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STEP2 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

major risk factors for suicide

A 
psychiatric disorders
feelings of hopelessness or worthlessness
impulsivity
increasing age
male sex
access to weapons
history of suicide attempts
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2
Q

neurotransmitters decreased in depression

A

serotonin, norepinephrine, dopamine

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3
Q

medical illnesses that can cause depressive symptoms

A 
hypothyroidism
hyperparathyroidism
Parkinson disease
stroke
HIV
Cancer (esp CNS neoplasms, which can mimic depression)
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4
Q

Drugs known to cause depressive symptoms

A

sedatives (alcohol, benzodiazepines, antihistamines)

withdrawal from stimulants (cocaine, amphetamines)

some antihypertensives (methyldopa, clonidine, beta- blockers)

first- generation antipsychotics (haloperidol)

prochlorperazine

metoclopramide

long-term glucocorticoid use

interferon- alpha (contraindicated in depression)

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5
Q

MDD with atypical features

A 
mood reactivity
increase appetite and weight gain
hypersomnia
leaden paralysis
hypersensitivity to rejection
responds well to MAOIs
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6
Q

MDD with seasonal pattern

A

recurrent depression exhibiting a regular temporal or seasonal pattern
treatment: light therapy (10,000 lux at least 30 min/day)

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7
Q

MDD with peripartum onset

A

onset during pregnancy or up to 4 weeks postpartum

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8
Q

MDD with psychotic features

A

delusions or hallucinations develop during an episode of MDD

No psychosis except during depressive episodes (the depression is always present even when the psychosis isn’t_

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9
Q

Schizoaffective disorder

A

baseline psychosis

mood disorder secondary to psychosis

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10
Q

persistent depressive disorder (formerly known as dysthymic disorder)

A

chronic, persistent depression for at least 2 YEARS (MDD no longer precludes persistent depressive disorder as it used to in DSM4)

depressed mood plus 2 SIGECAPS symptoms

more difficult to treat than MDD

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11
Q

SSRIs

A

citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

first line for depression as well as anxiety

work in 3-4 weeks

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12
Q

SNRIs

A

desvenlafaxine, duloxetine, milnacipran (fibromyalgia only), venlafaxine

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13
Q

Atypical antidepressants

A

buproprion, mitrazapine, nefazodone, trazodone

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14
Q

TCAs

A

amitriptyline, doxepin, imipramine, nortriptyline

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15
Q

MAOIs

A

phenelzine, tranylcypromine

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16
Q

side effects of SSRIs

A 
sexual dysfunction
insomnia/agitation
weight gain
risk of suicidal ideation
risk of serotonin syndrome
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17
Q

Serotonin syndrome

A

mental status changes: anxiety, agitation, delirium, restlessness, disorientation

autonomic excitation: diaphoresis, tachycardia, hyperthermia, hypertension, vomiting, diarrhea

Neuromuscular hyperactivity: tremor, muscle rigidity, hyperreflexia, myoclonus
ocular clonus (slow, continuous, horizontal eye movements)
spontaneous or inducible clonus
positive Babinski sign bilaterally

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18
Q

Which drugs increase the risk of serotonin syndrome

A 
SSRIs
SNRIs
MAOIs
TCAs
St. John's wort
Tryptophan
Triptans
Linezolid
Levodopa
Stimulants (cocaine, ecstasy- MDMA, amphetamines)
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19
Q

How do we treat serotonin syndrome?

