Exam 3 Flashcards
What is the most common psychiatric disorder in the US?
Anxiety
What is are the DSM-5 symptom criteria for diagnosis of GAD?
A. Excessive anxiety and worry predominating for at least 6 months
B. Patient finds it difficult to manage the worry
C. 3/6 Anxiety Physical symptoms present most days
D. The disturbance is not due to a medication or other diagnosis
What are the six physical symptoms listed in the DSM-5 as associated with GAD?
-Restlessness
-Easily fatigued
-Difficulty concentrating or mind going blank
-Irritability
-Muscle tension
-Sleep disturbance
What are the DSM-5 symptom criteria for major depressive disorder?
Five or more symptoms present during the same 2 weeks period and represent a change from previous functioning. Symptoms: depressed mood, anhedonia (loss of interest or pleasure), weight loss or gain, insomnia or hypersomnia, psychomotor agitation, fatigue, feeling worthless or guilty, decreased concentration, suicidal ideation
What are the risk factors for major depression?
-Adolescent or older adult
-Female gender
-Family Hx
-Hx of migraines, pain, recent MI, peptic ulcer disease
-Medical conditions: chronic disease or insomnia
-Lifestyle: stress, poverty, lack of education, trauma
What are the common presenting symptoms of depression in the geriatric patient?
-Poor appetite, disrupted sleep, pain, feelings of guilt and worry, suicidal ideation, memory problems, psychomotor agitation
What are the first line pharmacologic treatment options for major depressive disorder?
SSRIs, SNRIs, TCAs, bupropion (a norepinephrine dopamine reuptake inhibitor)
What are the concerns about pharmacological treatment for major depression in the elderly?
-SSRI- increased risk for development of SIADH in elderly
-Increased risk for falls, osteoporosis, and fractures
-Generally the elderly are more sensitive to side effects of medications, have decreased drug metabolism, multiple medical morbidities, and polypharmacy
What are the nonpharmacological treatment options for major depressive disorder?
-Interpersonal and cognitive behavioral therapy
-Support group, counseling
-Establish a routine, increase activities, relaxation, massage, exercise, good nutrition
What are the pharmacological treatment options for GAD?
First line- SSRIs (escitalopram, paroxetine, sertraline),
Acute treatment: SNRIs (Buspirone, venlafaxine)
If needing sedation- TCAs (imipramine)
Antihistamines- hydroxyzine
What are the nonpharmacological treatment options for GAD?
-Cognitive-behavioral therapy/Counseling
-Patient education: symptom recognition, interpretation, decrease intake of stimulants (caffeine/nicotine), relaxation skills
What is the difference between major mood disorders (unipolar) and bipolar disorders I and II?
Unipolar: another name for major depressive disorder, unipolar meaning without mania
Bipolar I: at least one episode of reported mania with or without depression episode; essential feature is mania
Bipolar II: recurrent moods of hypomania and depression
Mnemonic DIGFAST for manic episode
Distractibility
Insomnia
Grandiosity (inflated self-esteem)
Flight of ideas (racing thoughts)
Activities (increased, goal-directed)
Speech (increased)
Thoughtlessness (poor judgement)
How do you assess suicide risk?
Mnemonic SAD PERSONS;
S- Male Sex
A- <19, >45yrs
D- Depression
P- Previous attempts
E- Excessive alcohol/substance use
R- Rational thinking loss
S- Social supports lacking
O- Organized plan
N- No spouse
S- Sickness
What are the stages of grieving?
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
What are the phases of grief?
-Avoidance
-Confrontation
-Accommodation
How would you identify intimate partner violence?
a pattern of assaultive and coervice behaviors that my include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats by an intimate partner
What is the clinical presentation of PTSD?
Patient would describe reexperiencing of the event, a pattern of avoidance, and emotional numbing (negative thoughts or feelings, hyperarousal symptoms such as jumpiness)
What are some screening tools for PTSD?
Primary care PTSD Screen for DSM-5 (PC-PTSD-5), Trauma Screening Questionnaire (TSQ)
What are the DSM-5 criteria for a diagnosis of PTSD?
Traumatic or threatened event results in symptoms of re-experiencing the trauma, avoidance, and cognitive mood changes that last greater than a month and cause active distress
What is the pharmacological management for PTSD?
SSRIs- paroxetine, sertraline
TCAs
Anxiolytics- Buspirone to reduce intrusive sx
What is the nonpharmacological management for PTSD?
Safety assessment, trauma-focused psychotherapy, CBT, written narrative exposure
S&S of anorexia nervosa
Hypothermia, constipation, lethargy, nervous energy, hypotension, dehydration, dry skin, hypertrophy of salivary glands
S&S of bulimia nervosa
Tooth erosion, periodontal disease, swollen salivary glands, esophageal irritation, GERD, calluses on the back of hands, abdominal pain, irregular menses