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Behavioral Medicine > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Fluoxetine (prozac)

A

*Class: SSRI *Indication(disease): Major depressive disorder, Generalized anxiety disorder, Social anxiety disorder, Obsessive compulsive disorder, Panic disorder, Premenstrual dysphoric disorder, PTSD *Action: Increase serotonin at neurons by blocking serotonin reuptake (potent inhibitors of CYP-2D6 of CYP-450 pathway) *Side Effects: General symptoms:drowsiness, nausea, dry mouth, insomnia, diarrhea, restlessness, dizziness, headache, weight gain Sexual symptoms: reduced libido, anorgasmia, erectile dysfunction Activation of suicidal ideation – particularly adolescents develop a safety plans if this develops Most side effects dissipate after 1-2 weeks Titrating the medication helps to reduce the chance of side effects For sustained side effects – consider switching to another SSRI or an SNRI Can just switch medications out with equivalent doses *Complications: Caution with interactions – particularly with other medications/herbs that can increase serotonin. Can develop: Serotonin syndrome- when serotonin too high too quickly. Never prescribe SNRI and SSRI. Don’t prescribe MAOIs *Special Facts: Longest half-life – good for non-compliant patients Higher agitation and lower somnolence rate – consider for low energy depression

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2
Q

Paroxetine (paxil)

A

*Class: SSRI *Indication(disease): Major depressive disorder, Generalized anxiety disorder, Social anxiety disorder, Obsessive compulsive disorder, Panic disorder, Premenstrual dysphoric disorder, PTSD *Action: Increase serotonin at neurons by blocking serotonin reuptake (potent inhibitors of CYP-2D6 of CYP-450 pathway) *Side Effects: General symptoms:drowsiness, nausea, dry mouth, insomnia, diarrhea, restlessness, dizziness, headache, weight gain Sexual symptoms: reduced libido, anorgasmia, erectile dysfunction Activation of suicidal ideation – particularly adolescents develop a safety plans if this develops Most side effects dissipate after 1-2 weeks Titrating the medication helps to reduce the chance of side effects For sustained side effects – consider switching to another SSRI or an SNRI Can just switch medications out with equivalent doses Anticholinergic side effects – dry mouth, blurry vision, constipation, sedation Greater rate of weight gain and sexual side effects *Complications: *Special Facts: Shortest half life - widthrawal symptoms with abrupt discontinuation, Don’t start with this due to higher rates of side effects”

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3
Q

Sertraline (zoloft)

A

Class:SSRI

Indication(disease):Major depressive disorder, Generalized anxiety disorder, Social anxiety disorder, Obsessive compulsive disorder, Panic disorder, Premenstrual dysphoric disorder, PTSD

Action: Increase serotonin at neurons by blocking serotonin reuptake (Potent inhibitors of CYP-2D6)”

Side Effects: General symptoms:drowsiness, nausea, dry mouth, insomnia, diarrhea, restlessness, dizziness, headache, weight gain
Sexual symptoms: reduced libido, anorgasmia, erectile dysfunction
Activation of suicidal ideation – particularly adolescents develop a safety plans if this develops

Most side effects dissipate after 1-2 weeks
Titrating the medication helps to reduce the chance of side effects
For sustained side effects – consider switching to another SSRI or an SNRI
Can just switch medications out with equivalent doses
“, as well as GI side effects

Special Notes: Good for anxiety (PTSD), safest for patients with cardiovascular conditions

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4
Q

Citalopram (celexa)

A

*Class: SSRI *Indication(disease): Major depressive disorder, Generalized anxiety disorder, Social anxiety disorder, Obsessive compulsive disorder, Panic disorder, Premenstrual dysphoric disorder, PTSD*Action: Increase serotonin at neurons by blocking serotonin reuptake *Side Effects: General symptoms:drowsiness, nausea, dry mouth, insomnia, diarrhea, restlessness, dizziness, headache, weight gain Sexual symptoms: reduced libido, anorgasmia, erectile dysfunction Activation of suicidal ideation – particularly adolescents develop a safety plans if this develops Most side effects dissipate after 1-2 weeks Titrating the medication helps to reduce the chance of side effects For sustained side effects – consider switching to another SSRI or an SNRI Can just switch medications out with equivalent doses *Complications: Cardiovascular risk - QT prolongation - consider baseline EKG, dose dependent *Special Facts: Good for anxiety, good tolerability

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5
Q

Escitalopgram(lexapro)

A

*Class: SSRI *Indication(disease): Major depressive disorder, Generalized anxiety disorder, Social anxiety disorder, Obsessive compulsive disorder, Panic disorder, Premenstrual dysphoric disorder, PTSD *Action: Increase serotonin at neurons by blocking serotonin reuptake *Side Effects: General symptoms:drowsiness, nausea, dry mouth, insomnia, diarrhea, restlessness, dizziness, headache, weight gain Sexual symptoms: reduced libido, anorgasmia, erectile dysfunction Activation of suicidal ideation – particularly adolescents develop a safety plans if this develops Most side effects dissipate after 1-2 weeks Titrating the medication helps to reduce the chance of side effects For sustained side effects – consider switching to another SSRI or an SNRI Can just switch medications out with equivalent doses *Complications: *Special Facts: Good to start with, stereoisomer of citalopram - no QT prolongation, well tolerated and efficacious”

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6
Q

Fluvamine(luvox)

A

Class: SSRI

Indication:Major depressive disorder, Generalized anxiety disorder, Social anxiety disorder, Obsessive compulsive disorder, Panic disorder, Premenstrual dysphoric disorder, PTSD, PRIMARY is OCDI

Action: increase serotonin at neurons by blocking serotonin reuptake”

Side Effects: General symptoms:drowsiness, nausea, dry mouth, insomnia, diarrhea, restlessness, dizziness, headache, weight gain
Sexual symptoms: reduced libido, anorgasmia, erectile dysfunction
Activation of suicidal ideation – particularly adolescents develop a safety plans if this develops

Most side effects dissipate after 1-2 weeks
Titrating the medication helps to reduce the chance of side effects
For sustained side effects – consider switching to another SSRI or an SNRI

Can just switch medications out with equivalent doses
“as well as nausea and insomnia

Special Notes: Older, not used frequently

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7
Q

Venlafaxine (effexor)

A

*Class: SNRI *Indication(disease): Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder *Action: Dual action (seretonin + noepinephrine) *Side Effects: Nausea, dizziness, diaphoresis, sexual dysfunction, hypertension *Complications: Lethal in overdose *Special Facts: Helpful with migraines, hot flashes, typically severe withdrawal if abruptly discontinued, brain zaps

