Flashcards: Clinical psychiatry

syndrome characterized by significant disturbance in an individual's COGNITION, EMOTION REGULATION, or BEHAVIOR that reflects a dysfunction in psychological, biological, or developmental processes underlying mental functioning. Associated with SIGNIFICANT DISTRESS OR DISABILITY IN SOCIAL, OCCUPATION, OR OTHER IMPORTANT ACTIVITIES

1) General appearance and behavior2) Mood and affectivity3) Speech characteristics4) Thoughts5) Perception6) Sensorium and Cognition7) Judgement and Insight

Part of MSElook for:1) Appearance2) Behavior3) Psychomotor activity4) Attitude

Part of MSElook for:1) Mood 2) affect3) appropriateness (to situation, does face match what is being said?)4) Range5) Mobility6) Reactivity

Part of MSElook for:1) speech characteristics2) Thought process (ex: formal thought disorder)3) Though content (ex: delousions)4) Depressive cognitions, anxiety, phobias, obsessions, SI

What the person says does not make sense compared to the normal thought process which is logical and goal oriented. EX:Loosening of associations (no connection between sentences)Tangentiality (goes on tangent)Derailment (shift in speak)Word Salad / incoherence (speak gibberish)Circumstantiability (gives tedious details about everything)

Part of MSE1) Hallucinations2) Illusions

Part of MSElook for:1) level of consciousness2) Attention and concentration3) Orientation and memory4) language, reading, writing5) Visuospatial ability6) Abstraction7) General Fund of information

Part of MSE:Test judgement / social judgement / clinical judgement Grades of insight (what is person's understanding of known illness)

an immediate expression of emotion (ex: it is the weather, where as mood is the climate)

1) Blunted - reduction in expression2) Flat - absent expression3) Inappropriate - discordance between expression and content of speech4) Labile - abnormal variability with rapid shifts

emotional experience over a more prolonged period of time (ex: mood is climate where as affect is weather)

Involves:IncoherenceLoose associationsTangentialityDerailmentCircumstantialityFlight of ideas

A firm and fixed false belief that is held with firm conviction in spite of evidence of the contrary and not in keeping with the person's religious and/or cultural beliefs

1) Bizarre2) Jealousy3) Erotomanic4) Grandiose5) Persecutory (most common)6) Somatic (feelings on body parts)7) Thought insertion (think others put thoughts in their head)8) Thought broadcast (think others know about my thoughts)

Perception in the absence of external stimulus

1) Auditory (most common)2) Visual (inorganic brain disease)3) Tactile4) Olfactory (inorganic brain disease)5) Gustatory 

Apprehensive anticipation of future danger or misfortune accompanied by a feeling of worry, distress and/or somatic symptoms of tension

Discrete periods of sudden onset of fear or terror, often associated with FEELINGS OF IMPENDING DOOM

Recurrent, persistent, thoughts, urges or images that are experienced as INTRUSIVE AND UNWANTED, and it causes ANXIETY

Repetitive behaviors or mental acts that the individual feels driven to perform in response to obsession.These are done to reduce anxiety produced by obsessions.

"As if" phenomenonFeeling detachedFeeling like an outside observer

persistent fear of a specific object, activity or situation THAT IS OUT OF PROPORTION TO THE ACTUAL DANGER posed by the specific object, activity or situation and a compelling desire to avoid it. Impacts the person life

1) Delirium2) Major Neurocognitive Disorders3) Mild Neurocognitive Disorders

Characterized by disturbance in ATTENTION (reduced ability to direct, focus, sustain and shift attention) and AWARENESS (reduced orientation to the environment) that develops over a short period of timeAcute onset, fluctuating course, impairment of attention is associated with global impairment of cognitive functions (memory deficits, disorientation, language and perception)

substance withdrawal deliriummedication-induced deliriumdue to another medical conditiondue to multiple etiologiesif acute: hours to daysif persistent: weeks to months (not common)

CNS disorderMetabolic disorderCardiopulmonary disorder (oxygenation deficit to brain)Sepsis/ infectionsystemic illness

1)Hyperactive- hyperactive level of psychomotor activity may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care2)Hypoactive - Most common; hypoactive level of psychomotor activity that may be accompanied by SLUGGISHNESS AND LETHARGY that approaches to stupor. 3) Mixed level of activity - individual has normal level of psychomotor activity even though attention and awareness are disturbed. Activity levels may also rapidly fluctuate. 

DISTURBANCE IN ATTENTION OR AWARENESSacute onset, fluctuating symptomsConfusion, disorientation, illusions/hallucinations, emotional disturbance (apathy, anxiety, fear), emotional disturbance may manifest calling out, screaming, shouting, disturbed sleep awake cycle

Evidence of significant cognitive decline from previous level of performance in one or more of the 6 cognitive domains, based on history and neuropsychological testing:1) complex attention (sustained, divided and selective attention + processing speed)2) Executive function (planning, decision making, inhibition, mental flexibility)3) Learning and Memory (immediate, recent, remote, new learning, declarative, implicit)4) Language5) Perceptual motor (visual perception, visuo-constructual, praxis, diagnosis)6) Social cognition (behavior i out of norm, difficulty recognizing emotions)COGNITIVE DEFICITS MUST INTERFERE WITH EVERYDAY ACTIVITIES!!and not due to delirium and not explained by another medical disorder

Alzheimer's, Vascular Disease, FTLD, TBI, Lewy Body disease, Parkinson's, HIV infection, Substance Use, Huntington's Disease, Prion Disease

Major Neurocognitive Disorders impair activities of daily living (ADLs) and instrumental activities of Daily Living

Disturbance in the SIX domainsInsidious onsetgradual progressionPatients are adept at minimizing their symptomsCollateral history is importantALWAYS assess ADLs and IADLs

CT headTSHRPRB12, Folate levels

Alertness- awake and fully aware of stimuliLethargy - not fully alert, drifts to sleep when not actively stimulatedObtundation - difficult to arouse and when aroused patient is confusedStupor - patient responds only to vigorous stimulationComa - completely unarousableAssess with Glasgow Coma Scale

ability to attend to a specific stimulus w/o being distracted by extraneous stimuli

ability to sustain attention over a sustained period of time

Digit repetitionRandom letter test serial subtractionspell "world" backwardsAnatomical localization: ascending reticular activating system

