|Psychiatry & Behavioral Health End of Rotation PAEA™ Exam Topic List|
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|DEPRESSIVE DISORDERS; BIPOLAR AND RELATED DISORDERS (Pearls)|
|Bipolar I disorder
A manic episode with or without a major depressive episodes
|Major depressive disorder
Five or more SIEGECAPS for ≥ 2 weeks nearly every day and at least one of the symptoms is depressed mood or anhedonia
|Bipolar II disorder
At least one hypomanic episode and at least one major depressive episode
|Persistent depressive disorder
Chronic depressions - depressive symptoms for > 2 years
A chronic mood disorder characterized by episodes of depression and hypomania for at least 2 years.
|ANXIETY DISORDERS; TRAUMA- AND STRESS-RELATED DISORDERS (Pearls)|
|Generalized anxiety disorder
Excessive anxiety and worry occurring more days than not for at least 6 months
|Post-traumatic stress disorder
The patient has experienced a traumatic event which causes an acute stress reaction.
An occurrence of 3 panic attack episodes in three weeks
Excessive and persistent fear of a specific object, situation or activity that is generally not harmful (fear of flying or fear of spiders).
Specific phobia (see specific section)
Social phobia (social anxiety disorder)
|SUBSTANCE-RELATED DISORDERS (Pearls)|
Alcohol is a depressant - increases GABAa channel opening. Long-term use leads to downregulation of GABA channels (inhibitory) and upregulation of NMDA (excitatory)
Delirium Tremens (48 - 96 hours): autonomic instability, disorientation, hallucinations, agitation.
|Sedative-, Hypnotic-, or anxiolytic related disorders
Patient with CNS depression and a history of anxiety or panic disorder
Anxiolytics are medications such as benzodiazepines used for the treatment of anxiety disorders. They have additive effects with alcohol and tend to have a cumulative effect if doses are repeated indiscriminately.
Treat life-threatening intoxication with flumazenil which is a competitive GABA antagonist.
Binds to CB1/CB2 cannabinoid receptors
Cocaine: block biogenic amine (Dopamine (DA), norepinephrine (NE) and Serotonin (5-hydroxytryptamine; 5-HT)) reuptake
Amphetamines: methamphetamine, dextroamphetamine (Dexedrine), methylphenidate (Concerta).
Simulates biogenic amine (Dopamine (DA), norepinephrine (NE) and Serotonin (5-hydroxytryptamine; 5-HT) release + decreases reuptake (high dose)
Patient that is extremely aggressive and becomes enraged when sudden movements or loud sounds are made.
Patient wants to hurt himself. They say that he has "been freaking out" and seeing things that are not there.
Cigarette smoking is the leading preventable cause of death in the United States.
Treatment for cessation
|SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS (Pearls)|
Otherwise normally functioning person with a belief in something that does not exist.
One or more non-bizarre delusions of thinking—such as expressing beliefs that occur in real life such as being poisoned, being stalked, being loved or deceived, or having an illness, provided no other symptoms of schizophrenia are exhibited.
Major psychosis for greater than 6 months + difficulty functioning
Resistant cases – clozapine or antipsychotic + another med (benzo, carbamazepine, valproate, lithium)
A mental health condition including schizophrenia and mood disorder symptoms.
Schizoaffective disorder is a combination of symptoms of schizophrenia and mood disorder, such as depression or bipolar disorder. Symptoms may occur at the same time or at different times.
Major psychosis for > 1 week but < 6 months and no social or occupational impairment.
|DISRUPTIVE, IMPULSE-CONTROL AND CONDUCT DISORDERS; NEURODEVELOPMENTAL DISORDERS (Pearls)|
An 8-year old who is disruptive in class, always fidgeting, has difficulty concentrating and does not complete assignments.
Characterized by problems paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person's age.
Treatment: Stimulants (methylphenidate, mixed amphetamine salts)
A child is referred to your office for unusual animal cruelty and bullying at school.
