Behavioral Med/Psych Flashcards
Generalized Anxiety Disorder
DSM-5 sxs
> 6+ months
Excessive anxiety/worry Difficult to control worry a/w with 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
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
Agoraphobia
DSM-5 sxs
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
Agoraphobia
Tx
SSRIS - paroxetine, fluoxetine, sertraline,
SNRI - venlafaxine - 1st line
If not successful - benzo, lastly TCAs
BBs - reduce autonomic hyperarousal sxs
Insight oriented therapy - graded exposure
Or
CBT
Social Anxiety Disorder
DSM-5 sxs
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
Social Anxiety Disorder
DSM-5 tx
SSRIS - paroxetine, fluoxetine, sertraline,
SNRI - venlafaxine - 1st line
BBs - reduce autonomic hyperarousal sxs
Insight oriented therapy - graded exposure
Or CBT
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
A & B are the same as above
Ep is not severe enough to cause marked impairment in social or occupational
Bipolar Disorder ( 1 and 2)
tx
Mood stabilizer - Lithium — Plasma level q 4-8wks
Valproic acid
Olanzapine
Carbamazepine
Acute mania - 2gAPs
Risperidone, Aripiprazole
Haliperidol or Benzos - if + agitation or +psychotic sxs
good during tx initiations when acute mania is more likely
Lithium Side Effects
Muscle
Nephrotoxic
hypOthyroidism
Pregnancy teratogenic
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
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
Major Depressive Disorder
DSM-5 sxs
Five or more sxs during same 2 wk period
at least 1 symptom has to be 1) depressed mood or 2) loss of interest or pleasure
Significant distress or impairment in social functioning
Major Depressive Disorder
SIGECAPS
Sleep Interest Guilt Energy decreased Concentration lack of Appetite Psychomotor agitation Suicide
Major Depressive Disorder
Tx
SSRIs - 1st line
SNRIs - Venlafaxine or duloxetine
Atypical antidepressants - Bupropion or Mirtazapine
TCAs and MAOIs - less often
ECT - if unresponsive to psych meds
Major Depressive Disorder
Meds Major Side Effects
SSRIs - GI upset, weight gain, sexual dysfunction
4-6 wks to see efficacy
maintenance > 6 mos
Bupropion/Mitrazapine - less SD or ED
TCAs - weight gain, ortho hypotension, anticholinergic sxs
MAOIs - Tyramine free diet
