what does NOS mean?
dx for pts with atypical sx; mixed presentation, sx < dx threshold, or presentation that does not meet criteria for specific disorder
which access is the global assessment of function (GAS)?
axis 5
illusions, hallucinations, delusions, impaired reality orientation; problems in affect, motivation, perception, communication, disorganized speech
schizophrenia
are memory and consciousness impaired in schizophrenia?
no
what are positive sx of schizophrenia?
hallucinations, bizarre behavior, delusions
what are negative sx of schizophrenia?
flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech
motor immobility, excessive purposeless activity, bizarre postures, grimacing, echolalia, echopraxia (echo movement)
catatonia
dx for schizophrenia
at least 2 sx must be present during 1 month period & continuous signs must persist for at least 6 months:
delusion, hallucinations, disorganized speech, grossly disorganized behavior, negative sx
SOCIAL FX, OCCUPATIONAL FX, or both must be affected
false sensory perceptions
hallucinations
erroneous beliefs based on misinterpretation of reality, paranoia, idea of reference,
delusions
neurotransmitters involved in schizophrenia
GABA, D, 5ht, NE
tx of schizo
positive sx: haloperidol
negative sx: risperidone
Clozapine is 2nd line
side effect of antipsychotic meds
extrapyramidal sx, dyskinesias
delusions or hallucinations lasting for 2 weeks w/o mood disorder sx
schizoaffective disorder
vague complaints involving many organ sx not explained by any medical condition or substance use (usually GI, repro, neuro)
somatization
preoccupation w/ imagined defect in physical appearance
body dysmorphic disorder
one or more neuro sx that cannot be explained clinically, shifting paralysis, blindness, mutism
conversion disorder
intentionally fake mental or psych sx to assume sick role
factitious disorder
factitious disorder w/primary physical complaints
Munchausen syndrome
faking sickness to get benefits
malingering
preoccupation of contracting serious illness
hypochondriasis
depressive sx must be present for 2 week period, no manic sx, must include depressed mood or anhedonia, not result of bereavement
major depressive disorder
abnormally persistant elevated, expansive, irritable mood that lasts for 1 week
mania
at least 4 days of abnormally & persistently elevated, expansive, irritable mood
hypoomanic
mood disorder due to less daylight hours
seasonal affective
overeating, weight gain, oversleeping, reactive mood, leaden paralysis, oversensitivity to interpersonal rejection
atypical depression
how long does it take for antidepressants to kick in?
3-6 weeks
1st line tx for depression
SSRI (fluoxetine, paroxetine, sertraline)
reserved for severely depressed pts or those unresponsive or intolerant of other meds, where rapid improvement is needed
ECT
occurrence of one or more manic or mixed episodes which often cycle w/depressive episodes (not needed)
manic depression/bipolar I
tx for bipolar
lithium, valproic acid, carbamazepine
Lithium has a narrow therapeutic index; weight gain, tremor, thirst
at least one MDD episode w/ at least one hypomanic episode (never experienced manic episode)
bipolar II
less severe than manic & does not cause social impairment
hypomanic
chronic, persistent mild depression manifested by pessimism, brooding, loss of interest, decreased productivity
dysthymic disorder
moody, erratic, impulsive, somewhat volatile
cyclothymic
maladaptive behavioral or emotional sx developing after stressful event and ending w/I 6 mths
adjustment disorder
egosyntic, lack insight regarding problems, inflexible patterns of relating to others
personality disorder
what cluster is schizoid, schizotypal, paranoid?
cluster A (mad)
what cluster is antisocial, borderline, histrionic, narcissistic?
cluster B (bad)
what cluster is avoidant, dependent, obsessive compulsive?
cluster C (sad)
pervasive distrust & suspicion
paranoid personality
lifelong voluntary social withdrawal, eccentric
schizoid personality
strange, eccentric, peculiar throughts
schizotypal personality
inability to conform to social norms, disregard, violation, lack empathy
antisocial
unstable and unpredictable mood, impulsive
borderline personality
attention seeking, exaggerate thoughts & feelings
histrionic
inflated self image, grandiosity, need for admiration, lack of empathy, difficulty aging, fantasies of unlimited success, beauty, brilliance
narcissism
extreme sensitivity to rejection, intense social anxiety
avoidant
clinging, submissive, lack self confidence, dislike being alone
dependent
pervasive orderliness, perfectionism, inflexibility, rigid, stubborn
Obsessive compulsive
personality disorder (egosyntonic not distressing to patient)
disorder (egodystonic distressing to pt)
negativity, stubborn, irritability, procrastination, argumentive, resentful to those seeming more fortunate
passive aggressive
gloomy, pessimistic, low self esteem, overly critical
depressive
desire to cause pain sexually, physically, mentally;
seeking humiliation rather than physical inflicted pain
sadism; masochism
sadomasochism
demeaning, humiliating, cruel towards others
sadistic
persistent excessive anxiety regarding general life events that lasts 6 or more months
GAD
period of extreme anxiety that peaks within 10 minutes, declines w/I 30, and rarely lasts for more than an hr
panic attack
intense fear of impending harm or death, going crazy
panic disorder
PTSD has high comorbidities with?
substance abuse & depression
w/I 1 month of trauma and last 2 weeks-mth
acute stress disorder
fear of being stuck in place without escape route
agoraphobia
2 types of anorexia nervosa
restrictive & binge eating and purging
why can't bupriopion be used with anorexia nervosa?
lowers seizure threshold
binge eating as well as vomiting, laxatives, excessive exercise
bulimia nervosa
difference between anorexia nervosa and bulimia nervosa?
pts w/bulimia nervosa maintain normal body weight or are overweight
2 types of bulimia
purging- vomiting, laxatives
nonpurging- excessive exercise, fasting
BMI >30
obesity
tolerance and withdrawal are a part of
substance dependence
meds required for alcohol withdrawal
benzos, diazepam (valium), Librium, thiamine, folic acid, multivitamins
opioid withdrawal
naloxone, methadone, clonidine tapering
ADHD sx must manifest before what age
7
violation of basic rights of others or social norms, aggression toward people & animals, destruction of property, deceitfulness, serious violation of rules
conduct disorder
6 mths of negative, hostile, defiant behavior, loss of temper, arguments with adults, annoying others, anger, resentment, blaming others
oppositional defiant disorder
retinal hemorrhages & hyphema should be suspicious for
shaken baby syndrome