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Psychiatry > Disorders and Treatments > Flashcards

Disorders and Treatments Flashcards

0
Q

Tx for Major depressive disorder

A

SSRI, buproprion, venlafazine, mirtazapine, duloxetine

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1
Q

Criteria for Major depressive disorder

A
  • Must have *2 or more episodes of major depression characterized by at least *5 of [depressed mood, anhedonia, change in weight or appetitie, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue/loss of energy, feelings of worthlessness/xs guilt, dec concentration/indecisiveness, suicidal ideation] for at least *2 wks.
  • must never have manic, hypomanic, or mixed episode
  • sx cause significant distress/impaired functioning
  • sx not caused by substance or disease
  • sx not better accounted for by schizophrenia, schizoaffective, delusional, or psychotic d/o.
  • sx not better accounted for by bereavement
  • Think SIG E CAPS: sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidal. (5 or more for at least 2 weeks)
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2
Q

Criteria for Schizophrenia

A
  • Last at least *6 months
  • Includes at least *1 month of active phase sx: *2 of [delusions, hallucinations, disorganized speed, disorganized/catatonic behavior, negative sx]
  • Only *1 needed if delusions are bizzar; if auditory hallucinations involve commentary of pt or >/=2 voices talking to each other.
  • Negative sx= flattened affect, diminished flow/spontaneity of speech, diminished initiative/goal.
  • Schizoaffective and mood d/o must be r/o.
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3
Q

5 subtypes of schizophrenia

A
  1. Paranoid= preoccupation w/ delusion or auditory hallucinations
  2. Disorganized= disorganized speech/behavior; flat/inapp. affect
  3. Catatonic= 2 or more [motor immobility, xs purposeless motor activity, extreme negativism/mutism, peculiar voluntary movements, echolalia/echopraxia.
  4. Undifferentiated= 2 or more [delusions, hallucinations, disorganized speech, disorganized behavior, negative sx] but doesn’t meet criteria of other subtypes
  5. Residual= absence of prominent delusions, hallucinations, disorganized sppech/behavior, but continuing negative sx.
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4
Q

Tx for schizophrenia

A

Atypical antipsychotics: Risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole

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5
Q

Criteria for panic attack

A

A period of intense fear lasting for a discrete period of time with at least 4 of [palpitations, sweating, trembling, SOB, feeling of choking, chest pain, nausea, dizziness, derealization/depersonalization, fear of losing control/going crazy, fear of dying, numbness/tingling, chills/hot flashes]

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6
Q

Criteria for panic disorder

A
  • recurrent unexpected panic attacks
  • attacks followed by 1 month of [concerns about having more attacks, consequences of attacks, change in behavior as result of attacks]
  • with or without agoraphobia
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7
Q

Tx for panic disorder

A

SSRI and CBT

Short acting BNZ for immediate relief

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8
Q

Criteria for social phobia

A
  • marked persistent fear of at least one social or performance situation in which exposure to unfamiliar ppl or poss scrutiny of others occurs.
  • person fears that s/he will be humiliated or embarrassed
  • exposure to feared situation/s invariably provokes anxiety that can take form of panic attack.
  • person recognizes that the fear is unreasonable
  • avoidance/anticipation of situation interferes with normal routine
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9
Q

Criteria for Phencyclidine intoxication

A
  • Hostility, violence, impulsivity, psychomotor agitation
  • 2 or more of [*nystagmus, HTN/tachy, numbness, ataxia, dysarthria, muscle rigidity, seizure/coma, hyperacusis] w/in 1 hr of ingestion
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10
Q

Tx for PCP

A
  • gastric lavage contraindicated (emesis/aspiration risk)
  • minimal stimulation (dark room, away from others)
  • if poss, avoid restraints bc risk of muscle breakdown
  • if poss, avoid low-potency antipsychotic bc anticholinergic s/e can worsen symptoms
  • BNZ only when necessary bc of delayed excretion of drug
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11
Q

Criteria for Generalized Anxiety Disorder

A

Excessive and uncontrollable anxiety persisting for *at least 6 months

  • 3 of 6 [restlessness/on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance]
  • focus of anxiety not related to another axis 1 disorder
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12
Q

Criteria for Bipolar disorder, manic (I)

