Psychiatric Disorders and Treatments, Exams of Psychiatry

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CAM 3 Psychiatry

What is the 1st line tx option for seasonal affective disorder? - ANS SSRIs What med has a specific indication for seasonal affective disorder? - ANS Bupropion (Wellbutrin) True/False 20-25% of the population will experience anxiety disorders. - ANS true - super common! What is the median age of onset for anxiety disorders? - ANS 12 y/o How long must a pt have sx to be diagnosed w generalized anxiety disorder? - ANS 6 months What questionnaire/scale is most commonly used in primary care for generalized anxiety disorder? - ANS GAD- What is the 1st line tx for generalized anxiety disorder? - ANS SSRIs --> Escitalopram, citalopram, Sertraline, Paroxetine & SNRIs almost always going w an SSRI Which antidepressant should be avoided in the tx of generalized anxiety disorder & why? - ANS Bupropion bc it is very stimulating & can worsen anxiety

What med can be added on to SSRIs short term while waiting on the effects to kick in for pts w generalized anxiety disorder? - ANS benzos --> given for 1-2 weeks just to get em going What anxiolytic drug can be given to pts w generalized anxiety disorder as monotherapy or adjunct therapy? - ANS Buspirone (Buspar) True/False Benzodiazepines can be used long term for generalized anxiety disorder bc it is the most effect tx option.

• ANS false - only for short term use! 35-year-old female with a complaint of worry which she cannot control for the last year. She tells you that her symptoms daily consisting of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 17 but have worsened. What is your most likely dx & 1st line tx option? - ANS generalized anxiety disorder SSRI or SNRI Which of the following symptoms is generally not characteristic of GAD? A - awakening with apprehension and unrealistic concern about future misfortune B - worry out of proportion to the likelihood or impact of feared events C - a 6-month or longer course of anxiety and associated symptoms D - association of the anxiety with depression E - anxiety exclusively focused on health concerns - ANS E - anxiety exclusively focused on health concerns What is the psychotherapy of choice for this GAD? A - cognitive-behavioral therapy (CBT) B - hypnosis

C - supportive psychotherapy D - psychoanalytic psychotherapy E - none of the above - ANS A - cognitive-behavioral therapy (CBT) Which of the following pharmacologic agents is not recommended in the treatment of GAD? A - venlafaxine B - buspirone C - benzodiazepines D - selective serotonin reuptake inhibitors (SSRIs) E - clozapine - ANS E - clozapine When is the average age of onset for panic disorder? - ANS 22 y/o How long do sx of worry following a panic attack have to persist to be diagnosed w panic disorder? - ANS 1 month What is the DSM 5 criteria for diagnosing panic disorder? - ANS 1 month of worry after 1+ panic attack(s)

4 related sx --> SOB, palpiations, chest discomfort, GI upset, sweating, chills, dizziness, & more What is considered first line in the long term treatment of panic disorder A - Benzodiazepines B - TCAs C - SSRIs D - Wellbutrin - ANS C - SSRIs

30-year-old male who arrives at your ED in distress stating that he had " a heart attack." The event started suddenly and was associated with diaphoresis, chest pain, tachycardia, and tachypnea. Troponins and ECG are within normal limits. Upon further questioning, he reports some numbing around his lips and that he has such episodes every few days for the past three months. The attacks have become so severe that he has been missing work and didn't go to last week's Christmas party. He denies recreational or illicit drug use. He further shares that he recently divorced and has had no social support. Recent lab results have all been normal or within standard limits, including TSH and vitamin B12. What is your pt's most likely dx? - ANS panic disorder ___________ is fear or anxiety regarding places from which escape may be difficult. - ANS agoraphobia What is the most disabling phobia bc it commonly interferes w life & work? - ANS agoraphobia How long must sx persist to be dx w agoraphobia? - ANS 6+ months How long must sx persist for any type of phobia to be diagnosed according to DSM 5? - ANS 6+ months __________ is fear of social situations or situations involving scrutiny or involvement w strangers. - ANS social anxiety disorder (social phobia) How long must sx persist to make a dx of social anxiety disorder? - ANS 6+ months 21 y/o female presents to your office stating she is going to drop out of college. Pt states that for the last 8 months, she has been experiencing such crippling anxiety about going to class due to the fear of being scrutinized by classmates & professors. It has become so bad that she avoids going to class so she does not have to feel that degree of anxiety. What disorder does your pt most likely have? - ANS social anxiety disorder What is the 1st line tx for panic disorder? - ANS SSRIs

