psychiatry Flashcards

1
Q

panic attack

A

rapid onset of severe anxiety

last

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2
Q

generalized anxiety disorder

A

excessive anxiety over general life events > 6 months

dx criteria: > 3
-restless or hypervigiliance
easy fatigue
irritability
sleep disturbance
mm tension
difficulty concentrating
( present with HA or fatigue)
  • onset in 20s
  • r/o medical disorders ( substance abuse, thyroid issues, over use of caffeine

tx: behavior therapy+meds
- ssri, snris, buspirone
- benzols as short term- for severe sxs.
- TCAS may help 2nd line.

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3
Q

PTSD

A

exposure to traumatic event

sx: last greater than 1 month
-develop in as little as one a week
-
3 major elements:
reliving trauma, detachment, and hyperarousal

men-combat experience
women-rape/assualt

dx: 
reliaient event- memories/ flashback
-avoids places/people to remind of event
-increased arousal - sleep issues and anger
-exagerated started response

tx: 1st line SSRI ( sertaline/ paroxetine)
benzos, trazodone for insomnia

crisis counseling

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4
Q

phobias

A

most common mental disorder in US
-irrational fever/ persistent excess anxiety when present with object/situation
has to appear functioning

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5
Q

specific phobia

fear of specific object/

A

animal/ insects
natural phenomena
blood, needles,
situational

onset in childhood

tx: desensitization /exposuretherapy
- short term bentos

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6
Q

social phobia

A

fear of social situations in which embarrassment to humiliation may occur
Inciting events:
public speaking, using restrooms, eating in public

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7
Q

agoraphobia

A

anxiety about placing self in situation in which a problem may occur and help

Inciting events:
outside the home
on a buse/ train

sx: panic attack
F>M

tx; SSRI, SNRI ( effexor)
2nd line- benzos, TCA

  • beta blockers can help with tremor and performance situations
  • insight therapy, gradual exposure.
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8
Q

OCD

A

thoughts, images that are intrusive and inappropriate resulting in activity

-ego distonic- causes distres to pt

types: contamination, worry about doing things, intrusive thoughts, need for symmetry, religious, compulsive hoarding, pull out hair, counting/ repeating phrase
tx: behavioral /relaxation therapy
SSRI- higher doses

TCA
in refaratcoty cases: gabapentin, effexor, zypreza , lithium

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9
Q

attention deficit disorder

A

20-50 percent have dysfunctional sxs as adults

M>F , first born son

dx;
hyperactivity, impulsivity, or inactiveness before age 7

occurs> 2 settings
> 6 sxs of inattention, hyperactive, developmentally inappropriate and present for > 6 months.
sx: fights/squims, leaves seat often, restlessness, talking excessively
inattention sxs: IOWA Connors rating scale
careless mistakes , forgetful, easy distracted

tx: 1st line- Ritalin, Concerta, Daytran ( watch for weight loss and growth retardation)
-adderall
2nd line- anti depressants
behavior modification

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10
Q

autism

A

> 6 sxs
impaired social interaction( need 2)
- lack of eye contact by 18 months

impaired communication( need 1)

  • don’t progress with language ( 12-18 months)
  • repetitive language

repetitive behvoir/ activities

  • intense ritual
  • upset by change in routine
  • preoccupation with parts of objects

tx: therapy - behavior

EEG- 25% have seizure disorder

risperdole/ abilify
haldol
SSRI- help with repetitive behavior

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11
Q

anorexia nervosa

A

common in developed countries, ballet, 15-30, females

  • self-imposed starvation
  • less than 85% of expected wt for height( > 15% below norma)
  • egocentonic, not distressing to patient

restrictive- eat very little, odd food-related obsessions

binge eating/purging- eat in binding–> purging

  • complications:
  • electrolyte abn
  • hypothermia
  • orthrostatic hypertension
  • lanugo
  • loss of tooth enamel, cavities

tx: restore nutritional state
hospitalize > 20% below expected wt

out pt-
behavoir/ family therapy
supervised wt gain

-use antidepressants but make sure weight loss not a SE
Wellbutrin CI

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12
Q

buleimia nervosa

A
high achievers
binge eating
- tend to maintain a normal body weight or overweight
-purging--> self-induced vomiting
-excessive exercise or fasting

ages 15-30

physical findings:
dental erosions, calluses on hands, esophagitis
electrolyte deficiencies

tx; restore nutritional state
SSRI help
Wellbutrin CI
behavoir/ family/ group therapy

