FINAL Flashcards
Major Depression Disorder
-5+ in 2 week period:
-DEPRESSED MOOD or LOSS OF INTEREST OR PLEASURE
-Depressed most of the day, nearly every day
-anhedonia
-weight loss when not dieting or weight gain (> 5% in a month), or decrease or increase in appetite
-Insomnia or hypersonic
-Psychomotor agitation or retardation (observable by OTHERS)
-Fatigue
-worthlessness or guilt
-bad concentration, or indecisiveness
-suicidal ideation
-impairment in social, occupational, or other important areas of functioning.
-not attributable substance or medical condition
depression pharmacotherapy
-SSRIs (Prozac): Inhibit the reuptake of Serotonin.
-SE: Insomnia, sedation, agitation, GI upset, headache, !decreased libido, erectile dysfunction, anorgasmia!
-SNRIs (Effexor): Inhibit the reuptake of Serotonin and Norepinephrine.
-SE: Insomnia, anxiety, hypertension, headache, decreased libido, erectile dysfunction, and anorgasmia, lowers threshhold for seizures, less ED
-NDRIs (Wellbutrin): Inhibit reuptake of dopamine and norepinephrine
SE: Decreased seizure threshold, headache, insomnia, agitation, tachycardia, dizziness, less ED
-!Fewer sexual side effects!
-Off-Label and Adjunctive Drugs:
-Antipsychotics: added in resistant or psychotic depression
-Antiepileptics: resistant or agitated depression
-Phenytoin, ethosuximide, carbamazepine, oxcarbazepine, gabapentin, sodium valproate, pregabalin and lamotrigine
-Lithium: adjunct in resistant depression
-Psychostimulants: improve effectiveness of antidepressants in resistant depression while specifically targeting sadness, anhodenia, decreased energy, and decreased cognition.
-ex. ritalin, Adderall
mania symptom domains
-Elation: Euphoria, grandiosity, pressured speech, impulsivity, increased libido, recklessness, social intrusiveness, decreased need for sleep
-Dysphoria: Depression, anxiety, hostility, irritability, suicide, violence
-Cognition: Racing thoughts, distractibility, disorganization, inattentiveness
-Psychotic: Delusions, hallucinations
bipolar disorder tx
-ANTIMANIACS
-lithium - DOC
-SE: Hypothyroidism, tremor, thirst, polyuria, GI distress, arrhythmia, leukocytosis
-Teratogenic in first trimester
-Narrow therapeutic index
-Initial Labs: CBC, U/A, BUN/Creatinine, HCG Electrolytes, Thyroid Functions, EKG
-ANTIEPILEPTICS
-Depakote (divalproex sodium, valproate)
-SE: Headache, GI upset, tremor, elevated LFTs. thrombocytopenia, hepatotoxicity
-Initial Labs: CBC, LFTs, HCG
-Equetro/Tegretol (carbamazepine)
-SE: Sedation, GI upset, elevated LFTs. leukopenia, thrombocytopenia, aplastic anemia
-Initial Labs: CBC, LFTs, HCG
-Lamictal (lamotrigine)
-SE: Exfoliating dermatitis, Stevens-Johnson Syndrome, dizziness, ataxia, sleepiness
-Initial Labs: N/A
-ANTIPSYCHOTICS
-All atypical antipsychotics are FDA approved
-SE: lethargy, somnolence, dry mouth, wt gain, and orthostatic hypotension
-parkinson-like symptoms.
anxiety
-MC mental health illness in USA
-PCP treats 90% of time
-high rate comorbid psychiatric disorder -> Depression (50%)
-High rates of alcohol and drug abuse
-high rates of suicide attempts
-5X more likely to see medical care
-6X more likely to be hospitalized for a psychiatric condition
-Affects 1/8 children -> strong genetic component
Generalized Anxiety Disorder
-6 MONTHS 3+ -> only 1+ in children:
-edginess or restlessness
-tiring easily, more fatigued than usual
-impaired concentration / mind goes blank
-irritability
-increased muscle aches or soreness
-difficulty sleeping (trouble falling asleep, staying asleep, restlessness at night, unsatisfying sleep)
social anxiety
-6 months
-affecting either interpersonal or occupational functioning
phobic disorder
-6 months
-rule out -> agoraphobia, OCD, separation anxiety
-animal, natural environment, blood-injection, situational
-agoraphobia- 6 months
PTSD
-Criterion A: Exposure to death, threatened death, serious injury, or sexual violence in 1+ of following:
-Direct experience
-Witnessing first hand
-Learning relative/friend was exposed to trauma
-Repeated or exposure to details of trauma -> first responders, medics, police officers
-Criterion B: Presence of 1+ INTRUSIVE symptoms:
-Recurrent distressing memories
-Recurring nightmares
-Flashbacks
-Intense distress with reminders
-Physical reactions with reminders
-Criterion C: AVOIDANCE 1+ of following:
-Avoidance of distressing memories
-Avoidance of external reminders, like people, places, conversations, and activities
-Criterion D: Negative alterations to mood and cognition, 2+ of following:
-cant remember aspects of trauma
-negative thoughts about oneself, others, or the world
-Blaming oneself or others for the trauma
-Persistence negative emotional state -> fear, horror, anger, guilt, or shame
-Diminished interest
-detachment or estrangement from others
-Inability to experience positive emotions
-Criterion E: REACTIVITY, 2+ of following:
-Irritability and angry outbursts
-Reckless and self-destructive behavior
-Hypervigilance- constantly assessing threats
-Exaggerated startle response
-Problems with concentration
-Difficulty sleeping
-Criterion F: > 1 month
-Criterion G: impairment in social, occupational, and other important areas of functioning.
