Things I Still Don't Know Flashcards
What are the two types of anorexia nervosa?
restricting type and binge eating type/purging type
what are the cardiac medical complications associated with anorexia nervosa?
bradycardia, hypotension, QT dispersion, cardiac atrophy, and mitral valve prolapse
what are the dermatologic medical complications associated with anorexia nervosa?
Xerosis, lanugo, carotenoderma, acrocyanosis, seborrheic dermatitis
what complications are associated with refeeding syndrome?
hypophosphatemia, hypokalemia, CHF, peripheral edema, rhabdomyolysis, seizures, hemolysis
what are common comorbid mood disorders associated with anorexia nervosa?
depression, anxiety: OCD***
what is needed for the minimum first line care for AN?
nutritional rehabilitation and psychotherapy
hospitalization necessary due to complications of starvation, resistance to re-feeding, suicidality
How long should hospitalization last in an AN patient?
until normal weight is achieved to reduce relapse and rehospitalization
How much weight should an inpatient AN patient gain per week?
2-3 lbs (.9-1.5 kg)
how much weight should an outpatient AN patient gain per week?
.5-1 lb (.2-.5 kg)
what is the usual initial intake of calories for an AN patient?
30-40 kcal/kg
then progressively increased to match body tolerance and weight gain goals
When should you consider pharmacotherapy in patients with AN?
consider only for patients who have been resistant to other therapies and who are willing to take medications
What medications should be avoided in patients with AN and why?
bupropion: increased seizure risk with binging and purging
and TCAs: cardiotoxicity
caution with antipsychotics and antidepressants with risk of QT prolongation
what is the only adjunctive medication shown to help with weight gain in patients with AN?
olanzapine (2.5-10 mg)
what can be prescribed to patients to help reduce anxiety associated with confronting meals?
lorazepam
how is bulimia nervosa defined?
recurrent episodes of binge eating with recurrent compensatory behavior to prevent weight gain such as vomiting, misuse of laxatives, fasting, or exercise
how long do symptoms of BN need to occur in order to be diagnosed?
both need to occur at lease once a week for 3 months
what are the electrolyte medical complications associated with BN?
dehydration, hypokalemia, hypochloremia, and metabolic alkalosis
what are the GI medical complications associated with BN?
mallory-weiss syndrome
what are the dental and skin medical complications associated with BN?
tooth enamel erosions and dental caries, scar and callus on dorsum of hand (Russel’s sign), and xerosis
what are the cardiac medical complications associated with BN?
hypotension, orthostasis, sinus tach, ECG changes, and arrhythmias
What is the most critical assessment you have to do in the treatment plan of a patient with BN?
always monitor the patients for SI
what is the best standard treatment for BN patients?
combination of nutritional rehabilitation, CBT, and pharmacotherapy
what medication should be avoided in patients with BN? Why?
bupropion: increased seizure risk with binging and purging
what is the first line pharmacotherapy for patients with BN?
fluoxetine 60 mg daily
what is second line pharmacotherapy treatment for BN patients?
other SSRIs at doses higher than starting dose used to treat MDD (sertraline or fluvoxamine)
what is the first line treatment for patients with binge eating disorder?
psychotherapy
generic name for vyvanse?
lisdexamfetamine dimesylate
in order to have an intellectual disability, what deficits must be present?
must have adaptive functioning deficits in three domains: conceptual, social, and practical
What are the diagnostic tools used for intellectual disability?
denver developmental screening test, wechler intelligence scale for children
*severity is based on adaptive functioning- not IQ scores
what is global developmental delay?
unable to undergo systemic assessments of intellectual functioning
meet observational diagnostic criteria of intellectual disability disorder
what are the 4 communication disorders?
language disorder, speech-sound disorder, social (pragmatic) communication disorder, and childhood-onset fluency disorder (stuttering)
What is occurring in autism spectrum disorder?
there is an abnormal reaction to sensory input
what is the core neurophysiological feature of autism?