What med can be added on to SSRIs on a prn basis for panic disorder? - ANS beta blockers --> Propranolol What role does benzodiazepines play in the tx of panic disorder? - ANS short term or occasional use for severe sx What is the 1st line tx for social anxiety disorder? - ANS psychotherapy w CBT What is the 1st line tx specific phobias? - ANS systematic desensitization exposure them little by little You are managing a 25 y/o female w a severe agoraphobia. You are working on systematic desensitization as her primary tx, but would like to add on a prn med that can be used 1 hr prior to exposure to help ease this process. What med may this be? - ANS Propranolol 20-40 mg What antihistamine can be used when treating panic disorder? - ANS hydroxyzine A 50-year-old male presents to your clinic complaining of intense fear of snakes for 2 years. Whenever he sees a picture of snakes or hears someone talking about snakes, he gets diaphoretic, nervous, and has an intense sense of doom. Which of the following is the first-line treatment for his most likely diagnosis? A - Benzodiazepines B - Propranolol C - Exposure therapy D - SSRIs - ANS C - Exposure therapy

OCD has a high comorbidity w what mood disorder? - ANS major depressive disorder What meds can be used to manage OCD? - ANS SSRIs --> higher dose than norm or Clomipramine (TCA) What type of therapy is used for pts OCD? - ANS exposure & response prevention --> gradually exposure pt to feared situations or CBT 26-year-old PA student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette's syndrome. What disorder does your pt most likely have? - ANS OCD Obsession = fear of failing Compulsion = waking up to check book A 17-year-old boy feels compelled to walk around the house 12 times before leaving "to keep his family safe." What other psychological phenomenon might be seen in this patient? A - Auditory hallucinations B - Visual hallucinations

C - Night terrors D - Vocal tics E - Cataplexy - ANS D - Vocal tics this pt has OCD & neuro abnormalities like tics are common An 11-year-old girl is brought into the clinic by her parents, who are distraught over her behavior. They state that over the past several months she has started to act oddly, combing the hair of her toy dolls for hours without stopping and repetitively counting her steps in the house. She is often brought to tears when confronted about these behaviors. The patient has no past medical history. The patient's vital signs are all within normal limits. On physical exam, the patient is a well-nourished 11-year-old girl in no acute distress. She has occasional motor tics, but the remainder of the exam is benign. What is the diagnosis in this patient? A - Autism spectrum disorder (ASD) B - Generalized anxiety disorder (GAD) C - Obsessive compulsive disorder (OCD) D - Tourette's syndrome E - Major depressive disorder (MDD - ANS C - Obsessive compulsive disorder (OCD) __________ is persistent difficulty discarding or parting with possessions, regardless of their actual value

• ANS hoarding Hoarding, trichotillomania, excoriation disorder, body dysmorphic disorder are all part of ________ associated disorders? - ANS OCD associated disorders 25 y/o is presents to your office by her mom who is concerned about her recent behaviors. The mom states that her daughter has been collecting "useless items" in her apartment over the last yr. When she tried to persuade her daughter to throw away several years' worth of old newspapers, her daughter had an angry outburst and refused to speak to her for two weeks. The patient reluctantly admits that she

