Psych Flashcards
PTSD
Trauma Re-experiencing Avoidance Unable to function Month Arousal
Psychotherapy - CBT SSRI's Prazosin for nightmares Benzos for anxiety Trauma therapy Eye movement desensitisation and reprocessing - EDR
Acute stress disorder
3 days to a month
Trauma
Impairment of function
>/= 9 Intrusive symptoms, negative mood, dissociative symptoms, arousal symptoms
CBT for treatment
Usually no pharmacotherapy
Adjustment disorder
Stress within 3 months - emotional/behaviour
Distress out of proportion / impairment
Not another disorder
Not normal bereavement
Stress for not more than 6 months after stressor terminated
Mood, anxiety, conduct disturbance, or mixed
Persistent if lasts over 6 months
Treat with psychotherapy, crisis intervention, benzodiazepines
OCD
Obsessions (recurrent and persistent thoughts, urges or images - unwanted –> anxiety) / Compulsions (behaviours or mental acts compelled to perform in response to obsession –> usually to reduce anxiety or distress but usually excessive or not realistic)
>1 hour a day or significant functional impairment
Not due to substances
Not another mental disorder
CBT
SSRI
Clomipramine - TCA or risperidone
Panic Disorder
STUDENTS fear the 3 C’s
1 month or more anxiousness - persistent concern or worry about additional panic attacks or their consequences / maladaptive change in behaviour
Not due to substance or medical condition
Not another mental disorder
CBT - exposure, cognitive restructuring, relaxation techniques
Pharmaco -
- SSRI/SNRI –> other antidepressants
- Avoid bupropion or TCA”s due to stimulating effects
- Benzodiazepines only for short term use
STUDENTS fear the three C’s
Sweating Trembling Unsteadiness Depersonalisation/derealisation Excessive heart rate / palpitations Nausea Tingling SOB Fear of dying / going crazy Choking Chills Chest pain
GAD
FIRST C Fatigue Irritability Restlessness Sleep disturbance Tension Concentration issues
Functional impairment
Not attributable to substance or medical condition
Not another mental disorder
Decrease caffeine, alcohol Good sleep hygiene FBC, TFT, UEC, urinalysis and urine drug CBT and mindfulness SSRI and SNRI's PRN benzos
ALWAYS RULE OUT:
caffeine, stimulant use, alcohol/drugs!!!!
Separation Anxiety Disorder
Excessive distress when anticipating or expericeing separation
Persistent and excessive worry about losing attachment
Persistent and excessive worry about untoward event
Persistent reluctance to separate due to fear
Excessive fear or persistent reluctance about being alone
Refusal to sleep
Nightmares involving separation
Complaints of physical symptoms
> 4 weeks
Distress
Not another mental disorder
Selective mutism
Failure to speak in specific social situations
Education/occupation affected
At least 1 month
Not due to lack of knowledge with spoken language
Not explained better by another communication disorder or not during course of another disorder like schizo
Social anxiety disorder
Fear or anxiety about social situations
Individual fears that they will act in a way or show anxiety that will be negatively evaluated
Social situations almost always provoke fear or anxiety
Fear is out of proportion to actual threat posed by social situation
Persistent - 6 months or more
Distress
Not due to substance or medical condition
Not explained by another mental disorder
Agoraphobia
COOPE
Closed areas Open areas Outside the home Public transport Enclosed places
Avoids situations
Actively avoided or endured with intense fear
Out of proportion
Persistent - >6 months
Significant distress
Excessive despite presence of another medical condition
Not another mental health disorder
Substance induced anxiety
Panic attacks / anxiety
Symptoms soon or during after substance
Substance capable of producing the symptoms
Not other anxiety disorder
Not during delirium
Clinically significant distress - improves following stopping substance
Body Dysmorphic Disorder
Preoccupation with 1 or more perceived flaws in physical appearance
Repetitive behaviours in response to appearance concerns
Clinically significant distress in functioning
Not another disorder
Anorexia Nervosa
Energy restriction
Intense fear of gaining weight or becoming fat
Disturbance in self-perceived weight or shape
Bulimia nervosa
Recurrent episodes of binge-eating
Recurrent inappropriate compensatory behaviour in order to prevent weight gain
Binge-eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months
Self evaluation is unduly influenced by body shape and weight
Disturbance does not occur exclusively during episodes of AN
Medication induced psychotic disorder
Delusions/Hallucinations Evidence of above soon after substance intoxication or withdrawal or after exposure Not better explained by another disorder Not during delirium Significant clinical distress
Psychosis due to another medical condition
Hallucinations/Delusions Evidence not due to another medical condition Not another mental disorder Not during delirium Clinically significant distress
Schizophreniform
A - same as schizophrenia
B - rule out schizoaffective, psychotic features of bipolar or depression
—- If mood episodes have occurred during active-phase symptoms, present for minority of total duration
C - other causes
D - Less than 6 months
Schizophrenia
Delusions, Hallucinations, Disorganised speech, disorganised behaviour, negative symptoms
Loss of function to work
Continuous for over 6 months
Schizoaffective, depressive or bipolar with psychotic features have been ruled out
Not due to substance or medical condition
If history of Autism of childhood communication —> can only be diagnosed if prominent delusions or hallucinations occur with other symptoms of schizophrenia for at least 1 month
Schizoaffective disorder
Same as A for schiozphrenia
Delusions or hallucinations for 2 or more weeks in absence of major mood episode during lifetime duration of illness
Major mood episode symptoms are present for the majority of total duration of active and residual periods of the illness
Not due to substance or medical condition
Bipolar type in young, depressive type in older
Brief psychotic disorder
2 or more of - Delusions - Hallucinations - Disorganised speech - Grossly disorganised or catatonic behaviour Rule out schizoaffective etc. - No depressive or manic concurrently with active-phase symptoms Rule out other causes
Delusional Disorder
Delusions for over a month
Criteria A for schizophrenia NEVER been met - if hallucinations are present, not prominent and related to the delusional theme.
Functioning not markedly impaired
Manic or depressive episodes - brief if occurred
Not due to substance or another medical condition
Major depressive episode
5/9 of
- Appetite
- Sleep disturbance
- Anhedonia
- Depressed mood
- Fatigue
- Agitation - psychomotor
- Concentration
- Esteem - Excessive feelings of guilt or worthlessness
- Suicidal
Functional impairment
Not substance induced, not secondary to medical condition, not another psychiatric diagnosis
Major depressive disorder
Major depressive episode criteria present
Not schizoaffective and not superimposed on schizophrenia or other psychotic disorder
There has never been a manic or hypomanic episode
Exercise, mindfulness, zinc supplementation
Antidepressants
Change class or add augmenting agent if no response
Need to allow at least 4 weeks to see if antidepressant is working
ECT
TMS
Phototherapy
ECT - particularly for melancholic and psychotic symptoms, postnatal depression and psychosis, previous good response to ECT, strong suicidal ideation, catatonia
Psychotherapy
Social skills training
Experimental - magnetic seizure therapy, deep brain stimulation, vagal nerve, ketamine
Manic episode
> 1 week
GIFTS DP At least 3 or 4 if mood is only irritable
- Goal directed activity or psychomotor agitation
- Inflated self esteem or grandiosity
- Flight of ideas
- Talkative or pressure
- Sleep - decreased need for
- Distractibility
- Pleasurable activities
Significant impairment
Not due to substance or medical condition
Hypomanic episode
At least 4 days
Greater than or equal to 3 of GIFTS DP
Different to character when not symptomatic
Disturbance in mood and change in functioning
Not severe enough to cause marked impairment
Not due to substance or medical condition
