psychiatry disorders Flashcards
basis of cognitive behavior therapy
thoughts determine emotions
recognize unrealistic perceptions + behavior patterns
replace negative thoughts with images/actions that facilitate recovery
journaling
challenging beliefs
mindfulness of thoughts and how affecting emotions
relaxation
cognitive behavior therapy treatment tools
analysis of dreams, fantasies, associations, as well as verbal and physical expression of thoughts
therapist helps client to recognize and confront the inner conflicts responsible for symptoms and behavior problems
psychoanalysis
fractures at various phases of healing rib fractures spiral fracture: twist arms subdural hematoma: blunt trauma or shaking child retinal detachment: shake baby
child abuse
physician is legally obligated to report to CPS suspected
child abuse
child neglect
if suspect sexual abuse
look for evidence of anal or genital trauma
if + STD = sexual abuse
sexual knowledge or behavior
failure to provide food shelter supervise medical neglect failure to send to school
child neglect
poor socialization skills poor language skills inability to trust others poor feeding weight loss poor muscle tone
child neglect
consequence of child neglect: emotionally withdrawn sadness fearfulness irritability
reactive attachment disorder (> 9 mo)
onset: 3-4 yo
1) deficits in social communication and social interaction: “living in his own world”, lack of responsiveness to others, delayed language, poor eye contact, no social smile
2) restricted or repetitive behavior:
rocking, spinning, hand flapping
insistence on sameness, inflexible adherence to routine
fixation or fascination of objects: vacuum cleaner, sprinklers
hyperreactivity or hyporeacivity to sensory input (don’t notice extreme of temperature)
autism spectrum disorder
onset must be
ADHD
treatment of ADHD
CNS stimulants:(amphetamines ↑ release of NE) methylphenidate (ritalin) dexmethylphenidate dextroamphetamine (adderall) NE reuptake inhibitor: atomexetine
onset: school-age
fear of separation from:
parents, home, blanket
impairs functioning: won’t go to school
separation anxiety disorder
related to OCD
chronic, compulsive, nervous hair pulling
young girls
broken hairs of varying length
relieves stress
treatment: education (stop pulling hair) → CBT: mindful, what is the stress, deal with it → fluoxetine (SSRI) or clomipramine (TCA)
hair-pulling disorder (trichotillomania)
impulse-control disorder pattern of behaviors that violate social norms and RIGHTS OF OTHERS - don't care if society says its wrong to do: aggressive violent threatening/bullying destruction of property deceitful theft: blow up car cruelty to ANIMALS
conduct disorder (
impulse-control disorder
pattern of disobeying authority and hostile behavior (talk back to teacher)
hostility, annoyance, vindictiveness, disobedient, resentfulness
NO serious violations of social norms
NO disregard for rights of others (vs conduct disorder)
oppositional defiant disorder (less severe than conduct disorder)
onset: 10-11 yo
tics: stereotyped motor
movements (facial, vocal - coprolalia = obscene speech in 20%)
tics must last >1 yr
usually resolves by 18 yo, but may persist
Tourette syndrome
treatment of Tourette syndrome
antidopamine:
fluphenazine (high potency typical)
pimozide (high potency typical)
tetrabenazine (degrade dopamine)
types of eating disorders
all more common in women
anorexia nervosa
bulimia nervosa
binge-eating disorder
diagnosis of anorexia nervosa
low body weight: BMI
excessive dieting \+/-purging excessive exercising high achieving, self-conscience body weight: BMI
anorexia nervosa
treatment of anorexia nervosa
supportive therapy: nutritional education
CBT
counseling
treat depression: indirectly help anorexia
diagnosis of bulimia nervosa`
BMI within normal range
1) episodes of binge eating: perceives as uncontrollable (eat faster than normal, unbearably full, large meal when not hungry, eating alone, feeling disgusted after fact)
2) inappropriate, compensatory behavior to prevent weight gain: purging or laxatives, or strict caloric restriction (for a few days), or intense exercise
3) unhealthy preoccupation with weight
enlarged parotid glands: induced vomiting, ↑ serum amylase (inflammation)
