Psych Flashcards
1
Q
Childhood Disorders
A
Intellectual Disability (formerly mental retardation)
Autism Spectrum Disorders
ADHD
Tourette Disorder
2
Q
Intellectual Disability (formerly mental retardation)
Definition
A
In order to determine the level of intellectual disability, patients must exhibit deficits in both interllectual functioniong (cognitive abilities) as well as social adaptive functioning (the ability to do daily activites). the disorder is momre frequent in boys, with the highest incidence in school age children.
3
Q
Mild mental retardation
IQ range:
Level of functioning:
A
IQ range: 50-55 to 70
Level of functioning: reaches sixth grade level of education, can work and live independently, needs help in difficult or stressful situations
4
Q
Moderate mental retardation
IQ range:
Level of functioning:
A
IQ range: 30-4- to 50-55
Level of functioning: reaches second grade level of education, may work with supervision and support, neds help in mildly stressful situations
5
Q
Severe mental retardation
IQ range:
Level of functioning:
A
IQ range: 20-25 to 35-40
Level of functioning: little or no speech, very limited abilities to manage self-care
6
Q
Profound mental retardation
IQ range:
Level of functioning:
A
IQ range: below 20
Level of functioning: needs continuous care and supervision
7
Q
Intellectual Disability (formerly mental retardation)
Treatment
A
Genetic counseling, prenatal care, and safe environements for exptectant mothers
if due to medical conditions, effective treatmeent for disorder
special education to improve level of functioning
behavioral therapy to help reduce negative behaviors
8
Q
Autism Spectrum Disorders
definition
A
Autism Spectrum Disorders are characterized by problems in social interactions, and language wthat tend to occur in children yougner than age 3 and impari daily functioning. this diagnosis has replaced autism, Rett’s syndrome, and Asperger’s disorder
9
Q
Autism Spectrum Disorders
symptoms
A
children with ongoing Autism Spectrum Disorders have ongoing deficits in social communicaitons and social interactionacross variousareas. the deficits include social connection, poor eye contact, and problems iwth language, relationships, and understanding others. other features include stereotyped or repetitive movements, inflexibility, and unusual interest in sensory aspects of the environment.
10
Q
Autism Spectrum Disorders
treatment
A
the goal of the treatment is to improve the patient’s abitlity to develop relationships, attend school, and achieve independent living.patients with autism specturm diosrders may benefit from behabioral modification programs that seek to imporove language and ability to connect iwth others. if the patient is aggressive, use antipsychotic medications such as risperidone.
11
Q
Autism Spectrum Disorders
facts
A
more common in boys
usually seen by 3 months of age
rule out deafness
language deficits, aggression, lack separation anxiety, are withdrawn
12
Q
Attention Deficit Hyperactivity Disorder
Definition
A
a disorder characterized by inattention. short attention span, or hyperactivity that is severe enough to interfere with daily functioning in school, home, or work. the sx must be presetn fro more than 6 months and usually appear before the age of 7. the sx may persist into adulthood
13
Q
Attention Deficit Hyperactivity Disorder
diagnosis
A
sx must be present in at least 2 areas, such as home and school. at home, children interrupt others, fidget in charis, and run or climb excessively; are unabel to engage in leusre activities; and talk excessibely. at school, they are unabelt o pay attn, make careless mistakes in schoolwork, do not follow through with instructions, have difficulties organizing tasks, and are easily distracted.
14
Q
Attention Deficit Hyperactivity Disorder
1st line treatment
A
methylphenidate and dextroamphetamine. side effects include insomaina, decreased appetite, GI disturbances, increased anxiety, and headach. these drugs work well in reducing these sx of inattention and hyperactivity bc they affect the noradrenergic and dopaminergic pathways of attention
15
Q
Attention Deficit Hyperactivity Disorder
2nd line treatment
A
atomoxetine, a ne reuptake inhibitor with fewer side effects and less risk of abuse. the alpha-2 agonists clonidine and guanfacine can also be used, because they enhance cognition and attention in the prefrontal cortex.
16
Q
Oppositional defiant disorder
Epidemiology
A
usually noted by age 8; seen more in boys than girls before puberty, but equal incidence after puberty
17
Q
Oppositional defiant disorder
Features
A
often argue with others, lose temper, easily annoyed by others, and blame others for their mistakes. tend to have problems with authority figures and justify theri bhabior as response to others’ actions. these behabiors manifest with others that do not include siblings
18
Q
Oppositional defiant disorder
Treatment
A
teach parents appropriate child managmeent skills and how to lessen the oppositional behavior
19
Q
Conduct disorder
Epidemiology
A
seen more frequently in boys and in children whose parents ahve antisocial pernoality disorder and alcohol dependence. dx is given only to those under the age 0f 18 years
20
Q
Conduct disorder
Features
A
persistent behabior where rules are broken. these inlcude aggression to tohers such as bullying, cruelty to animals, fighting, or using weapons. destory property such as vandalism or setting fires. steal items from others or lie to obtain goods from others. violate rules(turancy, runnign away from home, breaking curfew)
21
Q
Conduct disorder
Treatment
A
behaviroal intervention using rewards fro prosocial and nonaggressive behavior. if aggressive, antipsychotic meds may be used
22
Q
Disruptive mood dysregulation (DMDD)
Epidemiology
A
seen more frequently in boys age 6-10 years. should not be diagnosed before the age of 6 or after the age of 18. children with DMDD usually do not develop bipolars disorder int adulthood; they are more likely to develop depression anxiety.
