psych packet 2 Flashcards
Anorexia Nervosa
TREATMENT
*** 3 BASIC TX GOALS FOR ED PTS:
1) Restore a normal _______ state in pts with anorexia this means restoring weight within a normal range
2) Modify patients disturbed eating behaviors this will get pt maintain _____ within a normal range and reverse or lessen abnormal eating behaviors
3) Help change the patients erraneous beliefs about ____, weight loss, and body shape/size
- Use a multidisciplinary team approach
o May need acute medical intervention to correct fluid and electrolyte disorders, cardiac problems, and organ failure
- _________ = primary therapy used in INPATIENT centers
o Weight restoration = central goal
o Patients are encouraged to eat a greater amount of calories to earn specific _______ (activities, family visits, etc.)
Goal directed, positive reinforcement
o During behavioral therapy, patients also have individual and family therapy (to work on agreement and cooperation on their goals) and group psychotherapy
_______ psychotherapy: focus on education about the illness & later on in therapy it is used to help the patient resolve problems and conflicts that contributed to or reinforced abnormal eating behavior
• What triggered this? How did it get to the point where you viewed your body image like this?
Can do family or couples therapy
o Usually done in outpatient clinics
o Some pts can benefit from additional supervision and support from in-day treatments (partial hospital – they go for the day then come home)
o Serious disorders will need to be in-patient:
Severe starvation and weight loss
Hypotension or hypothermia
Electrolyte imbalances
Suicidal ideations or psychosis
Failure of outpatient treatment
- INCREASING WEIGHT:
o Reintroducing foods at modest caloric levels (1500-1800 kcal/d)
Gradually increase by 400 kcal every 2-3 days
Goal is to achieve weight gain rate of 1-2 kg per week (take in generally 3,500-4000 kcal/d)
o Monitor patients after feeding (to prevent purging)
o Can use stool softeners or bulk laxatives to alleviate severe constipation
o Possible need for tube feedings (if they cant eat)
o Vitamins are also given (since they are lacking)
o Monitor serum electrolytes and liver enzymes
o ECG to assess palpitations with hypokalemia
- ADJUNCTS to behavioral therapy:
o _____
o 2nd gen antipsychotics: OLANZAPINE showed that anorexia pts gained more weight than those taking placebo (can stimulate appetite but it has no effect on cognitive distortions / body image)
- For maintenance à cognitive behavioral therapy and psychotherapy are helpful, often for > 1 yr
nutritive
weight
food
behavioral therapy
privileges
individual
SSRI’s
Bulimia Nervosa
- Sometimes inpatient is necessary, but generally outpatient tx is adequate
o Day treatments often used - Most effective = high intensity tx 40 hours per week
o __________ and individual psychotherapy are also effective
o ______ is very effective
o No nutritional rehab is needed because patients are of normal weight
o Overeaters anonymous (OA) is helpful
o Antidepressants of every class are effective
____ 60 mg FDA approved à works best with cognitive behavioral therapy
TCA & MOA can ↓ binge and purge cycles but are not considered first line
AVOID ______ (Wellbutrin) potential for seizures
o Try other drug therapies when accompanied by psychosis, MDD, bipolar disorder, or an anxiety disorder (to treat psych disorder AND bulimia)
CBT
group therapy
prozac
bupropion
binge eating disorder
TREATMENT
- Lisdexamphetamine (______ ) as a stimulant is FDA approved to treat binge-eating disorder
- ________ and interpersonal psychotherapy
VYVANSE
CBT
PICA
TREATMENT = consists of ________
behavior modification
rumination disorder
TREATMENT
- ____________
- Habit reversal using special _____ techniques (diaphragmatic breathing) to compete with the urge to regurgitate
behavioral modification
breathing
avoident/restrictive food intake disorder
- Behavioral management programs are recommended: ___ and family-based approaches have been recommended
CBT
panic disorders
TREATMENT:
- _____ therapy that tries to change very negative thoughts that accompany panic attacks are an effective tx for panic disorder
o Teach pt. that panic is unpleasant but not dangerous, and it will end soon
- BEHAVIORAL THERAPY:
o Use exposure therapy
o Instruct pt to stop hyperventilation, and use diaphragmatic breathing
o Visualization
o Systematic desensitization
- DRUG THERAPY:
o Substantially reduce frequency and severity of panic attacks or prevent them:
o The primary medications used today for panic disorder are several types of antidepressants, including ______ , and the _____(sometimes in combination with these SSRIs)
Often start benzodiazepines because they work immediately, then load SSRIs
________: work immediately (short acting)
• Work by potentiating effects of gamma-aminobutyric acid (GABA) a major inhibitory neurotransmitter
• Drugs in the class all work similarly but differ in duration of action
• Side effects: include ______, potential for drug abuse and addiction
• Use with caution in patients with a history of substance abuse
• Rapid discontinuation can lead to ____ effects