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8
Q

Duloxetine (cymbalta)

A

*Class: SNRI *Indication(disease): Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder,Fibromyalgia, diabetic neuropathic pain, chronic muscoskeletal pain *Action: Dual action (seretonin + noepinephrine) (p450 moderate inhibitor) *Side Effects: Nausea, dizziness, diaphoresis, sexual dysfunction, hypertension *Complications: *Special Facts: Most $$$

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9
Q

Desvenlafaxine(pristiq)

A

*Class: SNRI *Indication(disease): Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder *Action: Dual action (seretonin + noepinephrine) *Side Effects: Nausea, dizziness, diaphoresis, sexual dysfunction, hypertension *Complications: *Special Facts:

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10
Q

Bupropion (Wellbutrin,IR,SR,XL)

A

Class; Antidepressant

Indication: Depression

Action: Dopamine (+norepineephrine) reuptake inhibitor (p450 moderate inhibitor)

Side Effect: Weight loss

Morning can worsen anxiety, evening can cause insomnia

Special Notes: Contraindications:Seizures, abrupt alcohol/benzo withrdrawal, eating disorders

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11
Q

Mirtazapine (remeron)

A

*Class: Antidepressant *Indication(disease): Depression *Action: Enhances noradrenergic and serotenergic transmission *Side Effects: Weight gain (cancer patients), increased appetite, sedation; dose it at bed time, may cause agranulocytosis/neutropenia(rare) CBC baseline *Complications: *Special Facts:

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12
Q

Trazodone

A

*Class: Seretonin Modulator *Indication(disease): Insomnia/Depression *Action: Antagonist and agonist at postynaptic seretonin receptor and inhibit reuptake of postsynaptic serotonin *Side Effects: Dry mouth, orthostatic hypotension, priapism (RARE) but SERIOUS side effect *Complications: *Special Facts: Low dose - insomnia, High dose - depression

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13
Q

Vortioxetine (trintellix)

A

Class:Seretonin Modulator

Indication:Depression

Action:Antagonist and agonist at postynaptic seretonin receptor and inhibit reuptake of postsynaptic seretonin

Side Effects:Nausea

Special Notes:May help more with cognitive dysfunction with depression (geriatric)

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14
Q

Amitriptyline (Elavil)

A

*Class: TCA *Indication(disease): Depression *Action: Inhibits reuptake of serotonin and norepinephrine, named for chemical structure (3-ring central structure) *Side Effects: Orthostatic hypotension is common, dry mouth, blurry vision, constipation *Complications: LETHAL in overdose (as little as 10x normal dose), AVOID if suicidal *Special Facts: Neurologic- Chronic pain/fibromyalgia, migraine prophylaxis

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15
Q

Nortriptyline (Pamelor)

A

Class: TCA

Indication: Depression

Action: Inhibits reuptake of serotonin and norepinephrine, named for chemical structure (3-ring central structure)

Special Facts: Lower anticholingeric effects

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16
Q

Imipramine(Tofranil)

A

*Class: TCA *Indication(disease): Depression/Bedwetting *Action: Inhibits reuptake of serotonin and norepinephrine, named for chemical structure (3-ring central structure) *Side Effects: *Complications: *Special Facts: Treat nocturnal euresis in children

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17
Q

Clomipramine(Anafranil)

A

Class: TCA

Indication: Depression

Action: Inhibits reuptake of serotonin and norepinephrine, named for chemical structure (3-ring central structure)

Special Notes: FDA approved for OCD(ONLY TCA that is)

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18
Q

Doxepin(Sinequan)

A

*Class: TCA *Indication(disease): Depression/Insomnia *Action: Inhibits reuptake of serotonin and norepinephrine, named for chemical structure (3-ring central structure) *Side Effects: *Complications: *Special Facts: Treat insomnia at low doses

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19
Q

Desopramine(Nopramin)

A

Class: TCA

Indication: Depression

Action: Inhibits reuptake of serotonin and norepinephrine, named for chemical structure (3-ring central structure)

Special Facts: Lower anticholingeric effects

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20
Q

Tranylcypromine(Parnate)

A

*Class: MAOI *Indication(disease): Resistant Depression (Last resort) *Action: Inhibit the action of MAO-A and B – enzymes that metabolize 5HT (serotonin), DA (dopamine), and NE (norepinephrine) *Side Effects: Dizziness *Complications: Seretonin syndrome can occur with antidepression, meperidine (dermol) antibiotics: isoniazid or linezolid) *Special Facts: Dietary restrictions when on this (No tyramine) which is usually metabolized in the GI tract, but blockade of MAO allows it to flow into general circulation causing Hypertensive crisis from eating tyramine, otherwise they’re usually potent hypotensives

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21
Q

Phenelzine(Nardil)

A

*Class: MAOI *Indication(disease): Resistant Depression (Last resort) *Action: Inhibit the action of MAO-A and B – enzymes that metabolize 5HT (serotonin), DA (dopamine), and NE (norepinephrine) *Side Effects: Dizziness *Complications: Seretonin syndrome can occur with antidepression, meperidine (dermol) antibiotics: isoniazid or linezolid) *Special Facts: Dietary restrictions when on this (No tyramine) which is usually metabolized in the GI tract, but blockade of MAO allows it to flow into general circulation causing Hypertensive crisis from eating tyramine, otherwise they’re usually potent hypotensives

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22
Q

Selegiline(Emsam) - Transdermal patch

A

Class: MAOI

Indication: Resistant Depression (Last resort)

Action: Inhibit the action of MAO-A and B – enzymes that metabolize 5HT (serotonin), DA (dopamine), and NE (norepinephrine)

Side Effects: DizzinessSeretonin syndrome can occur with antidepression, meperidine (dermol) antibiotics: isoniazid or linezolid)

Special Facts: Dietary restrictions when on this (No tyramine) which is usually metabolized in the GI tract, but blockade of MAO allows it to flow into general circulation causing Hypertensive crisis from eating tyramine, otherwise they’re usually potent hypotensives

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23
Q

Valproic acid (Depakote)

A

*Class: Anticonvulsants/Lithium *Indication(disease): Bipolar Disorder *Action: *Side Effects: Nausea, tremor, poluryia and thrist, weight gain, loose stool, cognitive impairment(sudden worsening could be a sign of lithium toxicity), long term include nephrotoxicity, hypothyroidism, cardiac disturbances, also hair loss, easily bruised (thrombocytopena), tremor *Complications: *Special Facts: Dietary restrictions with tyramine: Avoid -> Cheeses Overripe or dried fruit Snow peas Sauerkraut Homemade yeast breads, sourdough bread Aged, dried, fermented, or pickled meats and sausages, processed meats Dried, salted, smoked meats and fish Soybean products – tofu, soy sauce Tap or unpasteurized beer/ale; wine Caution: chocolate and caffeine”

