Behavioral Dynamics Exam 2 Cards Flashcards
(386 cards)
1
Q
Substance
A
Alcohol, tobacco, illicit drugs, or improperly used medication
2
Q
Substance use
A
Sporadic consumption with no major adverse events
3
Q
At-risk substance use
A
4
Q
Codependency
A
Condition characterized by a person who is significantly affected by another person’s substance abuse or addiction
5
Q
Substance abuse
A
Maladaptive use causing impairment or distress over a 12 month period - one of the substance abuse criteria must be met
6
Q
4 Substance abuse criteria
CURFEW - But the EW doesn’t stand for anything
A
Failure to fulfill major role obligations
Use of drugs in hazardous situations
Recurrent legal problems due to substance use
Continued use despite persistent social of interpersonal problems resulting from use
7
Q
Dependence
A
State of adaptation manifested by a substance-class specific withdrawal syndtrome
8
Q
Addiction - 4Cs
A
Impaired control over use
Compulsive use
Continued use despite harm
Craving for substance
9
Q
Line between use and addiction generally
A
When patients no longer have control over their use
10
Q
Patients 12+ years old who report illicit drug use in the past month
A
1 in 10 (14%)
11
Q
Percent of people with a substance abuse problem who are not aware of it
A
95%
12
Q
Correlation between age at first use and probability of addiction
A
Younger age of first use=higher risk of later addiction
Late teens to early 20s are highest ages of risk
13
Q
Lifetime prevalence of EtOH use
A
4 out of 5 patients
14
Q
Prevalence of EtOH use within the past 12 months
A
2 out of 3 patients
15
Q
Prevalence of EtOH use in the past 12 months in ages 12-20
A
1 in 10 patients
16
Q
Prevalence of lifetime vaping 12 and up
A
1 out of 2 patients
17
Q
Numbers of people abusing marajuana or pain killers respectively
A
Marijuana - 4.3 million
Pain killers - 1.9 million
18
Q
What substance is the leading preventable cause of death in the US
A
Tobacco
19
Q
Three core reasons why people use substances
A
To feel good (ie. experimentation)
To feel better (escape from anxieties)
To fit in
20
Q
Anandamide
4 things it is involved in
A
Neurotransmitter involved in pain regulation, appetite, mood, and memory
Similar to THC
21
Q
5 things stimulated by Dopamine
A
Movement, motivation, reward, addiction, well-being
22
Q
4 things stimulated by serotonin
A
Mood, memory, sleep cognition
23
Q
2 things stimulated by glutamate
A
Learning, memory
24
Q
2 things stimulated by endorphins
A
Lessened pain, euphoria
25
2 things stimulated by GABA
relaxation, anxiolytic
26
What happens in the brain as we get addicted
Fewer dopamine receptors become available
27
Which should be treated first - mental illness or substance use?
Whichever is more pressing
28
Opponent-process theory
Every process has an opponent or opposite process that sets in after the primary process is over - on repetition the primary process gets weaker and secondary process gets stronger
Chronic drug use leads to lower highs and more severe withdrawals
29
Proportion of US adults who use alcohol in a risky manner
3 in 10
30
Average moderate and binge drinking for men
Average - 15 drinks per week
Moderate 1-2 per day
Binge 5+ on one occasion
Anything more than moderate is heavy drinking
31
Average, Moderate, and binge drinking for women
Average 8+ drinks per week
Moderate 1 per day
Binge 4+ drinks on 1 occasion
Anything more than moderate is heavy drinking
32
Excessive drinking criteria in the elderly
1+ per day or 7+ per week
33
How much alcohol makes up a drink
Beer
Wine
Malt Liquor
Hard Liquor
.5-.6 oz of alcohol
Beer - 12 oz
Malt 8 oz
Wine 5 oz
Hard Liquor 1.5 oz
Go down by ~3.5 oz each time
34
How much alcohol in ounces and drinks can the liver process in 1 hour
1 drink or .5 ounces
35
Telescoping effect and 4 factors that lead to it
Faster timeline from first drink to alcohol dependence - often in women
Lower EtOH dehydrogenase
Lower total body water
Smaller volume of distribution
Drink like (possibly male) partner
36
Male to female ratio for alcohol use
4 to 1
37
CAGE Questions
Have you ever felt you ought to cut down on your drinking?
Have people annoyed you by criticizing you for your drinking
Have you felt guilty about your drinking
Do you need a drink in the morning to steady your nerves (Eye Opener)?
38
How many CAGE questions raise a red flag? Prompt a more in depth assesment?
Even one yes is a red flag
2+ prompts a more in-depth assesment
39
Apraxia
Inability to have coordinated movements
40
Agnosia
Inability to process physical input - can be irreversible
41
MOA of EtOH
Crosses blood brain barrier and acts as a sedative/hypnotic
Stimulates GABA, Glutamate, and Serotonin receptors
42
Blood alcohol level at which motor actions become clumsy
0.1%
43
Delirium Tremens
Effect of Alcohol Withdrawal in which GABA receptors are reduced - causes sensory hyperacuity, halucinations, hyperreflexia, anxiety, agitation, etc.