23
Q
Disruptive mood dysregulation (DMDD)
Features
A
chronic, severe, persistent irritability with temper outbursts and agnry, irritable, or sad mood betweent he outbursts.these occur almost every day, are noticable by others, and are out of proprtion to the situations. the outbursts are inconsistent with developmetnal issues. Sx occur year-round; there is no period lasting 3 months or more w/o all sx.the sx are severe neough to intergere with home, school, or peers
24
Q
Disruptive mood dysregulation (DMDD)
Treatment
A
treatment is individualized tot he needs of the pariculare childs and his/her family it may include individual therapy as well as work with the child’s family and/or school. it may also include the use of medications to address specific sx
25
Difference between oppositional defiance disorder and conduct disorder
in odd kids do not brak rules of society and do not commit crimes
26
disruptive mood dysregulation disorder overview
children with intermittent explosive diosrder arenot aggressive on such a conitnuous basis
27
Tourette Disorder
definition
characterized by the oset of mutiple tics, lasting more than 1 year, and is seen before the age of 18, more commonly seen in boys and will begin by the age of 7
28
Tourette Disorder
motor tics
most commonly involve the muscles of the face and neck:
head shaking and blinking
29
Tourette Disorder
vocal tics
grunting, coughing, and thraot clearing
30
Tourette Disorder
treatment
dopamin antagonists, such as the antipsychotic agents like haloperidol, pimozide, and risperidone.
can also use clonidine, an alpha 2 agonist
31
Mood disorders
MDD
bipolar disorder
persistent depressive disorder (dysthymia)
cyclothymic disorder
mdd with atypical features
mdd with seasonal pattern
bereavement
32
Major Deppressive Disorder
definition
mood disorders peresent with at least a 2 week course of sx that is a change fromt he perivous level of unctioning. the sx included derpressed mood or anhedionia (absence of pleasure) and 4 others including depressed mood most of the day, weight canges, sleep changes, psychomotor disturbances, fatigue, poor concentrations, and thoughts of death and worthlessness
33
Major Deppressive Disorder
diagnosis
rule out any medical causes, the nost common of which is hypothyroidism. the mos tcommon neurological assocaitons are Parkinsons diease and neurocognitive disorders
34
Major Deppressive Disorder
first - line treatment
SSRI such as fluoxetine, paroxetine, sertrlaine, citolopram, or escitalopram. ssris are chosen due their effectiveness and relatively mild side effects, and because they are less toxic in overdoes than other antidepressants
if no effect after 4 weeks, withch to other SSRI
if some improvement is noted, but not ful response, increase the dose of the SSRI
although TCA's can be sued, their lethal potential militates against routin use
35
Major Deppressive Disorder
second-line treamtent
SNRIs such as venlafaxine, duloxetine, or desvenlafaxine. side effects include htn and sweating
36
Major Deppressive Disorder
psychotherapy
such as cognitive therapy has been proven to be effective. the goal of cognitive therapy is to reduce derpession by teaching patients to identify negative congitions and develop positive ways of thinking
37
ssri's should not be taken with
mao inhibitors bc they dacuse a dramatic increase in serotonin
38
pt with depression and neuropathic pain
use duloxetine, since it is approved for both depression and neuropathy
39
pt with depression who is fearful of wieght gain or sexual side effects or is a smoker tyring to quit
use bupropion, since it has fewer sexual side effects and less wieght fain than SSRIs. may also be used as adjunct or replacement treatment for SSRI-induced sexual side effects. bupropion has been approved for smoking cessation
40
Mirtazapine
antidepressant and sedative effects
41
Bipolar Disorder
Definition
a mood siroder whre the pt experiences manic sx that alst at least one week that cause significant disress int he elvel of fucntioning. usually starts with depression and increased energy despite lack of sleep
42
Bipolar Disorder
manic sx
elevated mood, increased self-esteem, distracitbility, pressured speech, decreased need for sleep, an increase in goal-directed activity, racing thoughts, and excessive involvement in pleasurable activities
43
Bipolar Disorder
diagnosis
make sure the condition is not secondary to drug use, such as cocaine or amphetamine use. obtain a good hx and urine drug screen
44
Mania vs hypomania
mania - last more than 1 week, affect functioning and are severe enough to warrant hospitalization
hypomania - last less than one week, do not severely affect functioning, and are not severe enough to warrant hospitalization
45
Bipolar Disorder type I
mania and depression
46
Bipolar Disorder
type II
hypomania and depression
47
Bipolar Disorder occurs more frequently in
young individuals
48
Bipolar Disorder
treatment for acute mania
use lithium, valpric acis, and atypical antipsychotics as first line treatments
if severe sx use atypical antipsychotics due to shorter onset of action
49
Bipolar Disorder
treatment for bipolar depression
use lithium, quetiapine, lurasidone, or lamotrigine. lurasidone is approved for bipolar depression and is the only medication in pregnancy category B indicated for the disorder
50
when do you not use lithium
if kidneys are compromised
51
lithium is the correct answer to
most Bipolar Disorder questions
52
Bipolar Disorder pt who is on lithium is combative and aggressive
put on antipsychotic, no reason to get lithium level if they are physcially aggressive
53
Persistent Depressive Disorder (formely dysthymia)
characterized by the presence of depressed mood that lasts most of the day and is preseent almost continously. sx must be preset formore than 2 years (1 year in children or adolescents).
54
Persistent Depressive Disorder (formely dysthymia)
treatment
antidepressant medications and psychotherapy
55
cyclothymic disorder
characterized by the presence of hypomanic episodes and mild depression. sx must be present for more than 2 years
56
cyclothymic disorder
treatment
lithium, valproic acid or anitpsychotic medications, and psychotherapy
57
Major Depressive Disorder with Atypical Features
charactierzed by reverse vegetative changes such as incrase sleep, increased wieght, and increased appetite, and interpersonal rejection snesitivity that results in significant social or occupational impairment. the paitest mood tends to be worse in the evcening. pts may complain of extermities feeling heavy
58
Major Depressive Disorder with Atypical Features
treatment
ssris (fluoxetine, sertlraine, paroxetine, citalopram, escitalopram) or MAOIs (phenelzine, isocarboxazid, or tranylcypromine).
59
Major Depressive Disorder with Atypical Features
usually the right answer
maois
60
Major depressive disorder with seasonal pattern (formerly seasonal affective disorder)
Cahracterized by seasonal hanges in mood during fall and winter. sx include wieght fain, increased sleep, and lethargy.
