Psych Flashcards
Generalized Anxiety Disorder (GAD) criteria and tx
*excessive anxiety/worry (apprehensive expectation) about various events/activities lasting ≥6MO
*difficulty controlling the worry
Associated w/ 3+SXS: restlessness/feeling keyed up, fatigue, impaired concentration, irritability, muscle tension, insomnia
*only 1 symptom required in children
tx
Psychotherapy + pharmacotherapy = most effective
*CBT
*SSRIs (sertraline, citalopram), SNRIs (venlafaxine)
*+/- short-term BDZ course or augmentation w/ buspirone
Panic Disorder criteria and tx
*2+ unexpected panic attacks w/o an identifiable trigger (4+SXS of panic attack)
*1+SXS for ≥1MO following attack
*concern about future attacks/consequences (e.g., losing control, heart attack, going crazy)
*significant maladaptive change in behavior (e.g., avoidance behavior)
tx
CBT + pharmacotherapy = most effective
*SSRIs first line (sertraline, citalopram, escitalopram)
*SNRIs (venlafaxine) also efficacious
*TCAs (clomipramine, imipramine) if above not effective
*BDZs until other medications reach full efficacy
Specific Phobias definition, criteria and tx
Specific Phobia: intense fear of object/situation leading to avoidance &/or anxiety endurance
*≥6MO of persistent, excessive fear elicited by a specific situation or object which is out of proportion to any actual danger/threat
*exposure triggers IMMEDIATE response
*avoided when possible or tolerated w/ intense anxiety
Subtypes:
*animals (spiders, dogs, mice)
*situational (airplanes, elevators)
*natural environment (heights, thunder)
*blood-injection injury (needles, blood)
tx
*CBT TOC (exposure & desensitization therapy)
*short term BDZs or BBs in some pts
Agoraphobia definition, criteria and tx
*intense fear of being in public spaces where escape or obtaining help may be difficult
*avoidance behaviors may become as extreme as complete confinement to home
*often develops w/ panic disorder
*onset usually before 35yo
criteria
*intense fear/anxiety of 2+ SITUATIONS d/t concerns of difficulty escaping, obtaining help in case of panic, or other embarrassing sxs (e.g., falling/incontinence in elderly)
*outside home alone
*open spaces (e.g., bridges)
*enclosed spaces (e.g., stores)
*public transportation (e.g., trains, buses)
*crowds/lines
*agoraphobic situations always provoke fear/anxiety that is out of proportion to actual danger posed
*agoraphobic situations are avoided, require a companion, or endured w/ fear/anxiety
*lasting ≥6MO
tx: CBT + SSRIs
Social Anxiety Disorder (Social Phobia) definition, criteria, tx
def: fear of scrutiny or acting in embarrassing way
*phobic stimulus related to social scrutiny & negative evaluation
criteria
*fear/anxiety about 1+ SOCIAL SITUATIONS in which individual is exposed to possible scrutiny by others, lasting ≥6MO
*fears he/she will act in a way or show anxiety sxs that will be negatively evaluated (humiliating, embarrassing, rejection, offend others)
*social situation almost always provokes fear or anxiety that is out of proportion to actual threat posed
*social situations avoided or endured w/ intense fear/anxiety
tx
*CBT TOC
*SSRIs (sertraline, fluoxetine) or SNRIs (venlafaxine) first line pharmacotherapy if needed for debilitating symptoms
*BDZs (clonazepam, lorazepam) can be used
*beta blockers (propranolol) for performance-only/public speaking anxiety
Selective Mutism definition, criteria, tx
definition
*failure to speak in specific situations despite intact ability to comprehend/use language (rare)
*symptom-onset typically during childhood
*majority of pts suffer from anxiety (social)
*may remain silent or whisper
criteria
*consistent failure to speak in select social situations where speaking is expected (e.g., school) despite speaking in other situations lasting ≥1MO (not limited to first month of school)
*NOT attributable to language difficulty or communication disorder
*interferes w/ educational/occupational achievement or social communication
tx
*psychotherapy (CBT, family therapy)
*Medications: SSRIs (esp. w/ comorbid social anxiety disorder)
Separation Anxiety Disorder definition, criteria, tx
Stranger Anxiety: begins ~6mo, peaks ~9mo
Separation Anxiety: emerges ~1y, peaks ~18mo
*considered pathological when anxiety becomes extreme or developmentally inappropriate
*may be preceded by stressful life event
criteria
*fear/anxiety/avoidance lasting ≥4WKS (children/adolescents) or ≥6MO (adults) that causes distress or impairment in important areas of functioning (social, academic, occupational, etc.)
