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Psychiatry > Impulse, Eating, Sleep/wake > Flashcards

Impulse, Eating, Sleep/wake Flashcards

1
Q

Intermittent explosive disorder

A

Verbal/physical outbursts: 2x/week, for 3+ months
OR
Outbursts resulting in physical damage, 3+ times/year

  • Not premeditated
  • Out of proportion reaction to stressor
  • Cause impairment or distress

Mgmt:

  1. SSRI (fluoxetine), mood stabilizers (anticonvulsants, lithium)
  2. CBT
  3. Group/family therapy
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2
Q

Kleptomania

F > M

A

Uncontrollable urges to steal unnecessary objects
Increasing tension right before theft

*Strongly assoc with bulimia nervosa, OCD

Mgmt:

  1. SSRI’s
  2. CBT
  3. Naltrexone use (may help?)
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3
Q

Pyromania

A

At least 2 epi’s of fire setting

  • Highly comorbid with mood/substance disorders, gambling, conduct disorder
  • Episodic epi’s that wax, wane

Mgmt:
Not really anything … CBT, SSRI, mood stab

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4
Q

What are the 2 types of anorexia nervosa?

A
  1. Restricting type
    Has not regularly engaged in binge-eating or purging; wt loss from dieting, exercise, and/or fasting
  2. Binge-eating/purging type
    Binges —> purging (laxatives, self induced vomiting)
    Sometimes will purge w/o binging
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5
Q

Anorexia vs. bulimia, MDD

A

Anorexia: low body wt + restriction of calorie intake
Bulimia: nml or over- wt; sx usually more ego-dystonic, more likely to seek help

Anorexia vs MDD:
Anorexics have a good appetite

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6
Q

Physical sx of anorexia

A 
Amenorrhea
Cold intolerance/hypothermia
Hypotension (esp orthostasis)
MVP
Constipation
Lanugo
Alopecia
Edema
Dehydration
Peripheral neuropathy
Seizures
Hypothyroidism
Osteopenia
Osteoporosis
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7
Q

Lab/imaging abn of anorexia

A

Enlg’ed ventricles
Decrease in gray and white matter
Peripheral neuropathy

Decreased Na, Cl, K (alkalosis if vomiting)
Arrhythmia (esp QTc pr)
Hypercholesterolemia
Transaminitis
Normocytic, normochromic aemia
High BUN
High GH, cortisol
Low LH, FSH, sex steroid hormones (estrogen, T), glu
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8
Q

Tell me about anorexia!

Assoc with 3 things
Mgmt

A
  • Assoc with OC personality traits
  • Bimodal onset (13-14, 17-18 yo)
  • Difficulty with separation, autonomy, struggle to gain control

Mgmt:

  1. CBT
  2. Family therapy (Maudsley)
  3. Supervised wt gain program

** If no improvement with standard therapy, can consider adding –> olanzapine (antipsychotic)

F/u: Refeeding syndrome
Fluid retention + low Ph, Mg, Ca
+/- resp failure, delirium, seizures, arrhythmias
(tx: replace lytes, slow feeding)

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9
Q

How do you dx and manage bulimia?

A

Binge eating: excessive food intake within 2 hrs (accompanied by lack of control)
Compensatory behaviors: vomiting, diuretics, laxatives

1+/week, duration: 3+ months

Mgmt:
1. SSRI (fluoxetine) + therapy COMBO (CBT, fam therapy, etc)

** AVOID BUPROPION **

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10
Q

Binge eating disorder

Dx
Mgmt

A

Not fixated on body wt and shape
Binges, assoc with distress
1+/week, duration: 3+ months
Usually obese

Mgmt:

  1. Individual psychotherapy; strict diet + exercise
  2. Possibly drugs for wt loss:
    - Stimulants (phentermine, etc) - suppress appetite
    - Topiramate, zonisimide - wt loss
    - Orlistat - don’t absorb fat
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11
Q

What characterizes REM sleep?

A

Increase in

  • BP
  • HR
  • RR
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12
Q

Dyssomnias
(insomnia or hypersomnia)

Dx
Mgmt

A

3+/week, duration: 3+ months
*Not adequately explained by comorbid moods disorders

Acute: <3 months
Chronic: 3+ months

Mgmt:

  1. CBT (first line for chronic insomnia)
  2. Sleep hygiene
  3. Meds:
    - BZ’s (short term; falls in elderly; addiction)
    - Non-BZ’s (zolpidem causes more falls in elderly, and cognitive impairment in women at high doses)
    - Antidepressants - trazodone
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13
Q

Hypersomnolence disorder (M = F)

Dx
Etiology
Mgmt

A

Criteria: excessive sleepiness despite 7 hrs, with:

  • recurrent pds of sleep
  • prolonged nonrestorative sleep >9 hr
  • difficulty being fully awake after awakening

3+/week, duration: 3+ months

Etio:

