, decreased spontaneous movements, poverty of expressive gestures, poor eye contact, lack of voice inflections, and slowed speech.
    Affective flattening or blunting
  38. A loss of the ability to initiate goal-directed behavior and carry it through to completion. Patients seem to have lost their will or drive.
  39. The inability to experience pleasure. Many patients describe themselves as feeling emotionally empty. They are no longer able to enjoy activities that previously gave them pleasure, such as playing sports or seeing family or friends.
  40. A patient may not believe that he or she is ill or abnormal in any way.
    Lack of insight
  41. What are the subtypes of schizophrenia as recognized in the DSM IV-TR?
    Paranoid, disorganized, catatonic, undifferentiated and residual
  42. This subtype of schizophrenia involves preoccupation with one or more systematized delusions or frequently auditory hallucinations
    Paranoid schizophrenia
  43. How do paranoid schizophrenic patients differ from disorganized schizophrenic patients?
    Paranoid schizophrenic patients tend to be an older age at onset, and are more likely to be married, to have children, and to be employed. Their premorbid functioning and their outcome tend to be better.
  44. Which schizophrenia subtype is characterized by disorganized speech and behavior and flat or inappropriate affect?
    Disorganized schizophrenia
  45. The onset of this schizophrenia subtype occurs at an early age with the development of negative symptoms such as avolition, flat affect, and cognitive impairment. These patients often seem silly and child-like and occasionally grimace, giggle inappropriately, and appear self-absorbed.
    Disorganized schizophrenia
  46. Which schizophrenia subtype is dominated by at least two of the following: motoric immobility (eg catalepsy, stupor), excessive motor activity, extreme negativism, peculiarities of voluntary movement (eg, stereotypies, mannerisms, grimacing), and echolalia or echopraxia. Reported to be less common than it was in the past, which may be a benefit of the modern treatment era.
    Catatonic schizophrenia
  47. What is undifferentiated schizophrenia?
    The subtype for patients meeting criteria for schizophrenia but not criteria for the paranoid, disorganized, or catatonic subtypes.
  48. What is residual schizophrenia?
    A diagnosis for patients who no longer have prominent psychotic symptoms but who once met criteria for schizophrenia and have ongoing evidence of illness such as blunted affect or eccentric behavior.
  49. What is the strongest predictor of outcome for schizophrenia? What are some other important predictors?
    IQ. Age at onset, gender, severity and type of initial symptoms, and structural brain abnormalities.
  50. What is the major differential diagnosis for schizophrenia?
    Separating schizophrenia from schizoaffective disorder, mood disorder, delusional disorder, and personality disorders
  51. What is the chief distinction between schizoaffective disorder and psychotic mood disorder, and schizophrenia?
    In schizophrenia, a full depressive or manic syndrome either is absent, develops after the psychotic symptoms, or is brief relative to the duration of psychotic symptoms.
  52. How is schizophrenia different from delusional disorder?
    Schizophrenia is characterized by bizarre delusions, and hallucinations are common.
  53. How are personality disorders different from schizophrenia?
    They may be characterized by indifference to social relationships and have a restricted affect, bizarre ideation, or odd speech, but they are not psychotic.
  54. Siblings of a schizophrenic patient have how much of a chance of developing the illness themselves?
  55. Children who have one parent with schizophrenia have how much of a chance of developing the illness themselves?
  56. For persons with one sibling and one parent with schizophrenia, how much is the risk that they will develop the illness themselves?
  57. What is the risk for children with two schizophrenic parents that they will develop the illness themselves?
  58. In schizophrenia, what is the concordance rate for identical twins? for non-identical twins?
    46%; 14%
  59. What kinds of brain abnormalities might you see in the neuroimaging of schizophrenic patients?
    Cerebral ventricular enlargement, sulcal enlargement, and cerebellar atrophy. Decreased size in temporal regions, decreased thalamus size, increase in CSF in the ventricles and on the brain surface, selective decrease in cortical gray matter, maybe white matter as well.
