High Behavioral Health

What are the Criteria B symptoms of PMDD. Catergory C?

Criteria B

• Marked lability

• Marked irritability

• Marked depressed mood

• Marked anxiety

Crtiera C

• Decreased interest

• Concentration diffciulty

• Lethargy

• Change in appetite

• Sleep disturbances

• Sense of overwhelm

• Physical symptoms (Breast tenderness / myaglia)

In what timeframe must onset occur for peripartum depression

During pregnancy or within 4 weeks postpartum

What symptoms are required to make a diagnosis of MDD

Depressed mood

OR

Apathy / Anhedonia

In terms of MDD, what is considered “significant weight change”

Greater tahn 5%

When must distruptive mood dysregulation be dx

Between 6 and 18

When does the age of onset need to be for disruptive mood dysregulation

Before 10

For MDD, how many symptoms are needed and for hjow long?

5 symptoms for 2 weeks

Anhedonia

the loss of pleasure in something that used to provide pleasure

What criteria is need for the “atypical features” for MDD

Mood Reactivity + 2 of the following:

• Weight Gain or appetite increase

• Hypersomnia

• Leaden paralysis

• Sensitivity to rejection

For dysthymia, how many symptoms and how long

Depressed mood + 2 depressive symptoms for 1 year (Children) or 2 years (Adult) no more than 2 month gap

What needs to be true for substance/medication induced mood disorders

The symptoms developed after intoxication or withdrawal

Substance needs to be able to cause those symtpoms

What are indicators that make manic symptoms mania

Needs hospitalization to prevent harm

Psychotic features

What is the criteria for Bipolar I/II “With Rapid cycling”

4 mood episodes over 12 months

How does hypomania differ from manina

Hypomania does cause a change but does not markedly impair the patient like mania

What is needed to make a dx of Bipolar I

1 manic episode

What is needed to make a dx of Bipolar II

One hypomanic episode + one depressive episode

For cyclothermia, how long does the patient need to present

2 years with no gap longer than 2 months

Persecutory Delusions

A thought that someone/something is actively trying to harm them

Grandiose Delusio

delusions where the patient feels higher than other or have something that makes them special

What is needed to dx Delusional disorder

1 delusion for 1 month

What is the timeframe for brief psychotic disorder

1 day to 1 month

What is the timeframe for schizophreniform

1 month to 6 monthjs

For a schizophrenia dx, how many symptoms for how long?

2 symptoms (one being delusion, hallucination, or disorganized speech) for 6 months with at least 1 month of positive symptoms

How does autism affect the dx of schizophrenia

The required symptom must be delusion or hallucination (Disorganzied speech does not count with autism)

What is the difference between a mood disorder with psychotic features and schizoaffective

In schizoaffective, there is 2 weeks at least where the psychotic symptoms are present w/o mood symptoms

In panic attack, how many symptoms are needed for dx

4

Symptoms of panic attack

PANICSS

• Palpitations

• Abd Distress

• Numbness / Nausea

• Intense fear of death

• Choking, chills, chest pain

• Sweating, shaking

• SOB

What is needed to dx panic disorder

1 attack followed by 1 month of worrying about the next attack or changing behavior to avoid attack

What are the agoraphobic settings

Public transport

Open Spaces

Enclosed spaces

Line or Crowds

Outside home along

What is neeeed to dx agoraphobia

Fear of 2 setttings due to escape difficulty for 6 months

What needed for specific phobia dx

Marked fear of a specific object/situation for 6 months

What is needed for social phobia

Fear of social situations due to embarassment for 6 months

What is the difference from panic attack and panic disorder

Disorder → Worrying about future attacks

What are the GAD symptoms

Restlessness

easily fatigued

Difficulity concentrating

Irritability

Muscle tension

Sleep Disturabance

What is needed for GAD diagnosis

Anxiety with 3 symptoms for 6 months

How many symptoms are needed and for how long to dx ADHD

5 (Adults) or 6 (Under 17) for 6 monts

Inattentive Symptoms

Fail to attention to details

Difficulty sustaining attention

Does not seem to listen

Does not follow through on instructions

Difficulty with orgnaizing tasks

Avoids sustained mental effor

Losses things often

Easily distracted

Forgetful in daily

Hyperactiivty-Impulsive Symptoms

Fidgets

Leaves seat

Runs around

Difficuly in quiet leisure

on the go

talks excess

bulrts out answer

difficulty awaiting turn

intrudes on others

For specific learning, how long must it present

6 months

In ADHD, when must onset occur by

12 y/o

For intermittent explosive, how long must it present and how frequently should it be

2 episodes weekly for 3 months (Anger but no harm)

OR

3 episodes in 1 year (harm)