keeps "most things just in case they become useful later on." She also states that she has felt less interested in seeing friends because she does not want them to come over to her apartment. She has also not been sleeping well, as her bed has become an additional storage space and she must sleep on her futon instead. The patient states that she is frustrated with herself and feels hopeless, and she sometimes wishes she were "away from all of this," but she cannot control her behaviors. What disorder does your pt have? - ANS hoarding disorder ___________ is repetitive pulling of one's hair despite desire to stop. - ANS trichotillomania In pts w trichotillomania, where do they most commonly pull hair from? - ANS scalp, eyebrows, eyelashes, beard What other conditions often co-exists w trichotillomania? - ANS major depressive disorder excoriation disorder 15 y/o girl who is brought to your office by her mother. The patient has no prior medical history, but after having been in a car accident, she started pulling her hair out. Pt is embarrassed of this & states she has tried to stop, but cannot control it. What disorder does your pt most likely have? - ANS trichotillomania __________ is distressing and recurrent compulsive picking of the skin resulting in skin lesions. - ANS excoriation disorder What is the most common location on the body for pts w excoriation disorder to pick at? - ANS face Excoriation disorder often co-exists w what other disorders? - ANS OCD trichotillomania

MDD

25-year-old male PA student presents to student health with a chief complaint of picking at his skin. He states that at times he has urges to pick his skin that he struggles to suppress. Typically, he will participate in the act during finals or when he has "too many assignments to do." The patient states that he knows that his behavior is not helping his situation and is causing him harm; however, he has trouble stopping. On physical exam, you note a healthy young man with scars on his arms and face. His neurological exam is within normal limits. What disorder does your pt have? - ANS excoriation disorder __________ is preoccupation with an imagined defect in physical appearance/exaggerated distortion of a minor flaw. - ANS body dysmorphic syndrome In pts w body dysmorphic syndrome, what location on the body is the most common focus of concern? - ANS the face 24 y/o male with a history of acne is at your office for concerns of acne scarring on his face. On exam, you notice very few scattered pustules but no noticeable scarring. You recommend he use topical benzoyl peroxide cream and send him home. The patient returns for follow-up three months later this time very concerned. He reports that he is having trouble sleeping at night because of concern over his appearance, he feels people are staring at him because of his acne, he is very self-conscious, he has been avoiding social events, and has trouble approaching girls. He is having trouble concentrating in class and it is now affecting his grades. He washes his face at least 6 times per day and admits to spending several hours each day in front of the mirror. Again on the exam, you notice only very mild comedomes but no visible scarring. What disorder does your pt have? - ANS body dysmorphic syndrome How do you manage OCD associated disorders? (hoarding, trich, body dysmorphic, & excoriation) - ANS SSRIs & CBT

_____________ is characterized by the incongruence of a pts gender identity & their external sexual anatomy at birth. - ANS gender dysphoria How long must sx persist to be diagnosed w gender dysphoria? - ANS 6+ months Which disorder is characterized by intense fear or scrutiny or embarrassment and avoidance of social situations? - ANS social anxiety disorder __________ is loss of contact w reality & includes hallucinations, delusions, disorganized thoughts and/or behavior. - ANS psychosis How long do sx have to persist to be dx w schizophrenia? - ANS 6+ months How long do sx have to persist to be dx w schizophreniform disorder? - ANS 1-6 months How long do sx have to persist to be dx w brief psychotic disorder? - ANS < 1 month When is schizophrenia most commonly diagnosed? - ANS MEN = 18- WOMEN = 25- RARELY going to dx this in peds pts or pts > 45 What are some examples of positive sx associated w schizophrenia? - ANS hallucinations delusions

disorganized thinking, speech, & behavior What are some examples of negative sx associated w schizophrenia? - ANS apathy blunt affect social withdrawal anhedonia What are some examples of cognitive dysfunction sx associated w schizophrenia? - ANS deficits in memory or attention reasoning & prob solving decreased IQ slower processing speeds __________ are false, fixed beliefs not held by others. - ANS delusions ___________ are false sensory perceptions that seem convincingly real despite lack of external stimulus.

