EOR- Psychiatric Flashcards
Generalized Anxiety:
Treatment Protocols
Names of Medications
Treatment Protocol:
Psychosocial intervention- You can find another job
Psychotherapy
CBT
EMDR
Relaxation
Yoga
Meditation
Spiritualism
Family Therapy/Psychoeducation
CBT vs. Pharmacotherapies:
Serotonergic Antidepressants show similar efficacy to CBT. It is pt preference.
GAD & MDD
Benzos,
Medications :
SSRI
Paroxetine
Sertraline
Citalopram
Escitalopram
SNRI
Venlafaxine
Duloxetine
Pristiq
Buspirone (Antianxiety Agent)
Generalized Anxiety Disorder
Longer onset of action than Benzos
Monotherapy: w/ absence of MDD
Augmentation
Vistirl- (Hydroxyzine)
Hydroxyzine
Propranolol
Not approved for GAD
Do not give with Asthma or history of smoking
Benzodiazepines
Acute Anxiety/Maintenance Long Term
Can be used for adjunct when SSRI/SNRI have not reached efficacy.
DEPRESSION PRESENT: SRI are favored over Benzo’s.
Medications:
Clonazepam(Long Acting) -> Lorazepam( Mid Acting) -> Alprazolam (Xanax) (Short Acting but the strongest and most addictive)
Clonazepam- Long acting and less addicting
Librium- Alcohol related anxiety
Diazepam
Lorazepam- Mid acting
Panic Disorders
- Definition
- Time period of symptoms
- Time to reach peak symtpoms
- Treatment
Specific Phobias
- Management
- Predictable situations-Treatment vs Unpredictable
Bipolar
- Difference between bipolar I and bipolar II
- Treatment:
- Bellagio Method
- Pneumonic for Mania
Major Depressive Disorder
- Pneumonic for Presentation:
- Management
- Dosing Regimine?
Persistent Depressive Disorder
Suicidal Behaviors:
- Who is more likely to complete suicide
- Who attempts suicide more often?
Conduct Disorder vs Oppositional Defiant Disorder
Dissociative Disorders:
- Dissociative Disorders:
- Dissociative Amnesia
- Dissociative Fugue
- Dissociative Identity
Anorexia Nervosa:
1.
Binge Eating Disorder
Bulimia Nervosa
Exhibitionistic Disorder
Female Sexual Interest and Arousal Disorder
• A female dysfunction marked by a persistent reduction or lack of interest in sex and low sexual activity, as well as, in some cases, limited excitement and few sexual sensations during sexual activity
Fetishistic Disorder
• A paraphilic disorder consisting of recurrent and intense sexual urges, fantasies, or behaviors that involve the
use of a nonliving object or nongenital part, often to the exclusion of all other stimuli, accompanied by clinically significant distress or impairment
Male Hypoactive Sexual Desire Disorder
A male dysfunction marked by a persistent reduction or lack of interest in sex and hence a low level of sexual activity
Pedophilic Disorder
A paraphilic disorder in which a person has repeated and intense sexual urges or fantasies about watching, touching, or engaging in sexual acts with children,
and either acts on these urges or experiences clinically significant distress or impairment
• Person is greater than age 16 and age gap is greater than five years
- Use of pornography • Psychotherapy
- Medical management
Sexual Masochism Disorder
A paraphilic disorder characterized by repeated and intense sexual urges, fantasies, or
behaviors that involve being humiliated, beaten, bound, or otherwise made to suffer
Voyeuristic Disorder
• A paraphilic disorder in which sexual arousal is derived from observing unsuspectin
individuals undressing or naked
Obsessive-Compulsive
Presentation
• Repetitive thoughts (obsessions) or behaviors
(compulsions) that are disabling and cause anxiety or
distress
• Difficult to control
• Disruption of daily living • Need to perform rituals
Diagnostic Studies
• Yale-Brown Obsessive Compulsive Scale
Management
• Medications and therapy
Body Dysmorphic Disorder
• Obsession with some perceived or imagined flaw or flaws in one’s appearance
Attention-Deficit Hyperactivity Disorder (ADHD)
- Presentation
- Duration of Symptoms to make a diagnosis
- Number of Setting?
- Treatment:
Autism Spectrum Disorder
- What are the 3 areas of life that Autism affects?
- When do we screen for autism?
