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PA EOR BH > psychoses > Flashcards

psychoses Flashcards

1
Q

Delusional Disorders

A

> 1 delusion, >1 month WITHOUT other psychotic sx. must be plausible but unlikely. Lanie.

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2
Q

> 1 psychotic sx w/ onset and remission <1month

A

Brief psychotic disorder

Montana w/ frostbite

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3
Q

meet schizophrenia definition BUT <1 month

A

schizoPHRENIFORM disorder

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4
Q

Schizophrenia + mood disturbance (mania, MDD)

A

ShizoEFFECTIVE disorder

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5
Q

Criteria for shizophrenia

A

> 6 months duration of illness with 1 month of acute sx almong w/ funcitional decline

> 2 positive sx and must have 1+ hallucination, delusion, or discoganized speech

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6
Q

(+) H sx auditory

A

often 3rd person, can be command

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7
Q

(+) H sx olfactory

A

stench foul smell common

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8
Q

(+) H sx tactile

A

insects on skin or being touched

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9
Q

(+) H sx somatic

A

sensation arising from within the body

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10
Q

(+) H sx gustatory

A

can be a part of persecutory delusions (tasting poison)

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11
Q

(+) D sx persecutory

A

force/person interfeing with them observing them or wishes harm to the pt

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12
Q

(+) D sx Refeence

A

ransdome events take control of patient’s thought, feelings and behaviors

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13
Q

(+) sx D reference

A

random events take on a persone sig )directed at them)

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14
Q

(+) sx D control

A

some agency takes contol o fpts thoughts eelings and behavors

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15
Q

(+) sx D Grandiose

A

Unrealistic beliefs in ones own powers

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16
Q

(+) sx D nihilsm

A

exaggered belief in the futility of evyerthing and catastrophic events

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17
Q

(+) sx D erotomanic

A

believes another person is in love with them

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18
Q

(+) sx D jealousy

A

suspects unfaithful

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19
Q

(+) sx D doubles

A

believes someone close to them has been switched by a double

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20
Q

(-) sx thought to be caused by dopamine dysfuntion in the mesocoritcal pathway. seritonin may play a role.

A

flat, social withdrawal, lack emotion, avolition (lack self motivation) lack communication, poor eye contact

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21
Q

RF schizophrenia

A

MC family hxk

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22
Q

MOA 2nd gen antipsycotics

A

dopamine and seritonin antagonists

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23
Q

Best for (+) sx

A

1st gen Haloperidol and chlorpromazine BUT cause extrapyrimidal effects

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24
Q

2nd gen best when develop resistance to other 2nd gen

A

clozapine

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25
Q

AE clozapine

A

agranuloctyosis get CBCweekly

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26
Q

AE olanzapine

A

DM

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27
Q

General AE 2nd gent AP

A

myocarditits, seizures QT porlongation, weight gain

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28
Q

AP 1st gen MOA

A

only dopamine antagonist. good for (+) sx

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29
Q

Extrapyramidal sx (EPS)

A

rididity, bradykiesia, tremor, akathisia (restlessness)

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30
Q

3 EPS syndromes

A
  1. Dyskinesia
  2. tardive dyskinesia
  3. parkinsominsm
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31
Q

Dyskinesia (dystonic reactions) - short term use

A

Reversible extrapyramidal sx.
happens hours after admin
decreased dop leads to increased ach
trismus, tongue protrussions, facial grimicing, torticollis, difficulty speaking
tx: diphenhydramine IV for anticholinergic properties.
or benztropine for antichokinergic agent
bezos may be used bc mediates dop/ach balance with GABA

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32
Q

Tardive dyskinesia (long term us)

A

long term use
repetative involuntary movement in extremities
lip smacking, teeth grinding, tongue rolling.

