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Psychology Flashcards

1
Q

delusional disorder

A

1+ DELUSION lasting 1+ month WITHOUT OTHER PSYCHOTIC SYMPTOMS
-other than delusion, bx not obviously odd and no significant impairment of fx

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2
Q

brief psychotic disorder

A

1+ psychotic symptom w/ onset and remission <1 month

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3
Q

schizophreniform disorder

A

meets criteria for schizophrenia but <6 mo duration

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4
Q

schizoaffective disorder

A

SCHIZOPHRENIA + MOOD DISORDER

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5
Q

schizophrenia

A
  • 1% of population; mc males, RF: FAMILY HX
  • pt w/ dz have dec CNS gray matter, inc size ventricles, inc CNS dopamine receptors

6+ MONTHS DURATION of illness w/ 1 month acute symptoms and FUNCTIONAL DECLINE

Criteria: 2+ of following, at least one must be hallucination, delusion or disorganized speech

  • Hallucinations: AUDITORY MC, visual, olfactory, tactile, somatic, gustatory
  • Delusions: PERSECUTORY, GRANDIOSE, reference, control, nihilism, erotomanic, jealousy, doubles

Positive sx: EXCESS DOPAMINE RECEPTORS
-HALLUCINATIONS, DELUSIONS, disorganized speech and thinking, abnormal behavior

Negative sx: DOPAMINE DYSFUNCTION
-FLAT EMO AFFECT, social withdrawal, lack of emo expression, avolition (lack self-motivation), lack of communication and reactivity, poor eye contact

  • tx: hospitalization for acute psychotic episodes
  • ANTIPSYCHOTICS: DOPAMINE RECEPTOR ANTAGONISTS (first line = 2ND GEN: Risperidone, Olanzapine, Quetiapine)
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6
Q

major depressive disorder

A
  • RF: family hx, female>male, highest 20s-40s
  • alteration in nt: serotonin, epi/norepi, dopamine, acetylcholine, histamine
  • neuroendocrine dysregulation: adrenal, thyroid or gh

DEPRESSED MOOD OR ANHEDONIA W/ 5+ ASSOCIATED SX almost every day for 2 WEEKS

  • sx not due to SUD, bereavement or medical condition
  • somatic: constipation, headache, skin changes, chest/abdominal pain, cough, dyspnea
  • cause clinical distress, impairment in social, occupation or other areas
  • tx:
  • psychotherapy in mild/mod, +/- combine w/ meds
  • SSRIs 1ST LINE IN MILD-MOD (use 3-6 wks to see if effect)
  • bupropion 2nd line, TCAs and MAOi 3rd line
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7
Q

bipolar I

A

1+ MANIC OR MIXED EPISODE which often cycles w/ occasional depressive episodes (maj depressive episodes not required for the diagnosis)

  • RF: m=w, FAM HX STRONGEST RF
  • ave onset 20-30s

-MANIA: 1 WEEK OR HOSPITALIZATION REQ, W/ MARKED IMPAIRMENT OF SOCIAL/OCCUPATIONAL FX

  • tx:
  • LITHIUM 1ST LINE, valproic acid, carbamazepine
  • 2nd gen antipsychotics, haloperidol, benzos
  • ANTIDEPRESSANTS MAY PRECIPITATE MANIA
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8
Q

bipolar 2

A

1+ HYPOMANIC EPISODE AND 1+ MAJ DEPRESSIVE EPISODE (mania or mixed episodes absent)

  • tx:
  • acute mania: LITHIUM, valproate, 2nd gen antipsych
  • depression: LITHIUM, valproate, carbamazepine
  • mixed: 2nd gen antipsych
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9
Q

persistent depressive disorder (dysthymia)