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24
Q

Lamotrigina (Lamictal)

A

Class: Anticonvulsants/Lithium

Indication: Bipolar Disorder

Side Effects: Nausea, tremor, poluryia and thrist, weight gain, loose stool, cognitive impairment(sudden worsening could be a sign of lithium toxicity), long term include nephrotoxicity, hypothyroidism, cardiac disturbances, can cause aplastic anemia.agrnulocytosis rarely

Special Notes: Associated with thrombocytopenia and liver failure, teratogenic (women must be on birth control if she doesn’t want children)

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25
Q

Carbamazepine (Tegretol)

A

*Class: Anticonvulsants/Lithium *Indication(disease): Bipolar Depression (type II), NOT acute mania (type I) *Action: *Side Effects: Nausea, tremor, poluryia and thrist, weight gain, loose stool, cognitive impairment(sudden worsening could be a sign of lithium toxicity), long term include nephrotoxicity, hypothyroidism, cardiac disturbances (P450 inducer) *Complications: Risk of Stevens Johnson syndrome, start medications low and titrate them if they miss can increase risk *Special Facts: Stevens Johnson syndrome, induces liver enyzmes

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26
Q

Haloperidol (Haldol)

A

*Class: 1st gen. Antipsychotics *Indication(disease): Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation) *Action: Antagonism of dopamine receptors *Side Effects: Extrapyramidal side effects (EPS), Taradive dyskinesia (TD) - involuntary movements[effect of dopamine on movements, continues after discontinuation], QT prolongation, Orthostatic hypotension *Complications: *Special Facts:

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27
Q

Chlorpromazine(Thorazine)

A

Class: 1st gen. Antipsychotics

Indication: Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation), intractable hiccups!

Action: Antagonism of dopamine receptors

Side Effects: Extrapyramidal side effects (EPS), Taradive dyskinesia (TD) - involuntary movements[effect of dopamine on movements, continues after discontinuation], QT prolongation, Orthostatic hypotension

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28
Q

Fluphenazine(Prolixin)

A

Class: 1st gen. Antipsychotics

Indication: Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation)

Action: Antagonism of dopamine receptors

Side Effects: Extrapyramidal side effects (EPS), Taradive dyskinesia (TD) - involuntary movements[effect of dopamine on movements, continues after discontinuation], QT prolongation, Orthostatic hypotension

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29
Q

Thioridazine(Mellaril)

A

*Class: 1st gen. Antipsychotics *Indication(disease): Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation) *Action: Antagonism of dopamine receptors *Side Effects: Extrapyramidal side effects (EPS), Taradive dyskinesia (TD) - involuntary movements[effect of dopamine on movements, continues after discontinuation], QT prolongation, Orthostatic hypotension *Complications: *Special Facts:

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30
Q

Olanzapine(Zyprexa)

A

*Class: 2nd gen. antipsychotics *Indication(disease): Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation) *Action: Antagonism of dopamine receptors *Side Effects: QT prolongation, increase prolactin, metabolic risks * biggest one [hyperlipidemia,hyperglycemia, weight gain], agranulocytosis, sedating; PRN *Complications: *Special Facts:

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31
Q

Risperidone(Risperdal)

A

*Class: 2nd gen. antipsychotics *Indication(disease): Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation) *Action: Antagonism of dopamine receptors *Side Effects: QT prolongation, increase prolactin, metabolic risks * biggest one [hyperlipidemia,hyperglycemia, weight gain], agranulocytosis *Complications: *Special Facts: More likely to increase prolactin, Unique indication in children

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32
Q

Quetiapine(Seroquel)

A

Class: 2nd gen. antipsychotics

Indications: Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation)

Action: Antagonism of dopamine receptors

Side Effects: QT prolongation, increase prolactin, metabolic risks * biggest one [hyperlipidemia,hyperglycemia, weight gain], agranulocytosis, Sedating

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33
Q

Ziprasidone(Geodon)

A

*Class: 2nd gen. antipsychotics *Indication(disease): Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation) *Action: Antagonism of dopamine receptors *Side Effects: QT prolongation, increase prolactin, metabolic risks * biggest one [hyperlipidemia,hyperglycemia, weight gain], agranulocytosis *Complications: *Special Facts:

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34
Q

Aripirazole(Abilify)

A

*Class: 2nd gen. antipsychotics *Indication(disease): Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation) *Action: Antagonism of dopamine receptors *Side Effects: *Complications: *Special Facts: LESS sedating, lower metabolic effects, restless at higher doses, no QT prolongation (safest for cardiac history)

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35
Q

Clozapine(Clozaril)

A

Class: 2nd gen. antipsychotics

Indication: Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation)

Action: Antagonism of dopamine receptors

Special Notes: arangulocytosis, unique efficiency in treatment-resistant schizophrenia, blocks receptors for several neurotransmitters, inlcuding dopamine, norepinephrine, seretonin, acetylcholine

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36
Q

Lurasidone(Latuda)

A

*Class: 2nd gen. antipsychotics *Indication(disease): Psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder (second generation) *Action: Antagonism of dopamine receptors *Side Effects: *Complications: *Special Facts: newest, low metabolic effect, low cardiac effects, $$$

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37
Q

??

A

*Class: Anxiolytics *Indication(disease): Anxiety prefferred maintenance treatment *Action: *Side Effects: *Complications: *Special Facts:

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38
Q

Lorazepam(Ativan)

A

*Class: Anxiolytics / Benzodiazepines *Indication(disease): Anxiety *Action: Facilitate the action of GABA on CNS excitability *Side Effects: Impaired psychomotor performance, amnesia, dependence/withdrawal - long term at high dose treatments, rebound anxiety - short term treatment, cognitive/learning impairment - high doses *Complications: *Special Facts: Avoid in patients with any substance use or substance use disorder (similar to the way alcohol affects, are used as a tapering scale during the period of alcohol withdrawal)

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39
Q

Alprazolam(Xanax)

A

Class: Anxiolytics / Benzodiazepines

Indications: Anxiety

Action: Facilitate the action of GABA on CNS excitability

Side Effcts: Impaired psychomotor performance, amnesia, dependence/withdrawal - long term at high dose treatments, rebound anxiety - short term treatment, cognitive/learning impairment - high doses

