Test #2 Flashcards
1
Q
Primary approach for treatment of Anxiety D/O
A
Psychotherapy
If it gets too severe try out meds.
2
Q
What do benzodiazepines ends in? What are other names they are referred to as?
A
LAM and PAM
Also referred to as tranquilizer, sedative
3
Q
Pros of Benzos
A
- Very Effective
- Fast Acting 20-30 min.
- Well Tolerated
- Better anti-anxiety specificity than barbiturates
- Less lethal in overdoes than barbiturates
4
Q
Cons of Benzos
A
- Dependence Potential
- Can cause Sedation
- Longer half-life drug accumulation
- Short half-life anterograde amnesia
- Abused
- Affect Sleep Architecture - Can prevent you from having a good night sleep
5
Q
Advantages of BuSpar
A
- No tolerance or dependence
- No interaction w/CNS depressants
- No interaction with Alcohol
- No impaired psychomotor function
6
Q
Disadvantages of BuSpar
A
- Delayed onset of action
- 1-2 weeks symptom reduction
- Less effective than benzos
- SE: nausea, dizziness, anxiety(?)
7
Q
ADVANTAGES OF . . .
- No tolerance or dependence
- No interaction w/CNS depressants
- No interaction with Alcohol
- No impaired psychomotor function
A
Advantages of BuSpar
8
Q
DISADVANTAGES OF . . .
- Delayed onset of action
- 1-2 weeks symptom reduction
- Less effective than benzos
- SE: nausea, dizziness, anxiety(?)
A
Disadvantages of BuSpar
9
Q
Block histamine receptors in CNS
- Vistaril/Atratax (hydroxyzine)
- Benadryl (diphenhydramine)
A
Antihistamines
10
Q
Advantages of Antihistamines
A
- Work in 20-30 minutes
- Last 4-6 hours
- Non-habit-forming
11
Q
Disadvantages of Antihistamines
A
- SE: sedation, drowsiness, impaired performance
- Anxiolytic tolerance
- Anti-anxiety; overtime you keep taking it and you’ll develop a tolerance
- Narrow therapeutic window (sedation)
- Fine line between managing anxiety and falling asleep
12
Q
Beta Blockers end in . . .
A
LOL
Inderal (propranolol)
Tenormin (atenolol)
13
Q
Advantages of . . .
- Work in 20-30 minutes
- Last 4-6 hours
- Non-habit-forming
A
Advantages of Antihistamines
14
Q
Disadvantages of . . .
- SE: sedation, drowsiness, impaired performance
- Anxiolytic tolerance
- Anti-anxiety; overtime you keep taking it and you’ll develop a tolerance
- Narrow therapeutic window (sedation)
- Fine line between managing anxiety and falling asleep
A
Disadvantages of Antihistamines
15
Q
Advantaged of Beta Blockers
A
- Peripheral manifestations
- Removing symptoms tacicardia
- Performance anxiety
- Antihypertensive
- Adjunctive for PD
- Non-habit-forming
16
Q
Disadvantages of Beta Blockers
A
- Internal experience
- Doesn’t do much for the cognitive or worry
- Reduce physiological sxs not cognitive
- SE: dizziness, lowered blood pressure, depression - long term use
- Rebound blood pressure elevation
17
Q
Advantaged of . . .
- Peripheral manifestations
- Removing symptoms tacicardia
- Performance anxiety
- Antihypertensive
- Adjunctive for PD
- Non-habit-forming
A
Beta Blockers
18
Q
Disadvantages of . . .
- Internal experience
- Doesn’t do much for the cognitive or worry
- Reduce physiological sxs not cognitive
- SE: dizziness, lowered blood pressure, depression - long term use
- Rebound blood pressure elevation
A
Beta Blockers
19
Q
Primary use and Secondary use of the Minipress and Catapres
A
Primary: Hypertension
Secondary: nightmares (PTSD) and ANXIETY
20
Q
Treatment of Panic D/O
A
Combination of Medication and Psychological Treatment
Panic D/O is CHRONIC, medication treatment should be >1 year
21
Q
How soon does Benzo withdrawal start?
A
1-4 days
22
Q
How long does the acute phase of Benzo withdawl last
A
10-14 days
23
Q
Short Term Symptoms of Acute Withdrawl
A
Insomnia Palpitations Sweating Headache Weight loss Tinnitus Anxiety/panic attacks naseau muscle aches abnormal body sensations perceptual changes hallucinations
24
Q
4 dopaminergic pathways
M* M* N T
A
- Mesolimbic
- Mesocortical
- Nigrostriatal
- Tuberoinfundibular
25
Increased dopamine drive in _______ system -> POSITIVE symptoms
Mesolimbic
26
Decreased dopamine in drive_____ system -> NEGATIVE symptoms
Mesocortical
27
extrapyramidal (facial movements, tremors) symptoms
| Motor control, death in these can result in Parkinson's
Nigrostriatal
28
prolactin elevation symptoms
- Hormonal regulation, maternal behavior, pregnancy, and other sensory processors
- Gynecomastia - develop breasts, lactate
Tuberoinfundibular
29
First gen anti-psychotics improve ______ symptoms
Positive
30
Second gen anti-psychotics improve/reduce _____ symptoms
Negative
31
A con of first gen anti-psychotics: you experience ____ symptoms
Extrapyramidal
32
Type of symptom:
Motor functioning symptoms, Parkinsonian; (2) Dystonic; - sustained muscle spasm contraction (3) Akathisia - constant state of restlessness
Extrapyramidal
33
Overall effectiveness of med
20-30%
34
First Gen Antipsychotics end in . . .