erosion of enamel of teeth
bulimia nervosa
treatment of bulimia nervosa
SSRI: fluoxetine + pyschotherapy
become OBESE
episodes of binge eating: at least 1/week for 3 mo
may not like to eat but it soothes them - feel compelled, un controllable
NO compensatory behavior: purging
binge-eating disorder
complication of purging/chronic vomitting: electrolyte imbalance
hypokalemic hypochloremic metabolic alkalosis:
purge HCl → hypochloremic, ↓H+ → HCO3 in serum from gastric parietal cell without any H+ to buffer and allow for HCl reabsorption →metabolic alkalosis
compensation: cells have K/H countertransporter: H+ into serum for K+ out of serum and into cells→ hypokalemic
mood disorder
episodes of depressed mood + episodes of elevated mood (manic episode)
bipolar disorder
at least 1 week of abnormally and persistently elevated, expansive, or irritable mood
abnormally and persistently increased goal-directed activity or energy
DISRUPTS functioning socially or occupation, may require hospitalization, may have psychotic features (delusions: thinks superhero)
manic episode
diagnosis of manic episode
at least 3 of following for at least 1 week (DIG FAST)
Distractability
Irresponsibility (sexual, buy)
Grandiosity (↑ self-esteem)
Flight of ideas
Activity (goal-directed)/agitation (may be happy or irritated, due to ↑energy)
Sleep (↓ need)
Talkativeness (pressured speech, talk louder)
diagnosis of hypomanic episode
at least 4 days of manic symptoms (less severe)
NO IMPAIRMENT in social or occupational functioning
diagnosis of bipolar disorder
at least 1 manic episode (bipolar I disorder) or
at least 1 hypomanic episode + 1 major depression episode (bipolar II disorder)
if giving antidepressants for depression with history of mania/hypomania in past (=bipolar disorder)
antidepressant will cause mania/hypomanic episode
neurotransmitter imbalance with depression vs bipolar disorder
depression: ↓dopamine ↓5HT ↓NE mania: (antidepressant may ↑5HT or NE → trigger mania) ↑5HT ↑NE
too mild to be diagnosed as bipolar disorder
duration: at least 2 years (periods of normal mood
cyclothymic disorder
treatment of bipolar disorder
mood stabilizer for mania:
lithium (severe BP)
atypical antipsychotic: risperidone, aripiprazole, olanzapine
antiepileptics: lamotrigine, valproic acid, carbamazepine
2 or more distinct identities (or personalities)
more common in women
can be associated with sexual abuse
dissociative identity disorder
persistent feelings of detachment from body/thoughts
feel like outside observer watching life go by -seems like dream
depersonalization/derealization disorder
amnesia for an event or series of events
generalized amnesia of identity and personal life history
+/- dissociative feud: don’t know who they are, assume new identity while gone
dissociative amnesia
can loss of loved one lead to major depression
yes (even if within first 2 mo)
diagnosis of major depressive disorder (5 stars)
at least 5 or more of 9 following for at least 2 weeks (1 week for manic):
1 must be: depressed mood and/or anhedonia (lack of interest in previous interests)
SIGE CAPS:
Sleep disturbance (hypersomnia or insomnia)
Interest diminished (anhedonia)
Guilt (worthlesness)
Energy loss (fatigue)
Concentration impaired
Appetite changes (weight gain or loss)
Psychomotor retardation (mentally + physically sluggish)/agitation (antsy)
Suicidal ideation (preoccupied with death)
mood reactivity: respond to positive things positively
↑ appetite and weight gain
hypersomnia
leaden paralysis: legs, arms weighed down
hypersensitive to rejection
tx: MOAi
MDD with atypical features
during pregnancy or within 4 wks after delivery
5 of 9 MDD sx for at least 2 weeks
tx: antidepressant
MDD with peripartum onset (occurs around time of childbirth)
5 of 9 MDD sx for at least 2 weeks AND
delusions, hallucinations (psychosis only present with depression - if psychosis at times when no mood sx = schizoaffective dx)
MDD with psychotic features
recurrent for 2 years
5 of 9 MDD sx for at least 2 weeks only during specific seasons only (fall, winter)
tx: ↑ light exposure
MDD with seasonal pattern
onset 2-3 days after delivery, resolves within 10 days
tx: supportive, follow-up for postpartum depression
maternal postpartum blues
