FINAL EXAM NU 664 SET 1
QUESTIONS AND CORRECT
ANSWERS
Although its efficacy in treating major depressive disorder is not as well researched as these three
therapies, psychoanalytically oriented psychotherapy ANSW✅✅has long been used for depressive
disorders, and many clinicians use the technique as their primary method.
What differentiates the three short-term psychotherapy methods from the psychoanalytically
oriented approach are the ANSW✅✅active and directive roles of the therapist, the directly
recognizable goals, and the end points for short-term therapy.
·Obsessive and compulsive/Anxiety/trauma and stress related disorders
Diagnostic criteria ANSW✅✅Obsessions (thoughts) or Compulsions (behaviors) or both
The thoughts are often intrusive and unwanted and cause distress; not usually involving real-world
worries
The behaviors are repetitive and an attempt to suppress / cope with / eliminate the thoughts
Time consuming
Common obsessions include: worries about contamination, repeated doubts, need to have things in
a specific order, aggressive or horrific thoughts, may occur during pregnancy as intrusive thoughts
about baby that are ego-dystonic and sexual imagery
· Obsessive and compulsive/Anxiety/trauma and stress related disorders screening tools, assessment
acronyms ANSW✅✅Yale-Brown Obsessive-Compulsive Scale (YBOCS)
10-items
10-15 mins completion time
Standard instrument used in virtually every drug trial and can be used to monitor treatment
Obsessive and compulsive/Anxiety/trauma and stress related disorders ANSW✅✅Body
Dysmorphic Disorder
ED
Trichotilomania
Hypochondriasis
,OC Personality D/O
Tic or ST movement disorder
Obsessive and compulsive/Anxiety/trauma and stress related disorders basic neuroscience (brain
areas related to fear/anxiety) ANSW✅✅Lack of efficient processing in OFC and lack of cognitive
flexibility
Brain areas related to fear/anxiety include:
Cortico-striatao-thalamo-cortico (CSTC) pathway r/t obsessions
Amygdala - traumatic memories of the hippocampus can activate the amygdala
HPA axis - cortisol levels
Feelings of fear regulated by connections between amygdala and ACC and amygdala and OFC
Obsessive and compulsive/Anxiety/trauma and stress related disorders epidemiology
ANSW✅✅Fairly consistent rates, lifetime prevalence in GO 2-3% to 10% of outpatients in clinics
OCD the 4th most common d/o
Equal rates in adult men / women w/ mean age of onset about 20 years
More common among adolescent boys than girls
More common among singles than married ind
Less often among blacks than whites
Obsessive and compulsive/Anxiety/trauma and stress related disorders onset, progression
ANSW✅✅Mean age of onset about 20 years
Most have onset before age 25, less have onset over age 35 years
Can occur in adol and childhood as early as age 2 years
High comorbidity with depression (about 67%)
Obsessive and compulsive/Anxiety/trauma and stress related disorders etiology
ANSW✅✅Biological factors: Serotonin more likely involved as SSRIs more effective in tx; NE less
involved although given clonidine's efficacy NE may be partially involved as clonidine lowers NE
amount released from PreS neurons.
Genetics: 3-5 fold higher probability if familial link
, Obsessive and compulsive/Anxiety/trauma and stress related disorders pharmacological treatment
ANSW✅✅SSRIs, clomipramine, and if needed augment with Depakote, lithium, tegretol
Buspar, Effexor, pindolol
Among children, sertraline + therapy more effective than either alone
CBT should be tried prior to initiation of meds
For children: FDA approved (at least 6 yrs), sertraline
Fluoxetine (at least 7)
Fluvoxamine (at least 8)
Clomipramine (at least 10) (first anti-dep studied and only TCA FDA approved for tx of anxiety d/os in
children, but not rec as first line due to SE profile as compared to other SSRIs
Obsessive and compulsive/Anxiety/trauma and stress related disorders therapeutic treatment
ANSW✅✅Behavior therapy, exposure, desensitization, flooding, aversion, thought stopping,
implosion therapy, resolving underlying aggressive impulses, ECT, DBS
Serotonin syndrome ANSW✅✅Migraines, myoclonus, agitation and confusion on the mild side to
hyperthermia, seizures, coma, cardiovascular collapse, permanent hyperthermic brain damage and
even death on the severe end
PANS ANSW✅✅a clinical diagnosis given to children who have a dramatic - practically overnight -
onset of neuropsychiatric symptoms including Obsessive Compulsive Disorder (OCD) and/or eating
disorder
PANDAS ANSW✅✅Pediatric Autoimmune Neuropsychiatric Disorders Associated with
Streptococcal Infections; this is a subset of PANS
In Obsessive and compulsive/Anxiety/trauma and stress related disorders it is wise to rule out
ANSW✅✅underlying medical disorders and tx of comorbid conditions - Hair pulling and skin
picking. Substance induced, depressive d/o
Major and Minor Neurocognitive Disorders ANSW✅✅Significant decline from previous level of
performance in one or more cognitive domains (complex attention, executive function, learning and
memory, language, perceptual-motor, or social cognition) based on:
a. Concern of the individual, a known informant, or clinician that has witnessed the decline
b. A substantial impairment in cognitive performance documented by neuropsychological testing
QUESTIONS AND CORRECT
ANSWERS
Although its efficacy in treating major depressive disorder is not as well researched as these three
therapies, psychoanalytically oriented psychotherapy ANSW✅✅has long been used for depressive
disorders, and many clinicians use the technique as their primary method.
