Psych 2.0 Flashcards
Define Fear and what part of the NS controls it
Define Anxiety
How long does anxiety have to be present to be relevant
Emotional response to imminent threat; Autonomic
Anticipation of future threats;
Phobic stimulus w/ active avoidance
x6mon
How is Anxiety d/t Specific Phobia Tx first line or w/ meds?
What is the key feature of a Social Anxiety d/o
What is the key feature of a Panic D/o
First line: psychotherapy
Meds: SSRI/SNRI
Fear of social situation where scrutiny may occur
Recurrent, unexpected attacks
How are Panic d/os Tx
How is Agoraphobia Tx
Define Generalized Anxiety d/o
First line: psychotherapy, S/SNRI, TCA
Just like GAD:
Group therapy w/ SS/NRI, Gabapentin
Excessive worry about multiple things x 6mon
How is Generalized Anxiety D/o Tx
How is Generalized Anxiety categorized into severity
What are five examples of Somatic Sxs
Psychotherapy;
Gabapentin Buspirone SS/NRI Propranolol TCA
GAD-7 scores:
5-9: mild 10-14: mod 15-21: severe
Pain SOB Tremor Fatigue Paralysis
Define Somatization
What Sx is MC present
What aggravating issue can these Pts exhibit
Physical Sxs mimicking absent Dz x6mon;
Pysch distress felt in physical form
Pain
Dr shopping
How is Somatic Sx D/o Tx
Define Illness Anxiety D/o and how are they Tx?
What is unique about their presentation
Social/Peer support
Refractory= SS/NRI but expect exacerbated Sxs
Hypochondriasis;
Pt worries they MAY acquire serious illness;
Therapy; SSRI if underlying A/D d/o
Absent/minimal somatic Sxs w/ high anxiety
Define Conversion D/o and what can it AKA?
How are these Pts managed for Tx
Define Factitious D/o
Altered voluntary motor/sensory function;
Functional Neurological Sx d/o
Non-pharm, possibly w/ hypnosis
Falsified S/Sxs or induced issue w/ intent of deception but no secondary gain
How is Factitious D/o managed
Define La Belle Indifference
Define Obsession and Compulsion
Psych consult w/ confrontation/biofeedback; Short term anxiolytics
CPS removes child if Munchausen by Proxy
Pt w/ sudden, unexpected lack of concern to Conversion D/o Sx
O: intrusive thought/urge/images causing anxiety
C: behavior/acts done in response to obsession
OCD is MC in ? gender
What are these Pts at risk for in the future
How are these Pts Tx
Male
Half have SIs
One quarter will have attempts
Systemic desensitization/CBT
SSRIs/Clomipramine- TCA
Define Body Dysmorphic D/o
What are the MC areas reported
How is this Tx
Perceived defect in body not observable by others
Hair Nose Skin
Psychotherapy
SSRI/Clomipramine- TCA
Define Hoarding D/o
What is rare in these Pts Hx
How are they Tx
Difficulty discarding items regardless of value
Theft
CBT, rarely SSRIs
Define Trichotillomania
What areas are MC affected
How are they Tx
Pulling out own hair
Scalp Eye brow/lid
Biofeedback/Desensitization/Habit reversal
Hydroxyzine, Topical steroids
Anti-depressants/psychotics
Define Excoriation
What parts of the body are MC affected
How is this Tx
Picking at skin
Face Arms Hands
CBT w/ habit reversal
Fluoxetine, Naltrexone
Define MDD
What are two common presenting complaints
What risk is present at all time for these Pts
Depressed mood/loss of interest w/ 4 SIGECAPS Sxs x 2wks
Fatigue, Insomnia
Suicide w/ biggest RF: Hx of attempts
How is MDD Tx
When is electroconvulsive therapy indicated
What meds may be used
CBT w/ phototherapy
Medication can’t be used
Extremely suicidal
SSRI (Tx sex dysfunction w/ PD5-I/buproprion)
SNRI if chronic pain
What medication is safe for Ps w/ MDD and acute MI/unstable angina Hx
What class needs to be used w/ caution for MDD Pts
What class is used as third line Tx
Sertraline
TCA w/ cardiac/seizure Pts
MAOI
What class of drug is used for short term Tx or refractory depression of MDD
Maintain therapy x ? long after resolution of MDD Sxs