- Treatment:
• Developmental delay in socialization, language, and cognition
• Autism spectrum disorders (ASD) encompasses:
o Autistic disorder: disruption of social interaction and
language at age 3 or earlier
o Childhood disintegrative disorder: pervasive
developmental disorder - not otherwise specified
o Asperger disorder: a child has normal cognitive
development but poor relationships and does not spontaneously seek activities with others
Treatment
• Refer to autism specialists, speech & language
pathologist
• Second-generation antipsychotics (risperidone,
aripiprazole) for aggression or hyperactivity, mood lability;
can also use haloperidol, carbamazepine
• SSRIs for stereotyped or repetitive behavior
Personality Disorders Overview
- Cluster A
- Cluster B
- Cluster C
Histrionic
- Presentation
- Treatment
- Pneumonic for Histrionic
Schizotypal
Presentation
• Discomfort with social and interpersonal relationships • Odd, eccentric behavior (“magical thinking”)
• Few friends
• Social anxiety
Management
• Psychotherapy, antipsychotics
Schizoid
Inability to form and maintain meaningful personal relationships; neither desires nor enjoys close relationships, including being part of a family
Borderline
• Poor impulse control, poor self-image, unstable interpersonal relationships
- Self-harming behaviors, suicide threats without attempts
- Demonstrates “splitting” between providers
Narcissistic
Presentation
• Need for admiration, grandiose thoughts, concerned about what others think yet lack empathy
- Arrogant, entitled
- Lack empathy
- Self-importance and superiority
Management
• Psychotherapy, antidepressants
Antisocial
• No concern for others, neglect of dependents; lack of
remorse, morals, or empathy
Obsessive-Compulsive Personality Disorder
- Preoccupation with perfectionism
- Attempts to control interpersonal relationships, obsessive
thoughts, and performance of compulsions impede daily
functioning
• Inflexible and rigid
• No one specific irrational or recognized obsession
(different from OCD)
Paranoid Personality disorder
• Persistent feelings of suspiciousness and mistrust of other people
Dependent Personality disorder
• Characterized by behaviors demonstrating an excessive need to be taken care of
Avoidant Personality disorder
• A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts
Schizophrenia
- Positive Symptoms?
- Negative Symptoms
- Management
- Time frame for Diagnosis
Presentation
• Two of the following in a one month period and
continuous signs for more than six months; hallucinations/delusions not needed for diagnosis
• Delusions
• Hallucinations: auditory (most common), tactile,
olfactory, visual
• Disorganized speech or thought processes, unable
to stay on topic (loose associations) unable to provide
answer related to questions (tangential response) • Disorganized behavior: unpredictable agitation,
inappropriate sexual behavior, childlike silliness,
catatonic motor behavior, lacking self-care or hygiene
• Negative symptoms: blunted affect, poor posture, lack
goal-directed activities or initiative
• Impairment: inability to hold job or maintain
relationships
Management
• Hospitalize if suicidal, unable to care for self, or pose a
threat to self or others
• First line: serotonin and dopamine antagonists
(SDAs); atypical antipsychotics (risperidone, olanzapine, aripiprazole, ziprasidone, quetiapine, asenapine, paliperidone) for negative symptoms & fewer side effects
Narcolepsy
Pathophysiology
• Caused by a hypocretin deficiency in lateral
the hypothalamus (per DSM-V)
Presentation
• Classic tetrad:
o Excessive daytime sleepiness: naps can be refreshing o Hallucination: hypnagogic (just before sleep) and
hypnopompic (just before waking)
o Cataplexy: loss of muscle tone following strong
emotional stimulus
o Sleep paralysis: short paralysis with awakening
Diagnostic Studies
• Polysomnography
Management
• Modafinil, methylphenidate, or amphetamines
Somatization Disorder
- Somatic Symptom Disorder
- Malingering
- Factitious Disorder
Illness Anxiety Disorder
Presentation
• Hypochondriasis
• Preoccupied with serious illness, despite negative exam/
testing
• Evaluate for other medical diagnosis
Management
• Management is CBT, psychotherapy, antidepressants
Adjustment Disorder
Presentation
• Disproportionate response to a stressor than would
normally be expected (e.g., job loss, physical illness)
which begins within three months of the stressful event • Remission of symptoms usually within six months
• Stressors
o Marital conflict
o Financial conflict
o Family conflict or parental separation o School problems or changing schools o Sexuality issues
o Death or illness in the family
Management
• Psychotherapy
Post-Traumatic Stress Disorder
- Nightmare treatment
- 1st line
Presentation
• Recent traumatic event which causes an acute stress reaction
• Once the symptoms persist past one month it is now considered post-traumatic stress disorder (PTSD)
Management
• SSRIs are first line
• CBT
• Prazosin for nightmares
• Benzodiazepines, if used, should not be continued more
than two weeks after a traumatic event
Vulvovaginitis
Causes
Treatment
Erythema infectiosum, also known as fifth disease,
Rubella
