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First Aid Flashcards

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1
Q

Definition of Generalized Anxiety Disorder

A

uncontrollable, excessive anxiety or worry about multiple activities or events that leads to significant impairment or distress. male:female is 1:2, clinical onset is in early 20s. Presents with anxiety on most days (6 or more months) with 3 or more somatic symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, disturbed sleep.

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2
Q

short term therapy for generalized anxiety disorder

A

benzodiazepines. taper once long term therapy is established (i.e. with SSRIs) in view of high risk of tolerance and dependance

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3
Q

dangers of stopping benzos “cold turkey” when treating GAD short term

A

may develop potentially lethal withdrawal symptoms similar to alcohol withdrawal

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4
Q

Long term therapy for generalized anxiety

A

lifestyle changes, psychotherapy, medications (SSRIs are first line, venlafaxine, buspirone), patient education

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5
Q

5 anxiolytic meds

A

SSRIs, Buspirone, Beta blockers, Benzodiazepines, Flumazenil

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6
Q

Side effects of SSRIs

A

Nausea, GI upset, somnolence, sexual dysfunction, agitation

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7
Q

side effects of Buspirone

A

seizures with chronic use. no tolerance, dependence or withdrawal

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8
Q

Beta Blocker side effects

A

bradycardia, hypotension

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9
Q

Benzodiazepines side effects

A

decreased sleep duration, risk of abuse, tolerance, and dependence, disinhibition in young or old patients; confusion

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10
Q

MOA of Flumazenil

A

competitive antagonist at GABA receptor

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11
Q

Side effects of Flumazenil

A

resedation, nausea, dizziness, vomiting, and pain at the injection site.

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12
Q

how to OCD patients generally present

A

to a nonpsychiatrist- i.e. to a dermatologist with a skin complaint 2/2 overwashing hands

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13
Q

difference btwn OCD and OCPD

A

OCD: patient recognizes these behaviors as excessive and irrational products of their mind. they wish they could get rid of the obsession and/or compulsion

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14
Q

Treatment for OCD

A

Pharmacotherapy (SSRIs are first line pharmacologic treatment), cognitive behavioral therapy (CBT) using exposure and desensitization relaxation techniques. patient education is imperative.

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15
Q

Definition of panic disorder

A

characterized by recurrent, unexpected panic attacks. two to three times more common in females than in males. agoraphobia is present in 30-50% of cases. average age of onset is 25

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16
Q

Definition of a panic attack

A

defined as discrete periods of intense fear or discomfort in which at least 4 of the following symptoms develop abruptly and peak within 10 minutes: tachypnea, chest pain, palpitations, diaphoresis, nausea, trembling, dizziness, fear of dying or ‘going crazy’, depersonalization, or hot flashes.

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17
Q

perioral and/or acral paresthesias

A

fairly specific to panic attacks. produce hyperventilation and low O2 saturation

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18
Q

Panic disorder patients present with symptoms for how long

A

1 or more months of concern about having additional attacks or significant behavior change as a result of attacks.

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19
Q

panic disorder therapy

A

short term: benzos (avoid long term use cause of addiction or tolerance), taper once tx (i.e. SSRIs). long term: CBT, SSRIs, TCAs

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20
Q

do patients with phobias recognize that their fear is excessive?

A

yes

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21
Q

PTSD treatment

A

short term: beta blockers, alpha agonists (i.e. clonidine). Long term: SSRIs are first line, buspirone, TCAs and MAOIs may be helpful. bEnzos are used but should be avoided if possible. psychotherapy and support groups are useful.

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22
Q

definition of a cognitive disorder

A

affects memory, orientation, judgement, and attention.

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23
Q

Dementia

A

a decline in cognitive functioning with global deficits. level of consciousness is stable (vs. delerium). Prevalence is highest among those greater than 85 years old. common cause is alzheimers and vascular dementia.

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24
Q

other causes of dementia (DEMENTIA)

A

Degenerative diseases (parkinsons, huntingtons), endocrine (thyroid, parathyroid, pituitary, adrenal), metabolic (alcohol, electrolytes, vitamin B12 deficiency, glucose, hepatic, rengal, wilson’s disease), exogenous (heavy metals, carbon monoxide, drugs), neoplasia, trauma (subdural hematoma), infection (meningitis, encephalitis, endocarditis, syphilis, HIV, prions, lyme), affective disorders (pseudodementia), stroke/structure (vascular dementia, ischemia, vasculitis, normal pressure hydrocephalus).

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25
Q

Diagnosis of dementia

A

memory impairment and 1 or more of: the 4 As of dementia (progression of cognitive impairment follows this order- Amnesia, aphasia, apraxia, agnosia), impaired executive function (problems with planning, organizing, and abstracting in the presence of a clear sensorium, personality/mood/behavior changes, often become more confused later in the day and at night.

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26
Q

Rule out treatable causes of dementia. get what labs

A

CBC, RPR, CMP, TFTs, HIV, B12/folate, ESR, UA, head CT or MRI.

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27
Q

avoid benzos in dementia because

A

may exacerbate disinhibition and confusion

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28
Q

Major Causes of delirium

A

I WATCH DEATH: Infection, Withdrawal, Acute metabolic/substance Abuse, Trauma, CNS pathology, Hypoxia, deficiencies, endocrine, acute vascular/MI, toxins/drugs, heavy metals

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29
Q

Major Depressive Disorder

A

characterized by 1 or more major depressive episodes. the male-to-female ratio is 1:2. onset is usually in mid 20s, in elderly, prevalence increases with age. chronic illness and stress increase risk. approximately 2-9% of patients die by suicide.

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30
Q

SIGECAPS

A

sleep (hyper or insomnia), interest, guilt, energy, concentration, appetite, psychomotor agitation or retardation, suicidal ideation

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31
Q

diagnosing major depressive disorder

A

depressed mood or anhedonia and 5 or more of SIGECAPS for a 2 week period.

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32
Q

TCA toxicity

A

three Cs: Convulsions, Coma, Cardiac Arrhythmias

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33
Q

what % of patients with MDD respond to medication

A

50-70% (allow 2-6 weeks to take effect, treat for 6 months.

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34
Q

most effective treatment regimen for MDD

A

psychotherapy combined with antidepressants is more effective than either alone

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35
Q

ECT

A

safe, highly effective and often lifesaving therapy that is reserved for refractory depression or psychotic depression, or if rapid improvement in mood is needed

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36
Q

adverse effects of ECT

A

post ictal confusion, arrhythmias, headache, and anterograde amnesia

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37
Q

how long to wait to start an MAOI if patient was on fluoxetine? other SSRIs?

A

5 weeks for fluoxetine, 2 weeks for other SSRI

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38
Q

Bipolar type I

A

involves at least 1 manic episode or mixed episode (usually needing hospitalization)

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39
Q

Bipolar type II

A

At least 1 MDE and 1 hypomanic episode

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40
Q

rapid cycling type bipolar

A

4 or more episodes (MDE, manic, mixed, or hypomanic) in 1 year

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41
Q

cyclothymic type bipolar

A

chronic and less severe, with alternating periods of hypomania and moderate depression for more than 2 years.

