Psych path 4 Flashcards
Postpartum mood disturbances:
Post partum blues
50-85% incidence rate
Depressed affect, tearfulness, fatigue lasting 2-3 days after delivery
Usually resolves in 10-14 days
Treatment: supportive, f/u for post partum depression
Postpartum mood disturbances:
Post partum depression
10-15% incidence rate
Depressed affect, anxiety, and poor concentration
within 4 weeks after delivery
Lasts 2 wks to a year or more
Tx: antidepressant, psychotherapy
Postpartum mood disturbances:
Post partum psychosis
0.1-0.2% incidence rate
Delusion, hallucination, confusion, usual behavior
Possible homocidal, suicidal ideation or attempt
Ususually lasts 4 to 6 wks
Tx: antipsychotic, antidepressant, possible inpt hospitalization.
Electroconvulsive therapy
1) treatment for major depressive disorder refractory to other treatment
2) For pregnant women with major depressive disorder
3) when immediate response is necessary (acute suicidality)
4) depression with psychotic features, for catatonia
Produces painless seizures in anesthesized pts
Major side effects: disorientation, temporary anterograde and retrograde amnesia usually fully resolving in 6 months.
Risk factor for suicide completion
Sex (male)
Age (teenage or elderly)
Depression
Previous attempt Ethanol or drug sue Rational thinking gone Sickness (medial illness, >3 medical prescriptions) Organized plan No spouse Social support lacking
Women try more often, men succeed more
SAD PERSONS
Anxiety disorder
Inappropriate fear/worry and its physical manifestation when the source of fear is either not real or insufficient to account for the severity of the symptom
Symptoms AFFECT daily funcitoning
Lifetime prevalence of 30% in women and 19% in men
Panic disorder, phobias, OCD, PTSD, and GAD
Panic disorder
Presence of recurrent periods of intense fear
PANICS:
Palpitation/Paresthesia
Abdominal stress
Nausea
Intense fear of dying or losing control, lightheadeness
Chest pain, chills, choking, disconnected
Sweating, shaking and SOB
Strong genetic component
Tx: CBT, SSRI, venlafaxine, benzo
Specific phobias
Excessive and unreasonable fear and interferes with normal functioning.
Person recognizes that fear is excessive
Can treat with systemic desensitization
Social phobias
(social anxiety disorder)
Exaggerated fear of embarrassment in social situation
(public speaking, using public restroom)
Treatment: SSRI
“Social phobia = SSRI”
OCD
Intrusive thoughts, feelings, or sensations (obsessions)
Relieved partly by performance of repetitive tasks (compulsion).
Ego dystonic: behavior inconsistent with one’s belief and attitude (vs. obsessive-compulsive personality disorder)
Associated with Tourette’s disorder
Tx: SSRI, clomipramine (TCA)
“oCd=Clomipramine”
PTSD
Traumatic events
Involve nightmares and flashbacks, intense fear, helplessness
Disturbance lasts > 1 month
Tx: psychotherapy, SSRI
Acute stress disorder
Lasts between 2 days and 1 month
(vs. > 1 month in PTSD)
PTSD~aSD
Generalized anxiety disorder
Pattern of uncontrollable anxiety for at least 6 months
Unrelated to specific person, situation or devent
Associated with sleep disturbances, fatigue, GI, concentration
Treatment: SSRI
“GAD=6 months, because G looks like 6”
Adjustment disorder
(Compare to GAD~AD) Emotional symptoms (anxiety and depression) causing impairment following an identifiable psychosocial stressor (divorce, illness)
Lasting less than 6 months (vs. >6 months in GAD)
(>6 months in the presence of stressor)
Malingering
In order to attain a specific 2nd gain (avoiding work, drugs)
Poor compliance with treatment or f/u of dx tests
Complaints ceases after gain (vs. factitious order)
Factitious disorder
Patient consciously created physical or psychological symptoms in order to assume sick role and to get medical attention (primary gain)
Factitious disorder: Munchausen’s syndrome
Chronic factitious disorder with predominantly physical signs and symptoms
Multiple hospitalization and willingness to receive invasive procedures
Factitious disorder: Munchausen’s by proxy
When illness in a child or elderly is caused by the caregiver.
Motivation is to assume a sick role by proxy
Form of child/elder abuse
Somatoform disorder
Physical symptoms with no identifiable physical cause
Both illness production and motivations are unconscious drives
Symptoms NOT intentionally produced or feigned.
More common in women
Somatoform disorder:
somatization disorder
Variety of complaints in multiple organ systems
(at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic)
Over a period of years, developing before age 30 years
Somatoform disorder:
conversion
Sudden loss of sensory or motor function
(paralysis, blindness, mutism), often following an acute stressor.
Patient always aware but sometimes indifferent toward symptoms (la belle indifference)
More common in females, adolescents, and young adults
Somatoform disorder:
hypochondriasis
Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance
Somatoform disorder:
Body dysmorphic disorder
Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning.
Patient often repeatedly seek cosmtic surgery.
Somatoform disorder:
pain disorder
Prolonged pain with no physical finding.
Pain is the predominant focus of clinical presentation and psychological factors play an important role in severity, exacerbation, or maintenance of the pain