A

CHRONIC DEPRESSED MOOD 2+ YEARS IN ADULTS

  • usually milder than mdd, mc F, late teens/early adult
  • PT ABLE TO FUNCTION
  • sx:
  • general loss of interest, social withdrawal, pessimism
  • chronic depressed mood 2+ years adults (1+ year children adolescents), most days; not sx free for >2 mo
  • at least 2 of following: insomnia/hypersomnia, fatigue, low self-esteem, decreased appetite or overeating, hopelessness, poor concentration
  • tx: like depression
  • psychotherapy, SSRIs FIRST LINE MED TX
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10
Q

cyclothymic disorder

A
  • SIMILAR TO BP 2 BUT LESS SEVERE
  • prolonged period of MILDER ELEVATIONS AND DEPRESSIONS IN MOOD

-sx:
-recurrent episodes of HYPOMANIC SX W/ RELATIVELY MILD DEPRESSIVE EPIDOSDES (don’t meet other criteria)
FOR AT LEAST 2 YEARS (1 yr in kids)
-symptom-free periods <2 mo
-no manic or mixed episodes

-tx: similar to BP 1 –> mood stabilizers and neuroleptics

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11
Q

panic attacks

A
  • usually peaks w/in 10 min and lasts <60 min
  • sympathetic overdrive

4+ of following:
-dizzy, sob, palpitations, tremble, chest pain, nausea/abd, choking sensation, chills, depersonalization, paresthesia, fear losing control, fear dying, sweating

-tx acute:
BENZOS 1st LINE

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12
Q

panic disorder

A

-2/3x mc in women; sx usually before 30yo

  • RECURRENT UNEXPECTED ATTACKS (AT LEAST 2)
  • usually peaks w/in 10 min and lasts <60 min
  • 4+ sx of panic attacks
  • at least one of following for at least 1 MONTH:
  • PANIC ATTACKS FOLLOWED BY CONCERN FOR FUTURE ATTACKS
  • worry about the implication of attacks (losing control)
  • significant bx change related to attacks

+/-AGORAPHOBIA

  • tx:
  • Long term: SSRIs 1ST LINE, CBT
  • Acute: BENZOS
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13
Q

generalized anxiety disorder

A
  • excessive anxiety/worry a majority of days 6+ MONTHS
  • not episodic or situational
  • F>M, onset usually in early 20s
  • sx: associated w/ 3+ of following:
  • fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness and headaches
  • tx:
  • ANTIDEPRESSANTS SSRIs, SNRIs
  • BUSPIRONE (BUSPAR) - no sedation
  • benzos, b-blockers, TCAs
  • PSYCHOTHERAPY
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14
Q

social anxiety disorder

A
  • PERSISTENT 6+ MONTHS
  • INTENSE FEAR OF SOCIAL OR PERFORMANCE SITUATIONS for fear of embarrassment –> provokes anxiety and expected panic attacks
  • tx:
  • ANTIDEPRESSANTS SSRIs or SNRIs
  • beta-blockers for performance anxiety
  • benzos for infrequent needs
  • PSYCHOTHERAPY
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15
Q

phobias

A
  • PERSISTENT 6+ MONTHS, INTENSE FEAR/ANXIETY OF SPECIFIC SITUATION, OBJECT, PLACE
  • fear out of proportion to real danger, actively avoid with intense fear/anxiety

-EVERYDAY ACTIVITIES MUST BE IMPAIRED BY DISTRESS OR AVOIDANCE

  • tx:
  • EXPOSURE/DESENSITIZATION - TREATMENT OF CHOICE
  • childhood phobias may decrease w/ age
  • short-term benzos or b-blockers for some
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16
Q

PTSD

A

Criteria:

EXPOSURE to actual or threatened death, serious injury or sexual violence via:

  • direct experience of the event
  • witnessing the event in person
  • learning the event happened to someone close
  • experiencing extreme or repeated exposure to aversive details of the traumatic event

PRESENCE OF 1+ OF INTRUSION SYMPTOMS leading to distress or impairment in fx:

