Disorders Flashcards
(66 cards)
Schizophrenia
Onset: late teens to early 30s.
Cause: DA hyperactivity
Symptoms: positive (delusions, hallucinations, disorganized speech or behavior, catatonia), negative (flat affect, apathy, anhedonia, inattentiveness).
Diagnosis: pos and neg symptoms with social and occupational deterioration for >or= 6mo
Types: paranoid, catatonic, disorganized, undifferentiated, residual.
NT abnormalities: increased (5HT, NE, DA), decreased GABA
Tx: 1. antipsychotic med: haloperidol or chlorpromazine.
2. risperidone (for neg symptoms)
3. clozapine
Side effects: antipsych meds (akathisia, tremors, rigidity, TD, acute dystonia, NMS)
clozapine (agranulocytosis)
ADHD
Onset: before 7yr, usually males.
Cause: unknown, maybe DA depletion or prenatal substance abuse.
Symptoms: inattention, impulsiveness, hyperactive behavior.
Prognosis: usually improves with age, may develop personality disorder.
Diagnosis: age >7yr, symptoms in two separate locations.
Tx: 1. behavior management
2. psychostimulants (methylphenidate)
Side effects: insomnia, depressed mood, irritability, tics, decreased growth rate.
GAD
Symptoms: uncontrollable and excessive anxiety about daily events, secondary symptoms (difficulty concentrating, restlessness, easily fatigued, sleep disturbance, muscle tension).
Lab tests needed: thyroid function, CBC, glucose, electrolytes, calcium, ECG
Diagnosis: anxiety occurs most days for >or= 6mo with 3+ secondary symptoms.
Tx: 1. psychotherapy, relaxation techniques
2. anxiolytics (benzo, buspirone)
Acute anxiety tx: benzo
Chronic tx: buspirone
OCD
Obsession: persistent intrusive thoughts/impulses/ideas/images that cause anxiety and can’t be controlled.
Compulsion: repeated mental/motor behavior to lessen anxiety, follows obsession.
Comorbidity: Tourette syndrome.
Diagnosis: recurrent obsessions and compulsions that cause significant distress, patient knows it doesn’t make sense.
Tx: 1. SSRI
2. TCAs
3. behavior modification techniques
Panic Disorder
Onset: 20-30yrs old, females.
Medical conditions: mitral valve prolapse, thyroid disorders.
Presentation: recurrent, unexpected, discrete periods of intense fear or discomfort, >4 panic symptoms, worry about another attack.
Symptoms: palpitations, tachycardia, sweating, shaking, SOB, choking feeling, chest discomfort, nausea, dizziness, fear of losing control or dying.
Diagnosis: recurrent attacks, >4 panic symptoms, >or= 1 mo associated anxiety.
Comorbidity: agoraphobia
Tx: 1. TCAs, MAOIs, SSRIs, benzos.
2. CBT
Agoraphobia Tx: exposure therapy
PTSD
Risk: traumatic events
Presentation: re-experience (hallucinations, flashbacks), increased arousal (anxiety, sleep disturbance, hypervigilance), avoidance of traumatic stimuli
Diagnosis: symptoms last >1 mo with severe fear/hopelessness/horror.
Tx: psychotherapy and medication (TCAs, SSRIs, carbamazapine, valproate)
Alternative to imipramine: phenelzine (MAOI)
Social Phobia
Presentation: excessive, persistent fear of social or performance situations.
Diagnosis: history
Tx: 1. behavioral therapy
2. SSRI or MAOI
Take propranolol 30 min before performance situations.
Bipolar Disorder
Mania (or hypomania) and major depression
Manic features: highly elevated or grandiose self esteem, decreased need of sleep, pressured speech, racing thoughts, flight of ideas, easily distracted, increased goal directed activity or psychomotor activation, excessive involvement in pleasurable activities.
Manic diagnosis: 3-4 features that last 1 week or need hospitalization.
Type 1: 1+ episode of mania w/ or w/o MDD.
Type 2: 1+ hypomanic episode and MDD.
Tx: rapid = benzo or antipsychotic.
long term = 1. psychotherapy, cognitive therapy, lithium
2. carbamazepine or valproic acid.
Side effects of lithium: GI distress, weight gain, fatigue, tremor, hypothyroidism
Toxic effects of lithium: vomiting, diarrhea, ataxia, confusion, seizure, coma.
Adjustment Disorder
Stressors: marital problems, divorce, moving, financial hardship, criminal victim.
Presentation: depressed or anxious mood within 3 mo of stressor, lasts <6 mo.
Diagnosis: history and presentation
Tx: 1. psychotherapy
For severe anxiety: short term use of benzos.
For depressed mood: antidepressants.
Complicated Bereavement
Risk factors: sudden or traumatic death, death of child, concurrent stress, insecure personality
Presentation: sudden or delayed onset (up to 1 yr) of depressive symptoms after death, last >2mo.
At risk for: major depression, suicide
Tx: 1. bereavement therapy
2. has disturbed sleep or anxiety: use benzo short term
3. antidepressant if have impaired social/occupational functioning or symptoms >2mo.
4. has psychotic symptoms: antipsychotics
Cyclothymic Disorder
Presentation: hypomanic symptoms and depressive symptoms >or= 2yr, symptom free <2mo at a time.
Diagnosis: history and presentation
Tx: 1. group and individual psychotherapy
2. Mood stabilizers and antidepressants
Dysthymic Disorder
chronic, mild depression
Presentation: continuous depressed mood, symptoms most of time for >or= 2 yr.