1) Level of consciousness2) Attention3) Language4) Memory5) Constructional ability6) higher cognitive function (fund of information, calculation, proverb interpretation)

disorder of articulation

loss of speech melody (ex: monotone)

impaired production / comprehension of spoken language

loss of reading ability in a previously literate person

acquired disturbance of writing

handednessspontaneous speechcomprehensionrepetition (no ifs ands or buts)namingreadingwriting

word or syllable substitution

Error in comprehension and production of speech

disproportionate deficit in repetition; lesion in arcuate fasciculus and left parietal region

intact repetition; disruption of language functions

inability to name

process that allows an individual to store information for later recall3 stages: registration, encoding, recall

1) Immediate, short term2) Recent3) Remote

Digit repetition (immediate memory)New learning ability (short term)recent memory (orientation)Remote memory (historical facts about patient experiences)

any condition in which there is impaired attention (ex: encephalopathy)

mamillary bodies, medial temporal lobe, hippocampus, dorsal medial thalamic nuclei

Association cortex

ability to draw or construct two or three dimensional figures or shapesconstructional tasks are extremely sensitive in detecting organic brain disease

copying geometric shapesdrawing on command3D block construction

Parietal lobeRight Parietal Lobe lesions produce higher incidence and greater severity of defect than left parietal lobe lesions

Fund of informationCalculation (parietal)Proverb interpretation (frontal)Social judgement (frontal)

acquired disorder of learned, skilled, sequential movements that cannot be accounted for by elementary disturbances of strength, coordination or lack of comprehension or attention.INABILITY TO CARRY OUT MOTOR COMMANDS IN THE ABSENCE OF ANY GROSS MOTOR DEFICIT

1) Finger agnosia2) Right-Left disorientation3) Dysgraphia4) DyscalculiaParietal lobe lesions- dominant or bilateralANGULAR GYRUS

ADVascularLewy Body

characterized by a persistent disturbance of eating or eating related behavior that results in altered consumption or absorption of food and significantly impairs physical health or psychosocial functioning (patients judge how they look)

PicaRumination DisorderAvoidant/Restrictive Food intake Disorder

Anorexia NervosaBulimia NervosaBinge Eating Disorder

persistent eating of nonnutritive, non food substances for over a period of 1 monthEx: paper, soap, cloth, chalk, hair, stringInappropriate to developmental levelNot culturally supportedOften associated with Intellectual Disability

Repeated regurgitation of food over a period of at least 1 month (bringing up their food without effort)Regurgitated food is swallowed or spit outNot due to medical conditionNOT OCCURRING EXCLUSIVELY during Anorexia, Bulimia, or BED

Avoiding food due to lack of interest in eating / avoiding food based on sensory characteristics (color, taste, texture)Weight loss / nutritional deficiency / dependence of enteral supplementsDoes not occur exclusively during AN or BNTHERE IS NO BODY IMAGE DISTURBANCEOften associated with Intellectual Disability, Autistic Spectrum Disorder, and phobias about choking

Restriction of energy intake leading to SIGNIFICANTLY LOW BODY WEIGHTIntense fear of gaining weight or becoming fat, even though underweightDisturbance in the way in which the body is shaped (patient always checks their weight)Two subtypes

1) Restrictive - worst prognosis2) Binge-eating / purging type - binge and then try laxatives or purgingDistribution is 50-50 and there is crossoverSeverity of illness is based on BMI

High risk group is adolescent girls and young women10-20 X more common in women, more frequent in professions that require thinnessmore frequent in caucasians

1) self-induced starvation to a significant degree2) relentless drive for thinness or a morbid fear of fatness3) presence of medical signs and symptoms resulting from starvation

pts control what they eatdrastic reduction in food intakerefuse to eat with families or in public spacesPreoccupation with food - cooking, collecting recipesPeculiar behaviors - hiding food, carrying candy in pocketsRitualistic behaviorsbinging followed by self-induced vomiting, diuretic and laxative abuse

HypothyroidismHypothermiaLoss of cardiac muscle, PVC, bradycardiaConstipation, abdominal painamenorrhea, low LH and FSHLanugo (thin hair in back of neck), dry skinOsteoporosis (IRREVERSIBLE)Abnormal tasteMild cognitive impairment

Electrolye abnormalities (low K, hypochlormemic alkalosis, low Mg)Salivary gland and pancreatic inflammation, increase in amylase (swelling of parotid glands)Erosion of dental enamelSeizures

course is variableRestrictive type has poor prognosisamong highest mortality rates of all mental illnessesMortality rates are high 

Nutritional Rehab (weight gain 2-3 lbs per week)Psychotherapy  (CBT, family therapy, self help groups)Pharmacotherapy (Cyproheptadine and other antihistamines, limited role of antidepressants like mirtazepine, TCA, fluozetine

Bulimia- means binge eatingdistinguishing feature from AN is that ATTEMPTS TO RESTRICT FOOD ARE PUNCTUATED BY BINGES COMPENSATED BY PURGING AND/OR LAXATIVE ABUSEThere is loss of control over eating and is followed by guilt

Recurrent episodes of binge eating: 2 hr period of excessive food intake and loss of control while eating. Recurrent inappropriate compensatory behaviorAbove occurs once a week for at least 3 mosself evaluation influenced by body shapedoes not occur exclusively during episodes of anorexiaSeverity is defined in terms of episodes of compensatory behavior per week

more prevalent than ANonset in adolescence or young adult hoodmost patients are within normal weight range or slightly overweightmenstrual irregularitiesmedical complications due to purging or laxative abusecross over between AN and BNPATIENTS REGARD BEHAVIOR AS MORE EGO DYSTONIC

less heritability than ANincreased childhood and parental obesityearly menarcheparental alcoholismincreased Hx of childhood abuse

Mostly secondary to purging or laxative abuseElectrolyte imbalancearrhythmiasdental erosions

depressionsubstance abuseimpulse control disordersBipolar affective disorderDissociative disorders

1) CBT is effective2) antidepressants have anti-bulimic effect

recurrent episodes of binge eating (eating food that is definitely larger than what most people would eat over a discrete period of time plus a sense of lack of control)most common eating disordereating more rapidly / eating til uncomfortably full / eating when not hungry / eating alone or embarrassment / guiltAT LEAST ONCE A WEEK FOR 3 mos; NO COMPENSATORY BEHAVIOR

Anxiety disordersdepressionsubstance abuseDisorder is more prevalent among those seeking weight loss treatmentCross over not commonMedical complications related to obesity

for Bulima Nervosa and Binge Eating Disorder

Good for adolescent anorexia nervosa

enduring pattern of perceiving, relating, and thinking about the environment and oneself that is seen in a wide range of social and personal situationsIt is: stable, predictable, flexible and adaptable