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42
Q

symptoms of mania (screening for bipolar)

A

DIG FAST (distractability, insomnia, grandiosity, flight of ideas, activity/psychomotor agitation, sexual indiscretions, talkativeness/pressured speech

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43
Q

SSRIs (examples, indications, side effects)

A

Fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine. for depression, anxiety. has sexual side effects, GI distress, agitation, insomnia, tremor, diarrhea. Serotonin syndrome (fever, myoclonus, mental status changes, cardiovascular collapse) can occur if SSRIs are used with MAOIs, illicit drugs, or herbal medications.

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44
Q

Atypical Antipsychotics (examples, indications)

A

Bupropion, mirtazapine, trazodone. for depression, anxiety.

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45
Q

Bupropion side effects

A

decreased seizure threshold, minimal sexual side effects. contraindicated in patients with eating disorders and seizure patients

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46
Q

Mirtazapine side effects

A

weight gain, sedation

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47
Q

Trazodone side effects

A

highly sedating, priapism

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48
Q

SNRIs (examples, indications, side effects))

A

venlafaxine, duloxetine. for depression, anxiety, chronic pain. Venlafaxine can cause diastolic hypertension

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49
Q

TCAs (examples, indications, side effects)

A

nortriptyline, desipramine, amitriptyline, imipramine. Depression, anxiety disorder, chronic pain, migraine headaches, enuresis. Lethal with overdose owing to cardiac conduction arrhythmias (i.e. prolonged conduction through the AV node, long QRS). monitor in the ICY for 3-4 days following an OD. Anticholinergic effects (Dry mouth, constipation, urinary retention, sedation).

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50
Q

MAOIs (examples, indications, side effects)

A

Phenelzine, tranylcypromine, selegiline. for depression, especially atypical. Side effects: hypertensive crisis if taken with high tyramine foods (aged cheese, red wine). sexual side effects, orthostatic hypotension, weight gain.

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51
Q

Manic Episode

A

manic episode is 1 week or more of persistently elevated, expansive, or irritable mood plus 3 DIG FAST symptoms. psychotic symptoms are common in mani.

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52
Q

Treatment of Bipolar Mania

A

acute therapy: antipsychotics. maintenance therapy- mood stabilizers. use benzodiazepines for refractory agitation.

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53
Q

Treatment of bipolar depression

A

mood stabilizers +/- antidepressants. start mood stabilizers FIRST to avoid inducing mania. ECT may be used if refractory. In patients with severe depression or bipolar II with predominantly depressive features, antidepressant treatment can be augemented with low dose lithium

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54
Q

Characteristics of a personality disorder

A

MEDIC: Maladaptive, eduring, deviate from cultural norms, inflexible, cause impairment in social or occupational functioning.

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55
Q

Lithium (indications and side effects)

A

first line mood stabilizer. used for acute mania (in combo with antipsychotics) for ppx in BPD, and for augmentation in depression treatment. Side effects: thirst, polyuria, diabetes insipidus, tremor, weight gain, hypothyroidism, nausea, diarrhea, seizures, teratogenicity (first trimester), acne, vomiting. narrow therapeutic window. toxicity > 1.5 mEQ/L

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56
Q

Carbamazepine (indications and side effects)

A

second line mood stabilizer, anticonvulsant, trigeminal neuralgia, Side effects: skin, rash, leukopenia, AV block. Rarely aplastic anemia (monitor CBC weekly). SJS

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57
Q

valproic acid (indications and side effects)

A

for BPD, anticonvulsant. Side effects: GI, tremor, sedation, alopecia, weight gain. rarely: pancreatitis, thrombocytopenia, fetal hepatotoxicity, and agranulocytosis.

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58
Q

Lamotrigine (indications and side effects)

A

second line mood stabilizer, anticonvulsant. side effects: blurred vision, GI distress, SJS. increase dose slowly to monitor for rashes

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59
Q

personality disorder clusters A B and C

A

Weird, Wild, Wimpy (alphabetical)

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60
Q

cluster A disorders

A

Paranoid, Schizoid, Schizotypal

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61
Q

Paranoid

A

distrustful, suspicious, interpret others’ motives as malevolent

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62
Q

Schizoid

A

isolated, detached “loners”, restricted emotional expression

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63
Q

Schizotypal

A

odd behavior, perceptions, and appearance. Magical thinking: ideas of reference

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64
Q

Cluster B disorders

A

Borderline, histrionic, narcissistic, antisocial

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65
Q

Borderline personality disorder

A

unstable mood, relationships, and self image. feelings of emptiness. impulsive. history of suicidal ideation or self-harm.

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66
Q

Histrionic personality disorder

A

excessively emotional and attention seeking. sexually provocative, theatrical

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67
Q

Narcissistic personality disorder

A

grandiose; need admiration; have sense of entitlement, lack empathy

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68
Q

Antisocial personality disorder

A

Violate rights of others, social norms, and laws. Impulsive; lack of remorse. Begins in childhood as conduct disorder

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69
Q

Cluster C disorders

A

Obsessive-compulsive, avoidant, dependent

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70
Q

Obsessive-compulsive disorder

A

Preoccupied with perfectionism, order, and control at the expense of efficiency. inflexible morals and values.

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71
Q

Avoidant personality disorder

A

socially inhibited, rejection sensitive. Fear being dislike or ridiculed

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72
Q

Dependent personality disorder

A

submissive, clingy, have a need to be takenc are of. Have difficulty making decisions. Feel helpless

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73
Q

Schizophrenia (etiology)

A

Dopamine dysregulation (frontal hypoactivity and limbic hyperactivity), and bran abnormalities on CT and MRI (enlarged ventricles and decreased cortical volume.

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74
Q

Subtypes of schizophrenia

A

Paranoid, disorganized, catatonic

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75
Q

Paranoid type schizophrenic

A

delusions and/or hallucinations are present. cognitive function is usually preserved. Associated with the best overall prognosis

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76
Q

Disorganized type schizophrenic

A

speech and behavior patterns are highly disordered and disinhibited with flat affect. The thought disorder is pronounced, and the patient has poor contact with reality. carries the worst prognosis

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77
Q

Catatonic type schizoprenia

A

rare form characterized by psychomotor disturbance with 2 or more of the following; excessive motor activity, immobility, extreme negativsm, mutism, waxy flexibility, echolilia, or echopraxia

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78
Q

Schizophreniform disorder

A

symptoms of schizophrenia with a duration of less than 6 months

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79
Q

positive schizo symptoms

A

hallucinations, delusions, disorganized speech, bizarre behavior, and thought disorder

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80
Q

negative schizo symptoms

A

flat affect, decreased emotional reactivity, poverty of speech, lack of purposeful actions, anhedonia.

