First Aid Flashcards
(317 cards)
1
Q
Definition of Generalized Anxiety Disorder
A
uncontrollable, excessive anxiety or worry about multiple activities or events that leads to significant impairment or distress. male:female is 1:2, clinical onset is in early 20s. Presents with anxiety on most days (6 or more months) with 3 or more somatic symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, disturbed sleep.
2
Q
short term therapy for generalized anxiety disorder
A
benzodiazepines. taper once long term therapy is established (i.e. with SSRIs) in view of high risk of tolerance and dependance
3
Q
dangers of stopping benzos “cold turkey” when treating GAD short term
A
may develop potentially lethal withdrawal symptoms similar to alcohol withdrawal
4
Q
Long term therapy for generalized anxiety
A
lifestyle changes, psychotherapy, medications (SSRIs are first line, venlafaxine, buspirone), patient education
5
Q
5 anxiolytic meds
A
SSRIs, Buspirone, Beta blockers, Benzodiazepines, Flumazenil
6
Q
Side effects of SSRIs
A
Nausea, GI upset, somnolence, sexual dysfunction, agitation
7
Q
side effects of Buspirone
A
seizures with chronic use. no tolerance, dependence or withdrawal
8
Q
Beta Blocker side effects
A
bradycardia, hypotension
9
Q
Benzodiazepines side effects
A
decreased sleep duration, risk of abuse, tolerance, and dependence, disinhibition in young or old patients; confusion
10
Q
MOA of Flumazenil
A
competitive antagonist at GABA receptor
11
Q
Side effects of Flumazenil
A
resedation, nausea, dizziness, vomiting, and pain at the injection site.
12
Q
how to OCD patients generally present
A
to a nonpsychiatrist- i.e. to a dermatologist with a skin complaint 2/2 overwashing hands
13
Q
difference btwn OCD and OCPD
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OCD: patient recognizes these behaviors as excessive and irrational products of their mind. they wish they could get rid of the obsession and/or compulsion
14
Q
Treatment for OCD
A
Pharmacotherapy (SSRIs are first line pharmacologic treatment), cognitive behavioral therapy (CBT) using exposure and desensitization relaxation techniques. patient education is imperative.
15
Q
Definition of panic disorder
A
characterized by recurrent, unexpected panic attacks. two to three times more common in females than in males. agoraphobia is present in 30-50% of cases. average age of onset is 25
16
Q
Definition of a panic attack
A
defined as discrete periods of intense fear or discomfort in which at least 4 of the following symptoms develop abruptly and peak within 10 minutes: tachypnea, chest pain, palpitations, diaphoresis, nausea, trembling, dizziness, fear of dying or ‘going crazy’, depersonalization, or hot flashes.
17
Q
perioral and/or acral paresthesias
A
fairly specific to panic attacks. produce hyperventilation and low O2 saturation
18
Q
Panic disorder patients present with symptoms for how long
A
1 or more months of concern about having additional attacks or significant behavior change as a result of attacks.
19
Q
panic disorder therapy
A
short term: benzos (avoid long term use cause of addiction or tolerance), taper once tx (i.e. SSRIs). long term: CBT, SSRIs, TCAs
20
Q
do patients with phobias recognize that their fear is excessive?
A
yes
21
Q
PTSD treatment
A
short term: beta blockers, alpha agonists (i.e. clonidine). Long term: SSRIs are first line, buspirone, TCAs and MAOIs may be helpful. bEnzos are used but should be avoided if possible. psychotherapy and support groups are useful.
22
Q
definition of a cognitive disorder
A
affects memory, orientation, judgement, and attention.
23
Q
Dementia
A
a decline in cognitive functioning with global deficits. level of consciousness is stable (vs. delerium). Prevalence is highest among those greater than 85 years old. common cause is alzheimers and vascular dementia.
24
Q
other causes of dementia (DEMENTIA)
A
Degenerative diseases (parkinsons, huntingtons), endocrine (thyroid, parathyroid, pituitary, adrenal), metabolic (alcohol, electrolytes, vitamin B12 deficiency, glucose, hepatic, rengal, wilson’s disease), exogenous (heavy metals, carbon monoxide, drugs), neoplasia, trauma (subdural hematoma), infection (meningitis, encephalitis, endocarditis, syphilis, HIV, prions, lyme), affective disorders (pseudodementia), stroke/structure (vascular dementia, ischemia, vasculitis, normal pressure hydrocephalus).
25
Diagnosis of dementia
memory impairment and 1 or more of: the 4 As of dementia (progression of cognitive impairment follows this order- Amnesia, aphasia, apraxia, agnosia), impaired executive function (problems with planning, organizing, and abstracting in the presence of a clear sensorium, personality/mood/behavior changes, often become more confused later in the day and at night.
26
Rule out treatable causes of dementia. get what labs
CBC, RPR, CMP, TFTs, HIV, B12/folate, ESR, UA, head CT or MRI.
27
avoid benzos in dementia because
may exacerbate disinhibition and confusion
28
Major Causes of delirium
I WATCH DEATH: Infection, Withdrawal, Acute metabolic/substance Abuse, Trauma, CNS pathology, Hypoxia, deficiencies, endocrine, acute vascular/MI, toxins/drugs, heavy metals
29
Major Depressive Disorder
characterized by 1 or more major depressive episodes. the male-to-female ratio is 1:2. onset is usually in mid 20s, in elderly, prevalence increases with age. chronic illness and stress increase risk. approximately 2-9% of patients die by suicide.