Symptoms: appetite change, sleep disturbances, fatigue, low self-esteem, decreased concentration, hopelessness.
Diagnosis: history and presentation
Tx: psychotherapy, antidepressants.
MDD
Onset: 20-50yr
NT affected: NE, 5HT
Criteria: depressed mood most of day/every day, decreased interest and pleasure in activities, feel worthless or have guilt, fatigue or low energy, decreased concentration, increased indecisiveness, weight gain or loss, psychomotor agitation or retardation, recurrent thoughts of death, SI, suicide plan or attempt.
Diagnosis: five + criteria for >or=2wks includes depressed mood or loss of interest/pleasure.
Lab tests: CBC, electrolytes, liver function, UA, thyroid function, drug screen, CT or MRI.
Tx: mild = psychotherapy.
1. SSRI, TCA, MAOI for at least 4 wks at max dosage
2. ECT
Use SSRI in pts with cardiac disease and suicide risk.
SSRI side effects: GI effects, sexual dysfunction, appetite suppression.
TCA side effects: dry mouth, constipation, sexual dysfunction, fatal in OD.
Use MAOIs in those with anxiety or atypical depression (increased sleep and appetite).
MAOI side effects: hypotension, tyramine hypertensive crisis.
Postpartum Depression
Risk factors: mood disorder, social stresses, infant health problems or irritability
Causes: genetics, decreased estrogen/progesterone/cortisol
Diagnosis: major depressive episode within 4 wks of birth.
Up to 15% women.
Tx: psychotherapy and medication, ECT if severe.
1. SSRI
2. TCAs
Postpartum Blues
mild depressive symptoms in 1st week after birth, resolve in 2nd week.
85% women.
Puerperal Psychosis
Mood disorder with psychosis within 6wks of childbirth.
Medical Emergency
Body Dysmorphic Disorder
Presentation: gradual onset of excessive preoccupation with imagined defect in appearance, causes significant distress and psychosocial impairment.
Diagnosis: history and presentation
Tx: psychotherapy, medication
1. fluoxetine
2. clomipramine
3. pimozide (antipsychotic) if refractory
Conversion Disorder
Cause: redirection of unconscious psych conflict into physical symptoms.
Presentation: loss of physical functioning (neuro), acute stressor precedes symptoms.
Diagnosis: symptoms cause significant impairment without medical explanation, psychological stress
Tx: psychotherapy and reassurance.
Factitious Disorder
aka Munchausen syndrome
Presentation: intentionally produced symptoms of medical or psych illness without obvious motive, causes hospitalizations.
Diagnosis: history, presentation, evidence of feigning.
Tx: avoid unnecessary procedures and hospitalizations.
Hypochondriasis
Presentation: fear of having serious disease, preoccupation causes significant distress or impairs functioning.
Diagnosis: lasts >6mo despite med eval and reassurance.
Tx: regular office visits and psychotherapy
Pain Disorder
Presentation: pain causing disability or distress, caused by psych factors.
Diagnosis: history, presentation, negative medical workup.
Tx: manage medical disorders, treat pain with minimal surgery or opiates, psychotherapy.
Somatization
Presentation: starts before 30yr, persists years, multiple medical complaints needing tx or impairing functioning.
Complaints: pain, GI disturbance, menstrual irregularities, sexual, pseudoneurologic.
Diagnosis: pain in 4 sites plus symptoms in 3 areas: GI (2 symptoms), sexual, neuro.
Tx: regular office visits, no lab tests or procedures without indication, psych consult.
Anorexia Nervosa
Risk factors: female, family history, industrialized society.
Criteria: fear of gaining weight, distorted perception of one’s weight or body.
Presentation: low weight, amenorrhea.
Symptoms: constipation, abd pain, cold intolerance, lethargy or excess energy.
Physical signs: cachexia, hypotension, hypothermia, xerosis, lanugo, bradycardia, parotid gland swelling, edema, dental enamel erosion, calluses on dorsum of hand.
Lab test abnormalities: anemia, leukopenia, hypokalemia, hypochloremic metabolic alkalosis, hypercholesterolemia, hypoalbuminemia, low plasma estradiol, high plasma cortisol
Associated medical complications: cardiac arrhythmia, prolonged QT interval, decreased LV mass, gastric/intestinal dilation, osteoporosis, sick euthyroid syndrome, cognitive dysfunction.
Psych comorbidities: depression, aniety, OCD features.
Tx: psychotherapy (family and behavioral), chlorpromazine, cyproheptadine, fluoxetine.
Prognosis: up to 50% full recovery; increased mortality in 5-18%; 25% little improvement.
Bulimia Nervosa
Presentation: recurrent binge eating and inappropriate behaviors to prevent weight gain.
Behaviors: vomiting, laxatives, fasting excessive exercise.
Psych symptoms: influenced by feelings toward body shape or weight.
Physical signs: normal weight, eroded dental enamel, scars on hand, enlarged parotid gland.
Lab abnormalities: electrolyte disturbances, metabolic alkalosis and increased serum amylase (vomiting type), metabolic acidosis (laxative type).
Med complications: acute dilation/rupture of stomach, esophageal tears, arrhythmias, ipecac intoxication.
Psych comorbidities: depression, anxiety, subsatnce abuse/dependence, personality disorders.
Tx: psychotheraphy (cognitive behavioral), antidepressants, hospitalize.
