1 - Psychiatry Flashcards
What are the major Mood Disorders?
Bipolar Disorders: -Bipolar I (manic) -Bipolar II (hyopmanic) -Cycothymic -NOS Depressive (Unipolar) Disorders: -MDD (single episode, recurrent) -Dysthymic -NOS
Describe the following for MDD:
1) clinical presentation
2) epidemiology
3) tx
4) major comobidities
MDD: five or more symptoms w/in same 2wk period, one of which is EITHER depressive mood or loss of interest/pleasure
1) Symptoms: Depression, Interest(loss of), Weight change, Sleep, Motor activity, Energy, Guilt, Concentration, Suicide [Depression Is Worth Studiously Memorizing; Extremely Grueling Criteria. Sorry]
- presentation varies w age: 1) Prepuberty: physical complaints, anxiety, agitation; 2) Adolescence: substance abuse, behavioral issues, hygiene issues; 3) Elderly: dementia-like(memory loss, confusion), apathy, weight loss
2) Epidemiology: 17% overall incidence, female:male(2:1), GENETICS, Vulnerability (minority, no social support, low SES), stressor/childhood issues
3) Tx: SSRI, SNRI, TCA, MAOI; CBT, BT, Family Th; ECT(acute)
4) Co’s: Anxiety, Substance abuse(27%), Personality disorders, Eating disorders, Psychosis
Describe the following for Bipolar I:
1) clinical presentation
2) epidemiology
3) tx
4) major comobidities
Bipolar I (manic depression): >1wk(less if hospitalized) of “manic” mood; >3 symptoms (4 if only irritable mood)
1) Symptoms: Distractability, Insomnia, Grandiosity, Flight of ideas, increased Activity, pressured Speech, Thoughtlessness/poor judgement/euphoria (DIG FAST)
- CAN have MDE, but NOT req’d
- typically episodic w/ normal function btwn episodes; but Progressive
- HIGH rate of suicide
2) Epidemiology: onset 15-30, GENETICS, women>men
3) Tx:Acute-> anti-psychotics, ECT; Chronic -> Lithium, therapy, antidepressants (worry about forcing into mania)
4) Co’s: Substance Abuse(61%!!),
What is Dysthymic Disorder?
- DD: mood disorder of >2yrs of depressed mood with 2 associated symptoms
- NO MDE and NO hypomanic episode
- chronic, light depression that is resistance to Tx
What is Cyclothymic Disorder?
- Mood disorder of >2yrs with numerous periods of hypomanic and depressive SYMPTOMS
- NO MDE
- NO hyopmanic episode
- “Symptom Period” patient is not w/o symptom for >2 mo
What is the benefits of Electroconvulsive Therapy?
- ECT is HIGHLY effective tx for depression and acute manic depression
- Fastest efficacy
- used when medications ineffective or there is a need for rapid improvement in symptoms (suicide risk), catatonia
- avoid if recent MI/Stroke (not absolute contraindication)
- memory loss is possible
What is Somatization Disorder?
- Somatization DO: hx of physical complaints BEFORE 30y/o occurring over a several year period meeting ALL of the following: 4 pain, 2 GI, 1 sexual, 1 pseudoneurological symptoms (not all at the same time)
- for ALL of the related symptoms, they EITHER cannot be explained by a medical condition OR the patient’s response is excessive given the extent of the medical indications
- symptoms are NOT CONSCIOUSLY PRODUCED/FAKED
- Risk/Prevalence: female>male, frequently a learned affect (family exposure),
- frequently present as Masochistic -> recount how much they have suffered/sacrificed
What is conversion disorder?
1) symptoms affecting voluntary motor/sensory function
2) onset/exacerbation preceded by acute stressor
3) NOT INTENTIONAL PRODUCED/FAKED
4) cannot be explained by medical condition
5) causes clinically significant distress
6) NOT just sex/pain symptoms, NOT somatization
- when the symptom is paralysis = good prognosis, other = bad
- Psychogenic Nonepileptic Seizures -> no prolactin released, no injuries from seizure, fail Hoover’s sign, can respond DURING seizure, no incontinence… mitigate neg effects of seizure
What is Hypochondriasis?