A

Pt must exhibit a continuously and abnormally elevated or irritable mood for *at least 1 week
-During period when mood is disturbed, pt must exhibit *3 or more of [inflated self-esteem or grandiosity, dec need for sleep, inc talkativeness, racing thoughts, psychomotor agitation, xs involvement in pleasurable activities that have high potential for bad consequences (overspending, promiscuity)

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13
Q

Tx for bipolar disorder, manic (I)

A

1st line: lithium or valproic acid (mood stabilizers)
2nd line: carbamazepine or oxcabazepine
Risperidone and olanzapine for antipsychotics
*Lamotrigine better for bipolar d/o, depression

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14
Q

Schizoaffective disorder

A

*history of presence of psychosis in absence of mood symptoms
Psychotic symptoms present with and in absence of mood d/o
Mood d/o present only with psychotic symptoms

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15
Q

Schizophrenia

A

Psychotic symptoms present

Brief duration of mood symptoms

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16
Q

Mood d/o with psychotic features

ie. Major depression w/ psychosis

A

Psychotic symptoms present only during mood d/o

Mood disorder presents in the absence of psychotic symptoms

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17
Q

Euphoria, hypervigilance, anxiety, irritability, anger, impaired judgment.
Mydriasis, autonomic instability, diaphoresis, N/V, psychomotor agitation, chest pain/arrhythmias, confusion, seizures, stupor/coma, weight loss.

A

Cocaine intoxication

-Cocaine cleared from body in 72 hours

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18
Q

Dysphoria, irritability, anxiety, hypersomnia, hyperphagia, depressed mood
Miosis

A

Cocaine withdrawal

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19
Q

Criteria for Delirium

A

-Disturbance of consciousness w/ reduced ability to focus attention.
-Change in cognition (memory, orientation, language) or perceptual disturbance
-Develops over short period of time (hrs-days) and *fluctuates
(EEG is sensitive in diagnosing delirium- generalized slowing)

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20
Q

Tx for delirium

A
  • Detect/Correct underlying condition

- Behavioral management with low dose high potency antipscyhotic or short-acting BNZ

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21
Q

Criteria for Major depression with psychotic features

A

Must have *5 or more for *2 weeks
[depressed mood almost everyday for most of the day, decreased pleasure/interest in usual activities, change in appetite/weight, insomnia/hypersomnia, psychomotor retardation, dec energy, sense of worthlessness/guilt, dec concentration, suicidal ideation]

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22
Q

Tx for major depression with psychotic features

A

SSRI and atypical antipsychotic
increased gradually until therapeutic response achieved
-if depression persists, try different SSRI; then augment w/ lithium or buspiron, then switch class of antidepressant.

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23
Q

Tx of major depression with psychotic features in child

A

SSRI+atypical antipsychotic

  • continue antipsych for 3 months, then taper off
  • continue antidepressant for 6-9 months, then taper over 2-3 mo by 33%.
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24
Q

Criteria for Conduct Disorder

A

*At least 3 in last 12 months, at least 1 in last 6 months
[aggression towards ppl/animals, destruction of property, deceitfulness or theft, serious rule violation]
-persistent, repetitive pattern of behavior that infringes on basic rights of others or violates major age-appropriate societal norms

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25
Q

Oppositional defiant disorder

A
  • negative behavior pattern
  • does not typically cause significant harm to others
  • if symptoms after age 18–> Conduct disorder (antisocial personality d/o cannot be dx til after age 18 and must have had CD)
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26
Q

Tx of Obsessive-Compulsive d/o

A

SSRI or clomipramine (TCA)

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27
Q

Criteria for PTSD

A
  • Has been exposed to situation where pt witness, experienced, or was confronted w/ events that actual/threatened death/serious injury.
  • Re-experience of the event
  • Avoids reminders of event
  • Feelings of detachement, numbness, restricted range of affect
  • Persistent symptoms of hyperarousal, irritability, difficulty conc, hypervigilance
  • Acute if < 3 mo; Chronic if > 3 mo. (lasts longer than 1 mo, otherwise acute stress d/o)
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28
Q

Tx for PTSD

A

SSRI (sertraline, paroxetine)
May add TCA or MAOI
Trazadone for sleep
Alpha-2 agonists (clonidine, prazosin)

