Psych Final Flashcards
REM Sleep Behavior Disorder
ROS: vocalizations and/or complex motor movements occur during REM sleep, REM w/o atonia is confirmed by PSG, disturbance not induced by a substance, common in older males, assoc w/ neurodegenerative dz’s
Features: action-filled violent dream
Tx: clonazepam (benzo), modified sleep environment
Nicotine Withdrawal
ROS: dysphoric mood, restlessness/anxiety, difficulties concentration, irritability/anger, increased appetite, decreased HR
Anti-androgens for Paraphilias
Depo-provera used to decrease testosterone levels and thus libido
Acamprostate
Mechanism: NMDA receptor antagonist that reduces craving for ETOH by decreasing uncomfortable feelings assoc w/ protracted abstinence
Use: helps prevent the “slip” from happening in the first place bc the person feels euthymic and doesn’t crave ETOH
Hallucination Persisting Perception Disorder
“Flashback” perceptual experiences long after LSD is metabolized
ROS: false perceptions of movement, intensification of color
Delirium Tremens
ROS: confusional state, severe and uncommon, seen after chronic use of heavy sedative (e.g. ETOH), assoc w/ high mortality rate
Sexual Masochism
Sexual arousal from receiving phychological/physical suffering
Narcolepsy
ROS: recurrent irresistible sleep occurring w/in the same day, at least 1 of - cataplexy, hypocretin deficiency, characteristic PSG abnormalities
Time: several times per wk for >3mo
Cannabis
Most commonly used illegal substance, rarely causes hallucinations, shorter acting than LSD (2-4 hrs) unless ingested, assoc w/ “amotivational syndrome”
Nightmare Disorder
ROS: extremely dysphoric dreams that typically involve threats to survival, security or physical integrity
Characteristics: awakening in 2nd half of sleep (during REM), rapid alertness, dream content well remembered, good recall of awakening
Tx: if needed antidepressants to decrease REM
Delayed Ejaculation
Marked delay in, or absence of ejaculation
Sodium Oxybate
*aka Xyrem
Schedule III tx cataplexy and somnolence, available via restricted distribution system
Central Sleep Apnea
ROS: multiple episodes of cessation of breathing per night caused by CNS dysregulation of breathing, no thoracic effort occurs
Tx: respiratory stimulants, nocturnal O2, etc.
Erectile Disorder
Problems maintaining or attaining an erection
Non-REM Sleep Arousal Disorder
ROS: repeated episodes of incomplete awakening from sleep w/ sleep walking or sleep terrors
Voyeurism
Sexual arousal from observing unsuspecting person either naked, in the process of disrobing, or engaging in sexual activity
*person must be @ least 18yo
Anorexia Nervosa
ROS: restriction of food that leads to being significantly underweight based on BMI < 18.5, intense fear of weight gain, body image disturbance
Subtypes: binge-eating/purging type, restricting type
Onset: usually in adolescence and have chronic course
CAGE ?s for ETOH
Cut back?
Annoyed with others?
Guilty about drinking?
Eye opener drink?
*>2 is suggestive of addiction
Periodic Limb Movements
ROS: repetitive muscle contractions during sleep, usually of lower limb, assoc w/ multiple sleep stage arousals, pt c/o daytime sleepiness but is UNAWARE of movements, confirm using PSG
Tx: anti-Parkinson’s drugs, benzos, anticonvulsants
Bath Salts
ROS: agitation, paranoia, hallucinations, CP, tachycardia, HTN, suidicality
*designer drug containing in part amphetamine-like chemicals
Hypersomnolence Disorder
ROS: excessive sleepiness despite sufficient sleep (@ least 7 hrs), avg sleep episode = 9.5 hrs, nml PSG
Time: >3mo
Tx: stimulants to promote wakefulness
Antidepressant tx for Paraphilias
SSRIs are used to reduce libido, control impulses and reduce obsessions
Restless Leg Syndrome
ROS: urgent o move legs in response to uncomfortable sensations that occur/worsen during inactivity, nocturnal worsening of sx’s, temp relief from discomfort by moving, pt is AWARE of sx’s
Tx: anti-Parkinson’s drugs to increase DA (also benzos, anticonvulsants, etc.)