  • Viral infections
  • Head trauma
  • Genetic (AD)

Mgmt:
1. Lifelong tx with modafinil or stimulants (methylphenidate)
(second line = atomoxetine)
2. Scheduled napping

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14
Q

Obstructive sleep apnea / hypopnea (M > F)

A

Repetitive collapse of upper airway
Polysomnography: apneic / hypopneic episodes (>15/hr)

  • Excessive daytime sleepiness
  • Sleep fragmentation
  • Snoring
  • Morning HA’s
  • HTN

Mgmt:

  1. CPAP … or BiPAP
  2. Wt loss, exercise
  3. Surgery
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15
Q

Central sleep apnea

A

5+ central apneas/hour of sleep
(cessation of both airflow and ventilatory effort)
insomnia, daytime sleepiness

Etio:

  1. PRIMARY: idiopathic
  2. SECONDARY:
    - Cheyne-Stokes breathing - sec to HF, stroke, renal failure)
    - Opioid use

Mgmt:

  1. Treat underlying condition
  2. CPAP/BiPAP
  3. Supplemental O2
  4. Meds (acetazolamide, theophylline (stimulates breathing), sedative-hypnotics)
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16
Q

Sleep related hypoventilation

A

Polysomnography: decreased respiration, high CO2

Complications:

  • pulm HTN
  • cor pulmonale
  • cardiac arrhythmias
  • polycythemia
  • neurocog dysfxn
  • resp failure due to severe blood gas abnormalities

Mgmt:

  • Tx underlying condition
  • CPAP/BiPAP
  • Meds to promote breathing: bronchodilators, theophylline
17
Q

What is the classic narcolepsy 4 sx?

A
  1. Excessive daytime sleepiness; “sleep attacks”
  2. REM-relate dsleep phenomena (ie - sleep paralysis)
  3. Hypnagogic or hypnapompic hallucinations
  4. Cataplexy (NO LOC) - mild or generalized
18
Q

How do you dx narcolepsy?

A

Excessive daytime sleepiness
Falling asleep at inappropriate times
Hallucin/sleep paralysis at beginning/end of sleep

3+/week, duration: 3+ months
At least one of:
- cataplexy (loss of muscle tone with strong emotion)
- hypocretin deficiency in CSF
- reduced REM sleep latency on polysomnography

19
Q

How do you manage narcolepsy?

A
  1. Sleep hygiene
  2. Scheduled daytime naps
  3. Avoidance of shift work

Daytime sleepiness:

  • amphetamines
  • nonamphetamines (methylphenidate Ritalin, modafinil, sodium oxybate)

Cataplexy:

  • sodium oxybate ***
  • TCA’s
  • SSRI/SNRI’s
20
Q

Sleepwalking

A

Behaviors during slow wave sleep
Eyes usually open
Don’t remember dreams / + amnesia
Rarely with violent behavior

** STRONGLY assoc with fam hx

Mgmt:
1. Don’t really need. Education.
Refractory –> low dose BZ (clonazepam)

21
Q

Sleep terrors

A
  • Recurrent epi’s of sudden terror arousals (screaming/crying), occur during slow wave sleep
  • Signs autonomic arousal
  • Hard to wake up during episode
  • Don’t remember dreams / + amnesia
    END WITH: return to sleep w/o awakening

Mgmt: same as for sleepwalking (education, refractory BZ’s)

22
Q

Nightmare disorder

assoc with PTSD

A

Second half of sleep episode
END WITH: awakening with vivid recall
- NO confusion, disorientation upon awakening

Mgmt:
1. No tx always needed. Reassurance.
2. Imagery rehearsal therapy (IRT) - mentally rehearsing modified nicer outcome of a recurrent nightmare
^^ good for PTSD recurrent nightmares
3. Meds rarely used - prazosin, antidepressants

23
Q
  1. Non REM sleep arousal disorder

2. REM sleep behavior disorder
males, >50 yrs

A
  1. Repeated incomplete arousals; first 1/3 of sleep (sleep walking, sleep terrors)
  2. Repeated arousals assoc with vocalization or complex motor behavior during REM; second 1/2 of sleep
    - lack of muscle atonia during REM sleep
    - NO confusion, disorientation upon awakening
    ** Usually present with injury to bed partner
    ** RF: psych meds; underlying NCD
    Mgmt:
    - DC likely causative medication
    - Clonazepam usually works
    - Melatonin can help
    - Ensure environmental stafety
24
Q

Restless legs syndrome (F > M)

RF
Mgmt

A

Only occurring or worsening in evening

RF:

  • strong familial component
  • iron deficiency
  • psych meds + medical comorbidities
Mgmt:
1. Remove any offending agents
2. Low ferritin --> iron replacement
3. FIRST LINE TREATMENT: dopamine ag's, BZ's
Refractory --> low dose opioids

Psychiatry (7 decks)

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