• Low toxicity in overdose situation (but can cause respiratory depression)
• Risk of falls, especially in elderly patients
• Can be dosed PRN anxiety symptoms
àLong Acting (1/2 life >20 hours):
______ (Valium) – effective for muscle spasms (also used for musculoskeletal disorders)
Clonazepam (Klonopin)
àIntermediate Acting (1/2 life 6-20 hours):
Aprazolam (_______) – causes euphoria, high abuse potential
Lorazepam (Ativan) – seizure treatment, alcohol detox
Oxazepam (Serax)- used in alcohol detox
Temazepam (Restoril) – primary indication was for insomnia
àShort acting (1/2 life < 6 hours):
Triazolam (Halcion) – insomnia
Midazolam (Versed) – very short ½ life. Mainly used in surgical settings (pre-surgery)
- ADJUNCTIVE THERAPY:
o The serotonin-norepinephrine reuptake inhibitor (SSNR) = venlafaxine (Effexor) has also been shown to help control panic attacks
o _____ (BuSpar) – non-BDZ anxiolytic: slower onset of action than BDZ (takes 1-2 weeks to take effect)
Need to dose daily
___ addiction potential
o Hydroxyzine (Atarax) – antihistamine: short-acting PRN med for anxiety
Causes sedation (like Bendadryl), dry mouth, constipation, urinary retention
o Beta-blocker (Propranolol) – treats the autonomic effects of panic attack (palpitations, sweating, tachycardia)
àwith all antipanic drugs, start low and go slow until effective dosage is achieved
o Relapse is common when the drug is discontinued
o Long term use is safe
o Most efficacious = medication plus cognitive-behavior therapy
cognitive SSRI's, benzos benzodiazepines sedation rebound diazepam xanax buspirone low
agoraphobia
TREATMENT
- When panic is present —> ___ tx is often employed
- Absence of panic –> exposure therapy alone is okay
- Can’t desensitize —> ______ does not generalize to an undrugged state
drug
exposure
anxiolytics
social phobias
TREATMENT:
- Most people deal with problem by avoiding the feared stimulus
o Not always possible
o Familial or possible dopaminergic pathways play a role in social anxiety
- Can use a combo ___ and ____ or Venlafexine XL (approved by FDA)
o MAOIs , Benzos, Beta blockers
o CBT: systematic desensitization
CBT, SSRIs
GAD
TREATMENT
- __________ Clonazepam or Diazepam): return of symptoms when drugs discontinued
- _______ (Buspar): non-addictive, takes weeks to be effective
- TCAs used less these days
- _____
- Behavioral or psychotherapy
BENZODIAZEPINES
BUSPIRONE
OCD
TREATMENT
- _______ : 60-80% reduction in symptoms for 75% patients who comply with tx
- Drug therapy:
o Antidepressants: ____ = clomipramine (Anafranil)
o _____ first line: ______ (Prozac), fluvoxamine (Luvox), sertraline (Zoloft)
o Anxiolytics: limited role
o Antipsychotics: unlikely to be beneficial, except with recurrent tics
CBT
TCAs
SSRI’s
fluoxetine
PTSD
TREATMENT
- Symptoms of mood and anxiety disorders, impulsivity, and substance abuse are often found together
- _____ help with re-experiencing, avoidance and numbing, hyperarousal
o Also help with depression, impulsivity, obsessive thinking, substance abuse and suicidal ideation
o FDA approved SSRI’s: sertraline (____), paroxetine (Paxil)
Use these although other SSRIs likely are effective
They ↓ depressive symptoms & ↓ intrusive symptoms such as nightmares and flashbacks and normalize sleep
o _______ (antidepressant): appears effective
o _____: reduce anxiety à short term use (habit forming)
- ____ help reexperiencing and sleep disturbance
o Prazosin = alpha-receptor antagonist targets nightmares and hypervigilance
- ___: use for reexperiencing
- Establishing a sense of safety and separation from trauma is an important first step in treating PTSD
o ______ : preferred treatment modality - effective in reducing PTSD symptoms by providing patients skills to control anxiety and counter dysfunctional thoughts
Patients often engage in avoidance behavior: miss appts, cognitively disconnect, use substances, etc.
o Group and family therapy
o Eye movement desensitization and reprocessing (EMDR) therapy, but research suggests that its efficacy is driven by its exposure component, not eye movements
SSRI's ZOLOFT venlafaxine benzos MAOI TCA's CBT
Acute Stress Disorder
TREATMENT
- ____ involving exposure and anxiety management (e.g., relaxation training, re-breathing) has been shown to help prevent the progression to full-blown PTSD
- Anxiety is severe, short course of a ____-
- ____ immediately after the trauma my reduce the later development of symptoms of PTSD
CBT
benzo
beta blockers
Adjustment Disorders
TREATMENT
- _____ (supportive, group) = mainstay of treatment
o _____ psychotherapy: help patient adapt to the stressor when it is ongoing or to better understand the stressor once it has passed
o Group psychotherapy: supportive atmosphere for persons who have experienced similar stressors
- Use pharmacotherapy to target additional symptoms (depression, anxiety, insomnia)
o Medications to target the patient symptoms: ____ for sleep, ____ for anxiety
o If condition persists à reconsider the diagnosis.
IE: adjustment disorder with depressed mood might develop into a major depressive disorder that would respond to antidepressant medication
therapy
supportive
hypnotic
benzo