• ANS hallucinations ____________ are misperceptions of real eternal stimulus. - ANS illusion

What is the most common type of hallucination associated w schizophrenia? - ANS auditory True/False 70% of pts w schizophrenia experience hallucinations. - ANS true __________ delusion is the belief that one is carrying a severe disease or other malfunction not supported by medical evidence. - ANS somatic delusion can be seen w schizo What objective rating scales can be used to help make a dx & determine the severity of schizophrenia? - ANS PANSS - positive & negative syndrome scale BPRS - brief psychiatric rating scale In order to make a dx of schizophrenia, you must have 1 of what 3 findings? - ANS delusions hallucinations disorganized speech What are the 3 phases of schizophrenia? - ANS 1. prodromal phase

2. active phase
3. residual phase

What is the #1 target for treatment of schizophrenia? - ANS positive sx --> delusions, hallucinations, disorganization What is the tx of choice for schizophrenia? - ANS 2nd generation antipsychotics used in crisis & maintenance What is the 1st line tx for psychosis related to schizophrenia? - ANS 2nd gen antipsychotics --> Ariprprazole or Risperidone pref How do you manage acute phase schizophrenia when psychotic symptoms are fully expressed? - ANS 1. Hospitalize

2. SGAs --> Ziprasidone, Aripiprazole, Olanzapine injectable +/- Benzos & Diphenhydramine What is the most effective drug for acute schizophrenia? Why is it not used as 1st line? - ANS Clozapine Risk of neutropenia What med is a good option for schizophrenia pts w suicidal or self injurious behavior? - ANS Clozapine What is the most common form of EPS associated w schizophrenia? - ANS akathisia --> feeling of restlessness

What are some extrapyramidal (EPS) sx associated w antipsychotic use? - ANS akathisia parkinsonism dystonia After the 1st acute psychotic episode for schizophrenia, how long does a pt need to remain on antipsychotics? - ANS min 2-3 years 26-year-old male presents with 'voices in my head." The patient was well until 8 months ago when he began to hear voices of two men plotting to kill him. His fear of being killed has resulted in his missing multiple days of work, and he was recently fired. On physical exam, he is disheveled and has incoherent, disorganized speech. What disorder does your pt most likely have? - ANS schizophrenia Which of the following is the most appropriate management of acute psychosis in a patient with schizophrenia? A - Amitriptyline (Elavil) B - Olanzapine C - Lithium (Eskalith) D - Sertraline (Zoloft) - ANS B - Olanzapine Pts w schizophrenia have a 20% shorter life expectancy. What are they more at risk of compared to the normal population? - ANS Suicide Accidents Poor physical health

Alcohol & drug abuse HIGH rates of chronic heavy smoking After the 1st acute psychotic episode of schizophrenia, pts must stay on antipsychotics for 2-3 years. Why do providers often try to take them off of the meds at this point? - ANS do not want them on SGAs forever if you can avoid it bc increased risk of metabolic & cardiovascular shit Which of the following seems to be the only effective tx for pts who have failed tx w a conventional antipsychotic or a 2nd gen antipsychotic therapy for schizophrenia? - ANS clozapine _________ disorder has features of both schizophrenia & mood disorders. - ANS schizoaffective disorder How does schizoaffective disorder differ from schizophrenia? - ANS occurrence of 1+ episode of depression or mania in a person's life To make a dx of schizoaffective disorder, significant mood sx (depression/mania) must be present > _____ % of the total duration of illness. - ANS > 50% How do you differ between schizoaffective disorder and other mood disorders like MDD or Bipolar? - ANS schizoaffective must have at least 2 weeks of psychotic episodes w/out mood sx What are the 2 subtypes of schizoaffective disorder? - ANS depressive & bipolar How do you tx a pt w depressive schizoaffective disorder? - ANS SGAs

Antidepressant (SSRI)

Psychotherapy How do you tx a pt w bipolar type schizoaffective disorder? - ANS SGAs

