CK2 Flashcards
Postopartum mood disturbances - types and incidence rate
- Maternal (postpartum) “blues” –> 50-85%
- Postpartum depression –> 10-15%
- Postpartum psychosis –> 0.1-0.2%
Maternal (postpartum) “blues” - manifestation (and when)
characterised by depressed affect, tearfulness, and fatigue stating 2-3 days after delivering
Postpartum depression - manifestations
characterised by depressed affect, anxiety and poor concentrating starting within 4 weeks after delivery
Postpartum psychosis - risk factors
- history of bipolar or psychotic disorder
- first pregnancy
- family history
- recent discontinuation of psychotropic medication
Postpartum psychosis - treatment
- hospitalization and initiation of atypical antispycotic
- if sufficient –> Electroconvulsive therapy (ECT)
normal grief?
Normal bereavement (πένθος) characterised by 1. shock 2. denial 3. guilt 4. somatic symptoms 5. yearning 6. hallucinations of the deceased person Duration varies widely (usually less than 6-12 months)
Pathologic grief?
Persistent lasts more , satisfies major depressive criteria and causes function impairment
Hallucinations (eg, hearing the voice of a deceased loved one) in the absence of other psychotic symptoms are not consider pathologic
Electroconvuslive therapy is used mainly for
- treatment-refractory depression
- depression with psychotic symptoms
- acutely suicidal patients
Panic disorder defined by
recurrent panic attacks not associated with known trigger
panic attacks?
periods of intense fear and discomfort peaking in ten minutes with at least four of the following mnemonic --> PPANICCCSSS Palpitations Paresthesias Abdominal distress Nausea Intense fear of dying or loosing control Chest pain Chills Choking Sweating Shaking Shortness of breath AND light-headedness, depersonalizatio, derealization
Panic disorder - diagnosis
requires panic attack followed by 1 month or more of 1 (or more) of the following
- Persistent concern of additional attacks
- Worrying about consequences of attack
- Behavioural change related to attacks
specific phobia - definition
severe, persistent (6 or more months) fear or anxiety due to presence or anticipation of a specific object or situation
Person often recognises fear is excessive
Specific phobia - treatment
CBT with exposure (first line)
- short acting benzo (limited role, ma help acutely if terapist unavailable or insufficient time)
Agoraphobia?
exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, leaving home alone (in at least 2 situations)
it is associated with PANIC DISORDERS
Agoraphobia - treatment
CBT, SSRIs, MAO inhibitors
Social anxiety disorder? (and examples)
exaggerated fear of embarrassment in social situations (eg. public speaking, using public restrooms)
Social anxiety disorder - treatment
CBT, SSRIs, venlafaxine
- Beta blocekrs or benzo for performance-only subtype like speeches)prefer b blockers due do sedative effect
Generalized anxiety disorder?
anxiety lasting more than 6months, unrelated to specific person, situation, or event
Generalized anxiety disorder - treatment
first line: CBT, SSRIs,SNRIs
second line: Buspirone, TCAs, benzoidazepines
Adjustment disorder?
emotional symptoms (anxiety, depression) causing impairment following (within 3 months) an identifiable psychosocial stressor (eg. divorce, illness) and lasting less than six months (more than six moths in presence of chronic stressor)
Adjustment disorder - duration
less than six months (more than six moths in presence of chronic stressor)
Post-traumatic stress disorder - manifestations
may involve nightmares or flashbacks, intense fear, helplessness, horror –> leads to leads to avoidance of stimuli associated with the trauma and persistently increased arousal –> impairs social-occupational functioning
IT LASTS MORE THAN A MONTH
situations that are associated with Post-traumatic stress disorder
Dissociative identity disorder (multiple personality disorder)
Post-traumatic stress disorder - treatment
first line: cognitive behavioural therapy (CBT), SSRIs, venlafaxine
Acute stress disorder?
variation of post-traumatic stress disorder that lasts between 3 days and 1 month
Acute stress disorder - treatment
cognitive behavioural Trauma Focused brief CBT
- consider pharmacotherapy for insomnia, intese anxiety
- monitor for development of past traumatic stress disorder
Obsessive compulsive disorder is considered to be
egodystonic: behaviour inconsistent with one’s own beliefs and attitudes (vs obsessive-compulsive personality disorder)
Obsessive compulsive disorder is associated with
Tourette syndrome
Obsessive compulsive disorder - treatment
first line: cognitive behavioural therapy (CBT), SSRIs, clomipramine
Body dysmorphic disorder - everything (definition, treatment etc)
preoccupation with minor or imagined defect in appearance –> significant distress or impaired functioning
Treatment: CBT
OFTEN SEEK COSMETIC SURGERY
hedonistic?
seeks pleasure without regard to consequences
Cluster A personality disorder - types
- Paranoid
- Schizoid
- Shizotypal
Cluster A personality disorder - Paranoid
Pervasive distrust and suspiciousness
Projection is the major defence mechanism
Cluster A personality disorder - Schizoid
Voluntary social withdrawal, limited emotional expression, content with social isolation (vs avoidant)
Cluster A personality disorder - Schizotypal
Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
Cluster B personality disorder - Antisocial
- Disregard for and violaton of rights of others, criminality, impulsivity,
- males>females
- more than 18 years old and history of conduct disorder before 15
- if under 18 –> conduct disorder
Cluster B personality disorder - Borderline
Unstable mood and interpersonal relationships, impulsivity, self-mutilation, boredom, sense of emptiness
females more common
Cluster B personality disorder - Histrionic?
Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance
Cluster B personality disorder - Narcissistic
Grandiosity, sense of entitlement
lack empathy and requires excessive admiration
often demands the best and react to criticism with rage
Cluster C personality disorder - obsessive-compuslve
preoccupation with order, perfectionism and control, ego-syntonic: behavior consistent with one’s own beleifs and attitudes
Cluster C personality disorder - Dependent
Submissive and clingy, excessive need to be taken care of, low self-confidence
Somatic symptoms and related disorders?
Category of disorders characterised by physical symptoms with no identifiable physical cause. Both illness production and motivation are inconsious drives. Symptoms not intentionally produced or feigned.
More common in women
Somatic symptoms and related disorders - types
- Conversion disorder (functional neurologic symptom disorder)
- Illness anxiety disorder (hypochondriasis)
- Somatic symptom disorder
- pseudocyesis
Conversion disorder?
Loss of sensoty or motor function (eg. paralysis, mutism, blindness), often following an acute stressor
Patient is aware of but sometimes indifferent toward symptoms (labelle indifférence)
ex. paralysis, mutism, blindness
Illness anxiety disorder (hypochondriasis)?
preoccupation with and fear of having a serious illness despite medical evaluation and reassurance (MINIMAL SOMATIC SYMPTOMS)
Somatic symptom disorder?
Variety of bodily complaints in one or more organ systems lasting for months to years.
May occur with medical illness
Somatic symptom disorder is associated with
excessive, persistent thoughts and anxiety about symptom
Anorexia nervosa
Excessive dieting exercise, or binge eating/purging
intense fear of gaining weight and body image distortion (distortion or overvaluation of body image)
BMI less than 18.5
Anorexia nervosa symptoms/findings
- decreased bone density
- severe weight loss
3, metatarsal stress fructures - amenorrhea (loss of puslatile GnRH secretion)
- lanugo (the growing of fine white hairs all over the body)
- electrolyte disturbances
- anemia
- Reefining syndrome (increased insulin –> Hypophosphatemia –> cardiac complications) if severe malnourished patient
- commonly coexists with depression
Bulimia nervosa - time
occurring weakly for at least 3 months
Bulimia nervosa symptoms
- parotitis
- enamel erosion
- electrolyte disturbances
- alkalosis
- dorsal hand calluses from induced vomiting (Russell sign)
- overvaluation of body image
Binge eating disorder
regular episodes of excessive, uncontrollable eating without inappropriate compensatoru behaviros
Binge eating disorder - increased risk of
DM
Binge eating disorder - treatment
psycotherapy such as CBT is first line
SSRI, lisdexamfetamine
Gender dysphoria?
Strong, persistent cross-gender identification.
Characterised by persistent discomfort with one’s sex assigned at birth, causing significant distress and/or impaired functioning
Sexual dysfunction - differential diagnosis includes
- Drugs (eg. antihypertensive, neuroleptics, SSRIs, ehtanol)
- Diseases (eg. depression, diabetes, STIs)
- Psychological (eg. performance anxiety)
example of drugs that are related with sexual dysfunction
antihypertensive, neuroleptics, SSRIs, ethanol
sleep terrors vs nightmares
sleep terrors –> during non-REM sleep (no memory of arousal)
nightmares –> during REM sleep (memory of scary dream)
Causes and triggers of sleep terrors / treatment
causes: unknown
triggers: 1. emotional stress 2. fever 3. lack of sleep
treatment: self limited
Narcolepsy - defnition and manifestations
- disordered regulation of sleep-wake cycles
- 1ry characteristic is excessive daytime sleepiness
Narcolepsy is caused by
decreased hypocretin (orexin) production in LATERAL hypothalamus strong genetic component
Narcolepsy is associated with
- hallucinations (hypnagogic and hypnopompic)
- Nocturnal and narcoleptic sleep episodes that start with REM sleep
- Cataplexy (loss of all muscle tone following strong emotional stimulus, such as laughter) in some patients
Narcolepsy - treatment
daytime stimulants (amphetamines, modafinil) and nighttime sodium oxybate (GHD)
Stages of change in overcoming substance addiction (and explain)
- Precontemplation - not yet acknowledging that there is a problem
- Contemplation - acknowledging that there is a problem, but not yet ready or willing to make a change
- Preparation/determination - getting ready to change behaviours
- Action/willpower - changing behaviour
- Maintenance - maintaining the behaviour changes
- Relapse - returning to old behaviours and abandoning new changes
