Other mental health disorders Flashcards
cutting
- not associated with suicide;
- attempt to feel something while depressed;
- typically superficial
- happens frequently in borderline personality disorders
Physical signs and symptoms of anxiety
- fatigue
- headaches
- nausea
- paresthesia (usually peripheral);
- muscle tension/aches
- dysphagia
- shortness of breath
- chest pain
- diaphoresis
mental signs and symptoms of anxiety
- excessive worry about both rational and irrational things;
- feeling of impending doom/disaster
- insomnia
- irritability
- restlessness;
- difficulty concentrating
DSM-5 criteria for general anxiety disorder
A. excessive anxiety/worry occuring more days than not over 6 months;
B. difficult to control worry
C. worry/anxiety associated with 3 + of following sx:
- restlessness or feeling keyed up or on edge;
- being easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance
D. anxiety, worry, or physical sx cause distress or impairment in social, occupational, or other important areas;
E. disturbance not caused by substance or other condition
F. not better explained by other condition
Cognitive behavior therapy
not done in primary care;
- desensitizes to anxieties and sets up coping mechanisms;
- requires referral
Medications for anxiety in Primary care
- SSRIs are the mainstay
Benzodiazepines in primary care
- work well with short-term anxiety or terrible panic;
- not preventatitve, act as a band-aid;
- controlled substance with addictive properties;
- avoid use as first-line med;
5 HT1A receptor partial agonists in primary care for treatment of anxiety
- example is buspirone
- adjunct or substitute for benzos;
- not as effective but safer and not addictive
Tricyclics and anxiety in primary care
- long-term concern: dry-mouth side effect leading to tooth decay
non-mental health medications in primary care
- Propranolol;
- clonidine;
- hydroxyzine/diphenhydramine
Propranolol for anxiety
- short-acting antihypertensive that slows down the heart rate for patient’s with fear of public speaking or interviewing;
Clonidine for anxiety
blood pressure medication often used with patients with substance-abuse problems
- can prolong opioid high
hydroxyzine/diphenhydramine for anxiety
- makes people sleepy;
- used as adjuncts for older and younger patients
General anxiety disorder comorbidities
- depression
- substance use/abuse
- dysthymia
- IBS
- headaches
- ADHD
incidence of anxiety compared to depression
1:2
Who treats bipolar disorder
specialist only; not treated in primary care
Bipolar disorder is referred to as
manic depressive disorder
Bipolar disorder involves what 2 pones of severity
High: - extra excited -happy - little need for sleep - incredibly creative; Low: - severe depression
Bipolar disorder is diagnosed based on
cycling between highs and lows
how is bipolar disorder different from unipolar depression
natures of highs (during depressed phase, virtually identical);
Treatment of bipolar
antidepressants can fail if depression alone is assumed;
- can lose effect or make things worse;
- managed best with mood stabilizer plus antidepressant
Which category of Bipolar is most severe
- Bipolar 1
Mixed bipolar disorder
dysthymia or another disorder attached to bipolar diagnosis, with cycling
Bipolar 1
true differentiation between high-highs and high-lows
Bipolar 2
low-lows but not high-highs;
- may get back to normal, or a little above normal;
- not completely manic
genetic and bipolar
more association with genetic association than any other mental illness;
- commonly runs in family
Asks all depressed patients what
about family history of bipolar disorder
Recurrence of bipolar
- recurs even if treated;
- generally requires meds for rest of life
Bipolar is often misdiagnosed in early childhood as
ADHD
Signs and symptoms of mania
- racing thoughts;
- lack of need to sleep;
- excess energy;
- grandiosity;
- hyperactivity;
- impulsive behavior
Clues that a patient has bipolar disorder
- family history;
- input from family members {often different than pt perception};
- marked changes in mood, behavior, or productivity;
- failure of multiple antidepressants;
- on/off response to antidepressants;
- hypomanic response to antidepressants;
- mood stabilizers or bigger meds have more side effects;
- unless pt is stable, cooperation between NP and mental health provider is required
