Pathological reaction to psychosocial stressor = impairment in social function Sxs event starts within 3 mos of incident, resolves w/in 6 mos if extreme stressor = consider PTSD/ASD Tx - psychotherapy - CBT

6 months or more Intense anxiety about being in situation you can't escape Potentially incapacitating or embarrassing reaction - lack of bowel or bladder control Pts may be unable to leave home Tx - SSRIS - paroxetine, fluoxetine, sertraline, - venlafaxine - 1st line If not successful - benzo, lastly TCAs BBs - reduce autonomic hyperarousal sxs Insight oriented therapy - graded exposure Or CBT

Minor - 6to 24 hrs tremor, anxiety, N/V, and or insomnia Major - 10 to 72 hrs visual and auditory hallucination, diaphoresis, tachycardia, elevated BP Seizures - within 48 hrs Delirium Tremens - 3 to 10 days hallucination, disorientation, fever tx with benzo thiamine and folic acid

W \> M, MC than bulemia Sxs Individual w/ dysmorphia terrified of gaining weight failing to maintain normal body weight Restricting - caloric intake, excessive exercise Purging - vomiting, laxatives Dx BMI \< 18.5 less than 85% ideal height/weight Tx Nutritional rehab, and CBT first line Olanzapine/Zyprexa Refeeding syndrome = hypophosphatemia, rhabdo, no more than 1 lb per wk

inappropriate death, after Sxs numbness, vivid dreams, crying, loneliness even halllucination/delusion Tx good palliative care hospice care Complicated Bereavement \> 6mos that impairs functioning Socially isolated, poor support white old male

Normal weight/BMI _Both occur once weekly for at least 3 mos:_ Recurrent ep of binge eating High calories, high carbs feeling of guilt, loss of control Compensatory behavior purging (vomiting/laxative) non-purging (starvation/exercise) Sxs dental caries, parotid swelling knuckle scarring Tx - CBT, SSRI, nutritional, anxiolytics

Unwanted pregnancy, developmental difficulties, Parental - poor impulse control, hx of abuse, depression, young parent Non-biologically related male living in single femal home Sxs Full H&P cigarette burns different stages of bruise healing, bone fractures inconsistent stories about injury PE - injury and STD screening , usu hypersexual, masturbate excessively

Behavioral Med/Psych - 6% Flashcards by Katie Mac

Acute Stress Disorder/PTSD

Acute Stress Disorder - 2days to 4 weeks

PTSD - severe rx to severe stressor occuring >4 wks

Rape, war, assault, major car accident

may experience directly, witnessed, experienced indirectly

Sxs

Trauma
Re-experiencing event - nightmares, flashbacks, intrusive memories
Avoidance - crowds/groups, activities/ppl/place a/w trauma
Unable to function
1 Month in duration
Arousal - hypervigilance, anger exaggerated startle

Multidimensional
Acute tx
CBT, SSRI

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Adjustment Disorder

Pathological reaction to psychosocial stressor = impairment in social function

Sxs

event starts within 3 mos of incident, resolves w/in 6 mos
if extreme stressor = consider PTSD/ASD

Tx - psychotherapy - CBT

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Agoraphobia

6 months or more Intense anxiety about being in situation you can’t escape

Potentially incapacitating or embarrassing reaction - lack of bowel or bladder control

Pts may be unable to leave home

Tx -

SSRIS - paroxetine, fluoxetine, sertraline,
- venlafaxine - 1st line If not successful - benzo,
lastly TCAs BBs - reduce autonomic hyperarousal sxs Insight oriented therapy - graded exposure Or CBT

