impulse control disorders, sleep disorder, sex disorder Flashcards
intermittent explosive disorder DSM
failure to resist aggressive impulses that result in assault or property destruction. aggression out of proportion to triggering event
intermittent explosive behavior epic/etio tx
idivi behavior remit quickly/spontaneously –> remorse. tens-20s. often hx of child abuse, head trauma, seizures. tx- SSRI (bc low lvl of 5HT is associated with impulsiveness and aggression), anticonvulsants, lithium, propranolol. no indigo psychotherapy= useless. group/fam therapy useful.
kleptomania
F>M. 1/4 bulimia nervosa have this. don’t steal for personal gain. tx- insight oriented psychot or behavior psychoterapy, SSRI.
pyromania tx
most children recover. behavior therapy, supervision, SSRI
pathological gambling tx
gambler’s anonymous. tx comorbid mood D, anxiety D and substance abuse prob. often have ADHD
trichotillomania
recurrent pulling out of one’s hair. result in visible hair loss. usually involve scalp, eyebrow, facial pubic hair. tension bf and relief afterward. usually after stressful event. often have OCD mood D, borderline. adult onset harder to tx. use SSRI, antipsychotics, lithium. hypnosis. relaxation techniques. behavioral therapy.
anorexia nervosa dsm
wt 15% below normal. intense fear of gaining wt or becoming fat. disturbed body image. amenorrhea.
anorexia types
restrictive: eat little, exercise a lot , odd
binge eating/purging- bing then purge with laxative, exercise, or diuretics. MDD and substance abuse
anorexia physical findings
amenorrhea, electrolyte abn (hypochloremic, hyperkalemia alkalosis), hypercholesterolemia, arrhythmia, cardiac arrest, lanugo, melanosis coli (darkened area of colon secondary to laxative abuse, leukopenia, osteoporosis
anorexia prog
variable. may fluctuate., relapse or deteriorate. 10% mortality due to starvation, suicide or electrolyte disturbance.
bulimia nervosa dsm
recurrent episodes of binge eating. inappropriate attempts to compensate for overeating and prevent wt gain- laxative, vomit, diuretics exercise. binge eating and compensatory behavior occur at least 2/wk for 3mo. perception of self worth is excessively influenced by body wt and shape.
anorexia v bulimia
latter maintain norml wt. sx more ego-dystonic (distressing) so more likely to seek help.
binge eating
excessive food intake w/in 2hr period accompanied by sense of lack of ctrl.
binge eating physical findings
hypocholoremia hypokalemic alkalosis. esophagitis, dental erosion, calloused knuckes, salivary gland hypertrophy
bulimia tx
idivi psychotherapy, CBT, group therapy, pharm (SSRI=first line then TCA)
binge eating disorder
recurrent epic of binge eating with severe distress over it. occur at least 2d/wk for 6mo and not associated with compensatory behavior. 3/5
1) eating rapidly
2) eating until uncomfortably full
3) eating large amount when not hungry
4) eating alone due to embarrassment over eating habits
f5) felling disgusted, depressed or guilty after overeating.
obesity
20%> ideal body wt
binge eating D tx
psychotherapy, behavioral therapy, strict diet + exercise program. tx comorbid mood D or anxiety D. pharm (adjunct, stimulants, orlistat-inhibit pancreatic lipase decreasing amount of fat absorbed from GI, sibutramine)
sleep D causes
medical condition, physical condition (obesity), sedative w/d, use of stimulants, MDD, mania or anxiety, NT ban (elevated do or NE decr total sleep time, incr cal cause incr total sleep time and incr REM sleep,
primary sleep D
dyssomnias (disturbance in amount, quality or timing of sleep). parasomnias (ban events in behavior or physiology during sleep
dyssomnias
primary insomnia, primary hypersomnia, narcolepsy, breathing related disorder
primary insomnia
difficulty initiating or maintaining sleep resulting in daytime drowsiness or difficulty fulfilling tasks. disturbed >3/wk for >1mo. affect 30% pop. exacerbated by anxiety and worrying about getting enough sleep
primary insomnia tx
1st line- sleep hygiene. pharm (short term)- benadryl, ambien(zolpidem), sonata (zaleplon), desyrel (trazodone)
primary hypersomnia
> 1mo excessive daytime sleepiness or excessive sleep not attributable to medical conditions, medication, poor sleep hygiene, insufficient sleep or narcolepsy. usually begin in adolescence.