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SIGECAPS
sleep (hyper or insomnia), interest, guilt, energy, concentration, appetite, psychomotor agitation or retardation, suicidal ideation
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diagnosing major depressive disorder
depressed mood or anhedonia and 5 or more of SIGECAPS for a 2 week period.
32
TCA toxicity
three Cs: Convulsions, Coma, Cardiac Arrhythmias
33
what % of patients with MDD respond to medication
50-70% (allow 2-6 weeks to take effect, treat for 6 months.
34
most effective treatment regimen for MDD
psychotherapy combined with antidepressants is more effective than either alone
35
ECT
safe, highly effective and often lifesaving therapy that is reserved for refractory depression or psychotic depression, or if rapid improvement in mood is needed
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adverse effects of ECT
post ictal confusion, arrhythmias, headache, and anterograde amnesia
37
how long to wait to start an MAOI if patient was on fluoxetine? other SSRIs?
5 weeks for fluoxetine, 2 weeks for other SSRI
38
Bipolar type I
involves at least 1 manic episode or mixed episode (usually needing hospitalization)
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Bipolar type II
At least 1 MDE and 1 hypomanic episode
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rapid cycling type bipolar
4 or more episodes (MDE, manic, mixed, or hypomanic) in 1 year
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cyclothymic type bipolar
chronic and less severe, with alternating periods of hypomania and moderate depression for more than 2 years.
42
symptoms of mania (screening for bipolar)
DIG FAST (distractability, insomnia, grandiosity, flight of ideas, activity/psychomotor agitation, sexual indiscretions, talkativeness/pressured speech
43
SSRIs (examples, indications, side effects)
Fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine. for depression, anxiety. has sexual side effects, GI distress, agitation, insomnia, tremor, diarrhea. Serotonin syndrome (fever, myoclonus, mental status changes, cardiovascular collapse) can occur if SSRIs are used with MAOIs, illicit drugs, or herbal medications.
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Atypical Antipsychotics (examples, indications)
Bupropion, mirtazapine, trazodone. for depression, anxiety.
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Bupropion side effects
decreased seizure threshold, minimal sexual side effects. contraindicated in patients with eating disorders and seizure patients
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Mirtazapine side effects
weight gain, sedation
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Trazodone side effects
highly sedating, priapism
48
SNRIs (examples, indications, side effects))
venlafaxine, duloxetine. for depression, anxiety, chronic pain. Venlafaxine can cause diastolic hypertension
49
TCAs (examples, indications, side effects)
nortriptyline, desipramine, amitriptyline, imipramine. Depression, anxiety disorder, chronic pain, migraine headaches, enuresis. Lethal with overdose owing to cardiac conduction arrhythmias (i.e. prolonged conduction through the AV node, long QRS). monitor in the ICY for 3-4 days following an OD. Anticholinergic effects (Dry mouth, constipation, urinary retention, sedation).
50
MAOIs (examples, indications, side effects)
Phenelzine, tranylcypromine, selegiline. for depression, especially atypical. Side effects: hypertensive crisis if taken with high tyramine foods (aged cheese, red wine). sexual side effects, orthostatic hypotension, weight gain.
51
Manic Episode
manic episode is 1 week or more of persistently elevated, expansive, or irritable mood plus 3 DIG FAST symptoms. psychotic symptoms are common in mani.
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Treatment of Bipolar Mania
acute therapy: antipsychotics. maintenance therapy- mood stabilizers. use benzodiazepines for refractory agitation.
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Treatment of bipolar depression
mood stabilizers +/- antidepressants. start mood stabilizers FIRST to avoid inducing mania. ECT may be used if refractory. In patients with severe depression or bipolar II with predominantly depressive features, antidepressant treatment can be augemented with low dose lithium
54
Characteristics of a personality disorder
MEDIC: Maladaptive, eduring, deviate from cultural norms, inflexible, cause impairment in social or occupational functioning.
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Lithium (indications and side effects)
first line mood stabilizer. used for acute mania (in combo with antipsychotics) for ppx in BPD, and for augmentation in depression treatment. Side effects: thirst, polyuria, diabetes insipidus, tremor, weight gain, hypothyroidism, nausea, diarrhea, seizures, teratogenicity (first trimester), acne, vomiting. narrow therapeutic window. toxicity > 1.5 mEQ/L
56
Carbamazepine (indications and side effects)
second line mood stabilizer, anticonvulsant, trigeminal neuralgia, Side effects: skin, rash, leukopenia, AV block. Rarely aplastic anemia (monitor CBC weekly). SJS
57
valproic acid (indications and side effects)
for BPD, anticonvulsant. Side effects: GI, tremor, sedation, alopecia, weight gain. rarely: pancreatitis, thrombocytopenia, fetal hepatotoxicity, and agranulocytosis.