ENDURING PATTERN OF INNER experiences and behavior that deviate from cultural standards. Manifested as: Cognition, affect, interpersonal functioning, impulse controlPattern is rigidly pervasiveOnset in adolescence and the behavior pattern is stable and of long durationSignificant distress and / or impairment in social, occupational functioning

A: ODD (paranoid, schizoid, schizotypical)B: SAD (antisocial, borderline, histrionic, narcissistic)C: Anxious (avoidant, dependent, obsessive-compulsive)

Person has no psychotic delusions but is suspicious and bears grudgesFeatures: Suspects that he is being exploited or deceived, doubts loyalty or trustworthiness of friends, reluctant to confide, reads hidden meaning, bears grudges, perceives attack on his reputation and is quick to react and counterattack, argumentative, difficult to get along, suspicious about spouses fidelity. Life-long disorder may go on to have schizophrenic breakdownMore common in males, minorities, immigrants, and deaf, patients with schizophreniaDifferential: Schizophrenia, Delusional DisorderTx: Psychotherapy is 1st choice; pharmacotherapy has limited role (antianxiety and neuroleptics)

Person NEITHER DESIRES NOR ENJOYS CLOSE RELATIONSHIPS, always chooses SOLITARY ACTIVITIES, no interest in having a sexual relationship, NO CLOSE FRIENDS, indifferent to praise or criticism, emotional detachment, less likely to be involved in activitiesMore common in males, onset in early childhood, Lifelong courseDifferential: Paranoid PD, Schizotypical PD, SchizophreniaRx: Psychotherapy 1st choice, Neuroleptics, Benzos, SSRI's

Person has a pattern of social interpersonal beliefs with reduced capacity for close relationships AND cognitive and perceptual distortions:Ideas of reference, odd beliefs (UFO's, black magic), Unusual perceptual experiences, odd thinking, suspicious, Inappropriate or constricted affect, Behavior or appearance that is odd (wear all black in hot weather), BRIEF PSYCHOTIC EPISODESmore likely in relatives of schizophrenia, 10% risk of suicide, schizophrenic breakdownDifferential: Schizophrenia, Paranoid PD, Borderline PDRx: Pharmacotherapy (1st  choice, neuroleptics), Psychotherapy is difficult

In cluster B; person has pervasive pattern of DISREGARD FOR RIGHTS OF OTHERS, inability to conform to social norms, multiple and continuous criminal acts, impulsivity or failure to plan ahead, physical fights or aggressiveness, lack of remorse. HISTORY OF CONDUCT DISORDER IN CHILDHOOD IS NEEDED.common in males (FH is 5x more likely), wide spectrum of people and professions, mellow with age, graduate to other psychiatric disorders (depression, substance abuse, somatic symptom disorders)Diffirential: Substance abuse disorders, mania, ADHD, mental retardationRx: Treat co-morbid psychiatric disorders, self help groups, psychotherapy, antiepileptic, B-blockers for aggression

Cluster B; person has a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by EARLY ADULTHOOD and present in a variety of contexts. IMPAIRED CAPACITY TO FORM STABLE INTERPERSONAL RELATIONSHIPSaffective instability (rapid mood swings), impulsivity, identity disturbance (chronic boredom or emptiness), recurrent manipulative suicidal and parasuicidal behaviors (cutting behavior), idealization/devaluation (splitting- let me tell you something i've never told anyone before), fear of abandonment, brief psychotic episodes under stress

More common in women, genetic factors, adverse childhood events reported, severity of abuse related to severity of symptomsNeurobiological findings in: anterior cingulate cortex, prefrontal cortex, hippocampus, amygdala

Psychotherapy: Dialectical Behavior Thearpy (DBT)Pharmacotherapy: symptom focused- neuroleptics (though disturbances), SSRI's (dysphoria), Valproate (mood swings)

based largely in behaviorist theory with some cognitive therapy elements; weekly individual and group session and available telephone consultations4 essential parts: DBT skills training group, DBT individual therapy, DBT phone coaching, therapy for DBT therapist consultation team and providers

Cluster BColorful dramatic, and extroverted, uncomfortable if they are not center of attention, sexually promiscuous, exaggerated display of emotion, considers relationships to be more intimate than they actually areMore likely diagnose in women; association with somatization disorder, alcohol abuse, sexual dysfunctionDifferential: Borderline PDRx: Psychotherapy (psychoanalytically), Pharma (SSRI's)

Cluster B; GRANDIOSE SENSE OF SELF-IMPORTANCE; preoccupied with fantasies of unlimited success and power, believes they are special, requires excessive admiration, sense of entitlement, unable to show empathy, arrogant, haughty attitudedifficult to treat, aging handled poorly, often accompanies borderline and histrionic traitsRx: Psychothearpy, pharma (lithium for mood swings)

Cluster C; excessive discomfort with or fear of intimate social relationships that results in the pathological avoidance of social interactions, extreme sensitivity to criticism, not asocial BUT FEAR OF REJECTION, FEAR OF BEING CRITICIZED OR REJECTED IN ASOCIAL SITUATION, view self as socially inept and unappealing. want to be in relationship but fear of rejectionInfants who are timid more likely to develop this disorderRx: Psychotherapy (CBT, social skills training, group therapy) Pharma (SSRI's, MAOI's, B-blockers)

Cluster C; display clinging, submissive behavior, strong desire for others to care for them. Extremely preoccupied with fears of abandonement, fear of being alone and will go to extreme lengths to preserve any relationship, submissive and passive to others, fear that any direct expression of anger will end in rejection, may volunteer for unpleasant tasks, agree with others who may be wrongfolie a deux (shared psychosis), anxiety disorders, panic, agoraphobiamore common in femalesPharmacotherapy, Psychotherapy, remove the couple 

Cluster C; pervasive pattern of perfectionism and inflexibility ; emotional constrition, orderliness, subbornness, indecisivenessformal and serious people, lack of sense of humor, miserly, unable to discard worn out objects, fear of making mistakes makes them indecisivemore common in men, flourish in positions of methodical work, are good assistantsoften associated with delusional disorderDifferential: OCDRx: Psychotherapy (group therapy), Pharma (Benzos, Clonazepam, TCA clomipramine)

OCD- have true obsessions and compulsions that they find EGO-DYSTONICOCPD- find that their behaviors are EGO-SYNTONIC and REWARDED BY OTHERSoccasionally the two can co-exist

1) Loss of touch with reality (delusions, hallucinations, thought disorder)2) Inability to meet the daily demands of life3) Absence of insight (don't know they have it)