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81
Q

schizoaffective disorder

A

combines the symptoms of schizophrenia with a major affective disorder (MDD or BPD)

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82
Q

delusion v. hallucination v. illusion

A

Delusion: fixed false idiosyncratic belief. Hallucination- perception without an existing external stimulus. illusion: misperception of an actual external stimulus

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83
Q

Treatment of schizophrenia

A

antipsychotics, long term follow up. supportive psychotherapy, training in social skills, vocational rehabilitation, and illness education may help

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84
Q

ADHD

A

persistent pattern of excessive inattention and/or hyperactivity/impulsivity. more common in males; typically presents between ages 3 and 13. often shows a familial pattern. Diagnosis requires 6 or more symptoms from each category listen below for 6 or more months in at least 2 settings

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85
Q

Typical antipsychotics (examples, indications, side effects)

A

Haloperidol, droperidol, fluphenazine, thioridazine, chlorpromazine. Psychotic disorders, acute agitation, acute mania, tourette’s syndrome. Thought to be more effective for positive symptoms of schizophrenia. primarily block D2 receptors. For patients in whom compliance is a problem, consider depot forms of haloperidol, fluphenazine, etc.

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86
Q

DMS IV criteria for schizophrenia

A

two or more must be present for at least 1 month: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (flattened affect etc). Must cause significant social or occupational functional deterioration, duration of illness fora t least 6 months (including prodromal or residual periods in which above criteria may not be met), symptoms not due to medical, neurological, or substance-induced disorder

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87
Q

genetic predisposition to schizophrenia

A

50% concordance rate among monozygotic twins, 40% risk if both parents have schizophrenia, 12% if one first degree relative is affected

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88
Q

what pathway is responsible for negative schizophrenia symptoms

A

prefrontal cortical

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89
Q

what pathway is responsible for positive symptoms of schizophrenia

A

mesolimbic

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90
Q

what pathway is blocked by neuroleptics that causes hyperprolactinemia

A

tuberoinfundibular

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91
Q

what pathway causes extrapyramidal side effects when blocked by neuroleptics

A

nigrostriatal

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92
Q

CT scans of patients with schizophrenia often show

A

enlargement of the ventricles and diffuse cortical atrophy

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93
Q

neurotransmitter abnormalities implicated in schizophrenia

A

elevated serotonin (risperidone and clozapine antagonize serotonin and dopamine), elevated norepinephrine (long term antipsychotic use decreases activity of noradrenergic neurons), and decreased GABA

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94
Q

better prognostic factors in schizophrenia

A

later onset, good social support, positive symptoms, mood symptoms, acute onset, female sex, few relapses, good premorbid functioning

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95
Q

worse prognostic factors in schizophrenia

A

early onset, poor social support, negative symptoms, family history, gradual onset, male sex, many relapses, poor premorbid functioning (social isolation)

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96
Q

Typical antipsychotics/neuroleptics

A

chlorpromazine, thioridazine, trifluoperazine, haloperidol. D2 antagonists. better at treating positive than negative symptoms. important side effects and sequelae (EPS, NMS, TD)

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97
Q

Atypical neuroleptics/antipsychotics

A

Risperidone, clozapine, olanzapine, quetiapine, aripiprazole, ziprosidone. Antagonize 5-HT2 receptor as well as dopamine. better at treating negative symptoms. lower incidence of EPS.

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98
Q

EPS

A

dystonia- spasms of neck, face, tongue. parkinsonism (resting tremor, rigidity, bradykinesia), akathisia (feeling of restlessness)

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99
Q

Treatment of EPS

A

antiparkinsonian agents (benztropine, amantadine, etc), benzodiazepine

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100
Q

two antipsychotics with highest incidence of EPS

A

haloperidol and trifluoperazine

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101
Q

antipsychotics with more anticholinergic side effects

A

chlorpromazine and thioridazine

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102
Q

Tardive Dyskinesia (and tx)

A

darting or writhing movements of face, tongue, and head. d/c offending agent and substitute atypical. benzodiazepines, beta blockers, and cholinomimetics may be used short term. often persists despite withdrawal of agent.

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103
Q

Neuroleptic malignant syndrome

A

confusion, high fever, elevated BP, tachycardia, “lead pipe” rigidity, sweating, and greatly elevated creatine phosphokinase.

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104
Q

Schizophreniform V. Schizophrenia

A

schizophreniform: symptoms have lasted between 1 and 6 months. schizophrenia: symptoms more than 6 months.

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105
Q

Schizoaffective disorder

A

meet criteria for either major depressive episode, manic episode, or mixed episode. have had delusions or hallucinations for 2 weeks in the absence of mood disorder symptoms, have mood symptoms present for substatial portion of psychotic illness, not due to medical illness

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106
Q

Brief psychotic disorder

A

1 day to 1 month.

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107
Q

delusional disorder criteria

A

nonbizarre, fixed delusions for at least 1 month, does not meet criteria for schizophrenia, functioning in life not significantly impaired.

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108
Q

schizotypal

A

paranoid, odd or magical beliefs, eccentric, lack of friends, social anxiety, criteria for true psychosis are not met

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109
Q

schizoid

A

withdrawn, lack of enjoyment from social interactions, emotionally restricted

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110
Q

Major depressive episode criteria

A

must have at least 5 of following symptoms for at least a 2 week period: depressed mood, anhedonia, change in appetite or weight, worthlessnes or guilt feelings, insomnia or hypersomnia, diminished concentration, psychomotor agitation or retardation (restlessness or slowness), fatigue or loss of energy, recurrent thoughts of death or suicide.

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111
Q

manic episode criteria

A

period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week and including at least three of the following: distractibility, inflated self esteem or grandiosity, increase in goal directed activity, decreased need for sleep, flight of ideas/racing thoughts, more talkative or pressured speech (rapid and uniterruptible), excessive involvement in pleasurable activities that have a high risk of negative consequences (i.e. buying sprees, sexual indiscretions)

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112
Q

DIG FAST

A

distractibility, insomnia, gradiosity, flight of ideas, activity/agitation, speech (pressure), thoughtlessness

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113
Q

possible medical conditions that can cause depressive episodes

A

cerebrovascular disease, endocrinopathies (cushings, addisons, hypoglycemia, hyper/hypothyroid, hyper/hypocalcemia), parkinson’s, viral illnesses (mono), carcinoid syndrome, cancer (lymphoma, and pancreatic cancer), collagen vascular disease (i.e. lupus).

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114
Q

possible medical conditions that can cause manic episodes

A

metabolic (hyperthyroidism), neurological disorders (temporal lobe seizures, multiple sclerosis, neoplasms, HIV infection

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115
Q

medication/substances that can induce depressive episodes

A

EtOH, anti-HTN, barbiturates, corticosteroids, levodopa, sedative-hypnotics, anticonvulsants, antipsychotics, diuretcs, sulfonamides, withdrawal from psychostimulants

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116
Q

medication/substances that can induce mania

A

corticosteroids, sympathomimetics, dopamine agonists, antidepressants, bronchodilators, levodopa

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117
Q

SSRI side effects

A

headache, GI disturbance, sexual dysfunction, rebound anxiety

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118
Q

TCA side effects

A

most lethal in OD, sedation, weight gain, orthostatic hypotension, anticholinergic effects, can aggravate prolonged QT

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119
Q

MAOI side effects

A

hypertensive crisis when used with sympathomimetics or ingestion of tyramine rich foods (wine, beer, cheese, liver, and smoked meats). Serotonin syndrome when combined with SSRIs. most common side effect is orthostatic hypotension (tyramine is an intermediate in the conversion of tyrosine to NE.