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33
Q

parkinsonism (low dopamine in nigrostrial)

A

rigidity tremor

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34
Q

In addition to EPS sx of 1st gen there are more SE

A

NMS, QT prolongation, cardiac arrythmias, sedation, ach effects, dermatitis, blood dyscrasias HIGH PROLACTIC (worse with 2nd gen). WEIGHT GAIN

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35
Q

NMS 1st gen

A

due to dopamine blockade
AMS, rigidity, tremor, autonomic instability, tachycardia, tachypnea, hyperthermia/fever
mgmt. stop agent.
tx hyperthermia w/ cookjng blaken, ice
give DOPAMINE agonists like bromocriptine, amantadine, levo/carb

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36
Q

Name 1st gens

A

haloperidol, droperidol, fluphenazine, perphernaine, chlorpromazine , thioridazine

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37
Q

MOA 1st and 2nd

A 
1st = dopamine antagonist
2nd = dop and seritonin antagonist
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38
Q

SE of 2nd gen

A

EPS (less than 1st esp clozapine and quetiapine)

Increased prolactin, hyperglycemina, hyperlipidemia, weight gain, NMS

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39
Q

Name 2nd gen

A

quet, olanza, cloza, loxapine

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40
Q

Name benzisoxazoles

A

risperidone, ziprasidon

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41
Q

MOA benzisoxazole

A

Dopaminte antagonist and serotonin antagonist but at diffenet sites than second

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42
Q

IND for risperidone, ziprasidone

A

shciazoprhenia, bipolar, psychosis,

risperdal ok for tourettes

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43
Q

SE rispidone and ziprasidione

A

EPS, INCREASED prolactin, sedation , weight gain, hypotension, prolonged QT

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44
Q

Quinolones

aripiprazole (abilify)

A

MOA dopamine and serotonin antaonist, indicated for psychotic disorders. may be called 3rd gen

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45
Q

Lithium MOA

A

increases NorEP and serotonin receptor sensitivity

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46
Q

Lithium indications

A

bipolar, acute mania

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47
Q

Lithium SE

A

HYPOTHYROIDISM. ARRYTHMIAS, sodium depletion. increased urination and thirst, DI, Hyperparathyroid/hypercalcemia.
seizures , tremor, HA, weight gain, GI disturb,

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48
Q

Lithium pregnantcy

A

CI

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49
Q

Lithium has a narrow TI

A

monitor plasma levels every 4 - 8w

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50
Q

What behavior can carbamazepine or valproate suppress

A

impulse and aggressive

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51
Q

MDD RF

A

MC female, 20-40s

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52
Q

MDD

A

2weeks +, must be almost every day, >5 sx

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53
Q

MDD sx

A

andendonia, dis sleep, guilt, workthlessness, suicide, psycholoto agitation, weight change, appetite change, concentraiotn

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54
Q

MDD cannot be assoc

A

bereavment, substances, medical conditions

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55
Q

Somatic sx of MDD

A

constipation, HA, skin changes, chest or abdominal, cough, dyspnea

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56
Q

Subtypes “course specifiers” of MDD

A
  1. SAD
  2. atypical depression
  3. Melancholia
  4. Catatonic depression
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57
Q

MDD: SAD

A

same time each year

mgmt: ssri, light tx, bupropion

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58
Q

MDD: atypical depression

A

similar to MDD
BUT
experience mood reactivity (improved mood w/ (+) ecents)

sx: weight gain, appetitie, increase, hypersomina, heavy leaden felling in arms or legs, oversensitiity to interpersonal rejection
mgmt MAO inhibitors

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59
Q

MDD: melancholia

A

anhedoia, lack mood reactivity, depression, severe weight loss/ app loss, guilt, PA, or PR, sleep,
may have worse mood in the morning

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60
Q

MDD: catatonic depression

A

motor inability, stupor and extreme withdrawl

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61
Q

mgmt mild/ mod depression

A
  1. psychotherapy
  2. medications
  3. electroconvulsive therapy
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62
Q

Meds MDD

A

1st: SSRI
2nd snri, buproprion, mirtazapine
3rd: TCAs and MAO inhibitors

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63
Q

Min time to give and antiD

A

3-6 weeks

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64
Q

Name SSRIs

A 
citalopram (celexa)
escitalopram (lexapro)
paroxetine (paxil)
fluoxetine (prozac)
sertraline (zoloft)
fluvoxamine (zyvox)
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65
Q

MOA SSRI

A

inhibits CNS seritonin receptors from taking back the seritonin and hence increaseing seitonin in the cleft

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66
Q

Ind SSRI

A

1st line depression and anxiety

less SE, lower toxicity

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67
Q

Avoid citalopram in which patients?