  • RE-EXPERIENCE >1 MO AS REPETITIVE RECOLLECTIONS AND DISSOCIATIVE REACTIONS
  • AVOIDANCE of stimuli/triggers
  • NEGATIVE ALTERATIONS IN COGNITION AND MOOD - inability to remember important part of event, persistent exaggerated beliefs, horror, guilt, anger, shame
  • AROUSAL + REACTIVITY angry outbursts, irritable bx, reckless bx, sleep disturbance, concentration issues, startle response
  • tx:
  • SSRIs 1ST LINE TREATMENT (paroxetine, sertraline, fluoxetine)
  • TRAZADONE MAY HELP W/ INSOMNIA
  • COGNITIVE BX THERAPY
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17
Q

acute stress disorder

A

SIMILAR TO PTSD BUT SYMPTOMS <1 MONTH and onset occurs within 1 month of event

  • tx:
  • COUNSELING/PSYCHOTHERAPY
  • if persistent –> tx as PTSD
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18
Q

adjustment disorders

A

AN EMOTIONAL OR BEHAVIORAL RX TO AN IDENTIFIABLE STRESSOR –> CAUSES A DISPROPORTIONATE RESPONSE that would normally be expected w/in 3 months of the stressor; resolves usually w/in 6 moh

  • sx:
  • marked distress out of proportion
  • significant impairment in areas of functioning
  • tx:
  • PSYCHOTHERAPY 1ST LINE (individual or group)
  • meds may be used, pt may self-medicate w/ etoh, drugs
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19
Q

dissociative identity disorder

A

PRESENCE OF 2+ DISTINCT IDENTITIES OR STATES OF PERSONALITIES that take control of bx

  • gaps in recall of events may occur for everyday
  • MC in women; may be associated w/ hx of SEXUAL ABUSE, PTSD, substance abuse
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20
Q

depersonalization / derealization disorder

A

PERSISTENT FEELINGS OF DETACHMENT OR ESTRANGEMENT from:

  • oneself (depersonalization) ex. “feel out of body”
  • surrounding environment (derealization)
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21
Q

dissociative amnesia

A

INABILITY TO RECALL PERSONAL / AUTOBIOGRAPHIC INFORMATION
-often 2ry to abuse, stress, trauma –> significant impairment

DISSOCIATIVE FUGUE: ABRUPT CHANGE IN GEOGRAPHIC LOCATION w/ loss of identity or inability to recall past

  • must r/o seizures or brain tumor before dx
  • tx: PSYCHOTHERAPY
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22
Q

OCD + related disorders

A 
OCD
body dysmorphic disorder
hoarding
trichotillomania
excoriation (skin picking)
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23
Q

obsessive-compulsive disorder

A
  • men = women, but men often present in teens
  • ave age onset 20y (rare after 507)
  • sx: 4 major patterns
  • CONTAMINATION
  • PATHOLOGIC DOUBT (turn something off)
  • SYMMETRY / PRECISION
  • INTRUSIVE OBSESSIVE THOUGHTS w/out compulsions
  • tx:
  • SSRIs, tca, snri
  • COGNITIVE BX THERAPY
24
Q

body dysmorphic disorder

A

-EXCESSIVE PREOCCUPATION THAT 1+ BODY PART IS DEFORMED OR AN OVEREXAGGERATION OF A MINOR FLAW which causes them to be ashamed or self-conscious

  • may commit repetitive acts in response to the preoccupation (mirror, skin picking, seeking reassurance)
  • MC FEMALES, often begins in teens
  • may also have anxiety or depression
  • tx:
  • ANTIDEPRESSANTS (SSRIs, TCAs)
  • PSYCHOTHERAPY
25
Q

somatic symptom disorder (used to be somatization disorder)

A

chronic condition where pt has PHYSICAL SYMPTOMS INVOLVING 1+ PART OF THE BODY BUT NO PHYSICAL CAUSE CAN BE FOUND
-mc women; onset before 30y

Criteria:

