Week 13

Question 1

Dx criteria for anorexia nervosa

• associated with?
• most commonly seen in?
• comorbid conditions

Answer 1

• excessive dieting w/ or w/out purging
• body weight <85% ideal body weight

Associated with

• decreased bone density
• severe weight loss
• metatarsal stress fractures
• amenorrhea
• electrolyte disturbance

Mostly in females

Commonly coexists with depression

Question 2

Dx criteria for bulimia nervosa

• associated with
• most commonly seen in?

Answer 2

• binge +/- purging
• often followed by self induced vomiting or use of laxatives or emetics
• B.W. in normal range
• binge eating + inappropriate compensatory behavior occur at least 2x/week for 3 months

Associated with

• parotitis
• enamel erosion
• electrolyte disturbance
• alkalosis
• dorsal hand calluses from induced vomiting

ADOLESCENT GIRLS

Question 3

Definition of binge

Answer 3

(1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
(2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

Question 4

Alteration of which NT fx contributes to dysregulation of appetite, mood, and impulse control in AN and BN.

Answer 4

brain serotonin

Question 5

Best tx for

1. AN
2. BN

Answer 5

AN - family based tx

BN - CBT

Question 6

Only drug approved by FDA for BN

Drugs that are beneficial for AN

Answer 6

BN - fluoxetine (good for acute) = SSRI

AN - atypical antipsychotics except ziprasidone b/c it prolongs the QT interval

Question 7

Which antidepressant is contraindicated in BN tx and why?

Answer 7

Bupropion - inc risk of seizure

Question 8

DSM-IV-TR criteria for intermittent explosive disorder (3)

Answer 8

A. Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.

B. The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.

C. The aggressive episodes are not better accounted for by any other mental disorder (e.g. Antisocial PD, Borderline PD, Conduct Disorder, ADHD, a Manic Episode, a Psychotic Disorder), are not due to the direct physiological effects of a substance, or a general medical condition (e.g. head trauma, Alzheimer’s disease).
What you see: a pattern of aggressive behavior & over-reacting.

Question 9

Kleptomania DSM-IV-TR

Answer 9

Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.
A. Increasing sense of tension immediately before committing the theft.

B. Pleasure, gratification, or relief at the time of committing the theft.

C. The stealing is not committed to express anger or vengeance and is not in response to a delusion or hallucination.

D. The stealing is not better accounted for by Conduct Disorder, a Manic Episode, or Antisocial Personality Disorder

Question 10

Pyromania DSM-IV-TR

Answer 10

A. Deliberate and purposeful fire setting on more than one occasion.

B. Tension or affective arousal before the act.

C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g. paraphernalia, uses, consequences).

D. Pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath.

E. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment (e.g. in dementia, Mental Retardation, Substance Intoxication)

F. The fire setting is not better accounted for by Conduct Disorder, a Manic Episode, or Antisocial Personality Disorder

Question 11

Pathological gambling DSM-IV-TR

Answer 11

A.
Persistent and recurrent maladaptive gambling behavior as indicated by 5 or more of the following:

1) Is preoccupied with gambling (e.g. reliving past gambling experiences, planning the next venture, thinking of ways to get money to gamble with)
2) Needs to gamble with increasing amounts of money to achieve the desired excitement
3) Has repeated unsuccessful efforts to control, cut back, or stop gambling
4) Is restless or irritable when attempting to cut down or stop gambling
5) Gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g. feelings of helplessness, guilt, anxiety, depression
6) After losing money gambling, often returns another day to get even (“chasing” one’s losses)
7) Lies to family members, therapist, or others to conceal the extent of involvement with gambling
8) Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling
9) Relies on others to provide money to relieve a desperate financial situation caused by gambling

B. The gambling behavior is not better accounted for by a Manic Episode

Question 12

Trichotillomania: DSM-IV-TR Criteria

Answer 12

A. Recurrent pulling out of one’s hair resulting in noticeable hair loss

B. An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior

C. Pleasure, gratification, or relief when pulling out the hair

D. The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g. a dermatological condition)

E. The disturbance causes clinically significant distressor impairment in social, occupational, or other important areas of functioning

equal in males and females

Question 13

Most common comorbidity with anxiety disorders (2)

Answer 13

Depression and substance abuse

Question 14

Panic disorder and generalized anxiety disorder linked with dysregulation of?

Answer 14

brain noradrenergic system

-fear and stress response

Question 15

OCD linked with dysregulation of

Answer 15

serotonergic transmission

Question 16

Dx criteria for PD (PANICS)

Answer 16

Need one of the following for one month

• persistent concern about having more attacks
• worry about implication of attacks
• change in behavior due to attacks

Defined by presence of recurrent periods of intense fear and discomfort peaking in 10 min with at least 4 of the following:

• Palpitations
• Paresthesias
• Abdominal distress
• Nausea
• Intense fear of dying or losing control
• LIght headedness
• Chest pain
• Chills
• Choking
• disConnectedness
• Sweating
• Shaking
• Shortness of breath

Question 17

Tx for panic disorder

Answer 17

• CBT
• SSRIs
• Venlafaxine (SNRI)
• benzos

Question 18

Dx criteria for GAD

Answer 18

• Unrealistic or excessive worry about 2+ life circumstances for AT LEAST 6 months
• Anxiety is difficult to control
• Physical component

Question 19

Tx for GAD

Answer 19

Antidepressants
-SSRis, SNRIs

Buspirone 
o	FDA approved for GAD
o	Agonist at 5-HT type 1a receptors 
o	More specific target than SSRIs
o	Fewer side effects but takes time to work 

Benzos

CBT

Question 20

3 classes of phobias

Answer 20

1. Agoraphobia
   o Fear of being outside of home
   o CBT and behavior mods to tx
2. Social anxiety disorder
   o Fear of 1+ social or performance situations
   o Anxiety is out of proportion to actual threat
   o Situation is avoided
   o Interferes with person’s life
   o Comes on in adolescence
   o Equal in males and females

o	Treatment
• CBT
•	Antidepressants 
•	SSRIs and MAOIs 
•	Beta blockers 
• Public speaking phobias 
•	Can take it before speaking to block some of the effects that come on 
o	Reduce anxiousness b/c they know that people can’t see how anxious they are (outward signs reduced)

3. Specific phobia 
o	Everything else 
o	Same criteria as others 
o Treatment
•	Behavior mods 
•	Exposure training 
•	Systematic desensitization 

• Antidepressants
• SSRIs – paroxetine, sertraline
• SNRI – venlafaxine

Question 21

PTSD dx requires disturbances to last greater than

Answer 21

1 month

Question 22

Areas of brain involved with OCD

Answer 22

• Orbitofrontal cortex
• Prefrontal cortex
• Caudate nucleus
• Frontal-striatal-thalamo-frontal loop that’s dysregulated
• In extreme cases, can do surgery to disrupt this loop

Question 23

Tx for OCD

• pharm, psychotx, extreme cases
• for refractory OCD?

Answer 23

Pharm
o SSRIs
o Augmentation strategies
o One TCA (clomipramine) good for refractory OCD

Psychotx
o CBT

Extreme cases
o Cingulotomy
o DBS