disorganized thinking hallucinations delusions suicidal or homicidal ideation lasts days - 6 wks tx: atypical antipsychotic or ECT
postpartum psychosis
at least 2 years of chronic persistent depression
may meet MDD criteria or have milder depressive sx
depressive symptoms at least every 2 mo
persistent depression disorder
depression sx or irritability or anxiety or mood swings that are related to menstrual cycle
severe enough to interfere with work or school or social (vs PMS)
premenstrual dysphoric disorder
major risk factors for suicide
psychiatric disorder (90% persons have one: MDD, bipolar, PTSD)
feelings of hopelessness or worthlessness
impulsivity: may lead to acting on thoughts
increasing age (more successful): young adults make more attempts
male sex (more successful): women make more attempts
access to weapons
history of suicide attempts
side effects of all antidepressants
worsening depression
↑ risk of suicide
antidepressants
SSRI, SNRI: most common
TCA: may be used
MAOi: almost never used
atypical antidepressants:
buproprion (NE, dopamine reuptake inhibitor): use if sexual dysfunction on SSRI
mirtazapine (α2 antagonist): use if depressed elderly, or depressed and not sleeping
trazodone, nefazodone (serotonin modulators)
ECT
treatment for: refractory MDD, catatonic schizophrenia, pregnancy or postpartum with depression/psychosis
anesthetize patient: electric current to brain produces controlled, painless seizure
SE: disorientation, amnesia, usually self-limited over couple months
electroconvulsive therapy
panic attacks: anxiety palpitations chest pain ab distress fear of dying feeling of impending doom worry about future attacks r/o acute MI, PE
panic disorder
treatment of panic disorder
CBT: address dysfunctional emotions and improve reactions
SSRIs: DOC
TCAs
BZD: only use during acute panic attack due to abuse potential (presence can reduce likelihood of attack)
ßblocker: ↓ symp tone
treatment of phobia
systematic desensitization: exposure to small amount, then increase
fear of embarrassment social situations
social anxiety disorder
treatment of social anxiety disorder
SSRI: if everyday
ßblocker: if public speaking (no ↑HR, symp tone)
phobia of open spaces or public situations (crowd, open spaces, bus)
agoraphobia
perform specific rituals to feel normal
obsession: intrusive thoughts that can’t be controlled
compulsive: performance of task to relieve obsession
OCD
treatment for OCD
SSRI
clomipramine (TCA)
common treatment for depression or anxiety
SSRI
persistent re-experiencing of a previous traumatic event for >1 mo (onset can occur at anytime after event): nightmares flashbacks intense fear hypervigilent: startle easily ↑ risk of somatatization
post-traumatic stress disorder
persistent re-experiencing of a previous traumatic event for
acute stress disorder or normal bereavement
treatment of PTSD
psychotherapy
SSRI
uncontrollable anxiety + worry for > 6 mo
may have: insomnia, irritability
generalized anxiety disorder
identifiable psychosocial stressor (divorce, illness, death) that causes anxiety
symptoms last
adjustment disorder
treatment of generalized anxiety disorder
BZD: for panic attacks or acute phobia (MRI, dentist)
SSRI: DOC
SNRI
buspirone
consciously faking a medical problem to obtain a secondary gain (money, avoid work, obtain drugs)
malingering
consciously faking a medical problem to play a sick role
factitious disorder
severe type of factitious disorder
self harm, seek invasive procedures to play sick role
munchausen syndrome
symptoms of a disease but no identifiable cause (not faking) complaint in 1 or more organ systems excessive anxiety + worry lasts at least 6 mo may be predominantly pain
somatic symptom disorder
worried will get serious illness (ask for repeated mammograms, really worried have cancer) but NO SYMPTOMS
illness anxiety disorder (hypochondriasis)
neuro symptoms that don’t fit with
any pathology: usually begin after acute stressor
weakness
paralysis
non-epileptic seizure
blindness
symptoms resolve in 2 wks, may persist for years
conversion disorder
concerned about minor imperfections (breast, nose, ears)
want surgery - multiple
distressing - see something we don’t see
look in mirror all the time
body dysmorphic disorder