A

discontinue all serotonergic agents and symptoms usually resolve in 24 hours

Supportive care to normalize vital signs

  • oxygen, IV fluids, cardiac monitoring
  • if medical treatment for tachycardia or HTN is needed, use short- acting agents (esmolol, nitroprusside)

Sedation with benzodiazepines

If T>41, sedation, paralysis, ET tube- mechanical cooling

  • paralysis should relieve the hyperthermia, which is caused by muscle activity
  • there is no benefit in using antipyretics in this scenario

If agitation despite benzodiazepine then use a serotonin inhibitor like cyproheptadine

Adter sx resolve, assess need to resume serotonergic agent

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20
Q

side effects of SNRIs

A 
sexual dysfunction
insomnia/agitation
nausea
dizziness
hypertension (venlafaxine)
risk of serotonin syndrome
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21
Q

norepinephrine dopamine reuptake inhibitor (NDRI)

A

buproprion

blocks presynaptic reuptake of NE and DA

use this to treat fatigue and hypersomnia, but not anxiety

also indicated for smokine cessation

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22
Q

NDRI (buproprion) side effects

A

blocks pre-synaptic re-uptake of DA

insomnia, weight loss, lowers seizure threshold, contraindicated in anorexia, eating disorder, seizure disorder

no sexual dysfunction!

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23
Q

Alpha2 antagonist- mirtazapine

A

blocks alpha 2- adrenergic receptors, which leads to increased NE release

side effects include sedation for unknown reasons, appetite stimulation, and weight gain

useful in cancer patients who have comorbid depression

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24
Q

Serotonin modulators: trazadone, nefazodone, vilazodone

A

these drugs have a variety of effects on serotonin receptors (agonist/antagonist depending on the receptor subtype)

The main side effect is sedation
Trazedone can even be used as a sleep aid

priapism

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25
Q 
TCAs: 
amitriptyline
clomipramine
imipramine
nortriptyline
A

not really used much anympre
block NE and serotonin reuptake
3rd line due to poor side effect profile

side effects:
anticholinergic effects (amitriptyline especially)
sedation
sexual dysfunction
weight gain
dangerous in overdose
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26
Q

What findings are seen in TCA OD?

A

cardiotoxicity: tachycardia, hypotension, conduction abnormalities

CNS toxicity:sedation, obtundation, coma, seizures

antiCholinergic symptoms: mydriasis, xerostomia, ileus, urinary retention

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27
Q

MAOIs
tranylcypromine
phenelzine

A

inhibits MAO; increases levels of serotonin, DA, NE

not used often, due to side effects and interactions with food (tyramine builds up and stimulates autonomic nervous system)

side effects: drug- drug interactions
hypertensive crisis

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28
Q

what foods contain tyramine and should be avoided while on MAO in order to avoid hypertensive crisis?

A

foods that are spoiled, pickled, aged, smoked, fermented, or marinated

  • fermented cheeses (cream cheese and cottage cheese are ok)
  • smoked or aged meats (sausage, bologna, pepperoni, salami, smoked or pickled fish)
  • chianti, most beers and wines (especially over 120 mL)
  • soy sause, shrimp paste, miso soup
  • sauerkraut, avocados, ripe bananas, fava beans
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29
Q

What are the indications for electroconvulsive therapy?

A

severe, debilitating depression refractory to antidepressants
psychotic depression
severe suicidality
depression with food refusal leading to nutritional compromise
depression with catatonic stupor
situations where a rapid antidepressant response is required (eg pregnancy)
previous good response to ECT
bipolar/mania
schizophrenia/psychosis (catatonia especially)

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30
Q

TCA that can be used to treat bedwetting in children

A

imipramine

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31
Q

Bipolar I disorder

A

at least one manic episode

may or may not have MDD or hypomanic episodes

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32
Q

Bipolar II disorder

A

At least one hypomanic episode
At least one major depressive episode
Never had a manic episode

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33
Q

Manic episode

A

elevated, expansive, or irritable mood
increased goal- directed activity or energy

lasts at least one week

Distractability
Insomnia
Grandiosity
Flight of ideas
Activity/agitation
Speech
Taking risks
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34
Q

Manic episode versus hypomanic episode

A

Manic:
at least 3 DIG FAST symptoms
at least 1 week
impaired function, or requires hospitalizations, or includes psychotic features

Hypomanic episode
at least 3 DIG FAST symptoms
lasts at least 4 days
no impairment in functioning, hospitalizations, or psychosis

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35
Q

Treatment for bipolar

A

Lithium (unless renal failure, in which case lithium is contraindicated and valproic acid and carbamazepine are choice)
Anticonvulsants (valproate, carbamazepine, lamotrigine)

Lithium and anticonvulsants are mood stabilizers

Atypical antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone)
ECT

do not use SSRIs, which can push a patient into mania. treat depression in the setting of bipolar, with mood stabilizers

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36
Q

What are side effects of lithium in treating bipolar disorder?