61
Major depressive disorder with seasonal pattern (formerly seasonal affective disorder)
treatment
phototherapy and bupropion or ssris
in phototherapy pts should be 12-18 inches from a source of 10000lux of white fluorescet light w/o uv wavelngtsh for 30 minutes each morning, eyes should be open but not necessary to look at the light
62
Postpartum blues or "baby blues"
onset
immediately after birth up to 2 weeks
63
Postpartum blues or "baby blues"
sx
sadness, mood lability tearfulness
64
Postpartum blues or "baby blues"
mothers feelings towards baby
no negative feelings
65
Postpartum blues or "baby blues"
treatment
supportive, usually self-limited
66
Depressive disorder with peripartum onset
onset
wihtin 1-3 months after virth
67
Depressive disorder with peripartum onset
sx
depressed mood, weight changes, sleep disturbances, and excessive anxiety
68
Depressive disorder with peripartum onset
mothers feelings towards baby
may have negative feelings toward baby
69
Depressive disorder with peripartum onset
treatment
antidepressant medications
70
Bipolar disorder with peripartum onset
brieft psychotic disorder with peripartum onset
onset
during regnancy up to 4 weeks after birth
71
Bipolar disorder with peripartum onset
brieft psychotic disorder with peripartum onset
sx
depression, mania, hallucinations, delusions, and htoughts of harm
72
Bipolar disorder with peripartum onset
brieft psychotic disorder with peripartum onset
mothers feelings towards baby
may have thoughts of harming baby
73
Bipolar disorder with peripartum onset
brieft psychotic disorder with peripartum onset
treatment
antipsychotic medications, lithium, and possibbley antidpressants
74
Bereavement (grief)
normal bereavement usually begins after the death of a loved one and includes feelings of sadness, worryign about the deceased, irritability, sleep difficulties, poor concentrations, and tearfulness.
75
Bereavement (grief)
timeframe
typically lasts less than 6 months to 1 year but can go longer
76
Bereavement (grief)
treatment
supportive psychotherapy
pharmacotherapy is the wrong answer
77
Diagnosis of major epresion (greater severity than bereavement)
htoughts of death
morbid preoccupation with worthlessness
marked psychomotor retardation
psychosis
prolonged functional impairment
sx last longer than 2 weeks and adverstly affect funtioning
78
Trycyclic antidepressants
amitriptyline, nortriptyline, imipramine
79
Trycyclic antidepressants
ae
hypo/hypertenstion, dry mouth, constipation, confusion, arrhythmias, sexual side effects, wieght gain, gi distrubances
80
Monamine oxidase inhibitors
phenelzine, isocarboxazid, tranylcypromine
81
Monamine oxidase inhibitors
ae
monitor diet, givent aht food righ in tryamine will produce htn. safe foods include white wine and processed chees. unsafe foods include red wine, aged cheese, and chocolate
82
SSRI
fluoxetine, paroxetine, sertraline, citalopram, citalopram, escitalopram, fluvoxamine
83
SSRI
ae
ha, weight changes, sexual side effects, GI distrubances
84
SNRI
venlafaxine, duloxetine, desenlafaxine
85
SNRI
ae
htn, blurry vision, weight changes, sexual side effects, GI disturbances
86
Buproprion ae
increased risk for seizures
87
trazodone ae
priapism
88
mirtazapine ae
weight gain and sedation
89
Lithium
ae
tremors, weight gain, gi distrubance, nephrotoxic, teratogenic, leukocytosis, diabetes insipidus
90
lithium
severe toxicity
confusion, ataxia, lethargy, and abrnomral reflexes
91
Valproic Acid ae
tremors, weight gain, gi distrubances, alopecia, teratogenic, hepatotoxic. must monitor levels; toxicity causes hypnatremia, coma, or death
92
Lamotrigine ae
stevens-johnson syndrome
93
electricoconvulsive therapy
ha, transient memory loss
94
what is the single most effective treatment for depression
ECT, usually used for refractory pts, all others are equal in effectiveness but ssris have best side effect profile
95
Serotonin Syndrome
definition
a potentially life-threatening disorder occurring as a result of therapeutic drugs use of SSRIs. often with inadvetent interagions between drugs, od, or recreational use of drugs that are serotonergic in origin
96
Serotonin Syndrome
common sx
cognitive effects: agitation confusion hallucinations hypomania
autonomic effects: sweating, hyperthermia, tachycardia, nausea, diarrhea, shivering
somatic effects: termors, myoclonus
97
Serotonin Syndrome
treatment
stop ssri med
sx treatement of fever diarreha htn
cyproheptadine (serotonin antagonist)
98
Brief Psychotic Disorder
duration of sx
more than 1 day but less than 1 month
99
Brief Psychotic Disorder
sx
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior
100
Brief Psychotic Disorder
treatment
antipsychotic medication
101
Schizophreniform disorders
duration of sx
more than 1 month but less than 6 months
102
Schizophreniform disorders
sx
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative sx (flat affext, poor grooming, social withdrawal)
103
Schizophreniform disorders
treatment
antipsychotic medications
104
Schizophrenia
duration of sx
more than 6 months
105
Schizophrenia
sx
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative sx (flat affext, poor grooming, social withdrawal). severly affects level of functioning.
106
Schizophrenia
treatment
antipsychotic medications
107
Scizophrenia
definition
a thought disorder that imparis judgment, behavior, and the ability to interpret reality. the sc must be present for at least 6 months and itmust affext functioning. there is an equal incidency in men and women but it affexte mean earlier due the earlier age of onset. urine drug screen is improtatnt in order to rule out occaine or amphetamine use
108
Scizophrenia
treatment for acutely psychotic
hospitalize
109
Scizophrenia
first line treament
ensure pt safter and use an atypical antipsychotic:
```
risperidone
olanzapine
quetipaine
ziprasidone
aripiprazole
paliperidone
iloperidone
lurasidone
```
110
Scizophrenia
emergency situations
if im medications is needed, consider shorta citing meds like:
olanzapine
ziprazidone
haldol is still used but it has more side effects so pick atypical first if given the choice
111
Scizophrenia
treatment for noncompliant patients
consider a long actine antipsychotic med like risperidone or paliperidone as first line treatment
hadol and fluphenazine are sitll used by have more side effects
112
Scizophrenia
clozapine
is used only when pts do not respond to an adequate trial of typical or atypical antipsychotics; never used as a first-line treatment.
