Psychology #3 Flashcards
What is the diagnostic criteria for Bipolar I Disorder?
-At least 1 manic episode
–abnormal, elevated, expansive, irritated mood for > 1 week that impairs function
–Thinking: flight of ideas, grandiose, racing thoughts
–Behavior: hyperactivity, pressured speech, no sleep, hypersexuality
What is the first line treatment for Bipolar I disorder?
Lithium
-Also decreases suicide risk
For acute mania, what medications are used?
Antipsychotics (Risperidone or Olanzipine)
What is another treatment option for Bipolar I, besides Lithium
Valproic Acid
What is the diagnostic criteria for Bipolar II Disorder?
-History of 1 major depressive episode + 1 hypomanic episode (abnormal, elevated mood < 1 week, doesn’t require hospitalization, no impairment of functioning)
Treatment for Bipolar II Disorder
-Lithium or 2nd gen antipsychotic
-Psychotherapy
Lithium MOA
Name some adverse effects of this medication
-Alters neuronal sodium transport
-Hypothyroidism
-Nephrogenic Diabetes Insipidus
-Hyperparathyroidism
-Hypercalcemia
-Hypermagnesemia
Lithium has a narrow therapeutic index and prior to starting, you should get a _____, _____ and ______.
How often should you monitor labs in this patient?
What are two contraindications to this medication?
ECG, TSH, CBC, beta-HCG
Every 4-8 weeks
Pregnancy, Severe renal disease
What is one CAUTION you should remember when using Lithium?
Caution in use with NSAIDs. They increase Lithium levels in the body and can lead to confusion, tremor, slurred speech, vomiting.
Generalized Anxiety Disorder (GAD) is what?
What screening tool can you use to screen for this and what is considered positive
Excessive anxiety or worry for at least 6 months in various aspects of life. Anxiety is out of proportion to event. At least 3 of the following
–fatigue, concentration, muscle tension, sleep changes, headaches, shakiness.
–causes impairment, not due to substances
GAD-7 : 10 or more is positive
Treatment for GAD
-SSRI
-Buspirone (as adjunct)
-CBT, Psychotherapy
-Benzos for short-term
Buspirone MOA
It does not (2 things)
Partial serotonin receptor agonist and dopamine receptor agonist
Does not cause sedation and does not have abuse potential
What is panic disorder?
Recurrent, unexpected panic attacks (2 or more)
–often followed by concern about future attacks
–persistent worry about attacks
–maladaptive behavior related to attacks
Treatment for panic disorder
-SSRI + CBT
Explain what a panic attack is
-Sudden episode of fear or discomfort that peaks within 10 minutes and rarely lasts > 1 hour
-Sympathetic system overdrive
-Needs 4 or more of:
–Sense of impending doom
–sweating, dizziness, SOB, CP, fear of dying
–chills, hot flashes, nausea, abdominal pain
–depersonalization (detached from oneself)
–derealization (feelings of unreality)
What is the first-line treatment for a panic attack?
What should you do first
Benzodiazepines
Rule out life threatening conditions (heart attack, thyrotoxicosis)
Agoraphobia is _________
And the treatment is
Intense fear of being in places where escape is difficult (bridges, crowds, transport, etc.)
-Symptoms last > 6 months and cause dysfunction
-Treatment: SSRI + CBT
Specific phobias last how long and what is the treatment?
At least 6 months
Exposure and desensitization
-Short term Benzos or BB used in some patients
MC type of phobia is
Social Anxiety Disorder
-Such as public speaking
-Almost always causes panic attacks
Treatment for social anxiety disorder
-Psychotherapy (initially)
-SSRI’s
-Situational: BB (Propanolol) 30-60 minutes before performance
Regarding obsessive-compulsive disorder, what are obsessions?
What are compulsions?
Obsessions: recurrent or persistent thoughts (ego-dystonic and inconsistent with personal beliefs)
Compulsions: repetitive behaviors that cause distress, impairment, or time consuming
What is the primary neurotransmitter involved with OCD?
Serotonin
Treatment for OCD
-CBT + Pharmacotherapy (SSRI)
-TCA’s (Clomipramine) can be used
With PTSD, the traumatic event occurred when?
What is the treatment?
Anytime in the past
SSRI’s
CBT
With PTSD, what medications can be used for..
-Insomnia
-Nightmares and hypervigilance
-Insomnia: Trazodone
-Nightmares: Prazosin
On the other hand, with acute stress disorder, the traumatic event occurred when?
What is the treatment?
Occurred < 1 month ago and symptoms last < 1 month
-Treatment: Counseling and psychotherapy
If the symptoms last longer than 1 month with acute stress disorder, treat as…
PTSD
What psych condition has the highest mortality of all psych conditions?
Anorexia Nervosa
What are symptoms of anorexia nervosa
-Behaviors to keep a low weight
-Ego Syntonic: acceptable to them
-Restrictive vs Binge Eating
–Low caloric intake
–Diet pills, dieting
–Vomiting, enema, laxatives
Patients with anorexia nervosa have symptoms that are ________, which means they are acceptable to them
Ego-Syntonic
What are some exam findings of a patient with anorexia nervosa
-Lanugo (fine, downy hair)
-Dry Skin
-Salivary gland hypertrophy
-Amenorrhea, Osteopenia
-Hypotension, Bradycardia
-Russell’s Sign: callouses on hand
-BMI 17.5 or less
-Body weight: < 85% of ideal
What labs are expected with anorexia nervosa?
Hypokalemia
Metabolic Alkalosis
Both, from vomiting
Admit the patient with anorexia nervosa if weight is < _______%
Otherwise, the treatment is
-< 75%
Psychotherapy and SSRI’s (they lead to weight gain)
On the other hand, Bulimia Nervosa is
-Binge eating followed by compensatory behaviors
Patients with bulimia (explain the weight)
Their symptoms are ego-________
Can maintain a normal weight or overweight
Ego-Dystonic: troublesome to patient
Exam findings of a patient with Bulimia
-Teeth pitting or enamel erosion
-Russell’s Sign
-Parotid Gland Hypertrophy
What labs are expected with bulimia nervosa
-Hypokalemia
-Metabolic alkalosis
-Increased amylase (parotid glands)
Treatment for Bulimia (both initially and pharm)
-Psychotherapy
-Fluoxetine (pharm therapy first line)
What is refeeding syndrome a result of?
Fluid and electrolyte shifts during aggressive nutritional rehabilitation
What lab is specific for refeeding syndrome?
Hypophosphatemia
On the other hand, binge- eating disorder is NOT associated with….
What are the treatment options for this?
Not associated with compensatory behaviors
Psychotherapy, diet/exercise, Topiramate
Delusional Disorder requires what
1 or more delusion lasting > 1 month without other psychotic symptoms and no significant impairment in function
Treatment for delusional disorder
-2nd gen antipsychotics
-Psychotherapy
What is the strongest risk factor for suicide?
Who are at the highest risk?
What are other risks?
-Previous attempt of suicide
Elderly white men highest risk in US
-Others: live alone, chronic illness, white, positive family history, household with a gun
What two drugs treat suicidality?
Lithium and Clozapine
What acronym should be used to quantify risk of suicide and what is considered “safe?”
-SADPERSONS
-Sex, Age, Depression, Previous Attempt, ETOH, Rational Thinking (Lack of), Support Lacking, Organized Plan, No Spouse, Sickness
4 or less is safe