Schizophrenia, Schizophreniform disorder, brief psychotic disorder, schizoaffective disorder, mood disorder with psychotic features, delusional disorders

TWO OR MORE FOR 1 MONTH (one must be delusion, hallucination, or though disorder)Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms (diminished emotional expression, or avolition, alogia)Social and occupational dysfunctionContinuous signs of disturbance persists FOR 6 MONTHSSchizoaffective and Mood disorders excludedSubstance/General medical condition excluded

Paranoid (hallucination, delusion, persecution)Disorganized (no logical thought process, inappropriate affect)Catatonic (motor symptoms, molding shape)UndifferentiatedResidual (negative symptoms persist, don't want to talk, no motivation)

Same criteria as Schizophrenia but differ in time duration BETWEEN 1 AND 6 MONTHS

Same criteria as Schizophrenia but differ in time duration LESS THAN 1 MONTH

1) concurrent uninterrupted period of illness during which there is a MAJOR MOOD EPISODE (major depressive or manic) along with Criteria A for Schizophrenia2) DELUSIONS OR HALLUCINATIONS FOR 2 or MORE WEEKS  in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illnessSymptoms that meet the criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness 

3 or more of the following:Stupor, catalepsy (passive induction of a posture held against gravity), Waxy flexibility (molding), Mutism, Negativism (opposition or no response to instructions or external stimuli), Posturing, Mannerism, Stereotypy (repetitive, abnormally frequent, non goal directed movements), agitation, grimacing, echolalia (mimicking other's speech), Echopraxia (mimicking other's movements)Psychotic Causes: schizophrenia, depression, mania

Presence of one or more delusions with a duration of 1 MONTH OR LONGERCriteria A for schizophrenia has never been metfunctioning is not markedly impaired, and behavior is not obviously bizarre or oddnot attributable to substance use or other medical condition

ErotomanicGrandioseJealousPersecutorySomatic 

Delusion is that another person is in love with the individual

Delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery

Delusion that individual's spouse/partner is unfaithful. Most common type

Individual's belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals

Delusion involves bodily functions or sensation. "I have stomach cancer"

Positive Symptoms (delusions, hallucinations,these respond to treatment)Negative Symptoms (Alogia, amotivation, these don't respond to treatment as well)Aggression/Motor (violence, suicide/homicide)Cognitive Symptoms (Memory, planning, problem solving / executive functioning)Depression and Anxiety

Only half of patients obtain treatmentOnset earlier in men (15-25) than women (25-35)

Excess Dopamine in MESOLIMBIC Tract leads to positive symptomsHypofunctioning Dopaminergic tracts in MESOCORTICAL symptoms lead to negative symptomsSIDE EFFECT OF MEDS: occur due to blockage of dopamine receptors in NIGRASTRIATAL TRACT

glutamate activity at NMDA receptors is HYPOFUNCTIONAL due to abnormalities in the formation of glutamatergic NMDA synapses during neurodevelopmentex: PCP and ketamine (NMDA receptor antagonists) produce psychotic condition very similar to schizophrenia, mimic positive and negative symptoms

Elargement of ventricular system accompanied by overall reductions in grey matterLimbic system: Reduction in volume, particularly hippocampus, amygdala and para hippocampal gyrus. Anatomical abnormalities in the PFC as well as functional deficits. 

Heterogenous genetic basis; many risk genes exist; patients probably inherit several genes which interact with the environment

associated with neurodevelopmental issues; morphological abnormalities, obstetric complications, developmental issues, intellectual disability, disruptive behavior disorders, increased minor physical anomalies

VariableFluctuating course in first 5 yearsPositive symptoms diminish in intensity. Negative symptoms worsen10-20% have good outcome; >50% have poor outcome

Typical antipsychotics (neuroleptics) - high and low potencyAtypical Antipsychotics (neuroleptics) - Second generation antipsychotic or Serotonin Dopamine Antagonists

Assertive community treatment (designated case managers actively involved)Family educationSupported employment Social skills training

InformalVoluntary - conditional, most common, patients comes in if wants to be discharged has to wait 72 hrsTemporary - for 30 days of evaluationInvoluntary - against their will; in front of mental health judge w/in 30 days; risk to self or others

1) Bipolar and Related Disorders2) Depressive Disorders

1) Bipolar I Disorder2) Bipolar II Disorder3) Clycothymic Disorder4) Substance / Medication Induced Bipolar and Related Disorders5) Bipolar and Related Disorder due to another Medical Condition

1) Major Depressive Disorder2) Persistent Depressive Disorder (Dysthymia)3) Disruptive Mood Dysregulation Disorder4) Premenstrual Dysphoric Disorder5) Substance Induced Depression6) Depression due to another medical condition

Bipolar- have Manic episodes (with or without depressive episodes) OR Hypomanic Episodes + Depressive EpisodesMajor depression - have only depressive episodes

Distinct period of ABNORMALLY and PERSISTENT elevated, expansive or irritable mood AND abnormally and persistently increased goal directed activity or energy FOR 1 WEEK3 or more of the following:Inflated self esteem or grandiositydecreased need for sleepmore talkative / pressure of speech (can't interrupt, talk too fast)Flight of ideas / subjective feeling of racing thoughts (understandable based on context)DistracabilityPsychomotor agitationExcessive involvement in activities which have a high potential for painful consequences (ex: going on buying sprees, high risk sex)MOOD DISTURBANCE SUFFICIENTLY SEVERE TO CAUSE IMPAIRMENT IN SOCIAL OCCUPATIONAL FUNCTION OR TO NEED HOSPITALIZATION.not due to substance  use or medical condition

DIGFASTD - distractibility and easy frustrationI - irresponsibility and erratic uninhibited behaviorG - GrandiosityF - flight of ideasA - activity increased with weight loss and increased libidoS - sleep decreasedT - talkativeness

Distinct period of ABNORMALLY AND PERSISTENT elevated expansive or irritable mood AND ABNORMALLY AND PERSISTENTLY increased goal directed activity or energy FOR 4 DAYSSame clinical as manic episode but shorter durationEpisode is associated with unequivocal changes in functioning that is UNCHARACTERISTICDisturbance is mood and change in functioning is OBSERVABLE BY OTHERSTHE EPISODE IS NOT SEVERE ENOUGH TO CAUSE MARKED IMPAIRMENT IN FUNCTIONING OR NEED HOSPITALIZATION. IF THERE ARE PSYCHOTIC FEATURES THEN BY DEFINITION THE EPISODE IS MANICnot due to substance abuse or medical condition

5 or more of the following symptoms present during the same 2 WEEK PERIOD and represent a change from previous functioning, at least 1 symptom is DEPRESSED MOOD or LOSS OF INTEREST OR PLEASUREDepressed mood most of the day, nearly every day; markedly decreased interest or pleasure in all, or almost all activities; significant weight loss when not dieting or weight gain or decrease in appetitie nearly every day; insomnia or hypersomnia nearly every day; psychomotor agitation or retardation nearly every day; feeling of worthlessness or excessive or inappropriate guilt; Diminished ability to think concrete, or indecisiveness; recurrent thoughts of death, recurrent suicidal ideation without specific plan, or suicide attempt or a specific plan for committing suicide. 