primary hypersomnia tx
1st line- stimulants (amphetamine). SSRI in some
narcolepsy
sudden, attacks of sleep in daytime >3mo associated with
1) cataplexy- collapse due to sudden loss of M tone (70% of pt), associated with emotion, particularly associated with laughter
2) short REM latency
3) sleep paralysis- brief paralysis upon awakening in 50%
4) hypnagogic ( as pt falls asleep or is falling aslpep); hypnopompic (as pt wake up) hallu- 30%
narcolepsy epi tx
M=F, poor night time sleep, genetic component, onset child,
tx- timed daily naps + stimulants (amphetamine and methylphenidate). SSRI or sodium oxalate for cataplexy
breathing related D
sleep disruption and excessive daytime sleepiness (EDS) caused by abn sleep ventilation from either obstruction or central sleep apnea.
breathing related D epic
10% of adults. more in men and obese. associated with HA, depression, Pul HTN, sudden death in elderly and infants. obstructive sleep apnea (correlate with snoring), central sleep apnea (correlate with HF)
OSA RF
male, obese, male shirt collar >17. pior upper airway surgery, deviated nasal septum, kissing tonsils, large uvula, tongue, retrognathia
OSA tx
since respiratory effort present need to incr air flow. adequate sleep but still tired during day. nasal positive airway P (mCPAP), wt loss, nasal surgery, uvulopalatoplastay
CSA tx
periodic cessation of respiratory effect. mechanical ventilation such as b-PAP with backup rate
parasomnias
nightmare D
nightmare D
repeated awakening with real of nightmare. occur during REM sleep and causes sig distress. usually don’t tx but can use TCA to suppress total REM sleep. can fully awaken and remember the episode like night terror D or sleep walking D
night terror D
fear in sleep starting with scream + anxiety in 1st 3rd of sleep- stage 3/4. not awake, don’t remember. associate with sleepwalking D. usually no tx except maybe diazepam at bedtime
sleep talking D (somnambulism)
occur in 1st third of night during stage 3/4 and are never remembered. onset age 4-8, prevalence at age 12. M>F. run in farm.
sexual response cycle
desire –> excitement -> plateau (incr size of testicles, tightening of scrotal sac and secretion of seminal fluid v contraction of outer 1/3 of vagina, enlargemnt of upper 1/3 of vagina. facial flushing, incr pulse, BP, RR in both) –> orgasm (ejaculate v contraction of uterus and lower 1/3 of vagina –> resolution
progesterone
inhibits libido in both men and women by blocking androgen R; found in OCP, hormone replacement therapy, and tx for prostate ca.
meds that cause sexual dysfunction
antihypertensives, anticholingerics, antidepressants (SSRI) and antipsychotics (block dopamine)
drugs v sex
alc and mariguana enhance desire by suppress inhibition. long term decr desire. cocaine and amphetamine enhance libido by stimulating dop R> narcotic inhibit libido
libido v NT
enhanced by dopamine, inhibited by serotonin
disorders of desire
hypoactive sexual desire disorder (20% pop, more common in women)
sexual aversion D (avoidance of genital contact with sexual partner)
disorder of arousal
of excitement and plateau. male erectile D (primary - never had one or 2o can’t sustain)- 10-20% of men. female sexual arousal D - can’t maintain lubrication until completion of sex - 33%
sexual pain D
dyspareunia- genital pain bf, during, or after sexual intercourse. higher incidence in women than men. associated with vaginismus
vaginismus- involuntary M contraction of outer 3rd of vagina during insertion of penis or obj - more in higher socioeconomic groups and religious upbringing
dual sex therapy
marital unit. couple with male + female therapist. short term tx. incr sensory awareness and sexual contact
sexual behavior therapy
help respond correctly to stimuli that initially provoked anxiety. relaxation technique.
sildenafil
viagra
paraphilias
sexual D characterized by engagement in unusual sexual activities (fantasies/ urges) for at least 6mo that cause impairment in daily functioning. most in men. tx: insight oriented psychotherapy. some behavior therapy. anti-androgen for hyper sexual paraphilia in men
frotteurism
sexual pleasure men get from rubbing genitals against unsuspecting women.
