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What are somatoform disorders and what are the five main ones?
: A group of psychologic conditions in which the patient feels a physical symptom that is caused by psychological conditions
- 1. Somatization disorder
- 2. Conversion Disorder
- 3. Pain Disorder
- 4. Hypochondriasis
- 5. Body Dysmorphic Disorder
What is a Somatization Disorder?
Somatization Disorder: a chronic multisystem disorder characterized by complaints of pain, GI dysfunction, sexual dysfunction, and pseudoneurologic symptoms.
- + onset is usually early in life
- + psychosocial and vocational achievements are limited
What is a Conversion Disorder?
Conversion Disorder: a syndrome of symptoms that mimic neurologic or medical illness that is significantly of psychologic etiology
What is a pain disorder?
Pain Disorder: a clinical syndrome characterized predominantly by pain where psychologic factors are judged to be a main cause
What is hypochondriasis?
Hypochondriasis: is the chronic preoccupation with the idea of having a serious disease. Reassurance that this is not the case rarely is effective.
What is body dysmorphic disorder?
Body dysmorphic disorder: a preoccupation with an imagined or exaggerated defect in physical appearance.
(Ex: a person perceives themselves as overweight when in reality they are not)
Name three somatoform-like disorders.
- 1. Factitious disorder
- 2. Malingering
- 3. Dissociative Disorders
What is a factitious disorder?
Factitious disorder: faking physical or psychologic symptoms when there is no direct or obvious primary advantage to be gained. E.g. avoidance of responsibility, financial gain
What is Malingering?
Malingering: intentional faking of physical or psychological signs with the presence of obvious gain such as financial or avoidance of responsibility.
What are dissociative disorders?
Dissociative disorders: problems with consciousness, memory, identity, or perception due to psychological factors
What are the 7 main anxiety disorders?
- 1. Panic Disorder
- 2. Agoraphobia
- 3. Specific Phobia
- 4. Social Phobia
- 5. Obsessive-Compulsive Disorder (OCD)
- 6. Acute Stress Disorder
- 7. Generalized Anxiety Disorder (GAD)
What is panic disorder?
- Panic disorder: defined by recurrent unexpected panic attacks where one of the attacks is followed by one month or more of:
- + persistent concern of more attacks
- + worry about cause of attacks
- + change in behavior related to the attacks
- A panic attack peaks in 10 minutes or less and has at least four of the following:
- 1. palpitations or increased HR
- 2. sweating
- 3. trembling/shaking
- 4. SOB
- 5. choking sensation
- 6. chest pain
- 7. nausea or abdominal distress
- 8. dizziness
- 9. feelings of unreality
- 10. fear of losing control
- 11. fear of dying
- 12. paresthesias
- 13. chills or hot flashes
What is agoraphobia?
Agoraphobia: an anxiety about being in places or situations that are embarrassing, escape is difficult, or help is unavailable.
What are specific phobias?
Specific phobias: marked, persistent, and unreasonable fear that is cued by the presence or anticipation of a specific object or situation. The person usually recognizes their fear as excessive or unreasonable, but exposure causes immediate anxiety and can impair normal daily function.
What are social phobias?
Social phobias: marked and persistent fear of one or more social or performance situations involving strangers or potential scrutiny or judgment. The patient usually recognizes their fear as excessive or unreasonable but it can impair normal routine.
What is Obsessive-compulsive Disorder (OCD)?
OCD: disorder of obsessions and compulsions associated with anxiety or distress. Patient usually recognizes it as unreasonable or excessive, but can not control it. Compulsions and obsessions usually consume a lot of time and interfere with normal daily routine.
What is acute stress disorder?
Acute distress disorder:
Person is exposed to a traumatic event involving near death or serious injury to self or others. Response is shortly after or during and is marked by fear, helplessness, or horror. The person will have at least three of these dissociative symptoms:
- 1. numbing, detachment, emotional absence
- 2. reduced awareness of surroundings
- 3. feelings of unreality
- 4. feelings of depersonalization
- 5. amnesia specific to the event
The patient may re-experience the event (dreams, illusions, etc.)
Symptoms can last up to 4 weeks after the event.
What is generalized anxiety disorder (GAD)?
lacks a specific traumatic event or focus of worry. Excessive anxiety and worry are hard to control and are tied to a variety of events/activities. At least three of:
- 1. restlessness
- 2. easy fatigue
- 3. difficulty concentrating
- 4. irritability
- 5. muscle tension
- 6. difficulty falling or staying asleep
This impairs function socially, occupationally, etc.
What is post-traumatic stress disorder?
Event, fearful response, and persistent re-experience of the event are similar to acute distress disorder.
- + hallucinations
- + increased arousal
- + avoidance of stimuli related to trauma
Causes marked distress and impairs social and occupational function and lasts for more than 1 month
What are 7 main psychotic disorders?