SIGECAPS; depressed mood or anhedonia plus:S- sleep I - interestG - guiltE - energyC - concentrationA - appetiteP - psychomotorS - suicidal

AT LEAST ONE MANIC EPISODE there may or may not be a history of a major depressive episode

Recurring mood episodes consisting of:AT LEAST ONE HYPOMANIC EPISODE AND ONE OR MORE DEPRESSIVE EPISODE

Can be seen in Bipolar I and II4 or more episodes in the last 12 months which have met criteria for MANIA, HYPOMANIA OR DEPRESSIVE EPISODE and are demarcated by full or partial remissionpoor prognosis, associated with hypothyroidism

Mania or Hypomania, with mixed features: Criteria for mania and hypomania are present PLUS there are depressive symptomsDepressive episode with mixed features: Full criteria for a major depressive episode with manic or hypomanic symptomsExtremely labile

often seen in depressionneed 3 features to make diagnosis:Marked anhedoniaLack of reactivityDistinct quality of mood (never experienced before)MOOD WORSE IN THE MORNINGEARLY MORNING AWAKENING (at least 2 hrs)Marked retardation or agitationWeight lossExcessive or inappropriate guilt

Seen in patients with depression:Mood Reactivityweight gain or increased appetiteHypersomniaLeaden paralysis (arms feel heavy)Long standing pattern of interpersonal rejection sensitivity

relationship between mood episode and seasonmore likely in bipolar IIwinter type is related to latitude (higher), age (younger), and sex (females)

Delusions and hallucinations are consistent with the mood

the content of the delusions is not consistent with the polarity of the episodepoor prognosis

onset of symptoms during pregnancy or in the 4 weeks following deliverypsychotic symptoms may be present

duration of symptoms 2 yrs (1 yr in children)NUMEROUS HYPOMANIC SYMPTOMS AND DEPRESSIVE SYMPTOMS that do not meet criteria for a hypomanic or depressive episode.symptoms have been present for at least half the time in the 2 year period

Meets criteria for a Major Depressive EpisodeTHERE HAS NEVER BEEN A MANIC OR HYPOMANIC EPISODEnot due to substance use or medical condition

Responses to a significant loss that may include feelings of intense sadness, rumination about the loss, insomnia, poor appetite, weight lossPredominant feeling of emptiness and lossDysphoria tends to decrease over days/weeks"Pangs of Grief" - depression in wavesoften accompanied by positive emotions and humorSELF ESTEEM MAINTAINED 

Depressed mood on most days FOR 2 YEARS2 or more of following:Poor appetite or overeatinginsomnia or hypersomnialow energylow self esteempoor concentrationhopelessnesscriteria for major depressive disorder may also be present

Severe recurrent TEMPER OUTBURST manifested as verbal rages and physical aggressionoutbursts inconsistent with developmental levelonset before age of 10 yearsDx not made for first time before age of 6 or after age of 18 yrs"Temper Tantrums"

symptoms present in majority of menstrual cyclesin the final week before onset of menses ad improve within days of onset of menses

Onset: Bipolar I around 20 yrs, Bipolar II later; rare to start in fourth to fifth decadestrongest risk factor is family hx and depressionsuicide risk 15x than general population

7% in 18-29 yr olds; 3x higher in 60+Females more common40% start improving within 3 months and 80% by one yearsuicide risk 15-20%

Decreased levels of SEROTONIN and NE results in symptoms and deficiency in serotonin and NE leads to upregulation of post synaptic receptorsMedications (most antidepressants increase levels of monoamines, but takes weeks for symptoms to improve. Antidepressants can induce mania in patients with depression, increased NE metabolite, MHPG)Improvement in depression is related to down regulation of the receptors

Elevated HPA activityHypercortisolemiaThyroid dysfunction and depressionBlunted TSH response to TRHSteroids and mood disorder

1) PFC2) Anterior Cingulate Cortex3) Hippocampus4) Amygdala

Longs standing stress / adverse childhood eventsOCD, Histrionic, borderline personality more at riskdisturbance in mother-infant relationship in oral phasemania seen as reaction depression linked to learned helplessness

Electro Convulsive Therapy - good for depressionTranscranial Magnetic Stimulation - improvements in depressionVagal Nerve Stimulation - invasive, usually for epilepsy but also used in depression

CBT - goal to change patterns of thinking or behavior that are behind people's difficulties, and so change the way they feelInterpersonal Psychotherapy - based on principal that relationships and life events impact mood and that reverse is truePsychodynamic Oriented Psychotherapies - 

Marked fear and anxietySpecific thoughts associated with these symptomsSymptoms are disproportionate and persistent There is distress and impairment

1) Separation Anxiety Disorder - in childhood2) Selective Mutism - in childhood3) Specific Phobia - in childhood4) Social Anxiety Disorder (Social Phobia)5) Panic Disorder6) Agoraphobia7) Generalized Anxiety Disorder

fearful or anxious about separation from attachment figures to a degree that is developmentally inappropriatepersistent fear or anxiety about harm coming to attachment figures and events that could lead to loss of or separation from attachment figuresReluctance to go away from attachment figures, nightmares and physical symptoms of distressOften develop in childhood and can be expressed into adulthood

Consistent failure to speak in social situations in which there is an expectation to speak even though the individual speaks in other situationsHas significant consequences on achievement in academic or occupational settings or otherwise interferes with normal social communication. 