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120
Q

serotonin syndrome

A

autonomic instability, hyperthermia, seizures. coma or death may result.

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121
Q

ECT is performed by premedication with

A

atropine

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122
Q

how to treat catatonic depression

A

with antidepressants and antipsychotics concurrently

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123
Q

Bipolar I disorder criteria

A

occurrence of one manic or mixed episode (10 to 20% of patients experience only one manic episode). btwn manic episodes they may have euthymia, MDD, dysthymia, or hypomanic episodes, but none required for dx

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124
Q

rapid cycling definition

A

occurrence of four or more mood episodes in 1 year (major depressive, manic, mixed, etc)

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125
Q

treatment of bipolar

A

lithium, anticonvulsants (carbamazepine or valproic acid)- also mood stabilizers, especially useful for rapid cycling bipolar disorder. Olanzapine- typical antipsychotic

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126
Q

side effects of lithium

A

weight gain, tremor, GI disturbances, fatigue, arrhythmias, seizures, goiter/hypothyroidism, leukocytosis (benign), coma, polyuria, polydypsia, alopecia, metallic taste

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127
Q

Dysthymic disorder (CHASES)

A

. at least 2 year years. cannot be without symptoms for more than 2 months at a time. poor Concentration or difficulty making decisions, feelings of Hopelessness, poor Appetite or overeating, inSomnia or hyerSomnia, low Energy or fatigue, low Self esteem

128
Q

prognosis of dysthymic disorder

A

20% develop bipolar, more than 25% will have lifelong symptoms

129
Q

cyclothymic disorder

A

alternating periods of hypomania and periods with mild to moderate depressive symptoms. at least 2 years. no history of Major depressive episode or manic episode

130
Q

Autonomic symptoms of anxiety

A

palpitations, perspiration, dizziness, mydriasis, GI disturbances, and urinary urgency and frequency.

131
Q

neurotransmitter abnormalities in anxiety disorders

A

increased activity of NE, and decreased GABA and serotonin

132
Q

primary anxiety disorders

A

panic, agoraphobia, specific and social phobias, OCD, PTSD, Acute stress, GAD, medical condition, substance induced

133
Q

Medical causes of anxiety disorders

A

hyperthyroid, vit B12 def, hypoxia, neuro (epilepsy, brain tumors, MS), CVD, pheochromocytoma, hypoglycemia

134
Q

panic attack timing

A

peak in several minutes and subside within 25 minutes. rarely last >1 hour.

135
Q

definition of panic attack

A

PANIC: palpitations, abdominal distress, numbness, nausea, intense fear of death, choking, chills, chest pain, sweating, shaking, SOB. must have at least 4 symptoms

136
Q

diagnosis for panic disorder criteria

A

spontaneous panic attack w/ no obvious precipitant. and at least one of the attacks followed by a min. of 1 of the following: persistent concern about having additional attacks, worry about implications of attack, and a significant change in behavior related to the attacks

137
Q

neurotransmitter abnormalities in panic disorder

A

increased NE and decreased serotonin and GABA

138
Q

Rule out medical conditions for panic disorder

A

CHF, angina, MI, thyrotoxicosis, temporal lobe epilepsy, multiple sclerosis, pheochromocytoma, carcinoid syndrome, COPD, other cardiac/pulm/neuro/endo abnormalities.

139
Q

Rule out mental conditions for panic disorder

A

depressive disorders, phobic disorders, OCD, PTSD

140
Q

rule out drugs for panic disorder

A

Amphetamine, caffeine, nicotine, cocaine, and hallucinogen intoxication, alcohol, or opiate withdrawal.

141
Q

prognosis for panic disorder

A

10-20% –> significant symptoms, 50% mild, 30-40% symptom free post tx

142
Q

initial tx of anxiety

A

Acute: benzodiazepines. taper as SSRI is started. Maintenance: SSRIs (paroxetine and sertraline) take 2-4 weeks to be effective. continue tx for 8-12 months or relapse is common

143
Q

Agoraphobia

A

fear of being alone in public places. often develops secondary to panic attacks due to apprehension about having subsequent attacks in public places where escape may be difficult. 50-75% of patients have coexisting panic disorder.

144
Q

Dx criteria for agoraphobia:

A

anxiety about being in places or situations from which escape might be difficult or help wouldn’t be available, situations are either avoided, endured with distressed, or faced with companion, and symptoms are not explained by another mental disorder

145
Q

tx of agoraphobia

A

since its usually associated with panic disorder: SSRIs

146
Q

diagnostic criteria for specific phobias

A
  1. persistent excessive fear brought on by specific situation or object 2. exposure to the situation brings about an immediate anxiety response, 3. patient recognizes that the fear is excessive, 4. situation is avoided when possible or tolerated with intense anxiety 5. if person is under age 18, duration must be at least 6 months
147
Q

FDA approved tx of social anxiety disorder

A

paroxetine (Paxil)

148
Q

four most common mental disorders

A

phobias, substance induced disorders, major depression, OCD

149
Q

Diagnostic criteria for PTSD

A

having experienced a traumatic event, potentially harmful or fatal and initial reaction was fear or horror. Persistent reexperiencing of he event (i.e. in dreams, flashbacks, or recurrent recollections), avoidance of stimuli associated with the trauma (avoiding a location that will remind him or her of the event or having difficulty recalling details, numbing of responsiveness, persistent symptoms of increased arousal, symptoms for AT LEAST 1 month

150
Q

Treatment of PTSD

A

TCAs (imipramine and doxepin), SSRIs, MAOIs, anticonvulsants (for flashbacks and nightmares)

151
Q

Acute Stress disorder criteria

A

symptoms occur within a month of the trauma and last for maximum of 1 month. symptoms similar to PTSD

152
Q

Generalized anxiety disorder

A

persistent excessive anxiety and hyperarousal for at least 6 months.

153
Q

what % of patients with GAD have coexisting mental disorder (MDD or phobia or panic)

A

50-90

154
Q

treatment of GAD

A

combo of psychotherapy and pharmacotherapy: buspirone, benzodiazepines (clonzepam or diazepam) should be tapered off as soon as possible because of risk of tolerance and dependence. SSRIs, venlafaxine

155
Q

Adjustment disorders

A

occur when maladptive behavioral or emotional symptoms develop after a stressful life event. Symptoms begin within three months after the event, end within 6 months, and cause significant impairment in daily functioning or interpersonal relationships.

156
Q

difference btwn trigering events in PTSD and adjustment disorder

A

PTSD: event was life threatening, Adjustment disorder: not life threatening (i.e. divorce, loss of job)

157
Q

personality disorder criteria (CAPRI)

A

Cognition, affect, personal relations, impulse control. is pervasive and inflexible, stable and has onset no later than adolescence or early adulthood. leas to significant distress in functioning. is not accounted for by another mental/medical illness or by use of substance.