sensory integration deficits
the DSM5 criteria that best differentiate intellectual disability from autism spectrum disorder is what?
the presence of restricted interests or repetitive behaviors
what are the only 2 FDA approved drugs that are used for the irritability and agitation associated with autism?
risperidone and aripiprazole
ADHD is significantly comorbid with a wide range of other psychiatric disorders, such as what?
tic disorders
the potential for tics can be exacerbated by what?
by stimulant medications used to treat ADHD
what is executive function deficit?
an information processing dysfunction within the prefrontal cortex primarily due to a deficiency of dopamine and norepinephrine
How do you make the diagnosis of ADHD in children? IN those older than 17?
children: six or more symptoms
adults: 5 or more symptoms
What is the treatment of choice for preschool aged children (4-5) with ADHD?
parent and or teacher administered behavior management
if that doesn’t work: methylphenidate
what is the treatment of choice for elementary school aged children (6-11 years of age) with ADHD?
medications for ADHD and/or parent/teacher administered behavior management
what is the treatment of choice for adolescents (12-18) with ADHD?
medications for ADHD and behavior therapy
what are 2 alpha 2 adrenergic receptor agonists used for ADHD?
guanfacine and clonidine
what is the MOA of atomexetine?
selective inhibition of presynaptic norepinephrine reuptake
what is the MOA of modafinil?
for adults only
binds to dopamine transporter, inhibiting dopamine reuptake
what are the 3 types of motor disorders?
developmental coordination disorder, stereotypic movement disorder, and tic disorders
what is stereotypic movement disorder?
repetitive, compulsive, and purposeless motor behavior (hand shaking, body rocking, head banging, self biting)
What is the difference between tourette’s disorder and persistent (chronic) motor or vocal tic disorder?
T: 2 or more motor tics AND 1 or more vocal tics
persistent (chronic): 1 or more motor tics OR 1 or more vocal tics but not both
how can you treat tourette’s disorder?
antidopaminergic drugs: but may cause tardive dyskinesia
dopamine depleters: as effective but do not cause tardive dyskinesia
what are the only approved drugs for the treatment of TD?
haloperidol, pimozide, and aripiprazole
How is adjustment disorder defined?
symptoms develop within 3 months of an identifiable stressor
MUST resolve within 6 months
What is the first line treatment for adjustment disorder?
counseling, psychotherapy
what is the second line treatment for adjustment disorder?
antidepressants or anxiolytics
How do you diagnose PTSD?
- there must be an exposure to trauma
- directly experienced
- witnessed
- learned that trauma occurred to a loved one
- hear/see other’s trauma but MEDIA DOES NOT COUNT
- There must be an intrusion symptom
- memory
- dream
- flashback
- distress to reminder of traumatic event or feelings
- There must be an avoidance symptoms
- internal
- external
- there must be mood or cognitive symptoms
- can’t remember the traumatic event
- self-blame
- There must be reactive or emotional arousal symptoms
- irritable or angry outbursts
- hypervigilance
- exaggerated startle
- SYMPTOMS FOR MORE THAN ONE MONTH
what is the first line treatment for PTSD?
cognitive processing therapy (CPT)
Prolonged exposure (PE)
Eye-movement desensitization and reprocessing
if a patient is presenting with symptoms of PTSD but they have only been occurring for less than a month, what do you need to consider?
either acute stress disorder or adjustment disorder
Depression is at risk for what psychosomatic disorders?
coronary heart disease, stroke, and diabetic symptoms
What are the psychiatric symptoms associated with SLE?
depression, mood disturbances, psychosis, delusions, and hallucinations
What are the psychiatric symptoms associated with hyperthyroidism?
nervousness, excitability, irritability, pressured speech, insomnia, psychosis, visual hallucinations
what are the psychiatric symptoms associated with hypothyroidism?
lethargy, depressed, personality change, paranoia
what are the psychiatric symptoms associated with Diabetes mellitus?