113
need to know
side effect profiles of atypical antipsychotics.
114
Clozapine ae
Greater incidence of diabetes and wieght gain; avoid in diabetic and obese patients
115
Risperidone ae
greater incidence of movement disorders
116
Quetiapine ae
lower indicdence of movement diosrders; appropriate for use in pats with existing movement disorders
117
Ziprasidone ae
increased risk of prolongation of QT interval; avoid in pts with conduction defects
118
Clozapine ae
high risk of agranulocytosis; need to monitor cbc on regular basis; never used as first-line tratment given side-effect profile
119
Aripiprazole ae
partial dopamin agonist, approved as adjunct tratment for major depressive disored
120
Lurasidone ae
the only antipsychotic in pregnancy catefor B; safer for use in pregnant patients
121
Atypical antidepressant side effects
| -pines
olanzapine, quetiapine, asenapine, clozapine
increased risk of weigh tgain, metabolic syndrome, diabetes
122
Atypical antidepressant side effects
| -dones
risperidone, lurasidone, ziprasidone, iloperidone
increased risk of movement disorders, cardiac conduction problems
123
Meds least likely to cause weight gain and metabolic syndrome
abilify and ziprasidone
124
Acute Dystonia
onset of sx
hours to days
125
Acute Dystonia
sx
muscle spasms, such as torticollis, laryngeal spasms, occulogyric crisis
126
Acute Dystonia
treatment
benztropine, trihexyphenidyl, diphenhydramine
127
Akathisia
onset of sx
weeks
128
Akathisia
sx
generalized restlessness, pacing, rocking, inability to relax
129
Akathisia
treatment
reduce does, bblockers, switch to atypical med, benzo
130
Tardive Dyskinesia
onset of sx
rare before 6 months
131
Tardive Dyskinesia
sx
abnormal involuntary movements of head, limb, and trunk. perioral movements are the most common
132
Tardive Dyskinesia
treatment
switch to atypical antipsyhcotic. clozapine has the least risk
133
Neuroleptic Malignant Syndrome
onset of sx
not time limited
134
Neuroleptic Malignant Syndrome
sx
muscular rigidity, fever, autonomic changes, agitation, and obtundation
135
Neuroleptic Malignant Syndrome
treatment
dantrolene or bromocriptine
136
Delusional Disorder
definition
charactierized by the prominence of non-bizarre delusions for more than one month and no impariment in level of ucntioning (eg the pt may believe the country is about to be invaded, but he or shee sitll oeys the law, goes to work, and pays bills) Hallucinations, if present, are not prominent and are related to the delusional theme
137
delusional disorder
treatment
aytpical antipsychotic agents as first-line therapy
consider psychotherapy to help romote reality testing
138
Anxiety Disorders
panic disorder
phobias
139
Panic Disorder defintion
the experience of intense anxiety along with feelings of dread and doom. this is accompanied by at least 4 sx. these sensations typically last less than 30 minutes and may be accompanied by agoraphobia
140
agoraphobia
defined as the fear of places where escape is felt to be difficult
141
Panic Disorder
sx
need at least 4 of the following autonomic hyperactivity sx:
diaphoresis, trembling, chest pain, fear of dying, chills, palpitations, sob, nausea, dizziness, dissociative sx and paresthesias.
142
Panic Disorder typical case
women, can occur at any time, and usually has no specific stressor
143
Panic Disorder
rule out
thyroid dz, hypoglycemia, and cardiac disease
144
Panic disorder
treatment
ssris (typically fluoxetine, paroxetine, and sertraline) are indicated for this disorder
along with ssris pats may benefit from benzos (such as alparzolam, clonazepam, or lorazepam) begin with botht hen taper and dc the benzo givent he potential for abuse
behavioral and individual therapy are also helpful in conjction with med (not as sole treatment)
145
first-line treatment for panic disorder
ssris
146
fisr-line treatment for panic attack
benzos
147
presenting with autonomic hyperactivity
panic attack
148
telling the dr a story about panic attacks
panic disorder
149
Phobias
definition
a phobia is the fear of an object or situation and the need to aboid it.
specific or social
150
specific phobia
fear of an object such as animals heights or cars
151
social phobia
fear of a situation, such as public restrooms, eating in public, or public speaking. these involve sitatuations where something potentially embarrassing may happen
152
Phobias
diagnosis
usually can be made by obtaining a goo dhx where pts indicate anxiety sx in specific siutations or when in contact with feared objects
153
Phobias
treatment
behavioral modification tehniques such as systematic desensitization, inwhich the pt while relaxed is exposed, often only in miagniation, to progressively more frightening aspects of the feared objects
pts are also tauht rleaxation techniques such as breathign or guided imagery
154
when are bblockers like propanolol and tenolol used for phobias
only for performance anxiety such as stage fright. they are given 30-60 minutes beofre the performance
155
Obsessive Compulsive Disorder
definition
a disroder where pts typically experience either obsessions alone or, most commonly, a combination of obsession and compultsion typically affect the individuals level of functioning
156
obsession
thoughts taht are intrusive, senseless, and distressing to the pt, thus increasing anxiety. these includ efear of contamination
157
compulsions
rituals, such as counting and chekcing, that are performed to neutralize obsessie thorughts. these are time consuming and tend to lower anxiety
158
Obsessive Compulsive Disorder
diagnosis
seen more frequentlyu in young pts. there is an equal incidence in men and womn, ocd can coexist with tourette disorder
159
Obsessive Compulsive Disorder
treatment
ssris are the treatment of choice. fluoxetine, paroxetine, sertrlaine, citalopra, or fluvoxamine ar emost commonly used as first-line agents
the main behavioral therapy used is exposure and response prevention
160
Obsessive Compulsive Disorder
tcas
if no ssirs and just tcas choose clomipramine
161
Hoarding Disorder
individuals with hoarding disorder have problems discarding their posessions such taht the home is overwhelmed by cluetter. the horading affets the indivviduals's level of functioning and imparis his/her abitlity to maintain a safe environment
162
Hoarding Disorder
traetment
ssris ar the treatment of choice
pts benefit from behavvioral modification techniques or psychotherapy (such as cognitive behavioral therapy)
163
Body dysmorphic disorder
Individuals with body dysmorphic disorder believe that some body part is abnormal, defective, or misshapen, although others do not see these perceived defects. These beliefs significantly impair in the patient's level of functioning. paitents spend excessive time checking the mirror and seeking reassurance.
