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PANCE > Behavioral Med/Psych - 6% > Flashcards

Behavioral Med/Psych - 6% Flashcards

1
Q

Acute Stress Disorder/PTSD

A

Acute Stress Disorder - 2days to 4 weeks

PTSD - severe rx to severe stressor occuring >4 wks

Rape, war, assault, major car accident

may experience directly, witnessed, experienced indirectly

Sxs

  • Trauma
  • Re-experiencing event - nightmares, flashbacks, intrusive memories
  • Avoidance - crowds/groups, activities/ppl/place a/w trauma
  • Unable to function
  • 1 Month in duration
  • Arousal - hypervigilance, anger exaggerated startle

Tx

  • Multidimensional
  • Acute tx
  • CBT, SSRI
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2
Q

Adjustment Disorder

A

Pathological reaction to psychosocial stressor = impairment in social function

Sxs

  • event starts within 3 mos of incident, resolves w/in 6 mos
  • if extreme stressor = consider PTSD/ASD

Tx - psychotherapy - CBT

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3
Q

Agoraphobia

A

6 months or more Intense anxiety about being in situation you can’t escape

Potentially incapacitating or embarrassing reaction - lack of bowel or bladder control

Pts may be unable to leave home

Tx -

  • SSRIS - paroxetine, fluoxetine, sertraline,
    • venlafaxine - 1st line If not successful - benzo,
  • lastly TCAs BBs - reduce autonomic hyperarousal sxs Insight oriented therapy - graded exposure Or CBT
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4
Q

Alcohol Withdrawal

A

Minor - 6to 24 hrs

  • tremor, anxiety, N/V, and or insomnia

Major - 10 to 72 hrs

  • visual and auditory hallucination, diaphoresis, tachycardia, elevated BP

Seizures - within 48 hrs

Delirium Tremens - 3 to 10 days

  • hallucination, disorientation, fever
  • tx with benzo
  • thiamine and folic acid
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5
Q

Anorexia Nervosa

A

W > M, MC than bulemia

Sxs

  • Individual w/ dysmorphia
  • terrified of gaining weight
  • failing to maintain normal body weight
  • Restricting - caloric intake, excessive exercise
  • Purging - vomiting, laxatives

Dx

  • BMI < 18.5
  • less than 85% ideal height/weight

Tx

  • Nutritional rehab, and CBT first line
  • Olanzapine/Zyprexa
  • Refeeding syndrome = hypophosphatemia, rhabdo, no more than 1 lb per wk
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6
Q

Bereavement

A

inappropriate death, after

Sxs

  • numbness, vivid dreams, crying, loneliness
  • even halllucination/delusion

Tx

  • good palliative care
  • hospice care

Complicated Bereavement > 6mos that impairs functioning

Socially isolated, poor support

white old male

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7
Q

Bipolar 1 Disorder

DSM-5 sxs

A

Manic episode → at least 1 lifetime manic ep = BP1D

Symptoms at least 1 wk of 3 or more sxs (or 4 or more if 1 symptom is only irritability) Distractibility

  • Indiscretion
  • Grandiosity
  • Flight of ideas
  • Activity increased
  • Sleep deficient
  • Talkativeness

Hypomanic Episode are the same as above

Ep is not severe enough to cause marked impairment in social or occupational

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8
Q

Bipolar 2 Disorder

DSM-5 sxs

A

Characterized by at least one or more major depressive episodes, at least one hypomanic episode Never experienced a manic episode Hypomanic ep - less severe and cause less social impairment F>M

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9
Q

Bipolar Disorder ( 1 and 2)

Treatment

A

Mood stabilizers - all C/I in pregnant

  • SSRIs can induce mania
  • Lithium — 300 mg BID -
    • Plasma level q 4-8wks
    • SE - tremor, N, polyuria, thirst, weight gain and diarrhea, renal and thyroid toxcity
  • Valproic acid/Depakote
    • monitor levels
    • SE - tremor, wt gain, N/V, hepatic failure and thrombocytopenia
    • C/I preggo
  • Carbamazepine/Tegretol
    • SE - SJS, hypoNa, N/V, Diarrhea

Acute mania

  • 2gAPs
  • Risperidone, Aripiprazole
  • Haliperidol or
  • Benzos - if + agitation or +psychotic sxs good during tx initiations when acute mania is more likely
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10
Q

Bulimia Nervosa

A

Normal weight/BMI

Both occur once weekly for at least 3 mos:

Recurrent ep of binge eating

  • High calories, high carbs
  • feeling of guilt, loss of control

Compensatory behavior

  • purging (vomiting/laxative)
  • non-purging (starvation/exercise)

Sxs

  • dental caries, parotid swelling
  • knuckle scarring

Tx - CBT, SSRI, nutritional, anxiolytics

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11
Q

Child Abuse

A

Unwanted pregnancy, developmental difficulties,

Parental - poor impulse control, hx of abuse, depression, young parent

Non-biologically related male living in single femal home

Sxs

  • Full H&P
  • cigarette burns
  • different stages of bruise healing, bone fractures
  • inconsistent stories about injury
  • PE - injury and STD screening , usu hypersexual, masturbate excessively
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12
Q

