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