164
Body dysmorphic disorder
treatment
SSRIs combined with individual psychotherapy are the treatment of choice
165
Posttraumatic Stress Disorder and Acute Stress Disorder
Definition
In both postraumatic stress disorder and acute stress disorder, individuals have been exposed to a stressor to which they react with fear and helplessness.
Patients continually relive the event and avoid anything that remids them of the event . these stressors are usually overwhelming and involve such events as war, rape, hurricanes, or earthquakes.
166
Posttraumatic Stress Disorder and Acute Stress Disorder
Sx
adversely affect the patients level of ucntioning
startle response, hypervigilance, sleep disturbances, anger outbursts, and concentration difficulties.
167
Posttraumatic stress disorder vs acute stress disorder
posttraumatic stress disorder
sx last for more than 1 month
168
Posttraumatic stress disorder vs acute stress disorder
acute stress disorder
sx last for more than 2 days and a maximum of 1 month. They occur within 1 month of the traumatic event
169
Posttraumatic Stress Disorder and Acute Stress Disorder
diagnosis
the main feature in correctly identifying the diagnosis is determining the time period when the traumatic events occurred in relationship to the sx. depression and substance abuse must be ruled out, bc both worsen the dx
170
Posttraumatic Stress Disorder and Acute Stress Disorder
first-line treatment
paroxetine and sertraline. prazosin is used to reduce the incidence of nightmares
relaxation techniques and hypnosis have been proven to be helpful in these patients
psychotherapy after traumatic events will allow for the development of coping techniques and acceptance of the event
171
Generalized Anxiety Disorder
definition
this is a disorder in which patietns experience excessive anxiety and worry about most things, lasting more than 6 months. typically, the anxiety is out of proportion to the event.
patients are usually women and complain of feeling anxious as long as they can remember
172
Generalized Anxiety Disorder
sx
anxiety is out of proprtion to the event
fatigue
concentration difficulties
sleep problems
muscle tension
restlessness
173
Generalized Anxiety Disorder
treatment
SSRIs such as fluoxetine, paroxetin, sertraline, or citalopram are inidicated in this disorder
Venlafaxine and buspirone are also effective
psychotherapy and behavioral therapy are beneficialas well, but are not considered first-line agents.
174
Main feature of generalized anxiety disorder
chronic worrying about things taht do not merit concern
accompanied by otehr sx of anxiety as well as sleep and concetration problmes
175
Antianxiety medication
benzos (diazepam, lorazepam, clonazepam, alprazolam, oxazepam, chlordiazepoxide, temazepam, flurazepam)
buspirone
176
Antianxiety medication
benzos ae
sedation, confusion, memory deficity, respiratory depression, and increased addiction potential
177
Antianxiety medication
buspirone ae
headaches, nausea, dizziness
178
Lorazepam
Indications
used frequently in emergency situationsbc it can be given im
179
Clonazepam
Indications
may be used if addiction is a concern given its longer half-life
180
Chlordiazepoxide, oxazepam, lorazepam
Indications
used frequently in treatment of alcohol withdrawal.
181
Benzos of choice for patients with liver problems
lorazepam and oxazepam
182
Alprazolam
Indications
used frequently in panic attaxk and panic disorder
183
Flumazepam, temazepam, triazolam
Indications
used as hypnotics (rarely used)
184
Flumazenil
benzodiazepine antagonist
used when the overdose is acute and you are certain that ehre is no chronic dependance
185
Why not give flumazenil to benzo dependant patients
it can cause seizures from acute withdrawal which can be tremor or seizures similar to delirium tremens (alcohol withdrawal)
186
Intoxication
Reversible experience with a substance that leads to either psychological or pysiological changes
187
Withdrawal
Cessation or reduction of a substance leading to either psychological or physicological changes
188
Use
Maladaptive pattern of use of substances that leads to engaging in hazardous situations, legal problems, inability to fulfill obligations, and continued use despite adverse consequences and cravings
189
Alcohol
Signs and sx of intoxication
Talkative, sullen, gregarious, moody, disinhibited
190
Alcohol
Treatment of intoxication
mechanical ventilation if severe
191
Alcohol
Signs and sx of withdrawal
tremors, hallucinations, seizures, delirium tremens
192
Alcohol
Treament of withdrawal
benzos, thiamine, multivitamins, folic acid
193
Amphetamines and cocaine (synthetic forms: bath salts)
Signs and sx of intoxication
euphoria, hypervigiliance, autonomic hyperactivity, weight loss, pupillary dilatation, perceptual disturbances
194
Amphetamines and cocaine (synthetic forms: bath salts)
Treatment of intoxication
antipsychotics and/or benzos and/or antihypertensives
195
Amphetamines and cocaine (synthetic forms: bath salts)
Signs and sx of withdrawal
anxiety, tremulousness, headache, increased appetite, depression, risk of suicide
196
Amphetamines and cocaine (synthetic forms: bath salts)
Treament of withdrawal
bupropion and/or bromocriptine
197
Cannabis (synthetic forms: K2 and spice)
Signs and sx of intoxication
impaired motor coordination, slowed sense of time, social withdrawal, increased appetite, conjunctival injection