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13
Q

obesity

A

> 20% over ideal body wt
-binge eating > 2 days/wk for 6 months
3
-eating rapidly, eating alone and eating until comfortable

tx: behavoir modification/ group therapy
food diaries
new eating patterns
tx underlying depression

adjuncts to suppress appetite: adiphex, didrex, xenical
gastric bass

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14
Q

adjustment disorders

A

emotional sxs in response to stressors:
- job loss, divorce, schoo/ financial problems, moving out of home,
resolves w/in 6 months

happens 3 months after stressors
sxs; depressed mood, teafullnes, anxiety

tx: 1st line -psychotherapy
sleep aides
bentos, hypnotics
SSR’s

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15
Q

Major depressive disorder

A

chronic coure
happens more in females

dx: SIG E CAPS
Sleep, interest, guilt,energy, concentration, appetite, psychomotor

tx: acute- SSRI
if no response > 6 weeks- rethink dx–> increase dose

combine therapy
behavior
ECT- severe depression, not eating, pregnant

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16
Q

SAD

A

fall or winter onset
ofter remits in spring
more common in colder climate

tx: light therapy
SSRI
wellbutrin

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17
Q

melancholia

A
anhedonia
psychomotor retardation
anorexia
depressed mood
feelings of guilt
sleep disturbance
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18
Q

atypical depression

A
overeat
over sleeping
reactive mood
leaden paralysis
oversensitive to interpersonal rejection

tx: MAOI ( marplan/ parante)
SSRI, atypical antipsychotics may help

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19
Q

catatonic depression

A

pt refuse to cooperate fo no reason
echolalia- echoing of others words

tx: benos
ECT
Valproic acid, lithium

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20
Q

psychotic depressio

A

delusions or hallucinations

tx: benzos and anti-depressants
anti-depressants + 2nd gen antipsychotic

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21
Q

postpartum depression

A

onset 4 weeks of delivery

tx: sertaline- oka with breastfeeding
estrogen may help

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22
Q

drug tx

A

1st line- SSRI

need to continue for 6 months or more

may add effector, cymbals

2nd line- TCA/tetracyclines

3rd line- MAOI- lease likely

SE: SSRI- GI upset, HA, sexual issues
TCA/tetracycline: wt gain, orthrostatic hypotension, somnolence
MAOI- need tyramine- free diet ( no wine, beer, most theses, smoked meat)

serotonin syndrome: acute onset ( minutes),
disorientation, n/v, hypothermia, coma, death
tx: benozo, aggressive cooling, IV hydration

23
Q

ECT for mood disorders

A
  • unresponsive pt
  • need a quick improvement
  • elderly and pregnancy
  • AE: memory loss, HA, nausea
24
Q