Fearful or anxious about or avoidant of circumscribed objects or situations to a degree that is persistent and out of proportion to the actual risk posed. ex: animal, natural environment, blood-injection-injury; situational, and othersmost common psychiatric disorder among women and second most common among men, after substance use disordersbimodal age of onset: childhood peak for animal phobia, natural environment phobia, and blood-injection-injury-phobia. early adulthood for situational phobiasRx: Behavior therapy (systemic desensitization)

fearful or anxious about or avoidant of social interactions and situation that INVOLVE THE POSSIBILITY OF BEING SCRUTINIZEDincludes social interactions such as meeting unfamiliar people, being seen eating or drinking, performing in front of othersCognitive ideation is being negatively evaluated by others: being embarrassed, humiliated, rejected, or offending others. Median age of onset 13 yrsMay have history of: anxiety disorders, mood disorders, substance-related disorder, bulimiaRx: Psycotherapy and Pharmacotherapy (SSRIs, benzodiazepines - best for short term, SNRI - venlafaxine, Buspirone)

experience RECURRENT unexpected panic attacks and is PERSISTENTLY CONCERNED OR WORRIED about having more panic attacks or changes in his or her behavior in maladaptive ways because of the panic attacks 

a symptom; abrupt surges of intense fear or intense discomfort that reach a peak within minutes, accompanied by physical and/or cognitive symptoms

Palpitations, sweating, trembling, shaking, SOB, feeling of choking, chest pain, discomfort, nausea or abdominal stress, feeling dizzy, unsteady, light headed, or faint, chills, parethesias, derealization or depersonalization, FEAR OF LOSING CONTROL OR GOING CRAZY, FEAR OF DYING

DepressionIncreased risk of committing suicideAlcohol or substance dependenceOCD

CV: MI, angina, arrhythmias, anemia, MVPPulmonary: asthma, PE, COPDNeuro: CVA, Epilepsy, MigraineEndocrine: Hypoglycemia, Hyperthyroidism, Pheochromocytoma

Pharmacotherapy (Alprazolam, Paroxetine, SSRIs, Clomipramine, benzos)CBTFamily and group therapy

fearful or anxious about TWO or more of the following:Using public transportationbeing in open spacesbeing in enclosed placesstanding in line or being in a crowdor being outside of the home alone in other situationsFear situations b/c of thoughts of escape might be difficult or help might not be available in the event of developing manic-like symptoms or other incapacitating or embarrassing symptoms. Often require presence of a companiononset usual before age 35; more common in women; panic attacks and panic disorder can precede agoraphobia

BenzodiazepinesSSRI's TCA, MAOIPsychotherapy (Behavior, Cognitive, Insight Oriented, Virtual)

Persistent and excessive anxiety and worry about various domains, including work and school performance, that the individual finds difficult to controlexperience physical symptoms: restlessness or feeling keyed up or on edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbanceWorry about realistic things persistently (did I close the door?)Onset: 30 yrs, starts later than other anxiety disorders, most in females, chronic with remission and relapses

sustained excessive anxiety and worry accompanied by either motor tension or restlessnessanxiety is excessive and interferes with other aspects of lifeMotor tension: shakiness, restlessness, headachesCo-morbidities: depression, other anxiety disorders

Pharmacotherapy: SSRI's Venalfaxine, Benzodiazepines, Buspirone, Tricyclics, MAOIPsychotherapy: CBT

OCDBody Dysmorphic DisorderHoarding DisorderTrichotillomania (hair pulling)Excoriation (skin picking)

common, disabling psychiatric disorder characterized by INTRUSIVE AND UNWANTED thoughts, images, or urges that CAUSE DISTRESS OR ANXIETY AND REPETITIVE thoughts or actions that the person feels drive to perform 

Recurrent and persistent thoughts, urges, or images, as INTRUSIVE AND UNWANTEDindividual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action

Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidlyBehaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded situation or eventTheses acts are not related in any realistic way to what they are designed to neutralize

Obsessions: doubts, images, thoughtsCompulsions: Yielding, controlling

mean onset 19.5 yrs, can start earlier; onset of symptoms usually gradualthere is a genetic predispositionNeurotransmitters: Dysregulation of 5HTLink between strep infection and OCD: Patients with Group A beta hemolytic strep infection can cause Rheumatic Fever and can develop SYDENHAM'S CHOREA and show OCD symptoms- "PANDAS"altered function in neurocircuitry between orbitofrontal cortex, caudate, and thalamusdevelopmental factors: emotional, physical, sexual abuse or neglect, social isolation, teasing, bullying

DepressionTourette's DisorderSchizophreniaOther anxiety disorders

Pharmacotherapy: SSRIs, Clomiprazime, BenzosPsychotherapy: CBT with "EXPOSURE AND RESPONSE PREVENTION"for severe: Deep Brain Stimulation, Ablative neurosurgery

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to othersRepetitive behaviors (looking at mirrors) or mental acts in response to the appearance concernspatients beliefs may reach delusional disorder

persistent difficulty in parting with possessions, which results in severely cluttered living spaces, distress, and impairment that are not attributable to another neurologic or mental disorderRx: CBT

Hair pulling disorder

Skin-picking disorder

Disorders have exposure to traumatic or stressful event and is listed explicitly as a diagnostic criterion1) Reactive attachment2) disinhibited social engagement3) PTSD4) Acute stress disorder4) Adjustment disorder

Emotionally withdrawn behavior toward adult caregiversChild rarely or minimally seeks comfort when distressedDoes not respond to comfort, minimal social and emotional responsiveness to others, limited positive affectEPISODE UNEXPLAINED IRRITABILITY, SADNESS, OR FEARFULNESSSOCIAL NEGLECT OR DEPRIVATION IN THE FORM OF PERSISTENT LACK OF HAVING BASIC EMOTIONAL NEEDS FOR COMFORT, STIMULATION, AND AFFECTION MET BY CAREGIVING ADULTS

Reduced or absent reticence in approaching and interacting with unfamiliar adults; Overly familiar verbal or physical behavior; diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settingsWillingness to go off with unfamiliar adult with minimal or no hesitationSOCIAL NEGLECT OR DEPRIVATION IN THE FORM OF PERSISTENT LACK OF HAVING BASIC EMOTIONAL NEEDS FOR COMFORT, STIMULATION, AND AFFECTION MET BY CAREGIVING ADULTS

1) Exposure to a traumatic event (outside of scope of normal behavior)2) intrusion symptoms associated with the traumatic event3) Avoidance of stimuli associated with the traumatic event4) Negative alterations in mood and cognition5) Alterations in arousal and reactivity