FEAR/ANXIETY CONCERNING SEPARATION (3+):
*excessive distress when anticipating/experiencing separation from attachment figure
*worry about loss of/harm to attachment figure (illness, injury, disaster, death)
*worry about experiencing event causing separation (getting lost, kidnapped, accident, illness)
*reluctance/refusal to leave home, attend school or work, or go out d/t fear of separation
*fear of/reluctance about being alone
*reluctance/refusal to sleep alone/away from home
*nightmares about separation
*repeated physical complaints during separation (HA, N/V, stomachache, etc.)
tx
*psychotherapy (CBT, family therapy)
*medications: SSRIs can be effective as adjunct to therapy
Mood Episodes: manic episode definition and criteria
MANIC EPISODE: abnormally elevated, expansive, or irritable mood PLUS ↑ energy/activity lasting ≥1WK (any length if requires hospitalization)
*3+SXS (4 if mood is only irritable): DIGFAST
D distractibility
I impulsivity (poor judgement, spending sprees, sexual indiscretions)
G grandiosity (increased self-esteem)
F flight of ideas (racing thoughts)
A activity/agitation (↑ goal-directed activity, psychomotor agitation)
S sleep (decreased need)
T talkativeness (pressured speech)
*+significant impairment or requires hospitalization or +psychotic features
Mood Episodes: hypomanic episode criteria
HYPOMANIC EPISODE: abnormally elevated, expansive, or irritable mood PLUS ↑ energy/activity lasting ≥4d
*3+SXS (4 if only irritable), DIGFAST
*obvious change in functioning is uncharacteristic of the individual when not symptomatic
*change observable by others
*Ø psychotic features
*Ø significant impairment, Ø hospitalization required
MIXED EPISODES: criteria met for manic (or hypomanic) episode concurrent w/ 3+SXS of MDE (SIGECAPS) lasting ≥1WK
Mejor depressive disorder criteria
MAJOR DEPRESSIVE EPISODE (MDE): 5+SXS (SIGECAPS), ≥2WKS
S sleep (insomnia or hypersomnia)
I interest (loss of interest or pleasure in activities i.e., anhedonia)
G guilt (excessive or inappropriate guilt, feelings of worthlessness)
E energy (loss of energy or fatigue)
C concentration (diminished concentration or indecisiveness)
A appetite (decrease or increase in appetite; weight loss or gain)
P psychomotor agitation/retardation (i.e., restlessness or slowness)
S suicide (recurrent thoughts of death, SI/SA)
*1 SYMPTOM MUST BE 1) DEPRESSED MOOD OR 2) ANHEDONIA
Bipolar Disorders criteria and tx
Mood Disorders: marked by relapses w/ relatively normal functioning between episodes
RF: first-degree relative w/ bipolar disorder ↑ likelihood 10x
*earlier onset = greater likelihood of psychotic features & poorer prognosis
*men & women equally affected (BP2 slightly MC in ♀︎)
*1-2% lifetime prevalence
*onset usually before age 30, mean age of first mood episode 18yo
*25-50% of patients attempt suicide, 10-15% die by suicide
Cyclothymic Disorder: 1/3 of patients eventually develop bipolar disorder, onset between ages 15-25
criteria
Bipolar I: 1+ manic episode +/- MDE
Bipolar II: 1+ MDE plus 1+ hypomanic episode
Cyclothymia: hypomanic sxs + periods of depression for ≥2y
*1yr for children/adolescents