A

Teratogenesis (Ebstein anomaly)
CNS effects (depression, tremor, cognitive dulling)
Thyroid dysfunction (hyperthyroidism, hypothyroidism, euthyroid goiter)
GI effects (nausea, vomiting, diarrhea, weight gain, metallic taste changes)
Nephrogenic diabetes insipidus (polyuria, polydipsia)

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37
Q

How do we treat nephrogenic diabetes insipidus that results from lithium toxicity?

A

hydrochlorothiazide with amiloride

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38
Q

Ebstein anomaly

A

tricuspid leaflets displaced inferiorly
tricuspid regurgitation or stenosis

RV hypoplasia

+/- patent foramen ovale

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39
Q

Cyclothymic disorder

A

mild hypomanic symptoms that do not meet criteria for a hypomanic episode

mild depressive symptoms that do not meet criteria for a major depressive episode

symptoms are present for at least 2 YEARS (Adults), or 1 year in children

periods of normal mood last less than 2 months during that 2 year (Adult) or 1 year (child) stretch

DOES cause significant distress or impairment in social/occupational functioning

Tx: mood stabilizers, psychotherapy

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40
Q

Dissociative disorders

A

Dissociative identity- multiple personalities, 2 or more distinct identities/ personalities)

Depersonalization/derealization disorder- depersonalization- persistent feelings of detachment from patient’s own body or thoughts, or feeling like people and things around the patient aren’t real

Dissociative amnesia- amnesia for a very specific event, or generalized amnesia of patient’s identity and personal life history.
May include dissociative fugue

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41
Q

Panic disorder

A 
recurrent panic attacks, with abrupt onset of intense fear and anxiety accompanied by 
palpitations or tachycardia
sweating
trembling/shaking
SOB
choking sensation
CP
dizziness/lightheadedness
nausea
hot flashes/chills
paresthesias
feeling of losing control
fear of dying

Panic attach is followed by a period of persistent worry about more panic attacks, or maladaptive behavior to prevent panic attacks. This period lasting at least one month

Treat with CBT, SSRIs, Benzodiazepines acutely (but beware addiction)

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42
Q

Generalized anxiety disorder

A

Excessive anxiety and worry occurring more days than not for at least 6 months

At least 3 of the following symptoms:

  • hyperarousal
  • difficulty concentrating
  • irritability
  • muscle tension
  • difficulty sleeping
  • fatigue

SSRIs, SNRIs, Buspirone, CBT

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43
Q

Specific phobias

A

marked fear out of proportion to the threat the situation poses, with avoidance of the feared exposure

exposure therapy- gradual desensitization

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44
Q

Social anxiety disorder

A

excessive anxiety related to social situations, with fear of being negatively evaluated by others (eg social interactions, being observed by others, performing in front of others)

Treat:
CBT, SSRI, SNRI
Benzodiazepine or beta- blocker (propanolol), as needed for performances

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45
Q

Buspirone as an anxiety medication

A

second- line treatment
may be used as monotherapy or in combination with SSRIs and SNRIs
Affinity for serotonin and dopamine receptors

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46
Q

Benzodiazepines as anxiety meds

A

increase the frequency of opening of GABA- receptor chloride channels

frequent use may lead to tolerance, dependence, withdrawal seizures

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47
Q

agoraphobia

A

excessive fear of being outside the home alone, using public transporation, and being in a crowd

this isn’t a specific phobia

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48
Q

delusion

A

irrational belief that cannot be changed by proof or rational arguments

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49
Q

illusion

A

misinterpret a stimulus that is actually there

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50
Q

hallucinations

A

sensory perception in the absence of external stimulus

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51
Q

Disorganized thought

A

circumstantiality- answers diverge from the question asked but eventually return to the original topic

tangentiality- answers diverge from the question asked and do NOT return to the original topic. The point keeps changing, though you can see the links