198
Cannabis (synthetic forms: K2 and spice)
Treatment of intoxication
consider use of antipsychotoics if pt is psychotic
199
Cannabis (synthetic forms: K2 and spice)
Signs and sx of withdrawal
irritability, anger, anxiety, sleep problems, restlessness, appetite problems
200
Cannabis (synthetic forms: K2 and spice)
Treament of withdrawal
sypmtomatic
201
Hallucinogens
Signs and sx of intoxication
ideas of reference, perceptual disturances, possible increase in psychosis, impaired judment, tremors, incoordination, dissociative sx
202
Hallucinogens
Treatment of intoxication
antipsychotics and/or benzos and/or talking down
203
Hallucinogens
Signs and sx of withdrawal
none
204
Hallucinogens
Treament of withdrawal
none
205
Inhalants
Signs and sx of intoxication
belligerence, apathy, aggression, impaired judgment, stupor, or coma
206
Inhalants
Treatment of intoxication
antipsychotics
207
Inhalants
Signs and sx of withdrawal
none
208
Inhalants
Treament of withdrawal
none
209
Opiates (synthetic forms: desomorphin aka krokodil)
Signs and sx of intoxication
apathy, dysphoria, pupillary constriction, drowsiness, slurred speech, coma, or death
210
Opiates (synthetic forms: desomorphin aka krokodil)
Treatment of intoxication
naloxone
211
Opiates (synthetic forms: desomorphin aka krokodil)
Signs and sx of withdrawal
fever, chills, lacrimation, abdominal cramps, muscle spasms, diarrhea
212
Opiates (synthetic forms: desomorphin aka krokodil)
Treament of withdrawal
clonidine, mehtadone, or buprenorphine
213
Phencyclidine (PCP)
Signs and sx of intoxication
belligerence, psychomotor agitation, violence, nystagmus, htn, seizures
214
Phencyclidine (PCP)
Treatment of intoxication
antipsychotics, and/or benzos and/or talking down
215
Phencyclidine (PCP)
Signs and sx of withdrawal
none
216
Phencyclidine (PCP)
Treament of withdrawal
none
217
Anabolic Steroids
Signs and sx of intoxication
Irritability, aggression, mania, psychosis
218
Anabolic Steroids
Treatment of intoxication
antipsychotics
219
Anabolic Steroids
Signs and sx of withdrawal
depression, headaches, anxiety, increased concern over body's physical state
220
Anabolic Steroids
Treament of withdrawal
SSRI
221
Positive CAGE test
two positive responses of the 4 questions
222
What is the CAGE test used for
to determine if someone is an alcoholic
223
CAGE test questions
C: have you ever tried to cut down on your drinking
A: have you ever gotten annoyed by others who have criticized your drinking
G: have you ever felt guilty about your drinking?
E:Have you ever use dalcohol as an eye-opener
224
Detoxification:
usually 5 to 10 days, mostly in hospital settings to assure safe detoxification
225
Rehabilitation:
usually 28 days or more, with a focus on relapse prevention technique
226
Pharmacologic treatments for substance abuse
disulfram (acetaldehyde dehydrogenase inhibitor), naltrexone (opiod receptor antagonist) and acamprosate
227
most withdrawal questions
are asked in a hospital setting the next day after admission
228
Somatic Symptom Disorder (formerly somatoform disorders)
definition
somatic sx disorder is characterized by the presence of one or more somatic symptoms that are distressinga nd cause impairment in functioning.
229
Somatic Symptom Disorder (formerly somatoform disorders)
Sx
excessive thoughts, feelings, or behaviors related to the somatic sx that are manifested by disproportionate and persistent thoughts about the seriousness of the sx, intense ancisty about the sxm and excessive time devoted to the sx or helath concerns.
230
Somatic Symptom Disorder (formerly somatoform disorders)
diagnosis
a pt must be symptomatic for more than 6 motnhs to be diagnosed with somatic sx disorder. the disorder is mostly seen in young women and usually has some psychological component of which the pt iw unaware.
231
Somatic Symptom Disorder (formerly somatoform disorders)
treatment
psychotherapy is the treatment of choic given the psychological source of the sx
232
Illness anxiety disorder (formerly hypochondiasis)
patients believe that htey have some specific disease despite constant reassurance
233
Conversion
Typically affects voluntary motor or sensory functions that are indicative of a medical condition but are usually caused by psychological factors. Can be associated with "la belle indifference" where the pt is unconcerned about his or her impairment
234
Factitious Disorder
definition
an individual faces an illness in order to get attention and emotional support in the pt role. This can be either a psychological or physical illness.
235
Factitious Disorder
Psychological Sx
hallucinations, delusions, depression, and bizarre behavior
236
Factitious Disorder
Physical sx
abdominal pain, depression, fever, nausea, vomiting, or hematomas. at ties these individuals may inflict life theatening injuies on themselves in order to get attn
237
Factitious Disorder
imposed on others
when a caregive fakes signs and sx on another person (usually a child) in order to assume the sick role.
238
Factitious Disorder
diagnosis
typically, patients with this disorder are women who may have a hx of being employed in healthcare.men more often have physical sx. the pts ultimate goal is to gain admissio to the hospita. you must always exclude any medical disorder with similar sx.