- 1. Schizophrenia
- 2. Schizophreniform Disorder
- 3. Schizoaffective Disorder
- 4. Delusional Disorder
- 5. Brief Psychotic Disorder
- 6. Psychotic Disorder Due to a General Medical Condition
- 7. Substance-induced psychotic disorder
What is schizophrenia?
: Decrease in performance of one or more of the following for a significant time:
- 1. Delusions
- 2. Hallucinations
- 3. Disorganized speech
- 4. Grossly disorganized or catatonic behavior
- 5. Negative symptoms, such as flat affect, alogia, avolition
Continuous signs of the disturbance must persist for 6+ months
What is schizophreniform disorder?
Schizophreniform disorder: symptoms similar to schizophrenia, but for less than 6 months. Does not need to have functional impairment
What is schizoaffective disorder?
Schizoaffective disorder: has features of both major mood disturbance and schizophrenia. The mood disturbance (depressive, manic, or mixed) is present for most of the illness and must be concurrent with schizophrenic symptoms for a time. During that time there must also be delusions and hallucinations for at least 2 weeks without prominent mood symptoms
What is delusional disorder?
characterized by non-bizarre delusions that involve real-life situations. Examples are having a serious disease or being deceived by a lover.
- + 1 month of delusion(s)
- + function is not markedly impaired
- + behavior is not obviously odd or bizarre
- + schizophrenic symptoms not present except for tactile and olfactory hallucinations related to the delusion
What is a brief psychotic disorder?
Brief Psychotic disorder:
between 1 day and 1 month of at least one of the following symptoms. The person then returns to normal.
- 1. delusions
- 2. hallucinations
- 3. disordered speech
- 4. grossly disorganized or catatonic behavior
What is a psychotic disorder due to a general medical condition?
Psychotic Disorder due to a General Medical Condition: prominent delusions or hallucinations during a medical illness. For diagnosis the symptoms do not occur exclusively during delirium. These symptoms are judged to have been caused by the illness.
What is a substance-induced psychotic disorder?
Substance-induced psychotic disorder:
prominent hallucinations or delusions induced by intoxication or withdrawal. Symptoms do not occur only during delirium. The substance is the cause here.
- + alcohol
- + cocaine
- + opioids
What are the DSM-V Depressive Disorders?
- 1. Disruptive Mood Dysregulation Disorder
- 2. Major Depressive Disorder
- 3. Persistent Depressive Disorder (Dysthymia)
- 4. Premenstrual Dysphoric Disorder
- 5. Substance/Medication-Induced Depressive Disorder
- 6. Depressive Disorder Due to Another Medical Condition
- 7. Other Specified Depressive Disorder (Minor)
- 8. Unspecified Depressive Disorder
What are the diagnostic criteria (DSM-V) for Major Depressive Disorder?
- CRITERIA A
- Five or more of the following during same 2-week period.
- At least one of depressive affect or anhedonia (interest)
- S - Sleep; insomnia
- I - Interest loss; sense of worthlessness
- G - Guilt
- E - Energy Loss/fatigue
- C - Concentration diminished
- A - Appetite
- P - Psychomotor agitation/retardation
- S - Suicidal thoughts (no planning)
- CRITERIA BThe symptoms cause daily dysfunction (social, occupational, etc.)
(A-C is a major depressive disorder)
- CRITERIA CIt is not attributable to other physiologic states, substances, or medical conditions
The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
- Criterion E
- There has never been a manic episode or a hypomanic episode.Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.
A. What is an SSRI?
B. Name 3
E. Top ADRs
A. Selective Serotonin Reuptake Inhibitor
- B. SSRI'S
- Citalopram (Celexa)
- Fluoxetine (Prozac)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
: Inhibits the SERT in the presynaptic membrane which reuptakes serotonin
- D. Indications
- MDD, Generalized Anxiety Disorder, OCD, bulimia, PTSD, PMDD
- E. ADR'sNausea, GI upset, diarrhea, sexual dysfunction
- Citalopram - long QT syndrome
A. What is an SNRI?
B. Name 3
E. Top ADRs
A. Serotonin-NE Re-uptake Inhibitor
- B. SNRI'sVenlafaxine (Efexor)
- Duloxetine (Cymbalta)
- Sibutramine (Meridia)
Blocks Norepinephrine (via NET) and Serotonin (via SERT) re-uptake in the presynaptic neuron, prolonging their action in the cleft.
- E. Top ADR'sIncreased blood pressure
- Increased heart rate
- CNS activation
- + SSRI effects:nausea, GI upset, diarrhea
A. What is an TCA?
B. Name 3
E. Top ADRs
- A. Tricyclic Anti-depressant
- B. TCA's
C. MOA: Block reuptake of monoamine, histamine, acetylcholine and alpha-2 adenoreceptors.