frustration, loneliness, withdrawn, depression
when should you treat for a vitamin B12 deficiency?
if the level is less than 400
what are the medical symptoms associated with acute intermittent porphyria (AIP)?
abdominal pain, fever, nausea, vomiting, constipation, peripheral neuropathy, paralysis
what are the psychiatric symptoms associated with AIP?
acute depression, agitation, paranoia, and visual hallucinations
how do frontal lobe tumors present?
mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, loss of smell
What are the medical symptoms of PCP induced mental disorder?
elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting
what are the psychiatric symptoms associated with PCP induced mental disorder?
agitation with blank stare, anxiety, stupor, aggression, panic, bizarre behavior
What psych symptoms could carticosteroids cause?
mania or psychosis (hallucinations)
what should you avoid using in elderly patients with delirium?
benzodiazepines
What is the most common cause of hallucinations?
delirium tremens
2 examples of a factitious disorder?
Munchausen’s and Munchausen’s by proxy
what are the prodromal signs and symptoms of schizophrenia?
schizoid or schizotypal personalities
few close friends as adolescents
minimal social activities
What are the positive symptoms of schizophrenia and when are they present?
typically present in the active phase
delusions, hallucinations, catatonia, and agitation
what are the negative features of schizophrenia and when are they typically present?
typically present in the residual phase
affective flattening, apathy, social withdrawal, anhedonia, poverty of thought, and content of speech
how long must the symptoms of schizophrenia be present in order to diagnose?
at least 6 months
what is the neurophysiology of the schizophrenic brain?
reduced brain volume, decreased limbic system, smaller prefrontal cortex, smaller thalamus
which neurotransmitter is elevated in schizophrenia?
dopamine
How do you make the diagnosis of schizophrenia?
two or more of the following for most of 1 month; at least one of the first three symptoms:
- delusions
- hallucinations
- disorganized speech
- grossly disorganzied or catatonic behavior
- negative symptoms
Durations of at least 6 months of persistent symptoms
if a schizophrenic patient is violent in the ED what can you give them?
lorazepam and haloperidol IM
What is the single leading cause of death in schizophrenia patients?
suicide
how do you make the diagnosis of schizophrenia catatonic type?
At least two of the following:
motoric immobility as evidenced by catalepsy or stupor
excessive motor activity
extreme negativism or mutism
posturing or prominent grimacing
echolalia or echopraxia (meaningless repetition of another person’s spoke words or mimic of actions)
what is used for treatment for catatonic disorder schizophrenia?
benzodiazepines
What is used for acute psychosis?
IM injections
haloperidol, fluphenazine, lorazepam
what is used in the stabilization phase of schizophrenia?
newer atypical antipsychotics
what is used for the treatment of the maintenance phase of schizophrenia?
to keep patients free from symptoms while avoiding incapacitating side effects
long-acting depot injections
what are two examples of first generation antipsychotic adverse effects?
EPSs and neuroleptic malignant syndrome
what are the side effects associated with clonzapine?
agranulocytosis and weight gain
what is the adverse effect of risperidone?
increased prolactin
what is the adverse effect associated with ziprasidone?
QTc prolongation
What is a brief psychotic disorder?
presence of at least one or more of the following. At least one of 1,2, or 3
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
duration of an episode of the disturbance is at least 1 day and no more than 1 month with eventual return to premorbid level of functioning
What is schizophreniform?
meets criteria A, D, and E for schizophrenia
an episode of the disorder lasts at least 1 month but less than 6 months
What is delusional disorder?
delusions of at least one month’s duration
has never met criterion A for schizophrenia (for more than a few hours)
functioning is not impaired, and behavior is not odd or bizarre
What is the timeline for schizophrenia?
greater than 6 months
what is the timeline for schizophreniform?