44
Wernike encephalopathy
With 3 classic symptoms
From chronic alcohol use - Confusion, ataxia, opthalmoplegia
Can be reversed with thiamine and B vitamins
45
Korsakoff Psychosis
Remember the 4As
Antero and retrograde amnesia, Aphasia, apraxia, agnosia
Treat with thiamine and B vitamins BUT only 20 percent are reversible
46
Onset timing of alcohol withdrawal
8-12 hours after the last drink
47
3 Benzodiazepams used for alcohol withdrawal
Diazepam (Valium), Lorazepam (Ativan), Chlordiazepoxide (Librium)
48
2 antihypertensives for alcohol withdrawal
Clonidine and Atenolol
49
3 Things to use for alcohol withdrawal
Benzos
Anti-HTN
Nutrition
50
Nutrition to give for alcohol withdrawal
B vitamins
Thiamine BEFORE IV glucose
Fluid replacement if needed
51
Scoring to assess alcohol withdrawal
CIWA scoring
52
Treatment for Mild and Non-Mild EtOH withdrawal
Mild - short course of tapering PO BZD
Moderate or Severe - Hospital admission with regular IV BZD until stable
Seek to involve social work/psych to treat underlying cause
53
2 common side effects and 1 uncommon for thiamine administration for alcohol withdrawal
Common - Low BP, May effect glucose metabolism
May rarely see anaphylaxis/bronchospasm
54
Naltrexone for chronic alcohol use
Blocks dopamine release in the brain - lack of reward for drinking - good for +hx and +craving
Hard on Liver
55
Acamprosate (Campral)
MOA
and Metabolism
Works to restore glutamate action and effects for chronic alcoholism
Hard on kidneys
666mg orally TID
56
Disulfiram (Antabuse)
Inhibits aldehyde dehydrogenase, makes any alcohol contact awful including mouthwash sometimes
Makes drinking an awful experience
Not very effective
57
4 other alternative drugs for chronic alcohol use
Anticonvulsants, Muscle relaxants, Antidepressants, Antinausea
58
Proportion of US deaths that are tobacco related
1 in 5
59
EVALI
Acute lung injury associated with vaping, involves the lungs filling with fluid
60
Ciggarette Pack to E-cig cartridge conversion
1 cartridge=1pack
61
Effect of nicotine on the body
Increases dopamine and epinephrine. Acts as a stimulant
62
Why does nicotine tolerance occur
Upregulation of nicotinic receptors
63
cigarette withdrawal timeframe
As early as 2 hrs after last cigarette, peaks at 72 hours can last 3-4 weeks
64
6 acute toxic affects of smoking
Nausea, salivation, pallor tachycardia, poor concentration, poor REM sleep
65
3 indicators of smoking that may not be readily obvious
Pharyngeal erythema, Continine (can also be from secondhand smoke), Anabasine (not usually from secondhand smoke)
66
Recommended treatment for tobacco use
Nicotine replacement - Vapes NOT recommended as therapy
Combo patch (LA) with Oral (SA)
67
Pro, Con and side effects of transdermal nicotine patch
Good compliance d/t simplicity
No chance to adjust dose - continuous
Skin irritation, insomnia, vivid dreams
68
Nicotine gum
Diminishes rather than stops withdrawal
Excessive salivation, HA, Mouth irritation
Avoid those with TMJ or poor dentition issues
69
4 steps for using nicotine gum
Chew
Stop when mouth begins to tingle
Resume chewing when tingling/minty taste fades
Repeat
70
Nicotine replacement option with the highest nicotine content and 4 side effects it has
Oral nicotine lozenge
Palpitations, HA, irritation, insomnia
71
Benefits and drawbacks of a nicotine inhaler
Helps satisfy behavioral cravings - same absorption as lozenge or gum
Can lead to irritation and bronchospasm - don't use in asthmatic patients
72
Two drugs used to treat tobacco use
Bupropion
Varenicline (Chantix)
73
MOA of bupropion for smoking and SEs and CIs
Blocks dopamine and NE reuptake and antagonizes nicotinic and cholinergic receptors - sustained release recommended
SE - insomnia, agitation, dry mouth, headache
CI - epilepsy, anorexia
74
MOA of Varencycline (Chantix), SEs and CIs
MOA - Partial antagonist for nicotinic cholinergic receptors, partially stimulates receptor and also blocks nicotine from binding
SE - vivid dreams, nausea, insomnia
CI-Hypersensitivity to tx
75
Potentail MOA for a nicotine vaccine
Would stop antibodies from crossing the BBB
76
Three things that usually happen after smoking cessation
Weight gain (1-2 kg in the first two weeks, 2-3 kg later on)
Depression and anxiety
Increased cough and mouth ulcers
77
Nicotine gum equivalent to 1 pack per day
4mg
78
Mu receptors
Mediate pain, respiratory depression, constipation and physical dependance
79
Kappa receptors
Analgesia, diuresis, sedation, psychological dependance
80
5 effects of a mild opioid intoxication
Pupillary constriction, Constipation, Slurred words, Drowsiness, Mood change
81
2 effects of severe opioid intoxication
Pinpoint pupils, respiratory depression
82
How much naloxone should be given for cardiorespiratory arrest?
2mg
83
What happens in long-term opioid use?
