psychiatry/behavorial Flashcards
a 15-year-old girl with type 1 diabetes mellitus and hypothyroidism presents to the emergency department because of sweating, shaking, and palpitations. This morning she was asked to deliver a speech for a class assignment. She states that she suddenly started to fear that she would make a mistake and her classmates would start laughing at her. The onset of symptoms began shortly after. Her blood glucose and thyroid studies are all normal.
What is the likely Dx?
generalized anxiety disorder
To have full blown generalized anxiety disorder what criteria do you need to meet?
persistent and excessive worry pertaining to multiple events or domains that continue for 6 months or more
What is the Tx for GAD?
SSRIs- Paroxetine and escitalopram
SSNRI- Venlafexine
Buspirone- can be helpful but takes 2 weeks before it starts to kick in
How is panic disorder described?
characterized by recurrent unexpected panic attacks with at least a month of worry or avoidant behavior
What is the Tx for panic disorders?
SSRIs: Paroxetine, Sertraline, Fluoxetine
Benzodiazepines: for acute attacks (watch for abuse)
CBT (relaxation, desensitization, examining behavior consequences)
What is the Tx for phobias?
Exposure therapy (first line), teach to relax and try to understand/overcome the fear
SSRI + CBT
Benzodiazepines (i.e prior to flying)
Treat agoraphobia just as GAD with SSRIs and CBT
a 9-year-old boy who is brought by his mother after the child was suspended from school for being disruptive during class. The teacher noted that the patient is always fidgeting, has difficulty concentrating, and does not complete assignments. His mother notes that he often gets up and runs around the house when she is trying to call everyone for dinner and that this has been going on since he was 6 years old
What is the likely Dx?
ADHD
How is ADHD characterized?
problems paying attention, excessive activity or difficulty controlling behavior which is not appropriate for a persons age
When evaluating a pt you suspect ADHD in what are you looking for?
Hyperactivity, impulsivity, or inattentiveness manifesting prior to age 12 years.
> 6 symptoms of inattention, hyperactivity-impulsivity, developmentally inappropriate and duration of symptoms > 6 months
Symptoms must occur in more than one setting (example school and home)
individuals diagnosed with autism spectrum disorder have developmental delays in what categories
- socialization
- language
- cognition
a 3-year-old boy is brought to your office by his mother due to abnormal behavior. She reports that he does not appear to respond to affection, does not look her in the eyes, and constantly lines up his toys. He becomes agitated when she tries to take him away from his toys or if the mother cooks a different meal for dinner. On physical examination, he does not respond to questions and is distracted by the texture of the exam-table cloth.
What is the likely DX?
Autism spectrum disorder
Autism spectrum disorder can be used as an umbrella term for which other neurodevelopmental disorders
- childhood disintergrative disorder
- pervasive developmental disorder
- Asperger disorder
Describe asperger disorder?
a child has normal cognitive development, poor relationships and does not spontaneously seek activities with others
What are the DSM V criteria for Autism Spectrum disorders?
- social communication and social interaction deficit
- Restricted and repetitive patterns of behavior
- Symptoms must be present in the patients early developmental period
- Symptoms can not be better explained by other conditions
Tx for autism spectrum disorders?
Refer – Autism specialists, speech & language pathologist
Audiology evaluation, +/- EEG
Behavioral therapy
Medications used to treat autism spectrum disorders?
second generation antipsychotics- Risperidone, aripiprazole
SSRI’s- of course
a 16-year-old is brought to your office by her parents because they are concerned that she is acting differently. She is quiet and denies any changes in her personality or drug use. The parents step out of the room at your request and she begins crying. She states that school has been very difficult and has been very depressed for the past 6 months. She feels tremendous pressure from her parents and coaches. She says that she has been cutting her wrists for the past week and is planning to commit suicide. She instantly regrets telling you and begs you not to tell her parents.
likely DX?
depressive disorder
What is the criteria for major depressive disorder?
5 or more SIGECAPS for GREATER THAN OR EQUAL TOO 2 weeks, nearly everyday and at least one of the symptoms is depressed mood or anhedonia
What is SIGECAPS
S-sadness I- interest/anhedonia G- guilt E- Energy C- concentration A- Appetite P- Psychomotor activity S- Suicidal
What is the firs line Tx for major depressive disorder?
SSRI
What is the criteria for persistent depressive disorder?
depressive symptoms for >2years
They have not been without the depressive symptoms for for more than 2 months
There has never been a manic episode or hypomanic episode
If youre reading a question and it has that the pt has repeated episodes of significant depression and related symptoms during the week before menstruation what are you thinking they have?
Premenstrual dysphoric disorder
What is the Tx for premenstrual dysphoric disorder?
- SSRI (fluoxetine, sertraline, paroxetine, esctialopram) are first line
- Birth control, low dose estrogen, and diruretics
- SNRI such as venlafaxine may also be effective in women with predominatly pyscho symptoms
a 13-year-old boy is brought in by his parents as they are concerned about his behavior. He argues constantly with his parents and defies their every request. In school, he is tardy and does not listen to his teachers. He admits to starting smoking to bother his parents and he is disrespectful towards you. You learn that he has also gotten into weekly fights with his peers at school with no apparent cause. In addition, last week he was seen hitting one of the local neighborhood cats with a baseball bat trying to kill it. The patient lives at home with his two parents. The physical exam is unremarkable.
Likely Dx?
conductive disorder
Conduct disorder is described as?
a repetitive and persistent patter of behavior which the basic rights of others or major age-appropriate societal norms or rules are violated
Conduct disorder is commonly the precursor to what other disorder?
antisocial personality disorder
What are some behaviors seen in conduct disorder
- aggression to people or animals
- Destruction of property
- Deceitfulness or theft
- Serious Violations of rules
What are the differences btw oppositional defiant disorder and conduct disorder?
children with oppositional defiant disorder are
- Not aggressive towards people or animals
- do not destroy property
- do not show a pattern of theft or deceit
What are the treatment methods for oppositional defiant disorder?
- Pyschotherapy (CBT, Family therapy)
2. Pharmacotherapy- mood stabilizers, antipsychotics and stimulants
a 17-year-old female who is in your office for an annual sports physical. She is the star of her high school track team. She has not menstruated for 5 months. Her BMI is 15 kg/m2. On physical exam, you note calluses on the back of her hands and fine hair on her arms. She states that she only eats vegetables but has been trying to cut back as she thinks she is holding excess body fat.
What is the likely Dx?
Anorexia nervosa
How can you distinguish between anorexia nervosa and bulimia nervosa?
by body mass index <17 or bodyweight <85% of ideal body weight
What are the two types of anorexia nervosa?
- Binging/purging- Laxatives/diuretics abuse (dulcolax)
2. Restricting- Eating very little, exercise to excess
If weight is less that 75% of ideal body weight should they be hospitalized or just restore nutrients outpatient?
hospitalized
Describe bulimia nervose?
patient who has episodes of mass eating followed by self-induced vomiting or intense exercise
What would you see on exam in a Pt with bulimia nervosa?
- scars on knuckles
- Swollen parotid glands
- Dental erosions
4 Normal weight - Hypokalemia
What type of metabolic disorder can come from bulimia nervosa? alkalosis or acidosis?
metabolic alkalosis
Urinary chloride will be <20meq
What is the recommended pharmacotherapy for bulimia nervosa?
Fluoxetine 60mg PO once/day
What is the second leading cause of death in ages 15-19?
suicide