1-6 months
what is the timeline for brief psychotic disorder?
less than 1 month
What are the 4 factors involved in classical conditioning?
unconditioned stimulus, unconditioned response, conditioned stimulus, conditioned response
What is extinction?
it is possible to extinguish this learned response but must expose to CS many times without giving the UCS
What is generalization?
when other similar stimuli/situation also becomes the CS for the CR
What can you use classical conditioning for?
to treat phobias
what is the relaxation activity considered to be in classical conditioning?
a UCS
What is systematic desensitization?
make a list- a hierarchy of fears
select a feared object/ situation low on list and use relaxation to condition it until there is much less anxiety/fear
what is operant conditioning?
learning is the association of things that take place sequentially
what is classical conditioning?
learning is the association of things that take place together in time
Which antipsychotic medication is used for recurrent suicidal behavior?
clozapine
which antipsychotic drug is used for hallucinations/delusions associated with Parkinson Disease psychosis?
pimvanserin
what type of drugs reduce the positive symptoms of schizophrenia?
D2 antagonists
what does D2 antagonism increase?
prolactin levels
what do the FGA primarily block?
dopamine type 2 post synaptic receptors
what are the effects of alpha-adrenergic receptors being blocked?
orthostatic hypotension and dizziness/syncope
The FGA can be divided into two broad categories. What are they?
high potency and low potency
what are the high potency FGA?
haloperidol and fluphenazine
what are the effects of the high potency FGA?
more movement (EPS) and endocrine effects (prolactin)
what are the low potency FGA agents?
chlorpromazine and thioridazine
what are the effects of the low potency FGA?
more sedation, hypotension, tachycardia, ECG-changes
what is thioridazine associated with?
Torsade’s de Pointes and sudden death
How do you treat dystonia?
anticholinergics: benztropine, diphenhydramine, and trihexyphenidyl
how do you treat parkinsonism EPS associated with FGA use?
benztropine and dopamine enhancer Amantadine
How do you treat tardive dyskinesia caused by FGA use?
selective vesicular monoamine transporter 2 (VMAT2): valbenazine and deutetrabenazine
What is a major class warning of the SGA side effects?
there is a greater risk of stroke in the elderly with dementia
what are the SGAs that cause the most significant weight gain?
clozapine and olanzapine
what are the SGAs that cause the most metabolic effects (increase glucose and lipids)?
clozapine and olanzapine
What SGA agent is most likely to cause QTc prolongation/ ECG changes?
ziprasidone
What are the four antipsychotic screening scales and what do they screen for?
GASS- general side effects
BARS- akathisia
AIMS- movements disorders
EPRS- extrapyramidal symptoms
which SGA agent is most likely to cause agranulocytosis?
Clozapine
so monitor WBC
which SGA agent is most likely to cause seizures?
clozapine
what is drug reaction with eosinophilia and systemic symptoms (DRESS)?
rare drug-induced hypersensitivity
skin eruption, eosinophilia, a long latency (2-8 weeks_ between drug exposure and disease onset)
which SGA agent is most likely to cause DRESS?
olanzapine
Which class of drugs is likely to cause neuroleptic malignant syndrome?
SGAs
what is the presentation of NMS?
severe parkinson like movement disorder with wide spread muscle contraction, AMS, hyperthermia, dehydration
Adherence is critical in schizophrenia patients. How can you manage non-adherence in schizophrenia patients?
with long-acting injectable agents
what are the long acting injectable agents used in non-compliant schizophrenia patients?
risperidone
olanzapine
aripiprazole
paliperidone
which antipsychotic agent is most likely to cause orthostatic hypotension?
thioridazine
which SGA would have the lowest impact on BMI?
ziprasidone
when is the DAST-10 questionnaire used?
to screen for drug abuse
what occurs at .05 BAC?
judgement and restraint impaired
what occurs at .30 BAC?
stupor
what occurs at .4-.5 BAC?
coma
what are the neurological effects of alcohol?
polyneuropathy, cerebellar degeneration, dementia, Wernicke’s encephalopathy, korsakoff syndrome
What happens in cases of alcohol withdrawal?