Opioid Withdrawal
ROS: dysphoria, N/V/D, muscle aches, lacrimation and rhinorrhea, piloerectin, sweating, fever, yawning, pupillary dilation
*typically causes “flu-like” sx’s
Frotteurism
Sexual arousal from touching or rubbing against a non-consenting person
Insomnia Disorder
ROS: difficulty initiating or maintaining sleep
Etiology: classical conditioning - bed gets assoc w/ wakefulness (due to poor sleep habits)
Time: >3mo
Aversion Therapy for Paraphilia
While engaging in or thinking about one’s paraphilia, an actual stimulus is applied to the pt
-or-
While fantasizing about one’s paraphilia, a pt imagines aversive consequences (“covert sensitization”)
Cannabis Withdrawal
*“agitation”
ROS: irritability and nervousness, dysphoric mood, sleep disturbance, decreased appetite, HA, night sweats, stomach cramping, shakiness
Cannabis Intoxication
ROS: perceptual distortions, conjunctival injection, increased appetite, dry mouth
Naltrexone
Mechanism: opioid receptor blocker that reduces the pleasurable effects of ETOH
Use: helps person stop drinking after a few drinks when a “slip” occurs
Male Hypoactive Sexual Desire Disorder
Problems w/ ow libido
Opioid Intoxication
ROS: intense rush followed by euphoria and drowsiness, dysphoria, miosis, unconscious, respiratory depression
*OD can be lethal from respiratory depression
Pedophilia
Sexual arousal by prepubescent child (usually 13yo or younger)
*perpertrator must be @ least 16yo and 5 yrs older than the child
PCP Intoxication
ROS: depersonalization, agitation/belligerence/confusion, impulsivity and unpredictability, nystagmus, hyperacusis, decreased responsiveness to pain, ataxia, muscle rigidity, sz, coma
*psychiatric emergency bc of violent and unpredictable behaviors
Replacement Therapy
Usually 1-2 yrs
Benefits: oral administration, stable drug levels, less euphoria and less drowsiness
Methamhetamine
Half life (t1/2) = 12 hrs, physical changes with meth including “meth mouth” and “meth face”
Transvestism
Sexual arousal by cross-dressing
Buproprion and Varenicline
Used to tx nicotine use disorder
Masturbatory Reconditioning for Paraphilia
a. Directed masturbation phase - pt engages in approp fantasy while masturbating to orgasm
b. Satiation phase - during the post-oragsmic refractory period, pt masturbates to deviant fantasy w/o ability to orgasm
Sedative Withdrawal
ROS: agitation, insomnia, anxiety, ANS hyperactivity (can be fatal), nausea/vomiting, hand tremor, transient hallucinations, sz
- formication: sensation of bugs crawling under skin (hallucination)
Premature Ejaculation
Ejaculation occurring during partnered activities w/in about 1 min following vaginal penetration
Genito-Pelvic Pain/Penetration Disorder
ROS: difficulties w/ vaginal penetration or vluvovaginal/pelvic pain during vaginal intercourse or penetration attempts
Tx: dilator devices to expand vaginal opening in conjunction w/ relaxation techniques
Paraphilic “Disorder”
- acts on urge w/ non-consenting person
- acts on urge w/ consenting person and action causes significant distress/functional impairment
- does NOT act on the urge but the urge causes significant distress/functional impairment
Sedative Intoxication
ROS: sedation, sleepiness, decreased anxiety, disinhibition, impaired judgment, slurred speech, incoordination, stupor/coma, respiratory depression
Female Sexual Interest/Arousal Disorder
Problems w/ libido and/or physiological arousal
Exhibitionism
Sexual arousal from exposing genitals to an unsuspecting stranger
Narcolepsy Tx
Polytherapy (stimulant Modafinil for somnolence and antidepressants for cataplexy), monotherapy (Xyrem) for cataplexy and somnolence
Major Stimulant Intoxicatoin
ROS: euphoria, grandiosity, psychomotor acceleration, paranoia and hallucinations, inc HR and BP, appetite loss and insomnia, mydriasis, sz
Fetishism
Sexual arousal from nonliving objects or a highly-specific sexual focus on a non-genital body part
Substance Use Disorder
ROS: maladaptive pattern of substance use as manifested by >2 sx’s, if tolerance and withdrawal are the only 2 sx’s after approp use of rx drug then don’t dx SUD
Severity: based on # of sx’s out of 11