What are the indications to continue the full dosage indefinitely
Stimulants
x12mon
First episode before 20/after 50y/o
Over 40y/o w/ two episodes
One episode after 50y/o
Three episodes over lifetime
Define PDD
How is this Tx
Depressed mood x 2yrs w/ two Sxs w/ remission lasting no longer than 2mon
Same as MDD:
CBT, Phototherapy, SSRI, SNRI, TCA
Characteristics of Bipolar 1
Characteristics of Bipolar 2
What is the essential feature needed to make Dx of BP2
Manic mood x 1wk or needing admission w/ 3 Sxs d/t severity
Elevated mood x 4d w/ three Sxs w/out impairment or severe enough for admission
Hypomanic and depressive episode
What is first line Tx for Bipolar 1
What is used for acute management in rapid cyclers
What is used for long term management
Valproic acid
2nd generation antipsychotic and benzos
Lithium Valproate Quetiapine Lamotrigine
Why is BP2 scarier than 1
How is this Tx
Criteria for insomnia
Higher rate of successful suicides
Valproic acid- first line
2nd generation antipsychotic and benzos- rapid cycles
Lithium Valproate Quetiapine Lamotrigine- long term
Unhappy quality/quantity and can’t get to/stay asleep for 3 nights per week x 3mon
How is insomnia Tx
Define Hypersomnolence D/o
CBT w/: Hydroxyzine Exzopiclone Lorazepam Diphenhydramine Zolpidem/Zaleplon
Excessive sleepiness despite 7hrs or more of sleep3/week x 3mon
Criteria for Narcolepsy
What can trigger the visible and awake Sx of this condition
How is this Tx/managed
Irrepressible sleep/excessive napping 3x/wk x 3mon w/ cataplexy, hypocretin or +sleep study
Cateplexy triggered by laughter/joking
Dextroamphetamine sulfate
Modafinil
What is the s/e of using Modafinil for Narcolepsy Tx
What female Pt education piece is needed w/ this medication
Sleep study criteria for OSA
HA, anxiety
Dec OCP efficacy
5 episodes per hour w/ Sxs
15 episodes per hour
? is the MC breathing related sleep d/o
Define Circadian Rhythm sleep-wake cycle d/o
What can resolve this issue for some Pts
OSA
Altered rhythm leading to excessive sleepiness
Set own schedules, can have normal sleep quality/duration
How is Circadian Rhythm Sleep Wake d/o Tx
Criteria for Restless Leg Syndrome
How is this Tx
Melatonin Zolpidem Benzos
Urge to move legs d/t uncomfortable sensation that is relieved w/ movement
Fe replacement- if deficient
Ropinirole- first line dopamine agonist
Gabapentin
Clonazepam
Define Substance/Medication induced sleep d/o
Define Delusions
Define Hallucinations
Disturbed sleep after starting new medication that is capable of disturbing sleep
Fixed beliefs that don’t change w/ conflict/evidence
Perception of experiences w/out external stimulus
When/How is disorganized thinking suspected in a Pt
What are two types of disorganized thinking
Three examples of ‘positive’ Sxs of psychotic d/o
Inferred by their speech
Derailment- switches from topic to topic
Tangent- questions answered obliquely/unrelated
Hallucination Delusion Uncontrollable repetitive movements
Define Delusional D/o
Sxs of ? other d/o are considered mild compared to delusional d/o Sxs
How is this d/o Tx/managed
One delusion x 1mon w/out meeting schizophrenia criteria
Not functionally impaired, behavior is not odd
Bipolar
Protection from harm to self/others
Antipsychotics- drug of choice w/ antidepressants
Define Brief Psychotic D/o
How is this worked up and managed
Delusion, Hallucination or Disorganized speech for at least a day but back to normal within one month
Prevent harm to self/others; possible admit
Eval w/ brain imaging if first psychosis episode
Antipsychotics (TxOC) w/ antidepressants
Criteria for Schizophrenia
How does the onset of this Dz indicate the Dx
If Pt has a Dx of Autism or Communication d/o, a schizophrenia Dx can only be made if ?