Cluster A “Mad”

Personality Disorders

A

Paranoid

  • suspicious or distrust of others, often perceives attacks on own character

Schizoid

  • detachment from interpersonal relationships, limited emotions and solitary, no interest in sex or physical activities

Schizotypal

  • odd, eccentric individual, strong belief in magic or paranormal, psychotic
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13
Q

Cluster B “Bad”

Personality Disorders

A

Anti-social

  • persistent disregard for other rights, common in inmates, dx w/ conduct disorder

Borderline

  • unstable personality, always on the boder of instability/change

Histrionic

  • shallow, attention seeking, hypersexual, manipulative

Narcissitic

  • grandiose need for admiration, no empathy
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14
Q

Cluster C “Sad”

Personality Disorder

A

Avoidant

  • feels socially inhibited & inadequate, hypersensitive to criticism and avoids work/relationship that might lead to criticism

Dependent

  • needs to be taken care of, can’t make decision, clingy/separation anxiety

Obsessive Compulsive Personality

  • rigid preoccupation w/ order and rules, inflexible control freaks who can’t delegate
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15
Q

Cocaine

A

Stimulant

tachycardic, diaphoretic

avoid BB - drop BP, arterial vasospasm

w/d is not life threatening NV malaise, diaphroesis

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16
Q

Conversion Disorder

A

Trauma experience that causes involuntary alteration of motor or sensory function = substantial distress or psychosocial impairment

Sxs

  • Trauma
  • loss of sensory or motor function
  • everything is normal

Tx - self limited

17
Q

Cyclothymic Disorder

DSM-5, Sxs

A

Recurring period of less severe depressive eps and hypomania > 2 years Sxs free period for no more than 2 months at 1 time no Manic or Mixed episodes

18
Q

Domestic Violence

A

actual or threatened psychological, physical or sexual harm by current or former spouse

Screening

  • Past year - have you been hit, slapped, kicked, or otherwise physically hurt
  • in relationship w/ someone who threatenes or hurt you
  • forced to engage in unwanted sexual relationships

Tx - proper hotline, social work

mandated reported

19
Q

Persistent Depressive Disorder (Dysthymia)

DSM-5

A

Depressed mood for more days than not for at least 2 years for at least 2 of the follow:

* no mania or hypomania, substance or organic cause

  • Poor appetite or overeating
  • Insomnia or hypersomnia
  • Low Energy or fatigue
  • Low Self esteem
  • Poor concentration or difficulty making decisions Feelings of hopelessness

Tx - Antidepressants + psychotherapy SSRIs first choice

20
Q

Elder Abuse and Neglect

A

Withholding appropriate emotional interaction, food, medicine, water, or clothing

Financial neglect

Sxs

  • MC with family or spouse
  • sexual abse - dehydration, malnutrition, skin tears
21
Q

Factitious Disoder (Malingering)

A

Falsification of sxs - deception for 2/2 gain (usu meds, disability gain)

a/w antisocial personality disorder

Sxs

  • Discrepancy btwn observed and reported distress
22
Q

Generalized Anxiety Disorder

DSM-5 sxs

A

> 6+ months Intrusive worry and thoughts about multipe aspect of life

Difficult to control worry a/w 3+ symptoms

  1. Restlessness or feeling keyed up or on edge
  2. Easily fatigued
  3. Difficulty concentrating or mind going blank
  4. Irritability
  5. Muscle tension
  6. Sleep Disturbances

Tx

  • CBT
  • SSRI - Zoloft/Sertraline, Paxil/Paroxetine
  • SNR - Venlafaxine/Effexor, Cymbalta
  • Buspirone - if worried about GI SE
  • Benzos - Ativan/Lorazepam, Valium/Diazepam, Klonopin/Clonazepam
    • good for acute attacks
23
Q

Generalized Anxiety Disorder

tx

A
  • Psychotherapy - CBT
  • SNRI - venlafaxine
  • SSRIs - Paroxetine/Paxil,
  • Escitalopram/Lexipro several weeks to work Buspirone - 2 wks to work Benzo in interim until SSRI response
24
Q

Heroin and Opiates

A

Intox = sedation and lethargy

OD = respiratory collapse

Narcan/Naloxone - use for OD = 0.4mg IV and repeat

may precipitate w/d

Medical detox -

  • Buprenorphine/Naloxone (Suboxone)
  • Long active opiate effect prevents w/d - slowly tapered
  • Methadone
25
Q