  • one or more vague somatic sx that are distressing or result in significant disruption of daily life, can’t be explained medically
  • excessive thoughts, feelings or bx related to the somatic sx: disproportionate and persistent thoughts, high anxiety about them, excessive time/energy devoted
  • sx may change, being symptomatic is persistent (usually >6 months)
  • may or may not be associated w/ other med conditions

-tx: REGULARLY SCHEDULED VISITS TO HEALTHCARE PROVIDER (may be reluctant to seek mental health counseling)

26
Q

illness anxiety disorder (used to be hypochondriac)

A
  • sx last 6+ months
  • age 20-30y

Criteria:

  • PREOCCUPATION W/ FEAR OR BELIEF ONE HAS OR WILL CONTRACT A SERIOUS, UNDIAGNOSED DZ (despite medical workup showing no dz)
  • somatic symptoms usually not present (or mild)
  • care-seeking type, frequently get tested, “doctor shop”

-tx: REGULARLY SCHEDULED VISITS TO HEALTHCARE PROVIDER

27
Q

functional neurological sx disorder (conversion disorder)

A

NEUROLOGIC DYSFUNCTION suggestive of physical disorder THAT CAN’T BE EXPLAINED CLINICALLY
-sx cause stress / impairment

  • SX NOT INTENTIONALLY PRODUCED OR FAKED
  • pt often have depression, anxiety, schizo, personality d/o
  • sx: episodic and recur during stress; mc female and onset in adolescence or young adult
  • MOTOR DYSFUNCTION: PARALYSIS, MUTISM, aphonia, seizures, gait abnormal, tics, weakness, swallowing
  • SENSORY DYSFUNCTION: BLINDNESS, anesthesia, paresthesia, visual change, deafness
  • tx:
  • PSYCHOTHERAPY - TX OF CHOICE
28
Q

factitious disorder (Munchausen)

A

INTENTIONAL FALSIFICATION OR EXAGGERATION OF SIGNS + SYMPTOMS OF MEDICAL OR PSYCHIATRIC ILLNESS FOR PRIMARY GAIN

  • assuming sick role to get sympathy
  • inner need to be seen as ill or injured, NOT FOR CONCRETE PERSONAL GAIN (LIKE MALINGERING)

Types:

  • FACTITIOUS DISORDER IMPOSED ON SELF
  • FACTITIOUS DISORDER IMPOSED ON ANOTHER
  • sx:
  • CREATION OF EXAGGERATION OF SX OF ILLNESS (may hurt self, lie, mimic, inject self with substances)
  • WILLING OR EAGER TO UNDERGO SX REPEATEDLY OR PAINFUL TESTS for sympathy; may hospital jump or use other names, often have extensive knowledge of medical terminology

-tx: nonspecific

29
Q

malingering

A

INTENTIONAL FALSIFICATION OR EXAGGERATION OF SIGNS + SX OF MEDICAL OR PSYCHIATRIC ILLNESS
-FOR SECONDARY GAIN (financial - lawsuits, insurance, food, shelter, avoidance of prison/school/work, to obtain drugs)

  • not a mental illness
  • different from factitious disorder bc for gain (factitious to get sympathy and assume “sick role”)
30
Q

obesity

A
  • dx:
  • BMI > 30 KG/M2 OR BODY WEIGHT >20% OVER IDEAL
  • BINGE EATING (50%) - at least weekly for 3 months
  • tx:
  • behavioral modification, medical therapy (if depression)
  • ANTI-OBESITY MEDS: ORLISTAT, LORCASERIN
  • surgical options
31
Q

