adult psych Flashcards
Criteria for PTSD
A: The person has been exposed to a traumatic event in which the person experienced, witnesses, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of others
B: The traumatic event is persistently reexperienced in one (or more) ways
- Recurrent and intrusive distressing recollections of the event
- Recurrent distressing dreams of event
- Acting or feeling as if the traumatic event were recurring: sense of reliving the experience
- Intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event.
- Physiological reactivity on exposure to internal/ external cues.
C: Persistent avoidence of stimuli associated with the trauma and numbing of general responsiveness (not present before trauma), as indicated by 3 or more of the following
- efforts to avoid thoughts, feelign, conversations about trauma
- efforts to avoid activies, places, or people that arouse memories of trauma
- Inability to recall an important aspect of trauma
- Diminished interest or participation in significant activities
- Feeling of detachment or estrangement from others
- Restriced affect
- Sense of a foreshorted future.
D: Persistent symptoms of increased arousal (>2)
- difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- hypervigilance
- exaggerated startle response
E: distubances duration >1month
F: Disturbance causes clinically significant distress or impairment in social, occupational or other important areas.
Risk factors for developing PTSD
PRE TRAUMA FACTORS gender ( female more @risk) <25yrs education (those with less formal education >risk) childhood trauma childhoood adversity adverse life events psychiatric disorders Genetics (eg fam hx of PTSD)
TRAUMA FACTORS Severity Type of trauma (eg: rape= more personal than accident) Betrayel Peritraumatic dissociation Participation in trauma
POST TRAUMA
poor social support
development of acute stress disorder (develops within one month after exposure)
Clinal features of PTSD
Reexperiencing the traumatic event
Physical or emotional avoidence of stimuli ass with the trauma, or an inability to remember traumatic details of the event
Negative alterations in cognitions & mood involving numbing of emotions and persistent distorted blame and negative emotional states.
Persitent symptoms of increased arousal, such as irritability, insomnia and increased startle responses.
Things to consider before/ with diagnosis of PTSD
Medical conditions:
head injury/ injuries during the traumatic event
epilepsy
alcohol use & substances
Differentiate PTSD from: adjustment disorder dissociative disorder borderline PD factitious disorder malingering
Treatment of PTSD
Prevention*: more of a theoretical thing
Psychotherapy:
Mainly CBT
Psychosocial therapies
exposure therapy (desensitise pt to anxiety caused be traums)
cogntive therapy (aims to correct irrational beliefs)
stress inoculation training (teaches a set of skills: relaxation, breathing, assertivness)
Pharmacotherapy
1. SSRIs (sertraline and paroxetine)..allow trial of 3 months before referring to psychiatrist.
The SNRI, Venlafaxine can be used as an alternative
if SSRIs not well tolerated, use TCA
- Atypical antipsychotics for treatment resistent PTSD.
- Alpha 1 adrenergic blocker Prazosin to reduce nightmares and insomnia
- Propranolol for decreasing the heightened reactivity in PTSD
How long do we treat for in PTSD
acute PTSD: 12months
chronic PTSD:: 24 months
Criteria for anorexia nervosa
A: Restriction of energy intake relative to requirements. Significantly low body weight (BMI >17 is mild, 15-16 is moderate & <15 extreme )
B: Fear of weight gain, and persistent behavior that interferes with weight gain.
-restrictive type and purging type
C: disturbed body image
Criteria for Bulimia nervosa
A: Repeated episodes of binge eating
episodes of excessive food intake AND loss of control during these episodes
B: Recurrent compensatory behavior
- vomiting
- Laxative
- self-administered enema
- diuretic abuse
- appetite suppresant abuse
- excessive exercise
- fasting
C: Binge eating episode frequency: once/week for 3 months
D: Self evaluation is influenced by body build or weight
E: not part of anorexia.
