impulse control disorders, sleep disorder, sex disorder

Question 1

intermittent explosive disorder DSM

Answer 1

failure to resist aggressive impulses that result in assault or property destruction. aggression out of proportion to triggering event

Question 2

intermittent explosive behavior epic/etio tx

Answer 2

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.

Question 3

kleptomania

Answer 3

F>M. 1/4 bulimia nervosa have this. don’t steal for personal gain. tx- insight oriented psychot or behavior psychoterapy, SSRI.

Question 4

pyromania tx

Answer 4

most children recover. behavior therapy, supervision, SSRI

Question 5

pathological gambling tx

Answer 5

gambler’s anonymous. tx comorbid mood D, anxiety D and substance abuse prob. often have ADHD

Question 6

trichotillomania

Answer 6

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.

Question 7

anorexia nervosa dsm

Answer 7

wt 15% below normal. intense fear of gaining wt or becoming fat. disturbed body image. amenorrhea.

Question 8

anorexia types

Answer 8

restrictive: eat little, exercise a lot , odd

binge eating/purging- bing then purge with laxative, exercise, or diuretics. MDD and substance abuse

Question 9

anorexia physical findings

Answer 9

amenorrhea, electrolyte abn (hypochloremic, hyperkalemia alkalosis), hypercholesterolemia, arrhythmia, cardiac arrest, lanugo, melanosis coli (darkened area of colon secondary to laxative abuse, leukopenia, osteoporosis

Question 10

anorexia prog

Answer 10

variable. may fluctuate., relapse or deteriorate. 10% mortality due to starvation, suicide or electrolyte disturbance.

Question 11

bulimia nervosa dsm

Answer 11

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.

Question 12

anorexia v bulimia

Answer 12

latter maintain norml wt. sx more ego-dystonic (distressing) so more likely to seek help.

Question 13

binge eating

Answer 13

excessive food intake w/in 2hr period accompanied by sense of lack of ctrl.

Question 14

binge eating physical findings

Answer 14

hypocholoremia hypokalemic alkalosis. esophagitis, dental erosion, calloused knuckes, salivary gland hypertrophy

Question 15

bulimia tx

Answer 15

idivi psychotherapy, CBT, group therapy, pharm (SSRI=first line then TCA)

Question 16

binge eating disorder

Answer 16

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.

Question 17

obesity

Answer 17

20%> ideal body wt

Question 18

binge eating D tx

Answer 18

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)

Question 19

sleep D causes

Answer 19

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,

Question 20

primary sleep D

Answer 20

dyssomnias (disturbance in amount, quality or timing of sleep). parasomnias (ban events in behavior or physiology during sleep

Question 21

dyssomnias

Answer 21

primary insomnia, primary hypersomnia, narcolepsy, breathing related disorder

Question 22

primary insomnia

Answer 22

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

Question 23

primary insomnia tx

Answer 23

1st line- sleep hygiene. pharm (short term)- benadryl, ambien(zolpidem), sonata (zaleplon), desyrel (trazodone)

Question 24

primary hypersomnia

Answer 24

> 1mo excessive daytime sleepiness or excessive sleep not attributable to medical conditions, medication, poor sleep hygiene, insufficient sleep or narcolepsy. usually begin in adolescence.

Question 25

primary hypersomnia tx

Answer 25

1st line- stimulants (amphetamine). SSRI in some

Question 26

narcolepsy

Answer 26

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%

Question 27

narcolepsy epi tx

Answer 27

M=F, poor night time sleep, genetic component, onset child,

tx- timed daily naps + stimulants (amphetamine and methylphenidate). SSRI or sodium oxalate for cataplexy

Question 28

breathing related D

Answer 28

sleep disruption and excessive daytime sleepiness (EDS) caused by abn sleep ventilation from either obstruction or central sleep apnea.

Question 29

breathing related D epic

Answer 29

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)

Question 30

OSA RF

Answer 30

male, obese, male shirt collar >17. pior upper airway surgery, deviated nasal septum, kissing tonsils, large uvula, tongue, retrognathia

Question 31

OSA tx

Answer 31

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

Question 32

CSA tx

Answer 32

periodic cessation of respiratory effect. mechanical ventilation such as b-PAP with backup rate

Question 33

parasomnias

Answer 33

nightmare D

Question 34

nightmare D

Answer 34

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

Question 35

night terror D

Answer 35

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

Question 36

sleep talking D (somnambulism)

Answer 36

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.

Question 37

sexual response cycle

Answer 37

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

Question 38

progesterone

Answer 38

inhibits libido in both men and women by blocking androgen R; found in OCP, hormone replacement therapy, and tx for prostate ca.

Question 39

meds that cause sexual dysfunction

Answer 39

antihypertensives, anticholingerics, antidepressants (SSRI) and antipsychotics (block dopamine)

Question 40

drugs v sex

Answer 40

alc and mariguana enhance desire by suppress inhibition. long term decr desire. cocaine and amphetamine enhance libido by stimulating dop R> narcotic inhibit libido

Question 41

libido v NT

Answer 41

enhanced by dopamine, inhibited by serotonin

Question 42

disorders of desire

Answer 42

hypoactive sexual desire disorder (20% pop, more common in women)
sexual aversion D (avoidance of genital contact with sexual partner)

Question 43

disorder of arousal

Answer 43

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%

Question 44

sexual pain D

Answer 44

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

Question 45

dual sex therapy

Answer 45

marital unit. couple with male + female therapist. short term tx. incr sensory awareness and sexual contact

Question 46

sexual behavior therapy

Answer 46

help respond correctly to stimuli that initially provoked anxiety. relaxation technique.

Question 47

sildenafil

Answer 47

viagra

Question 48

paraphilias

Answer 48

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

Question 49

frotteurism

Answer 49

sexual pleasure men get from rubbing genitals against unsuspecting women.