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29
Q

Criteria for Dysthymic disorder

A
  • Depressed mood most of the day for more days than not for *at least 2 yrs (1 yr for child)
  • Presence of *2 or more depressive sx [change in appetite, change in sleep, low energy, low self-esteems, poor conc, indeciveness, hopelessness].
  • During the 2 yr period, pt never without depressive sx for *>2 months.
  • Criteria for major depression not met during first 2 yrs of mood disturbance.
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30
Q

Tx for dysthymic disorder

A

SSRI

SNRI, burpoprion, TCA, MAOI

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31
Q

Cyclothymia

A

Numerous episodes of hypomania and dysthymia for 2 years

1 yr for young

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32
Q

Criteria for Dementia

A

Multiple cognitive deficits involving both *memory impairment and *aphasia, apraxia, agnosia, or disturbance in executive functioning

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33
Q

Tx for Alzheimer’s dementia

A

Acetylcholinesterase inhibitors [donepzil, galantamine, rivastigmine, tacrine]
NMDA Rc antagonist [memantine]

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34
Q

Tx for agitation in dementia

A

Low dose high potency typical or atypical antipsychotic

or low dose, short acting BNZ

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35
Q

Criteria for Hypochondriasis

A

Preoccupation with fears of having a serious illness based on a *misinterpretation of bodily symptoms, lasting *6 months
-Preoccupation persists despite medical evaluation and reassurance.
-Not delusional or specifically about appearance
(Complaints/disease can change over time, usually can be reassured temporarily).

36
Q

Somatization disorder

A

Numerous somatic complaints related to several bodily areas

-focus is on the symptoms themselves (not a specific disease)

37
Q

Conversion disorder

A

neurological sx: sensory deficit, motor weakness, seizures

38
Q

Criteria for Schizoaffective disorder

A
  • Psychotic sx are accompanied by prominent mood symptoms (mania or depression) during part of the illness.
  • At other times, psychotic symptoms present with no mood symptoms lasting at least *2 weeks
39
Q

Tx for schizoaffective d/o, manic

A

Mood stabilizer + antipsychotic

40
Q

Tx for schizoaffective do, depressive

A

Antipsychotic alone, if not affective add antidepressant

41
Q

Criteria for ADHD, inattentive

A
  • Six or more symptoms of inattention or hyperactivity/impulsivity
  • Sx present before age 7
  • Impairment present in more than 1 setting
  • careless mistakes, difficulty focusing attention, seeming not to listen, failing to follow directions, difficulty in organizing tasks, avoiding tasks requiring sustained mental effort, losing things, easily distracted, forgetful.
42
Q

Criteria for ADHD, hyperactive/impulsive

A
  • Six or more symptoms of inattention or hyperactivity/impulsivity
  • Sx present before age 7
  • Impairment present in more than 1 setting
  • Hyperactivity: fidgeting/squirming, leaving one’s seat, running/climbing excessively/inappropriately, difficulty playing quietly, often being “on the go,” talking excessively.
  • Impulsivity: blurting out answers before question is complete, difficulty waiting one’s turn, interrupting others.
43
Q

Tx for ADHD

A
  • Stimulant: methylphenidate, amphetamine (rapid onset, s/e tics)
  • Atomoxetine (not stimulant, gradual onset, less tics)
  • Pemoline (stimulant action, s/e= rare hepatic toxic rxn, ALT q2 wks.
44
Q

Criteria for Bulimia nervosa

A
  • Recurrent episodes *at least 2x per week for 3 months of binge eating and inappropriate compensatory behaviors (purging, fasting, xs exercise).
  • Self-eval largely based on body shape and weight.
  • Usually near/normal weight
  • high achievers, more alcohol abuse, later onset
  • enlarged parotids, dental caries, calluses on fingers, esophageal tear
  • *hypochloremic-hypokalemic alkalosis; hyperamylasemia, hypoMg
45
Q

Tx for bulimia nervosa

A

Nutritional rehabilitation
CBT, group, family therapy
SSRI

46
Q

Criteria for Acute Stress d/o

A
  • Develops shortly after traumatic event (within 4 weeks), lasts *at least 2 days, no more than *4 weeks.
  • At least 3 dissociative sx [feeling of numbness, detachment, or lack of emotional responsiveness; decreased awareness of surroundings; derealization; dissociative amnesia.
47
Q

Criteria for adjustment d/o

A

Characterized by mood disturbance (anxiety, depression) in response to a difficult situation
-no avoidance symptoms or re-experiencing as in acute stress d/o or PTSD)

48
Q

Tx of acute stress d/o

A

Mobilize social support

usually resolves w/out pharmacological intervention

49
Q

Abdominal pain, sweats, diarrhea, body aches, *mydriasis (dilation), *anxiety, lacrimation, salivation, rhinorrhea, fever, sensitivity to touch and light, goose flesh, autonomic hyperactivity

A

Opiod withdrawal

50
Q

Apathy, psychomotor retardation, miosis, drowsiness

A

Opiate intoxication

51
Q

Tx for opiod withdrawal

A

Clonidine for autonomic hyperactivity
Methadone (long acting, short term)
Loperamide for loose stools, promethazine for N/V, ibuprofen for muscle/joint aches.