Two of the five Sxs, most of the time, for one month:
Delusion Hallucination
Disorganized speech/behavior or catatonia
Negative Sxs
Dec level of function in one area of life
Prominent delusion/hallucinations w/ schizophrenia Sxs and w/out mood episodes
How is schizophrenia Tx
Define Dissociation
What are the two parts of Dissociative Symptoms
Protect self/others from harm
Full eval w/ imaging
Antipsychotics (TxOC) w/ antidepressants
Disconnecting from thoughts/feelings/memories
Depersonalization: sense of being in a dream
Derealization: surroundings are dreamlike
Criteria for Acute Stress D/o
How is this Tx non-pharm
What meds can be used for Tx/management
9 Sxs lasting 3-30d after experiencing trauma
Psych debrief
Exposure therapy
Trauma CBT
Benzos
Morphine- early pain relief= dec PTSD
Propranolol
SSRI
Define PTSD
Non-pharm Tx
Exposure to trauma w/ intrusive Sxs, avoiding stimuli associated w/ event, and at least two negative alterations in cognition/mood and two alterations in arousal/reactivity
Psychotherapy
Cognitive processing therapy
Prolonged exposure therapy
Eye movement desensitization therapy
Pharm Tx for PTSD
SSRIs- only class approved for Tx: Sertraline Peroxetine
Propranolol- peripheral Sxs
Clinidine- hyperarousal
Prazosin- nightmares
Carbamazepine- impulse/anger management
Benzos- anxiety/panic attacks
Trazodone- insomnia
Define Adjustment D/o
One of ? Sxs needs to be present
What time frame should these Sxs resolve
Emotional behavior Sxs developing w/in 3mon of identifiable stressor
Distress OOPT stressor intensity
Impaired social/occupational function
<6mon of stressor or consequences
How is Adjustment D/o Tx
What meds may be used
Immediate: bag breathing
Removal from stressed situation
Log daily stressors
Stress reduction exercises
SSRIs
Benzo/Antihistamine sedatives
Time frame for Acute Stress Reaction
Time frame for PTSD
Time frame for Adjustment D/o
Trauma causing Sxs 3-30d and PTSD-like Sxs
Trauma causing Sxs 30d/> and PTSD-like Sxs
Stress Sxs presenting <3mon, resolving <6mon
Define Bereavement
What is the natural response to this situation and in ? two stages
When the above response becomes ‘complicated’ its AKA ?
Someone who is close dies
Grief: Acute, Integration
Persistent Complex Bereavement D/o
What happens in the acute phase of grief
What happens in the integration phase of grief
What are the four hallmarks of healing from death
Intense, distressing emotions of numb/shock/denial that act as adaptive mechanism to relieve pain
Transition period months later but can be extended if loss was d/t suicide
Recognize they’ve grieved
Think/talk about deceased w/out emotions
Return to work/daily activities
Seek companionship/pleasure w/ others
Criteria for Persistent Bereavement D/o
What are the RFs for this to develop
What are common comorbidities seen in these Pts
Sxs x 12mon (x6mon if death was of child) that is OOPT to norm
Hx of Anx/Dep Insecurity Multiple previous deaths Death of child/young adult Violent death Hostile/insensitive behavior of others
Depression PTSD Substance abuse
How is Persistent Complex Bereavement D/o Tx
Without Tx, Pts may develop ? issues by 13mon, 25mon?
What is the strongest RF for suicide and what is a strong predictor for suicide
Monitor q1-4wks
Behavioral therapy (first line)
Pharmacotherapy (second line) if PTSD/depression present
13: HTN Eating Depression Smoking
25: CV/Neoplastic dz
RF: Previous attempt/threat
Predict: psych d/o
What are the RFs from highest to lowest for suicide risk
When does age become a RF
Never married Widowed Separated Divorced Married w/out kids
Males >85y/o
What are protective factors against suicide
What acronym is used to assess suicide risk objectively
What are the subjective and objective part of the assessment
Social/Family connections
Pregnancy
Parenthood
Religion
AMSIT:
Appearance Mood Sensorium Intellect Thoughts
Mood: subjective
Affect: objective
When are SSRIs used in assessing suicide risk
When are suicide rates the highest after d/c
6 red flags for history of child abuse
Pt w/ underlying psych condition
First week
Delay in seeking care Impossible history for injury No Hx or denies trauma Evolving story of events Resuscitation efforts at home Self inflicted/inflected by sibling/pet
Define Anorexia Nervosa
This condition rarely presents prior to ? milestone
How is this Tx
Restricted intake w/ lower than normal body weight and intense fear of weight gain
Puberty
Restore normal weight, eating behavior and psych
All Pts Dx w/ Anorexia Nervosa need to be co-managed/Tx w/ ? on the team
What are the four indications to admit
Psychiatrist
Hypovolemia
Major electrolyte d/o
Out Pt failure
Protein energy malnutrition
Define Bulimia Nervosa
What risk is w/ this type of eating d/o
How are they Tx
Loss of control while eating, eating too much in one sitting w/ inappropriate compensatory mechanisms to prevent weight gain x 3mon
Inc suicide risk
Psychotherapy
Fluoxetine hydrochloride/SSRIs
Define Binge Eating D/o
How are these Pts Tx
Define ADHD
Recurrent binge eating w/out compensatory mechanisms
Psychotherapy w/ CBT
Impaired function/development w/ inattention and hyperactivity/impulsitivity
How is ADHD Tx
What medication may be used in Pts when the above is c/i or if Pt has major depression
What meds are used if Pt has underlying HTN issues
Psychoeducation w/ Stimulants
1st: Desipramine (TCA)
2nd: Atomoxetine
Guanfacine, Clonidine
What may be the first Sx of Autism Spectrum D/o
What are the only two FDA approved psychotropic meds for these Pts
How is Oppositional D/o categorized
Delayed language development w/ lack of social interest
Risperidone, Aripiprazole
Mild: one setting
Mod: two settings
Sev: three/more settings
Oppositional D/o actions can be at everyone except ?