Loose associations- no clear sequence to the thoughts presented

Word salad- words strung together incoherently

Neologism- new words

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52
Q

Schizophrenia:at least 2 of the following during a 1 month period (including at least 1 of the first 3)

plus social/occupational dysfunction

for a duration of at least 6 months

A

delusions
hallucinations (most common type is auditory)
disorganized speech
grossly disorganized or catatonic behavior
negative symptoms (flat affect, poverty of speech, lack of emotional reactivity)

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53
Q

Schizophrenia risk factors

A

family history
being born in late winter/early spring
maternal illness/malnutrition during pregnancy
+/- psychoactive drug use during adolescence and young adulthood
male gender

Neuroimaging- enlargement of lateral and third ventricals
cortical thinning

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54
Q

Schizophrenia negative symptoms

A 
flat affect
social withdrawal
avolition/apathy
anhedonia
poverty of speech
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55
Q

schizotypal personality disorder

A

odd thoughts/behavior/appearance

discomfort with interpersonal relationships

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56
Q

schizoid personality disorder

A

voluntary social isolation

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57
Q

schizoaffective disorder

A

psychosis with intermittent mood disorder

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58
Q

schizophrenia

A

psychosis that lasts at least 6 months

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59
Q

schizophreniform disorder

A

psychosis for less than 6 months

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60
Q

brief psychotic disorder

A

psychosis less than 1 month

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61
Q

Delusional disorder

A

delusions for one month or more
no other symptoms of shizophrenia (hallucinations, if present, are not prominent and are related to the delusion)
social/occupational function is not impaired

62
Q

What drugs cause psychosis?

A 
hallucinogens (LSD, PCP)
stimulants (cocaine, amphetamines)
withdrawal from benzodiazepines, alcohol, barbiturates
glucocorticoids
anabolic steroids
63
Q

Parkinson disease

A

loss of dopamine- producing neurons in the substantia nigra

resulting in depigmentation,
increased ACh
increased Lewy body formation (eosinophilic inclusions of alpha- synuclein and ubiquitin proteins, with a halo around the Lewy body)

64
Q

risk factors for PD

A

family history
advancing age
head trauma
MPTP metabolite, which destroys DA cells of substantia nigra

65
Q

Parkinsonism

A

bradykinesia, hypokinesia, akinesia
postural instability (can’t make small adjustments)
festinating gait (difficulty initiating walking)
shuffling gait to keep upright
pill- rolling tremor (while at rest)
cogwheel rigidity
mask- like facies
orthostatic hypotension (autonomic dysfunction)
cognitive dysfunction
depression

66
Q

Huntington

A 
CAG repeat on chromosome cuatro
caudate atrophy on MRI
acetylcholine and GABA are decreased
cognitive decline (dementia)
choreiform movements
cuarenta (40)= age of onset
usually fatal within 20 years of diagnosis

symptomatic treatment with DA antagonists (tetrabenazine), or antipsychotics (haloperidol, risperidone)

67
Q

Personality disorder

A

persistent behavior that deviates significantly from cultural norms, with symptoms that lead to impaired function in society, beginning in late adolescence

and not attributable to:
drug use
medical conditions
other psych disorders

68
Q

Cluster A personality disorders

A

Weird- inability to develop meaningful social relationships, also without psychosis
paranoid
schizoid
schizotypal

69
Q

Paranoid personality disorder

A

long-standing suspiciousness and general distrust of others, look for clues to validate distrust

70
Q

Schizoid personality disorder

A

schizoids avoid
voluntary social withdrawal
limited emotional expressions
don’t smile, content with social isolation