52
Q

Anxiety, restlessness, irritability, insomnia, hyperreflexia, tremor, tachycardia, HTN, diaphoresis, hyperthermia, muscle fasciculations
seizure, delirium

A

Alcohol or BNZ withdrawal

53
Q

Anxiety, depression, irritability, headaches, poor concentration, sleep disturbance, inc BP and HR

A

Nicotine withdrawal

54
Q

Tx for opioid overdose

A

Naloxone for life-threatening CNS and respiratory depression

55
Q

Criteria for Pain disorder

A

Pain at one or more sites that is sever enough for clinical eval; pt’s primary complaint

  • psychological factors play an important part in the initiation, worsening, or severity of pain
  • cannot be explained by another axis 1 condition
  • often chronic
56
Q

Tx of pain disorder

A
  • Validate existence of pain but educate about contributing pysch factors
  • TCAs, SSRIs, biofeedback, pain clinics
57
Q

Criteria for adjustment disorder

A

Development of an emotional response to a specific stressor *within 3 months of the onset of the stressor, but does not persist beyond *6 mo
-5 different subtypes: with…depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, mixed diturbance of emotions and conduct.

58
Q

Tx for adjustment disorder

A

Supportive psychotherapy

59
Q

Criteria for Factitious disorder

A

Intentional production or feigning of physical or psychological signs/symptoms

  • motivation is to assume the sick role (primary gain)
  • absent external incentives
60
Q

Criteria for sleep terror disorder

A

Episodes of apparent abrupt awakening usually occuring in the early part of the sleep cycle.

  • behavioral exhibition of intense emotion w/ extreme autonomic responses
  • Pt often unresponsive to efforts to soother or calm.
  • Little memory of episode in AM after normal awakening
61
Q

Criteria for Primary insomnia

A

Sleep problems occurred for *at least 1 month and causes significant distress/impairment.
-non-restorative sleep, inability to initiate/maintain sleep, multiple awakenings during the night, preoccupation with getting enough sleep

62
Q

Tx for primary insomnia

A

Sleep hygiene education, relaxation training/CBT

Ramelteon (melatonin Rc agonist), Trazodone, Zolpidem (BNZ Rc agonist no longer than 2 wks).

63
Q

Criteria for Somatization disorder

A

Pt has history of multiple physical symptoms that began *before age 30; have persisted over several years, causes distress/impairment function

  • 4 pain sx of different site/system
  • 2 GI sx (n,v, abd pain)
  • 1 Sexual/repro sx
  • 1 pseudonuerological (weakness, sensory loss)
  • unconsciously produced.
  • chronic d/o, prognosis= guarded/poor
64
Q

Post partum blues

A

Transient mood changes occurring shortly after delivery

  • mood lability, depressed/irritable mood, interpersonal hypersensitivity/tearfullness
  • peaks within 3-5 days, resolves within 7-14 days post partum
65
Q

Acute dystonic reaction

A

-brief, ~painful muscle contractions, acute onset bilateral upward gaze (oculogyric crisis), torticollis, laryngeal spasm, posturing of trunk/limbs
*hours-days of tx w/ antipsych.
-An EPS (termors, muscle spasms, rigidity)
Tx= IM benztropine, diphenhydramine

66
Q

Neuroleptic-induced Parkinsonism

A

termor, ridigidy, bradykinesia

*days-weeks after initiation/inc dosage of antipsych.

67
Q

Akathisia

A

subjective feeling of restlessness, anxiety, pacing, frequent sitting/standing
*days-weeks of initiation antipsych, esp women.

68
Q

Criteria for Tourette d/o

A

Presence of both motor and vocal tics during course of illness, not necessarily at same time; tics occur almost every day for at least *1 yr, no tic free period for >3 consecutive months; onset before age 18.

