Psych Flashcards
Depression
Low serotonin
Low dopamine
Low NE
Low GABA
High glutamate and NMDA
Low glial cells
Screenings: zung self depression scale, PHQ8, beck depression inventory, general health questionnaire, CES depression scale: selfCARE, geriatric depression scale
Assess for target symptoms- energy, appetite, sleep impact on life, use of drugs, history of psych issues, meds, alcohol
SIG E CAPSS
-sad mood
-interest change
-guilt
-energy
-concentration
-appetite
-psychomotor changes
-sleep changes
-suicide
4 or more plus mood or interest change
Can be single or recurrent, with or without psychosis, partial, remission, mild, moderate or severe, catatonia, with mania, peri partum, seasonal
Management of MDD
Medications
Lifestyle changes- exercise, stress management, spirituality, sleep, folate, omega 3, CBT, group or family therapy, light therapy
Pharmacological tx for MDD
See weekly for SE and symptoms
Use objective scale
If only 20% improvement in 4-6 weeks, maximize dose before switching to another med
Referrals if needed especially if failure to respond, pregnancy, severe SI features, severe impairment, coexisting issues, psychosis, bipolar, eating disorder; OCD, substance abuse
Agoraphobia
Situations are avoided or need companion or endured with anxiety
Anxiety at a proportions to actual danger
Six months or more duration
Remission is rare without treatment
Two or more out of the five situations
-outside the house alone
-standing on line or being in a crowd
-being in an open space
-being in an enclosed space
-use a public transportation
Treatment includes SSRI , CBT, exposure to fear and gradual desensitization
Anxiety disorders
Broad spectrum
Separation anxiety, panic disorder, phobias, social anxiety, generalized anxiety, OCD; trichitillomania, hoarding, excoriation disorder, PTSD, ASD, adjustment disorder
Screening: zung anxiety inventory; neck anxiety inventory, Hamilton anxiety rating scale, Yale brown obsessive compulsion scale, primary care PTSD
Other disorders can mimic anxiety-thyroid, hypoglycemia; adrenal insufficiency, hyperadrenalism, Pheochromocytoma, menopause, CHF, PE, angina, asthma, COPD, DM, PNA, encephalitis, peptic ulcers, IBS, vitamin B12 deficiency, anemia, UTI, fatigue; cancer, meds, stimulants
Social phobia
Marked or persistent fear of one or more social or performance situations in which the person is exposed to possible scrutiny
Strong, genetic influence
Treatment includes a beta blocker, such as inderal or cognitive behavioral therapy
Can also start an SSRI/SNRI like Prozac Paxil, Zoloft, Celexa Lexapro , Effexor Cymbalta
Panic disorder
Chronic waxing and waning
Unexpected panic attacks
-palps, pounding heart, accelerated HR
-sweating, trembling, shaking
-sensation of SOB or smothering, feeling of choking, chest pain
-paresthesia
- nausea or abdominal distress
At least 1 attack follow by 1 month of concern about another attack, worry; avoidance
SSRI plus CBT
-Zoloft, Paxil, Effexor, curable, pristiq, can use benzodiazepine with caution, use ad adjunct and not first line
Simple phobia
Things like the environment, blood injections, etc.
Treatment with desensitization, maybe an SSRI
Generalized anxiety disorder
Excessive anxiety and worry about events or activities most days for six months
Difficult to control worry
Three of the six symptoms
-easily fatigued, restless, being keyed up or on edge
-muscle tension, difficulty, concentrating or mind goes blank
-Irritability or sleep disturbances
First line is SSRI , can also use SSRI or BuSpar, Seroquel, Xanax and clonazepam
Benzodiazepines are not considered first line used with caution and avoid if possible
Cognitive behavioral therapy, progressive, and relaxation therapy bio feedback
OCD
Obsessive or compulsive or both
Very time consuming can cause clinical significant distress or impairment and daily life
Obsessions are recurrent and persistent thoughts, or images that are intrusive and inappropriate that can cause anxiety
Compulsions are repetitive behaviors or mental acts that the person feels driven to perform in response to the obsession or due to rules they must abide by
Examples include checking, counting, doubting, contamination
Yale Brown obsessive compulsive scale
SSRI but you generally need a higher dose
Tricyclic antidepressants, but these are second and third line
Can also use antipsychotics as well
Referral to psychotherapy
Body dysmorphic disorder
Preoccupied with minor or imaginary physical flaws
Can also coexist with anxiety where they pick at the skin
SSRI are the first line
Cognitive behavioral therapy with desensitization
Other compulsive related disorders
Hoarding
Exploration disorder -picking at skin
Trichotillomania-hair pulling
PTSD
Following severe stressor usually greater than one month duration
Some red flags include patients who make frequent visits or frequently hospitalized, multiple unexplained symptoms, high emotional distress, comorbid, depression, anxiety that’s not getting better, using drugs to forget and numb out
Must meet where patient has exposure to a traumatic event and symptoms, one of the following, including
-recurrent, involuntary intrusive, distressing memories of the event
-recurrent distressing dreams of the event
-Flashbacks
-intense or prolonged psychological distress at exposure to internal or external cues
-marked physiological reaction to internal or external cues that resemble the traumatic event
-stimuli avoidance
-inability to express positive emotions
-decrease interest in activities
-persistent negative emotional state
-inability to remember an important aspect about the traumatic event
-Hypervigilance
SSRI for treatment, Zoloft and Paxil are good, trazodone for sleep, clonidine for starter response, use buspar for anxiety, Depakote or Tegretol for aggression, atypical antidepressants, gabapentin off label, benzos for sleep and anxiety
Psychotherapy EDMR, CBT group therapy
Acute stress disorder
Similar symptoms to PTSD only they occur immediately after a trauma
Disassociative symptoms like numbing detachment reduction in awareness of surroundings, de realization, depersonalization, amnesia persistently, reexperience, avoidance of stimuli that evoke recognition of trauma
Bipolar disorder
Diagnosis is made when at least one hypomanic episode or at least one manic episode have occurred
Mood stabilization and breaking the cycle is goal
Lithium , divalproex, or level one antipsychotic such as risperidone, olanzapine Seroquel or aripiprazole
Can use an antidepressant to stop depressive episodes
Bipolar one
Manic episode at least 1 requires
Full manic episode
More than 7 days of mania at least once
Severe impairment during mania
Often hospitalized
May not have depressive episodes
Bipolar two
Hypomanic episode without full mania and depressive episode
4-7 days of hypomania in life
No hospitalization for mania
At lease one MDD episode 14 days in life
Acute agitation
Benzodiazepine like lorazepam
Antipsychotic like Haldol Geodon Zyprexa Abilify
SSRI/SNRI beta blockers Alpha agonist antipsychotics lithium
CBT
Alcohol use
One drink per day for women and adults over 65 and two drinks per day for men is considered moderate use
Nicotine
Attaches to neurons in the brain, flood the brain with dopamine
Ecstasy MDMA
Intense millions of attachment and connections to others highly increase energy
Bruxism
Insomnia and motor restlessness
Hallucinations, severe chest pain, cordial erosion, subarachnoid hemorrhage can lead to multi organ system failure
Thermo regulation in the brain is turned off can be toxic long-term
Treat with SSRI
Opiate
Heroin or anything prescribed
Risk her higher and higher tolerance and risk of overdose
Withdrawals include, yawning, abdominal cramps, diarrhea
Respiratory depressants
GHB and Rohypnol
Date, rape, drugs, that cause amnesia and muscle relaxation they are hypnotics They are dangerous with alcohol.
