Psychosocial disorders Flashcards
How soon after the patient’s last drink will alcohol withdrawal symptoms present?
12 hours after last drink (peak symptoms seen at 24 to 48 hours)
What are the three stages of alcohol withdrawal?
Stage 1 (mild) - symptoms develop 8-12 hours after last drink
- Anxiety, nervousness, depression, fatigue, N/V, abdominal pain, irritability, jumpiness, shakiness, mood swings, nightmares
Stage 2 (moderate) - symptoms develop after 24 hours
- HTN, hyperthermia, rapid and/or irregular heartbeat, elevated RR, sweating, mental confusion, heightened mood disturbance
Stage 3 (severe) - aka delirium tremens
- Autonomic hyperactivity (agitation, hallucinations, disorientation), seizures
Alcohol withdrawal pharmacotherapy
- Benzodiazepines
- Chlordiazepoxide (Librium), diazepam (valium) for adequate hepatic function
- Lorazepam for patients with hepatic dysfunction
- Adjunct with anticonvulsants to prevent cravings
- Carbamazepine, oxcarbazepine, divalproex
- OR neuroleptic agents to reduce severity of withdrawal symptoms and agitation
- Phenothiazine, haloperidol
Alcohol withdrawal treatment and management
Correct alcohol induced nutritional deficiencies
- Vitamin B supplementation
- Vitamin C
- Folic acid
- Magnesium
Adequate fluid intake, psychosocial support and counseling
Medications that can be prescribed to treat anxiety (as adjunctive therapy in depression with anxiety)
- Buspirone
- Lorazepam
- Oxazepam
- Alprazolam
- Clonazepam
- Diazepam
Benzodiazepine withdrawal symptoms
Seen within hours or days of cessation
- Tachycardia, sweating, tremors, insomnia, N/V, transient hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures
Benzodiazepine treatment and management
- Gradually reduce dose by 25% a week
- CBT
Clinical presentation of opioid intoxication
- Constricted pupils
- Respiratory depression
- Extreme drowsiness
Opioid withdrawal symptoms
- HTN
- Tachycardia
- Diarrhea, nausea
- Temperature dysregulation
- Fever
- Papillary dilation
- Restlessness
- Myalgia
- Lacrimation
- Rhinorrhea
Opioid use disorder treatment and management
- Long term rehab
- Methadone
- Alternative: buprenorphine with naloxone (suboxone)
- Lower abuse potential, less withdrawal discomfort, greater safety against overdose
- Alternative: buprenorphine with naloxone (suboxone)
Stimulant (cocaine, amphetamine, meth, MDMA) clinical presentation
- Enlarged pupils
- Increased body temp
- Increased HR and BP
- Headache
- Abdominal pain and nausea
- Increased energy and alertness
- Insomnia
- Restlessness
What are the three stages of eating disorder recovery?
- Physical recovery
- Behavioral recovery
- Psychological recovery
What reported symptom strongly suggests a patient is suffering from anorexia?
Amenorrhea - for 3+ cycles when not using contraception
C GASP DIE mnemonic to describe depression symptoms
- Concentration difficulties or indecisiveness
- Guilt or feeling worthless
- Appetite abnormality or weight change
- Sleep disturbance
- Psychomotor retardation or agitation
- Death or suicide (thoughts or acts of)
- Interest (diminished)
- Energy (loss)
WATCHERS mnemonic to identify symptoms of GAD
- At least three of the following occurring on most days for 6+ months
- Worry
- Anxiety (“on edge”)
- Tension (in muscles)
- Concentration (difficulty)
- Hyperarousal
- Energy (loss)
- Restlessness
- Sleep disturbance
Bipolar I vs bipolar II
Bipolar I → cycles of elevated or irritated mood lasting >1 week (depression and mania)
Bipolar II → depression with episodes of mania lasting <4 days with little social incapacitation
- Hypomania - can be productive
DIG FAST mnemonic for bipolar disorder
- Symptoms present for at least 1 week, or less if hospitalized
- Distract-ability
- Irresponsibility
- Grandiosity
- Flight of idea
- Activity increased
- Sleep (decreased)
- Talkativeness
TCA adverse effects
Anticholinergic activity
- Blurred vision
- Dry mouth
- Memory loss
- Sweating
- Anxiety
- Postural hypotension
- Dizziness
- Tachycardia
SSRI and SNRI adverse effects (general)
- Nausea
- Dry mouth
- Dizziness
- Excessive sweating
- Sexual dysfunction
- Can switch to bupropion (wellbutrin), venlafaxine, duloxetine
True/false: In early SSRI/SNRI therapy, patients often complain of drug-related AEs (headache, nausea, diarrhea)
True - typically resolves within 2-6 weeks of medication use
Recommended length of pharmacological intervention in depression
Acute + continuation phase
- In acute phase, 4-8 weeks of treatment needed before concluding that patient is partially responsive or unresponsive
- Patient’s successfully treated during acute phase should continue same course of treatment for 4-9 months
- Minimum of 6 months or minimum of 9 months total treatment
Pharmacologic treatment options for bipolar disease
Severe mania → lithium, valproic acid, carbamazepine, second generation antipsychotic (risperidone)
Bipolar depression → olanzepine-fluoxetine, lamotrigine
Closely monitored for first 6 weeks with dose adjustments made based on serum concentrations
Initial treatment of choice for panic disorder
SSRIs
- Paroxetine (paxil) first choice since less energizing
Pharmacological treatment of PTSDq
- SSRI/SNRI
- Beta blockers or alpha adrenergic agonist (clonidine) for hyperarousal
- Nighttime dose of prazosin (minipress) to decrease nightmares and sleep disturbance