58
Lamotrigine (indications and side effects)
second line mood stabilizer, anticonvulsant. side effects: blurred vision, GI distress, SJS. increase dose slowly to monitor for rashes
59
personality disorder clusters A B and C
Weird, Wild, Wimpy (alphabetical)
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cluster A disorders
Paranoid, Schizoid, Schizotypal
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Paranoid
distrustful, suspicious, interpret others' motives as malevolent
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Schizoid
isolated, detached "loners", restricted emotional expression
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Schizotypal
odd behavior, perceptions, and appearance. Magical thinking: ideas of reference
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Cluster B disorders
Borderline, histrionic, narcissistic, antisocial
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Borderline personality disorder
unstable mood, relationships, and self image. feelings of emptiness. impulsive. history of suicidal ideation or self-harm.
66
Histrionic personality disorder
excessively emotional and attention seeking. sexually provocative, theatrical
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Narcissistic personality disorder
grandiose; need admiration; have sense of entitlement, lack empathy
68
Antisocial personality disorder
Violate rights of others, social norms, and laws. Impulsive; lack of remorse. Begins in childhood as conduct disorder
69
Cluster C disorders
Obsessive-compulsive, avoidant, dependent
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Obsessive-compulsive disorder
Preoccupied with perfectionism, order, and control at the expense of efficiency. inflexible morals and values.
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Avoidant personality disorder
socially inhibited, rejection sensitive. Fear being dislike or ridiculed
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Dependent personality disorder
submissive, clingy, have a need to be takenc are of. Have difficulty making decisions. Feel helpless
73
Schizophrenia (etiology)
Dopamine dysregulation (frontal hypoactivity and limbic hyperactivity), and bran abnormalities on CT and MRI (enlarged ventricles and decreased cortical volume.
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Subtypes of schizophrenia
Paranoid, disorganized, catatonic
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Paranoid type schizophrenic
delusions and/or hallucinations are present. cognitive function is usually preserved. Associated with the best overall prognosis
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Disorganized type schizophrenic
speech and behavior patterns are highly disordered and disinhibited with flat affect. The thought disorder is pronounced, and the patient has poor contact with reality. carries the worst prognosis
77
Catatonic type schizoprenia
rare form characterized by psychomotor disturbance with 2 or more of the following; excessive motor activity, immobility, extreme negativsm, mutism, waxy flexibility, echolilia, or echopraxia
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Schizophreniform disorder
symptoms of schizophrenia with a duration of less than 6 months
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positive schizo symptoms
hallucinations, delusions, disorganized speech, bizarre behavior, and thought disorder
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negative schizo symptoms
flat affect, decreased emotional reactivity, poverty of speech, lack of purposeful actions, anhedonia.
81
schizoaffective disorder
combines the symptoms of schizophrenia with a major affective disorder (MDD or BPD)
82
delusion v. hallucination v. illusion
Delusion: fixed false idiosyncratic belief. Hallucination- perception without an existing external stimulus. illusion: misperception of an actual external stimulus
83
Treatment of schizophrenia
antipsychotics, long term follow up. supportive psychotherapy, training in social skills, vocational rehabilitation, and illness education may help
84
ADHD
persistent pattern of excessive inattention and/or hyperactivity/impulsivity. more common in males; typically presents between ages 3 and 13. often shows a familial pattern. Diagnosis requires 6 or more symptoms from each category listen below for 6 or more months in at least 2 settings
85
Typical antipsychotics (examples, indications, side effects)
Haloperidol, droperidol, fluphenazine, thioridazine, chlorpromazine. Psychotic disorders, acute agitation, acute mania, tourette's syndrome. Thought to be more effective for positive symptoms of schizophrenia. primarily block D2 receptors. For patients in whom compliance is a problem, consider depot forms of haloperidol, fluphenazine, etc.
86
DMS IV criteria for schizophrenia
two or more must be present for at least 1 month: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (flattened affect etc). Must cause significant social or occupational functional deterioration, duration of illness fora t least 6 months (including prodromal or residual periods in which above criteria may not be met), symptoms not due to medical, neurological, or substance-induced disorder
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genetic predisposition to schizophrenia
50% concordance rate among monozygotic twins, 40% risk if both parents have schizophrenia, 12% if one first degree relative is affected
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what pathway is responsible for negative schizophrenia symptoms
prefrontal cortical
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what pathway is responsible for positive symptoms of schizophrenia
mesolimbic
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what pathway is blocked by neuroleptics that causes hyperprolactinemia
tuberoinfundibular
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what pathway causes extrapyramidal side effects when blocked by neuroleptics
nigrostriatal
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CT scans of patients with schizophrenia often show
enlargement of the ventricles and diffuse cortical atrophy
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neurotransmitter abnormalities implicated in schizophrenia
elevated serotonin (risperidone and clozapine antagonize serotonin and dopamine), elevated norepinephrine (long term antipsychotic use decreases activity of noradrenergic neurons), and decreased GABA
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better prognostic factors in schizophrenia
later onset, good social support, positive symptoms, mood symptoms, acute onset, female sex, few relapses, good premorbid functioning
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worse prognostic factors in schizophrenia
early onset, poor social support, negative symptoms, family history, gradual onset, male sex, many relapses, poor premorbid functioning (social isolation)
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Typical antipsychotics/neuroleptics
chlorpromazine, thioridazine, trifluoperazine, haloperidol. D2 antagonists. better at treating positive than negative symptoms. important side effects and sequelae (EPS, NMS, TD)
97
Atypical neuroleptics/antipsychotics
Risperidone, clozapine, olanzapine, quetiapine, aripiprazole, ziprosidone. Antagonize 5-HT2 receptor as well as dopamine. better at treating negative symptoms. lower incidence of EPS.
