Psychosocial Flashcards
Depression
Mood state characterized by diminished interest in formal activity, fatigue, feelings of sadness, and impaired concentration nearly every day.
Dysthymia
Chronic form of depression lasting at leas 2 and frequently many more years
Stable causality
“it will always be this way”
Global thinking
“Everything is ruined”
Internal vs. external causes
“it’s my fault”
Biochemical theories in depression
Neurotransmitter imbalance (dopamine/serotonin/epi/norepi) Thyroid dysfunction Med side effects
DSM-5 Criteria
States that a person must have 5 or more of the following symptoms for the same 2-week period and represent a change in precious functioning:
*Depressed mood most of the day, nearly everyday
*Markedly diminished interest or pleasure in almost all activities (Anhedonia)
Weight change >5%
Insomnia/hyperinsomnia
Psychomotor agitation/retardation
Fatigue/loss of energy
Lack of concentration/indecisiveness nearly every day
Excessive guilt or feelings of worthlessness
Recurrent thoughts of death/suicide ideation w/o plan or attempt
“In Sad Cages”
In terest: loss of pleasure S leep disturbances A ppetite changes D epressed mood C oncentration difficulty A ctivity: agitation/retardation G uilt feelings E nergy loss S uicidal ideation
Stages of grief
DABDA
Denial, anger, bargaining, depression, acceptance
Selective Serotonin Reuptake Inhibitors (SSRI’s)
Paroxetine, fluoxetine, sertraline, citalopram, fluvoxamine Low OD danger Fast symptom response No postural hypotension Sexual dysfunction
Serotonin syndrome
Cognitive changes, neuromuscular changes and autonomic hyperactivity (high fevers)
Tricyclics and MAOI;s
Increased SE and high OD potential
TCA’s-anticholinergic effects (dry mouth and constipation) –HIGH OD potential (cardiac)
MAOI’s= Wine + Cheese = Hypertensive crisis
Generalized anxiety disorder
Excessive worry/anxiety about life circumstances
Panic Disorder
Morbid dreads of seemingly harmless object/situation; may lead to agoraphobia
Obsessive compulsive disorder
OCD Repetitive thoughts (obsession) that a person is unable to control and/or urge to perform an act that cannot be resisted without great difficulty (compulsion), interferes with normal ADL's
Post-traumatic stress disorder
PTSD
Having anxiety for at least 6 months after a severe trauma/event perceived as a threat to one’s integrity
Flashbacks, nightmares and intrusive thoughts
Benzodiazepines
Most commonly used
high abuse potential
Antihistamines
For those with COPD or potential for abuse
Beta blockers
to reduce tachycardia, palpitations and breathlessness
TCA’s and MAOI’s
May be beneficial for panic attacks but less efficacious for GAD
Buspirone (Buspar)
Only antianxiety med not classified as a tranquilizer, takes 3-4 weeks to reach full therapeutic effects
Incidence of suicide
80% of pts who state intent of suicide DO
Second leading cause of death among adolescents
Hopelessness is commonly a predicting variable!
Women attempt more often, but men are 3x more likely to succeed
SUICIDAL mnemonic
S ex U nsuccessful attempts I dentified family members w/ attempt hx CI Chronic illness hx D epression, drug abuse, drinking A ge of pt L ethal method available
Antipsychotics
Lithium- use caution when prescribing (LOW therapeutic index) can become lethal with just a little
Significant weight gain w/ atypical antipsychotics
CAGE
C: Have you ever felt the need to cut down on your drinking?
A: Have people annoyed you by criticizing your drinking?
G: Have you ever felt guilty about your drinking?
E: Have you ever had a drink first thing in the AM to steady your nerves or get rid of a hangover? (eye-opener)
Korsakoff syndrome
chronic memory impairment d/t severe Vit B12 deficiency
Delirium
Sudden, transient onset of clouded sensorium; may occur at any age associated with a physical stressor
Causes of delirium
Toxins Alcohol/drug abuse Trauma Impactions in the elderly Poor nutrition Electrolyte imbalances Anesthesia
Dementia
Neurocognitive d/o
Gradual memory loss with decreased intellectual functioning usually occurring over the age of 60
Causes of dementia
Atherosclerosis Neurotransmitter deficits Corticol atrophy Ventricular dilation Loss of brain cells possible viral causes Alzheimer's disease
DEMENTIA mnemonic
To rule out other diseases indicative of dementia D: drug reactions/interactions E: emotional disorders M: metabolic/endocrine disorders E: eye and ear problems N: nutritional problems T: tumors I: infection A: arteriosclerosis
Alzheimer’s Disease
Development of multiple cognitive defects characterized by both memory impairment and one or more of the following:
- aphasia (speech difficulty)
- apraxia (inability to perform a previously learned task)
- agnosia (inability to recognize an object)
- Inability to plan, organize, sequence and make abstract differences
S/s of Alzheimer’s
Limb rigidity Flexion posture Disorientation Recent memory impairment Impaired judgment Gait disturbances
Cause/incidence of AD
Most common cause of dementia
Earliest complaint= loss of short term memory
Acetylcholine deficiency
Management of AD
Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
*Acetylcholinesterase inhibitors are often prescribed in conjunction with NMDA receptor antagonists sucj as Memantine to improve thinking and ADL’s
Cerebellar Function
Balance and coordination
+ Romberg
Finger to nose test
Heel-to-shin test
