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Psychiatry PA EOR Exam with correct Answers 100%
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Psychiatry PA EOR Exam with correct Answers
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Psychiatry PA EOR Exam with correct AnswersMDD Criteria - Answer- Must have at least five of the following symptoms (must include either number I or number 2) for at least a 2-week period: 1. Depressed mood 2. Anhedonia (loss of interest in pleasurable activities) 3. Change in appetite or body weight (f or J,) 4. Feelings of worthlessness or excessive guilt 5. Insomnia or hypersomnia 6. Diminished concentration 7. Psychomotor agitation or retardation (ie, restlessness or slowness) 8. Fatigue or loss of energy 9. Recurrent thoughts of death or suicide
Manic episode criteria - Answer- A period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary) and including at least three of the following (four if mood is irritable): I. Distractibility 2. Inflated self-esteem or grandiosity 3. tin goal-directed activity (socially, at work, or sexually) 4. J, need for sleep 5. Flight of ideas or racing thoughts 6. More talkative or pressured speech (rapid and uninterruptible) 7. Excessive involvement in pleasurable activities that have a high risk of negative consequences (eg, shopping sprees, sexual indiscretions) These symptoms cannot be due to substance use or medical conditions, and they must cause social or occupational impairment. Seventy-five percent of manic patients have psychotic symptoms.
Mania vs hypomania - Answer- Mania: Lasts at least 7 days, Causes severe impairment
in social or occupational functioning, May necessitate hospitalization to prevent harm to self or others, May have psychotic feature
Hypomania: Lasts at least 4 days, No marked impairment in social or occupational functioning, Does not require hospitalization, No psychotic features
Bipolar 1 disorder criteria - Answer- The only requirement for this diagnosis is the occurrence of one manic or mixed episode - depression, dysthymia, and hypomania can
happen between episodes, but are not required for diagnosis Bipolar 1 and 2 treatment - Answer- Lithium Anticonvulsants (carbamazepine or valproic acid) are also mood stabilizers. They are especially useful for rapid cycling bipolar disorder and mixed episodes, although associated with T risk of suicide. Atypical antipsychotics (olanzapine, quetiapine, ziprasidone) are effective as both monotherapy and adjunct therapy Psychotherapy: Supportive psychotherapy, family therapy, group therapy (prolongs remission once the acute manic episode has been controlled). • ECT: Works well in treatment of manic episodes
Lithium Side Effects - Answer- Weight gain • Tremor • Gastrointestinal disturbances • Fatigue • Cardiac arrhythmias • Seizures • Goiter/hypothyroidism • Leukocytosis (benign) • Como • Polyuria (nephrogenic diabetes insipidus) • Polydipsia • Alopecia • Metallic taste
Bipolar 2 Criteria - Answer- History of one or more major depressive episodes and at least one hypomanic episode. Remember: If there has been a full manic episode even in the past, then the diagnosis is not bipolar II disorder, but bipolar I.
Cyclothymic disorder - Answer- Alternating periods of hypomania and periods with mild to moderate depressive symptoms.
Chronic disorder - 1/3 of patients are eventually diagnosed with bipolar disorder
Cyclothymic disorder criteria - Answer- • Numerous periods with hypomanic symptoms and periods with depressive symptoms for at least 2 years. • The person must never have been symptom free for > 2 months during those 2 years. • No history of major depressive episode or manic episode.
Cyclothymic disorder treatment - Answer- Same as bipolar disorder
Persistent depressive disorder (dysthymia) - Answer- Chronic mild depression
Dysthymic disorder (DD) = 2 D's 2 years of depression 2 listed criteria Never asymptomatic for > 2 months
Dysthymia Criteria - Answer- l. Depressed mood for the majority of time most days for at
least 2 years (in children or adolescents for at least I year) 2. At least two of the following: • Poor concentration or difficulty making decisions • Feelings of hopelessness • Poor appetite or overeating • Insomnia or hypersomnia • Low energy or fatigue • Low self-esteem 3. During the 2-year period: • The person has not been without the above symptoms for > 2 months at a time. • No major depressive episode. • The patient must never have had a manic or hypomanic episode (this would make the diagnosis bipolar disorder or cyclothymic disorder, respectively)
Cannot have psychotic features
Dysthymia treatment - Answer- Cognitive therapy and insight-oriented psychotherapy are most effective. Antidepressant medications (SSRis, TCAs, or MAOis) are useful when used concurrently with psychotherapy
Exhibitionistic disorder - Answer- Exposure of one's genitalia to an unsuspecting individual, with the additional requirement that the person has acted on these sexual urges with a nonconsenting person or the sexual urges or fantasies have resulted in clinically significant distress or functional impairment
Exhibitionistic disorder criteria - Answer- A. 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. B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Exhibitionistic disorder treatment - Answer- Psychotherapy, support groups, and SSRIs - First line Sometimes antiandrogen drugs - in order to lower testosterone and lower sexual desire
Fetishistic disorder - Answer- Sexual preference for inanimate objects (eg, shoes or pantyhose).
Example: Men being aroused by women's shoes
Fetishistic disorder criteria - Answer- A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors. B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., vibrator)
Fetishistic disorder treatment - Answer- Insight oriented psychotherapy and behavior therapy
SSRIs can be used
Pedophilic disorder - Answer- Pedophilic disorder is defined by sexually arousing fantasies, urges, or behaviors involving sexual activities with a prepubescent child (generally age 13 years or younger). For the criteria for pedophilic disorder to be met, however, the individual has to have acted on these sexual urges, or the sexual urges or
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