98
EPS
dystonia- spasms of neck, face, tongue. parkinsonism (resting tremor, rigidity, bradykinesia), akathisia (feeling of restlessness)
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Treatment of EPS
antiparkinsonian agents (benztropine, amantadine, etc), benzodiazepine
100
two antipsychotics with highest incidence of EPS
haloperidol and trifluoperazine
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antipsychotics with more anticholinergic side effects
chlorpromazine and thioridazine
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Tardive Dyskinesia (and tx)
darting or writhing movements of face, tongue, and head. d/c offending agent and substitute atypical. benzodiazepines, beta blockers, and cholinomimetics may be used short term. often persists despite withdrawal of agent.
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Neuroleptic malignant syndrome
confusion, high fever, elevated BP, tachycardia, "lead pipe" rigidity, sweating, and greatly elevated creatine phosphokinase.
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Schizophreniform V. Schizophrenia
schizophreniform: symptoms have lasted between 1 and 6 months. schizophrenia: symptoms more than 6 months.
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Schizoaffective disorder
meet criteria for either major depressive episode, manic episode, or mixed episode. have had delusions or hallucinations for 2 weeks in the absence of mood disorder symptoms, have mood symptoms present for substatial portion of psychotic illness, not due to medical illness
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Brief psychotic disorder
1 day to 1 month.
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delusional disorder criteria
nonbizarre, fixed delusions for at least 1 month, does not meet criteria for schizophrenia, functioning in life not significantly impaired.
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schizotypal
paranoid, odd or magical beliefs, eccentric, lack of friends, social anxiety, criteria for true psychosis are not met
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schizoid
withdrawn, lack of enjoyment from social interactions, emotionally restricted
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Major depressive episode criteria
must have at least 5 of following symptoms for at least a 2 week period: depressed mood, anhedonia, change in appetite or weight, worthlessnes or guilt feelings, insomnia or hypersomnia, diminished concentration, psychomotor agitation or retardation (restlessness or slowness), fatigue or loss of energy, recurrent thoughts of death or suicide.
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manic episode criteria
period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week and including at least three of the following: distractibility, inflated self esteem or grandiosity, increase in goal directed activity, decreased need for sleep, flight of ideas/racing thoughts, more talkative or pressured speech (rapid and uniterruptible), excessive involvement in pleasurable activities that have a high risk of negative consequences (i.e. buying sprees, sexual indiscretions)
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DIG FAST
distractibility, insomnia, gradiosity, flight of ideas, activity/agitation, speech (pressure), thoughtlessness
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possible medical conditions that can cause depressive episodes
cerebrovascular disease, endocrinopathies (cushings, addisons, hypoglycemia, hyper/hypothyroid, hyper/hypocalcemia), parkinson's, viral illnesses (mono), carcinoid syndrome, cancer (lymphoma, and pancreatic cancer), collagen vascular disease (i.e. lupus).
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possible medical conditions that can cause manic episodes
metabolic (hyperthyroidism), neurological disorders (temporal lobe seizures, multiple sclerosis, neoplasms, HIV infection
115
medication/substances that can induce depressive episodes
EtOH, anti-HTN, barbiturates, corticosteroids, levodopa, sedative-hypnotics, anticonvulsants, antipsychotics, diuretcs, sulfonamides, withdrawal from psychostimulants
116
medication/substances that can induce mania
corticosteroids, sympathomimetics, dopamine agonists, antidepressants, bronchodilators, levodopa
117
SSRI side effects
headache, GI disturbance, sexual dysfunction, rebound anxiety
118
TCA side effects
most lethal in OD, sedation, weight gain, orthostatic hypotension, anticholinergic effects, can aggravate prolonged QT
119
MAOI side effects
hypertensive crisis when used with sympathomimetics or ingestion of tyramine rich foods (wine, beer, cheese, liver, and smoked meats). Serotonin syndrome when combined with SSRIs. most common side effect is orthostatic hypotension (tyramine is an intermediate in the conversion of tyrosine to NE.
120
serotonin syndrome
autonomic instability, hyperthermia, seizures. coma or death may result.
121
ECT is performed by premedication with
atropine
122
how to treat catatonic depression
with antidepressants and antipsychotics concurrently
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Bipolar I disorder criteria
occurrence of one manic or mixed episode (10 to 20% of patients experience only one manic episode). btwn manic episodes they may have euthymia, MDD, dysthymia, or hypomanic episodes, but none required for dx
124
rapid cycling definition
occurrence of four or more mood episodes in 1 year (major depressive, manic, mixed, etc)
125
treatment of bipolar
lithium, anticonvulsants (carbamazepine or valproic acid)- also mood stabilizers, especially useful for rapid cycling bipolar disorder. Olanzapine- typical antipsychotic
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side effects of lithium
weight gain, tremor, GI disturbances, fatigue, arrhythmias, seizures, goiter/hypothyroidism, leukocytosis (benign), coma, polyuria, polydypsia, alopecia, metallic taste
127
Dysthymic disorder (CHASES)
. at least 2 year years. cannot be without symptoms for more than 2 months at a time. poor Concentration or difficulty making decisions, feelings of Hopelessness, poor Appetite or overeating, inSomnia or hyerSomnia, low Energy or fatigue, low Self esteem
128
prognosis of dysthymic disorder
20% develop bipolar, more than 25% will have lifelong symptoms
129
cyclothymic disorder
alternating periods of hypomania and periods with mild to moderate depressive symptoms. at least 2 years. no history of Major depressive episode or manic episode
130
Autonomic symptoms of anxiety
palpitations, perspiration, dizziness, mydriasis, GI disturbances, and urinary urgency and frequency.