Desensitization and Downregulation of opioid receptors
Leads to both physical and psychological dependance
84
Grade 0 opioid withdrawal
Craving, anxiety
85
Grade 1 Opioid withdrawal
Yawning, Lacrimation, Rhinorrhea, persperation
86
Grade two opioid withdrawal
First treatable grade
mydriasis, piloerection, anorexia, tremors, hot and cold flashes, itching
87
Grade 3 opioid withdrawal
Increased temp, HTN, Tachycardia, tachypnea
88
Grade 4 opioid withdrawal
Vomiting, Diarrhea, Weight loss, hemoconcentration, spontaneous orgasm/ejaculation
89
Length of opioid withdrawal for morphine or heroin
7-10 days
90
2 opioid-like drugs that can be given for ACUTE opioid withdrawal
Methadone and Buprenorphine
91
2 drugs that can treat symptoms of ACUTE opioid withdrawal
Clonidine, Lofexidine
92
Difference between Buprenorphine, other opioids and nalaxone
Nalaxone is an antagonist
Buprenorphone is a partial agonist
Heroin is a full agonist
93
Drug indicated for chronic opioid use treatment but not for acute
Naltrexone - opioid antagonist
94
Black Box warning for naltrexone
Hepatocellular injury
95
MOA and side effects of methadone
Opioid agonist
Constipation, drowsiness, edema, reduced libido
Greater chance for lethal OD than buprenorphine
96
4 criteria a patient must meet at least one of to qualify for methadone
One year of continuous use or intermittent use for over 1 year
Have been on methadone mainainance within the past to years and show signs of imminent return to opioids
Recently released from prison or hospital and show signs of imminent return
Pregnant and opioid dependant
97
MOA and SEs of buprenorphine
Available as long acting implant
Partial opioid agonist
HA, Nausea, insomnia
98
Best long term outcomes for opioid withdrawal
Therapy COMBINED with medication
99
5 symptoms of meth use
Picking at skin, Aggression, Dilated pupils, Dry mouth leading to tooth decay, Rhabdomyolosis
100
Treatment for amphetamine intoxication
Treat symptoms:
Antihypertensives, airway management, Fluids, Cooling for hyperthermia
101
Timeframe for meth withdrawal
develop in a few hours, peak in 1-2 days, resolve in two weeks
102
3 acute and 3 subacute amphetamine withdrawal symptoms
Acute: dysphoria, anhedonia, vivid drems/insomnia
Subacute: Depression, suicidal thoughts, insomnia/hypersomnia
103
Treatment for amphetamine withdrawal (4)
None proven some possibilities are:
Benzodiazepines, antidepressants, antipsychotics, behavioral therapy
104
First line for chronic amphetamine use treatment
Bupropion and naltrexone
105
Second line treatment for chronic amphetamine use
Mirtazapine
106
Adjunct or alternative treatment for chronic amphetamine use
Methylphenidate (stimulant) Topiramate (anticonvulsant
107
What causes a high temperature in meth users
muscle rigidity
108
Antipsycotic that might be used for meth addiction
Haldol
109
MOA of benzodiazepines
enhance the effect of GABA
Causes sleep, relaxation of muscles, etc.
110
What happens with chronic BZD use?
GABA receptors change and BZD has less affinity for them
111
Sign of BZD overdose and what it might be combined with
CNS depression with normal vital signs
Often overdose with other substances especially alcohol
112
Anxiolytic overdose treatment
Flumazenil - competitive antagonist of GABA receptor
Use with caution, can precipitate withdrawal seizures side effects may not be worth it
113
BZD treatment for withdrawal from BZDs
Titrate to effect IV, slowly wean over a period of months
114
4 potential adjunct medications for BZD withdrawal
Beta blockers, antipsychotics, SSRIs, antihisthamines
All shown to be inferior treatments for acute withdrawal
115
4 aspects of treating chronic BZD use
4 Anticonvulsants used
Treat underlying anxiety
Treat other substance abuse issues
6-12 month taper
Anticonvulsants (valproic acid, gabapentin, topiramate, lamotrigine)
116
Psychosis
Seeing/Hearing things that aren't there
117
MOA of cocaine
Blocks dopamine reuptake
118
Treatment for cocaine use
No set treatment
Dopamine agonist Bromocriptine
Antipsychotics for psychoses
119
Incidental effect of cocaine that could make it clinically useful
Causes vasoconstriction - can stop nosebleeds but also cause a heart attack
120
3 long term treatments for chronic cocaine use
Topiramate, Dopamine agonists/Stimulants, Disulfiram
121
THC in marajuana now compared to the 60's
was 1-5% now is 10-15%
122
MOA of THC
Mimics anandamide and increases dopamine levels
123
4 symptoms of acute marijuana use
Euphoria, Disinhibition, Hunger, Conjunctival infection
124
5 Long term effects of marijuana use
Increase in pulmonary cancer risk, EKG changes, infertility, brain volume loss, Cannabis hyperemesis syndrome
125
Tx for marijuana use and its goal
Sustained abstinence rather than controlled low level use
Psychosocial interventions are preferred over pharmacy
126
4 drugs that MAY be helpful for treating marijuana use
acetylcysteine, gabapentin, topiramate, varenicline
Antidepressants and synthetic THC have NO effect
127
Mood
Overall state of emotion at a given time
