USMLE Step 2 (Fach) / Psychiatry (Lektion)
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Step 2 CK
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- Paranoid personality disorder Cluster A - Distrustful, suspicious- Interpret others' motives as malevolent- Ensue loyalty of friends & family- React severely if feel they've been lied to- Hold grudges - Use projection as a defense ...
- Schizoid personality disorder Cluster A - Emotional coldness- Preoccupation with fantasy- Restricted emotional expression and anhedonia- Voluntary social withdrawal
- Schizotypal personality disorder Cluster A - Odd behaviour, perceptions, and appearance- Magical thinking (inventing causal relationships between behaviors and events with no evidence) that is inconsistent with patient's cultural norms- ...
- Borderline personality disorder Cluster B Diagnostic criteria:- Pervasive pattern of unstable relationships, self-image & affects & marked impulsivity, with ≥ 5 of the following features:→ Franctic efforts to avoid abandonment→ ...
- Histrionic personality disorder Cluster B - Attention-seeking, excessively emotional behavior- Often exhibits inappropriately sexually provocative and/or seductive behavior- Draws attention to self by way of physical appearance- Overestimates ...
- Narcissistic personality disorder Cluster B - Attention seeking, grandiosity, and need for admiration- Difficulty dealing with criticism- Lack of empathy How to handle them: Set rules, insist they are followed
- Antisocial personality disorder Cluster B - A history of a conduct disorder- ≥ 3 of the following 7 criteria after the age of 15 years:→ Repeatedly engaging activities that are grounds for arrest→ Deceitfulness→ Impulsivity/failure ...
- Obsessive-compulsive personality disorder Cluster C - Obsession with control and perfectionism that is often ego-syntonic (in contrast to obsessive-compulsive disorder!)- Rigid routines- Unwanted thoughts and compulsions Features of obsessive-compulsive ...
- Avoidant personality disorder Cluster C - Socially inhibited- Fear of rejection- Feelings of inadequacy- Fear of being disliked or ridiculed, yet desires to have friends and social interactions
- Dependent personality disorder Cluster C - Difficulty making everyday decisions often requiring others to assume responsibility- Difficulty initiating projects (e.g., applying for jobs) due to lack of self-confidence- Feelings of helplessness ...
- Schizophrenia Epidemiology: - Prevalence is approximately 1%- W=M- Peak onset is earlier in men (18-25 years) than in women (25-35 years) Clinical features:- Positive symptoms: Hallucinations, delusions, disorganized ...
- Obsessive-compulsive disorder Obsessive-compulsive disorder (OCD) is characterized by persistent and recurring thoughts, urges, or images (obsessions) that lead to repetitive behaviors or mental acts (compulsions). Epidemiology:- ...
- Generalized anxiety disorder Prolonged and excessive anxiety that is either unspecific or revolves around certain themes (e.g., health, work); not focused on a single specific fear. Epidemiology:- Most common anxiety disorder among ...
- Panic disorder Recurrent spontaneous panic attacks without a known trigger. Epidemiology- Lifetime prevalence: approx. 5%- Most common in patients of age 20-30- ♀ > ♂ (2:1) Associations:- Depression- Bipolar disorder- ...
- Specific phobia Persistent and intense fears of one or more specific situations or objects (phobic stimuli); always occur during encounters with the phobic stimulus, but may already surge in its anticipation. Epidemiology:- ...
- Post-traumatic stress disorder (PTSD) Characteristic symptoms that last > 1 month following ≥ 1 traumatic event(s). Epidemiology:- Lifetime prevalence: ∼ 9%- Duration of combat exposure directly proportional to risk of developing PTSD ...
- Adjustment disorder A maladaptive emotional or behavioral response to a stressor that lasts ≤ 6 months following termination of the stressor. Epidemiology:- Presents in ∼ 5-20% of individuals undergoing outpatient mental ...
- Bipolar disorder Epidemiology:- Sex: ♀ = ♂Lifetime prevalence: 1-3% Bipolar I disorder: One or more manic episodes (lasting ≥ 1 week) with or without major depressive episodesBipolar II disorder: One episode of ...
- Delirium Acute disturbance of consciousness with altered cognition that develops over a short period of time (usually hours to days). Children, the elderly, and hospitalized patients (eg, ICU psychosis) are particularly ...
- Obesity hypoventilation syndrome (Pickwickian syndrome) ... Breathing disorder that only affects morbidly obese individuals; frequently accompanied by OSA, it is characterized by diurnal hypercapnia. Etiology: morbid obesity Pathophysiology: ↑ production of ...
- Insomnia Epidemiology:- Prevalence: ∼ 10% (most common sleep-wake disorder) Etiology:- Poor sleep hygiene- Subclinical mood or anxiety disorders DSM-5 diagnostic criteria (primary insomnia is a diagnosis of ...
- Narcolepsy Epidemiology:- Sex: ♂ > ♀- Bimodal distribution: teens and early twenties; another smaller peak at around age 35 Clinical features:- Excessive daytime sleepiness: patients experience an irresistible ...
- Attention deficit hyperactivity disorder Epidemiology:- Sex: ♂ > ♀- Age of onset: usually before age 6- Prevalence: estimated to be 8-11% Comorbidities:- Oppositional defiant disorder- Conduct disorder- Depression- Anxiety Disorder- Learning ...
- Autism spectrum disorder Epidemiology:- Sex: ♂ > ♀ (4:1)- Age: symptoms typically evident before 2-3 years of age Clinical features:- Persistent impairment in communication and social interaction- Restricted, stereotyped ...
- Tourette syndrome Epidemiology:- Sex: ♂ > ♀- Age of onset: usually 2-15 years of age- Associated with ADHD and/or OCD Diagnostic criteria:- Multiple motor tics and at least 1 vocal tic with a variable anatomical location, ...
