MDT presentation and tx Flashcards

1
Q

Clinical Manifestations of what disorder?
(1) Some response to trauma is considered to be normal but in patients with this issue the symptoms go beyond the realm of normal with multiple impairments:
-(a) Affective dysregulation (anger common)
-(b) Cognitive impairment
-(c) Several behavior responses in response to regular stimuli:
–1) Flashbacks
–2) Severe anxiety symptoms
–3) Fleeing
–4) Combative behaviors
(2) These symptoms lead to compensatory behaviors by the individual
-(a) We call this an avoidance of triggering experiences
–1) Avoidance leads to furthering of symptoms such as emotional

A

Post-Traumatic Stress Disorder (PTSD)

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2
Q

Treatment for PTSD

A

1) Therapy and medication are both useful and can be used either alone or in combination
(a) Psychotherapy
(b) Since marital problems and substance abuse are commonly seen with PTSD, consider referral sources for counseling
(d) Medications
–1) Antidepressant medications (SSRIs) are the first line therapy of choice
-2) Other adjuncts may be used based on symptoms
–a) Prazosin for nightmares
–b) Beta blockers for tremors and sympathetic responses
–c) Antipsychotics for comorbid psychosis if needed

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3
Q

What is the focus of the Independent Duty Corpsman is screening for PTSD?

A

Symptoms must be present for at least four weeks following trauma for psychiatry to make the diagnosis

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4
Q

What issue?
1) Pathophysiology
-(a) Neuroimaging studies have shown structural brain changes
-(b) Deficits in dopaminergic function and serotonergic function
–1) Dopamine: Eating behavior, motivation and reward
–2) Serotonin: Mood, impulse control, obsessive behavior
2) Diagnostic Criteria (DSM V)
-(a) Restriction of energy intake that leads to low body weight
–1) Taking into account the sex, age, developmental trajectory, and physical health
-(b) Intense fear of gaining weight or becoming fat or persistent behavior that
prevents weight gain, despite being underweight
-(c) Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s own low body weight
3) Common physical exam findings
-(a) Low BMI (<17.5)
-(b) Emaciation
-(c) Hypothermia
-(d) Bradycardia
-(e) Hypotension
-(f) Hypoactive bowel sounds
-(g) Xerosis (dry and scaly skin)
-(h) Brittle hair and hair loss
-(i) Lanugo body hair
-(j) Abdominal distent

A

Anorexia Nervosa

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5
Q

What issue?
Diagnostic Criteria
(a) Recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain
-1) Self-induced vomiting
-2) Misuse of laxatives
-3) Diuretic use
-4) Enemas
-5) Fasting
-6) Excessive exercise
-7) Occurring on average at least once per week for three months
Clinical findings
(a) Dehydration
(b) Menstrual irregularities
(c) Mallory-Weiss syndrome
(d) Pharyngitis
(e) Erosion of dental enamel
(f) ECG changes may occur

A

Bulimia nervosa

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6
Q

What Issue?
(a) Episodes of binge eating
(b) Eating is associated with:
-1) Uncomfortably full
-2) Eating when not hungry
-3) Feelings of embarrassment
-4) Feelings of disgust, depression

A

Binge eating disorder

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7
Q

What Issue?
(a) Eating of nonfood substances
-1) Chalk, dirt, hair, metal, etc
(b) Inappropriate eating behavior for developmental level
(c) Not culturally, socially normal eating
(d) Associated with iron deficiency anemia

A

PICA

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8
Q

What issue?
(a) Repeated regurgitation of food
-1) May be rechewed, reswallowed, or spit out
(b) The regurgitation is not due to GERD, pyloric stenosis, or another medical condition

A

Rumination Disorder

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9
Q

What issue?
Variable presentation
(1) Changes in mood
-(a) Sadness, distress, numbness, anxiety, irritability
(2) Cognitive problems
-(a) Changes in work performance
(3) Neuro-vegetative symptoms
-(a) Loss of energy, changes in sleep, appetite, or weight gain
(4) Somatic symptoms
-(a) Headache, abdominal pain, pelvic pain, back pain, other physical complaints

A

Depression

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10
Q

Treatment of depression

A

psychotherapy, pharmacotherapy, or both
-Pharmacotherapy
1) SSRIs: Selective Serotonin Reuptake Inhibitors
-a) Fluoxetine, paroxetine, sertraline, escitalopram, citalopram
2) SNRIs: Serotonin- Norepinephrine Reuptake Inhibitors
-a) Venlafaxine, duloxetine

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11
Q

What issue?
1) Commonly seen in the Navy
2) May look similar to a major depressive disorder but does not meet criteria
3) Occurs in the context of a recent stressor
-a) Deployment, marital problem, recruit training, financial concerns, increasing responsibilities with rank
-b) Specifically NOT diagnosed in the context of bereavement
4) Resolves within six months when the stressor is removed

A

Adjustment Disorder

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12
Q

What issue?
1) Very common
2) Occurs in the context of childbirth
3) Usually occurs within 12 months after delivery
4) Same diagnostic criteria as depression
5) Likely due to genetic susceptibility and hormonal changes in addition to increased stressor

A

Post-Partum Depression

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13
Q

Treatment Post partum depression

A

(1) For mild to moderate, recommend psychotherapy such as CBT as initial treatment; especially useful for breastfeeding moms as they won’t expose children to antidepressants.
2) If CBT is unsuccessful or depression is more severe, antidepressants (SSRIs, Bupropion (Wellbutrin), Mirtazapine (Remeron)) are useful.
(3) SSRIs: Paroxetine (Paxil) or Sertraline (Zoloft) appear to have lowest adverse effects on infants.