Special Notes: Avoid in patients with any substance use or substance use disorder (similar to the way alcohol affects, are used as a tapering scale during the period of alcohol withdrawal)

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40
Q

Diapezam(Valium)

A

*Class: Anxiolytics / Benzodiazepines *Indication(disease): Anxiety *Action: Facilitate the action of GABA on CNS excitability *Side Effects: Impaired psychomotor performance, amnesia, dependence/withdrawal - long term at high dose treatments, rebound anxiety - short term treatment, cognitive/learning impairment - high doses *Complications: *Special Facts: Avoid in patients with any substance use or substance use disorder (similar to the way alcohol affects, are used as a tapering scale during the period of alcohol withdrawal)

41
Q

Clonazepram(Klonopin)

A

*Class: Anxiolytics / Benzodiazepines *Indication(disease): Anxiety *Action: Facilitate the action of GABA on CNS excitability *Side Effects: Impaired psychomotor performance, amnesia, dependence/withdrawal - long term at high dose treatments, rebound anxiety - short term treatment, cognitive/learning impairment - high doses *Complications: *Special Facts: Avoid in patients with any substance use or substance use disorder (similar to the way alcohol affects, are used as a tapering scale during the period of alcohol withdrawal), longer acting benzo - theoretically lower potential for abuse, not as rapid onset, still become dependent

42
Q

Buspirone(BuSpar)

A

*Class: Anxiolytics / Non-benzo *Indication(disease): Anxiety *Action: Facilitate the action of GABA on CNS excitability *Side Effects: Impaired psychomotor performance, amnesia, dependence/withdrawal - long term at high dose treatments, rebound anxiety - short term treatment, cognitive/learning impairment - high doses *Complications: *Special Facts: Affects serotonin levels, long onset (2-4wk), weaker anxiolytic response, no sexual syfunction, low risk of wt gain

43
Q

Hydroxyzine(Vistaril,Atarax)

A

Class: Anxiolytics / Non-benzo

Indication: Anxiety

Action: Facilitate the action of GABA on CNS excitability

Side Effects: Impaired psychomotor performance, amnesia, dependence/withdrawal - long term at high dose treatments, rebound anxiety - short term treatment, cognitive/learning impairment - high doses

Special Notes: First gen antihistamine, sedating properties ie dry mouth, used for PRN relief

44
Q

Gabapentin(Neurotonin)

A

*Class: Anxiolytics / Non-benzo *Indication(disease): Anxiety *Action: Facilitate the action of GABA on CNS excitability *Side Effects: Impaired psychomotor performance, amnesia, dependence/withdrawal - long term at high dose treatments, rebound anxiety - short term treatment, cognitive/learning impairment - high doses, sedation, dizziness, ataxia, fatigue *Complications: *Special Facts: Off label use for anxiety: anti-epileptic, neuropathic pain

45
Q

Methylphenidate(Ritalin,Concerta)

A

*Class: Stimulant DEA Schedule II *Indication(disease): ADHD *Action: Affect dopaminergic and noradrenegic systems -> release of catecholamines *Side Effects: Anorexia, weight loss, sleep disturbance, jitteriness, emotional lability, *tachycardia, *hypertension, priapism (rare) *Complications: *Special Facts:

46
Q

Amphetamine(Adderall,Adderall XR

A

Class: Stimulant

Action: DEA Schedule IIADHD

Side Effects: Affect dopaminergic and noradrenegic systems -> release of catecholamines

47
Q

Lisdexamfetamine(Vvyanese - longer acting amphetamine less potential for abuse)

A

*Class: Stimulant DEA Schedule II *Indication(disease): ADHD *Action: Affect dopaminergic and noradrenegic systems -> release of catecholamines *Side Effects: *Complications: *Special Facts:

48
Q

Modafinil(Provigil)

A

*Class: Stimulant DEA Schedule IV*Indication(disease): Naroclepsy, Shift work disorder*Action: Blocks dopamine reuptake*Side Effects: (P450 inducer)*Complications: *Special Facts:

49
Q

Atomoxetine(Stattera)

A

not a controlled med stimulant

ADHD

•Selective norepinephrine reuptake inhibitor (SNRI)

50
Q

psychiatric emergency-

A

A condition wherein the patient has disturbances of thought, affect and psychomotor activity leading to a threat to self or others. This condition needs immediate intervention.

51
Q

plan vs. intent suicde

A

plan- specifics on way to end life intent- resolved or determined Suicidal ideation – Thought of serving as the agent of one’s own death Suicidal intent – Subjective expectation and desire for a self-destructive act to end in death Suicide attempt – Self-injurious behavior with a nonfatal outcome accompanied vy explicit or implicit evidence that the person intended to die

52
Q

protective factors of suicde

A

Sense of responsibility to family Positive coping skills Having something to live for marriages are protective work is protective. decrease during wars

53
Q

drugs that reduce suicide

A

are lithium-bipolar when someone is manic and Clozaril-psychosis (only indicated in certain clinical scenarios). ketamine delirium- change in cognition or distrubance of perception. acute onset fluctuating course or organic (age, memory, opiod, impaired judgement, disturbed sleep wake

54
Q

Causes of delirium

A

I WATCH DEATH (infection, withdrawal, acute metabolic, trauma, CNS, Hypoxia, Deficiencies, Endocrinopathies, Acute Vascular Abnromalities, Toxins/drugs, Heavy metals. treat w/ haldol can have cognitive impairment long term

55
Q

agitation

A

A state of poorly organized aimless psychomotor activity that stems from physical or emotional unease A behavioral emergency Psychosis: non-compliant with meds Mania: bipolar pts who are non-compliant with meds Common causes Delirium Psychosis Mania Anxiety/depression Dementia- agitated Intoxication/withdrawal Medication side effects

56
Q

management of agitation

A

Antipsychotics – Haldol Benzodiazepines – Versed- stay away from don’t want to mix with alcohol use lorazepam, or diazepam (not as much bad on liver)

57
Q

suicide demographics

A

White non-Hispanic, elderly men are the highest risk for suicide. white are more likely, cities: higher in immigrants then native americans. protestant and jews higher than catholics lowest in muslims. higher social status greater risk and a drop have increase risk. Work is generally a protective factors against suicide. However, certain professions are at increased risk for suicide including physicians(psychiatrist, ophthalmologist, anesthesiologist), law enforcement, dentists, artists, mechanics, lawyers and insurance agents. poor physical health contributes to half . prisoners more likely to commit suicie 3x. Patients without a strong social support system, a history of impulsive behavior, and a suicidal plan of action are indications for hospitalization.