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated
Aggression to People and Animals
Destruction of Property
Deceitfulness or Theft
Serious Violations of Rules
The most effective treatment for an individual with conduct disorder is one that seeks to integrate individual, school, and family settings. Additionally, treatment should also seek to address familial conflicts such as marital discord or maternal depression.
|Autism spectrum disorder
A range of conditions classified as neurodevelopmental disorders. Individuals diagnosed with autism spectrum disorder present a developmental delay in socialization, language, and cognition
Autism spectrum disorders (ASD) encompasses
DSM V criteria
|Oppositional defiant disorder
A child is found to backtalk and resist following instruction from parents or authorities.
A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.
Unlike children with conduct disorder (CD), children with oppositional defiant disorder are not aggressive towards people or animals, do not destroy property, and do not show a pattern of theft or deceit.
Psychotherapy: is aimed at helping the child learn to express and control anger in more appropriate ways.
Pharmacotherapy to control ODD include mood stabilizers, antipsychotics, and stimulants.
|PERSONALITY DISORDERS; OBSESSIVE-COMPULSIVE AND RELATED DISORDERS (Pearls)|
|Antisocial personality disorder
Sociopath - a lack of remorse and no concern for others
A disregard for and violation of rights of others with lack of remorse which commonly results in criminality
|Narcissistic personality disorder
Concerned about what others think of them and need admiration
Need for admiration, grandiose thoughts, concerned about what others think yet lack empathy
|Avoidant personality disorder
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.
Focus on obsessions repetition of compulsive behaviors
|Body dysmorphic disorder
A beautiful woman is noted to complain that her hands are too big, yet they appear well-formed and appropriate.
Preoccupation with an imagined defect in physical appearance/exaggerated distortion of a minor flaw
|Obsessive-compulsive personality disorder
Patients tend to be preoccupied with order, perfectionism, and control
|Borderline personality disorder
Black and white perception unstable interpersonal relationship
Borderline personality disorder presents with emotional instability, unstable relationships, and self-harming behavior
|Paranoid personality disorder
Paranoid personality disorder is characterized by persistent feelings of suspiciousness and mistrust of other people.
|Dependent personality disorder
Submissive and clingy with an excessive need to be taken care of resulting from a low self-esteem
|Schizoid personality disorder
Patients tend to have emotional aloofness, indifferent to praise or criticism, without bizarre or idiosyncratic thinking
|Histrionic personality disorder
Attention seeking dramatic seductive behaviors
Needs to be the center of attention. Very dramatic. Dresses for attention. Very shallow. Seductive and flirtatious.
|Schizotypal personality disorder
Odd eccentric behavior and discomfort with social relationships
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships
|SOMATIC SYMPTOM AND RELATED DISORDERS; NONADHERENCE TO MEDICAL TREATMENT (Pearls)|
Patient consciously reports false symptoms, or induces symptoms, with the goal of playing the "sick role.
A condition in which a person, without a motive for reward, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient's role.
Factitious disorder imposed on self (Munchausen syndrome)
|Somatic symptom disorder
Preoccupation with having a serious illness
|Illness anxiety disorder
Obsession with the idea of having a serious but undiagnosed medical condition.
|FEEDING OR EATING DISORDERS (Pearls)|
Patient who refuses to eat due to fear of being overweight
Patient who has episodes of mass eating followed by self-induced vomiting or intense exercise
Frequent binge eating with or without purging
|PARAPHILIC DISORDERS; SEXUAL DYSFUNCTIONS (Pearls)|
Patient who enjoys walking around the park exposing his genitals to strangers
Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.
Sexual arousal by prepubescent children (generally 13 years or younger)
|Female sexual interest/arousal disorder
Requires absence/reduced of 3 of the following for 6 months that causes distress.
Must rule out other medical disorders prior to making the diagnosis.
|Sexual masochism disorder
Patient who requires that his partner strangle him and humiliate him in order for him to achieve and maintain an erection.
Arousal from being threatened or hurt during sexual activities
Patient insists on being able to see his girlfriends feet while they engage in sexual acts
Sexual arousal obtained by specific objects.
Patient caught spying through the windows of his fellow female dormmates
Recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.
|Male hypoactive sexual desire disorder
Characterized as a lack or absence of sexual fantasies and desire for sexual activity.