Mood stabilizers

Antidepressant (IF depressive sx present)

Psychotherapy You have a pt w depressive schizoaffective disorder & are initiating tx. When do you want to start antidepressants in this pt? - ANS once positive psychotic sx are stabilized hallucinations, delusions, etc 45-year-old truck driver who c/o hearing things that are not there for 2 weeks. He reports that he was severely depressed 5 months ago and was placed on Prozac by his PCP. His depression got better and he was "fine" until 2 weeks ago when he started to "hear things." His work and social life are not impaired by the hallucinations at this time. His friend was diagnosed with schizophrenia a few years ago and he was afraid that he now has schizophrenia. What does your pt most likely have? - ANS schizoaffective disorder (depressive type) How long must sx persist to make a dx of schizophreniform disorder? - ANS > 1 month but < 6 months How do schizophreniform & schizophrenia differ? - ANS ONLY differ based on duration of sx

Schizophreniform = > 1 month but < 6 months Schizophrenia = > 6 months 60-80% of pts w schizophreniform later develop into what? - ANS schizophrenia How long do you keep a pt w schizophreniform on antipsychotics for? - ANS til sx go away + 12 months How long do sx associated w brief psychotic disorder persist? - ANS < 1 month --> followed by complete remission __________ disorder is sudden onset of psychotic behavior that lasts < 1 month & is followed by complete remission. - ANS brief psychotic disorder 29 y/o male presents to clinic w his wife bc she thinks he went crazy. Wife states that pt woke up one day & was experiencing hallucinations & delusions. She thought he was having a stroke originally so she brought him to the ER, but everything came back normal & he was discharged. Wife states pt has diagnosed OCD, but it is well controlled & has never had sx like this associated w it. This behavior continued for 3 weeks, but then just stopped & now he is completely back to normal. Wife states she drug tested her husband every single day during this bc she did not trust him, but it came back normal every single time. What do you think was going on w your pt? - ANS brief psychotic disorder psychotic sx for > 1 day but < 1 month Brief psychotic disorder is often associated w what other psych condition? - ANS personality disorders Who do you generally see brief psychotic disorder in? - ANS Young pts --> 20-30s

Female > Male How do you manage a pt w brief psychotic disorder? - ANS combo of pharm (SGAs) & psychosocial intervention 75-year-old woman has been receiving 24-hour care at home due to a fall risk. She has a history of severe diabetic neuropathy, and as a result, she is unstable on her feet. Two months ago, she began thinking that her daughter was telling her caretakers to steal her money, although both her daughter and the caretakers deny this. She continues to maintain an active social life, and cognitive testing shows no new deficit. She denies auditory and visual hallucinations and feeling like people are "out to get her." What is your most likely dx? - ANS delusional disorder these delusions are false, but reasonable ... How long must sx persist to be dx w delusional disorder? - ANS > 1 month What type of delusions occur w delusional disorder? - ANS non-bizzare delusions --> meaning they are false, but realistic True/False Pts w delusions disorder are disheveled & experience significant functional impairments. - ANS false - these pts are pretty normal except for their delusional beliefs ____________ delusions are when a pt believes that another person, often of higher status, is in love w them. - ANS erotomanic _________ delusions is when a pt believes they have some physical disorder that they do not actually have. - ANS somatic

A 40-year-old man presents to the psychiatric clinic with a 3-month history of believing that his spouse is being unfaithful, despite no evidence to support this belief. He has no history of hallucinations, and his functioning at work and socially has not been significantly affected. Which of the following is the most likely diagnosis? A - Schizophrenia B - Bipolar disorder with psychotic features C - Delusional disorder D - Major depressive disorder with psychotic features E - Obsessive-compulsive disorder - ANS C - Delusional disorder reasonable delusion + > 1 month + lack of functional impairments Which of the following treatment approaches is most appropriate for a patient diagnosed with delusional disorder? A - High-dose antipsychotic medication as first-line treatment B - Cognitive-behavioral therapy (CBT) targeting delusional beliefs C - Immediate hospitalization in all cases D - Electroconvulsive therapy (ECT) E - Lifestyle modifications and dietary changes - ANS B - Cognitive-behavioral therapy (CBT) targeting delusional beliefs What are the mainstays of tx for acutely psychotic pts who are agitated or violent? - ANS antipsychotics & benzos Ex: haldol + lorazepam