A

long QT

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68
Q

SSRI - seritonin syndrome

A

acute AMS, seizures, coma and death, reslessess, sweating , tremor, hyperthemia, nausea, vomiting, abd pain, mydriasis, tachycardia

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69
Q

SNRI names

A

venlafaxine (effexor)
desvenlafaxine (pristiq)
duloxetine (cymbalta)

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70
Q

SNRI MOA

A

inhibits uptake of seritonin, NE, and DA

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71
Q

Ind SNRI

A

can be 1st line if have MDD with FATIGUE AND PAIN syndromes

2nd line if dont respond to SSRI

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72
Q

SE SNRI

A

same as SSRI: hyponatremia, noradrenergic sx

AND: HTN, dizziness

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73
Q

CI/ Cautions SNRI

A

renal/ hepatic ds, seizures
AVOID ABRUPT d/c
caution if have HTN
High suspicion for serotonin syndrome if using St johns wort

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74
Q

Name TCAs

A 
amitriptyline (elavil)
clomipramine (Anafranil)
desipramine (Normpramin)
doxepin (Sinequan)
imipramine (Tofranil)
Nortriptyline (Pamelor)
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75
Q

TCAs MOA

A

inhibits reuptake of serotonin or NE

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76
Q

TCAs IND

A

depression, INSOMINA, DM neuropathy, post herpetic neuroalgia, migraine, urge incontinence.

Nondepressed pts experience sleepiness. depressed patients feel elevated mood

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77
Q

TCAs why should not prescribe a truckload to MDD

A

easy to OD

Na channel blocker effts: sinuse or wide complex tachycardia, neurologic sx, ARDS, SIADH

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78
Q

SE TCAs

A

ANTICHOLINERGIC, PROLONGED QT (best indicator of OD)

weight gain, sedation

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79
Q

What use for TCA cardiotoxicity?

A

sodium bicarbonate

80
Q

Tetracyclic compunds

mirtazapine (Remeron) MOA

A

inhibits Serotonin and NE

81
Q

mirtazapine (Remeron) Ind

A

depression. less sexual dysfuction SE. may be used with trazadone

82
Q

mirtazapin S/E and CI

A

sedation, dry mough constipation, weight gain, AGRANULOCYTOSIS
CI: done use with MAO

83
Q

Buproprion MOA

A

inhibits neuronal uptake of DA and NE

84
Q

Buproprion indications

A

wellbutrin depression

zyban: smoking

85
Q

buproprion SE

A

SEIXURES, agitation, anxiety, restlesness, weight loss, HTN, HA
LESS GI and Sexual problems

86
Q

Bupropion CI

A

Seizure disorder
Eating disorder (bc makes not hungry)
drug/ETOH detox
avoid abrupt withdrawl

87
Q

MAO names

A

phenelzine (nardil)
tranylcypromaine (parnate)
isocarboxazid (marplan)
selegiline (eldepryl)

88
Q

MAO high yield

A

HTN crisis w/ tyramine containg foods
MAOI + SSRI may cause serotonin syndrome
MAOI + TCA may cause delirium and HTN t

89
Q

Trazadone

A

MOA serotonin antagonist and reuptake inhibitor. antidepressant, antianxiety, for insomnia
S/E priapism, cardiac arrhythmias

90
Q

BP I

A

1+ manic or mixed episode which often cycles with occasional depressive episodes but don’t need to be MDD

91
Q

BP II

A

1+ hypomanic and 1+ MDD

mania or mixed episodes are absent

92
Q

BP 1 facts

A

1% population. MC RF family hx.
average age onset 20s-30s, rare past 50s
earlier onset more likely psychotic features and poorer prognosis

93
Q

BP I MANIA

A

elevated, expansive or irritable for 1+ week
impairment social fx
> 3 following
mood: euphoria, irritable, labile, dysphoric
thinking: racing, flight ideas, disorganized, distractable, expansive or grandiose, impaired judgement
behavior: hyperactivity, pressured speech, less sleep, impulsivity, hypersexual, increased goal directed activity, phychotic sx (paranoia, delusions, hallucinations)

94
Q

BPII HYPOmania

A

sx similar to mania BUT
does not cause impairment or hopitilization
4+ days, no racing thoughts, no agitation

95
Q

MGMT of BP I

A
  1. mood stabilizer

2. therapy: cognitive, behavioral, and interpersonal. good sleep hygiene

96
Q

Mood stabilizers BP

A

1st line lithium, valproic acid, carbamazepine
2nd line 2nd gen antipsychotics: (except olanzipine)
2nd line also 1st gen antipsychotics haloperidol
- if psychosis or agitation develops add benzo
other txs: SSRI, TCA, MAOI or ECT