Either direct experience, witnessing an event, learning of event to close family or friend, or experiencing repeated or extreme exposure  to aversive details of the traumatic events (ex: first responders)

intrusive distressing memories of eventrecurrent distressing dreamsFlashbacksintense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble eventmarked physiological reactions to cues that resemble event

avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the eventavoidance of or efforts to avoid external reminders

inability to remember an important aspect of eventpersistent and exaggerated negative beliefs or expectations about self, others, or worldpersistent, distorted cognitionspersistent negative emotional statemarkedly diminished interest or participation in eventsfeelings of detachment or estrangement from otherspersistent inability to experience positive emotions

Irritable behavior and angry outburstsReckless or self-destructive behaviorHypervigilanceExaggerated startle responseproblems with concentrationSleep disturbance

Social withdrawaldepressionsuicidealcohol and substance abuse

Pharmacotherapy: SSRIs, TCA, MAOI, Clonidine, PrazosinPsychotherapy: Behavioral Therapy, CBT, Hypnosis, Eye movement desensitization and Reprocessing

Difference from PTSD: duration of symptoms, 3 days to 1 monthPTSD: more than 1 month

Emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of onset of the stressor. Marked distress is out of proportion to the severity or intensity of the stressorSignificant impairment in social, occupational, or other important areas of functioningPROBLEMS IN LIFE PRODUCE OUT OF PROPORTION DISTRESSWith:Depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, mixed disturbance of emotions and conduct

Need at AT LEAST TWO:Taken in larger amounts or over a longer period of time than intendedUnsuccessful attempts at cutting downGreat deal of time spent on substance useCRAVINGFailure to fulfill major role obligations (work, school, home)Persistent social or interpersonal problemsImportant activities given up for substance useUse in hazardous situationsUse in spite of physical and psychological problemsTOLERANCEWITHDRAWAL

AlcoholOpioidsStimulantsDissociative AnestheticsHallucinogensDepressants (Benzos)Cannabinoids (weed)Others: inhalants, anabolic steroidsTobaccoCaffeineGAMBLING DISORDER

pattern of drinking that brings BAC to 0.08Usually after 4 drinks for women and 5 for men within 2 hours

highest rates among caucasians of alcohol use; same across all races for heavy drinkingM>FDrinkers have higher education compared to illicit drug use

Binge Drinking on 5 or more days in the past monthRisk of alcohol-related problems if consumption is: exceeding 14 drinks per week or 4 per day for men. 7 drinks per week or 3 per day for women. 

Cut: ever felt you ought to cut down on drinking?Annoyed: Have people annoyed you by criticizing your drinking?Guilt: Ever felt bad or guilty about your drinking?Eye opener: Ever had an eye opener to steady your nerves in the AM?

Early onset (<25 yrs) has poorer prognosis than later onset of dependence

drink alone, binge less, drink less, higher ethanol levels than men, faster progression from first drink to problems, dependence quicker, progress to liver disease with less etoh and more quickly, higher mortality rate from alcohol related liver disease

Leading cause of Intellectual DisabilityMicrocephalyCraniofacial MalformationsShort StatureMaladaptive behavior

alcohol intoxicationalcohol withdrawal delirium tremensalcohol withdrawal seizuresalcohol-induced amnestic disorder (Wernicke-Korsakoff)Neurocognitive disorder associated with ETOH (trauma)Alcohol induced psychotic disorder (delusion of infidelity)alcohol induced mood disorder

Can see Seizures and autonomic hyperactivitybegins 8-24 hrs after cessation or reduction in drinkingTremors (shakes, jitters)Autonomic hyperactivity (BP, HR, Temp)other Sx: Gi- nausea/vomiting, anxiety, irritability, sweating, flushingcan progress to DT

Delirium occurring during alcohol withdrawalMedical emergencyUSUALLY DEVELOPS WITHIN 72 HRS; watch out for DTs for up to a week after ETOH cessationHigh mortality (20%)Confusion and disorientation, autonomic instabilityPerceptual disturbances (Visual, tactile, auditory hallucinations, illusions)

Inpatient vs outpatientDetoxification: Benzodiazepines (Lorazepam, Oxazepam, Temazepam)Rehab

Heroin (short acting)MorphineCodeineOxycodoneHyrdocodoneHydromorphone (Dilaudid)Fentanyl

M:F is 3:1Peak use in 20's, mature out by 40lower socioeconomic class

u receptors: analgesia, respiratory depression, dependencek receptors: analgesia, sedationsignificant effects on dopaminergic and noradrenergic system

Oralsnortingsmoking/chasing (heroin)IVSubcutaneous (skin popping)

RHINORRHEALACRIMATIONNausea and vomitingDiarrheaPILOERECTIONMuscle achesspontaneous ejaculationYAWNINGinsomnia (even with sleep)

DeliriumPsychosisMOOD DISORDER (most common)Sleep disorderSexual Dysfunction

Non-opioid Detox: Clonidine (alpha2 agonist)Methadone: detox and maintenanceBuprenorphine: detox and maintenance Opioid antagonist: Naltrexone (prevent from getting high); Naloxone (help with overdose)SSRI's (help with depression

CocaineAmphetaminesMethamphetiminesMethylphenidateSynthetic Cathinones (bath salts)Nicotine

binds to dopamine transporter and inhibits reuptake of synaptic dopamine. Results in dose-dependent increases in extracellular levels of dopamine. HAS SHORT DURATION OF ACTION BECAUSE COCAINE IS RAPIDLY METABOLIZEDcommon age 18-25Males twice as likelyRewarding effects: mesocortical and mesolimbic dopaminergic pathwaysIngest: snorting, freebasing, injecting

Seizures (common illicit drug)CVStrokesHTN CKD/End stage renal disease

Intoxication: Hyperawareness, hypersexuality, hypervigilence, psychomotor agitationDelirium: disorientation, confusion, anxietyPsychosis: during high use; delusions, stereotypes compulsive behaviorWithdrawal: "crash", dysphoria, cravingMood disorder: Depression (most often after crash)

SymptomaticNO DISTINCT WITHDRAWAL SYNDROMESSRIBupropionTCADopmaine agonistscocaine vaccine- does not really work

Act by releasing more DA by their action on the dopamine vesiclemore common in Europe, AustraliaNo specific withdrawal symptoms, "crash"can produce a psychosis similar to Paranoid SchizophreniaDELUSIONAL PARASITOSIS (FEEL LIKE THEY HAVE SKIN INFECTION OR SOMETHING UNDER THEIR SKIN)

