Psychiatry Flashcards
PTSD diagnostic criteria
1) Exposure to actual/threatened death, serious injury, or sexual violation in >=1 of the following ways
2) >=1 intrusive symptoms
3) >=1 avoidance symptoms
4) >=2 negative mood symptoms/dissociative symptoms
5) >=2 arousal/reactivity symptoms
- duration of above symptoms > 1 month
- clinically significant distress/impairment
- NO from substances NO from another medical condition
Acute Stress Disorder diagnostic criteria
1) Exposure to actual/threatened death, serious injury, or sexual violation in >=1 of the following ways
2) >=9 of the symptoms from any of the 5 categories: intrusive, negative mood, dissociative, avoidance, arousal
3) duration of symptoms for at least 3 days to 1 month after the trauma
4) clinically significant distress/impairment
5) NO from substance NO from another medical condition
Adjustment Disorder diagnostic criteria
1) Within 3 months of stressor, emotional/behavioral response
2) clinically significant behaviors/ symptoms as evident by >=1 of the following :
- marked distress out of proportion to severity of the stressor
- significant impairment
3) Does not meet criteria for another mental disorder
4) Does not represent bereavement
5) Once stressor or its consequence are terminated, symptoms do NOT persist more than 6 months
What are the specify of Adjustment Disorder ?
w/ depressed mood
w/ anxiety
w/ disturbance of conduct
Treatment for PTSD
** Therapy: CBT - early intervention is vital
** Reduce caffeine, alcohol, stress
** Medication: fluoxetine, paroxetine, sertraline, venlafaxine
- Second line: mirtazapine
- For nightmares: Trazodone (50-200mg) or Prazosin (1-15mg po QHS)
- continue > 8 weeks
- consider second generation atypical antipsychotics
or anticonvulsants
ADHD diagnostic criteria (DSM V)
> > Either (1) or (2): in adults only need 5 of 9 Sx
(1) >= 6 symptoms of inattention, persisted >= 6 mo that is inconsistent with developmental level, negatively impacts social, academic, occupational
(2) >= 6 symptoms of hyperactivity-impulsivity, persisted >=6 mo to a degree that is maladaptive and inconsistent with the developmental level
symptoms of eating disoder
Cardiorespiratory: palpitation, cp, sob, arrhythmia, edema, MVP
Diagnostic criteria of alcohol withdrawal syndrome
1) decreased EtOH use that has been heavy/ prolonged
2) has > or = 2 of the the following:
- autonomic hyperactivity (sweating,
tachycardia) ;
- increased hand tremor;
- insomnia;
- nausea or vomiting;
- transient visual, tactile, auditory hallucinations or illusions;
- psychomotor agitation;
- anxiety;
- tonic-clonic seizures
3) symptoms cause distress/impairment
contraindications to outpatient treatment of alcohol withdrawal syndrome
Abnormal laboratory results
Absence of a support network
Acute illness
High risk of delirium tremens
History of a withdrawal seizure
Long-term intake of large amounts of alcohol
Poorly controlled chronic medical conditions (e.g., diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure)
Serious psychiatric conditions (e.g., suicidal ideation, psychosis)
Severe alcohol withdrawal symptoms
Urine drug screen positive for other substances
symptoms of delirium tremens
severe hyperadrenergic state (i.e., hyperthermia, diaphoresis, tachypnea, tachycardia) characterized by disorientation, impaired attention and consciousness,
and visual and/or auditory hallucinations
Timing of alcohol withdrawal syndrome
12-24hrs after the last drink: tachycardia, tremors, anorexia, insomnia
24-72hrs: generalized seizures
3-5d: delirium tremens –> disorientation, fever, hallucinations
When to consider report to MOT of driving
- drinking + driving
- drove while intoxicated
- withdrawal seizure
1st meds to treat alcohol withdrawal as outpatient
anticonvulsants (not able to prevent seizure or delirium tremens)
- carbamazepine, gabapentin
Alpha-adrenergic agonist
- clonidine (s/e: Hypotension, dry mouth,
dizziness, constipation,
sedation)
contraindications to use Naltrexone or Acamprosate to treat EtOH dependence
Naltraxone:
- liver failure
- ongoing opioid use b/c risk of acute withdrawal
- can be used if pt will abstain from opioid
- ** use for abstinence OR reduction
- ** check LFTs 1,3,6 mos
Acamprosate
- severe renal impairment
- use ONLY for abstinence, does NOT reduce heavy drinking
complications of Alcohol Use Disorder
- CNS:
Wernicke encephalopathy (decreased thiamine=nystagmus, CNVI, ataxia, confusion)
Korsakoff psychosis
dementia - CVS:
HTN
cardiomyopathy
AFib
- GI cirrhosis PUD gastritis pancreatitis carcinoma
- Psycho
depression
anxiety