158
Q

Cluster A personality disorders

A

Schizoid, schizotypal, paranoid. eccentric, peculiar, withdrawn. familial association

159
Q

Cluster B personality disorders

A

antisocial, borderline, histrionic, narcissistic. emotional, dramatic, inconsistent

160
Q

Cluster C personality disorders

A

avoidance, dependent, OCD. anxious or fearful.

161
Q

diagnosis of paranoid personality disorder (PPD)

A

at least 4: suspicion w/out evidence of others, preoccupation w/doubts of loyalty or trustworthiness of acquaintances, reluctance to confide in others, interpretation of benign remarks as threatening or demeaning, persistence of grudges, perception of attacks on his or her character that are not apparent to others, quick to counterattack, recurrence of suspicions regarding fidelity of spouse or lover

162
Q

treatment of paranoid personality disorder

A

psychotherapy

163
Q

Schizoid personality disorder

A

lifelong pattern of withdrawal. often perceived as eccentric and reclusive. quiet and unsociable and have constricted affect. no desire for close relationships and prefer to be alone. unlike avoidant personlity disorder, they PREFER to be alone. four or more: neither enjoy nor desire close relationships, generally choose solitary activities, little (if any) interest in sexual activity, taking pleasure in few activities, few close friends or confidants, indifference to praise or criticism, emotional coldness, detachment or flattened affect

164
Q

difference btwn schizotypal and schizoid

A

schizoid is android, schizotypical bit the bible (patients with schizoid don’t have eccentric behavior or magical thinkign seen in patients with schizotypal)

165
Q

Schizotypal personality disorder

A

pervasive pattern of eccentric behavior and peculiar thought patterns. often perceived as strange and eccentric. five or more: ideas of reference, odd beliefs or magical thinking, unusual perceptual experiences, suspiciousness, inappropriate or restricted affect, odd or eccentric appearance or behavior, few close friends or confidants, off thinking or speech, excessive social anxiety.

166
Q

diagnostic criteria for antisocial personality disorder

A

refuse to conform to social norms and and lack remorse for actions. impulsive and deceitful. often violate law but appear charming at first. must be at least 18 years old for diagnosis, h/o behavior as child/adolescent must be conduct disorder. THREE OR MORE: failure to conform to social norms by committing unlawful acts, deceitfulness/repeated lying/manipulating others for personal gain, impulsivity/failure to plan ahead, irritability, aggressiveness, recklessness, irresponsibility/failure to sustain work or honor financial obligations, lack of remorse for actions.

167
Q

borderline personality disorder (IMPULSIVE)

A

impulsive, moody, paranoid under stress, unstable self image, labile/intense relationships, suicidal, inappropriate anger, vulnerable to abandonment, emptiness

168
Q

diagnostic criteria for BPD

A

unstable mood/behavior/relationships. impulsive. at least 5: desperate efforts to avoid abandonment, unstable relationships and self image, impulsivity in harmful ways (spending, sexually, substance use), recurrent suicidal threats or attempts or self mutilation, unstable mood, general emptiness feeling, difficulty controlling anger, transient stress related paranoid ideation

169
Q

histrionic personality disorder

A

attention seeking, dramatic. can’t form meaningful relationships. at least 5: uncomfortable when not center of attention, inappropriately seductive or provocative behavior, physical appearance to draw attention, speech that is impressionistic, theaterical and exaggerated expression of emotion, easily influenced by others, perceives relationships as more intimate than they are

170
Q

narcissistic personality disorder

A

five or more: exaggerated sense of self importance, preoccupied with fantasies of unlimited money, success, brilliance, believes s/he is special or unique, needs excessive admiration, sense of entitlement, takes advantage or others for self gain, lacks empathy, envious of others or believes others are envious of him/her, arrogant or haughty

171
Q

diagnostic criteria for avoidant personality disorder

A

avoids occupation that involves interpersonal contact due to a fear of criticism and rejection, unwilling to interact unless certain of being liked, cautious of intrapersonal relationships, preoccupied with being criticized or rejected in social situations, inhibited in new social situations because s/he feels inadequate, believes s/he is socially inept and inferior, reluctant to engage in new activities for fear of embarrassment.

172
Q

diagnostic criteria for dependent personality disorder

A

at least 5: difficulty making everyday decisions w/out reassurance from others, needs others to assume responsibility for most areas of life, cannot express disagreement, difficulty initiating projects, excessive lengths to obtain support from others, helpless when alone, urgently seeks a relationship when one ends, preocupied with fears of being left to care for self. Must manifest before early adulthood

173
Q

diagnostic criteria for OCPD

A

at least 4: preoccupation with details/rules/lists, perfectionism that is detrimental to completion of task, excessive devotion to work, excessive conscnientiousness and scrupulousness about morals and ethics, will nto delegate, unable to discard worthless objects, miserly, rigid and stubborn

174
Q

define substance abuse

A

pattern of substance use leading to impairment or distress for at least 1 year with one or more manifestations: failure to fulfill obligations at work, school, or home, use in dangerous situations (i.e. driving a car), recurrent substance-related legal problems, continued use despite social or interpersonal problems due to the substance abuse

175
Q

define substance dependence

A

substance use leading to impairment or distress manifested by at least 2 in 1 year period: tolerance, withdrawal, using substance more than originally intended, persistent desire to cut down, significant time spent in getting/using/recovering, decreased social, occupational, or recreational activities, continued use despite subsequent physical or psychological problem. [ADDICTION]

176
Q

alcohol’s effects on neurotransmitters

A

activates GABA and serotonin receptors in CNS and inhibits glutamate receptors. GABA is inhibitory –> sedating effect

177
Q

metabolizing alcohol

A

[alcohol] —etOH dehydrogenase–> [acetaldehyde] —aldehyde dehydrogenase—> [acetic acid]

178
Q

treatment of acute alcohol intoxication

A

ensure adequate airway, breathing, circulation. monitor electrolytes and acid/base status. obtain finger stick glucose. give thiamine to prevent or treat wernicke’s encephalopathy, naloxone to reverse any opioids, and folate.

179
Q

three things given to pt who presents with AMS

A

thiamine, glucose, naloxone

180
Q

tx for alochol dependence (long term)

A

AA, disulfiram (antabuse) inhibits aldehyde DH, psychotherapy and SSRIs, naltrexone

181
Q

earliest symptoms of EtOH withdrawal

A

begin btwn 6 and 24 hours after last drink. if mild- irritable and insomnia. severe- fever, disorientation, seizures, or hallucinations.

182
Q

how long does etoh withdrawal last

A

2-7 days

183
Q

DTs

A

most serious form of EtOH withdrawal and often begins w/in 72 hours of cessation of drinking.