Acts by both decreasing DA reuptake and promoting DA release via the dopamine transporterLonger duration than cocaine, b/c of slow metabolism, with effects lasting several hours longer

amphetamine-like stimulant found in the Khat plantexreme agitation, hallucinations/delusions, chest pain, suicidal thoughts, HTN, acute toxicity, Hyperthermia, delirium, violent behavior, FOAMING AT MOUTH, Extreme paranoia, DELUSIONAL PARACITOSIS, parkinson-like limb twitch, severe insomniasnorted, smoked, IV

PCP (phencyclidine)Ketamine

easy to synthesizeAngel dust, "wet," "balming fluid" "dipper"Smoking is method of ingestionsNMDA RECEPTOR AGONIST, also acts on the DA neurons in VTADOES NOT CAUSE ANY PHYSICAL DEPENDENCE

Psychiatric emergencyVertical or horizontal nystagmusHTN, tachycardiaataxiaREDUCED RESPONSIVENESS TO PAINPERCEPTUAL DISTURBANCESSeizuresComaViolent

airway, breathing, circulation, thermoregulation, neurologic status must be stabilizedavoid physical restraintsBENZODIAZEPINES for agitationNeuroleptics if psychoticHaloperidol, Ziprasidone

Psychedelics or PsychotomimeticsNatural: Psilocybin and MescalineSynthetic: Lysergic Acid Diethylamide (LSD)use more prevalent in whites, and younger populations

oral, smoking, IVACTS ON SEROTONERGIC RECEPTORS (5-HT2)Tolerance develops and reverses quicklyNO PHYSICAL DEPENDENCE OR WITHDRAWAL

Perceptual changes, illusions, depersonalization, derealization and hallucinationsPupillary dilationTachycardiaIncoordinationsweating

Hallucinogen persisting perception disorderFlashbacksDepression

BarbituratesBenzodiazepines: "Xanax"Flunitrazepam (Rohypnol)Gamma Hydroxybutyrate (GHB) (abuse in bodybuilders)

most commonly used illicit drugACTIVE COMPOUND DELTA-9 TETRAHYDROCANNABINOLmost potent form: hashreceptor is G-protein linked receptors, highest concentrations in basal ganglia, hippocampus, cerebellum

Dilatation of conjunctival blood vessels, tachycardia, increased appetite and dry mouthTolerance to effects but no physical withdrawalDepressionAmotivational syndrome: in heavy users, apathy, dullness, lethargy, impairment of judgement

chemically related to THCeffects more powerful and more dangerous than marijuanaanxiety, agitations, nausea, vomiting, HTN, shaking, seizures, hallucinations, paranoid, violent

volatile substances that produce chemical vapors that can be inhaled to induce psychoactive, or mind-altering, effect. CNS Depressants. Solvents, glues, paint thinners, fuelsNo specific withdrawal symptomsLong term cognitive deficits

Muscle building (GHB)feel good after usingEuphoriaNo specific withdrawalPhysical complications: liver Ca, testicular atrophyPsychiatric manifestations: euphoria, rage, depression

Preoccupation with gamblingrestless when not gambling or cutting downneed to gamble with increasing amounts of money to get excitementunsuccessful efforts to controlgambling to escape problemschasing one's losseslying to hide gambling/jeopardize relationshipsRx: SSRI's, Naltrexone, Mood stabilizers (related to dopamine)Increased risk of suicide

Tobacco use is common among patients with mental illnessCaffeinism can present with: anxiety, nervousness, jitters, muscle twitching

1) Somatic Symptom Disorder2) Functional Neurological Symptom Disorder3) Illness Anxiety Disorder4) Psychological Factors affecting Medical Condition5) Factious Disorder

Common feature:Prominence of somatic symptoms associated with significant distress and impairment. Somatic symptoms and the way the patient interprets them, incorporating cognitive affective and behavioral responses (that are out of proportion). 

One or more somatic symptoms that are distressing (Pain predominant symptom)EXCESSIVE THOUGHTS, FEELINGS, OR BEHAVIORS RELATED TO SOMATIC SYMPTOMS OR ASSOCIATED HEALTH BEHAVIORS1) persistent thoughts about seriousness of symptoms2) high level of anxiety about health/symptoms3) excessive time or energy devoted to symptomsIllness is chronic and debilitatingstress associated with exacerbations"care" rather than cure appraochneed regular visits, avoid medical workups, psychotherarpy, pharmacotherapy

Social Communication (need to tell others around them)Symptoms substitute repressed instinctual impulsesFaulty perception / interpretation of sensory inputs (unable to filter out unimportant sensory inputs)Alexithymia (inability to express emotions so they do it through physical symptoms)Cultural factors (psychological symptoms present as physical symptoms)

PREOCCUPATION WITH HAVING OR ACQUIRING AN ILLNESShigh levels of anxiety, easily alarmed about health issues, excessive health related behaviors (checks body for signs of illness repeatedly) or maladaptive avoidance (avoids doctors appointments)Ex: HYPOCHONDRIASIS

SSD - present when there are somatic symptomsIAD - there are minimal symptoms, but patients are primarily CONCERNED WITH THE IDEA THEY ARE ILL

Illness is lifelong with periodic exacerbationsearly or middle adult lifeTreat associated anxiety and depressionGroup Therapy

"Hysteria"Women > Men, any age but common in adolescents and young adults, more in rural populationAssociated with: Major depression, personality disorders (histrionic, dependent)Present with neurologic symptoms without any underlying pathology

One or more symptoms of altered motor or sensory symptomsIncompatibility between symptoms and recognized medical/neurological conditionsDeficit causes distress

Weakness, paralysisabnormal movements (tremors, gait disturbance, myoclonus)Swallowing symptomsSpeech symptoms (slurred, dysphonia)SeizuresAnesthesia or sensory loss

Psychoanalytic: unconscious intrapsychic conflict and conversion of anxiety into physical symptomLearned BehaviorBiological Factors?

Remove symptomPsychotherapyRelaxationAmytal interviewHypnosis

A medical condition is presentPsychological factors adversely affect the medical condition because:1) they influence the course2) they interfere with treatment3) they constitute well established health risk 

Anxiety exacerbating AsthmaChronic occupational stress leading to HTNTakotsubo Cardiomyopathy: transient cardiac dysfunction, triggered by physical or emotional stressMigraineIBSFibromyalgia

FALSIFICATION OF PHYSICAL OR PSYCHOLOGICAL SIGNS OR SYMPTOMS, OR INDUCTION OF INJURYDeceptive behavior is present even in the absence of rewards; person knows they don't have the symptomsbehavior is not explained by other psychosis

Factitious Disorder by ProxyEx: Parent says child is ill when they are notFactitious Disorder is different from Malingering. A person with malingering does it for a tangible reward