128
3 Criteria that must be met for all DSM psychiatric conditions
Condition is not cause by the direct effect of any drug or external exposure
The psychiatric disorder is not caused by the effects of a medical condition
There is significant impairment of social functioning, occupational functioning or both
129
4 physical symptoms of depression
Sleep changes, Fatigue, Appetite changes, Activity changes
130
3 psychological symptoms of depression
Feelings of worthlessness or guilt, concentration, Thoughts of death or suicide
131
2 drugs that can cause depression
Steroids and interferons
132
Atypical depression
Reactivity to pleasurable stimuli, hyperphagia and hypersomnia
133
What must a patient have to be diagnosed with MDD
At least ONE major depressive episode
134
3 screening tools for MDD
PHQ-2 - Initial screening for depression asks about key symptoms
PHQ-9 Further evaluation used as a follow up to PHQ-2
Zung self rated depression scale - allows for a more in-depth rating of current symptoms
135
Disthymia
Persistent depression
136
MC population for depression
Women, younger age groups
137
Preferred approach to depression
Combination of pharmacotherapy and psychotherapy
138
Diagnostic criteria for depression
A depressed mood or anhedonia for over two weeks and 4+ SIG E CAPS symptoms
139
5 criteria that indicate inpatient treatment of depression
Suicidal/homicidal ideation with intent and plan, Psychosis, Catatonia, Impaired judgement - dangerous
Unable to care for self d/t impaired functioning
140
Indications for ECT
Severe refractory depression and patients who cannot tolerate other therapies
141
Vagal nerve stimulation
Devide is implanted on the chest wall with contact to the left vagal nerve - used for epilepsy but may also aid in depression
142
Indications and Contraindications for transcranial magnetic stimulation
For treatment refractory depression, contraindicated in high seizure risk patients for patients with metal implants
Less effective than ECT
143
S-adenosylmethionine
Naturally occurring in the body, may raise dopamine levels and safe in pregnant patients with MDD
May trigger manic episodes
144
5-hydroxytryptophan
Natural precursor to serotonin. Risk of GI upset and serotonin syndrome
145
Omega-3 fatty acids for MDD
May work better when combined with antidepressants, may increase risk of bleeding
146
St. John's Wort for MDD
Increases serotonin and possibly NE and Dopamine causes photosensitivity and many Drug interactions
147
Saffron for MDD
Unclear MOA, can be fatal at high doses
148
Ginko for MDD
Improved mood in memory loss patients, may increase sensitivity to serotonin and bleeding risk
149
4 classes of oral antidepressants
SSRIs, SNRIs, Serotonin modulators, TCAs
150
3 1st gen antidepressants
MOAIs, TCAs, TeCAs
151
Presentation of an ECT seizure
May not be a full seizure - just foot tapping
152
Time required between an SSRI and a MOAI
2 weeks normally
5 weeks for prozac
153
Dosing for SSRIs
QAM with a typical half life of 24 hours
154
6 potential side effects of SSRIs
GI upset, Sleep changes, Headache, Anxiety, ED, Serotonin syndrome and prolonged QT
155
How is serotonin syndrome diagnosed
Clinical dx only
156
3 treatment options for serotonin syndrome
D/C serotonergic medications
Sedation with Benzodiazepines
Normalize vitals and hydration status
157
7 symptoms of Serotonin Syndrome
Agitation
Clonus
Diaphoresis
Hypertonicity
Hyperreflexia
Temperature over 38
Tremor
158
Sertraline class
SSRI
159
Two sertraline side effects
Insomnia and Diarrhea
160
Citalopram class
SSRI
161
Side effect of citalopram
QT prolongation
162
Benefit of citalopram
Least inhibition of hepatic cytochrome enzymes of all SSRIs
163
SSRI with the shortest half life
Fluvoxamine 15 hours
164
2 side effects of fluvoxamine
Somnolence
Cytochrome inhibitor
165
Class of fluvoxamine
SSRI
166
SSRI with the longest half life
Fluoxetine 3 days
167
3 side effects of fluoxetine
Insomnia
Anxiety
Contraindicated with tamoxifen
168
Class of paroxetine
SSRI
169
7 side effects of Paroxetine
Anticholinergic (cant see, cant pee...)
Orthostatic hypotension
Weight gain
Sexual dysfunction
CYP 450 inhibition
Contindicate with tamoxifen
170
MOA of SNRIs
Blocks reuptake of 5HT AND Norepinephrine
171
2 SNRIs with a greater effect on NE
Milnacipran
Levomilnacipran
172
4 non-MDD indications for SNRIs
Anxiety, Fibromyalgia, Neuropathy, Menopausal s/s
173
1 contraindication of SNRIs
Angle closure glaucoma
174
5 general side effects of SNRIs
GI
Sleep Change
Neuro
Sexual disfunction
Psych
175
2 main side effects of Venlafaxine
N/V
Elevated BP
176
How is desvenlafaxine different than venlafaxine
Synthetic metabolite, less pronounced side effects
177
Class of venlafaxine and desvenlafaxine
SNRI
178
Only SNRI with Cytochrome interaction
Duloxetine
179
2 benefits of duloxetine
Least associated with elevated BP
Indicated for chronic pain relief
180
Class of Milnacipran and Levomilnacipram
SNRI
181
Side effect and more common use for Milnacipram
Anticholinergic activity (Can't see...)