71
Q

schizotypal

A

dressed like a pickle
eccentric appearance, odd beliefs, magical thinking

interact with others awkwardly, visibly odd in their appearance

72
Q

Cluster B personality disorders

A 
wild, drama
Antisocial
Borderline
Histrionic
Narcissistic
73
Q

Antisocial

A

disregard for rights of others, criminality
male>female
“conduct disorder” under age 18

74
Q

Borderline

A

unusual variability and depth of moods
unstable moods
chaotic interpersonal relationships

impulsiveness, self- mutilation (cutting), sense of emptiness

females>males

splitting is typical
high likelihood of suicide

75
Q

Histrionic

A 
Excessive emotions
attention- seeking
seductive behavior
overly concerned with appearance
appearance can be provocative or exaggerated

“odd to us, but to them it looks very special”

76
Q

Narcissistic

A

excessively preoccupied with personal prestige, power, vanity
lack empathy
require excessive admiration

77
Q

Cluster C disorders

A

very anxious and fearful
anxiety disorders

worried, cowardly, compulsive, clingy

Avoidant
Dependent
Obsessive- compulsive

78
Q

Avoidant

A

hypersensitivity to rejection
socially inhibited, timid, feelings of inadequacy

want to relate to others but don’t know how

79
Q

Dependent

A

psychologically dependent on other people
very low self esteem
submissive and clinging
excessive need to be taken care of

80
Q

Obsessive- compulsive personality disorder

A

preoccupation with order

concerned with perfectionism and control

81
Q

Substance use disorder

A

problematic pattern of substance use that leads to significant impairment or distress

Characterized by
tolerance
withdrawal symptoms
persistent desire or unsuccessful attempts to cut down
Significant energy spent obtaining, using, or recovering from the substance
Important social, occupational, or recreational activities reduced
Continued use in spite of knowing the problems that it causes
Craving
Recurrent use in physically dangerous situations
Failure to fulfill major obligations at work, school, or home
Social or interpersonal conflicts

82
Q

Alcohol intoxication

A

CNS depression, mood elevation, disinhibition, decreased anxiety and sedation, severe mental impairment, somnolence, respiratory depression

83
Q

Alcohol withdrawal

A

agitation, anxiety, insomnia, tremor

84
Q

Where does alcohol act on the brain

A

GABA receptor, similar to benzos

85
Q

Treatment for alcohol intoxication

A

time, can be life-threatening

anxiety, tremor, agitation, tachycardia, severe withdrawal causes DT (2-3 days after cessation)

86
Q

Delirium tremens (DT)

A

2-3 days after cessation of alcohol
nightmares, agitation, disorientation, visual/auditory hallucinations, fever, hypertension, diaphoresis, seizures, autonomic hyperactivity

87
Q

how to treat alcohol withdrawal

A

benzodiazepines, preferably long-acting benzodiazepines
diazepam
lorazepam
chlordiazepoxide

88
Q

Complications of longterm alcohol use

A 
liver damage
fatty change (hepatocytes)
increased GGT
increased AST and ALT
alcoholic cirrhosis
hepatitis
pancreatitis
peripheral neuropathy
testicular atrophy
aspiration pneumonia
-klebsiella

GI bleeding

  • mallory- weiss tears
  • esophageal variceal bleed

malnutrition

  • b12
  • Wernicke-Korsakoff due to B1 thiamine deficiency
  • Wernicke is the thiamine deficiency
  • Korsakoff is secondary to Wernicke
89
Q

Wernicke encephalopathy

A 
confusion
nystagmus
ophthalmoplegia
ataxia
sluggish pupillary reflexes
coma 
death if untreated
90
Q

Korsakoff syndrome is the fallout of Wernicke

characteristics include…

A

anterograde amnesia
retrograde amnesia
confabulation
hallucinations

this is due to atrophy of the mammillary bodies

treatment:
IV thiamine BEFORE glucose repletion

91
Q

Thiamine vs glucose for the alcoholic (or malnourished) patient?