131
neurotransmitter abnormalities in anxiety disorders
increased activity of NE, and decreased GABA and serotonin
132
primary anxiety disorders
panic, agoraphobia, specific and social phobias, OCD, PTSD, Acute stress, GAD, medical condition, substance induced
133
Medical causes of anxiety disorders
hyperthyroid, vit B12 def, hypoxia, neuro (epilepsy, brain tumors, MS), CVD, pheochromocytoma, hypoglycemia
134
panic attack timing
peak in several minutes and subside within 25 minutes. rarely last >1 hour.
135
definition of panic attack
PANIC: palpitations, abdominal distress, numbness, nausea, intense fear of death, choking, chills, chest pain, sweating, shaking, SOB. must have at least 4 symptoms
136
diagnosis for panic disorder criteria
spontaneous panic attack w/ no obvious precipitant. and at least one of the attacks followed by a min. of 1 of the following: persistent concern about having additional attacks, worry about implications of attack, and a significant change in behavior related to the attacks
137
neurotransmitter abnormalities in panic disorder
increased NE and decreased serotonin and GABA
138
Rule out medical conditions for panic disorder
CHF, angina, MI, thyrotoxicosis, temporal lobe epilepsy, multiple sclerosis, pheochromocytoma, carcinoid syndrome, COPD, other cardiac/pulm/neuro/endo abnormalities.
139
Rule out mental conditions for panic disorder
depressive disorders, phobic disorders, OCD, PTSD
140
rule out drugs for panic disorder
Amphetamine, caffeine, nicotine, cocaine, and hallucinogen intoxication, alcohol, or opiate withdrawal.
141
prognosis for panic disorder
10-20% --> significant symptoms, 50% mild, 30-40% symptom free post tx
142
initial tx of anxiety
Acute: benzodiazepines. taper as SSRI is started. Maintenance: SSRIs (paroxetine and sertraline) take 2-4 weeks to be effective. continue tx for 8-12 months or relapse is common
143
Agoraphobia
fear of being alone in public places. often develops secondary to panic attacks due to apprehension about having subsequent attacks in public places where escape may be difficult. 50-75% of patients have coexisting panic disorder.
144
Dx criteria for agoraphobia:
anxiety about being in places or situations from which escape might be difficult or help wouldn't be available, situations are either avoided, endured with distressed, or faced with companion, and symptoms are not explained by another mental disorder
145
tx of agoraphobia
since its usually associated with panic disorder: SSRIs
146
diagnostic criteria for specific phobias
1. persistent excessive fear brought on by specific situation or object 2. exposure to the situation brings about an immediate anxiety response, 3. patient recognizes that the fear is excessive, 4. situation is avoided when possible or tolerated with intense anxiety 5. if person is under age 18, duration must be at least 6 months
147
FDA approved tx of social anxiety disorder
paroxetine (Paxil)
148
four most common mental disorders
phobias, substance induced disorders, major depression, OCD
149
Diagnostic criteria for PTSD
having experienced a traumatic event, potentially harmful or fatal and initial reaction was fear or horror. Persistent reexperiencing of he event (i.e. in dreams, flashbacks, or recurrent recollections), avoidance of stimuli associated with the trauma (avoiding a location that will remind him or her of the event or having difficulty recalling details, numbing of responsiveness, persistent symptoms of increased arousal, symptoms for AT LEAST 1 month
150
Treatment of PTSD
TCAs (imipramine and doxepin), SSRIs, MAOIs, anticonvulsants (for flashbacks and nightmares)
151
Acute Stress disorder criteria
symptoms occur within a month of the trauma and last for maximum of 1 month. symptoms similar to PTSD
152
Generalized anxiety disorder
persistent excessive anxiety and hyperarousal for at least 6 months.
153
what % of patients with GAD have coexisting mental disorder (MDD or phobia or panic)
50-90
154
treatment of GAD
combo of psychotherapy and pharmacotherapy: buspirone, benzodiazepines (clonzepam or diazepam) should be tapered off as soon as possible because of risk of tolerance and dependence. SSRIs, venlafaxine
155
Adjustment disorders
occur when maladptive behavioral or emotional symptoms develop after a stressful life event. Symptoms begin within three months after the event, end within 6 months, and cause significant impairment in daily functioning or interpersonal relationships.
156
difference btwn trigering events in PTSD and adjustment disorder
PTSD: event was life threatening, Adjustment disorder: not life threatening (i.e. divorce, loss of job)
157
personality disorder criteria (CAPRI)
Cognition, affect, personal relations, impulse control. is pervasive and inflexible, stable and has onset no later than adolescence or early adulthood. leas to significant distress in functioning. is not accounted for by another mental/medical illness or by use of substance.