What background/history indicates this d/o
What are the two MC co-occuring conditions
Siblings
Child care disrupted by different caregivers
ADHD, Conduct d/o
How is Oppositional Defiant D/o Tx
How is Conduct D/o Tx
Personality d/D/o is a pattern of behavior deviating from cultural norms w/ ? manifestations
Psychotherapy: reward/punish of behaviors
Psychotherapy along w/:
Antipsychotics: Haloperidol Risperidone Olanzapine
Lithium- mood stabilizer
Stimulants if ADHD present
CAPRI:
Cognition Affect Personal Relations Impulsive
What are the 3 Cluster A personality D/os
Paranoid- distrust or suspicion w/ quick reactions of anger (pathologically jealous/suspicious)
Schizoid- detachment from social relationships w/ restricted range of emotions (doesn’t fit in, doesn’t mind)
Schizotypical- discomfort w/ close relations and distorted behavior
Schizotypal personalities often improve w/ ? medications
What are the four Cluster B personality d/os
Antipsychotics
Antisocial- disregard for others since 15y/o and must be 18y/o for Dx
Borderline- unstable personal relationships w/ impulsivity and poor self image
Histrionic- excessively emotional and attention seeking
Narcissistic- grandiosity w/ need for admiration but lacking empathy
What findings are common in the history of Antisocial personality d/os
What are the three Cluster C personality D/os
“con man” Abuse Animal cruelty Arson
Avoidant- social inhibition w/ intense fear of rejection
Dependent- submissive/clingy need to be taken care of w/ separation anxiety
OCD- preoccupation w/ order/perfection
What class of medication is used for Sx relief of borderline personality d/o
What class is used for hostility, agitation Sxs
What meds are used for avoidant personalities
SSRIs reduce aggression, impulse
Anticonvulsant- dec behavior dyscontrol
Antipsychotics
SSRIs, Benzos
Alcohol intoxication increases w/ ? personality characteristics
What does alcohol withdrawal look like
Sensation seeking
Impulsivity
Tremors Autonomic hyperactivity Insomnia N/V/Tachy Tonic clonic seizure
? medication is used to discourage alcohol use
? medication is used to remove the pleasure effect of alcohol use
What is used if Pt is experiencing hallucinations during withdrawal
Disulfiram- aversion med
Naltrexone- opiate antagonist to dec pleasure
Haloperidol
Adjustment d/o can rarely but potentially evolve into ? psych Dxs
Pts w/ anxiety d/os are likely to self medicate w/ CNS depressants, MC being ?
Time frame for adjustment d/o to develop?
GAD, Major depression
Alcohol
W/in 3mon of stressor
What meds may be used for Adjustment D/o Tx
These Pts are at risk for ? future medical issues
Define Sunday Neuroses
Lorazepam- acute anxiety
SSRIs- long term management
Increased risk for autoimmune dzs
Pts do well w/ scheduled week but unscheduled weekend/retirement causes anxiety
How is GAD Tx w/ meds
What med is possibly the most anxiogenic antidepressant
? medication is used for reducing peripheral Sxs
SSRI: Escitalopram Paroxetine
SNRI: Venlafaxine Duloxetine
Buspirone
Propranolol
? medication is used in benzo over doses
How is panic d/os Tx w/ meds
Social phobia and agoraphobia can be Tx w/ ? meds
Flumazenil- benzo antagonist
SSRIs: Fluoxetine Paroxetine Sertraline
SNRI: Venlafaxine
SSRI: Paroxetine Sertraline Fluvoxamine
SNRI: Venlafaxine
Gabapentin
OCD Sxs can overlap w/ ? other spectrum Sxs
What meds are used during Tx
What meds can be used as adjuncts w/ SSRIs for Tx resistant cases
Body dysmorphia
Excoriation
Tic/Trichotillomania
Hoarding
SSRI: Fluoxetine Sertraline Paroxetine Fluvoxamine
Clomipramine
Antipsychotics/Topiramate
What procedure is FDA approved for Tx of OCD
Transcranial Magnetic Stimulation
