Behavioral Med/Psych - 6% Flashcards
Acute Stress Disorder/PTSD
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
Adjustment Disorder
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
Agoraphobia
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
Alcohol Withdrawal
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
Anorexia Nervosa
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
Bereavement
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
Bipolar 1 Disorder
DSM-5 sxs
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
Bipolar 2 Disorder
DSM-5 sxs
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
Bipolar Disorder ( 1 and 2)
Treatment
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
Bulimia Nervosa
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
Child Abuse
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
Cluster A “Mad”
Personality Disorders
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
Cluster B “Bad”
Personality Disorders
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
Cluster C “Sad”
Personality Disorder
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
Cocaine
Stimulant
tachycardic, diaphoretic
avoid BB - drop BP, arterial vasospasm
w/d is not life threatening NV malaise, diaphroesis
Conversion Disorder
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
Cyclothymic Disorder
DSM-5, Sxs
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
Domestic Violence
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
Persistent Depressive Disorder (Dysthymia)
DSM-5
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
Elder Abuse and Neglect
Withholding appropriate emotional interaction, food, medicine, water, or clothing
Financial neglect
Sxs
- MC with family or spouse
- sexual abse - dehydration, malnutrition, skin tears
Factitious Disoder (Malingering)
Falsification of sxs - deception for 2/2 gain (usu meds, disability gain)
a/w antisocial personality disorder
Sxs
- Discrepancy btwn observed and reported distress
Generalized Anxiety Disorder
DSM-5 sxs
> 6+ months Intrusive worry and thoughts about multipe aspect of life
Difficult to control worry a/w 3+ symptoms
- Restlessness or feeling keyed up or on edge
- Easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- 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
Generalized Anxiety Disorder
tx
- Psychotherapy - CBT
- SNRI - venlafaxine
- SSRIs - Paroxetine/Paxil,
- Escitalopram/Lexipro several weeks to work Buspirone - 2 wks to work Benzo in interim until SSRI response
Heroin and Opiates
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
Lithium Side Effects
Muscle Nephrotoxic hypOthyroidism Pregnancy teratogenic
Major Depressive Disorder
DSM-5, sxs
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
Major Depressive Disorder
Meds Major Side Effects
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
Major Depressive Disorder
Treatment
SSRIs - 1st line
SNRIs - Venlafaxine or duloxetine
Atypical antidepressants
- Bupropion or Mirtazapine
- TCAs and MAOIs - less often ECT - if unresponsive to psych meds
Methamphetamine
Psychostimulate, M&M
Intoxication - HTN, tachycardic, severe agitation and psychosis
Acute management - control agitation and hyperthermia w/ benzos
Panic Attack
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
Panic Disorder
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
Phobia
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
Schizophrenia
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
- Delusion
- hallucinations
- Disorganized Speech - freq derailment or incoherence
- Grossly disorganized or catatonic behavior
-
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
Social Anxiety Disorder
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
Somatic Symptom Disorder
Multiple system of complaints;
Significant distress or psychosocial impairement
persistent anxiety about sxs
Tx
- significant time and energy devotion to care fo pts