suicide risks

A
prior attempt
white male
> 45 y/o
 self-destructive pattern
recent sever loss
singel, separate
25
dysthymic disorder
chronic mild depression dx: depressed mood most of day X 2 years - need 2- SIG E CAPS ts: SSRI SNRI wellubrin TCA
26
bipolar 1 disorder
> 1 manic episodes and cycle with depression manic - abrupt escalation of mood- days without sleeping/ self-inhibited racing thought, flight of idea tx: lithium, valproate, zyprexa mania- gapatenin, lamictal depressive: SSRI, zyprexa family group/ cognitive therapy
27
bipolar 2
> 1 major depression > 1 hypomanic ( less severe) tx: same as bipolar 1
28
psychotic disorders
tried psychotic | > 1 day
29
delusional disorder
non bizarre delusions for > 1 dos behavior not obvious is odd ``` subtypes: erotmatic somatic jealous persecutor grandiose tx: antipsychotics ```
30
schizophrenia
chronic, depilating course lack insight, don't think behaviors is abn beter px if: late onset acute onset onset before 15 or after 50 rare subtype- paranoid most common catatonic- rare dx: > 2 in 1 mos periods and > 6 months - delusions - hallucinations - disorganized speech/thought processes sx: have to disrupt daily function tx; hospitalize therapy with 2nd generation anti-psychotic behavior therapy watch for side effects: extrapyramidal, parkinson sxs, neuroleptic syndrome, traduce dyskinesia
31
schizoaffective disorder
have major depressive, panic, or mixed responses - hallucinations or delusions present for 2 ore more weeks without mood sxs - better px than schizo tx: -2nd gen anitpsychotics - an add antidepressant/lithium/valproate - ect for mania/depression
32
somatization disorder
- weakness, dizziness, and pain, joint pain, back pain, nausea - onset before age 30 - have another mental disoorder tx: monthly schedule appointment resistant to see mental health provider -avoid medication
33
conversion disorder
> 1 neuro complaints not explained by medical/neuro disorder - unexpected lack of concern of sxs - paralysis, blindness, mutism sx: motor or sensory - lump in throat - deafness - seizures most common in teens and young adults r/o medical causes tx: therapy short term anxiolytics ( ativan)
34
hypochondriasis
- preoccupation wth belief/fear of medical investigation reveals not dx tx: therapy and regular appt SSR with depression and anxiety
35
Body dysmorphic disorder
- occupation with imagined defect in physical appeareance/exaggeratd distortion of minor flaw - face, hair, skin, breasts, genitalia tx: ssris reduce symptoms in > 50%, therapy
36
pain disorder
pain > 1 areas with no known cause - sx not intentionally produced tx: therapy, pain control program, SSRis, TCA - analgesics/sedatives not beneficial, can lead to abuse/dependence
37
substance use
- substance dependence 3 of the following tolerance withdrawal inability to quit ``` not able to keep up with commitment ETOH s/sx: look at GGT withdrawal- shakes, seizures tx: valium, thiamin, MMW, folic acid, antipsychotic ``` disulfarim+ETOH = nausea Detok, AA simulations( cocaine, crack) tx: bentos, antipsychotics opioids( morphine, oxycodone) tx: methadone or clonidine tapering dose benzos for mild withdrawal NSAIDS for mm aches naloxone CNS depressants-taper med over time nicotine- zyban, chanted, clonidine, inhaler marijuana- use anxiolytics
38
personality disorders
onset in teens/early adulthood - rigid inflexible traits - don't have insight into problem
39
Personality Diorders
Cluster A-odd, weird schizoid schizotype paranoid ``` Cluster B- BAD- emotional, impulsive, dramatic -antisocial borderline histrionic narcissistic ``` Cluster C-SAD anxious fearful avoidant obsessive-compulsive pervasive pattern of behavior
40
schizoid
``` >4 detached, don't want any activities with family aloof very constricted affect reality testing ``` tx: individual cognitive, group therapy low does ( zyprexa, risperidone) -ssri and stimulants
41
schizotypal
weird fantasies or odd religious practices most common to turn into schizophrenia - strange beliefs - bizarre appearance - not full blown pyschosis tx: therapy, social skills training antipsychotics antidepressants
42
paranoid
long standing mistrust and suspiciousness hostile > 4 other are deceiving them reluctant to confide in others persistent (bears grudges) tx: 1st line- individual therapy behavior techniques low dose anxiolytics/antipsychotics
43
antisocial
failure to conform to social standards manipulative, no empathy more common in urban areas, prisons begins as conduce disorder- h/o physical/sexual abuse/hurting animals, starting fires ``` > 3 18 or older impulsive irresponsible reckless ``` tx: psychotherapy ssri, lithium
44
borderline
border of neurosis or psychosis moody, suicidal, emptiness ``` > 5 -unpredictable behavior impulse spending or sexual disorder -self harm or suicide attempts -cannot tolerate being alone ``` tx: splitting- people are either all good or all bad 1st line- dialectical behavior therapy ( group therapy) meds- antipsychotics, SSRI short term benzos
45
histrionic
center of attention attention seeking exaggerate thought and feelings -somatization, substance disorders tx: 1st line- group therapy +/- antidepressants/anxiolytics ( regression)
46
narcissistic
big ego - feel they are special - sense of self -entilment - midlife crisis tx: 1st line psychotherapy pharm rarely indicated
47
avoidant
extreme sensitivity to rejection - see themselves as unappealing tx: therapy
48
obsessive compulsive
- perfectionism - excessive adherence to morals - reluctance to relate tasks - poor social skills - hoarding personality- OCPD- ego syntonic - no recurrent obsessions OCD is ego- dystonic + obsessions/compulsions tx; 1s line- cognitive-behavior therapy SSRI help reduce anxiety
49
acute stress disorder
similar to PTSD - differ in onset and duration - PTSD sxs develop anytime after event and last > 1 month - occur w/in 1 month of traumatic event MVA ``` exposure to traumatic event > 3 sense of numbing or detachment reduce awareness of surrounds derealization depersonliziton ``` - distress of event relived in flashback/exposure to trauma tx: therapy/support group SSRI, TCA, anticonvulsants, anxiolytics
50
child abuse
physical signs - any injury that cannot be explained - spiral fx - burns - brusises or injuries in regular patterns ( face, back, buttocks, thighs - internal hemorrhage kids manifest: anxiety, PTSD, depression, failure to thrive neglect: an adult allows leaving a child less than 13 ``` common age: 9-12 male known by child any raises - anal, itching - knowledge of sexual acts -sexual knowledge ```
51
elder abuse
- bruises, weiht loss, lack of glasses or hearing - s/s drugging - lack of medical care - threat - refusing to let them travel- - financial abuse - neglect- denying them of their basic rights wath out for caregiver wth -don't allow pt to answer
52
domestic violence
- may close ranks with abuser - who leaves abuser has greater risk of being killer - suffer damage to ego defense management: medical attention and contact numbers to referral agencies
53
uncomplicated bereavement
-normal gried- resolve in 1 year sxs: shock, confusion, sadness, numbness, guilt may report illusions or deny aspect of death tx; social contact/ reassurance +/- bentos for insomnia
54
neuroleptic malignancy syndrome
-occur with high potency antipyschotica lead pipe rigidity elevated CPK DSM5.org