-Criterion H: not due to medication, substance use, or another medical condition
OCD related disorders
-trichotillomania
-body dysmorphic disorder
-hoarding disorder
-excoriation disorder
-obsessions:
-contamination
-pathologic doubt
-need for symmetry
-scrupulous
-aggressive/violent
-sexual
-compulsions:
-cleanings
-checking, arranging
-congessing
-counting
-praying
drugs that cause anxiety
-social- alcohol, caffeine, nicotine
-prescription drugs- corticosteroids, beta agonist, theophylline, methylphenidate
-OTC drugs- decongestants
-illicit drugs- cocaine, amphetamine, marijuana, LSD, K2
-drug withdrawal- alcohol, caffeine, nicotine, benzodiazepines, beta blockers, heroin, pain meds
anxiety tx: pharmacotherapy
-SSRIs (Prozac, Lexapro): 1st Line Tx!!
-Starting dose lower than Depression -> SE are more common compared to Depression
-Therapeutic dose often higher compared to Depression
-SNRIS (Effexor XR, Pristiq, Cymbalta): Indicated in Anxiety and Depression
-Tricyclic Antidepressants: Anafranil indicated for OCD
-Serotonin Partial Agonists (BuSpar): Indicated for GAD only
-No tolerance, dependence, withdrawal, and sedation
-Benzodiazepines: Not first-line tx, but -> immediate onset.
-SE: Sedation, confusion, impaired memory, ataxia, behavioral disinhibition, respiratory depression, tolerance, dependence, withdrawal
-death -> in pts with impaired respiratory function (COPD, Sleep Apnea)
-Antihypertensives:
-Alpha-2 Agonists (Clonidine): Reduces sympathetic activity
-Beta-blockers (Inderal) Decrease autonomic response
-Anticonvulsants (Neurontin, Lyrica): Increase GABA levels in the brain
-Antipsychotics (Risperdal, Geodon): Decrease dopamine in brain
-Block Serotonin-2 pathways in the brain
personality disorder
-A. behavior deviates from expectations of pts culture
-2 of following:
-cognition (perception and interpretation of self, others and events)
-affect (range, intensity, lability, and appropriateness of emotional response)
-interpersonal functioning
-impulse control
-B. inflexible across social situations.
-C. impairment in social, occupational, or other
-D. long duration and onset traced back to adolescence or early adulthood
dx- Minnesota Multiphasic Personality Inventory
paranoid personality etiology
-MC in families with hx of schizophrenia or delusional disorder
-MC in pts whos family emphasized avoiding scrutiny and failure
-MC in people who suffer mistreatment -> prisoners, refugees, war victims
schizoid etiology
-in families with autism and schizophrenia
-defense mechanism to avoid emotional distress from repeated failures in past
-slightly MC in pts with no family emotional nuturing
antisocial personality / etiology
-impulsive -> dont plan ahead
-irresponsible
-5x more likely in pts with 1st degree male with ASPD
-increase risk if father is alcoholic
-twin studies show correlation
-Lack of consistent person for child to bond with
-Neglect and physical abuse in childhood noted.
borderline personality
-sees things are good or bad
-increased in pts with 1st degree relative who have substance abuse or mood disorders
-raised in invalidating environment
-neglect and childhood sexual, physical, or emotional abuse
-conflict with maternal figure noted in childhood
-impulsivity gets better past 30 but interpersonal problems persist
-67%- substance abuse
-50% depression
-10% suicide
-dialectical behavior therapy (DBT)
narcissistic etiology
-child remains self centered due to lack of empathy from parents
-reaction to combat low self esteem secondary to lack of parental appreciation
avoidant personality etiology
-parental rejection or not enough early love
-pt never took personal risks to realize failing is not fatal
obsessive compulsive personality etiology
-parental reinforcement of conformity
-harsh discipline
-compensation for lack of control in other areas of life
anorexia
-significantly low body wt compared to expected wt with age, sex, development
-BMI < 17.5 or <85% of expected
-dependent edema
-cardiac arrhythmias- tachy, brady
-bloating
-appetite REMAINS
-ritualistic exercise
-3 MONTHS
-labs:
-leukopenia
-hypoglycemia
-hypokalemia, hypochloremia
-metabolic alkalosis
-EKG- ST depression, T wave flattening/inversion, prolonged QTC
bulimia
-1x week for 3 months
-high calories, sweet, smooth texture
-50% anorexics become bulimic (hard to not eat)
-russels sign
-malnutrition not obvious
-impulse control problems
-many are borderline
-dehydration
-low Mg, hypokalemia, hypochloremia (metabolic alkalosis)
-gastric ulcers
-esophageal tears
-esophageal cancer
-bradycardia, hypotension