*hypomanic/depressive sxs do not meet criteria for manic/major depressive episode
*sxs do not cease >2mo
Rapid Cycling Specifier: 4+ mood episodes within 12mo
tx
Acute Mania: lithium + antipsychotic
*valproate + antipsychotic reasonable alternative
*aripiprazole, haloperidol, olanzapine, quetiapine, risperidone
Lithium MOA, ADRs
MOA: inhibit 5HT/NE reuptake & 2nd messenger systems
*REDUCES SUICIDE RISK
ADRs: hypothyroidism, tremor, weight gain, leukocytosis
*GI (N/V/D, metallic/salty taste, i.e., dysgeusia)
*dermatologic (acne vulgaris, psoriasis)
*cardiac arrhythmia (bradycardia, abnormal T waves, edema)
*CNS (sedation, lethargy, ataxia, slurred speech, HA)
ADRs (duration-related): nephrogenic diabetes insipidus, hyperparathyroidism & hypercalcemia, interstitial nephritis, polyuria/polydipsia
Monitoring: BUN/Cr, electrolytes/calcium, TSH/PTH, lithium levels (q1-3mo)
Pregnancy: Ebstein’s anomaly w/ use (esp. 1st TM)
Valproate MOA and ADRs
MOA: blocks Na channels, ↑ GABA
Formulations: valproic acid, valproate sodium, divalproex sodium
ADRs: alopecia, GI disturbances, tremor, diplopia, PCOS
ADRs (dose-related): CNS (dizziness, sedation, tremor, HA), thrombocytopenia
ADRs (non-dose-related): hepatotoxicity, hyperammonemia & encephalopathy, SJS/TEN/DRESS, pancreatitis
BOXED WARNINGS: hepatotoxicity, fetal risk (neural tube defects), pancreatitis
CI: hepatic dysfunction, pregnancy; DIs: ↑ lamotrigine levels
Monitoring: LFTs, CBC, ammonia level (warning s/sxs: lethargy, vomiting, hypothermia)
Therapeutic Range: 50-100mcg/mL
Lamotrigine MOA and ADR
MOA: inhibits glutamate release/Na channels
*INEFFECTIVE FOR ACUTE MANIA, better for bipolar depression
ADRs: GI (N/V/C), contact dermatitis, infection, dizziness, drowsiness, blurred vision
ADRs (significant):
*aseptic meningitis (rare), blood dyscrasias (agranulocytosis, pancytopenia)
*hemophagocytic lymphohistiocytosis (s/sxs: fever, rash, hepatosplenomegaly)
BOXED WARNING: SJS/TEN/DRESS
Therapeutic Range: 1-6mcg/mL
Monitoring: LFTs, renal function, concurrent anticonvulsant levels (↓ valproate levels)
Pregnancy: increased risk for cleft lip/palate
Major Depressive Disorder (MDD) definition, criteria, tx
*marked by episodes of depressed mood associated w/ loss of interest in daily activities
*+/- somatic sxs (fatigue, HA, abdominal pain, muscle tension, etc.)
≥2WKS, 5+SXS *1 symptom must be 1) depressed mood or 2) loss of interest or pleasure (anhedonia)
S sleep (insomnia or hypersomnia)
I interest (loss of interest or pleasure in activities i.e., anhedonia)
G guilt (excessive or inappropriate guilt; feelings of worthlessness)
E energy (loss of energy or fatigue)
C concentration (diminished concentration or indecisiveness)
A appetite (decrease or increase in appetite; weight loss or gain)
P psychomotor agitation/retardation (i.e., restlessness or slowness)
S suicide (recurrent thoughts of death, SI/SA)
Psychopharmacologic: SSRIs/SNRIs first-line
*evaluate response q3-4wks
*once therapeutic effect achieved, continue ≥6mo
Therapy: CBT
*combo of meds + CBT = most success
Treatment-Resistant: TCAs, MAOIs, atypical APs, stimulants, carbamazepine, ECT
Pharm: should give drug ≥6wks at maximum dose before switching
