Misc. - 4 Flashcards by Arteen Ahmed

Nomenclature around premenstrual dysphoria?

Premenstrual symptoms

Premenstrual syndrome

Premenstrual Dysphoric Disorder

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Normal premenstrual symptoms are usually……. !

mild and transient

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Normal premenstrual symptoms include

Minor mood change
Physical discomfort (e.g. bloating)

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Premenstrualy syndrome refers to

Mild to moderate symptoms including
Emotional, physical and cognitive changes
not impairing

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when do premenstrual syndrome (PMS) is thought to happen?

during luteal phase

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how does PMS changes to PMDD?

when symptoms cause impairment in daily functioning + one affective symptom (mood lability, depression or anxiety)

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Prevalence of normal PM symptoms?

60-80%

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Prevalence of PMS?

20-40% (mild to moderate)

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Prevalence of PMDD?

1-8% (moderate to severe)

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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

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criteria for PMTS in ICD 11?

at least specific clyclic association with luteal phase and impairment

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Management of PMDD/PMTD?

Combined oral contraceptives (COC)
SSRI
CBT

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COC in Rx PMDD/PMTD

drospirenone and ethinylestradiol

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SSRI in Rx PMDD/PMTD

Only if affective symptom present

either continue or on during luteal ph.

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why could PMDD be result of?

Heightened sensitivity to cyclinical variationin reproductive hormones

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Onset in PMDD?

about 1 week before menses

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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

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RISK FOR PMD?

OBESITY
CIGARRETE SMOKING
PREV. TRAUMA

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Treatments with strong evidence in PMD?

SSRI

COC
GnRH

CBT &DBT

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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