A

Always give thiamine before glucose to any patient with mental status changes or to any malnourished alcoholic patient

92
Q

treatments for alcoholism recovery

A 
alcoholics anonymous
naltrexone
disulfiram
topiramate
acomprosate
93
Q

Benzodiazepine intoxication

A 
CNS depression
decreased anxiety
disinhibition
coma
respiratory depression
94
Q

Benzodiazepine withdrawal

A

agitation
anxiety
seizures

95
Q

How do we treat Benzodiazepine overdose

A

flumazenil

96
Q

5 stages of behavioral change

A

precontemplation
contemplation
preparation

97
Q

precontemplation

A

patient in denial, doesn’t ackowledge that there is a problem

98
Q

contemplation

A

thinking about change, though they aren’t ready for it yet

99
Q

preparation

A

making concrete plans to change

100
Q

action

A

implementing the plan

101
Q

maintenance

A

the change had been made and they are ready to not go back to previous behaviors

102
Q

Amphetamines

A

increase release of intracellular stores of catecholamines

103
Q

cocaine

A

blocks reuptake of catecholamines (in the synaptic cleft)

104
Q

amphetamine and cocaine intoxication

A

euphoria and high energy

this may lead to agitation, anxiety, insomnia

increased BP, tachycardia, cardiac arrest, stroke (cocaine), pupullary dilateion, erosions in the nose (cocaine)

105
Q

indications for amphetamines

A

ADHD

short- term weightloss

106
Q

Amphetamine and cocaine withdrawal symptoms

A

depression
lethargy
weightgain
headache

107
Q

Treat amphetamine intoxication

A

benzodiazepines

haloperidol

108
Q

treat cocaine intoxication

A

benzodiazepines
haloperidol
no beta blockers, because the alpha receptors will continue to be stimulated
phentolamine is an alpha blocker that could be useful

109
Q

caffeine and nicotine intoxication

A 
excitability
restlessness
diuresis (caffeine)
premature atrial contractions
premature ventricular contractions
110
Q

caffeine and nicotine withdrawal symptoms

A

irritability
anxiety
craving
tiredness

111
Q

Treating nicotine withdrawal

A

nicotine replacement
(patch, gum, lozenge)

buproprion
varenecline

112
Q

hallucinogen intoxication

A 
hallucinations
delusions
anxiety
paranoia
tachycardia
pupillary dilation
flashbacks (chronic use)
113
Q

treat hallucinogen intoxication

A

remove patient from dangerous environment and place in a quiet dark room

antipsychotics (PO, IM)
Benzodiazepines for anxiety and agitation

114
Q

marijuana intoxication

A

euphoria, sense of well-being
anxiety, paranoia, delusions

perception of slowed time
impaired judgment
social withdrawal 
increased appetite
dry mouth 
hallucinations
redness of eyes
115
Q

marijuana withdrawal

A

irritability
insomnia
nausea

peak 4-8 hours, but still there for about a month

116
Q

opioids (morphine, heroin, methadone)

A 
CNS depression
Euphoria
n/v
constipation
pupillary constriction (miosis)
seizures
respiratory depression
117
Q

Treat opioid intoxication with

A

naloxone

naltrexone

118
Q

opioid withdrawal- symptoms and treatment

A 
sweating
dilated pupils
piloerection
yawning
rhinorrhea
flu-like symptoms

uncomfortable but not life- threatening

treat with methadone, suboxone (naloxone plus buprenorphine- this decreases withdrawal symptoms without providing a satisfying high)

119
Q

PCP

A 
belligerance
impulsiveness
agitation
nystagmus (horizontal and vertical)
homicidal ideation/ violence
psychosis
delirium
120
Q

How to treat PCP intoxication

A

treatment: benzodiazepines, antipsychotics

121
Q

PCP withdrawal

A

violence (again)
depression
anxiety
irritability

122
Q

Anorexia

A

patient refuses to maintain normal body weight
risk factors- female adolescents (14-18yo especially)
high socioeconomic status

diagnosis:
distorted body image
intense fear of gaining weight
restricted caloric intake relative to energy requirements

features:
amenorrhea
cold intolerance and/or hypothermia
dry, scaly skin
hair loss
lanugo (fine, downy hair)
hypogonadism
osteoporosis
comorbid anxiety, OCD, depression

treatment:
psychotherapy
SSRI for comorbid depression or anxiety
buproprion is contraindicated (risk of seizures)
hospitalization may be required to address nutritional deficiencies and complications

123
Q

What is refeeding syndrome?