How does fire setting for Conduct disorder differ from pyromania

It is often done with intent to harm

circumlocations

substituting complicated or offensive words for an easier one

Dissociative Fuge

A seemingly purposeful wandering in assocaitedw with dissociatve disorders

Functional Neurologic Symptom Disorder (Conversion)

A condition of a neurological symptom not explain by organic or neuro pathology

What is needed to diagnosis somatic symptom disorder

At least 1 somatic symptom for 6 months with high preoccupation

Psychological Factors Affecting Other Medical Conditions

A patient with a underlying medical condition has psychological factors that adversely effect that condition

Localized amnesia

Failure to recall events during a

circumscribed period of time

Selective amnesia

recall some but not all of

the events during a circumscribed period of time

Generalized amnesia

Complete loss of memory

for one’s life history

Derealization

Experiences of unreality or

detachment with respect to surroundings

Depersonalization

xperiences of unreality, detachment or being an

outside observer with respect to one’s thoughts,

feelings, sensations, body or actions

Dissociative Identity Disorder

Disruption of identity characterized by two or

more distinct personality states,

What mental act is associated with body dysmorphia

comparing self to others

What does not count for body dysmorphia

Weight

For OCD, what is considered time consuming for obessions

1 hour per day

Obsessions

Recurrent and persistent thoughts,

Compulsions

Repetitive behaviors or mental acts

excoriation

skin picking disorder

neuro condition is associated with hoarding disorder

Prader-Willi Syndrome

Brain Injury

CVA

What is needed to dx both trichotillomanina and excoriation

Repeated attempts to stop

What substances cause seizures in withdrawal

ETOH

Sedatives

For substance use disorder, how many signs are needed and in what duration

2 signs within 12 months

What is most likley to cause hallucinations in withdrawal

ETOH

What symptoms is highly associated with ETOH intoxications

Nystagmus

What symptoms are assocaited with cannabis intox

Bilateral conjunctivits

Tachycardia

Increased appetite

Yawning, myalgia, piloerection, and dialted pupils are all associated with

Opioid withdrawal

In DSM-5, what substances do not have withdrawal criteria

Hallucinogen

PCP

Inhalants

What substance intoxication is most likely to cause arrythmia

Caffiene

Tolerance

Decreased effect with continuous use

What is considered “full remission” by DSM-5

No symptoms are presetn

For MDD, what is considered full remission

No symptoms for 2 monthjs

First Line Treatment for Borderline Personality Disorder

Dialectal Behavior Thearpy

What should be taken into account when doing a mental status exam

The social / cultural background of the patient

Ideas of Reference

the concept where the patient believes message are meant for them

Neologism

The creation of a new word to avoid using a word that a patrient has difficulty with

Transference

The expections of the patient brought into an encounter

Asking correlation between two objects tests what

Abrast thoguht

What is the best test for mild cognitive impairment

MOCA

What should always be included in psychiatric history

past suicide attempts or suicidal thought

mood

how they perceive their emotional state

flat affect

A patient has no reaction

obtunded

A patient is in a state where they can be aroused with heavy stimuli but quickly return to sleep

Pressured Speech

A speech pattern where the patient talks so quick it is hard to get words in

Sign of mania

What is the focus of CBT

changing the perceptions of the patient’s thoughts

A patient is diagonsed with new onset MDD. She is currently breastfeeding her infant. What is the best option?

Serataline (Zoloft)

Where is most serotonin found in the bodyu

enterochroffamin cells of the GI tract

Where is dopamine found in the brain

substantia nigra

You decide to start a patient on Serataline (Zoloft). What patient education should be given with regards to food

Food will increase the absroption

What role does serotonin play in clotting

Promotes platelet aggregation

What electrolyte abnormality is most common with SSRIs

HypoNa

What substance use is associated with bugs crawling on skin

Cocacine

A patient on Lexapro is admitted to the ED for Serotonin Syndrome. She was seen yesterday at the urgent care for a fracture and given medication for the pain. What medication is most likely?

Tramadol

A patient is started on SSRIs and asks about effectiveness. When should clinical effect kick in

3-6 weeks

Conner’s Scale

an assessment tool for ADHD

Brain zaps are a common sign of

SSRI withdrawal syndrome

A patient is being treated for MDD. She has tryed SSRIs and SNRIs and improves but states the sexual side effects are too much. What should be done?

Switch to bupropion (Wellbutrin)

What condition is a contraindication for trazadone

Sickle Cell Disease (Priapism Risk)

What is the safest SSRI to start in those with cardiac issues

Sertaline

A patient has depression, fatigue, and fibromylagia. What agent is the best fit to treat all condtions

Duloxetine (Cymbalta)