Highest in Montana and Wyoming for men, in Alaska and Idaho for women. Lowest in New Jersey for both sexes. Montana has the highest overall rate. The most popular suicide site in the world is the Golden Gate Bridge.

Globally most common method of suicide is hanging.

Older persons attempt suicide less often than younger persons, but are more often successful. women 55+, men 45+

58
Q

EPS

A

Can occur with antipsychotic use – especially 1st generation (haldol) Akathisia- inability to stay still Parkinsonism- tremor, rigidity, bradykinesia, Dystonia- repititve muscle contractions uncontrolled extrapyramidal symptoms

59
Q

treatment for akathisia

A

propranolol – beta blocker for symptomatic relief benztropine (Cogentin) – anticholinergic Antagonizes acetylcholine receptors Diminishes the excess Ach activity caused by removal of dopamine inhibition when dopamine receptors are blocked May prolong dopamine action Common side effects: dry mouth, blurry vision, confusion, constipation dried up Dangerous side effects: angle-closure glaucoma, cardiac arrhythmias, urinary retention lorazepam (Ativan) – benzodiazepine for symptomatic relief

60
Q

parkinsonism

A

Etiology- tremors or bradykinesia Dopamine blockade getting too low Treatment Reduce dose if possible benztropine (Cogentin) – anticholinergic amantadine (Symmetrel) – non-anticholinergic antiparkinsonian Side effects: hypotension, mild agitation Exact MOA unknown – potentiates dopamine Elderly, female patients are at highest risk – can occur at all ages

61
Q

agression

A

half of homicides/assaults had alcohol before and are more likely to commit suicide. schizophrenia just as likely (more likely commit suicide early on)

62
Q

serotonin syndrome

A

atients on multiple serotonergic drugs are at risk for developing this condition, and anyone p/w hyperthermia, myoclonus, flushing, and hypertension needs to have Serotonin Syndrome on their DDx. Serotonin Syndrome from SSRI and SNRI Pathology: High dose, multiple serotonergic drugs Symptoms: Hyperthermia, myoclonus (spasms), flushing, hypertension Treatment: Hold medications, correct vitals

  • Clinical features: mental status changes, autonomic hyperactivity, and neuromuscular abnormalities- not to specific to differentiate from NMS
  • Anxiety, agitated delirium, restlessness, disorientation
  • Tachycardia
  • Hypertension
  • Hyperthermia
  • Slow, continuous, horizontal eye movements (ocular clonus)
  • Dilated pupils
  • Tremor
  • Deep tendon hyperreflexia (common)
  • Inducible or spontaneous muscle clonus (common)
  • Clonus = involuntary, rhythmic movements can happen or if they are moving
  • Muscle rigidity
  • Bilateral Babinski signs
  • Dry mucus membranes
  • Flushed skin and diaphoresis
  • Increased bowel sounds

Treatment

  • Discontinue ALL serotonergic medications
  • Supportive care
  • Consider sedation with benzodiazepines
  • Antidote = cyproheptadine
  • Serotonin receptor antagonist
  • Used if no response to benzos/supportive care
63
Q

Neuroleptic malignant syndrome:

A

Life-threatening complication of treatment with antipsychotic drugs or other dopaminergic drugs Incidence: 0.01%-0.02% of patients treated with antipsychotics for both first and second generation

  • Motor/behavioral symptoms:
  • Muscular rigidity and dystonia
  • Akinesia- movement, muscular rigitiyor dystonia
  • Mutism
  • Obtundation
  • Agitation
  • Autonomic symptoms:
  • Hyperthermia
  • Diaphoresis
  • Tachycardia
  • Hypertension

lab findings are what differentiates it from serotonin syndrome:

  • Increased WBC
  • Increased CPK
  • Creatine phosphokinase—sign of muscle breakdown
  • Increased liver enzymes

Treatment Removal of causative agent ICU admission High dose anti-psychotic Rx or a withdrawal of anti-psychotic Rx // more prevalent in patients who are just starting on meds, if you titrate too quickly.

  • lorazepam (Ativan)
  • Dantrolene
  • Muscle relaxant
  • Bromocriptine
  • Dopamine agonist
  • ECT (electroconvulsive therapy)- last ditch effort

Alteration in dopaminergic pathways leading to severe Sx that are life-threatening Muscle rigidty can lead to rhabdomyolysis, severe autonomic instability These patients are also at risk for renal failure. usually resolve in 24-72 hours untreated can last weeks

64
Q

dystonia

A
  • Torticollis – neck muscles cocked to the side and contraction fairly common
  • Retrocollis– neck extension not as common head back
  • Oculogyric crisis – upward deviation of the eyes
  • Blepharospasm – blinking
  • Laryngospasm – rare but life threatening – airway compromise
  • Limbs and trunk- involuntary contractions
  • Highly disturbing to patients-intereferewith function and quality of life
  • Typically acute onset

occurs in

  • Patients under age 30
  • High doses of antipsychotics early in treatment
  • History of an acute dystonic reaction
  • Cocaine use

treatment

  • Mild-moderate: oral benztropine(Cogentin) or diphenhydramine (Benadryl)- anti-hisatmine(anticholinergic works similar to cogentin)
  • MOA: anticholinergic, diminishes Ach activity
  • Severe: IM/IV
  • Can add benztropine (Cogentin) to medication regimen after acute treatment of the dystonic reaction as a preventive to prevent it happening again
65
Q

tardive dyskinesia

A
  • Usually occurs after6 months of treatment or chronic use
  • Abnormal movements of face, mouth, jaw, and extremities characterized by:
  • Sucking, smacking of lips
  • Choreoathetoidmovements of the tongue
  • Chorea = irregular, migrating contractions dancing migrating movements
  • Athetosis = twisting, writhing usually facial movements
  • Facial grimacing
  • Lateral jaw movements
  • Choreiform or athetoid movements of the extremities and/or truncal areas
  • Severe cases may lead to breathing and swallowing difficulties

most usually remit except if elderly

treatment: •Clozapine (Clozaril) – only antipsychotic to have minimal risk of TD and may help improve existing symptoms of TD

66
Q

abrupt discontinuation of antidepressenat

A

emerge 2-5 days after. last 7-14

  • Nausea/vomiting
  • Diarrhea
  • Headaches
  • Lightheadedness/dizziness
  • Diminished appetite
  • Sweating/chills
  • Tremors
  • Paresthesias
  • Fatigue/somnolence
  • Sleep disturbances

less common:

