Pschy / Behav. Flashcards
What 3 symptoms are effected in GAD
1st the amygdala and then
Autonomic nervous system
Followed by HPA Axis influence
Average age at onset for GAD
Women at 30 years old
2 physical manifestations of GAD
Increased heart rate
Increased sweating
DSM-5 time frame for GAD
Worry excessive more days than not for at least 6 months
Management GAD
CBT = 1st line
SSRIs = pharma management
Hyperexcitation of what two things occur in panic disorder
Amygdala and Hypothalamus
Panic disorder occurs when ?
Episodic
Panic order classically has what after an attack?
1 month of worry of another attack
Rule out substance USE
Bipolar 1 vs. 2
1 = Depressoin with mania ; think more psychosis longer than a 1 week MANIA = any psychosis
2 = Depression with hypomania = less than 4 days of manic sxs
Primary risk factor of bipolar disorder
Family history
Pneumonic for Bipolar
DIGFAST
Distratibility
Impulsivity
Grandiosity
Flight of ideas
Activity increase
Sleep defecit
Talkativeness
How would we treat mood in bipolar
Lithium
Valproate acid
Carbamazepine
What if used alone can cause Mania in bipolar
SSRIS
2 concerns for lithium
Thyriod issues = hypothyroid
Nephrogenic DI
Decrease in what hormones cause anorexia nervosa
Dopamine and serotonin
2 types of anorexia
Restricting type
Binge eating/purging type
4 sxs of anorexia nervosa
Denial of illness = Dont FEEL they have a problem
Amenorrhea
Weight loss
Intense fear of gaining weight
Type of hair assoc with anorexia nervosa
Lanugo Hair
BMI with anorexia
Low what 3 electrolytes in anorexia nervosa
K+
Magnesium
Chloride
What it’s reseeding syndrome
High GLUCOSE = High INSULIN = increase cellular uptake of phosphate
Low phosphate + DEMAND for phosphate when feeding =
Tissue hypoxia
Heart Failure
Peripheral Edema
Type of heart condition assoc with anorexia nervosa
MVP
*dont forget seizures
MC electrolyte abnormality seen in bulimia nervosa
Low cholesterol
Low K+
Metabolic Alkalosis
4 sxs of bulimia nervosa
Distorted body image
Fear of weight gain
Binge eating
Self induced vomiting laxative use
Forced vomit in bulimia nervosa causes what sign on the hand
Russell sign ; forced acid on the hand.
Bulimia nervosa treatment
CBT and Fam therapy
Dont forget adding fluoxetine ; because they are sad about there selves
Why do you avoid bupropion in bulimia
Lowers the seizure threshold
MDD ,,, SND?
Sleepy
Not interested
Depressed
Serotonin
Norepinephrine
Dopamine
[all decreased]
DSM 5 for MDD
5 or more sigecaps for at least 2 weeks
SSRI side effects
Fluvoxamine
Fluoxetine
Setraline
Paroxetine
Paroxetine and Fluvoxamine = sedating ;
Fluvoxamine = N/V
Paroxetine = Weight Gain
Fluoxetine and Sertaline = activating ;
Fluoxetine = akathasia
Sertraline = withdrawal ; sexual dysfunction
SAD PERSONS risk factor for suicide
Sex = MALE
Age = adolescents and greater 70
Depression
Poor financial / previous attempts
Excess ETOH
Rational decision making decreased
Spouse absent
On their own // LGBTQ community
No JOB
Sickness or recent stress
PMDD ; what meds
Affects quality of life + Breast tenderness + Bloating [ w/ an affective sxs]
SSRI
OCPs
GnRH agonist
What phase does PMDD occur in the cycle
Luteal phase ; 2 weeks before period
If PMDD wants pharm management and wants get pregnant do what>
And if they dont?