anorexia nervosa

A

REFUSAL TO MAINTAIN A MINIMALLY NORMAL BODY WEIGHT

  • morbid fear of fatness or gaining weight
  • mid-teens mc age, 90% women
  • 60% incidence of depression
  • sx:
  • EXHIBITS BX TARGETED AT MAINTAINING A LOW WEIGHT
  • restrictive type: reduced eating, excess exercise
  • purging type: vomiting, diuretic, laxatives, enema abuse
  • dx:
  • BMI <17.5 kg/m or body weight <85% ideal
  • physical exam: emaciation, hypotn, bradycardia, skin or hair changes (lanugo), dry skin, amenorrhea, osteoporosis
  • labs: leukocytosis, leukopenia, anemia, hypoK, inc BUN, hypothyroid
  • tx:
  • medical stabilization - hospitalization for <75% expected body weight; electrolyte imbalance
  • psychotherapy
  • pharmacotherapy
32
Q

bulimia nervosa

A

MAJOR DIFFERENCE FROM ANOREXIA –> BULIMIA HAVE NORMAL WEIGHT OR +/- OVERWEIGHT

  • sx:
  • BINGE EATING - OCCURS AT LEAST WEEKLY FOR 3 MO
  • COMPENSATORY BEHAVIOR:
  • purging type: self-induced vomiting, diuretic, laxatives
  • non-purging type: reduced calories, excess exercise
  • TEETH PITTING OR ENAMEL EROSION
  • RUSSELL’S SIGN (CALLUSES ON DORSUM OF HAND FROM INDUCED VOMITING)
  • labs: HYPOK, HYPOMG (maybe arrhythmias)
  • tx:
  • psychotherapy
  • pharmacotherapy - FLUOXETINE HAS BEEN SHOWED TO REDUCE BINGE-PURGE CYCLE
33
Q

personality disorders

A

10-15% of population
-pervasive inflexible personality trait causing impaired fx or distress

Cluster A: SOCIAL DETACHMENT (WEIRD, ODD, ECCENTRIC)

Cluster B: DRAMATIC, WILD, ERRATIC, IMPULSIVE, EMO

Cluster C: ANXIOUS, WORRIED, FEARFUL

34
Q

schizoid personality disorder

A

Cluster A

VOLUNTARY SOCIAL WITHDRAWAL + ANHEDONIC INTROVERSION

  • usually early childhood onset, MC MALES
  • “HERMIT-LIKE” BEHAVIOR
  • sx:
  • inability to form relationships
  • ANHEDONIC: appears indifferent to others, lacks response to praise or criticism; PREFERS TO BE ALONE
  • appears eccentric, isolated, “COLD” FLAT AFFECT

-tx:
-PSYCHOTHERAPY FIRST LINE
+/- short-term antipsychotics, antidepressants

35
Q

schizotypal

A

Cluster A

ODD, ECCENTRIC BX W/ PECULIAR THOUGHT PATTERNS suggestive of schizophrenia but WITHOUT PSYCHOSIS (DELUSIONS)
-early adult onset

  • sx:
  • ODD IN BX, APPEARANCE, INAPPROPRIATE AFFECT OR SPEECH, “MAGICAL THINKING” (clairvoyance, telepathy, superstition, fantasies), may talk to self
  • pervasive discomfort with close relationships

-tx:
-PSYCHOTHERAPY - TX OF CHOICE
+/- short-term antipsychotics, antidepressants

36
Q

paranoid personality disorder

A

Cluster A

PERVASIVE PATTERN OF DISTRUST AND SUSPICIOUSNESS OF OTHERS
-onset early adulthood, mc males

  • sx:
  • DISTRUST + SUSPICIOUSNESS: MISINTERPRETS THE ACTIONS OF OTHERS as malevolent, sees hidden messages, easily insulted, lack of interest in social relationships, bears grudges, doesn’t forgive, blames problems on others
  • PREOCCUPIED W/ DOUBT REGARDING THE LOYALTY OF OTHERS

-tx:
-PSYCHOTHERAPY - TX OF CHOICE
+/- short-term antipsychotics, benzos

37
Q

antisocial personality disorder

A

Cluster B

DEVIATING SHARPLY FROM THE NORMS, VALUES AND LAWS OF SOCIETY (harmful or hostile to society)