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Alcohol Withdrawal

Minor - 6to 24 hrs

tremor, anxiety, N/V, and or insomnia

Major - 10 to 72 hrs

visual and auditory hallucination, diaphoresis, tachycardia, elevated BP

Seizures - within 48 hrs

Delirium Tremens - 3 to 10 days

hallucination, disorientation, fever
tx with benzo
thiamine and folic acid

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Anorexia Nervosa

W > M, MC than bulemia

Sxs

Individual w/ dysmorphia
terrified of gaining weight
failing to maintain normal body weight
Restricting - caloric intake, excessive exercise
Purging - vomiting, laxatives

BMI < 18.5
less than 85% ideal height/weight

Nutritional rehab, and CBT first line
Olanzapine/Zyprexa
Refeeding syndrome = hypophosphatemia, rhabdo, no more than 1 lb per wk

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Bereavement

inappropriate death, after

Sxs

numbness, vivid dreams, crying, loneliness
even halllucination/delusion

good palliative care
hospice care

Complicated Bereavement > 6mos that impairs functioning

Socially isolated, poor support

white old male

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Bipolar 1 Disorder

DSM-5 sxs

Manic episode → at least 1 lifetime manic ep = BP1D

Symptoms at least 1 wk of 3 or more sxs (or 4 or more if 1 symptom is only irritability) Distractibility

Indiscretion
Grandiosity
Flight of ideas
Activity increased
Sleep deficient
Talkativeness

Hypomanic Episode are the same as above

Ep is not severe enough to cause marked impairment in social or occupational

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Bipolar 2 Disorder

DSM-5 sxs

Characterized by at least one or more major depressive episodes, at least one hypomanic episode Never experienced a manic episode Hypomanic ep - less severe and cause less social impairment F>M

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Bipolar Disorder ( 1 and 2)

Treatment

Mood stabilizers - all C/I in pregnant

SSRIs can induce mania
Lithium — 300 mg BID -
- Plasma level q 4-8wks
- SE - tremor, N, polyuria, thirst, weight gain and diarrhea, renal and thyroid toxcity
Valproic acid/Depakote
- monitor levels
- SE - tremor, wt gain, N/V, hepatic failure and thrombocytopenia
- C/I preggo
Carbamazepine/Tegretol
- SE - SJS, hypoNa, N/V, Diarrhea

Acute mania

2gAPs
Risperidone, Aripiprazole
Haliperidol or
Benzos - if + agitation or +psychotic sxs good during tx initiations when acute mania is more likely

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Bulimia Nervosa

Normal weight/BMI

Both occur once weekly for at least 3 mos:

Recurrent ep of binge eating

High calories, high carbs
feeling of guilt, loss of control

Compensatory behavior

purging (vomiting/laxative)
non-purging (starvation/exercise)

Sxs

dental caries, parotid swelling
knuckle scarring

Tx - CBT, SSRI, nutritional, anxiolytics

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Child Abuse

Unwanted pregnancy, developmental difficulties,

Parental - poor impulse control, hx of abuse, depression, young parent

Non-biologically related male living in single femal home

Sxs

Full H&P
cigarette burns
different stages of bruise healing, bone fractures
inconsistent stories about injury
PE - injury and STD screening , usu hypersexual, masturbate excessively

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Cluster A “Mad”

Personality Disorders

Paranoid

suspicious or distrust of others, often perceives attacks on own character

Schizoid

detachment from interpersonal relationships, limited emotions and solitary, no interest in sex or physical activities

Schizotypal

odd, eccentric individual, strong belief in magic or paranormal, psychotic

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Cluster B “Bad”

Personality Disorders

Anti-social

persistent disregard for other rights, common in inmates, dx w/ conduct disorder

Borderline

unstable personality, always on the boder of instability/change

Histrionic

shallow, attention seeking, hypersexual, manipulative

Narcissitic

grandiose need for admiration, no empathy

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Cluster C “Sad”

Personality Disorder

Avoidant

feels socially inhibited & inadequate, hypersensitive to criticism and avoids work/relationship that might lead to criticism

Dependent

needs to be taken care of, can’t make decision, clingy/separation anxiety

Obsessive Compulsive Personality

rigid preoccupation w/ order and rules, inflexible control freaks who can’t delegate