What differentiates the three short-term psychotherapy methods from the psychoanalytically
oriented approach are the ANSW✅✅active and directive roles of the therapist, the directly
recognizable goals, and the end points for short-term therapy.
·Obsessive and compulsive/Anxiety/trauma and stress related disorders
Diagnostic criteria ANSW✅✅Obsessions (thoughts) or Compulsions (behaviors) or both
The thoughts are often intrusive and unwanted and cause distress; not usually involving real-world
worries
The behaviors are repetitive and an attempt to suppress / cope with / eliminate the thoughts
Time consuming
Common obsessions include: worries about contamination, repeated doubts, need to have things in
a specific order, aggressive or horrific thoughts, may occur during pregnancy as intrusive thoughts
about baby that are ego-dystonic and sexual imagery
· Obsessive and compulsive/Anxiety/trauma and stress related disorders screening tools, assessment
acronyms ANSW✅✅Yale-Brown Obsessive-Compulsive Scale (YBOCS)
10-items
10-15 mins completion time
Standard instrument used in virtually every drug trial and can be used to monitor treatment
Obsessive and compulsive/Anxiety/trauma and stress related disorders ANSW✅✅Body
Dysmorphic Disorder
ED
Trichotilomania
Hypochondriasis
,OC Personality D/O
Tic or ST movement disorder
Obsessive and compulsive/Anxiety/trauma and stress related disorders basic neuroscience (brain
areas related to fear/anxiety) ANSW✅✅Lack of efficient processing in OFC and lack of cognitive
flexibility
Brain areas related to fear/anxiety include:
Cortico-striatao-thalamo-cortico (CSTC) pathway r/t obsessions
Amygdala - traumatic memories of the hippocampus can activate the amygdala
HPA axis - cortisol levels
Feelings of fear regulated by connections between amygdala and ACC and amygdala and OFC
Obsessive and compulsive/Anxiety/trauma and stress related disorders epidemiology
ANSW✅✅Fairly consistent rates, lifetime prevalence in GO 2-3% to 10% of outpatients in clinics
OCD the 4th most common d/o
Equal rates in adult men / women w/ mean age of onset about 20 years
More common among adolescent boys than girls
More common among singles than married ind
Less often among blacks than whites
Obsessive and compulsive/Anxiety/trauma and stress related disorders onset, progression
ANSW✅✅Mean age of onset about 20 years
Most have onset before age 25, less have onset over age 35 years
Can occur in adol and childhood as early as age 2 years
High comorbidity with depression (about 67%)
Obsessive and compulsive/Anxiety/trauma and stress related disorders etiology
ANSW✅✅Biological factors: Serotonin more likely involved as SSRIs more effective in tx; NE less
involved although given clonidine's efficacy NE may be partially involved as clonidine lowers NE
amount released from PreS neurons.
Genetics: 3-5 fold higher probability if familial link
, Obsessive and compulsive/Anxiety/trauma and stress related disorders pharmacological treatment
ANSW✅✅SSRIs, clomipramine, and if needed augment with Depakote, lithium, tegretol
Buspar, Effexor, pindolol
Among children, sertraline + therapy more effective than either alone
CBT should be tried prior to initiation of meds
For children: FDA approved (at least 6 yrs), sertraline
Fluoxetine (at least 7)
Fluvoxamine (at least 8)
Clomipramine (at least 10) (first anti-dep studied and only TCA FDA approved for tx of anxiety d/os in
children, but not rec as first line due to SE profile as compared to other SSRIs
Obsessive and compulsive/Anxiety/trauma and stress related disorders therapeutic treatment
ANSW✅✅Behavior therapy, exposure, desensitization, flooding, aversion, thought stopping,
implosion therapy, resolving underlying aggressive impulses, ECT, DBS
Serotonin syndrome ANSW✅✅Migraines, myoclonus, agitation and confusion on the mild side to
hyperthermia, seizures, coma, cardiovascular collapse, permanent hyperthermic brain damage and
even death on the severe end
PANS ANSW✅✅a clinical diagnosis given to children who have a dramatic - practically overnight -
onset of neuropsychiatric symptoms including Obsessive Compulsive Disorder (OCD) and/or eating
disorder
PANDAS ANSW✅✅Pediatric Autoimmune Neuropsychiatric Disorders Associated with
Streptococcal Infections; this is a subset of PANS
In Obsessive and compulsive/Anxiety/trauma and stress related disorders it is wise to rule out
ANSW✅✅underlying medical disorders and tx of comorbid conditions - Hair pulling and skin
picking. Substance induced, depressive d/o
Major and Minor Neurocognitive Disorders ANSW✅✅Significant decline from previous level of
performance in one or more cognitive domains (complex attention, executive function, learning and
memory, language, perceptual-motor, or social cognition) based on:
a. Concern of the individual, a known informant, or clinician that has witnessed the decline
b. A substantial impairment in cognitive performance documented by neuropsychological testing