  • Electric shock-like sensations (especially SNRIs- cymbaltaeven if missing a dose)
  • Cardiac arrhythmias (more common with tricyclic antidepressants)
  • Myalgias/arthralgias
  • Balance difficulties
  • Psychological symptoms:
  • Agitation/irritability/aggressiveness
  • Rebound Anxiety
  • Panic attacks
  • Worsening of mood
  • Mood lability
  • Memory/concentration difficulties
67
Q

psychoanalysis

A

Can involve dream analysis and free association. intensive several sessions/week. freud childhood

68
Q

psychodynamic therapy

A

based on psychoanalysis. Focuses on increasing patient’s awareness (insight) of unconscious thoughts and behaviors, gain new insights into motivations, and resolve conflicts

69
Q

behavior

A

reinforcement and desensitization, thought exercises symptom reduction

70
Q

cognitive

A

changed distorted though how they behave and feel

71
Q

cognitive behavioral therapy

A

identify unhealthy or negative beliefs and behaviors and replace them with healthy, positive ones. Based on the premise that a patient’s own thoughts, not other people or situations, determines how she or he behavesEven if an unwanted situation doesn’t change the patient can change the way she or he thinks and behaves in a more healthy manner. Evidence-based treatment for many psychiatric disorders: Depression, anxiety, panic disorder, OCD, PTSD, eating disorders

72
Q

dialectial behavioral therapy DBT

A

Teaches behavioral skills to help a patient tolerate stress, regulate emotions, and improve relationships with others. Includes skills training, mindful practice, and close monitoring of and intervention in crises that may develop. Borderline personality disorder (mood instability) , eating disorders, substance abuse

hypnosis- Useful in treating habitual problems and symptom management: Smoking cessation, Chronic pain, phantom limb pain

73
Q

interpersonal therapy

A

Patient learns to evaluate how she or he interacts with others and develops strategies for dealing with relationship and communication problems

supportive therapy- medical practice to help individuals cope w/ illness, crisis, maintain optimism

74
Q

electroconvulsive therapy

A

Indications: seizure under general anesthesia don’t use if increase intracranial pressure, pregnancy, or cardiac. Adverse cognitive effects: confusion, disorientation, memory loss. Possible persistence of retrograde amnesia – inability to recall events from before undergoing ECT

Used for: Major depressive disorder

Refractory/resistant to antidepressant medications

Previous response to ECT

Psychotic features (delusions, hallucinations)

Persistent suicidal intent that medication is not working on

Catatonia/Schizophrenia

Bipolar depression or mania

75
Q

magnetic stimualtion therapy

A

Magnetic pulses (instead of electricity) to stimulate a precise target and induce a seizure in the brain

Done under anesthesia + muscle relaxer

Early stages of testing

Compared with ECT, fewer memory side effects, shorter seizures, shorter recovery

76
Q

vagal nerve stimulation-

deep brain stimulation-

psychosurgery-

A

batter to brain for epilepsy

essential tumor, advanced parkinson’s, dystonia. neurosurgical place electrodes in thalamus

Neurologic disorders – epilepsy, Psychiatric disorders – intractable MDD and OCD

77
Q

Transcranial magnetism

A

depression pulses to stimulate nerve cells, no seizure, no anesthesia, no side effects bad for metallic devices

78
Q

major depressive disorder

A

more common in woman than men. Occurs most often in individuals without close interpersonal relationships, divorced, separated. norepinephrine and serotonin (monoamine). anatomic changes precede depression hypopituitary adrenal access, frontal cortex, and subscortical structures. SIGECAPS (sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidality for 2 weeks. decreased libido. anhedonia- presenting symptom in geriatric pop. stomach, headache, delusions hallucinations. last 6-13 months pt have more frequent episodes lasting longer.

Common side effects

GI upset, headache, sexual dysfunction, insomnia vs sedation, agitation, anxiety

79
Q

bereavement

A
  • Typically resolves 6-12 months
  • Typically does not cause severe functional impairment
  • Treatment: Supportive psychotherapy, grief counseling
  • Shock
  • Sadness
  • Anxiety
  • Anger
  • Guilt
  • Lonelinessis the most lasting manifestation
  • Most individuals are expected to return to school/work in a few weeks
  • Establish equilibrium within a few months
  • Capable of pursuing new relationships within 6 months – 1 year
  • Symptoms >1 year = Persistent Complex Bereavement Disorder
  • Somatic distress
  • Throat tightness, shortness of breath, sighing, weakness, loss of appetite
  • Preoccupation with the image of the deceased
  • Visualizing, hearing the voice, imagining conversations
  • Guilt about things done or not done
  • Hostility towards others
  • Changes in behavior
  • Difficulty initiating normal routine
80
Q

adjustment disorder

A
  • Emotional/behavioral symptoms in response to a stressor (move, new or old relationship)
  • Occurs within 3 months of the stressor, resolves within 6 months
  • Treatment:Psychotherapy, medication not indicated
81
Q

persistent depressive disorder

A
  • Depressed mood for at least 2 years
  • Typically less severe than MDD
  • Presence (while depressed), of 2+ of the following:
  • Poor appetite or overeating.
  • Insomnia or hypersomnia.
  • Low energy or fatigue.
  • Low self-esteem.
  • Poor concentration or difficulty making decisions.
  • Feelings of hopelessness.
  • Clinical Features
  • Symptoms tend to be more subjective than major depression
  • Changes in sleep, appetite, libido, psychomotor slowing are less common
  • Lethargy and anhedoniaare characteristically worse in the morning (fatigue, lethargy, and anhedoniaimprove throughout the day)
  • No psychotic symptoms
  • Episodes of MDD may occur-Try to hit all of the hormones associated with it but not doubling up
  • AKA “double depression”
  • Poor prognosis
  • Medications
  • SSRIs
  • Psychotherapy
  • CBT
  • Insight oriented (psychodynamic) therapy: commonly used for dysthymia
  • HospitalizationàTypically not required *unless suicidal ideation
82
Q

schizoeffective disorder

A
  • Can be difficult to distinguish MDD with psychotic features from schizoaffective disorder, depressive type
  • MDD with psychotic features:Mood symptoms precede psychotic symptoms, psychosis resolves when depression is treated
  • Schizoaffective disorder, depressive type: Mood symptoms + psychotic symptoms that are independent of each other (treat both: antidepressant + antipsychotic)
  • Schizophrenia= no mood symptoms
83
Q

dementia

A
  • Both can present with impaired memory and poor concentration
  • Consider a trial of antidepressants
  • Pseudo-dementia (aka “dementia syndrome of depression”)= depression that mimics dementia
  • Cognitive symptoms develop after mood symptoms, tends to be quicker onset than dementia, resolves when depression is treated
84
Q

panic disorder

A

sudden more difficult to predict no trigger, more common in woman unexpected painic attacks

  • Occur suddenly
  • Often begin with a 10 minute period of rapidly increasing symptoms
  • Generally last 20-30 minutes
  • Physical symptoms coupled with extreme fear and sense of impending doom or death
  • Four or more of the following symptoms occur during a panic attack:
  • Palpitations, pounding heart, or accelerated heart rate.
  • Sweating.
  • Trembling or shaking.
  • Sensations of shortness of breath or smothering.
  • Feelings of choking.
  • Chest pain or discomfort.
  • Nausea or abdominal distress.
  • Feeling dizzy, unsteady, light-headed, or faint.
  • Chills or heat sensations.
  • Paresthesias (numbness or tingling sensations).
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself).
  • Fear of losing control or “going crazy.”
  • Fear of dying.