158
Cluster A personality disorders
Schizoid, schizotypal, paranoid. eccentric, peculiar, withdrawn. familial association
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Cluster B personality disorders
antisocial, borderline, histrionic, narcissistic. emotional, dramatic, inconsistent
160
Cluster C personality disorders
avoidance, dependent, OCD. anxious or fearful.
161
diagnosis of paranoid personality disorder (PPD)
at least 4: suspicion w/out evidence of others, preoccupation w/doubts of loyalty or trustworthiness of acquaintances, reluctance to confide in others, interpretation of benign remarks as threatening or demeaning, persistence of grudges, perception of attacks on his or her character that are not apparent to others, quick to counterattack, recurrence of suspicions regarding fidelity of spouse or lover
162
treatment of paranoid personality disorder
psychotherapy
163
Schizoid personality disorder
lifelong pattern of withdrawal. often perceived as eccentric and reclusive. quiet and unsociable and have constricted affect. no desire for close relationships and prefer to be alone. unlike avoidant personlity disorder, they PREFER to be alone. four or more: neither enjoy nor desire close relationships, generally choose solitary activities, little (if any) interest in sexual activity, taking pleasure in few activities, few close friends or confidants, indifference to praise or criticism, emotional coldness, detachment or flattened affect
164
difference btwn schizotypal and schizoid
schizoid is android, schizotypical bit the bible (patients with schizoid don't have eccentric behavior or magical thinkign seen in patients with schizotypal)
165
Schizotypal personality disorder
pervasive pattern of eccentric behavior and peculiar thought patterns. often perceived as strange and eccentric. five or more: ideas of reference, odd beliefs or magical thinking, unusual perceptual experiences, suspiciousness, inappropriate or restricted affect, odd or eccentric appearance or behavior, few close friends or confidants, off thinking or speech, excessive social anxiety.
166
diagnostic criteria for antisocial personality disorder
refuse to conform to social norms and and lack remorse for actions. impulsive and deceitful. often violate law but appear charming at first. must be at least 18 years old for diagnosis, h/o behavior as child/adolescent must be conduct disorder. THREE OR MORE: failure to conform to social norms by committing unlawful acts, deceitfulness/repeated lying/manipulating others for personal gain, impulsivity/failure to plan ahead, irritability, aggressiveness, recklessness, irresponsibility/failure to sustain work or honor financial obligations, lack of remorse for actions.
167
borderline personality disorder (IMPULSIVE)
impulsive, moody, paranoid under stress, unstable self image, labile/intense relationships, suicidal, inappropriate anger, vulnerable to abandonment, emptiness
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diagnostic criteria for BPD
unstable mood/behavior/relationships. impulsive. at least 5: desperate efforts to avoid abandonment, unstable relationships and self image, impulsivity in harmful ways (spending, sexually, substance use), recurrent suicidal threats or attempts or self mutilation, unstable mood, general emptiness feeling, difficulty controlling anger, transient stress related paranoid ideation
169
histrionic personality disorder
attention seeking, dramatic. can't form meaningful relationships. at least 5: uncomfortable when not center of attention, inappropriately seductive or provocative behavior, physical appearance to draw attention, speech that is impressionistic, theaterical and exaggerated expression of emotion, easily influenced by others, perceives relationships as more intimate than they are
170
narcissistic personality disorder
five or more: exaggerated sense of self importance, preoccupied with fantasies of unlimited money, success, brilliance, believes s/he is special or unique, needs excessive admiration, sense of entitlement, takes advantage or others for self gain, lacks empathy, envious of others or believes others are envious of him/her, arrogant or haughty
171
diagnostic criteria for avoidant personality disorder
avoids occupation that involves interpersonal contact due to a fear of criticism and rejection, unwilling to interact unless certain of being liked, cautious of intrapersonal relationships, preoccupied with being criticized or rejected in social situations, inhibited in new social situations because s/he feels inadequate, believes s/he is socially inept and inferior, reluctant to engage in new activities for fear of embarrassment.
172
diagnostic criteria for dependent personality disorder
at least 5: difficulty making everyday decisions w/out reassurance from others, needs others to assume responsibility for most areas of life, cannot express disagreement, difficulty initiating projects, excessive lengths to obtain support from others, helpless when alone, urgently seeks a relationship when one ends, preocupied with fears of being left to care for self. Must manifest before early adulthood
173
diagnostic criteria for OCPD
at least 4: preoccupation with details/rules/lists, perfectionism that is detrimental to completion of task, excessive devotion to work, excessive conscnientiousness and scrupulousness about morals and ethics, will nto delegate, unable to discard worthless objects, miserly, rigid and stubborn
174
define substance abuse
pattern of substance use leading to impairment or distress for at least 1 year with one or more manifestations: failure to fulfill obligations at work, school, or home, use in dangerous situations (i.e. driving a car), recurrent substance-related legal problems, continued use despite social or interpersonal problems due to the substance abuse
175
define substance dependence
substance use leading to impairment or distress manifested by at least 2 in 1 year period: tolerance, withdrawal, using substance more than originally intended, persistent desire to cut down, significant time spent in getting/using/recovering, decreased social, occupational, or recreational activities, continued use despite subsequent physical or psychological problem. [ADDICTION]
176
alcohol's effects on neurotransmitters
activates GABA and serotonin receptors in CNS and inhibits glutamate receptors. GABA is inhibitory --> sedating effect
177
metabolizing alcohol
[alcohol] ---etOH dehydrogenase--> [acetaldehyde] ---aldehyde dehydrogenase---> [acetic acid]
178
treatment of acute alcohol intoxication
ensure adequate airway, breathing, circulation. monitor electrolytes and acid/base status. obtain finger stick glucose. give thiamine to prevent or treat wernicke's encephalopathy, naloxone to reverse any opioids, and folate.