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Cocaine

Stimulant

tachycardic, diaphoretic

avoid BB - drop BP, arterial vasospasm

w/d is not life threatening NV malaise, diaphroesis

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Conversion Disorder

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Trauma experience that causes involuntary alteration of motor or sensory function = substantial distress or psychosocial impairment

Sxs

Trauma
loss of sensory or motor function
everything is normal

Tx - self limited

Cyclothymic Disorder

DSM-5, Sxs

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Recurring period of less severe depressive eps and hypomania > 2 years Sxs free period for no more than 2 months at 1 time no Manic or Mixed episodes

Domestic Violence

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actual or threatened psychological, physical or sexual harm by current or former spouse

Screening

Past year - have you been hit, slapped, kicked, or otherwise physically hurt
in relationship w/ someone who threatenes or hurt you
forced to engage in unwanted sexual relationships

Tx - proper hotline, social work

mandated reported

Persistent Depressive Disorder (Dysthymia)

DSM-5

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Depressed mood for more days than not for at least 2 years for at least 2 of the follow:

* no mania or hypomania, substance or organic cause

Poor appetite or overeating
Insomnia or hypersomnia
Low Energy or fatigue
Low Self esteem
Poor concentration or difficulty making decisions Feelings of hopelessness

Tx - Antidepressants + psychotherapy SSRIs first choice

Elder Abuse and Neglect

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Withholding appropriate emotional interaction, food, medicine, water, or clothing

Financial neglect

Sxs

MC with family or spouse
sexual abse - dehydration, malnutrition, skin tears

Factitious Disoder (Malingering)

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Falsification of sxs - deception for 2/2 gain (usu meds, disability gain)

a/w antisocial personality disorder

Sxs

Discrepancy btwn observed and reported distress

Generalized Anxiety Disorder

DSM-5 sxs

Study These Flashcards

> 6+ months Intrusive worry and thoughts about multipe aspect of life

Difficult to control worry a/w 3+ symptoms

Restlessness or feeling keyed up or on edge
Easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep Disturbances

CBT
SSRI - Zoloft/Sertraline, Paxil/Paroxetine
SNR - Venlafaxine/Effexor, Cymbalta
Buspirone - if worried about GI SE
Benzos - Ativan/Lorazepam, Valium/Diazepam, Klonopin/Clonazepam
- good for acute attacks

Generalized Anxiety Disorder

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Psychotherapy - CBT
SNRI - venlafaxine
SSRIs - Paroxetine/Paxil,
Escitalopram/Lexipro several weeks to work Buspirone - 2 wks to work Benzo in interim until SSRI response

Heroin and Opiates

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Intox = sedation and lethargy

OD = respiratory collapse

Narcan/Naloxone - use for OD = 0.4mg IV and repeat

may precipitate w/d

Medical detox -

Buprenorphine/Naloxone (Suboxone)
Long active opiate effect prevents w/d - slowly tapered
Methadone

Lithium Side Effects

Muscle Nephrotoxic hypOthyroidism Pregnancy teratogenic

Major Depressive Disorder DSM-5, sxs

**5+** sxs during same **2 wk period** at least 1 symptom has to be 1) depressed mood or 2) loss of interest or pleasure causing significant distress or impairment in social functioning **_SIGECAPS_** * Sleep changes * Interest - loss of * Guilt or worthlessness * Energy * decreased Concentration * Appetite changes or weight * Psychomotor agitation or slowing * Suicide thoughts of Dx - CBC, TSH, CMP, RPR, UA, B12 and Folate