A

Sudden shift from fat metabolism to carbohydrate metabolism may cause-

hypophosphatemia
hypokalemia
hypomagnesemia
CHF and arrhythmias
Rhabdomyolysis
Delirium
Seizures
124
Q

Bulimia nervosa

A

Bulemics usually maintain a normal body weight

Recurrent episodes of binge eating

Inappropriate compensatory behaviors to prevent weight gain (purging, intense exercise, severe caloric restriction)

Recurrent vomiting may cause

  • scarred hands
  • dental erosions
  • enlarged parotid glands and elevated serum amylase
  • hypochloremic metabolic alkalosis

treatment:

  • cognitive behavioral therapy
  • pharmacotherapy: SSRIs
125
Q

Binge- eating disorder

A

episodes of binge eating
no inappropriate compensatory behaviors
patients tend to be overweight/obese

treatment:
- cognitive behavioral therapy
- SSRIs, topirimate, stimulants

126
Q

Obsessive- compulsive disorder

A

Obsessions: recurrent, UNWANTED, intrusive, anxiety- provoking thoughts or urges
Compulsions: repetitive behaviors or mental acts performed to relieve the anxiety caused by obsessive thought.

Diagnosis requreist hat the obsessions and compulsions are TIME- CONSUMING and cause impairment in social/occupational functioning

Treatment: cognitive behavioral therapy

Exposure and response prevention

Pharmacotherapy (SSRIs)

combination can be effective

127
Q

Body dysmorphic disorder

A

preoccupation with a perceived defect in appearance

repetitive behaviors/mental acts related to perceived defects (can be internal or external)

Treatment:
avoid performing needless surgery
psychotherapy
SSRIs for refractory cases (off label use)

128
Q

Hoarding disorder

A

anxiety, distress associated with getting rid of stuff

diagnosis requires impaired social function

129
Q

changes associated with bulimia?

A

hypochloremic metabolic alkalosis from vomiting

increased amylase from salivary gland inflammation

130
Q

Trauma disorders

A

PTSD
Acute stress disorder
Adjustment disorder

131
Q

PTSD diagnosis

A
  1. exposure to something traumatic
  2. Rexperiencing the traumatic event (memories, dreams, flashbacks)
  3. Avoidance of stimuli associated with the traumatic event
  4. Negative changes in cognition and mood
  5. Hyperarousal (irritable behavior, reckless behavior, hypervigilance, sleep disturbance)

These symptoms have to last at least 1 month

132
Q

What are the treatment options for PTSD?

A

Psychotherapy, including behavioral (exposure) therapy and cognitive therapy

SSRIs are first line
Benzodiazepines should be avoided due to lack of efficacy and potential for abuse

alpha blocker (prazosin) may be used to resolve nightmares and improve sleep

no evidence to support use of TCAs, MAOIs, atypical antipsychotics, or mood stabilizers

133
Q

acute stress disorder versus PTSD

A

This is like PTSD but

134
Q

Adjustment disorders

A

emotional response to psychosocial stressor

-depressed mood
-anxiety
-disturbance of conduct
in any combination

  • clinically significant emotional or behavioral reaction causing marked distress and/or impairment in social/occupational functioning
  • symptoms develop in response to an identifiable psychosocial stressor (cancer, divorce, death of a loved one, family conflict, loss of job, moving, major life changes)
  • symptoms begin within 3 months of the onset of the stressor
  • symptoms disappear within 6 months of the stressor disappearing

Also, the symptoms cannot meet the criteria for another disorder

135
Q

Somatic symptom and related disorders

A

conversion
somatic symptom disorder
illness anxiety disorder
factitious disorder

136
Q

Conversion disorder

A

Neurological sx without recognized or medical cause

  • motor: weakness/paralysis, tremor, dystonia/myoclonus, gait disorder, dysphagia, dysphonia
  • sensory (numbness/paresthesias, blindness, deafness)