23-year-old male with c/o visual & auditory hallucinations that have been ongoing for 2 months. He is a graduate student at a local university, and he states that his hallucinations have been getting worse. He is still able to attend classes, but it is becoming more difficult to focus in class. His father was diagnosed with schizophrenia when he was about his age. He is currently taking no medications. His labs and imaging are all within normal range. What does your pt most likely have? - ANS schizophreniform disorder does not meet dx for schizophrenia yet bc < 6 months A 20-year-old female presents to the emergency room via ambulance. She was found by the police walking naked in the woods behind her home. Her speech displays minimal thoughts and is disorganized and she appears to be responding to internal stimuli. Further questioning reveals she feels that she is being watched by aliens. Her family provided further history that she has been acting bizarre for 2 months now. What is the most likely diagnosis? A - Schizophrenia B - Schizophreniform disorder C - Schizoaffective disorder D - Schizotypal personality disorder - ANS B - Schizophreniform disorder

1 month but < 6 month 27 y/o female is brought into the hospital by husband after he caught her trying to drown their newborn baby. Pt is 3 weeks postpartum from her 3rd child. Husband states she has been acting really strange for the last week so, but never was like this w previous pregnancies. On exam, you realize the pt is experiencing hallucinations, delusions, & appears unaware of her most recent actions. Given your most likely dx, how are you going to manage this pt? - ANS post partum psychosis

1. ADMIT

2. Meds --> SGA + Lithium ____________ is all of the characteristics that distinguish a continually developing, self organizing human being from a predictable machine like object. - ANS personality _________________ is a defense mechanism in response to stress that attempts to change the external environment. Ex: threats & manipulation - ANS alloplastic defenses _______________ is a defense mechanism in response to stress that attempts to change internal psychological processes. - ANS autoplastic defenses ____________ is where a character deficits perceived by the pt as objectionable, distressing, or inconsistent to self. - ANS ego dystonic ___________ is when the character trait is acceptable/consistent w self & the pt tends to blame others for problems. - ANS ego syntonic common to see w personality disorders ___________ is a defense mechanism where the pt uses abstract thinking or generalizations to minimize disturbing feelings. - ANS intellectualization think of this as rationalizing your feelings

____________ is a defense mechanism where a pt deals w conflict by falsely attributing feelings, impulse, or thoughts to another person. - ANS projection 25 y/o male is really angry w his therapist bc she forces him to talk about things he does not want to talk about. He calls out the therapist & accuses her of being angry w him. What type of defense mechanism is this pt using to cope w his feelings? - ANS projection What personality disorders fall under cluster A? - ANS paranoid schizotypal schizoid Which cluster of personality disorders can be described as "odd & eccentric"? What disorders fall under this category? - ANS cluster A paranoid, schizotypal, schizoid 33 y/o female says that her coworkers are planning to have her fired and they often ridicule her when she is not there. She is attempting to pursue legal action to get her coworkers reprimanded for this behavior as she knows that they have an intention to harm her in some way. Co-workers state that they have no idea what she is talking about & that they have only offered to help her in her work. When you look at the pt's file, you find she has made similar complains at 4 previous jobs. Given this info, what personality disorder does this pt most likely have? - ANS paranoid personality disorder How do you manage a pt w paranoid personality disorder? - ANS Supportive psychotherapy --> improve insight & sx management strategies SGAs IF pt has paranoid delusions