Following a month of:

  • Persistent concern or worry about additional panic attacks or their consequences
  • A significant maladaptive change in behavior related to the attacks (restricted activities) agoraphobia

Treatment:

  • SSRIs
  • Good for long-term, maintenance treatment to decrease the number of total
  • Not effective at relieving acute panic attacks
  • Benzodiazepines- as needed interrupt it
  • Effective resolution of acute panic attack
  • Abuse and dependence issues
  • Best used short-term while waiting for SSRI to become therapeutic orPRN (because of overuse and abuse)
  • Taking as needed
85
Q

Agoraphobia

A
  • Fear/anxiety regarding places from which escape might be difficult
  • Disabling – severely interferes with functioning
  • May develop as a complication of panic disorder, maladaptive
  • Marked fear or anxiety about 2+ of the following 5 situations:
  • Using public transportation
  • Being in open spaces (parking lots, bridges)
  • Being in enclosed places (shops, theaters)
  • Standing in line or being in a crowd
  • Being outside of the home alone
86
Q

social anxiety disorder

A
  • most of the general population experiences some degree of social anxiety or self-consciousness – the differentiating factor is when the anxiety prevents one from participating in desired activities or causes marked distress
  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
  • The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (embarrassing).
  • The social situations almost always provokefear or anxiety.
  • The social situations are avoidedor endured with intense fear or anxiety.
  • The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
  • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
  • The fear, anxiety, or avoidance causes clinically significant distress or impairment in social/occupational/other areas of functioning.
  • Treatment:
  • Cognitive-behavioral therapy
  • SSRIs
  • Benzos- acute
  • Beta-blockers – performance subtype only
  • Propranolol (Inderal) low dose as needed (rebound hypertension can occur)
87
Q

generalized anxiety

A
  • Associated with 3+of the following 6 symptoms:
  • Restlessness/feeling on edge.
  • Being easily fatigued.
  • Difficulty concentrating or mind going blank.
  • Irritability.
  • Muscletension neck discomfort
  • Sleep disturbance (difficulty falling or staying asleep/restless, unsatisfying sleep).
  • Treatment
  • Psychotherapy
  • CBT, supportive, insight oriented
  • Medications
  • SSRIs/SNRIs
  • Benzos – short term
  • Buspirone
88
Q

OCD

A

Obsession= recurrent, intrusive thought, feeling, idea, or sensation. Mental event

  • Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, in most individuals cause marked anxiety or distress.
  • The individual attempts to ignore/suppress/neutralize the thought with a compulsion

Compulsions:conscious, standardized, recurrent action. Behavior

  • Repetitivebehaviors(hand washing, checking) or mental acts (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
  • The behaviors are aimed at preventing/reducing anxiety or distress; however, these behaviors are not connected in a realistic way or are clearly excessive
  • The obsessions or compulsions are time-consuming (>1 hour per day) or cause clinically significant distress or impairment in functioning

ex. sexual behavior, gambling, substance person usually derives pleasurefrom the activity and may wish to resist it only because of its deleterious consequences

equal between men and woman

tretment

  • Behavior therapy (desensitization)
  • Medications
  • SSRIs – fluoxetine, paroxetine, sertraline, citalopram
  • TCA – clomipramine
89
Q

body dysmorphic disorder

A
  • Preoccupation with an imagined defect in appearance that causes clinically significant distress or impairment in functioning.
  • At some point during the course of the disorder, the individual has performed repetitive behaviors (mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (comparing his or her appearance with that of others) in response to the appearance concerns
  • The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • Treatment- with mixed success not common that they will voluntarily present to a psychologist
  • SSRI or clomipramine
  • Psychotherapy – CBT
90
Q

hoarding

A
  • Obsessive fear of losing important items that may be of future use
  • Distorted beliefs about the importance of possessions
  • Extreme emotional attachment to possessions
  • The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (family members, cleaners, authorities).
  • The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
  • Treatment
  • Difficult to treat
  • Most effective treatment is CBT
  • SSRIs have showed mixed results
91
Q

trichotillomania

A
  • Similar to OCD – tension before hair pulling àrelief of tension or gratification after the hair pulling ex. Head, arm, eyebrows
  • Repeated attempts to decrease or stop hair pulling.
  • The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
92
Q

ptsd

A

A.) Exposureto actual or threatened death, serious injury, or sexual violence in 1+ of the following ways:

–Directly experiencing the traumatic event.

–Witnessing, in person, the event as it occurred to others.

–Learning that the traumatic event occurred to a close family member or close friend.

–Experiencing repeated or extreme exposure to aversive details of the traumatic event (first responders collecting human remains).

B.) Presence of 1+ of the following intrusion symptoms:

–Recurrent, involuntary, and intrusive distressing memories of the traumatic event.

–Recurrent distressing dreams related to the trauma (nightmares)

–Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event were recurring.

–Intense or prolonged psychological distressat exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Markedphysiological reactionsto internal or external cues that symbolize or resemble an aspect of the traumatic event

C.) Persistent avoidanceof stimuli associated with the traumatic event; 1 or both of the following:

–Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event.

–Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event.

D.) Negative alterations in cognitionand mood;2 or more of the following:

–Inability to remember an important aspect of the traumatic event

–Persistent and exaggerated negative beliefsor expectations about oneself, others, or the world (“I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”)

–Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame himself/herself or others.

–Persistent negative emotional state (fear, horror, anger, guilt, or shame).

–Markedly diminished interest or participation in significant activities.

–Feelings of detachment or estrangement from others.

–Persistent inability to experience positive emotions (happiness, satisfaction, love)

E.) Marked alterations in arousaland reactivityassociated with the traumatic event; 2 or more of the following:

–Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.

–Reckless or self-destructive behavior.

–Hypervigilance.