delirium tremens
- tremulousness
- delusions
- hallucinations
- seizures
what causes wernicke’s encephalopathy?
thiamine deficiency
what is the clinical triad of wernicke’s encephalopathy?
ophthalmoparesis with nystagmus
ataxia
confusion
how do you guide treatment of alcohol withdrawal?
the clinical institute withdrawal assessment (CIWA)
what is the detox order set on a patient with alcohol withdrawal?
benzodiazepines
antipsychotics (haloperidol)
IV Fluids (BANANA BAG→ magnesium, potassium, thiamine, folic acid)
what is in a banana bag?
magnesium, potassium, thiamine, and folic acid
What drug can be used to maintain abstinence in alcoholics following withdrawal that’s MOA is inhibits GABA in the CNS
acamprosate
what drug can improve abstinence in alcohol dependence whose MOA is an opioid antagonist
naltrexone
what is the MOA of gabapentin when used for alcohol dependence treatment and rehabilitation?
prevents pain response and has anxiolytic activity
promotes abstinence and reducing drinking in individuals with alcohol use disorder
what is disulfram used for?
it is not commonly used due to poor efficacy and potential for severe medical complications
used to control alcohol intake as a deterrent
what is a common adverse reaction of disulfram?
produces unpleasant adverse effects if the patient drinks alcohol during the course of treatment
What should you use on a patient with known liver impairment who is withdrawing from alcohol?
lorazepam (bc it doesn’t require liver metabolism)
What is the treatment for withdrawal of stimulants?
antidepressants and hospitalization
how do you treat hypertension and hyperthermia caused by stimulants?
phentolamine
How do you treat psychotic symptoms caused by stimulants?
haloperidol
how do you treat a patient who is withdrawing from sedatives/hypnotics/anxiolytics? *which can be fatal
phenobarbital (used to wean patients off)
what are the common signs of LSD and PCP intoxication?
violent behavior, rapid SI or HI
what should you suspect if a patient presents with LSD or PCP intoxication?
polysubstance user
how do you treat LSD and PCP intoxication?
diazepam and sedation with haloperidol
what is a common symptom of LSD and PCP withdrawal?
flashbacks
how do you treat a patient who is withdrawing from LSD and PCP?
benzodiazepine administration
how do you assess opiate withdrawal?
Clinical opiate withdrawal scale (COWS)
how do you treat a patient withdrawing from opioids?
buprenorphine or methadone
or buprenorphine and naloxone
how do you maintain treatment for an opioid dependent patient?
buprenorphine (with or without naloxone)
what is the MOA of stimulants?
block presynaptic reuptake, interference with vesicular monoamine transporter, and increase NT release
what is methylphenidate’s main activity?
inhibition of DA reuptake and inhibition of NT pre-synaptic reuptake
what forms do IR amphetamine-based stimulants come in?
T(d), L(ds), C (as), and ODT
what forms do extended release amphetamine-based stimulants come in?
liquid (a) and capsules (a, d, and l)
what forms do immediate release methylphenidate come in?
tabs (d, m) and liquid (m)
what forms do sustained methylphenidate come in?
tabs
what forms do extended release methylphenidate stimulants come in?
capsule, chewable tablet, liquid, transdermal patch, tablet
what are the three non-stimulants for ADHD?
atomoxetine, guanfacine, and clonidine
when is the onset of activity for non-stimulant ADHD medications?
1-4 weeks following administration
what is the main effect of non-stimulants?
to enhance neurotransmitter transmission
what is the MOA of atomoextine?
inhibition of NE pre-synaptic reuptake
what is the MOA of guanfacine/ clonidine?
agonist of CNS alpha2 adrenergic receptors
what is a notable adverse effect of atomexetine?
suicidal thoughts
what antihypertensives can be used for ADHD?
clonidine and guanfacine
what is recommended for discontinuation of clonidine and guanfacine?
downward dose titration over 1+ weeks bc of risk of rebound hypertension
what antidepressant can be used for nicotine withdrawal?
bupropion
what antidepressant can be used for enuresis?
imipramine
what antidepressant can be used for diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain?
duloxetine
what antidepressant can be used for stress incontinence?
duloxetine
what are the serious side effects of SSRIs?
serotonin syndrome
what are some of the symptoms of serotonin syndrome?
abdominal pain, flushing/sweating, hyperreflexia, hyperthermia, mental status changes
what are the symptoms of antidepressant withdrawal?