  • genetic predisp, ~ au domniant
  • comorbid: OCD, ADHD
69
Q

Tx for Tourette d/o

A

1st line= clonidine (alpha agonist actiated presynaptic autoRc in locus ceruleus to reduce NE release), guanfacine (activates postsynaptic alpha Rc)
then atypical antipsych (Risperidol), then haloperidol

70
Q

PANDAS

A

Pediatric autoimmune neuropyschiatric disorder associated w/ streptococcal infxn
-OCD, tourette, tics more common in children w/ strep infxn in last 3 months.

71
Q

Criteria for anorexia nervosa

A

Refusal to maintain weight at or above 85% of expected weight for height/age; intense fear of gaining weight despite being underweight; amenorrhea
-dec K, dec Cl, metabolic acidosis, low albumin, inc LFT, normal TFT, dec estrogen/FSH/LH, EKG changes, gray matter loss in anterior cingulate cortex

72
Q

Tx of anorexia nervosa

A

Hospitilzation, restoration of nutrition, family therapy

73
Q

Malingering

A

Conscious production of signs/symptoms with external gain as motivation.

74
Q

Criteria for Autistic spectrum d/o

A

Qualitative impairment in social interaction skills manifested by symptoms such as marked impairment in *nonverbal behaviors, failure to develop appropriate peer relationships, lack of social reciprocity; impairments in ability to communicate by *delay in learning spoken language; reptitive, stereotyped patterns of behavior.
-best predictors of ability to improve development= extent of language skills (measured by verbal IQ).

75
Q

Tx for autisim spectrum d/o

A

Family education, behavior shaping, speech therapy, occupational therapy, educational planning.

76
Q

Criteria for separation anxiety d/o

A

Developmentally inappropriate anxiety about separation from home or from the caretaker

  • at least 4 weeks, prior to age 18
  • comorbid: panic d/o as adults, major depression in young adulthood
77
Q

Tx of separation anxiety d/o

A

Pyschotherapeutic modalities and SSRI

78
Q

Criteria for dissociative fugue

A

Unexpected, sudden departure from home and travel to a new location

  • Pt unable to recall his/her past; unaware of identity, may create new
  • usually triggered by overwhelming events in life.
79
Q

Dissociate identity d/o

A

Person invents multiple personalities to help deal w/ traumatic event that ~occurred in childhood
-two or more personality states take recurrently take control of the person’s behavior

80
Q

Tx of dissociative fugue

A

Identification of precipitating event

Pyschodynamic psychotherapy

81
Q

Tx for alcohol withdrawal

A

BNZ- esp lorazepam and oxazepam (incase cirrhosis)

Carbamazepine and valproic acid

82
Q

Criteria for gender identity d/o

A

A strong, persistent, cross-gender identification

  • Children: repeatedly stating that one is a member of other sex, dressing in attire of other sex, preference for cross-sex roles in make-believe play, strong preference for playmates of other sex.
  • Adults: persistent discomfort w/ pt’s own sex and sense of inappropriateness in gender role; ~accompanied w/ getting ride of sex characteristics one was born w/
83
Q

Tx for BNZ overdose

A

Flumazenil

84
Q

Criteria for mental retardation (intellectual disability)

A

Significantly subaverage intellectual functiong, *IQ<70 and deficits in *adaptive functioning in at least 2 of [communication, self-care, home living, interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety]
-onest before age 18

85
Q

Causes of mental retardation

A

Down’s, Fragile x, PKU, Rett’s, Childhood disintegrative d/o, TORCH infxn, fetal alcohol syndrome, Maple syrup urine disease

86
Q

Criteria for conversion d/o

A

One or more sensory or motor deficits suggesting a neurological or medical illness. (a somatoform d/o)
-Deficit it preceded by conflicts/stressors.
-unintentionally produced
-not limited to pain or sexual dysfunction; cannot be fully explained by medical condition.
(may exhibit “la belle indifference”

87
Q

Criteria for fetishism

A

Pt has intense, recurring sexual desires/behaviors focused on inanimate objects such as shoes or female underwear

  • desires must be present for *at least 6 months
  • sexual fantasies/desires must be disturbing to the individual or cuase a problem w/ social/occupational functioning
  • pt does not wear the fetishistic object (transvestic fetishism)

Psychiatry (4 decks)

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