Misc. - 4 Flashcards
Nomenclature around premenstrual dysphoria?
Premenstrual symptoms
Premenstrual syndrome
Premenstrual Dysphoric Disorder
Normal premenstrual symptoms are usually……. !
mild and transient
Normal premenstrual symptoms include
Minor mood change
Physical discomfort (e.g. bloating)
Premenstrualy syndrome refers to
Mild to moderate symptoms including
Emotional, physical and cognitive changes
not impairing
when do premenstrual syndrome (PMS) is thought to happen?
during luteal phase
how does PMS changes to PMDD?
when symptoms cause impairment in daily functioning + one affective symptom (mood lability, depression or anxiety)
Prevalence of normal PM symptoms?
60-80%
Prevalence of PMS?
20-40% (mild to moderate)
Prevalence of PMDD?
1-8% (moderate to severe)
The term Premenstrual Tention Synrome in ICD 11?
-idiopathic
— changes in environmental, metabolic or behavioural during luteal phase of menstrual cycle
—–>impairing cyclic emotional, physical adn behaviours symptoms
criteria for PMTS in ICD 11?
at least specific clyclic association with luteal phase and impairment
Management of PMDD/PMTD?
Combined oral contraceptives (COC)
SSRI
CBT
COC in Rx PMDD/PMTD
drospirenone and ethinylestradiol
SSRI in Rx PMDD/PMTD
Only if affective symptom present
either continue or on during luteal ph.
why could PMDD be result of?
Heightened sensitivity to cyclinical variationin reproductive hormones
Onset in PMDD?
about 1 week before menses
Criteria for PMDD in ICD-11?
1- hx of PMD
2- majority of menses within past year
3- Pattern of mood, somatic and cognitive symptoms
4-Temporal link for symptoms & luteal
5-At least 2 symptomatic cycles
6-AT LEAST ONE AFFECTIVE SYMPTOMS
RISK FOR PMD?
OBESITY
CIGARRETE SMOKING
PREV. TRAUMA
Treatments with strong evidence in PMD?
SSRI
COC
GnRH
CBT &DBT
surgical Rx for PMDD?
bilateral salpingo-oophorectormy w/ or w/out hysterectomy
how long erection should last in priapism?
More than 4 hours
&
Unrelated to sexual dysfunction
example of meds that cause priapism
antidepressant
&
Antipsychotics
how meds cause priapism?
disturb the balance between sympathetic & parasympathetic input to penile or clitoral vasculature
which antipsychotics known to cause priapism?
chlorpromazine
why chlorpromazine causes priapism?
alpha-adrenergic blocking properties
which antidepressant causes priapism?
Trazodone
how trazodone causes priapism
alpha adrenergic blocking & maybe serotonin modulation
what other antidepressant can affect erection (dysfunction) through serotonin?
Citalopram
is priapism an urgent matter
yesss
conservative measures for priapism?
excrcise
cold pack
analgesia
(often not effective)
cornerstone of medical internvention in priapism?
intercavernosal injection of alpha-adrenergic agonist (phenylephrine)
Ambient cortisol levels in PTSD?
Lower than normal
whyy ambient cortisol levels in ptsd is lower than normal?
it has been attributed to chronic ‘adrenal exhaustion’ from inhibition of the HPA axis by persistent anxiety
two main brain structures involved in PTSD?
Amygdala
Hippocampus
What is another name for restless leg syndrome
Wittmaack-Ekbom’s syndrome
What is RLS
an urge to move the legs, associated often with dysaesthesias
What dysaesthesias are reported in RLS
creeping sensation
crawling
tingling
tingling
cramping or aching
when does urge happen in RLS?
evening or at rest
how does the urge improves in RLS
by moving temporarily
associated somatic symptoms iwth RLS
sleepiness and fatigue
assessments for parients with RLS
Iron status
Causative Medications
Current sleep disorders
why iron status is important in RLS?
If it is low, oral or intravenous administration may improve RLS
what medications can cause RLS?
Antidepressants
Neuroleptics agents
Dopamine-blocking antiemetics like metoclopramide
Sedative antihistamine
How can sleep disorder history help treating RLS?
Sleep disorders, fragmentations or insufficient may exacerbate RLS
Obstructive Sleep Apnoea Rx may improve RLS
Rx of intermittent RLS
-Mental alerting activities (games, etc)
-Avoiding coffee and alcohol
Carbidopa/levadopa, low-potency opioid (codein) and benzodiazepine (temazepam and z-drugs) can be considered
Rx for chronic persistent RLS
First line - Alpha2-delta calcium channel ligands (gabapentin, pregabalin or gabapentin enacarbi)
Second line-Non- ergot dopamine agonist (pramipexol, ropinirol and rotigotin patch)
Rx of refractory RLS
combination of alpha2-delta calcium channel blockers + benzo or non-ergot dopaine therapy
or
opioid monotherapy