Time: 12mo
Buprenorphine
Schedule III opioid drug
Addiction tx: available from dr’s office after approval by DEA, can be prescribed, administered or dispensed form clinic
Bulimia Nervosa
ROS: recurrent binge eating, recurrent inappropriate compensatory behavior for binge (purging or non-purging), self-eval is unduly influence by body shape and weight, usually have nml body weight
Onset: begin in adolescence and chronic
Time: >1X per wk for 3mo
Major Stimulant Withdrawal
ROS: dysphoric mood, fatigue and psychomotor slowing, hypersomnia w/ vivid unpleasant dreams, increased appetite
(Non-life threatening)
Disulfiram
Mechanism: inhibits enzyme that breaks down acetaldehyde
ROS: after ETOH consumption, acetaldehyde accumulation causes toxic rxn (e.g. hangover) lasting 30-60 mins
*typically only given short-term if person is going into a high risk situation bc of toxicity
MDMA
ROS: stimulant effect + mild hallucinogenic effects (perceptual alterations), common things look more interesting, empathogenesis, concern about neurotoxicity
Cocaine
Half life (t1/2) = 30 min, cocaine use more freq than meth bc of the t1/2
Binge-Eating Disorder
ROS: binge eating, assoc w/ rapid eating, until uncomfortably full, when not hungry, alone due to shame about quantity, feeling guilty/depressed after binge, NO inappropriate compensatory behavior
Onset:
Time: @ least 1X/wk for 3mo
*assoc w/ obesity (BMI >30)
Methadone
Schedule II opioid drug
Addiction tx: only available at an official federally regulated Opioid Tx Program, and cannot be prescribed, it can only be administered or dispensed
Naltrexone
Abstinence-based therapy, long-acting opioid receptor blocker to block opioid effects if relapse occurs, tends to be unsuccessful
Circadian Rhythm Sleep-Wake Disorder
ROS: excessive sleepiness or insomnia resulting from mismatch btwn persons circadian pattern and the sleep-wake schedule required by the environment
Tx: setting of circadian clock (light vs. no light to turn on/off melatonin from pineal gland)
Sexual Sadism
Sexual arousal from causing psychological/physical suffering of another person
PCP Intoxication Treatments
Antipsychotics (benzos), reduced environmental stimulation, restraints may be needed
*no withdrawal syndrome
Modafinil
Tx: Narcolepsy
Stimulant for somnolence
Insomnia Treatment
Stimulus control (make bet a cue for rapid-sleep onset), improving sleep hygiene methods - benzos for short term use (but poor quality sleep), benzo-like drugs better bc fewer side-effects
Naloxone
Tx overdose of opioid
Mechanism: short-acting opioid receptor antagonist
Use: for acute OD but NOT opioid addiction therapy
Indicators of excessive thinness
Low BMI, amenorrhea, constipation, hypothermia, bradycardia/hypotension, hypercholesterolemia, anemia, leukopenia, low bone mineral density
Gender Dysphoria
ROS: marked incongruence btwn ones assigned gender and ones experienced gender
Onset: 2-4yo
Time: @ last 6mo
*2-5X more male-to-female
Obstructive Sleep Apnea Hypopnea (OSAH)
ROS: multiple eps of breathing cessation/reduction occur per night due to upper airway obstruction (usually when soft tissue in back of throat collapses during sleep), duration of sleep maybe adequate but sleep is unrefreshing
Tx: CPAP (continuous positive airway pressure)
Dx: thoracic effort occurs on PSG
Female Orgasmic Disorder
ROS: delay in, the inability to, or having low-intensity orgasms
Tx: strengthen pubococcygeal muscle to increase orgasm potential
LSD
Most potent hallucinogen, lasts 8-132hrs
ROS: visual, poorly formed hallucinations, mydriasis
*no withdrawal syndrome
Cocaine withdrawal
Atypical depression, pt is hungry and sleeps a lot
Sleep Terorrs
ROS: abrupt arousal (usually w/ panicky scream), intense fear and ANS arousal, and unresponsiveness to comforting by others
Characteristics: occurs w/in first 1/3 of sleep (NREM), no dream imagery, amnesia of the episode
Cocaine OD
ROS: hallucinations and paranoia (mydriasis and tachycardia are sx’s of intoxication)
Buprenorphine
Can be prescribed by physician to tx opioid addiction/withdrawal
*methadone cannot be prescribed but has to be administered at a specific clinic