184
Q

tx of DTs

A

benzos

185
Q

wernicke-korsakoff syndrome

A

caused by thiamine (B1) deficiency resulting from poor diet of alcoholics. wernicke’s encephalopathy is acute and is reverse with thiamine: Ataxia, confusion, ocular abnormalities (nystagmus, gaze palsies), korsakoffe’s is irriversible: impaired recent memory, anterograde amnesia, +/- confabulations

186
Q

cocaine MOA

A

blocks dopamine reuptake from the synaptic cleft, causing a stimulant effect. dopamine plays role in behvaioral reinforcement

187
Q

death from cocaine OD

A

arrhythmia, seizure, or respiratory depression. vasoconstrictive effect may result in MI or CVA

188
Q

treatment of cocaine OD

A

benzos for mild to moderate agitation, haloperidol for severe agitation or psychosis, and symptomatic support

189
Q

symptoms of cocaine withdrawal

A

malaise, fatigue, depression, hunger, constricted pupils, vivid dreams, psychomotor agitation or retardation

190
Q

classic amphetamines

A

dextroamphetamine (dexedrine), methylphenidate (ritalin), methamphetamine (desoxyn, ice, speed, crystal meth, crack)

191
Q

substituted (designer) amphetamines

A

MDMA, MDEA

192
Q

medical use for amphetamines

A

treat narcolepsy, ADHD, and depressive disorders

193
Q

MOA of PCP

A

antagonizes NMDA glutamate receptors and activates dopaminergic neurons.

194
Q

rotatory nystagmus is pathognomonic for

A

PCP intoxication

195
Q

treatment of PCP intox

A

monitor BP, temperature, and electrolytes. acidify urine with ammonium chloride and ascorbic acid. benzodiazepines or dapamine antagonists to control agitation and anxiety, diazepam for muscle spasms and seizures, haloperidol to control severe agitation or psychotic symptoms.

196
Q

diagnostic evaluation of PCP intox

A

CPK, AST elevated. UA is positive for more than a week

197
Q

benzos MOA

A

potentiate effects of GABA by increasing the frequency of chloride channel opening.

198
Q

barbiturates MOA

A

are used in treatment of epilepsy and as anesthetics, and they potentiate the effects or GABA by increasing the duration of chloride openings

199
Q

Gamma hydroxybutyrate

A

GHB/grievous bodily harm is a dose specific CNS depressant that produces memory loss, respiratory distress, and coma. commonly used as date rape drug

200
Q

tx barbiturate intox

A

alkalinize urine with Na bicarb, activated charcoal to prevent further GI absorption

201
Q

tx for benzo intox

A

flumazenil for OD. charcoal to prevent GI absorption

202
Q

sedative-hypnotic withdrawal symptoms

A

autonomic hyperactivity (tachycardia, sweating, etc), insomnia, anxiety, tremor, nausea/vomiting, delirium, hallucinations. seziures may occur and may be life threatening

203
Q

tx of benzo withdrawal

A

administrate long acting benzo- chlorodiazepoxide or diazepam with tapering the dose.

204
Q

opiate intoxication symptoms

A

drowsiness, nausea/vomiting, constipation, slurred speech, constricted pupils, seizures, and respiratory depression, which may progress to coma or death in OD

205
Q

symptoms of serotonin syndrome

A

hyperthermia, confusion, hyper or hypotension and muscular rigidity.

206
Q

presentation of opiate withdrawal

A

dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, nausea/vomiting, fever, dialated pupils, muscle aches.

207
Q

treatment for opioid withdrawal

A

moderate: clonidine and/or buprenorphine. severe: detox with methadone tapered over 7 days

208
Q

MOA of cannabinoid

A

cannabinoid receptors in the brain inhibit adenylate cyclase. effects are increased when used with EtOH.

209
Q

long term effects of inhalants

A

permanent damage to CNS, peripheral nervous system, liver, kidney, and muscle

210
Q

how many mg of caffeine to intoxicate

A

250mg

211
Q

caffeine withdrawal

A

resolves within 1 week. includes headaches, nausea/vomiting, drowsiness, anxiety, or depression

212
Q

antidepressant that reduces nicotine cravings

A

zyban

213
Q

three main categories of cognitive disorders

A

dementia, delirium, amnestic disorders

214
Q

three most common causes of dementia

A

alzheimer’s (50-60%), vascular dementia (10-20%), major depression (“psuedodementia”)

215
Q

psychiatric causes of dementia

A

depression, delirium, schizophrenia, malingering

216
Q

organic causes of dementia

A

structural (forgetfulness of normal aging, parkinsons, huntingtons, downs, head trauma, brain tumor, NPH, MS, subdural hematoma), metabolic (hypothyroidism, hypoxia, malnutrition (B12, folate or thiamine deficiency), wilson’s disease, lead toxicity. Infectious (lyme disease, HIV dementia, CJD, neurosyphilis, meningitis, encephalitis

217
Q

minimum workup to exclude reversible causes of dementia

A

CBC, electrolytes, TFTs, VDRL/RPR, B12 and folate, brain CT or MRI

218
Q

dementia with stepwise increase in severity and focal neurological signs

A

multi-infarct dementia. dx w/ CT/MRI

219
Q

dementia with cogwheel rigidity and resting remor

A

lewy body dementia or parkinson disease. dx is clinical

220
Q

dementia with ataxia and urinary incontinence

A

NPH. confirm with CT and MRI. dilated cerebral ventricles

221
Q

Dementia and obesity, with coarse hair and constipation and cold intolerance

A

hypothyroidism. test T4, TSH

222
Q

dementia with diminished position and vibration sensation + megaloblasts on CBC

A

vitamin B12 deficiency.

223
Q

dementia and tremor with abnormal LFTs and kayser fleischer rings

A

wilson’s disease. dx with ceruloplasmin

224
Q

dementia with diminished position and vibration sensation + argyll robertson pupils (accommodation response present, response to light absent)

A

neurosyphillis. test CSF by fluorescent tremponemal antibody absorption test

225
Q

two types of delirium

A

quiet: seem depressed or exhibit symptoms similar to failure to thrive, an MMSE must be done to distinguish from depression and other diagnostic criteria. Agitated: obvious pulling out lines, may hallucinate

226
Q

differential for delirium: AEIOU TIPS

A

Alcohol, electrolytes, iatrogenic (anticholinergics, benzos, antiepileptics, blood pressure meds, insulin, hypoglycemics, narcotics, steroids, H2 receptor blockers, NSAIDs, abx, antiparkinsonians), oxygen hypoxia (bleeding, central venous, pulmonary), Uremia/hepatic encephalopathy, Trauma, Infection, Poisons, Seizures (post ictal)

227
Q

Aphasia

A

disorder of language, speaking, and understanding phrases

228
Q

apraxia

A

can’t do PRACticed movements like tying a shoe

229
Q

Agnosia

A

can’t recognize things that were previous KNOWN

230
Q

diagnostic criteria of alzheimer’s

A

memory impairment plus at least 1: aphasia, apraxia, agnosia, diminished executive functioning.