  60. What agents are considered first-line therapy for schizophrenia?
    Second-generation antipsychotics: risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole
  61. Which second-generation anti-psychotic is a second-line choice for schizophrenia treatment? Why? In what cases might it still be used?
    Clozapine. It is expensive and has a propensity to cause agranulocytosis. But you can still use it for patients at high risk for suicide.
  62. How many years of treatment are recommended after the initial psychotic episode for a schizophrenic patient?
    1-2 years because of a high risk for relapse and further social deterioration
  63. How many years of treatment are recommended for a schizophrenic patient with multiple psychotic episodes?
    At least 5 years for high risk of relapse
  64. What are some reasons to hospitalize schizophrenic patients?
    NBECSS: when the illness is New, when the Behavior is dangerous, when they need a special medical procedure like Ect, when they cannot Care for themselves, when Side effects become dangerous, when they are Suicidal. (new, behavior, Ect, Care, Side effects, Suicidal)
  65. What are key points for a clinician to remember about schizophrenia?
    MERCF- treat aggressively with Meds, develop an Empathetic relationship, develop a daily Routine for the patient (develop socialization and reduce boredom), develop Close relationships with local social services, and use Family therapy if possible
  66. What are the criteria for an episode of major depression according to the DSM IV-TR?
    WWF DIP MAC- Must have at least 5 of 9 symptoms for 2 weeks to rule out transient mood fluctuations: Worthlessness/guilt, Weight loss/weight gain, Fatigue, Death thoughts, Insomnia/hypersomnia, Psychomotor agitation or retardation, depressed Mood, Anhedonia, diminished ability to Concentrate. Sx do not meet criteria for Mixed Episode, cause clinically significant distress, not due to a substance or medical condition, sx not better accounted for by trauma. Sx must persist for longer than 2 mos after trauma or characterized by functional impairment
  67. Define initial insomnia, middle insomnia, and terminal insomnia.
    Initial: unable to fall asleep; middle: waking in the middle of the night, remaining awake for an hour or two and then falling asleep again; terminal insomnia: awakening early in the morning and being unable to fall asleep again
  68. What percentage of patients with any single depressive episode will develop a chronic form of depression at some time in their lives?
  69. What percentage of patients hospitalized with depression will eventually take their own lives?
  70. What factors suggest an increased risk of suicide in depressed patients?
    Divorced or living alone, hx of EtOH or drug abuse, being older rather than younger, having a hx of a prior suicide attempt, expressing suicidal ideation (particularly when detailed plans have been formulated)
  71. What percentage of patients who receive antidepressants will markedly improve?
  72. What is tachyphylaxis?
    "Poop-out": when medications cease to work on depressed patients
  73. What is the best-researched option to boost the effectiveness of antidepressants?
    Lithium carbonate
  74. What is the treatment of choice for some patients with severe depression and what are its indications?
    ECT: very severe depression, high potential for suicide, CV disease, and pregnancy
  75. In what percentage of patients will response to ECT occur?
  76. What is VNS?
    Vagal nerve stimulation: a device is implanted under the surface of the skin of the chest wall and an electrode is connected to the vagus nerve. It sends small electrical pulses to the vagus nerve on the left side of the neck, which in turn delivers these pulses to the brain. This action is believed to alter levels of NTs and functional activity of the CNS dysregulated in depression.
  77. What are the Cluster A personality disorders?
    The "eccentric" disorders: PSS: Paranoid, Schizoid, Schizotypal
  78. What are the Cluster B personality disorders?
    The "dramatic" disorders: BAHN: Antisocial, borderline, histrionic, narcissistic
  79. What are the Cluster C personality disorders?
    The "anxious" disorders: ADO: avoidant, dependent, obsessive-compulsive
  80. How are personality disorders defined in DSM IV?
    Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in early adolescence or early adulthood, is stable over time, and leads to distress or impairment
  81. On what Axis are personality disorders coded?
    Axis II
  82. Which Cluster of personality disorders is characterized by a pervasive pattern of abnormal cognition (e.g. suspiciousness), self-expression (e.g. odd speech), or relating to others (e.g. seclusiveness)?