FINISH:
flu-like symptoms
insomnia
nausea
imbalance
sensory disturbances
hyperarousal
all antidepressants have a black box warning of what?
increase in risk of suicidal ideations, behaviors, and actions- highest risk in children/adolescents/young adults
which SSRI has the most drug-drug interactions?
fluoxetine - CYP450 inhibitor
what is the MOA of second degree TCAs
MOA: inhibit NE > 5-HT
what are the side effects of TCA overdose?
3 Cs: coma, cardiotoxicity, and convulsions
non-TCA SNRIs have SE’s relatively similar to SSRIs, with generally less risk of what?
sexual dysfunction
SEs of SNRIs: include?
insomnia
hypertension
agitation/nervousness
what limits the use of nefazodone?
hepatic toxicity
what is the main side effect of NDRIs?
seizures (dose-dependent or those at risk)
what is the side effect associated with phenelzine?
sedation
when using MAOIs what is there major concern of?
hypertensive crisis
when is esketamine indicated?
for treatment-resistant depression in conjunction with ongoing antidepressant therapy AND MDD with suicidal ideations/behaviors
what is lithium’s MOA?
myoinositol depletion; lithium inhibits PKC and MARCKS: antimanic effects
what type of ion is lithium?
a monovalent ion
lithium interacts with what other agents?
other agents that impact Na+/K+:
diuretics, ACEi, and NSAIDs
3 mood stabilizers initially developed as anti-seizure agents utilized to treat bipolar disorder include?
valproic acid/ divalproex
lamotrigine
carbamazaepine
when is lamotrigine indicated?
for the maintenance of Bipolar disorder
what are the two basic physiological processes occur during the excitement stage. what are they?
vasodilation/constriction and mytonia
how do you make the diagnosis of erectile dysfunction?
at least one of the three following symptoms must be experienced on almost all occasions of sexual activity for 6 months
how long does marijuana test positive in the saliva?
1-7 days
how long does marijuana test positive in the hair?
90 days
how long does marijuana test positive in the blood?
1-7 days
how long does marijuana test positive in the urine?
3-77 days (10-30 days for regulars)
what are the labeled indications of dronabinol?
anorexia in AIDS pt, chemotherapy induced n and v
what is nabilone used for?
chemotherapy induced n and v
what is cannabidiol?
CBD- second most abundant cannabinoid
(-)- CBD enantiomer
where does THC and CBD accumulate?
in adipose tissue due to high lipophilicity
what is CBD metabolized by?
in the liver by 7 CYPs
What is epidiolex used for?
it is oral CBD solution recently approved for epilepsy in 2 years or older
what is the MOA of cocaine?
inhibition of dopamine reuptake
why is ketamine used?
to reduce the amount of morphine needed for pain control
what is an example of a mu-opioid receptor agonist?
buprenorphine
what is an example of a nicotinic receptor partial agonist?
varenicline (chantix)
what are the 4 drugs used for the treatment of alcohol withdrawal syndrome?
diazapam, lorazepam, oxazepam, and thiamine
what are the 3 drugs used for the prevention of alcohol abuse?
acamprosate, disulfram, and naltrexone
what are the drugs used for the treatment of acute methanol or ethylene glycol poisoning?
ethanol or fomepizole
what drug overdose causes constricted pupils?
heroin or other strong opioids
when is caffeine used medically?
with painkillers and for treating headaches after epidural anesthesia
What defines binge drinking?
for women: 4 or more drinks during a single occasion
for men: 5 or more drinks during a single occasion
what defines heavy drinking?