1) misinterpretation of symptoms leading to a preoccupation with having/getting sick
2) is NOT delusional, NOT solely concerning appearance(BDD), and NOT resolved by medical testing or advice
3) caused clinically significant distress/impairment
4) >6mo
- NOT INTENTIONALLY PRODUCED/FAKED
What is Body Dysmorphic Disorder?
- preoccupation with physical appearance leads to a clinically significant distress or impairment
- is able to acknowledge that the concerns are exaggerated, but cannot correct them
- high suicide rate(20%)
- may be associated projection, repression, dissociation, distortion
What is Factitious Disorder?
- INTENTIONALLY PRODUCED sickness/symptoms
- NO external gain (gain = malingering)
- hx of many tx and px, doctor shopping
- may have been in the medical field, hold a grudge, been sick recently
What is Factitious Disorder by Proxy?
Munchousen’s by proxy
- make their dependent sick to gain the access to medical tx
- req’s 15mo to dx
- parental projection, narcissism, or sadistic impulses
- hx of sibling death is common
How are somatoform disorders tx?
1) Therapy(CBT, BT) -> support reattribution to provide positive explanations for symptoms,
- > set regular appts to reassure them of medical access
- > change + association w/ being sick
2) Meds: SSRI (BBD)
What is General Anxiety Disorder? How is it Tx?
GAD
1) excessive worry/anxiety over life event
2) more often than not, lasting >6mo
3) >3: Muscle tension, Fatigue, difficulty Concentration, Restlessness, Irritability, Sleep disturbance {Macbeth Frets Constantly Regarding Illicit Sins}
-Typically a chronic condition if untx
TX: Meds very effective: SSRI, Buspirone (anxiolytic), BZ, Venlafaxine
What is a Panic Attack?
- Discreet period of intense fear in the absence of real danger
- peaks ~10 min
- has >4 panic symptoms (ie: dizzy, sweating, chills, tremor, choking, chest pain, shortness of breath, palpitations…)
- VERY common to go to a general med/specialist before a psych
What is Panic Disorder?
1) recurrent unexpected panic attacks
2) at least one of the attacks is followed by >1mo of worrying about another attack
3) NO agoraphobia(social phobia)
4) NOT due to substance abuse, medical condition or other phobia
-> Panic w/ Agoraphobia presents in ~1/2 of panic disorders
-genetic and environmental factors
-Comorbid with depression -> leads to HIGH risk of suicide
TX: SSRI(chronic), BZ (acute), venlafaxine, imipramine
AND CBT
What is OCD? How is it Tx?
1) EITHER obsession or compulsions are present: Obsession-> recurrent, persistent thoughts or impulses that cannot be represses and that are recognized as a product of their own mind; Compulsion-> repetitive acts/thoughts that are carried out to minimize/correct subject of obsessions
2) Recognized as being inappropriate/excesive
3) cause marked distress, are time consuming (>1hr), interfere with normal routine
4)high comorbidity with depression, tics and tourette’s
5)PANDAS-> OCD in children
TX: SSRI, clomipramine, venlafaxine, AND exposure therapy
-can use surgery, but VERY rare
What is a Phobic Disorder? How is Tx?
1) irrational fear of some stimulus that results is EITHER disabling avoidance OR anxiety/panic when avoidance is not possible
2) aware fear is unreasonable
Social: fear of embarrassing one-self in public forum
Specific
Agoraphobia: fear of places/situations where escape would prove difficult or embarrassing
TX: B-blockers, SSRI AND BT (exposure), CBT
What is Adjustment Disorder? How is it Tx?