Wants to = SSRI
Does not = OCPS
Refractive = GnRH agonist
OCD patients feel how about their obsession
Intrusive
Repetitive
Thoughts that they can’t control; but dont know how to stop
They are embarrassed
OCD sxs must last longer than what
1 hour per day
OCD have higher or lower dose SSRI compared to MDD
Higher
SCHIZOID
AVOID and lifelong
Cluster A think what ; SPS
Odd and eccentric ; WEIRDO
Schizotypal = awkward magic thinking
Paranoid = accusatory
Schizoid = aloof ; avoid
Cluster B ; 4 disorder think what
Borderline = up and down, labile
Antisocial = BAD, Conduct Disorder in child hood
Histrionic = Drama BOY , center of attention , BIG
Narcissistic = BEST , better than anyone else, react harshly to criticism
Cluster C disorders ; 3
Worried !
Dependent = CLINGY
Avoidant = COWARDLY; like people they dont like social situations
Obsessive - compulsive = cant get past DETAILS, RULES, SCHEDULES - over compulsive
Borderline needs what therapy
DBT ; dialectical behavioral therapy
Schizophrenia
Schizophreniform
Schizoaffective
[time frame]
Phrenia = 6 months, no depressive manic episode
Phreniform = 1 - 6 months
Affective = phrenia with depressive/manic episode ; with 2 at least weeks of normal periods
Risk factor from family for schizo
Advanced paternal age
Positive vs. Negative sxs
Positive = ADDS = delusions , hallucinations. Strange behavior
Negative = REMOVES = flat, Decresed fluency, social withdrawal
Brief psychotic disorder
One day - Less than one month of episodes
Delusional disorder is
Greater than 1 month of schizo disorder
Schizophrenia usually starts at what age
18 -25 yrs old
First line for schizo
2nd generation antipsychotics
Quetiapine
Risperidone
Clozapine ==== AGRANULOCYTOSIS
Serotonin syndrome think what
CNA
Cognitive issues
Neuromuscular issues
Autonomic instability
Neuropleptic malignant syndrome
Last days to weeks
Hyperthermia
Lead pipe rigidity
Slowed reflexes
1 reason for bad prognosis in schizo
Negative symptoms present
Conversion disorder think what
Somatic symptom disorder
Overly sensitive to normal body sensations
Only need one sxs
Adults = multiple
Kids = one complaint
Conversion disorder vs. Illness anxiety
Conversion = sensation is there, but report is out of proportion ; focused on a SYMPTOM
Illness anxiety = there is no actual sensation and it is blown out of proportion ; focused on a DISEASE
Somatic symptom disorder #1 thing you need to do
Make sure they see one provider ; with regular visits
Length of time for illness anxiety disorder
6 months of sxs
Cycle of illness anxiety
Seek care and also avoid care
Most effective 1st line for illness anxiety
CBT
Factious vs. Malingeering
Factious = Munchhowsens = want to assume sick role, invasive interventions, will hurt themselves for care ABUSE of self or child, exam inconsistent . NO OBVIOUS EXTERNAL REWARDS.
cpeptides can be used to test for exogenous insulin
Malingeering = They are lying but no obvious reason why. No secondary gain.
1st line ETOH use disorder pharm mangement
Naltrexone
Patho of alcohol withdrawal
Down regulation of GABA ; up regulation of NMDA receptors
Women vs. Men concerning drinks per day and week
W
Day = more than 3 per day
Week = more than 7 per week
M
Day = More than 4 per day
Week = more than 14 per week
Alcohol intoxication vs. withdrawal
Intoxication = slurred speech ; blackout ; euphoria
Withdrawal = seizures ; tremors ; cravings ; stomach pains
Delirium tremens happen during what stage of alcoholism
Withdrawal ; greater 48 hours after stoping drinks
Hepatic inpury
Wernickes vs Korsakoff
Wernickes = encephalopathy [disoriented] ; oculo motor dysfunction ; ataxia
Korsakaoff = same as above by add confabulation [ no understanding of the lies they make ]
Time frame for alcohol use or withdrawal disorder
12 month
Lab findings of alcohol use disorder
AST : ALT 2/1
GGT
Megalocystosis
Anemia
Carb deficient transferrin
Second line for alcohol use =
Disulfiram = they will have a reaction if they drink
Treatment of choice pharm for alcohol withdrawal
Benzo’s think:
Chlordiazepoxide
Diazepam
Lorazepam
Preventative measure screening for alcohol
Cage
Cut down
Affecting / Annoying life/job/family
Guilty
Eye opener in the morning
Meperidine is what type of drug
Opioid
NALOXONE REVERSAL
3 sxs opioid intoxication ; #1 withdrawal
Miosis
CNS depression
Hypoventilation
WITHDRAWAL = mydriasis
Opioid withdrawal treatment
Buprenoprhine
Methadone
QT prolongation
MC stimulant that I will see
Mathamphetamine
Mydriasisi + diaphoresis + dystopia + dyskinesia
Think Stimulent intoxication
Rotary nystagmus is what ?
