FCM Psychiatry + Infectious Diseases Block: Buzzwords and TRIM
Oppositional Defiant Disorder central feature?
"Conflict with authority"
Four clinical presentation categories for Conduct Disorder?
DADS
"DADS"
1. Destruction of Property
2. Aggression to People and Animals
3. Deceitfulness o...
FCM Psychiatry + Infectious
Diseases Block: Buzzwords and
TRIM
Oppositional Defiant Disorder central feature?
"Conflict with authority"
Four clinical presentation categories for Conduct Disorder?
DADS
"DADS"
1. Destruction of Property
2. Aggression to People and Animals
3. Deceitfulness or Theft
4. Serious Violations of Rules
40% of people with conduct disorder go on to develop ______________________
_____________________ disorder
antisocial personality
Main difference between PTSD and Acute Stress Disorder?
Length of Time of Symptoms
Acute Stress Disorder:
3 days - 1 month after trauma exposure
PTSD:
> 1 month in duration
Development and Course of Acute Stress Disorder:
When can it be diagnosed?
What happens if it progresses past one month?
Prevalence with PTSD?
How can symptoms worsen with Acute Stress Disorder?
- Cannot be diagnosed until 3 days after a traumatic event
- May progress to PTSD after 1 month or may be transient stress response that remits 1 month of
trauma exposure and does not result in PTSD
- Approximately half of individuals who eventually develop PTSD initially present with acute stress
disorder
- Symptom worsening during the initial month can occur, often as a result of ongoing life stressors or
further traumatic events
PTSD Clusters? 4
1. Re-Experiencing
2. Avoidance
,3. Negative Emotions and Cognitions
4. Hyperarousal
1. Physiological and psychological habituation
2. Emotional processing (sense-making)
Considerations:
- Selling the rationale - this is an avoidant, anxious population
- Promoting optimal engagement
- Dealing with resistance
- Knowing when to discharge
Overview of Cognitive Processing Therapy for PTSD?
CPT allows survivors to examine their beliefs to determine how realistic:
- Their negative judgments are about the past
- Their fears are about the present/future
12 session protocol with written homework assignments after every session
Focuses on identifying "stuck points" that impedes one's recovery from trauma
Goals:
- Empower patients to break their own rules of thinking
- Allowing patient to become their own therapist
What are different types of assessment tools for PTSD?
1. CAPS - Clinician Administered PTSD Scale
2. PCL - PTSD Checklist
3. SCID - Structured Clinical Interview for DSM
Intentional act, or failure to act, by a caregiver or another person in a relationship involving an
expectation of trust that causes or creates a risk of harm to an older adult (>60 years)
Can be emotional, physical, financial, sexual, or neglect
,elder abuse
Which type of elder abuse is:
- The most common?
- The least reported?
- On the rise due to technology?
Most common: Emotional abuse
Lease reported: Sexual abuse
On the rise due to technology: Financial abuse
Bruising pattern characteristics that would lead you to suspect elder abuse?
- Often larger in size
- In unusual locations: Arms, face, back, genitals, thigh area
- Patterned injuries such as hand slap or bite marks
- Ligature marks or scars around wrists, ankles, or neck (inappropriate restraint suggesting)
- Unexplained fractures - injuries in different stages of healing
- Burns in patterns inconsistent with unintentional injury or with the explanation provided
SIG-E-CAPS
Sleep
Interest/Anhedonia
Guilt
Energy
Concentration
Appetite
Psychomotor retardation
Suicidal ideations
Mnemonic from screening a mood disorder patient?
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at
least 1 week (or any duration if hospitalization is necessary)
During mood disturbance, 3+ of the following symptoms to a significant degree:
- Inflated self-esteem/grandiosity
- Decreased need for sleep
- More talkative
- Insomnia/hypersomnia every day
- Psychomotor agitation/retardation every day, observable by others
- Racing thoughts
, - Increase in goal oriented activity
- Excessive involvement in pleasurable activities with high potential for painful consequences
Manic Episode Characteristics
Combination of dysthymia (genetic, mild depression for 2 years, treatment resistant) and major
depressive disorder from DSM IV
Persistent Depressive Episode
Depression sub-type from lack of sunlight, common in cold climates
According to Chillura: "Not a mood disorder onto itself, rather a subtype of major depressive
disorder, bipolar I, and bipolar II"
Seasonal Affective Disorder
According to CURRENT:
5 or more of the following for at least 2 consecutive weeks.
Must include either depressed mood or loss of interest/pleasure
- Depressed mood
- Markedly diminished interest or pleasure
- Significant unintentional weight loss or decrease in appetite
- Insomnia/hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive/inappropriate guilt
- Diminished ability to think/concentrate/indecisiveness
- Recurrent thoughts of death/suicide
DSM-V Criteria for Major Depressive Disorder?
PPP: Mania + Depression (Although, depression is not a requirement for diagnosis)
Lecture:
- Alternating mania/depression
- 90% are hospitalized
- Depression 3x more frequent than mania
DSM-V Criteria for Bipolar I Disorder?
Alternating Hypomania + Depression
DSM-V Criteria for Bipolar II Disorder?
Difference between mania and hypomania for Bipolar I and Bipolar II disorders
Mania: Abnormal and persistently elevated, expansive, or irritable mood at least 1 week (or less if
hospitalization required) with marked impairment of social/occupational function
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