Marketed more for pain releif than depression
182
MOA of Bupropion
Acts as a dopamine-norepinephrine reuptake inhibitor and antagonizes nicotinic receptors
183
MOA of mirtazipine
Antagonizes A2 adrenergic, 5HT2 and 5HT3 receptors, causing increased release of Serotonin and NE
184
2 atypical antidepressants
Bupropion and Mirtazipine
185
4 side effects of wellbutrin
Dry mouth, insomnia, nausea, risk of seizures
186
1 benefit of bupropion
Can help with tobacco cessation
187
3 side effects of mirtazipine
Drowsiness, weight gain, sexual dysfunction
188
2 benefits of mirtazipine
Good for patients with insomnia, No hepatic cytochrome inhibition unlike Wellbutrin
189
Serotonin Modulators
2nd line therapy for those who cannot tolerate SSRIs may be first line
Block reuptake of 5HT
190
4 Serotonin modulators
Nefazodone
Trazodone
Vilazodone
Vortioxetine
191
2 Serotonin modulators that also antagonize 5HT receptors
Nefazodone and trazodone
192
2 serotonin modulators that also agonize 5-HT receptors
Vilazodone, vortioxetine
193
Clearance of serotonin modulators
Hepatic
194
3 side effects of serotonin modulators
Headache, diarrhea, nausea
195
Nefazodone class
Serotonin modulator
196
3 Side effects of Nefazodone
Hepatotoxicity, drowsiness, hypotension
197
2 side effects of trazodone
sedation, sexual dysfunction
198
class of vilazodone
Serotonin modulator
199
1 benefit of vilazodone
Faster onset than other SSRIs/SNRIs
200
2 side effects of vilazodone
headache and sexual dysfunction
201
Serotonin modulator not associated with sexual side-effects
Nefazodone
202
2 side effects of vortioxetine
Dizziness and sexual dysfunction
203
Indication for Ketamine/Esketamine
Severe refractory depression without psychosis
204
Route of Ketamine and Esketamine respectively
Ketamine - Usually IV
Esketamine - Nasal Spray
205
3 downsides of Ketamin/Esketamine
Abuse potential - short term therapy only!
Neurotoxicity
Psychotomimetic effects
206
MOA of Ketamin/Esketamine
Opioid agonist - exact MOA for depression not clear
207
3 shorter term, less serious effects of Ketamine/Esketamine
HTN, Anxiety, tachycardia
208
2 drug interactions of ketamine/esketamine
CNS depressants, other nasal sprays
209
MOA of MAOIs
Inhibit Monoamine Oxidases a and b which break down serotonin and norepinephrine and dopamine respectively
210
indication for MAOIs
Treatment resistant or atypical depression
211
4 MAOIs
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline
212
2 contraindications for MAOIs
CV disease, Pheochromocytoma
213
What can create a hypertensive crisis when combined with MAOIs
Foods with tyramine
Aged cheese, soy sauce, tofu, etc. (Pretty much anything fermented)
214
4 side effects of MAOIs
Hypotension, Urinary hesitancy, myoclonic jerks, edema
215
MOA of TCAs
Inhibit reuptake of 5 HT and NE but are second line due to side effects
216
2 TCAs more potent for blocking 5-HT reuptake
Tertiary amines
Amitriptyline, Doxepin
217
2 TCAs more potent in blocking NE reuptake
Secondary amines
Nortryptiline
Desipramine (Norpramine)
218
4 Side effects of TCAs
Easily overdosed w/ increased suicidal thoughts, Prolonged QT, weight gain, sexual dysfunction
219
Two TeCAs
Maprotiline
Amoxapine
220
MOA of TeCA
Block reuptake of NE
Still have risk for suicidal ideation
221
Use of lithium for MDD
Not as effective as other drugs and has numerous side effects and risks of toxicity
222
Use of antipsychotics for MDD
Typically an add-on to antidepressants
223
Criteria for dysthymia
Patients with ongoing depressive symptoms for TWO years or longer with no more than 2 months free of s/s
224
Other name for dythymia
Persistent Depressive Disorder (PDD)
225
6 criteria for dysthymia and how many must be met
Meet two of these:
Appetite changes
Sleep changes
Loss of energy
Can't think/concentrate
Low self esteem
Feelings of hopeless ness
226
Treatment for Dysthymia
1st line - SSRI
2nd line - TCA/MAOI
227
adjustment disorder with depressed mood
Low mood, tearfulness or feelings of hopeless ness in response to a stressor within three months of onset that either exceeds the expected distress given the stressor OR impairs functioning
Must resolve in 6 months
228
Two types of seasonal affective disorder
MC - Fall onset
Spring Onset
229
General presentation of fall onset and spring onset depression
Fall - increased everything (sleep, weight, appetite)
Spring decreased everything (sleep, weight, appetite)
230
Recommended light therapy for SAD
10,000 lux for 30 minutes in the morning
231
3 potential side effects from light therapy
Photophobia, HA, fatigue
232
Criteria for a major depressive episode
2+ weeks of:
Depressed Mood and Anhedonia with 5+ of the following
Weight/Appetite change
Sleep change
Activity change
Fatigue
Guilt
Lack of Concentration
Suicidal thoughts
233
Manic episode criteria