1) emotional/behavioral response to an identifiable stressor within 3 months of onset of stressor (when removed, sx resolve 6mo (w/ continuous stressor or consequence of stressor)
Tx:
1) symptom based (sleep aid, anxiety, etc)
2) reduce stress: support networks, eduction/de-stigmatize
3) protect from secondary injury (other stressors)
What is Acute Stress Disorder? How is Tx?
1) precipitating event that threatens life, injury, physical integrity of self or others
2) responds w/ fear, helplessness, or horror
3)Symptom Clusters must have at least:
-1 Reexperiencing
-1 Avoidance
-1 Hyperarousal
-3 Dissociative
4) >2d, <4wks
Tx:
1) watchful waiting: many resolve on their own
2) CBT
Describe the symptom clusters of Acute Stress Disorder/PTSD.
-Hyperarousal (ASD 1/PTSD 2): difficulty falling asleep, irritability, distracted, hyper-vigilance, exaggerated startle response
-Avoidance(ASD 1/PTSD 3): avoiding thoughts/places/experiences associated with stressor, amnesia, depressive-like symptoms(lack of interest, detachment, restricted range of affect)
Reexperiencing(ASD 1/PTSD 1): recurrent intrusive thoughts/images/perceptions, dreams, flashbacks, distress on Triggers
Dissociative(ASD 3/PTSD 0): sense of numbing, detachment, reduced awareness, derealization(1000yd stare), depersonalization, dissociative amnesia
What is PTSD? How is Tx?
1) precipitating event that threatens life, injury, physical integrity of self or others
2) responds w/ fear, helplessness, or horror
3)Symptom Clusters must have at least:
-1 Reexperiencing
-2 Hyperarousal
-3 Avoidance
4) >4wks; Acute: 3mo; Delayed: occurring >6mo after event
Tx:
1) Prevention: minimize exposure to trauma, prevent secondary injury (psychological first aid), tx co-morbids,
2) CBT, Stress Inoculation Tng,
3) SSRI, SNRI, mirtazipine/prazosin (nightmares), TCA/MAOI(refractive)
NO Benzodiazipam -> dependence/abuse
What are the Dissociative Disorders? What are their major characteristics?
1) Depersonalization Do: sense of detachment/removal from oneself that produces distress/impairment
- remains aware of reality (non-psychotic)
2) Dissociative Amnesia: >1 episode of amnesia regarding important information that is too extensive to be explained by normal forgetfulness
- causes significant distress/impairment
3) Dissociative Fugue: sudden, unexpected travel away from home/family loss of one’s identity/past
- assumes new ID
4) Dissociative Identity Disorder: presence of >1 ID/personalities that recurrently take control of behavior
- inability to recall important personal information
- causes significant distress/impairment
Describe sleep:
1) states
2) stages
3) rhythms
1) 2 states of consciousness: NREM and REM
- REM: Tonic phenomena -> atonia, dreams, penile/clitoris erection; Phasic phenomena-> Rapid eye mvmt, autonomic variability, myoclonic twitches
2) 5 Stages: W, N1, N2, N3, REM
- W: awake-> mostly alpha waves, no eye mvmt, normal muscle tone
- N1: transition-> theta waves(slower/lower freq), slow rolling eye mvmt(SREM),
- N2: sleep spindles/K-complexe, less tone,
- N3:deep sleep-> dominated by delta(slow) waves, no eye mvmt, variable/low tone
- R: REM-> low amplitude w/ sawtooth waves, REMs, atonia
3) 3 Cycles for sleep: ultradian, circadian, and lifetime
- circadian: endogenous rhythm controlled in Suprachiasmatic Nucleus(SCN); can be influenced by light exposure
- ultradian: “sleep cycle” of 90-100min, 3-6 cycles/night, N3 dominate in 1st 2 cycles, REM stages are longer in 2nd 1/2 of night
- life-cycle: general decrease in need for sleep with age; newborn~18hrs, infant~15hrs, kid~10hrs, adult~8hrs, elderly~6
