Disorders and Treatments Flashcards
(88 cards)
0
Q
Tx for Major depressive disorder
A
SSRI, buproprion, venlafazine, mirtazapine, duloxetine
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)
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.
3
Q
5 subtypes of schizophrenia
A
- Paranoid= preoccupation w/ delusion or auditory hallucinations
- Disorganized= disorganized speech/behavior; flat/inapp. affect
- Catatonic= 2 or more [motor immobility, xs purposeless motor activity, extreme negativism/mutism, peculiar voluntary movements, echolalia/echopraxia.
- Undifferentiated= 2 or more [delusions, hallucinations, disorganized speech, disorganized behavior, negative sx] but doesn’t meet criteria of other subtypes
- Residual= absence of prominent delusions, hallucinations, disorganized sppech/behavior, but continuing negative sx.
4
Q
Tx for schizophrenia
A
Atypical antipsychotics: Risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole
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]
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
7
Q
Tx for panic disorder
A
SSRI and CBT
Short acting BNZ for immediate relief
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
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
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
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
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)
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
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
15
Q
Schizophrenia
A
Psychotic symptoms present
Brief duration of mood symptoms
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
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
18
Q
Dysphoria, irritability, anxiety, hypersomnia, hyperphagia, depressed mood
Miosis
A
Cocaine withdrawal
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)
20
Q
Tx for delirium
A
- Detect/Correct underlying condition
- Behavioral management with low dose high potency antipscyhotic or short-acting BNZ
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]
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.
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%.
24
Criteria for Conduct Disorder
*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
25
Oppositional defiant disorder
- 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)
26
Tx of Obsessive-Compulsive d/o
SSRI or clomipramine (TCA)
27
Criteria for PTSD
- 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)
28
Tx for PTSD
SSRI (sertraline, paroxetine)
May add TCA or MAOI
Trazadone for sleep
Alpha-2 agonists (clonidine, prazosin)
29
Criteria for Dysthymic disorder
- 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.
30
Tx for dysthymic disorder
SSRI
| SNRI, burpoprion, TCA, MAOI
31
Cyclothymia
Numerous episodes of hypomania and dysthymia for 2 years
| 1 yr for young
32
Criteria for Dementia
Multiple cognitive deficits involving both *memory impairment and *aphasia, apraxia, agnosia, or disturbance in executive functioning
33
Tx for Alzheimer's dementia
Acetylcholinesterase inhibitors [donepzil, galantamine, rivastigmine, tacrine]
NMDA Rc antagonist [memantine]
34
Tx for agitation in dementia
Low dose high potency typical or atypical antipsychotic
| or low dose, short acting BNZ
35
Criteria for Hypochondriasis
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
Somatization disorder
Numerous somatic complaints related to several bodily areas
| -focus is on the symptoms themselves (not a specific disease)
37
Conversion disorder
neurological sx: sensory deficit, motor weakness, seizures
38
Criteria for Schizoaffective disorder
- 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
Tx for schizoaffective d/o, manic
Mood stabilizer + antipsychotic
40
Tx for schizoaffective do, depressive
Antipsychotic alone, if not affective add antidepressant
41
Criteria for ADHD, inattentive
- 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
Criteria for ADHD, hyperactive/impulsive
- 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
Tx for ADHD
- 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
Criteria for Bulimia nervosa
- 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
Tx for bulimia nervosa
Nutritional rehabilitation
CBT, group, family therapy
SSRI
46
Criteria for Acute Stress d/o
- 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
Criteria for adjustment d/o
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
Tx of acute stress d/o
Mobilize social support
| usually resolves w/out pharmacological intervention
49
Abdominal pain, sweats, diarrhea, body aches, *mydriasis (dilation), *anxiety, lacrimation, salivation, rhinorrhea, fever, sensitivity to touch and light, goose flesh, autonomic hyperactivity
Opiod withdrawal
50
Apathy, psychomotor retardation, miosis, drowsiness
Opiate intoxication
51
Tx for opiod withdrawal
Clonidine for autonomic hyperactivity
Methadone (long acting, short term)
Loperamide for loose stools, promethazine for N/V, ibuprofen for muscle/joint aches.
52
Anxiety, restlessness, irritability, insomnia, hyperreflexia, tremor, tachycardia, HTN, diaphoresis, hyperthermia, muscle fasciculations
seizure, delirium
Alcohol or BNZ withdrawal
53
Anxiety, depression, irritability, headaches, poor concentration, sleep disturbance, inc BP and HR
Nicotine withdrawal
54
Tx for opioid overdose
Naloxone for life-threatening CNS and respiratory depression
55
Criteria for Pain disorder
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
Tx of pain disorder
- Validate existence of pain but educate about contributing pysch factors
- TCAs, SSRIs, biofeedback, pain clinics
57
Criteria for adjustment disorder
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
Tx for adjustment disorder
Supportive psychotherapy
59
Criteria for Factitious disorder
Intentional production or feigning of physical or psychological signs/symptoms
- motivation is to assume the sick role (primary gain)
- absent external incentives
60
Criteria for sleep terror disorder
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
Criteria for Primary insomnia
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
Tx for primary insomnia
Sleep hygiene education, relaxation training/CBT
| Ramelteon (melatonin Rc agonist), Trazodone, Zolpidem (BNZ Rc agonist no longer than 2 wks).
63
Criteria for Somatization disorder
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
Post partum blues
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
Acute dystonic reaction
-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
Neuroleptic-induced Parkinsonism
termor, ridigidy, bradykinesia
| *days-weeks after initiation/inc dosage of antipsych.
67
Akathisia
subjective feeling of restlessness, anxiety, pacing, frequent sitting/standing
*days-weeks of initiation antipsych, esp women.
68
Criteria for Tourette d/o
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
Tx for Tourette d/o
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
PANDAS
Pediatric autoimmune neuropyschiatric disorder associated w/ streptococcal infxn
-OCD, tourette, tics more common in children w/ strep infxn in last 3 months.
71
Criteria for anorexia nervosa
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
Tx of anorexia nervosa
Hospitilzation, restoration of nutrition, family therapy
73
Malingering
Conscious production of signs/symptoms with external gain as motivation.
74
Criteria for Autistic spectrum d/o
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
Tx for autisim spectrum d/o
Family education, behavior shaping, speech therapy, occupational therapy, educational planning.
76
Criteria for separation anxiety d/o
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
Tx of separation anxiety d/o
Pyschotherapeutic modalities and SSRI
78
Criteria for dissociative fugue
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
Dissociate identity d/o
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
Tx of dissociative fugue
Identification of precipitating event
| Pyschodynamic psychotherapy
81
Tx for alcohol withdrawal
BNZ- esp lorazepam and oxazepam (incase cirrhosis)
| Carbamazepine and valproic acid
82
Criteria for gender identity d/o
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
Tx for BNZ overdose
Flumazenil
84
Criteria for mental retardation (intellectual disability)
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
Causes of mental retardation
Down's, Fragile x, PKU, Rett's, Childhood disintegrative d/o, TORCH infxn, fetal alcohol syndrome, Maple syrup urine disease
86
Criteria for conversion d/o
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
Criteria for fetishism
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)