7+ days of expansive elevated or irritable mood and increased energy/activity with 3+ of the following (4 if mood is only irritable)
Grandiosity
Decreased sleep need
Pressured speach
Flight of ideas
Goal directed activity
Risky behavior
234
Hypomanic episode
Only 4 days with classic manic symptoms - must be a change from baseline and cannot cause functional impairment
235
Bipolar 1
Depression with 1+ manic episodes
236
Bipolar 2
Depression with 1+ hypomanic episodes
237
Cyclothymia
Periods of mania and depression that fall short of diagnostic criteria
238
Eight subtypes of Depression and Bipolar disorders
Anxiety
Atypical
Catatonic
Melancolic
Mixed
Peripartum
Psychotic
Seasonal
239
Normal gender presentations of bipolar
Men = Manic
Women = Damsel in distress (Depressive)
240
Resolution time for hypomanic, manic, and major depressive episodes
Hypomanic - 4-8 weeks
Manic - 15-20 weeks
Major depressive - Over 20 weeks
241
Mixed episodes
Qualify for one end of the spectrum with 3+ criteria from the opposite end (ie. Manic episode with guilt, suicidal thoughts, and lethargy)
242
Rapid cycling BPD
4+ mood episodes per year
243
Screening tool for mania
Mood Disorder Questionnaire (MDQ)
244
3 goals of bipolar treatment
Control acute mood symptoms, Induce remission of mood symptoms, Prevent recurrence of symptoms
245
3 types of antimanic drugs
Lithium, Anticonvulsants, Antipsychotics
246
4 factors to evaluate severity of a manic episode
Suicide/homicide risk, Psychotic features, poor insight, aggression
247
Therapy for severe acute manic episodes
Antipsychotic (not lamotrigine) with lithium or valproate
248
Treatment for mild to moderate acute manic episodes
Monotherapy with Lithium, and antipsycotic or anticonvulsant
249
2 antipsycotics for manic episodes
Risperidone and Olanzapine
250
3 anticonvulsants for acute manic episodes
Carbamazepine, Valproate, Divalproex
251
Anticonvulsant that DOES NOT work for acute manic episodes but can treat bipolar
Lamotrigine - Okay for depressive episodes
252
Antipsychotics for depressive episodes of bipolar (3)
Lurasidone, Quetiapine, Olazapine
253
First, Second and Third line meds for Bipolar mantainance therapy
1st - Same med that managed the acute episode
2nd - Lithium, Quetiapine, Valproate, or Lamotrigine
3rd - Other antipsychotics or combo therapy
254
When should lithium levels be checked
5 days after dose change and 12 hrs after last dose
255
5 contraindications of Lithium
CKD, Dehydration, Sodium depletion, CV disease, Pregnancy
Caution in psoriasis and myasthenia gravis
256
Side effects of lithium
LITH-PA
Leukocytosis
Insipidus
Tremor/Teratogenesis
Hypothyroidism
Parathyroid
Arrhythmia
257
Lithium Baseline Labs (5)
Pregnancy, Renal function, Calcium, Urinalysis, Thyroid
258
Lithium maintanance labs
Baseline labs plus lithium
259
How frequently should lithium levels be checked
q 1-2 weeks until desired serum level is reached
q 2-3 months for first 6 months
260
Early and Late symptoms of Lithium Toxicity
Early - GI symptoms
Late - tremor, ataxia, confusion, encephalopathy, seizures
261
4 supportive care measures for lithium toxicity
ABC, IV hydration, Benzos for seizure, HD if severe
262
MOA of valproate
Anticonvulsant - increases GABA levels and effectiveness
263
3 contraindications of valproate
Liver disease, mitochondrial disease, pregnancy
264
2 Drug interactions of valproate
TCAs, other anticonvulsants
265
4 Side effects of valproate
Hair loss, bruising, weight gain, tremor
266
MOA of lamotrigine
Anticonvulsant - inhibits the release of glutamate
NOT for acute mania
267
Lamotrigine and oregnancy
Safer than lithium and other anticonvulsants
268
4 Side effects of lamotrigine
Nausea, drowsiness, pruritis, Steven-Johnson Syndrome and Toxic epidermal necrolysis
269
Steven Johnson Syndrome
Painful rash that turns into dead skin - treat like a burn patient
Result of a RAPID dose increase of Lamotrigine
270
MOA of Carbamazapine
Anti-convulsant, cholinergic, manic, depressant, diuretic, neuralgic
Similar to TCAs chemically
271
3 contraindications of carbamazepine
Bone marrow suppression, recent MAOI use, Not recommended in pregnancy
272
4 Side effects of Carbamazepine
Pruritis, Hyponatremia, leukopenia, SJS
273
MOA of antipsychotics
Serotonin and dopamine agonists
274
Use of antipsychotics for depression and bipolar disorder
Can be adjunct for depression, can be add-on OR initial therapy for bipolar
275
2 antipsychotics commonly used for Bipolar disorder
Quetiapine and Lurasidone
276
3 SEs of antipsychotics in general
Tardive dyskinesia, Dyslipidemia, Hyperglycemia
277
Side effect of Quetiapine
HTN
278
Side effect of Lurasidone
Akathasia
279
Akathasia
Restlessness
280
AIMS score
Abnormal Involuntary Rapid Movement score for tardive diskenesia
281
Severe AIMS score
4
282
Mild/Moderate AIMS score
2/3
283
Criteria for cyclothymia