Major Depressive Disorder **_Meds Major Side Effects_**

**SSRIs** * Prozac (Fluoxetine) - long 1/2 life= highest risk of SS * Paxil (Paroxetine) - most sedating, _C/I to pregnant_, shortest 1/2 life -uncomfortable w/d state * Zoloft (Sertraline) - _harsher GI effect_, good for preggo * Celexa (citalopram) + Lexapro (Escitalopram) - prolonged QTc * Luvox (Fluvoxamine) - FDA approv for OCD * GI upset, weight gain, sexual dysfunction 4-6 wks to see efficacy maintenance \> 6 mos **SNRI** * Venlafaxine (Effexor) (NE + SE) - HTN SE, * Duloxetine (Cymbalta) - GI SE, _black box liver failure_ **Bupropion (welbutrin) - 3rd line** * No sexual SE or wt gain, smoking cessation, lowers seizure threshold (C/I in bulemia) **Mitrazapine (remeron)** * Good for elderly, appetite booster **Trazodone** * helps with sleep, SE for priapism **TCAs -** * Imipramine - bedwetting, bladder contractions * Clomipramine - OCD Tx * Amtriptyline - chronic pain * QTc prolongation (need EKG), weight gain, ortho hypotension, anticholinergic sxs, widen QRS **MAOIs** * Tyramine free diet

Major Depressive Disorder Treatment

SSRIs - 1st line SNRIs - Venlafaxine or duloxetine Atypical antidepressants * Bupropion or Mirtazapine * TCAs and MAOIs - less often ECT - if unresponsive to psych meds

Methamphetamine

Psychostimulate, M&M Intoxication - HTN, tachycardic, severe agitation and psychosis Acute management - control agitation and hyperthermia w/ benzos

Panic Attack

Classic, discrete eps of **intense fear** begins abruptly lasts for several mins to 1 hr Sxs * CP, palps, dyspnea, choking sensation * N/V, faint * Derealization, depersonalization * feeling a sense of DOOM or going to die, crazy, won't escape

Panic Disorder

Syndrome of recurrent panic attacks Sxs * Persistent fear of further attacks * Maladaptive change in behavior related to attacks * wax and wane over time * a/w MDD Tx - * CBT mainstay * SSRIs - Paxil, prozac, zoloft * SNRI - effexor * Benzo - PRN only, caution against abuse and dependancy

Phobia

marked fear that is unreasonable and OOP; present for 6 mos actively avoid phobic objects MC - public speaking Tx * CBT * Benzo - for 1x, BB * SSRI - if severe, resistant

Schizophrenia

Psychosis - hallmark - inability to differentiate btwn what's real or not Schizophreniform - \> 1mo but \< 6 mo Two or more of following - sxs present for **1 month** for **at least 6 mo**s- at least one must be 1-3 1. Delusion 2. hallucinations 3. Disorganized Speech - freq derailment or incoherence 4. Grossly disorganized or catatonic behavior 5. **Negative sxs** * flat affect, empty speech, social w/d, lack of motivation **Positive Symptoms** * Delusion, hallucinations, disorganized speech, bizzare behavior **Prodromal Symptoms** * poor social skills, social w/d, unsual thinking Tx * APs - First gen - **Haliperidol, Chlorpromazine, Flupenazine** * SE - tardive dyskinesia, parkinsonism, dystonia, tremor, NMS, wt gain, DM * Atypical APs - Second Gen - **Risperidone, Olanzapine , Quetiapine, Ziprasidone, Aripiprazole** * ****Less SEs

Social Anxiety Disorder

**6 months or more** Fear of social or performance situations - embarrassing or humiliating in front of others occur Common inciting events - public speaking, using public restrooms, eating in public Tx * SSRIS - paroxetine, fluoxetine, sertraline, * SNRI - venlafaxine - 1st line BBs - reduce autonomic hyperarousal sxs * Insight oriented therapy - graded exposure Or CBT

Somatic Symptom Disorder

Multiple system of complaints; Significant distress or psychosocial impairement persistent anxiety about sxs Tx * significant time and energy devotion to care fo pts

Behavioral Med/Psych - 6% Flashcards

(35 cards)