239
Factitious Disorder cannot be diagnosed without first
confirming that a legitimate medical illness is not present
240
Factitious Disorder
treatment
no specific theapry has been proven to be effective in these patients. when a child is involved in Factitious Disorder imposed on others, child protective services should be contacted to ensure the child's safety
241
Malingering
definition
characterized by the conscious production of signs and symptoms for an obvious gain, such as avoiding work, evading criminal prosecution, or achieving financial gain
242
Malingering is not
a mental illness
243
Malingering
diagnosis
seen more frequently in prisoners and military personnel. it is typically diagnosed when there is a discrepancy betweent he pts complaints and actual physical or laboratory findings. if medical evaluation reveals malingering, then confront the pt with the outcome
244
A lack of cooperation from patients is characteristic of
Malingering
245
Adjustment Disorder
definition
characterized by a maladaptive reaction to an identifiable stressor, such as loos of job, divorce, or failure in school.
246
Adjustment Disorder
sx
usually occur within 3 months of the stressor and must remit within 6 months of removal of the stressor.
the sx include anxiety, depression, or disturbances of conduct.
they are severe enough to cause impairment in functioning
247
Adjustment Disorder
treatment
psycotherapy is the treatment of choice. both individual and group therapy have been used effectively
248
Personality disorders
a group of disorders that are characterized by personality patterns that inflexible and maladaptive
249
Paranoid
suspicious, mistrusful, secretive, isolated, and questioning of the loyalty of family and friends
250
Schizoid
choice of solitary activities, lack of close friends, emotional coldness, no desire for enjoyment or close relationships
251
Schizotypal
Ideas of refernce, magical thinking, odd thinking, exxentric behavior, increased social anxiety, brief psychotic episodes
252
Histrionic
must be the center of attention, inappropriate sexual behavior, self-dramatization, use phyuscial appearance to draw attention to self
253
Antisocial
Failure to conform to social rules, deceitful, lack of remorse, impulsive, aggressive towards others, irresponsible, must be over the age of 18
254
Borderline
unstable relationshiops, impulsive, recurrent suicidal behaviors, chronic feelings of emptiness, inappropriate anger, dissociative sx when severely stressed, brief psychotic episodes
255
Narcissistic
Grandiose sense of self, belief that they are special, lack of emmpathy, sense of entitlement, require excessive admiration
256
Avoidant
Unwilling to get involved with people, views self as socially inept, reluctant to take risks, feelings of inadequacy
257
Dependant
Difficulty making day to day decisions, unable to assume responsibility, unable to express disagreement, fear of being alone, seeks relationship as source of care
258
Obsessive compulsive
preoccupied with details, rigid, orderly, perfectionist, excessively devoted to work, inflexible
259
Adjustment Disorder
treatment
individual psychotherapy
medications if mood or anxiety sx are present
260
What personality diosreders have been associated with positive psychotic sx
borderline and schizotypal personality disorders
261
Anorexia Nervosa
Definition
Characterized by the failure to maintaine a normal body wieght, fear of and preoccupation with gaining weight and body image disturbance. there is an unrealistic self-evaluation as overweight. these pts tend to deny their
262
Anorexia Nervosa
sx
these pts tend to deny their emaciated conditions. they show great concern with appearance and frequently examine and weight themselves. they typically lose wiegh tby maintaining strict caloric control, excessive exercise, purging, and fasting, with laxative and diuretic abuse
263
Anorexia Nervosa
Diagnosis
anorexia is seen more frequently in teenage girls between ages of 14 and 18. there is evidence of severe weight loss. hypotension, bradycardia, lanugo hair and edema may be present. EKG changes such as rhythym disorders occur as a result of potassium deficiency, Arrhythmia is the most common cause of death.
264
Anorexia Nervosa
treatment
Hospitalization to prevent dehydration, starvation, electrolyte imbalances, and death
psychotherapy
behavioral therapy
ssris have been used to promote wieght gain
265
Bulimia Nervosa
definition
Characetized by frequent binge eating, as evidenced by eating large amoutns of ood in a discrete amount of time, as well as a loack of control of overeating episodes. This is accompanied by a compensatory behavior to prevent weight gain in the form of purging,, misuse of laxatives and diuretics, fasting, and excessive exercise. the patients self-evaluation is unduly influenced by body shape and weight
266
Bulimia Nervosa
diagnosis
bulimia is seen more frequently in woemn and occurs later in adolescence than anorexia nervosa. most of these women are of normal weight but do have a history of obesity
267
Bulimia Nervosa
treatment
does not require hospitalization unless severe electrolyte abnormality is present
psycotherapy
ssris
268
Binge Eating Disorder
The essential feature of binge eating disorder is reccuernt episodes of binge eating that occur at least 3 times per week for more than 3 months. patients are overweigt, and they usually lack a sense of control over their eating habits.
269
Binge Eating Disorder
episodes
associated with eating faster than usual, eating until feeling uncomfortably full, eating large amounts of food in the absence of hunger, eating alone, and feeling disgusted with oneself after the eating episode
270
Binge Eating Disorder
treatment
topiramate has been proven efficacious for binge eating disorder. ssris may have limited benefits
psychoteraphy is indicated, including cognitive behavioral therapy, interpersonal psychotherapy, and dialectic behavioral therapy
271
Eating Disorder Not Otherwise Specified
A designation of eating disorder noth otherwise specified (NOS) is used when patients do not meet criteria for either anorexia nervosa or bulimia nervosa
272
Binge Eating Disorder
exammples
criteria for anorexia present in girls but menstruation is normal
anorexic patient with normal weight
use of compensator behavior after eating normal amounts of food
273
Sleep Disorders
Narcolepsy
Sleep Apnea
Insomnia
274
Narcolepsy
definition
Excessive daytime sleepiness and abnormalities of REM sleep, narcolepsy most frequently begins in young adulthood.
sleep studies are usually indicated in the diagnosis
no therapy has been found to be curative
275
Narcolepsy
treatment
no therapy has been found to be curative
the pt is managed with forced naps during the day
modafinil is a medication used to maintain alertness
therapy can also include methylphenidate and dextroamphetamine
gammahydroxybutryate (GHB) may be given at bedtime to induce sx of narcolepsy and contain them at night.