  • MAY COMMIT CRIMINAL ACTS w/ disregard to laws
  • MAY BEGIN IN CHILDHOOD AS CONDUCT DISORDERS
  • MUST BE 18+ TO DIAGNOSE
  • sx:
  • INABILITY TO CONFORM TO SOCIAL NORMS W/ DISREGARD AND VIOLATION OF RIGHTS OF OTHERS
  • DRUNK DRIVING COMMON
  • tx:
  • PSYCHOTHERAPY establish limits
  • meds not helpful
38
Q

borderline personality

A

Cluster B

UNSTABLE, UNPREDICTABLE MOOD AND AFFECT, UNSTABLE SELF IMAGE AND RELATIONSHIPS
-mc women

  • sx:
  • extreme pattern instability in relationships but can’t tolerate being alone, MOOD SWINGS, sensitive to criticism and rejection (fear of abandonment)
  • BLACK/WHITE THINKING - extremes of all good / bad
  • IMPULSIVE IN SELF-DAMAGING BX - threats to self, self-mutilation, substance abuse, reckless driving, binge eat
  • tx:
  • PSYCHOTHERAPY - TX OF CHOICE
  • pharm: +/- short-term low dose antipsychotics, antidepressants, benzos
39
Q

histrionic personality disorder

A

Cluster B

OVERLY EMOTIONAL, DRAMATIC, SEDUCTIVE
“ATTENTION SEEKING”

  • sx:
  • SELF-ABSORBED, TEMPER TANTRUMS, NEED TO BE CENTER OF ATTENTION
  • INAPPROPRIATE, SEXUALLY PROVOCATIVE, SEDUCTIVE, w/ shallow or exaggerated emo, needs reassurance and praise
  • may think relationships are more intimate than actual
  • tx:
  • PSYCHOTHERAPY - TX OF CHOICE
40
Q

narcissistic personality disorder

A

Cluster B

GRANDIOSE, EXCESSIVE SENSE OF SELF-IMPORTANCE BUT NEEDS PRAISE AND ADMIRATION
-mc males

  • sx:
  • INFLATED SELF-IMAGE - CONSIDERS SELF SPECIAL, ENTITLED, REQUIRES SPECIAL ATTENTION BUT FRAGILE SELF ESTEEM (jealous of others, believes others are envious, trouble with aging process)
  • lacks empathy, reacts to criticism poorly, depression
  • tx:
  • PSYCHOTHERAPY TX OF CHOICE (individual or group)
41
Q

avoidant personality disorder

A

Cluster C

DESIRES RELATIONSHIPS BUT AVOIDS RELATIONSHIPS DUE TO “INFERIORITY COMPLEX” (intense feelings of inadequacy, sensitive to criticism, fears rejection)

  • tx:
  • psychotherapy - cbt, social training, group
  • beta-blockers for anxiety, ssri for depression
42
Q

dependent personality disorder

A

Cluster C

DEPENDENT, SUBMISSIVE BEHAVIOR (needy, clingy)

CONSTANTLY NEES REASSURANCE, RELIES ON OTHERS FOR DECISION MAKING AND EMO SUPPORT, uncomfortable alone, will not initiate things

  • tx:
  • psychotherapy - bx and group
  • anxiolytics or antidepressants
43
Q

obsessive-compulsive personality disorder

A

Cluster C

PERFECTIONISTS WHO REQUIRE A GREAT DEAL OF ORDER AND CONTROL (rigid routine, rules, details, inflexible, stubborn) change to routine may lead to anxiety, often makes moral judgement of others
PREOCCUPIED WITH MINUTE DETAILS (hard to finish projects, hesitates to delegate work to others, devotes self to work)

  • tx:
  • psychotherapy
  • beta-blockers for anxiety, ssri for depression
44
Q

autism spectrum disorder

A
  • maybe lined to combo of prenatal viral exposure, immune system abnormalities, and/or genetic factors
  • male:female 4:1