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14
Q

Clinical Manifestations of what issue
Occurs more days than not, for at least six months
(a) Most do not present with “excessive worry”
-1) If asked typically will admit to worrying excessively about minor matters
(b) Hyperarousal and muscle tension common
(c) Poor sleep
(d) Fatigue
(e) Difficulty relaxing
(f) Headaches
(g) Pain in the neck, shoulder, and back

A

Generalized Anxiety Disorder (GAD)

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15
Q

GAD Treatment

A

1) Benzos for Panic attacks
2) Hydroxyzine
-long term maintenance
–a) SSRI’s
–b) SNRI Venlafaxine

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16
Q

What issue?
A thought disorder that is a loss of contact with reality with a wide variety of signs and symptoms
(a) Delusions
(b) Hallucinations
(c) Thought disorganization
(d) Agitation and aggression

A

Psychosis

17
Q

What is used to treat acute agitation associated with psychosis

A

IMMEDIATE REFERRAL
Haldol
-In certain scenarios may be able to simply “re-direct” the patient to help them with their agitation
1) Offer reassurance and simply talking to them may be enough

18
Q

What is some corrective actions for sleep hygiene

A

(a) No caffeine/nicotine in evening
(b) Daily exercise regimen (avoid evening workouts)
(c) Avoid alcohol
(d) Limit fluids in evening
(e) Relaxation techniques

19
Q

What treatment is best for acute therapy
-Used when sleep hygiene is ineffective

A

Antihistamines beneficial and produce no dependency
1) Hydroxyzine
2) Diphenhydramine
-Trazadone
1) Long term use

20
Q

What issue?
(1) Pattern of socially irresponsible, exploitative, and guiltless behavior
(2) Lifelong disorder
(3) Wide range of symptoms with criminality being common
-(a) Disregard for and violation of rights of others
-(b) Unstable work history
-(c) History of arrests
-(d) Financial dependency on others
-(e) Poor school history
-(f) Alcohol abuse
-(g) Marital difficulties
-(h) Impulsive behaviors
-(i) Homelessness
-(j) “Wild” adolescence

A

Antisocial Personality Disorder (ASPD)

21
Q

What issue?
(1) Instability of interpersonal relationships, self-image, and emotions
(2) Very impulsive behaviors
(3) Common
(4) Most widely studied personality disorder
-(a) Associated with significant morbidity and increased mortality
(5) History of childhood trauma is common but relationship to BPD is unclear
(6) Interpersonal difficulties
-(a) Close individuals often target of widely ranged view
-(b) Tend to view others as all good or all bad
-(c) Tend to misinterpret otherwise neutral events, words, or interactions as “negative”
(7) Affective instability (unstable mood)
(8) Impulsive behaviors
(9) Tend to have poorer cognitive function
(10) Suicidal threats, gestures, and attempts more common

A

Borderline Personality Disorder (BPD)

22
Q

Clinical Findings for what issue?:
(1) Marked inattention, distractibility, organization difficulties, and poor efficiency (academic and occupational failure).
(2) Can also have low frustration tolerance, shifting activities, difficulty organizing, and daydreaming.
(3) Symptoms often attenuate during late adolescence although a minority will experience full symptoms into mid-adulthood.
(4) More frequent in males.

A

Attention-Deficit / Hyperactivity-Disorder

23
Q

Treatment ADHD

A

Stimulants are the most common treatment and include Methylphenidate and Amphetamine.
(a) Methylphenidate (Ritalin, Concerta, Metadate)
(b) Amphetamines (Adderall, Dexedrine, Vyvanse)

24
Q

What issue?
Failure to obtain erections in a situation in which they were anticipated, causing embarrassment, self-doubt, and loss of self-confidence.
(a) Can be caused by increased age, depression, smoking, diabetes, hypertension,
nervous tissue disorders (spinal cord injury, MS).
(b) Social anxiety and posttraumatic stress disorder (PTSD).

A

Erectile Dysfunction

25
Q

What issue?
(a) Complaint of female normal libido and sexual excitement without the capacity to reach orgasm.
(b) Marked delay in, marked infrequency of, or absence of orgasm OR marked reduced intensity of orgasmic sensations present on all or almost all sexual activity.
(c) May be psychogenic, drug-induced, or due to a general medical condition.
(d) Often related to depression and cognitive- behavioral therapy involving changing of negative sexual thoughts and attitudes can be an effective treatment.

A

Female Orgasmic Disorder

26
Q

Female Sexual Interest/Arousal Disorder treatment:

A

1) Both sex therapy and cognitive interventions have been used for desire and arousal problems.
2) Bupropion has been reported to increase various indices of sexual
responsiveness in women with low sexual desire.

27
Q

What issue?
(a) Includes four commonly comorbid symptoms:
-1) Difficulty having intercourse,
-2) Genito-pelvic pain,
-3) Fear of pain on vaginal penetration,
-4) Tension of the pelvic floor muscles.

A

Genito-Pelvic Pain / Penetration Disorder

28
Q

What Issue?
(a) Absence of desire for sexual activity and persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies for at least 6 months.
(b) May be due to:
-1) Hypogonadism (low testosterone),
-2) Transient stress or interpersonal conflict,
-3) Mood disorder,
-4) Schizophrenia,
-5) Substance abuse,
-6) Medications,
-7) Normal age-related decline in sexual desire.

A

Male Hypoactive Sexual Desire Disorder