women: 8 or more drinks per week
men: 15 or more drinks per week
what is ethanol metabolized by?
alcohol dehydrogenase to acetalldehyde
what is acetalldehyde metabolized by and to?
by: aldh to acetate
what is the MOA of disulfram?
irreversibly inhibits aldehyde dehydrogenase
what is the MOA of acamprosate?
weak NMDA receptor antagonist and GABAa receptor agonist
what happens when you mix opioids and sedative-hypnotics?
increased CNS depression, esp resp depression
what happens when you mix antipsychotic agents and opioid drugs?
increased sedation.
what happens when you mix MAOIs and opioid drugs?
hyperpyrexic coma
hypertension
which opioid agonist is combined with acetaminophen?
hydrocodone
what is pentazocine used for?
in the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate
what happens if you use pentazocine during pregnancy?
neonatal opioid withdrawal syndrome
what should you avoid using meperidine with?
avoid mixed agonist/antagonist analgesics use with meperidine because the analgesic effect may be reduced or may precipitate withdrawal symptoms
which opioid agonist is the lightest tool in the toolbox/ contains the least opioid analgesic activity?
codeine
what do you do if a patient overdoses on loperamide?
naloxone can be given as an antidote
what must you check in a patient who is on buprenorphine?
you must monitor patients starting or ending CYP3A4 inhibitors or inducers for potential over or under dosing
what is the key reason you would use naltrexone?
treatment of alcohol use disorder
what does naltrexone have high affinity for?
mu receptors
What are the three primitive defense mechanisms?
projection, denial, and splitting
what is displacement?
shifts aggressive impulses to less threatening target
parent yells at child when actually angry with spouse
what is an example of introjection defense mechanism?
an abused child becomes a abusive parent
what is isolation of affect?
person describing a murder with graphic detail but no emotional response evident
what is reaction formation?
converting unconscious wishes or impulses considered threatening into their opposite
two co-workers fight, but secretly attracted to each other
what are the mature defense mechanisms?
humor
suppression
altruism
sublimation
how do you distinguish quirkiness from personality disorders?
look for functional impairment
How do you make the diagnosis of a major depressive episode?
at least 5 of the following for a 2 week period with at least one being
depressed mood
or loss of interest
how do you diagnose major depressive disorder?
the presence of one or more major depressive episodes and the absence of any manic, hypomanic, or mixed episodes
what is the treatment of choice for psychotic depression?
ECT
what is significant about using ketamine for MDD?
there is a 50% reduction in suicidal thoughts within 24 hours
how do you make the diagnosis of persistent depressive disorder (dysthymia)?
depressed mood for most of the day (at least 2 years adults and 1 year children)
that has not been severe enough to meet the criteria for MDE
how do you diagnose a manic episode?
abnormal and persistently elevated expansive or irritable mood lasting at least 1 week with at least 3 symptoms (DIGFAST)
how do you diagnose a hypomanic episode?
episodes only need to last 4 days and must not include psychotic features
how do you make the diagnosis of bipolar II disorder?
patients have had one major depressive episode and one hypomanic episode
what are the drugs of choice for treatment of bipolar disorder type 1?
mood stabilizers: lithium, valproic acid
carbamazepine
how do you make the diagnosis of cyclothymic disorder?
it is characterized as dysthymic disorder with intermittent hypomanic period
2 years
how do you make the diagnosis of panic disorder?
recurrent unexpected panic attacks
at least one attack followed by one month of worry about additional attacks
how do you make the diagnosis of GAD?
excessive anxiety and worry occurring more days than not for at least 6 months for most of the day
what does sig e caps stand for?
sleep-lack of
interest-lack
guilt
energy-lack of
concentration-difficult
appetite- decreased or increased
psychomotor- decreased
suicidal ideation
what does DIG FAST stand for?
distractibility
inflated self esteem
grandiosity
flight of ideas
activity/agitation
speech-pressured
thoughtlessness