179
three things given to pt who presents with AMS
thiamine, glucose, naloxone
180
tx for alochol dependence (long term)
AA, disulfiram (antabuse) inhibits aldehyde DH, psychotherapy and SSRIs, naltrexone
181
earliest symptoms of EtOH withdrawal
begin btwn 6 and 24 hours after last drink. if mild- irritable and insomnia. severe- fever, disorientation, seizures, or hallucinations.
182
how long does etoh withdrawal last
2-7 days
183
DTs
most serious form of EtOH withdrawal and often begins w/in 72 hours of cessation of drinking.
184
tx of DTs
benzos
185
wernicke-korsakoff syndrome
caused by thiamine (B1) deficiency resulting from poor diet of alcoholics. wernicke's encephalopathy is acute and is reverse with thiamine: Ataxia, confusion, ocular abnormalities (nystagmus, gaze palsies), korsakoffe's is irriversible: impaired recent memory, anterograde amnesia, +/- confabulations
186
cocaine MOA
blocks dopamine reuptake from the synaptic cleft, causing a stimulant effect. dopamine plays role in behvaioral reinforcement
187
death from cocaine OD
arrhythmia, seizure, or respiratory depression. vasoconstrictive effect may result in MI or CVA
188
treatment of cocaine OD
benzos for mild to moderate agitation, haloperidol for severe agitation or psychosis, and symptomatic support
189
symptoms of cocaine withdrawal
malaise, fatigue, depression, hunger, constricted pupils, vivid dreams, psychomotor agitation or retardation
190
classic amphetamines
dextroamphetamine (dexedrine), methylphenidate (ritalin), methamphetamine (desoxyn, ice, speed, crystal meth, crack)
191
substituted (designer) amphetamines
MDMA, MDEA
192
medical use for amphetamines
treat narcolepsy, ADHD, and depressive disorders
193
MOA of PCP
antagonizes NMDA glutamate receptors and activates dopaminergic neurons.
194
rotatory nystagmus is pathognomonic for
PCP intoxication
195
treatment of PCP intox
monitor BP, temperature, and electrolytes. acidify urine with ammonium chloride and ascorbic acid. benzodiazepines or dapamine antagonists to control agitation and anxiety, diazepam for muscle spasms and seizures, haloperidol to control severe agitation or psychotic symptoms.
196
diagnostic evaluation of PCP intox
CPK, AST elevated. UA is positive for more than a week
197
benzos MOA
potentiate effects of GABA by increasing the frequency of chloride channel opening.
198
barbiturates MOA
are used in treatment of epilepsy and as anesthetics, and they potentiate the effects or GABA by increasing the duration of chloride openings
199
Gamma hydroxybutyrate
GHB/grievous bodily harm is a dose specific CNS depressant that produces memory loss, respiratory distress, and coma. commonly used as date rape drug
200
tx barbiturate intox
alkalinize urine with Na bicarb, activated charcoal to prevent further GI absorption
201
tx for benzo intox
flumazenil for OD. charcoal to prevent GI absorption
202
sedative-hypnotic withdrawal symptoms
autonomic hyperactivity (tachycardia, sweating, etc), insomnia, anxiety, tremor, nausea/vomiting, delirium, hallucinations. seziures may occur and may be life threatening
203
tx of benzo withdrawal
administrate long acting benzo- chlorodiazepoxide or diazepam with tapering the dose.
204
opiate intoxication symptoms
drowsiness, nausea/vomiting, constipation, slurred speech, constricted pupils, seizures, and respiratory depression, which may progress to coma or death in OD
205
symptoms of serotonin syndrome
hyperthermia, confusion, hyper or hypotension and muscular rigidity.
206
presentation of opiate withdrawal
dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, nausea/vomiting, fever, dialated pupils, muscle aches.
207
treatment for opioid withdrawal
moderate: clonidine and/or buprenorphine. severe: detox with methadone tapered over 7 days
208
MOA of cannabinoid
cannabinoid receptors in the brain inhibit adenylate cyclase. effects are increased when used with EtOH.
209
long term effects of inhalants
permanent damage to CNS, peripheral nervous system, liver, kidney, and muscle
210
how many mg of caffeine to intoxicate
250mg
211
caffeine withdrawal
resolves within 1 week. includes headaches, nausea/vomiting, drowsiness, anxiety, or depression
212
antidepressant that reduces nicotine cravings
zyban
213
three main categories of cognitive disorders
dementia, delirium, amnestic disorders
214
three most common causes of dementia
alzheimer's (50-60%), vascular dementia (10-20%), major depression ("psuedodementia")
215
psychiatric causes of dementia
depression, delirium, schizophrenia, malingering
216
organic causes of dementia
structural (forgetfulness of normal aging, parkinsons, huntingtons, downs, head trauma, brain tumor, NPH, MS, subdural hematoma), metabolic (hypothyroidism, hypoxia, malnutrition (B12, folate or thiamine deficiency), wilson's disease, lead toxicity. Infectious (lyme disease, HIV dementia, CJD, neurosyphilis, meningitis, encephalitis
217
minimum workup to exclude reversible causes of dementia
CBC, electrolytes, TFTs, VDRL/RPR, B12 and folate, brain CT or MRI
218
dementia with stepwise increase in severity and focal neurological signs
multi-infarct dementia. dx w/ CT/MRI
219
dementia with cogwheel rigidity and resting remor
lewy body dementia or parkinson disease. dx is clinical
220
dementia with ataxia and urinary incontinence
NPH. confirm with CT and MRI. dilated cerebral ventricles
221
Dementia and obesity, with coarse hair and constipation and cold intolerance
hypothyroidism. test T4, TSH
222
dementia with diminished position and vibration sensation + megaloblasts on CBC
vitamin B12 deficiency.