PCP use! Intoxication
Avoid what medicine in cocaine associated stimulant intoxication
Beta blockers
= unopposed alpha receptors = ischemia
1st Line best med for PTSD
Paroxetine
SSRIs
ASD vs. PTSD
ASD = 0-28 days
PTSD = at least one month after trauma w/ intrusive sxs / negative mood
Trauma must be what in PTSD
Experienced first hand
Not seen in movies or told by a story
PTSD protective measure
Can’t remember all the details of the event first hand.
Prazosin can be used for what
Nightmares and children with night terrors
Adjustment disorder develops in what time frame
Within 3 months of a disorder
REM sleep behavior disorder occurs most often when
1-2 hours before awakening
Nightmare disorder
Is not associated with motor activity
Sleep terrors occur when
1st 3rd of sleep
Unstable relationships
Everyone is good or bad
Self mutilation
Think
Borderline personality disorder
Lack of empathy think
Narcissist
MC SSRI to cause diarrhea
Sertraline
MC SSRI to cause HTN
Venlafaxine
with patient presenting in TCA OD think what? [the 3 c’s]
Convulsions
Coma
Cardiac issues
definition of anhedonia
Little interest or pleasure in doin things
Lithium in pregnancy can lead to what heart condition
Ebsteins anomaly
What supplement increases serotonin levels
St. John’s wart
Schizo patients love what substance most
Nicotine
What is the best drug in schizo patients to stop suicide
Clozapine
Major depressive disorder what you need to know
5 sxs over
2 week
With depressed mood/loss of interest; at least 1
TXM for seasonal Pattern depressive disorder
Light therapy
Then maybe—SSRI / Wellbutrin
Atypical depression 1st line TXM
MAOI’s = 1st line
Postpartum time frame
Pregnancy —> 4 week of delivery
SSRI’s —> sertraline - best
Disruptive mood dysregualtion disorder population
2 settings
Greater than 3 x per week
Before age 10 you get first sxs —must continue longer than 1 year
PMDD sxs
1 week before menses start —> continue through menses —>
Stop after menses
Dysthymia depression lasts
Longer than 2 years = adults
Kids = 1 year
not longer than 2 months without sxs
no manic/hypomanic sxs
Hyperthermia
Hypertonicity
Coma
Tremor
AMS
Restless think what
Serotonin syndrome
CNA
Serotonin syndrome treatment
DC agent
Benzo’s
Aggressive cooling
Cyproheptadine
Mc side effect of ECT for mood disorders
Short-term Memory loss [temporary]
good in refractive pregnancy
manic episodes lasts how long
Greater than 1 week ;
Or also epi doses of depressive sxs totally 1 week
Type of bipolar with highest suicidal rate
Bipolar 1
Bipolar 2
1 major depressive episodes with hypomania = lasts less 4 days
SGAs assoc with bipolar 1 and 2 TXM
Olanzipine
Aripiprazole
Depression [w/o MDD] and hypomania for longer than 2 years
Cyclothymic disorder
Brief psychotic d/o
Lasts longer than 1 day but less than 1 month
Return gradual to premorbid fxn
Schizophrenic form
Lasts 1-6 mo’s but no longer than 6
Schizophrenia keys
Age over 15 less than 50
1 mo : delusions; hallucinations; disorganized speech ; negative sxs
Dont think behavior is abnormal
Lasts longer than 6 months
Schizophrenia TXM
SAGs = Olanzipine / apriprazoles
Typical - good positive sxs - halodol
SE most concerning in Typical antipsychotics
Neuroleptic malignant syndrome
Tardive dyskenesia
What is neuroleptic malignant syndrome