Primary Signs:
SOCIAL INTERACTION DIFFICULTIES: significant emo discomfort or detachment (avoid eye contact, no response to affection)
IMPAIRED COMMUNICATION: inability to communicate or chooses not to in social settings; difficulties understanding what is not explicitly stated
RESTRICTED, REPETITIVE, STEREOTYPED BEHAVIORS a

Other Signs:

  • failure to devo social relationships, failure to show preference for parents over other adults, sensitive to visual, auditory or olfactory stimuli
  • unusual attachments to ordinary objects

-tx: refer to neuropsychologic testing, bx modification strategies, meds

45
Q

oppositional defiant disorder

A

persistent pattern of negative, hostile and DEFIANT BX TOWARDS ADULTS

At least 6 months of following:

  • angry/irritable mood (often blames others, resentment)
  • argumentative/defiant behavior
  • vindictiveness
  • tx:
  • psychotherapy - bx therapy

*not associated w/ psychosis; MAY PROGRESS TO CONDUCT DISORDER

46
Q

conduct disorder

A

persistent pattern of bx that DEVIATE SHARPLY FROM THE AGE-APPROPRIATE NORMS AND VIOLATE RIGHTS OF OTHERS

-SOCIAL AND ACADEMIC DIFFICULTY

4 MAIN AREAS:

  • SERIOUS VIOLATIONS OF LAWS
  • AGGRESSIVE/CRUEL TO ANIMALS
  • DECEITFULNESS (lying, stealing, lack guilt)
  • DESTRUCTION OF PROPERTY

Poor prognosis –> 40% DEVO ANTISOCIAL PERSONALITY DISORDER

47
Q

ADD / ADHD

A
  • dx:
  • sx of hyperactivity impulsivity or inattentiveness leading to impairment - MUST HAVE ONSET BEFORE 12Y AGE AND BE PRESENT FOR 6+ MONTHS

-SX MUST OCCUR IN AT LEAST 2 SETTINGS

  • tx:
  • bx modification
  • SYMPATHOMIMETIC MEDS (STIMULANTS) - DOC
  • methylphenidate (ritalin)
  • amphetamine / dextroamphetamine (adderall)
  • dexmethylphenidate (focalin)
  • NONSTIMULANTS: atomoxetine (strattera)
48
Q

tobacco use / dependence

A
  • sx of withdrawal:
  • restlessness, anxiety, irritability, sleep abnormalities, depression, nicotine craving
  • tx:
  • counseling and support therapy, CBT
  • NICOTINE TAPERING: gum, nasal spray, patch, lozenge
  • BUPROPION / ZYBAN: antidepressant
  • VARENICLINE / CHANTIX: blocks nicotine receptors, reduce nicotine activity
49
Q

opioid use / dependence

A

-heroin, oxycodone, morphine, meperidine and codeine

-sx:
OPIOID INTOXICATION
-EUPHORIA AND SEDATION: drowsy, impaired social fx, impaired memory, slow/slur speech, may devo N/V, seizures
-PUPILLARY CONSTRICTION
-RESPIRATORY DEPRESSION - BIOT’S BREATHING
-BRADYCARDIA
-HYPOTENSION

OPIOID WITHDRAWAL
-lacrimation, hypertension, pruritus, tachycardia, n/v/d, abd cramps, sweating, yawning, PILOERECTIONS (GOOSEBUMPS), PUPIL DILATION (MYDRIASIS), FLU-LIKE SX, RHINORRHEA, joint pain, myalgias

-tx:
-ACUTE –> NALOXONE (onset 2 min, duration 30-60) mc used in pt with respiratory depression
-WITHDRAWAL –> sx w/ clonidine, loperamide for diarrhea, nsaids for jt pain/cramps
+ buprenorphine and naloxone
-methadone tapering, benzos may be helpful
-LONG TERM –> methadone maintenance or suboxone (buprenorphine + naloxone)

50
Q

treat benzodiazepine intoxication?

A

FLUMAZENIL

51
Q

treat cocaine intoxication?