231
Q

neurotransmitter abnormalities in alzheimer’s

A

decreased levels of acetylcholine (due to loss of noradrenergic neurons in the locus ceruleus of the brainstem) and of norepinephrine (due to preferential loss of cholinergic neurons in the basal nucleus of meynert of the midbrain)

232
Q

what are senile plaques in alz composed of

A

amyloid protein

233
Q

what are neurofibrillary tangles in alz composed of

A

Tau proteins

234
Q

vascular dementia dx criteria

A

identical to alz in manifestations. memory impairment and at least 1: aphasia, apraxia, agnosia, diminshed executive functioning

235
Q

levodopa

A

degraded to dopamine by dopadecarboxylase

236
Q

carbidopa

A

peripheral dopadecarboxylase inhibitor

237
Q

amantadine

A

MOA unknown. parkinsons drug

238
Q

selegiline

A

monoamine oxidase-B inhibitors. inhibit breakdown of dopamine

239
Q

EEG in CJD

A

periodic sharp waves/spikes.

240
Q

common causes of delirium

A

CNS injury or disease, systemic illness, drug abuse/withdrawal, hypoxia

241
Q

causes of delirium (I’M DELIRIOUS)

A

Impaired delivery (of brain, substrates, such as vascular insifficiency due to stroke), Metabolic, Drugs, Endocrinopathy, Liver disease, Infrastructure (structural disease of cortical neurons), Renal failure, Infection, Oxygen, Urinary tract infection, sensory deprivation

242
Q

delirium + hemiparesis or other focal neurological signs and symptoms

A

CVA or mass lesion

243
Q

Delirium + elevated BP + papilledema

A

HTN encephalopathy

244
Q

Delirium + dilated pupils and tachycardia

A

drug intoxication

245
Q

delirium + fever + nuchal rigidity + photophobia

A

meningitis

246
Q

delirium + tachycardia + tremor + thyromegaly

A

thyrotoxicosis

247
Q

treating a delirious patient (FEUD)

A

fluids/nutrition, environment, underlying cause, drug withdrawal

248
Q

causes of amnestic disorders

A

hypoglycemia, systemic illness, hypoxia, head trauma, brain tumor, CVA, seizures, MS, HSV encephalitis, substances (etoh, benzos, medications)

249
Q

Normal grief

A

feelings of guilt and sadness, mild sleep disturbance and weight loss, illusions (briefly seeing deceased person or hearing his or her voice, attempts to resume daily activities/work, symptoms that resolve within 1 year, worst symptoms within 2 months.

250
Q

ABNORMAL grief (severe depression)

A

guilt and worthlessness, significant sleep disturbance and weight loss, hallucinations or delusions

251
Q

non REM sleep changes with age

A

increased amt of stage 1 and 2 sleep with decrease in stage 3 and 4 (deep sleep), increased awakening after sleep onset

252
Q

REM changes with age

A

increased number of REM episodes throughout the night. These are redistributed throughout the sleep cycle and are shorter than normal. total amt of REM sleep remains about the same

253
Q

causes of sleep disorder in the eldery

A

primary (most common is primary insomnia, others include nocturnal myoclonus, restless leg syndrome, and sleep apnea), other mental disorders, general medical conditions, social/environmental factors (etoh consumption, lack of daily structure)

254
Q

Treatment of sleep disorders in eldery

A

sedative/hypnotic drugs are more likely to cause side effects when used by the elderly, including memory impairment, ataxia, paradoxical excitement, and rebound insomnia. Therefore, other approaches should be tried first including alcohol cessation, increased structure of daily routine, elimination of daytime naps, and treatment of underlying medical conditions that may be exacerbating sleep problems. If sedative-hypnotics must be perscribed, medications such as hydroxyzine (vistaril) or zolpidem (ambien) are safer than the more sedating benzos

255
Q

definition of mental retardation

A

significantly subaverage intellectual functioning with an IQ of 70 or below. Deficits in adaptive skills appropriate for the age group. onset must be before the age of 18.

256
Q

genetic causes of mental retardation

A

down syndrome, fragile X syndrome

257
Q

conduct disorder

A

pattern of behavior that involves violation of basic rights of others or of social norms and rules with at least three acts within these categories during past year: aggression toward people and animals, destruction of property, deceitfulness, serious violations of rules

258
Q

most common diagnosis in outpatient child psychiatry clinics

A

conduct disorder

259
Q

tx of conduct disorder

A

individual psychotherapy focusing on behavior modification and problem solving skills is often useful. adjunctive pharmacotherapy may be helpful including antipsychotics or lithium for aggression and SSRIs for impulsivity, irritability, and mood lability

260
Q

oppositional defiant disorder

A

Diagnosis is at least 6 months of negativistic, hostile, and defiant behavior during which at least four of the following have been present: frequent loss of temper, arguments with adults, defying adults’ rules, deliberately annoying people, easily annoyed, anger and resentment, spiteful, blaming others for mistakes or behaviors

261
Q

three subcategories of ADHD:

A

predominantly inattentive type, predominately hyperactive- impulsive type, combined type

262
Q

diagnosis of ADHD

A

at least 6 symptoms involving inattentiveness, hyperactivity, or both have persisted for at least 6 months: inattention (problems listening, concentrating, paying attention to details or organizing tasks, easily distracted, often forgetful), hyperactivity-impulsivity. onset before age 7, behavior inconsistent with age and development

263
Q

what % of ADHD kids have symptoms that persist into adulthood

A

20

264
Q

etiology of ADHD is multifactorial, including:

A

Genetic factors (higher incidence in monozygotic twins than dizygotic), prenatal trauma/toxin exposure (fetal alcohol syndrome, lead poisoning, etc), neurochemical factors (dysregulation of peripheral and central noradrenergic systems), neurophysiological factors, psychosocial factors (emotional deprivation)

265
Q

Tx of ADHD

A

Pharm: CNS stimulants (methylphenidate [ritalin] is first line, dextroamphetamine [dexedrine] and pemoline [cylert], SSRIs/TCAs for adjunctive

266
Q

Diagnosis of Autism

A

problems with social interaction, impairments in communication, repetitive and stereotyped patterns of behavior and activities,

267
Q

difference between autistic and asperger’s

A

asperger’s children have normal language and cognitive development

268
Q

diagnosis of aspergers

A

impaired social interaction, restricted or stereotyped behaviors, interests, or activites

269
Q

Rett’s Disorder

A

normal prenatal and perinatal development, normal psychomotor development for first 5 months. normal head circumference at birth but decreasing rate of head growth btwn ages 5 and 48 months. loss of previously learned purposeful hand skills between ages 5 and 30 months. early loss of social interaction, problems with gait or trunk movements, severely impaired language and psychomotor development, seizures, cyanotic spells

270
Q

rett syndrome gene mutation

A

MECP2 on X chromosome

271
Q

Childhood disintegrative disorder

A

normal development in first 2 years of life, loss of previously acquired skills in at least two of the following areas: language, social skills, bowel/bladder control, play, motor skills. at least two: impaired social interaction, impaired use of language, restricted, repetitive, and stereotyped behaviors and interests

272
Q

tx of tourettes or tic syndrome

A

haloperidol or pimozide (dopamine receptor antagonists)

273
Q

diagnosis of enuresis

A

involuntary voiding after age 5. occurs at least twice a week for 3 months or with marked impairment.