    Cluster A- the "eccentric" disorders
  83. Which Cluster of personality disorders is characterized by a pervasive pattern of violating social norms (e.g. criminal behavior), impulsivity, excessive emotionality, grandiosity, "acting out" (e.g., tantrums, self-abusive behavior, angry outbursts), or violating the rights of others (e.g. criminal behavior)?
    Cluster B- the "dramatic" disorders
  84. Which Cluster of personality disorders is characterized by a pervasive pattern of abnormal fears involving social relationships, separation, and need for control?
    Cluster C- the "anxious" disorders
  85. The major share of differences in personality among individuals can be described by just five main factors. What are they?
    Extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience
  86. What percentage of the general population have a personality disorder?
  87. Which personality disorder has an age requirement?
    Antisocial- 18 years, along with a requirement that certain childhood behaviors be present in addition to the adult traits
  88. Which personality disorders are more frequent in men? in women?
    Men: antisocial; women: borderline, avoidant, dependent
  89. Which disorder is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts?
    Paranoid personality disorder
  90. What disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts?
    Schizoid personality disorder
  91. What disorder is characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts?
    Schizotypal personality disorder
  92. What personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years?
    Antisocial personality disorder
  93. Describe the therapy for paranoid personality disorder.
    Establish rapport with the patient. Avoid group therapy. Anti-psychotics may reduce suspiciousness.
  94. What personality disorder is characterized by a pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts?
    Borderline personality disorder
  95. Describe the pharmacotherapy for BPD.
    Tends to focus on the patient's target sx. SSRIs, MAOIs (rarely used), low dose anti-psychotics. Risperidone or olanzapine.
  96. What disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts?
    Histrionic personality disorder
  97. What are some treatments for histrionic personality disorder?
    Psychodynamic psychotherapy, CBT
  98. What disorder is characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts?
    Narcissistic personality behavior
  99. What disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts?
    Avoidant personality disorder
  100. What disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts?
    Dependent personality disorder
  101. What disorder is characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts?
    Obsessive compulsive personality disorder
  102. Why must fluoxetine be discontinued 4 weeks or longer before an MAOI can be administered?
    Fluoxetine is metabolized to norfluoxetine, which has a long half-life. Serotonin syndrome is a risk.
  103. What is the mechanism of action of Aripiprazole (Abilify)?
    Dopamine stabilizer. Partial agonist at the D2 and 5-HT1 receptors and an antagonist at 5-HT2 receptors.
  104. Aripiprazole lowers the risk for which conditions?
    More activating than sedating, extrapyrimidal symptoms, weight gain, hyperprolactinemia, delayed QT interval
  105. Why are atypical neuroleptics preferred to traditional antipsychotics?
    associated with reduced EPS and lesser risk of tardive dyskinesia
  106. What is the most common cause of failure in the treatment of acute psychosis with anti-psychotics? of relapse?
    inadequate dosage, noncompliance
  107. Ziprasidone (geodon) has affinity for which receptors?
    High for dopaminergic, serotenergic, and alpha-adrenergic; little for muscarinic and histamine
  108. What about Geodon makes it less likely to impair cognition?
    Lack of effect on muscarinic receptor
  109. Quetiapine (Seroquel): what is class and which receptors does it affect?
    atypical antipsychotic, high 5-HT2/D2 binding ratio, high affinity for histaminic and a-adrenergic receptors
  110. What are SE of quetiapine (Seroquel)? What are benefits?
    Orthostatic hypotention, sedation, dizziness. Low incidence of EPS while maintaining antipsychotic action.
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Behavioral Medicine