97
Q

Careful bc SSRI is BP

A

can cause mania

98
Q

BP 1 and 2

mania and MDD req

A

BP1 mania BP2 hypomania

BP1 maybe depression BP2 MDD

99
Q

Dysthima

A

persistent depressive disorder

100
Q

PDD = dysthimia define

A

> 2yrs chronic depressed mood (>1 peds)
typicaly milder than MDD

must have 2+
sleep problems, fatigue, low self esteem, diet problems hopelessness, poor concentration, indecisiveness

101
Q

Characteristics of PDD = dysthmia

A

MC women late teens, early adulthood
may progress to BP or MDD
no sx hypomania, mania, or psychotic features

PESIMISM, low productivity, social withdrawal, loss interest
“Ive always been this way”

102
Q

MGMT Persistent depressive disorder = dysthimia

A

ssri 1st line

103
Q

Define cyclothymic disorder

A

less severe BP 2
milder elevations and depressions of mood
may develop BP
men = women

104
Q

Cyclothymic disorder CM

A

must be 2+ years (1 year peds)
hypomanic sx that dont meet criteria for hypomania
no mania
mild depressive

105
Q

MGMT cyclothymic disorder

A

mood stabilizers and neuroleptics

106
Q

Define Panic attack

A

intense fear, abrupt, usually peaks at 10m, lasts <60m

107
Q

are panic attacks a disorder

A

no, but a feature

108
Q

Panic attack must have 4 +

A

dizziness, trembling, choking feeling, parasthesias, sweating, SOB, chest discomfort, chills or hot flashes, fear loosing control, fear dying, palpitations, increased HR, abd distress or nausea, depersonalization or derealization.

109
Q

1st line for panic attack

A

benzo loraz or alpraz

110
Q

Panic disorder demographic

A

3x more often women. usually before 30years of age

111
Q

criteria of panic disorder

A

2+ panic attacks

one of the following must last >1 month: 1. concern about future attack. 2. worry about implications of loosing control 3. sig change in behavior related to attacks.

msust have 4 of panic attack sx

must not be related to substance abuse

May have agoriphobia

112
Q

MGMT Panic disorder

A

long term mgmt
1st line SSRI or snri
2nd line CBT
acute: benzo

113
Q

GAD criteria

A 
> 6mos excessive anxiety or worry 
not episodic (unlike panic disorders), not situational and not focal

must have 3+ fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness and HA. no caused by medical illness

MC females onset in early 20s

114
Q

mgmt of GAD

A
  1. SSRI, snri
  2. buspirone
  3. benzo, BB, TCA
  4. psychotherapy: includes CBT
115
Q

Buspirone info

A

may take several weeks to work
blocks DA, increases serotonin
SE nausea, restless legs, EPS, dizziness
DOES NOT cause sedation

116
Q

Social anxiety disorder criteria

A

> 6 months, intense fear of social or performance situation in which exposed to scrutiny fear of embarrassment
can cause EXpected panic attack
often know its unreasonable

117
Q

Criteria PTSD

A
  1. direct
  2. witness
  3. close family/friend
  4. first responders to cat. event
118
Q

PTSD must have at least 1 intrusion sx

A
  1. reexperiencing > 1m like flashbacks
  2. avoidance of stimuli like events
  3. negative alterations in cognition and mood. inability to remember imp parts of event, exaggerated beliefs “world is unsafe”, horror guilt anger or shame
  4. arousal and reactivity. angry outbursts, irritable, reckless, hypervigilance, sleep and conc prob, exaggerated startle
119
Q

MGMT PTSD

A

SSRI first line
trazadone can be good for insomnia
CBT

120
Q

Acute Stress disorder

A

similar to ptsd but less than 1 month

121
Q

Adjustment disorder definition

A

emotional/BH rxn to indentifiable stressors
with a DISPROPORTIONATE response that would be expected within 3 mos
does not include bereavement

CM 1+

  1. marked distress out of proportion
  2. sig impairment of function
122
Q

MGMT of adjustment disorders

A
  1. PSYCHOTHERAPY first line
  2. meds not preferred but can be added
  3. may use substances to cope
123
Q