May or may not be the result of a specific psychological stressor

137
Q

How to treat conversion disorder

A

psychotherapy, CBT, physical therapy

find the root

138
Q

Somatic symptom disorder

A

one or more somatic symptoms that is distressing or distruptive

  • disproportionate and persistent thoughts about the seriousness of the symptoms
  • high anxiety about health or symptoms
  • excessive time and energy to symptoms or health concerns

Note: hypochondriasis no longer exists

139
Q

Illness anxiety disorder

A
  • preoccupation with having or acquiring a serious illness
  • high level of anxiety about health
  • individual performs excessive health- related behaviors
  • somatic symptoms are not present

helpful to see these patients at regular intervals

140
Q

Factitios disorder (Munchausen syndrome)

A

intentional induction of injury or disease, or falsification of signs/symptoms of illness

patient presents him/herself as ill or injured

deceptive behavior is present even in the absence of external reward

141
Q

Factitious disorder imposed on another (previously known as Munchausen by proxy)

A

child or elder abuse,

also in the absence of external gain

142
Q

Malingering

A

not a mental disorder

external reward desired

143
Q

overwhelming worry about contracting a serious illness, without any signs or symptoms

A

illness anxiety disorder

144
Q

overwhelming worry about the seriousness of existing physical symptoms

A

somatic symptom disorder

145
Q

ADHD

A

decreased attention span
inability to complete tasks
forgetfulness
excessive talking and movement

for diagnosis, questionnaires are given toparents as well as 2 people who have direct contact with the student

diagnosis: 6 inattention or 6 hyperactivity/impulsivity symptoms before age 12

The symptoms limit the ability to function in social, educational, or organized settings

146
Q

ADHD treatment

A
  1. stimulants
    methylphenidate
    lisdexamfetamine
    dextroamphetamine
  2. atomoxetine (milder, but also helps with focusing behavior)
  3. Tricyclic antidepressants:
    - imipramine
    - desipramine
    - nortriptyline
  4. buproprion
  5. Clonidine alpha-2 agonist
  6. eliminate foods high in caffeine and sugar
147
Q

Common complications of ADHD stimulant medications

A
  1. insomnia- sleep hygiene, take meds earlier, short duration formulation, clonidine at night
  2. appetite suppression and weightloss- administer meds after meals rather than before
  3. Tics- usually transient, choose low- moderate dose methylphenidate, which does not worsen tics
  4. psychosis- discontinue (no need to taper)
  5. decreased growth velocity (reassure parents that adult height is not affected. drug holidays can help with catch up growth.
148
Q

Side effects of atomoxetine

A
  1. increased risk of suicidality- close observation and usually discontinuation
  2. liver injury (d/c without taper)
149
Q

Tourette syndrome- therapeutic options

A

counseling/psychotherapy for social adjustment and coping

if interfering with necessary functions of life- anti-dopamine agents can be used

  • fluphenazine
  • pimozide
  • tetrabenazine

(all are generally tolerated better than haloperidol)

if only focal motor or vocal tics, Botox injections into affected muscles

if impulse control problems, clonidine or SSRIs

if refractory to medical management, consider deep brain stimulation of globus pallidus, thalamus, or other subcortical target (undergoing clinical trials)

150
Q

Autism spectrum disorder

A

severe, persistent impairement in interpersonal interactions

patient who is “living in his own world”
symptoms prior to age 3
lack of responsiveness to others, poor eye contact, absent social smile

impaired communication, language delay, repetative phrases

peculiar repetitive, ritualistic habits (spinning, hand flapping)

fascination with specific, seemingly mundane objects (vacuum cleaners, sprinklers)

below- normal intelligence

r/o metabolic causes
tx: behavior, speech, social, psychotherapy with peers
supervision if severe

STEP2 (34 decks)

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