A

BENZODIAZEPINE, neuroleptics and blood pressure reduction

52
Q

alcohol withdrawal

A

-sx:
UNCOMPLICATED
-6-24 hours –> INCREASED CNS ACTIVITY (tremors, anxiety, diaphoresis, palpiations, insomnia, n/v/d)
-no seizures or DTs

WITHDRAWAL SEIZURES
-6-48 hours –> USUALLY GENERALIZED TONIC-CLONIC; mc as single episode

ALCOHOLIC HALLUCINOSIS
-12-48 hours –> visual, auditory and/or tactile, CLEAR SENSORIUM AND NORMAL VITAL SIGNS

DELIRIUM TREMENS
-2-5 days –> DELIRIUM (ALTERED SENSORIUM), hallucinations, agitation, ABNORMAL VITAL SIGNS (tachy, htn, fever)

  • tx:
  • CAN BE FATAL
  • IV BENZOS –> POTENTIATES GABA-MEDIATED CNS INHIBITION (etoh mimics gaba at receptors)
  • IV FLUIDS + THIAMINE + MAGNESIUM (PRIOR TO GLUCOSE ADMIN), multivitamins (B12/folate) - intoxication may cause hypoglycemia
  • avoid meds that lower seizure threshold (bupropion, haloperidol, anticonvulsants, clonidine, beta-blockers)
53
Q

alcohol intoxication

A
  • sx:
  • disinhibition
  • DEPRESSION
  • labile mood - erratic bx, aggression

-tx:
Acute intox: OBSERVATION

Chronic or dependent: observe + IV THIAMINE AND MAGNESIUM (PRIOR TO GLUCOSE ADMIN) + B12/FOLATE

Psychosis or severe aggression: HALOPERIDOL

54
Q

alcohol dependence

A

CAGE SCREENING - 2+ considered positive

CUTDOWN - have you felt the need to cut down?
ANNOYED - have people told you they get annoyed when you drink?
GUILT - do you ever feel guilty about drinking?
EYE OPENER - have you ever needed an eye-opener to start your day or reduce jitteriness?

  • tx:
  • psychotherapy
  • DISULFIRAM (ANTABUSE) - inhibits aldehyde dehydrogenase (enzyme needed to metabolize alcohol) –> uncomfortable sx: hypotn, palpitations, flush, hyperventlilate, n/v, ha, dizzy (c/i for pt w/ cvd, dm, hypothyroid, epilepsy, kidney/liver dz)
  • NALTREXONE - opioid antagonist - reduce alcohol craving and reduces euphoria
  • gabapentin, topiramate
55
Q

suicide risk factors

A

PREVIOUS ATTEMPT OR THREAT IS STRONGEST SINGLE PREDICTIVE FACTOR
–> ask if have a plan

FEMALES ATTEMPT MORE THAN MALES, MALES ARE MORE SUCCESSFUL

RF:

  • increases w/ age (but teens attempt more often than older)
  • ELDERLY WHITE MEN HAVE HIGHEST RATES IN US
  • white > black
  • underlying psych disorders
  • substance abuse associated w/ increased risk
  • marital status: alone > never married > widowed > separated or divorced > married w/out kids > married w/ kids (marriage is protective)
56
Q

grief reaction

A

NORMAL GRIEF RESOLVES W/IN 1 YEAR

  • peaks w/in first couple of months, may progress to MDD
  • sadness, irritable, yearning, poor concentration, sleep disturbances, illusions/hallucinations, (knows not real)
  • normal: denial, shock, confusion, sadness, numbness, guilt

Abnormal grief: severe, continues >1 year, positive SI
-psychosis, psychomotor deficits, illusions/hallucinations (but thinks are real)

Persistent complex bereavement disorder: severe rx that persists >1 yr (or 6 mo in kids) after death of bereaved

  • tx:
  • psychotherapy: cbt, benzos for insomnia

Concepts / Lists (16 decks)

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