Define dissociative disorders

A

loss self, temp alt of consciousness, memory or personality, BH or motor function

124
Q

Dissociative identity disorder (formerly multiple personality disorder)

A

> 2 distinct identities or state of personalities that take control of BH
MC in women
may be assoc with sexual abuse, PTSD, substances

125
Q

Name 3 types of dissociative disorders

A
  1. dissociative identity disorder
  2. depersonalization/ derealization disorder
  3. dissociative amnesia
126
Q

Depersonization/ derealization disorder

A

PERSISTENt feelings of detachment or estrangement from
- oneself (detachment)
- surrounding (derealization)
reality testing is intact and sx are distressful

127
Q

Dissociative amnesia

A

inability to recall autobiographical info
sexual abuse, stress, trauma

dissociative fugue: abrupt change in geographical location. loss of ID to recall past

must r/o seizures or brain tumors

MGMT: psycotherapy

128
Q

List OC disorders

A
  1. OC disorder
  2. body dysmorphic disorder
  3. hoarding
  4. trichotillomania
  5. excoriation (skin picking)
129
Q

obsessive compulsive disorder def

A

anxiety disorder char by combo of thoughts (obsession) and behaviors (compulsions)
men = women, men earlier
20s

130
Q

Define obsessions

A

recurrent or persistent thoughts/ images. inappropriate and unwanted.

131
Q

Define Compulsions

A

repetitive BH feels driven to perform to relieve self of obsession.

132
Q

4 major patterns/ CM of OCD

A
  1. contamination: hand washing
  2. pathologic doubt: turn oven off
  3. symmetry/precision: arrange object with precision
  4. intrusive obsessive thoughts without compulsion
133
Q

MGMT OCD

A
  1. SSRI, tca, snri

2. CBT

134
Q

Body dysmorphic disorder

A

1+ body part flawed
repetive acts like mirror checking, seeking reassurance, comparison to others
MC females, may have anxiety or depression
MGMT
antidepressants, psycotherapy

135
Q

Somatic symptom disorder

A

physical sx in 1+ body part w/o physical cause
MC women before 30yo
usually 6+ months
MGMT: regular appt w/ provider

136
Q

Illness anxiety disorder (hypochondriasis)

A

6+ months
somatic sx not common but may be mild
MGMT reg scheduled visits w/ provider for reassurance

137
Q

Functional neurological symptom disorder (conversion disorder)

A

neurologic dysfunction that suggest a physical disorder that cannot be described clinically
NOT intentional or feigned

138
Q

CM functional neurologic symptom disorder (conversion disorder)

A

tend to be episodic during times of stress. MC females and onset in adolescence or early adulthood

  1. motor dysfunction: paralysis, mutism, etc
  2. sensory dysfunction: blindness, etc
  3. often have depression, anxiety, schiz, or PD

MGMT: psychotherapy

139
Q

Factitious Disorder def

A

Intentional, fain sick either psych or medical.
inner need seen ill but NOT for gain like malingering
deliberate unlike somatic disorders

140
Q

Types of factitious disorders

A
  1. imposed on self.

2. imposed on another

141
Q

CM factitious disorder

A
  1. do things to make themselves look sick
  2. willing/eager for surgery or painful tests
    may be a healthcare worker
142
Q

malingering

A

falsification for personal gain

143
Q

Child physical abuse

A

moms usually
cigarette burns, burns in stocking glove pattern, lacerations, healed fractures, subdural hematoma, bruises, retinal hemorrhages
look for hyphema or retinal hemorrhages in shaken baby syndrome

144
Q

Obesity leads to

A

DM, CAD, breast and colon cancers
BMI 30
>20% greater than ideal weight
binge eating

145
Q

Describe obesity binge eating

A

50% recurrent eating a lot. at least weekly fro 3 months

146
Q

MGMT obesity

A
  1. behavioral modification
  2. antidepresants if indicated
  3. Orlistat (dec GI fat absorption), Lorcaserin (serotonin agonist)
  4. surgery
147
Q

Anorexia types

A
  1. restrictive

2. purging type vomiting laxatives

148
Q

Dx anorexia

A

BMI < 17.5 or weight <85% ideal
PE: hypotension, bradycardia, lanugo, dry skin, salivary gland hypertrophy, amenorrhea, arrhythimas, osteoporosis
Labs: leukocytosis, leukopenia, anemia, hypokalemia, increased BUN (dehydration), hypothyroidism