- specify severity (in terms of binge episodes)
- mild: 1-3
- moderate 4-7
- severe 8-13
- extreme >14
Clinical features of anorexia nervosa
onset 10-30
Reduction in food intake
obsessed with food and fear weight gain
Obsessive compulsive behabvior regarding food is common: calorie counting etc
Purging, appetite suppresants are common.
often have concomitant MDD; AND anxiety
Physical complications of anorexia
High mortality (5-18%)
LOW
Amenorrhoea
Bradycardia
hypotension
hypothermia
Downy lanugo hairs on skin
fractures…osteoporosis
Hypokalemia…cardiac arrythmias
Clincal features of bulimia nervosa
Uncontrolled binge eating
skip meals and binge later
Binge sessions are followed by feelings of guilt and patients then do compensatory behavior
do bulimia patients ever experience a state of starvation
yes…. often skip meals and then binge later in the day
Which other psychiatric conditions if bulimia associated with
MDD substance use disorder anxiety disorders impulse control disorders dissociate disorders personality disorders
Physical comlications of bulimia
electrolyte disturbances
gastric/ oesophageal tears
hypokalemia
tooth enamel erosion
Binge eating disorder
Epis of binging, at least one per week for 3 months
with No compensatory behavior
Management guidelines for eating disorders
- Diagnosis
- Establish a good therapeutic relationship
- Monitor dietary habits and food intake
find out about baseline food intake, patients should
record daily eating habits in a diary - Stabalise weight and eating habits
Negotiate aggrement, to eat no less than previous
week.
Pt must not engage in more binging or vomiting - Psycho education_
Educated regarding energy balance, consequences
of weight loss, growth retardation, amenorrhoea, osteoporosis - Dietary advice: calorie counting must be strongly discouraged. Encourage patients to eat small meals frequently.
recommend balanced diet - Advice to family
give adivice, involve in rx.. dont shift blame - Cooperation with patient
Listen to patients view point - Cognitive dissonance
Dr asks pt questions that make the patient consider alternatives - Concentrate on all aspects
Concentrate on health rather than weight, avoid weight targets etc
Focus rather on pulse rate, menstruation and bone density - When to refer
Rapid weight loss is worse than low body mass.
Consider hospitalisation for BMI <16/17
excessive exercise, vomi, and laxatives need
hospitalisation. - Special investigations:
FBC
U & E
glucose
liver function tests
Urine examination
thyroid function
serum calcium and phosphate
ECG*some cases need extra imaging. - Hospitalisation:
Usually for complications
Initate refeeding carefully but firmly - Psychotherapy
CBT, esp for bulimia
Psychodynamic approach for AnorexiaAdolescents, and kids get family therapy - Pharmacotherapy:
Appetite stimulation: cyproheptadine
anxiety relief before meals: lorazepam
Zinc supplements
Comorbid depression and OCD are treated with SSRI
- No need to correct thyroid urgently, usually normalises with weight gain
What is a delusion
Fixed false belief related to external reality.
Maintained depsite what others believe or what contrary evidence shows.
Mood congruent delusion: contents of which are consistent with either depressed or manic mood.
eg: depression: delusional content involves themes such as inadequacy, guilt, sickness, death, nihilism, or deserved punishment
Mood incongruent delusions: contents are not consistent with either a depressed or manic mood.
What is a hallucination?
False sensory perception, not accompanied by stimulation of the relevant sensory organ.
(sensory perception in the abscence of an external stimulus)
What is an illusion?
Misperception of an actual external stimulus.
Rustling of leaves may be interpreted as the sound of voices.
What is affect?
Subjective feeling or emotional experience that is manifested by observable behaviours. (attitude, facial expression, tone of voice)
examples: euphoria, anger, sadness
Range of affect: normal, restricted, blunted, flat or labile
Mood
continuous and sustained emotion
weather vs climate…mood is the climate (over time )
1.Consequence based ethics (Utilitarianism)
The action that would give the best result for the most people in the long term.
`any action is good or right if it ensures the best outcome
- Rule based ethics
This theory is also known as Kantian, deontologival or DUTY BASED theory.
Kant said, what made an action morally good, is not the result but more the good intention behind it.
In Kant model, its the therapists duty lies in respect for the patients autonomy and freedom of choice..
- Virtue based ethics/ character ethics
Focuses on the particular individuals choice to do what is good.
The virtuous person will perform a virtuous action.
action is not driven by rules, obligations or results.
`the good life is spent in search of the good life.
therapist should ask themselves: what would a virtuous person do.