Lithium Side Effects

A

Muscle Nephrotoxic hypOthyroidism Pregnancy teratogenic

26
Q

Major Depressive Disorder

DSM-5, sxs

A

5+ sxs during same 2 wk period at least 1 symptom has to be

1) depressed mood or
2) loss of interest or pleasure

causing significant distress or impairment in social functioning

SIGECAPS

  • Sleep changes
  • Interest - loss of
  • Guilt or worthlessness
  • Energy
  • decreased Concentration
  • Appetite changes or weight
  • Psychomotor agitation or slowing
  • Suicide thoughts of

Dx - CBC, TSH, CMP, RPR, UA, B12 and Folate

27
Q

Major Depressive Disorder

Meds Major Side Effects

A

SSRIs

  • Prozac (Fluoxetine) - long 1/2 life= highest risk of SS
  • Paxil (Paroxetine) - most sedating, C/I to pregnant, shortest 1/2 life -uncomfortable w/d state
  • Zoloft (Sertraline) - harsher GI effect, good for preggo
  • Celexa (citalopram) + Lexapro (Escitalopram) - prolonged QTc
  • Luvox (Fluvoxamine) - FDA approv for OCD
  • GI upset, weight gain, sexual dysfunction 4-6 wks to see efficacy maintenance > 6 mos

SNRI

  • Venlafaxine (Effexor) (NE + SE) - HTN SE,
  • Duloxetine (Cymbalta) - GI SE, black box liver failure

Bupropion (welbutrin) - 3rd line

  • No sexual SE or wt gain, smoking cessation, lowers seizure threshold (C/I in bulemia)

Mitrazapine (remeron)

  • Good for elderly, appetite booster

Trazodone

  • helps with sleep, SE for priapism

TCAs -

  • Imipramine - bedwetting, bladder contractions
  • Clomipramine - OCD Tx
  • Amtriptyline - chronic pain
  • QTc prolongation (need EKG), weight gain, ortho hypotension, anticholinergic sxs, widen QRS

MAOIs

  • Tyramine free diet
28
Q

Major Depressive Disorder

Treatment

A

SSRIs - 1st line

SNRIs - Venlafaxine or duloxetine

Atypical antidepressants

  • Bupropion or Mirtazapine
  • TCAs and MAOIs - less often ECT - if unresponsive to psych meds
29
Q

Methamphetamine

A

Psychostimulate, M&M

Intoxication - HTN, tachycardic, severe agitation and psychosis

Acute management - control agitation and hyperthermia w/ benzos

30
Q

Panic Attack

A

Classic, discrete eps of intense fear begins abruptly

lasts for several mins to 1 hr

Sxs

  • CP, palps, dyspnea, choking sensation
  • N/V, faint
  • Derealization, depersonalization
  • feeling a sense of DOOM or going to die, crazy, won’t escape
31
Q

Panic Disorder

A

Syndrome of recurrent panic attacks

Sxs

  • Persistent fear of further attacks
  • Maladaptive change in behavior related to attacks
  • wax and wane over time
  • a/w MDD

Tx -

  • CBT mainstay
  • SSRIs - Paxil, prozac, zoloft
  • SNRI - effexor
  • Benzo - PRN only, caution against abuse and dependancy
32
Q

Phobia

A

marked fear that is unreasonable and OOP; present for 6 mos

actively avoid phobic objects

MC - public speaking

Tx

  • CBT
  • Benzo - for 1x, BB
  • SSRI - if severe, resistant
33
Q

Schizophrenia

A

Psychosis - hallmark - inability to differentiate btwn what’s real or not

Schizophreniform - > 1mo but < 6 mo

Two or more of following - sxs present for 1 month for at least 6 mos- at least one must be 1-3

  1. Delusion
  2. hallucinations
  3. Disorganized Speech - freq derailment or incoherence
  4. Grossly disorganized or catatonic behavior
  5. Negative sxs
    • flat affect, empty speech, social w/d, lack of motivation

Positive Symptoms

  • Delusion, hallucinations, disorganized speech, bizzare behavior

Prodromal Symptoms

  • poor social skills, social w/d, unsual thinking

Tx

  • APs - First gen - Haliperidol, Chlorpromazine, Flupenazine
    • SE - tardive dyskinesia, parkinsonism, dystonia, tremor, NMS, wt gain, DM
  • Atypical APs - Second Gen - Risperidone, Olanzapine , Quetiapine, Ziprasidone, Aripiprazole
    • ​Less SEs
34
Q

Social Anxiety Disorder

A

6 months or more

Fear of social or performance situations - embarrassing or humiliating in front of others occur

Common inciting events - public speaking, using public restrooms, eating in public

Tx

  • SSRIS - paroxetine, fluoxetine, sertraline,
  • SNRI - venlafaxine - 1st line BBs - reduce autonomic hyperarousal sxs
  • Insight oriented therapy - graded exposure Or CBT
35
Q

Somatic Symptom Disorder

A

Multiple system of complaints;

Significant distress or psychosocial impairement

persistent anxiety about sxs

Tx

  • significant time and energy devotion to care fo pts

PANCE (15 decks)

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