experience symptoms for 2+ years with no more than 2 months free of symptoms
284
Treatment for cyclothymia
Mood stabilizer such as lithium and potential antidepressant if refractory
285
Disruptive Mood Dysregulation Disorder
Persistently abnormal mood with frequent temper tantrums that interfere with ability to function at school/home
286
Requirements for diagnosis of DMDD
1 year of symptoms
3+ severe outbursts per week
At least 6 years old and before 10
Symptoms in multiple settings
287
Suicide risk rating tool
Colombia Suicide Severity Rating Scale (CSSR)
288
3 things that make anxiety pathologic
No reasonable cause
Excessive
Causes distress
289
Desensitization
Exposing a patient to an anxiety invoking stimulus in small doses
290
Modeling
An anxious patient observes others doing things that they find anxiety inducing
291
Flooding
A patient is exposed to anxiety at its worst and must use relaxation techniques to work through it
292
2 short term therapies for anxiety
Benzodiazepines, Hydroxyzine
293
First line long term therapy for anxiety
SSRIs or SNRIs
294
MOA of bezodiazepines
Enhance effect of GABA at the GABA receptor
295
3 side effects of benzodiazepines
Drowsiness, dizziness, dependance
296
2 Interactions of Benzodiazepines
ETOH and opioids
297
4 contraindications for benzodiazepines
Pregnancy, myasthenia gravis, respiratory depression, narrow angle glaucoma
298
Midazolam
Short acting BZD for procedural sedation
299
Triazolam
Short acting BZD for Insomnia
300
Alprazolam
XANAX
Intermediate acting BZD for anxiety
High abuse potential
301
Temazepam
Intermediate acting BZD for Insomnia
302
Oxazepam
Intermediate BZD for Insomnia and EtOH withdrawal
303
Lorazepam
Intermediate acting BZD for pretty much anything
304
Clonazepam
Intermediate acting BZD for seizures, panic anxiety
305
Diazepam
Valium
Long acting BZD for many things
306
Chlordiazepoxide
Long acting BZD for EtOH withdrawal
307
Flurazepam
Long acting BZD for insomnia
308
How should BZDs be used
PRN for 1-4 weeks
309
MOA of hydroxizine
Histamine H1 receptor agonist
310
Considerations for giving hydroxazine
Can be addictive, cause drowsiness, and interact with potassium
311
Buspirone
Second line - More for cognitive symptoms of anxiety, acts on 5HT and dopamine receptors - use with SSRI
312
Criteria for generalized anxiety disorder
Worry about multiple things for 6 months with 3+ diagnostic characteristics
313
Presentation of anxiety disorder
Persistent worry coupled with hyperarousal
314
Initial screening for anxiety
GAD-7
315
Self reported anxiety screening
Beck anxiety inventory
316
Panic disorder
recurrent episodes of panic attacks (intense fear/discomfort with multiple accompanying symptoms)
317
Agoraphobia
Avoidance of situations where help may be unavailable and leaving would be difficult
318
Number of additional symptoms needed to classify a panic attack
4+
319
Panic disorder criteria
1+ panic attacks followed by 1+ months of worry about additional attacks or maladaptive change
320
1st line treatment for panic disorder
CBT and SSRI - Paroxetine recommended
321
2nd line treatment for panic disorder
SNRIs or TCAs
322
2 Adjunct meds for panic disorder
Alprazolam - short onset, more rebound
Clonazepam - Less rebound less frequent dosing
323
Criteria for agoraphobia
6+ months of fear/anxiety with 2+ diagnostic criteria
324
Agoraphobia treatment
Treat similar to panic disorder
325
Criteria for social anxiety
6+ months of fear about 1+ social situations in which pt is exposed to potential scrutiny
326
First line treatment for generalized social anxiety
CBT, SSRI, SNRI possibly with a PRN BZD
327
First line treatment for performance only social anxiety disorder
PRN BZD before performance
PRN beta blocker such as propranolol
328
Acute stress disorder
Acute stress reaction occurring in the initial month after a patient experiences trauma
329
3 ways a person can experience trauma in acute stress disorder
Direct experience
Witnessing it
Having it happen to a close family member/friend
330
Treatment for acute distress disorder
Trauma oriented CBT with exposure therapy
BZDs may help - Antidepressants not usually used because they take time to work
331
Post traumatic stress disorder
Same criteria as Acute distress disorder, but lasts over 1 month
332
Medication recommendations for PTSD
SSRIs or SNRIs
333
3 potential add ons for PTSD
Atypical antipsycotics
Prazosin
BZDs
334
OCD
Characterized by obsessions, compulsions, or both
335
Obsessions and compulsions
Obsessions are a mental event (ie. thoughts) that cause distress
Compulsions are behaviors that pt feels driven to perform to make obsession stop
The two are not necessarily related
336
Two aspects of s/s of OCD
time consuming
Cause distress or functional impairment
337
Good/fair insight into OCD
Patient recognizes OCD beliefs may not be true
