EM Psych 6: Mania and Anxiety Flashcards

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1
Q

Remarks on bipolar disorders

A

the depressive periods tend to last longer than the manic periods

bipolar disorders affect men and women equally and have no race/ethnicity predilection

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2
Q

remarks on mania

A

mania can be diagnosed if there’s a distinct period of elevated, expansive, or irritable mood for at least 1 week

at least 3 of the ff:
- inflated self-esteem or grandiosity
- decreasesd need for sleep
- pressured speech
- flight of ideas
- dstractibility
- increase in goal-directed activity or psychomotor agitation
- involvement in high-risk activities (often sexual or financial in nature)

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3
Q

types of bipolar disorders

A

type I: mania, with or without major depressive episodes
type II: intermittent hypomania with depressive episodes (no full manic episode)
cylothymic: recurrent dysthymic and hypomania episodes(occur regularly over at least 2 years but symptoms not as severe as I and II)

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4
Q

remarks on the manic patient

A

little insight

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5
Q

remarks on treatment of bipolar disorder

A

Treatment for bipolar disorder is complex, often requires more than one medication, and thus should not be initiated by the emergency physician, except for traetment of acute agitation or to restart lithium or an anticonvulsant medication that has been recently stopped

the efficacy of antidepressant use in bipolar disorder is unclear because of the possible risk of precipitating mania

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6
Q

medications to treat the acutely manic patient include

A

“mode stabilizers” such as
lithium, valproic acid, or carbamazepine
with or without the addition of an antipsychotic (such as haloperidol) or a benzodiazepine

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7
Q

bipolar disorder meds that may trigger SJS/TEN

A

carbamazepine
lamotrigine

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8
Q

remarks on lithium

A

narrow therapeutic index and requires frequent monitoring

patients taking lithium must avoid dehydration to prevent toxic levels from accumulating

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9
Q

disposition of bipolar disorder patients

A

similar to that of the depressive disorder patient, including careful assessment of suicide risk

Lack of insight to the loss of cognitive abilities and delusional ideas may put the patient at significant risk for self-harm, though not explicitly expressed

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10
Q

remarks on anxiety disorders

A

Anxiety is the most common mental health disorder overall
although second behind mood disorder in ED presentation

Anxiety disorders, especially panic disorder, may mimic life-threatening conditions, such as ACS

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11
Q

Diagnosis of generalized anxiety disorder

A

chronic excessive anxiety and worry about real or imagined events, occurring more days than not, for at least 6 months

3 or more of the following six:
- restlessness
- irritability
- muscle tension
- easily fatigued
- difficulty concentrating or “mind going blank”
- sleep disturbance

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12
Q

remarks on panic disorder

A

Panic attacks are short-lived episodes of anxiety or intense fear accompanied by a range of somatic symptoms (commonly cardiac, GI, or neurologic), usually peaking within 10 minutes and but that may last up to an hour

the panic attack must be followed by 1 month of persistent concern about having additional attacks

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13
Q

irritating fear of crowded spaces

A

agoraphobia
- panic disorder with agoraphobia may be severely disabling both socially and occupationally

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14
Q

symptoms of PTSD have to be present for how long?

A

1 month

if bet 2 days and 1 month, it’s called acute stress disorder

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15
Q

Initially, assess patients who present with anxiety for life-threatening medical conditions, such as

A

myocardial infarction
PE
hypoglycemia
hypoxia
tachyarrthymias
thyroid storm
CVA

Also ask about suicidal and homicidal ideation, as there’s a 10-fold greater suicide risk among patients with anxiety disorders

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16
Q

One useful screening question for panic attack is:

A

“Have you experienced brief periods for seconds or minutes of an overwhelming panic or terror that was accompanied by racing heart, shortness of breath, or dizziness?”

Take care to identify victims of domestic violence, sexual abuse, or assault, because such past or present experiences can provoke panic attacks

17
Q

treatment of anxiety disorders

A

cognitive-behavioral therapy
antidepressants

benzodiaepine for acute panic attack
low-dose beta blockers to itigate physical symptoms may also be helpful

18
Q

disposition in patients with anxiety

A

After exclusion of a life-threatening medical condition, the need for admission or emergent psychiatric consultation is rare, except in patients expressing suicidal or homicidal ideation, or other psychiatric or medical comorbidities that prohibit the patient from self-care