```
-ZINES
Throazine
o Haldol (Haloperidol)
o Mellaril (Thioridazine)
o Stelazine (Trifluoperazine)
o Prolixin (Fluphenazine)*
o Trilafon (Perphenazine)
o Navane (Thiothixene)
o Loxitane (Loxapine)
o Moban (Molindone)
```
35
First even First Gen Anti-psychotic
Thorazine
36
Second Generation Anti-psychotics end in . . .
```
-PINE, -DONEo Clozaril (Clozapine) - first one developed
o Risperdal (Risperidone)*
o Zyprexa (Olanzapine)*
o Seroquel (Quetiapine)
o Geodon (Ziprasidone)
o Fanapt (Iloperidone)
o Invega, Invega Sustenna (Paliperidone)*
o Saphris (Asenapine)
o Abilify (Aripriprazole)
```
37
o PROS
Wider spectrum of action
Improve/reduce negative symptoms
More tolerable
Fewer extrapyramidal and anticholinergic side effects and less risk of TD
Clorzaril (Clozapine) has antisuicidal effects and is effective for those unresponsive to antipsychotics
o CONS
- Increased risk of agranulocytosis (requires weekly blood tests for first 6 mos.)
- Troublesome side effects (esp. WIEGHT GAIN and metabolic side effects)
- Increased rates of extrapyramidal side effects at higher than usual doses; if you take high doses only
- Prolactin elevations
- Electrocardiogram changes
Pros/cons of second gen antipsychotics
38
Goal of Anti-psychotics
Goal = reduce symptoms to increase functioning so the patient can benefit more from other forms of treatment: symptoms under control in order for patient to benefit from therapy and be stable enough to learn skills.
- Adhere to treatment
39
Steps in Stress Response Cycle
| S O I D W C
1. Stressful Event
2. Outcry
3. Intrusion
DENIAL
4. Working through
5. Completion
40
simultaneously an eruption of intense, unpleasant emotion AND denial (I can't believe it. It cant be true). Stake of shock, engulfed by very strong emotions. May last minutes, hours, or days. Move quickly to phase 2
Outcry
41
- waves of intense emotion and a strong impulse to think about, imagine, remember, or mentally relive the stressful event - not brought on willfully, emotions feel very raw, people feel very vulnerable, easily overwhelmed.
- Startle easily, don't sleep well, often have nightmares - can lose reality testing and have psychotic-like symptoms (hall & del)
Intrusion
42
may come right after outcry or on the heels of intrusion - state of emotional numbness - feel nothing - disassociation, avoidance, social withdrawal
Denial
43
_____ is prolonged with periodic emotional upheaval
| - periods of intrusion and denial
Working Through
44
Medications used to treat hyperarousal
A B A A M
```
o Antidepressants
o Benzodiazepines
o Alpha-2
AdrenergicAgonists
o Anticonvulsants
o Minipress/Pazosin
```
45
Treatment of PTSD
o Psychotherapy is primary; medications target specific symptoms as they arise
o Solid/safe patient-therapist relationship
o Restoration to some sense of control over turbulent emotions
46
PTSD PRESENTATION
Acute
< 3 months
47
PTSD PRESENTATION
| Chronic
> 3 months
48
Acute onset of PTSD
immediately following traumatic event
49
Delayed onset of PTSD
6+ months after the traumatic event
50
Factors that contribute to PTSD Presentation
o Single instance vs. recurring traumas
o Age at which the trauma occurs
o Stage of stress syndrome response
51
o Repeated episodes of trauma -> changed brain functioning/morphology -> increases the likelihood that subsequent stresses are responded to w/even more intense affective symptoms
o Eskalith/Lithium Carbonate; Depakote/Divaloprex; Tegretol, Equetro/Carbamazepine
kindling Effect Associated with PTSD
52
(opiate antagonist)
o Reduces relief of release endorphins
o Endorphins are kind of like opiates?
Naltrexone
53
Agression is well treated with ____
Antidepressants
54
Non habit forming hypnotic
Rozerem
55
Symptom Clusters
Positive
negative
mood
cognitive
56
Type of Sxs, takes days to treat
| hallucinations, delusions, conceptual disorganization, disorganized speech, excitement, grandiosity
Positive Sxs
57
Type of SXS takes weeks to months to treat
THINGS IT TAKES AWAY
Alogia, flat affect, anhedonia, avolition,
Negative Sxs
58
Type of sxs, takes weeks to months to treat
| attention impairment, memory dysfunction, impaired executive functioning, behavioral disorganization
Mood SXS
59
Type of sxs, takes weeks to months to treat
| depression, excitement aggression, anxiety, hostility poor social skills.
cognitive sxs