338
Poor insight OCD
Pt thinks beliefs are probably true
339
Treatment for OCD
CBT with exposure therapy and potential SSRI use (may need higher dose than usual)
340
3 things that might trigger a phobia
Anticipation
Exposure
Reminders
341
Criteria of a phobia
6+ months of disorder - out of proportion with functional impairment
342
Treatment for Phobia
First line - CBT with exposure therapy
Second line: BZD for infrequently encountered stimuli; SSRI/SNRI for frequently encountered stimuli
343
Dissociation
Segregation of any group of mental processes from the rest of someones psychological activity
344
5 core symptoms of dissociative disorders
Amnesia
Depersonalization
Derealization
Identity confusion
Identity alteration
345
Depersonalization
Feeling like a stranger in ones body - disconnected from ones self
346
Derealization
Sense of disconnection from one's surroundings - feels unfamiliar
347
Dissociative amnesia
Potentially reversible memory impairment that primarily affects autobiographical memory
348
Dissociative fugue
Sudden unexpected travel or wandering in a dissociative state
349
Criteria for dissociative amnesia
Inability to recall autobiographical information that is TRAUMATIC in nature
350
Localized amnesia
Inability to recall events related to a circumscribed period of time
351
Continuous amnesia
Failure to recall successive events as they occur
352
Generalized amnesia
Failure to recall one's entire life
353
Selective amnesia
Ability to remember some but not all of the events occurring during a circumscribed period of time
354
Systematized amnesia
Failure to remember a category of information such as memories relating to a specific person
355
Treatment for Dissociative amnesia
Psychotherapy - Meds may help some with recalling dissociated information
356
Criteria for DID
Must have two or more distinct personality states
357
Treatment for DID
Psychotherapy is the mainstay of treatment, however pharmacotherapy can be used to treat comorbid conditions
358
Impulse control disorder
Compulsion to perform obviously harmful behavior brings relief and then guilt
359
5 step cycle of Impulse control disorder
Urge-Tension-Act-Relief-Guilt
360
2 impulse control disorders more common in MEN
Gambling and Pyromania
361
Kleptomania
Involves compulsive theft of items that are NOT needed
362
Pharmacotherapy for Kleptomania
SSRIs, Lithium
363
Therapy for pyromania
Early intervention
364
2 pharmacotherapies for Pathologic gambling
SSRIs, Opiate antagonists
365
Pharmacotherapy
Clomipramine
366
Intermittent Explosive Disorder
Episodes of loosing control that are grossly disproportionate to stimulus followed by genuine regret - MALES more common
367
Infection that might lead to IED
Toxoplasmosis gondii
368
Criteria for IED
Aggression twice weekly for 3 months
3+ outbursts with damage to property, etc. in 12 months
At least six
Actions CANNOT be premeditated
369
Difference between conduct disorder and explosive disorder
Conduct disorder is persistent and repetitive while explosive disorder consists of outbursts
370
Pharmacotherapy for IED
Combo treatment of serotonergic, mood stabilizer (ie. lithium) and other drugs
371
Oppositional Defiant DIsorder
Frequent arguments with authority figures and misconduct while placing the blame on others - verbal rather than physical aggression
Reactive and Overt aggression
372
Reactive aggression
In response to rules not proactive (ie. bullying)
373
Overt aggression
Direct (shouting) rather than covert (spreading rumors
374
3 types of ODD
Angry/Irritable
Argumentative/Defiant
Vindictive
375
ODD criteria
6 months with 4+ symptoms
376
Frequncy/Age criteria for ODD
Most days for under 5
Once per week for over 5
377
Severity criteria for ODD
Mild - 1 setting
Moderate - 2 settings
Severe - 3+ settings
378
Treatment for ODD
Pharmacotherapy only indicated for comorbid conditions
Family or individual therapy 1st line
379
Conduct Disorder
More serious than ODD
Characterized by aggression and violation of the rights of others with violation of age-appropriate rules
380
Criteria for CD
3+ diagnostic criteria in 12 months and 1 in 6 months
381
4 general categories for CD criteria
Aggression to people/Animals
Destruction of property
Deceitfulness/Theft
Serious rule violations
382
4 characteristics of CD with lack of prosocial emotions
Lack of remorse or guilt
Lack of empathy
Unconcerned about performance
Shallow or deficient affect
DONT care about consequences
383
One disorder that should be considered as a possible comorbidity to conduct disorders
ADHD
384
Therapy for CD
EARLY therapy
Antipsycotics, Anticonvulsants, and SSRIs
385
Particularaly promising antipsychotic for conduct disorder
Risperidone
385
5 categories of acute trauma symptoms
Intrusion, Negative Mood, Dissociative symptoms, Avoidance symptoms, Arousal symptoms