149
Q

MGMT anorexia

A
  1. medical stalization: hosp if <75% ideal or electrolyte disturbance
  2. psychotherapy: CBT, supervised meals , weight monitoring
  3. pharmacotherapy: depression ssri
150
Q

CM bulimia

A
  1. binge eating: at least weekly for 3 months

2. compensatory behavior: purging type (laxative, vomit) OR non purging type restrictive

151
Q

PE bulimia

A

teeth pitting, enamel erosion, russells sig parotid gland hypertrophy, metabolic alkalosis

152
Q

Labs bulimia

A

hypokalemia, hypomangesemia

153
Q

MGMT bulimia

A
  1. psychotherapy CBT

2. pharmacotherapy: fluoxetine has been shown to reduce binge purge cycle (careful of cardio SE)

154
Q

Name Cluster A personality disorders

A
  1. schizoid - social detachment, weird odd
  2. schizotypal
  3. paranoid
155
Q

Schizoid PD

A

cluster A
MC males, loners hermit like, anhedoic, inability to form relationships life long, appears eccentric, cold flattened affect
MGMT: psychotherapy 1st line

156
Q

Schizotypal PD

A

cluster A
odd eccentric thought patterns but WO psychosis (delusions)
CM: odd in BH and appearance, inappropriate affect, magical thinking (clairvoyance, telepathy). may talk self in public. discomfort in relationships, restricted affect
MGMT: psychotherapy 1st line

157
Q

Paranoid PD

A

cluster A
pervasive pattern of distrust. MC males.
misinterprets actions of others. hidden messages, easily insulted, grudges, lack interest in social situations, precoupation with doubt of others loyalty
MGMT: psycotherapy 1st line

158
Q

Name cluster B disorders

A

Dramatic, wild, erractic and impulsive

  1. Antisocial PD
  2. Borderline PD
  3. Histrionic PD
  4. Narcissistic PD
159
Q

Antisocial

A 
Cluster B 
may begin in childhood (conduct)
harmful/hostile 
men 3x more women
drunk driving, lack empathy, little anxiety, extremely manipulative, deceitful, abuse, lies
MGMT: psycotherapy
160
Q

Borderline PD

A

Cluster B MC women
unstable, unpredictable
1. extreme, instability, sensitivity to criticism (fear abandoment)
2. black and white thinking
3. impusivity suicide threats, substance abuse, binge eating, spending, reckless driving
MGMT: psychotherapy

161
Q

Histrionic PD

A

Cluster B
overly emotional, dramatic, seductive, attention seeking, tember tantrums, seeks reassurance and prise often, believes relationships more intimate than truly are, easily influenced
MGMT: psychotherapy

162
Q

Narcissistic PD

A

Cluster B
MC males
inflated self image, fragile self esteem, reacts criticism with rage, becomes depressed, lack empathy
MGMT: psychotherapy

163
Q

Cluster C names

A

anxious, worried, fearful

  1. Avoidant
  2. Dependent
  3. Obsessive-Compulsive
164
Q

Avoidant PD

A

desires relationships but feels inferior
sensitivity to criticism, fears rejection
timid shy lacks confidence
MGMT psychotherapy and medications PRN

165
Q

Dependent PD

A

Cluster C
needy, clingy, constantly needs to be reassured, relies on others for decision making, may volunteer for unpleasant tasks

166
Q

Obsessive compulsive PD

A

Cluster C
PD - police department
order, control, rules, inflexible, moral judgement of others, hesitates to delegate work

167
Q

Autism RF

A

male: female 4:1

168
Q

CM Autism

A

primary
1. low social interaction
2. impaired communication
3. restricted repetitive stereotyped behaviors
other signs
failure show preference to parents over other adults, unusual sensitivities to smells, visual and auditory stimuli. unusual attachments to objects. savantism

169
Q

Autism MGMT

A

referral to neuropsychologic testing
BH mods
meds

170
Q

Oppositional Defiant Disorder

A 
defiant BH to adults
must be: >6mos 
AND have all three
1. angry/ irritable 
2. argumentative
3. vindictiveness 
MGMT: therapy
171
Q