- Major depressive disorder Episodic mood disorder primarily characterized by depressed mood and anhedonia that lasts for at least 2 weeks. Epidemiology:- Sex: ♀ > ♂- Lifetime prevalence: 15-25%- The peak age of onset is in ...
- Substance Abuse - Alcohol Epidemiology:- Prevalence: 13.9%; more common in Native Americans- Sex: ♂ > ♀= 2:1- Peak incidence: 21-34 years Intoxication:- Disinhibition, emotional lability, slurred speech, ataxia, aggression, ...
- Substance abuse - Opioids Intoxication:- Euphoria leading to apathy, CNS depression, constipation, pupillary constriction, and respiratory depression- Naloxone and naltrexone block opioid receptors and can revrse effects Withdrawal:- ...
- Substance abuse - Amphetamines Intoxication:- ↑ libido, constipation, tachycardia with arrhythmias, mydriasis, ↑ body temperature, ↑ perspiration, ↓ appetite, weight loss, grinding teeth- Neuropsychiatric symptoms: sleep disorders, ...
- Substance abuse - Cocaine Intoxication:- Psychomotor agitation, euphoria, impaired judgement, tachycardia, pupillary dilation, hypertension, paranoia, hallucinations, "cocaine bugs", sudden death. ECG changes from ischemia are ...
- Substance abuse - Phencyclidine hydrochloride (PCP) ... Intoxication:- Assaultiveness, belligerence, psychosis, violence, impulsiveness, fever, tachycardia, vertical/horizontal nystagmus, hypertension, impaired judgement, ataxia, seizures, delirium Withdrawal:- ...
- Substance abuse - LSD Intoxication:- Marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation, impaired judgement, diaphoresis, tachycardia, hypertension, heightened senses (eg, colors ...
- Substance abuse - Marijuana Intoxication:- Euphoria, slowed sense of time, impaired judgement, social withdrawal, ↑ appetite, dry mouth, conjunctival injection, hallucinations, anxiety, paranoia Withdrawal: none
- Substance abuse - Barbiturates Intoxication: - Low safety margin; respiratory depression Withdrawal:- Anxiety, seizures, delirium, life-threatening cardiovascular collapse
- Substance abuse - Benzodiazepines Intoxication:- Interactions with alcohol, amnesia, ataxia, somnolence, mild respiratory dpression Withdrawal:- Rebound anxiety, seizures, tremor, insomnia, hypertension, tachycardia
- Substance abuse - Nicotine Intoxication:- Restlessness, insomnia, anxiety, arrhythmias Withdrawal:- Irritability, headache, anxiety, weight gain, craving, bradycardia
- Anorexia nervosa Epidemiology:- Sex: ♀ > ♂ (10:1)- Age of onset: 10-25 years Diagnostic criteria:- Significant deliberate reduction in body mass (as measured by BMI) using strategies that include restrictive eating, ...
- Bulimia nervosa Epidemiology:- Sex: ♀ > ♂ (> 90% of affected individuals are young women)- Peak age: 20-24 years of age (late adolescence to early adulthood) Diagnostic criteria: All five criteria must be met for ...
- Social anxiety disorder Pronounced anxiety of social situations that may involve scrutiny by others and lasts ≥ 6 months. Epidemiology:- One of the most common mental disorders- Lifetime prevalence: approx. 5-10%- Peak incidence: ...
- Agoraphobia Inordinate fear or anxiety of being in situations that are perceived as difficult to escape from, or situations in which it might be difficult to seek help. Epidemiology:- ♀ > ♂ (2:1)- Age of onset: ...
- Pyromania Rare impulse control disorder more commonly found in males. Features:- Deliberate fire setting on ≥ 1 occasions- Tension, arousal prior to act; pleasure/relief when setting/witnessing fire- No external ...
- Kleptomania Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. Diagnotics:- Increasing internal tension before committing the theft and pleasure, ...
- Conduct disorder A repetitive and persistent pattern of disruptive behavior for ≥ 12 months that violates basic rights of others or age-appropriate societal norms or rules. Epidemiology:- Onset during childhood or adolescence; ...
- Oppositional defiant disorder Anger, irritable mood, and defiant behavior towards figures of authority lasting ≥ 6 months. Significantly impairs social and/or academic functioning. Epidemiology:- Usually appears in late preschool ...
- Hoarding disorder Epidemiology:- Point prevalence: ∼ 2-6%- ♂ > ♀ Diagnostic criteria:- Persistent urge to keep items; distress associated with getting rid of items- Difficulty discarding belongings- Accumulation ...
- Body dysmorphic disorder Epidemiology:- Point prevalence: ∼ 2%- ♂ ≈ ♀- Mean age of onset: ∼ 17 years Diagnostic criteria:- Persistent preoccupation with a perceived flaw in one's physical appearance- Flaws are mild ...
- Trichotillomania Epidemiology:- Lifetime prevalence: ∼ 2%- ♀ >> ♂- Onset usually in puberty following a stressful event- ↑ Incidence of comorbid major depressive disorder, OCD, and excoriation disorder Clinical ...
- Reactive attachment disorder Attachment disorder that is due to abuse and neglect (deprivation) and may be associated with signs of physical maltreatment, undernutrition, excessive appetite/food hoarding, or, if the disorder is severe, ...
- Separation anxiety disorder Fear, anxiety, or avoidance of separation from major attachment figures. Age of onset: childhood, with mean onset at 7.5 years Diagnostic criteria:- Duration: at least 1 month- Developmentally inappropriate ...
- Selective mutism Relatively uncommon disorder in which children do not speak in situations when speech is expected. It may coexist with social anxiety disorder and/or result in school refusal. Age of onset: generally ...