Gradual onset of
Confusion
High fever
Lead pipe rigidity
Elevated CPK
Clozapine think
Agranulocytosis ; requires weekly CBCs
Special license
Delusional disorder lasts how long
Greater than 1 month
daily FXN not effected
Types of delusions
Erotomanic
Somatic
Persecutory
Grandiose
E= another person in love with them
S = having a condition [medical/physical]
P = mistreatment or wrongful persecution
G = inflated self worth ; power ; knowledge
Delusions d/o TXM
SAGs
Schizoafffective disorder
Schizophrenia
+
Mood Disorder : MDD ; Mania ; mixed
[at least 2 weeks of only schizo sxs ]
Be careful taking SSRIs and what
Cold medications with : dextropmorphan
Specific adjunct good in GAD
Buspirone
Length of panic disorder
At least 1 month of panic sxs ; with worry of impending attack
Short course: BENZO —> SSRI —> treat for at least 1 year
Phobia time frame
6 months of sxs
Public speaking phobias =
Social phobia [social anxiety]
Panic disorder commonly accompanied by
Agorophobia
Obsessions vs. Compulsions
O = persist at thought image that are intrusive and unwanted resulting = anxiety
C = ritualistic repetitive BEHAVIORS to relieve anxiety ; time consuming
OCD effects the ego how
Ego dystonic = difficult for person; they know it’s not good for them.
What age do you have to be and sxs last how long for ptsd?
Over 6 years ; longer than 1 months
Acute stress disorder
3 days —> 1 month
Intrusive ; negative mood ; dissociative ; avoidance ; arousal sxs
Type of therapy indicated in OCD
Self therapy
- not group *
Somatic symptom disorder
1 or more physical complaints for 6 months
Concerns of seriousness OOP
TXM = therapy; provide reassurance regular visits with HCP ; minimize 2ndary gain
Illness anxiety disorder
Normal body sensation interpreted as manifestation of diseaes
Preoccupation with possibility of demise
6 months
-(negative) somatic sxs
Conversions disorder
No medical reason for the sxs that they ARE experiencing
Think : pseudo seizures
Stimulant pupils
Dilated
Opioid pupils
Constricted pupils
Cluster A ; B ; C
A = MAD ; odd eccentric ; weird
B = BAD ; emotional ; impulsive ; dramatic
C = SAD ; anxious ; fearful
Cluster A = MAD
Schizoid = recluse; no interpersonal relationships/or family
Schizotypal = disturbed ; perceptual distortion; odd eccentric behavior MAGICAL
Cluster B
Antisocial = no remorse; break the law; dont conform to a social norm
Borderline = IMPULSIVE ; intense interpersonal relationships; all good or all bad ; feelings of sever inadequacy
—> TXM : dialectical behavior therapy
HISTRIONIC = needs to be center of attention ; regression defense mechanism ; revert to childlike behavior
NARCISSISTIC = egotistical ; grandiose ; lacks empathy ; high performing
Cluster C
Avoidant = inferiority complex ; fear of rejection ; need to be assured to make any relationships
Dependent = need to be taken care of l submissive I clingy I helpless alone
Obsessive compulsive personality = preoccupied with orderliness ; perfection EGO SYNTONIC
ADHD 4 inattentive sxs
Careless mistakes
Forgetful
Easily distracted
Difficulty organizing tasks
ADHD : hyperactivity and impulsivity sxs
Leaves seat often
Fidgeting
Blurting out
Can’t wait turn
Stimulant ADE’s
Wt loss
Decreased growth
Age Austism is usually noticed ?