Conduct disorder

A 
violate rights other, dont follow norms
social and academic difficulties
4 main areas
1. serious law violations
2. aggressive/ cruel to animals
3. deceitfulness
4. destruction of property
MC boys, most grow into antisocial BH, poor px
172
Q

criteria for ADD/ADHD

A

before 12 and be present for 6 months

must be in 2 settings

173
Q

Hyperactive components

A
  1. fidgets in seat
  2. in motion constantly
  3. talks a lot
  4. impatience
  5. touches stuff
  6. trouble sitting for long
  7. difficulty doing quiet tasks
  8. restlessness
  9. blurts
  10. interprets conversation and activity of others
174
Q

MGMT ADHD sympathomimetic

also for narcolepsy, excessive daytime sleepiness

A

stimulants, tx of choice
methylphenidate (Ritalin), amphetamin/dextroamphetamine (adderall), dexmethylphenidate (focalin)
MOA: increases DA and NE in couple ways
SE anxiety, HTN, tachycardia, weight loss, growth delays and addiction

175
Q

MGMT ADHD 2nd line

A

Nonstimulants
Atomoxetine (Strattera)
MOA: selective NE reuptake inhibitor
can adjunct w/ bupropion, venlafaxine, guanfacine, clonidine

176
Q

opioid intoxication PE

A

miosis, resp depression, biots breathing, bradycardia, hypotension

177
Q

Opioid withdrawal

A

lacrimation, HTN, pruritus, tachycardia, NV, abdominal crams goose bumps, mydriasis, flu like sx

178
Q

MGMT opiod acute

A

naloxone (Narcan): onset 2 minutes, lasts 30m

179
Q

MGMT opioid withdrawal

A

symptomatic control: clonidine (dc sympathetic sx), loperamide diahrrea, NSAIDs, buprenorphine + naloxone
methadone tapering. benzos maybe

180
Q

Long term MGMT opioid withdrawl

A

methadone or suboxone

181
Q

alcohol uncomplicate WD

A

6-24h, no seizures, DT, or hallucinations

182
Q

Alcohol WD seizures

A

6-48h, usually generalized T-C. MC single episode

183
Q

alcohol hallucinations

A

12-48h, visual, aud, tactile hallucinations

clear sensorium and normal VS

184
Q

Delerium Tremens

A

2 - 5 days
Delerium (altered sensorium), hallucinations, agitation
Abnormal VS (tachy, HTN, fever, sweating)

185
Q

MGMT alcohol WD

A
  1. IV benzo
  2. IV fluids and supplements
  3. avoid meds that lower seizure threshold
186
Q

Benzodiazepines

A

MOA GABA inhibition
ethanol mimics GABA so WD has increased CNS activity
titrate to slightly somnolent and taper
lorazapam or oxazepam preferred if have cirrhosis

187
Q

Name the benzo

A

Diazepam (Valium)
Lorazepam (Ativan)
Chlordiazepoxide (Librium)
Oxazepam

188
Q

Describe IV supplementation alcoholics

A 
IV thiamine and magnesium
then can give glucose second
multivitamins including B12/folate
IV fluids plus dextrose
if glucose and thiamine out of order could cause Korsakoff's
189
Q

Avoid meds lower seizure threshold

A

bupropion, haloperidol, anticonvulsant, clonidine, BB

190
Q

CAGE screening

A 
Cutdown: felt need to cutdown?
Annoyed: people told you about drinking?
Guilt: felt guilty? 
Eye opener: needed morning dose?
need 2+
191
Q

MGMT alcohol abuse

A
  1. supportive AA
  2. disulfaram (antabuse)
  3. naltrexone : opiod antaganist reduces euphoria and craving
  4. gabapentin, topiramate
192
Q

Disulfaram (Antabuse)

A

MOA: inhibits aldehyde dehydrogenase so get uncomfortable sx
CI: CVD, DM, hypothyroid, epilepsy kidney or liver ds

193
Q

Suicide RF

A 
MC previous attempt or threat (plan?)
completes older, but teenagers try most
elderly white men is the highest
white> black
most have underlying psych disorder
SA increased risk
marital status: 
alone> never married > widowed > sep/divorced > married w/o > married with
194
Q

Grief rxn

A

only bereavement disorder considered mental disorder

195
Q

How long is normal grief

A

1 yr may turn to MDD

196
Q

Grief rxn: abnormal grief

A

suicide ideation, psychosis, psychomotor deficits, illusions, hallucinations

PA EOR BH (1 decks)

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