276
Specific Features of Narcolepsy
sleep attaxks
cataplexy
hynogogic and hynopompic hallucinatios
sleep paralysis
277
Specific Features of Narcolepsy
sleep attaxks
episodes of irresistibel sleepiness and feeling refreshed upone awakening
278
Specific Features of Narcolepsy
cataplexy
sudden loss of muscle tone: considered pathognomonic andmay be precipitated by loud noise or emotions
279
Specific Features of Narcolepsy
hypnogogic and hypnoponpic hallucinations
hallucinations that occur as the patient is going to sleep and waking up
280
Specific Features of Narcolepsy
sleep paralysis
patient awake but unable to move; this typically occurs upon awakening
281
Sleep Apnea
Definition
characterized by the cessation of airflow at the nose or mouth during sleep due to obstruction of the upper airway. this results in episodes of decresed arterial oxygenation saturation and episodic arousal
282
Sleep Apnea
diagnosis
patients are typically overwieght, have a very loud snore, and complain of daytime fatigue.
polysonmography will show episodes of apnea lasting more than 10 seconds. Accompanied by decreased arterial oxygenation, bradycardia, and increased diaphragmatic effort
283
Sleep Apnea
medical complications
arrhthymias, pulmonary htn, and occasionally death
284
Sleep Apnea
treatment
nasal continuous airway pressur (CPAP)
weight loss
corrective surgery
avoidane of sedatives and alcohol, which worsen the condition
285
Insomnia
definition
characterized by the inability to intiiate or maintaine sleep. Insomnia may be due to anxiety and depression. it is severe enough to adversely affect level of fucntioning.
286
Insomnia
Diagnosis
typically seen in women who copmlain of feeling tired or have increased appetite andyawning
287
Insomnia
treatment
treatment consists of lseep hygiene techniques such as going to bed and waking up at the same time, avoiding caffeinated beverages, and avoiding daytime naps.
Behavioral modification techniques include using the bed only for sleeping and not for reading, watching TV, or eating.
Medical Therapy consists of zolpidem, eszopiclone, or zaleplon
288
Sexual identity
based on a person's sexual characteristics
289
Gender Identity
based on a person's sense of maleness or femaleness, established by the age of 3
290
Gender role
based on external patterns of behavior that reflect inner sense of gender identity
291
Sexual orientation
Based on person's choice of love object; may be heterosexual, homosexual, bisexual, or asexual.
292
Masturbation
normal precursor of object related sexual behavior
all men and women mastrubate
commonly seen in adolescents, adults, and elderly
problematic only if it adversely interferes with daily functioning
293
Homosexuality
not considered a mental illness unless it is ego-dystonic (the person is not happy with his/her sexual orientation)
may be considered normal experimentation in teenagers
294
Impotence
Definition
persitent or recurrent inability to attain or maintain an erection until completion of the sexual act
295
Premature ejaculation
Definition
ejaculation before penetration or just after penetration, usually due to anxiety
296
genitopelvic pain disorder (formerly dyspareunia)
Definition
pain associted with sexual intercourse, not diagnosed if due to medical condition
297
Penetration disorder (formerly vaginismus)
Definition
involuntary constriction of the outer third of vagina preventing penile insertion
298
Impotence
Treatment
rule out medial causes or medication, psychotherapy, couples sexual therapy
299
Premature ejaculation
Treatment
psychotherapy, behavioral modification techniques (stop and go, squeeze), SSRI medication
300
genitopelvic pain disorder (formerly dyspareunia
Treatment
psychotherapy
301
Penetration disorder (formerly vaginismus)
Treatment
psycotherapy, dilator therapy
302
Paraphilic Disorders (formerly paraphilias)
definition
group of disorders that are recurrent, sexually arousing, adn seen mor efrequently in men
303
Paraphilic Disorders (formerly paraphilias)
diagnosis
usually focus on humiliation, nonconsenting partners, or use of nonliving objects, must occur for more than 6 months and cause distress as well as adversely affect level of functioning. do not diagnose if doen ine experimentation
304
Exhibitionism
recurrent urge to expose oneself to strangers
305
Fetishism
recurrent use of nonliving objects to achieve sexual pleasure
306
Pedophilia
recurrent urges or arousal toward prepubescent children
307
Masochism
recurretn urge or behavior involving the act of humiliation
308
Sadism
recurrent urge or behavior involving acts in which physical or spychological suffering of victim is exciting
309
Tranvestic Fetishism
recurrent urge or behavior involving cross dressing for sexual gratification; usually found in heterosexual males
310
Frotteurism
Rubbing, usually ones pelvis or erect penis, against a nonconsenting person for sexual gratification.
311
Paraphilic Disorders (formerly paraphilias)
treatment
individual psychotherapy
behavioral modification techniques such as aversive conditioning
antiandrogens or SSRIs to reduce sexual drive
312
Gender Dysphoria (formerly Gender Identity Disorder)
Diagnosis
characterized by the persistent discomfort and sense of inappropriateness regarding the pateitns assigned sex
313
Gender Dysphoria (formerly Gender Identity Disorder)
diagnosis
gender identity disorder will manifest by wearing the opposite genders clothes, using toys assigned to the opposite sex, play with opposite sex children when young, and feeling unhappy about the person's own sexual assignent. Patients will take hormones when older to deepen voice, if female, or soften voice with
314
Gender Dysphoria (formerly Gender Identity Disorder)
trying to change
Patients will take hormones when older to deepen voice, if female, or soften voice, if male. Women may bind their breasts and men may hide their penis and testicles. it is seen more frequently in young men
315
Gender Dysphoria (formerly Gender Identity Disorder
treatment)
sexual reassignment surgery if approved
individual psycotherapy
316
Suicide
Presentation
recent suicide attempt
complaints of suicidal thoughts
admission of suicidal thoughts
demonstration of suicidal behaviors (eg buying weapons, giving away possessions, or writing a will)
317
Suicide
Risk Factors
men
older adults
social isolation
presence of psychiatric illness/drug abuse
perceived hopelessness
previous attempts
318
Suicide
treatment
hospitalize patient
take all threats seriously