274
Q

when is bowel control usually achieved

A

by the age of 4

275
Q

Diagnosis of encopresis

A

involuntary or intentional passage of feces in inappropriate places, must be at least 4 years of age, has occurred at least once a month for 3 months.

276
Q

dissociative disorders

A

defined by loss of memory, identity, or sense of self. amnesia and feelings of detachment often arise suddenly and may be temporary in duration.

277
Q

dissociative amnesia

A

amnesia is the only dissociative symptom present. they are aware that they are having difficulty remembering but are not very troubled by it

278
Q

diagnostic criteria of dissociative amnesia

A

at least one episode of inability to recall important personal information, usually involving a traumatic or stressful event. Amnesia cannot be explained by ordinary forgetfulness. symptoms can cause significant distress or impairment in daily functioning and cannot be explained by another disorder, medical condition, or substance use

279
Q

treatment of dissociative amnesia

A

hypnosis or administration of sodium amobarbital or lorazepam during the interview may be helpful.

280
Q

Abreaction

A

strong reaction patients often get when retrieving traumatic memories

281
Q

Dissociative fugue

A

sudden unexpected travel away from home, accompanied by the inability to recall parts of one’s past or identity. often assume an entirely new identity and occupation after arriving in the new location. Unaware of their amnesia and new identity, and they never recall the period of the fugue.

282
Q

diagnostic criteria for dissociative fugue

A

sudden unexpected travel away from home or work plus inability to recall one’s past. confusion about personal identity or assumption of new identity. not due to dissociative identity disorder or the physiological effects of a substance or medical disorder

283
Q

Dissociative identity disorder

A

aka multiple personality disorder. presence of two or more distinct identities, at least two of the identities recurrently take control of person’s behavior, inability to recall personal information of one personality when the other is dominant. not due to substance of medical condition

284
Q

diagnostic criteria for depersonalization disorder

A

persistent or recurrent experiences of being detached from one’s body or mental processes. Reality testing remains intact during episode. causes social/occupational impairment

285
Q

somatization disorder

A

present w/multiple vague complaints involving many organ systems. at least two GI symptoms, at least one sexual or reproductive symptom, at least one neurological symptom, at least 4 pain symptoms, onset before age 30, cannot be explained by general medical condition or substance use

286
Q

diagnostic criteria for conversion disorder

A

at least one neurological symptom, psychological factors associated with initiation or exacerbation of symptom, symptom not intentionally produced, cannot be explained medically, causes significant distress or impairment, not accounted for by somatization disorder or other mental disorder, not limited to pain or sexual symptom

287
Q

timeline of hypochondriasis

A

fears present for at least 6 months

288
Q

difference between somatization and hypochondriacs

A

hypochondriacs worry about disease, somatization disorder is about symptoms

289
Q

intermittent explosive disorder

A

failure to resist aggressive impulses that result in assault or property destruction. level of aggressiveness is out of proportion to any triggering events.

290
Q

treatment of intermittent explosive disorder

A

SSRIs, anticonvulsants, lithium, and propanolol. individual psychotherapy is difficult and ineffective.

291
Q

kleptomania

A

failure to resist urges to steal objects that are not needed for personal or monetary reasons.

292
Q

most effective tx for pathological gambling

A

gamblers anonymous.

293
Q

trichotillomania

A

recurrent pulling out of one’s hair, resulting in visible hair loss, usually involves scalp but can involve eyebrows, eyelashes, and facial and pubic hair.

294
Q

what distinguishes anorexia from bullemia

A

anorexia involves low body weight and distinguishes it from bullemia

295
Q

anorexia diagnostic criteria

A

body weight at least 15% below normal. intense fear of gaining weight or becoming fat. disturbed body image, amenorrhea (not in DSM V)

296
Q

electrolyte abnormalities in anorexia

A

hypochloremic hyperkalemic alkalosis, hypercholesterolemia, arrhythmias, cardiac arrest, lanugo, melanosis coli, leukopenia, osteoporosis

297
Q

antidepressants useful as adjunctive treatment in anorexia to promote weight gain

A

paroxetine, mirtazapine

298
Q

diagnostic criteria of bulemia

A

recurrent episodes of binge eating, inappropriate attempts to compensate for overeating and prevent weight gain. The binge eating and compensatory behaviors occur at least twice a week for 3 months. perception of self worth is excessively influenced by body weight and shape.

299
Q

diagnostic criteria for binge eating

A

at least 2 days a week for 6 months and is not associated with compensatory behaviors (vomiting/laxative use, etc).

300
Q

pharm tx for binge eating

A

phentermine and amphetamine, orlistat (xenical) inhibits pancreatic lipase, thus decreasing amt of fat absorbed from GI tract. sibutramine (meridia) inhibits reuptake of NE, serotonin and dopamine

301
Q

elevated dopamine or NE can do what to sleep

A

decreased total sleep time

302
Q

elevated Ach does what to sleep

A

increased total sleep time and increased proportion of REM sleep

303
Q

serotonin affect on sleep

A

elevated serotonin causes increased total sleep time and increased proportion of delta wave sleep

304
Q

two categories of primary sleep disorders

A

dyssomnias (disturbances in the amount, quality, or timing of sleep and parasomnias (abnormal events in behavior or physiology during sleep)

305
Q

diagnosis of primary insomnia

A

difficulty initiating or maintaining sleep, resulting in daytime drowsiness or difficulty fulfilling tasks. occurs three or more times per week for at least 1 month

306
Q

short term pharm tx for insomnia

A

benadryl, zolpidem, zaleplon, trazodone

307
Q

diagnosis of hypersomnia

A

at least 1 month of excessive daytime sleepiness or excessive sleep not attributable to medical condition, medications, poor sleep hygiene, insufficient sleep or narcolepsy

308
Q

circadian rhythm sleep disorder

A

mismatch btwn circadian sleep-wake cycle and environmental sleep demands. subtypes- jet lag, shift work, delayed sleep or advanced sleep phase type

309
Q

what do TCAs do to REM sleep

A

suppress

310
Q

treatment of night terrors

A

usually none but small doses of diazepam at bedtime may be effective

311
Q

Somnambulism

A

Sleepwalking disorder.

312
Q

stages of the sexual response cycle

A

desire, excitement, plateau, orgasm, resolution

313
Q

what do dopamine and serotonin do to libido

A

dopamine enhances libido, serotonin inhibits libido

314
Q

Id

A

unconscious, involves instinctual sexual/aggressive urges and primary process thinking

315
Q

Ego

A

serves as a mediator btwn id and external environment and seeks to develop satisfying interpersonal relationships; uses defense mechanisms

316
Q

sublimation

A

satisfying socially objectionable impulses in an acceptable manner (thus channeling them rather than preventing them)

317
Q

free association

A

say whatever comes to mind during therapy sessons to bring forth thoughts and feelings from the unconscious

Psych (3 decks)

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