3-6 months
Precursor to antisocial personality
Conduct disorder
Conduct disorder :
Basic right s of others or major age appropriate rules are violated
Longer than 12months
Oppositional defiance disorder begins before when
8 years old
Behavior oppositional defiance
DONT HURT PEOPLE/DESTROY THINGS :
Angry/ irritable
Argumentative
Vindictive
Ego of anorexia
Ego syntonic = they dont hate their fear ; in order to control their environment
Restictive anorexia tend to have what traits
Obsessive compulsive
Anorexia BMIs
Less than 17 = mild
16 -16.99 = moderate
15-15.99 = severe
Less than 15 - EXTREME
Weight findings in bulimia
Normal or overweight
Rapid weight fluctuations
Bulimia electrolyte disturbance
Hypochloremia
Hypokalemia
Metabolic Alkalosis
Binge eating disorder BMI
Usually over 30 or greater than 20% of ideal
Ego of binge eating disorder
Ego dystonic
Endocrine problems due to eating disorders
INCREASE
-Growth hormone
-Plamsa cortisol
DECREASE
-Gonadotropins
-T3
-Estrogen
Spiral fx almost always related to
Child abuse
Care giver induces sxs in a child
Fictitious disorder
Munchausen by proxy
Insomnia disorder 1st line TXM
TXM = sleep hygiene !
2nd = short term hypnotics ; benzos
Narcolepsy =
Irrepressible need to sleep with
> 1 episode :
-Cataplexy = hypotonia with maintained consciousness ; grimaces or jaw opening episodes with tongue thrusting or global hypotonia
-CSF = + hypocretin
-REM latency on Psmn or multiple sleep tests
TXM of narcolepsy ?
Cataplexy —> ?
Cataplexy + sleep paralysis —> ?
Stimulants = methylphenidate
Cataplexy —> sodium oxybate
Cataplexy + sleep paralysis —> TCAs
Sleep walking vs. Night terrors
SW = rising from sleep and walking blank faced unresponsive ; awakened with GREAT difficulty = WILL WAKE UP ; SXS END
NT = terror arousa from sleep; screaming frantic ; intense fear ; unresponsive to comfort = WAKING UP DOESNT HELP
What do legs feel like in restless leg syndrome
Like worms l relieved by movement
ONLY OCCURS AT NIGHT
Erectile D/o =
Mae Sexual desire d/o =
Premature ejaculation =
Erectile D/o = PDE Inhibitors
Mae Sexual desire d/o = testosterone
Premature ejaculation = SSRI’s
Sex therapy
Female sexual interest arousal d/o TXM
Testosterone ; estrogen ; sex therapy
What is the definition of running against non consenting persons
Frotteurism
Akathasia vs. akinesia
Akathasia = subjective sense of restlessness with fidgeting rocking pacing ; cant sit still
Akinesia = state of motor inhibition or reduced voluntary movement
Avolition defintion
Lack in initiative or goals ; a negative sxs in schizophrenia
Mimicking behavior is called
Echopraxia
Concrete thinking =
Thinking by : Immediate experience rather than abstractions
-shizophrenia
Answeres becoming progressively less related to the original question =
Tangentiality
What part of MMSE assesses attention
Subtract serial 7s from 100
Assessing very short term memory assess what
Registration of information
Autism most closely effects what
Social interactions
Who is most commonly affected by major depressive disorder
Young adult Females
Treatments used in opioid dependence
Buprenorphine
Methadone
After heroin detox what might you see as far as ekectrolyte disturbance at 10 hours
Borderline personality disorder is best treated with
DBT
What is a fugue state
Traveling away from home without memory of the trip.
MC risk factor for bipolar disorder
Family history
Best therapy for histrionic personality
Individual CBT
Typical antidepressants common and ADEs
Common = halodol ; chlorpromazine ; Olanzipine
ADEs = coarse resting tremor ; excessive blinking
2nd gen AP common and ADE’s
Common = ripespiridone ; clozapine ; ariprazpole
ADEs = weight gain ; increased lipids; new onset diabetes
Clozapine = agranulocytosis
Lithium + an antipsychotic can cause what
Tardive dyskinesia
ADHD MC Risk Factor
Family history
Heroin is what kind of drug with what type of withdrawal sxs ; intoxication sxs
Opioid
Withdrawal = lacrimation ; rhinorrhea ; sweating ; yawning HTN ; Tachy !
Intoxication = bradycardia ; bradypnea hypotension
Most important cause of M and M in the US [preventable]
Tobacco use