–Exaggerated startle response.

–Problems with concentration.

–Sleep disturbance (difficulty falling or staying asleep or restless sleep).

•Duration of the disturbance (Criteria B, C, D, and E) is > 1 month.

prolonged exposure therapy and cognitive processing

early treatment optimal

SSRI’s

Sertraline (Zoloft)

Paroxetine (Paxil)

Fluoxetine (Prozac)

SNRI

Venlafaxine (Effexor)

  • Glucocorticoids- cortisol and the implications of that
  • Ketamine (success treating refractory depression)-

Alpha-blocker?

Prazosin– blockade of norepinephrine at post-synaptic alpha-1 receptor- crosses blood brain barrier and blocks norepinepherine for nightmares

2017 VA guidelines: insufficient evidence to recommend for or against the use of prazosinfor nightmares

93
Q

acute stress diorder

A
  • Symptoms last 3 days – 1 month
  • The symptom pattern in acute stress disorder must occur within 1 month of the traumatic event and resolvewithin that 1-month period.
  • If the symptoms persist for more than 1 month and meet criteria for PTSD, the diagnosis is changed from acute stress disorder to PTSD.

Presence of 9+ of the following symptoms:

Intrusion Symptoms

  • Recurrent, involuntary, and intrusive distressing memories of the traumatic event
  • Recurrent distressing dreams in which the content and/or affect of the dream are related to the event
  • Dissociative reactions (flashbacks)
  • Intense psychological distress/marked physiological reactions in response to reminders of the event

Negative Mood

•Persistent inability to experience positive emotions

Dissociative Symptoms

  • An altered sense of the reality of one’s surroundings or oneself (being in a daze, time slowing)
  • Inability to remember an important aspect of the traumatic event

Avoidance Symptoms

  • Efforts to avoid distressing memories, thoughts, or feelings
  • Efforts to avoid external reminders (people, places, conversations, activities, objects, situations)

Arousal Symptoms

  • Sleep disturbance
  • Irritable behavior and angry outbursts
  • Hypervigilance.
  • Problems with concentration.
  • Exaggerated startle response.
94
Q

adjustment disorder

A
  • An emotional response to a stressful event
  • Symptoms must begin within 3 months of the stressor

medical hospital surgical conditions

treat w/ psychotherapy

  • The development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor.
  • Symptoms/behaviors are clinically significant, evidenced by 1+ of the following:
  • Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
  • Significantimpairmentin social, occupational, or other important areas of functioning.
  • The symptoms do notrepresent normal bereavement.
  • Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

Specify whether:

  • With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.
  • With anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant.
  • With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
  • With disturbance of conduct: Disturbance of conduct is predominant.
  • With mixed disturbance of emotions and conduct: Both emotional symptoms (depression, anxiety) and a disturbance of conduct are predominant.
  • Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
95
Q

Bipolar I

A
  • The mood disturbance is severe enough to impair social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
  • The episode is not attributable to the physiological effects of a substance (drug of abuse, a medication) or another medical condition. Has to be greater than a week
  • Note:A full manic episode that emerges during antidepressant treatment (medication) but persists at a fully syndromallevel beyond the physiological effect of that treatment is sufficient evidence for a manic episode. Usually requires hospitalization

Treatment:

  • Treatment
  • Lithium
  • Anticonvulsants
  • Antipsychotics

•

  • First line treatment for:
  • Severe mania: Lithium or valproic acid (Depakote-anti-convulsant) + antipsychotic.
  • Hypomania or mild to moderate mania: Monotherapy with antipsychotic (olanzapine or risperidone)
  • Can also consider lithium, valproic acid, or other antipsychotics
  • Distractibility
  • Indiscretion (shopping sprees increased sexual promiscuity)
  • Grandiosity
  • Flight of ideas
  • Activity increase
  • Sleep deficit
  • Talkativeness (pressured speech)
96
Q

Bipolar II

A

•Current/pasthypomania (time frame and intensity) andcurrent/past major depressive episode:

•

Hypomanic Episode

  • A distinct period of abnormally and persistently elevated/irritable mood and increased activity/energy, lasting at least 4 consecutive daysand present most of the day, nearly everyday not a full blown manic episode. Doesn’t usually require hospitalization.
  • During the period of mood disturbance and increased activity, 3+ of the following symptoms (4 if the mood is only irritable) are present:
  • Inflated self-esteem or grandiosity.
  • Decreased need for sleep (feels rested after only 3 hours of sleep).
  • More talkative than usual or pressure to keep talking.
  • Flight of ideas or subjective experience that thoughts are racing.
  • Distractibility, reported or observed.
  • Increase in goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation (purposeless non-goal-directed activity).
  • Excessive involvement in activities that have a high potential for painful consequences (=engaging in unrestrained buying sprees, sexual indiscretions, foolish business investments).
  • The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
  • The disturbance in mood and the change in functioning are observable by others.
  • The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.
  • Note:A full hypomanic episode that emerges during antidepressant treatment (medication) but persists at a fully syndromallevel beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode.
  • Caution – 1-2 symptoms (irritability, edginess, or agitation following antidepressant use) is notsufficient for a hypomania diagnosis. Commonly mistaken for instead of correct anxiety or depression
97
Q

cyclothymic disorder

A

bipolar version of PDDD.

•For at least 2 years there have been numerous periods with hypomanic symptoms that do not meet full criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet full criteria for a major depressive episode.

•

  • During the 2-year period, the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
  • Treatment
  • Mood stabilizers + psychotherapy
98
Q

premenstrual dysphoric disorder

A
  • In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses.
  • Total of 5 symptoms – at least 1 from each category
  • 1+ of the following symptoms must be present:
  • Marked affective lability (mood swings; suddenly sad/tearful).
  • Marked irritability or anger or increased interpersonal conflicts.
  • Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
  • Marked anxiety, tension, and/or feelings of being on edge.

•

  • 1+ of the following symptoms must additionally be present:
  • Decreased interest in usual activities.
  • Subjective difficulty in concentration.
  • Lethargy, easy fatigability, or marked lack of energy.
  • Marked change in appetite; overeating; or specific food cravings.
  • Hypersomnia or insomnia.
  • A sense of being overwhelmed or out of control.
  • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating.

•

  • Daily SSRI
  • SSRI luteal phase therapy:
  • Start SSRI on day 14, discontinue on first day of menses or 1-2 days after
  • Not recommended if symptoms are continuous throughout cycle or if cycle is irregular

•

Note: oral contraceptives can also be used for PMDD – especially physical symptoms (bloating and breast pain)

Behavioral Medicine (3 decks)

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