A patient, Mr. Smith, has been exhibiting signs of paranoid personality disorder. He frequently accuses his coworkers of conspiring against him, believes that his neighbors are spying on him, and is convinced that his spouse is cheating on him without any substantial evidence. During the clinical interview, Mr. Smith displays a pervasive distrust and suspiciousness of others, interpreting their motives as malevolent. Which of the following findings is most consistent with a diagnosis of paranoid personality disorder in Mr. Smith? A) Mr. Smith has a history of brief psychotic episodes where he hears voices telling him what to do. B) Mr. Smith has thought content that shows evidence of projection and prejudice. C) Mr. Smith has a tendency to engage in risky behaviors without considering the consequences, often leading to legal issues. D) Mr. Smith has good insight and agrees her needs therapy. - ANS B) Mr. Smith has thought content that shows evidence of projection and prejudice. Who is schizoid personality disorder most common in? - ANS males True/False Pts w schizoid personality disorder often experience psychosis which can be managed w SGAs. - ANS false - they do NOT experience frank psychosis 50 y/o male who lives alone in a cabin on several acres of land. He rarely interacts with his family or community other than when he comes to town once a month to pick up supplies. According to his family, pt has always preferred to be alone & has never had any meaningful romantic or friendly relationships. Pt has held the same job for the last 10 years doing remote IT work where he does not have to interact w other people. When asked about his behavior, he does not seem to understand what is wrong w it & is content the way he is. What personality disorder does your pt most likely have? - ANS schizoid personality disorder True/False Pts w schizoid personality disorder have a hard time making meaningful relationships, but desire them greatly. - ANS false - prefer to be alone & are unbothered by it

Ms. Johnson prefers solitary activities, rarely seeks out social interactions, and appears indifferent to the praise or criticism from others. Ms. Johnson often seems aloof and detached in social situations and has difficulty expressing emotions. Which of the following findings is most consistent with a diagnosis of schizoid personality disorder in Ms. Johnson? A) Ms. Johnson frequently experiences illusions and has a rich fantasy life where she interacts with imaginary friends. B) Ms. Johnson has a long-standing pattern of being indifferent to social relationships and finds little pleasure in activities. C) Ms. Johnson has a tendency to engage in impulsive behaviors and lacks empathy for others, often leading to interpersonal conflicts. D) Ms. Johnson has a history of significant mood swings, alternating between periods of intense euphoria and deep depression. - ANS B) Ms. Johnson has a long-standing pattern of being indifferent to social relationships and finds little pleasure in activities. True/False Meds can be really helpful in treating schizoid personality disorder. - ANS false - only use for existing co- morbidities What is the primary tx for schizoid personality disorder? - ANS CBT What behavior would be most typical for a patient diagnosed with schizoid personality disorder? A - Chooses solitary activities B - Odd thinking and speech C - Reckless disregard for safety of others D - Uses physical appearance to draw attention - ANS A - Chooses solitary activities Pts w schizotypal are at an increased risk of developing what? - ANS schizophrenia

Which personality disorder is associated w social ineptness, as well as odd & magical thinking? - ANS schizotypal personality disorder Which cluster A personality disorder may experience brief psychotic sx like hallucinations when under stress? - ANS schizotypal personality disorder 15 y/o male pt is brought into clinic by mom. Mom states her son has always been an odd child & has difficulties making friends. Pt likes to spend a great deal of time alone in his room playing on-line games. Upon questioning, you realize pt is very superstitious & has odd, magical thought content. Pt further admits to having episodes of hearing ghosts when he get stressed out. What personality disorder do you think this pt has? - ANS schizotypal 27 y/o female has recently quit her job in order to start a small business. She claims that the spirits have told her to sell trinkets each of which has a unique power. She is known for dressing oddly and due to her strange behavior has trouble making friends. Which personality disorder does your pt most likely have? A - Schizoid B - Paranoid C - Schizotypal D - OCD - ANS C - Schizotypal What mood disorder commonly co-exits w schizotypal personality disorder? - ANS depression What type of therapy is a good option for pts w schizotypal personality disorder? - ANS group or individual