223
dementia and tremor with abnormal LFTs and kayser fleischer rings
wilson's disease. dx with ceruloplasmin
224
dementia with diminished position and vibration sensation + argyll robertson pupils (accommodation response present, response to light absent)
neurosyphillis. test CSF by fluorescent tremponemal antibody absorption test
225
two types of delirium
quiet: seem depressed or exhibit symptoms similar to failure to thrive, an MMSE must be done to distinguish from depression and other diagnostic criteria. Agitated: obvious pulling out lines, may hallucinate
226
differential for delirium: AEIOU TIPS
Alcohol, electrolytes, iatrogenic (anticholinergics, benzos, antiepileptics, blood pressure meds, insulin, hypoglycemics, narcotics, steroids, H2 receptor blockers, NSAIDs, abx, antiparkinsonians), oxygen hypoxia (bleeding, central venous, pulmonary), Uremia/hepatic encephalopathy, Trauma, Infection, Poisons, Seizures (post ictal)
227
Aphasia
disorder of language, speaking, and understanding phrases
228
apraxia
can't do PRACticed movements like tying a shoe
229
Agnosia
can't recognize things that were previous KNOWN
230
diagnostic criteria of alzheimer's
memory impairment plus at least 1: aphasia, apraxia, agnosia, diminished executive functioning.
231
neurotransmitter abnormalities in alzheimer's
decreased levels of acetylcholine (due to loss of noradrenergic neurons in the locus ceruleus of the brainstem) and of norepinephrine (due to preferential loss of cholinergic neurons in the basal nucleus of meynert of the midbrain)
232
what are senile plaques in alz composed of
amyloid protein
233
what are neurofibrillary tangles in alz composed of
Tau proteins
234
vascular dementia dx criteria
identical to alz in manifestations. memory impairment and at least 1: aphasia, apraxia, agnosia, diminshed executive functioning
235
levodopa
degraded to dopamine by dopadecarboxylase
236
carbidopa
peripheral dopadecarboxylase inhibitor
237
amantadine
MOA unknown. parkinsons drug
238
selegiline
monoamine oxidase-B inhibitors. inhibit breakdown of dopamine
239
EEG in CJD
periodic sharp waves/spikes.
240
common causes of delirium
CNS injury or disease, systemic illness, drug abuse/withdrawal, hypoxia
241
causes of delirium (I'M DELIRIOUS)
Impaired delivery (of brain, substrates, such as vascular insifficiency due to stroke), Metabolic, Drugs, Endocrinopathy, Liver disease, Infrastructure (structural disease of cortical neurons), Renal failure, Infection, Oxygen, Urinary tract infection, sensory deprivation
242
delirium + hemiparesis or other focal neurological signs and symptoms
CVA or mass lesion
243
Delirium + elevated BP + papilledema
HTN encephalopathy
244
Delirium + dilated pupils and tachycardia
drug intoxication
245
delirium + fever + nuchal rigidity + photophobia
meningitis
246
delirium + tachycardia + tremor + thyromegaly
thyrotoxicosis
247
treating a delirious patient (FEUD)
fluids/nutrition, environment, underlying cause, drug withdrawal
248
causes of amnestic disorders
hypoglycemia, systemic illness, hypoxia, head trauma, brain tumor, CVA, seizures, MS, HSV encephalitis, substances (etoh, benzos, medications)
249
Normal grief
feelings of guilt and sadness, mild sleep disturbance and weight loss, illusions (briefly seeing deceased person or hearing his or her voice, attempts to resume daily activities/work, symptoms that resolve within 1 year, worst symptoms within 2 months.
250
ABNORMAL grief (severe depression)
guilt and worthlessness, significant sleep disturbance and weight loss, hallucinations or delusions
251
non REM sleep changes with age
increased amt of stage 1 and 2 sleep with decrease in stage 3 and 4 (deep sleep), increased awakening after sleep onset
252
REM changes with age
increased number of REM episodes throughout the night. These are redistributed throughout the sleep cycle and are shorter than normal. total amt of REM sleep remains about the same
253
causes of sleep disorder in the eldery
primary (most common is primary insomnia, others include nocturnal myoclonus, restless leg syndrome, and sleep apnea), other mental disorders, general medical conditions, social/environmental factors (etoh consumption, lack of daily structure)
254
Treatment of sleep disorders in eldery
sedative/hypnotic drugs are more likely to cause side effects when used by the elderly, including memory impairment, ataxia, paradoxical excitement, and rebound insomnia. Therefore, other approaches should be tried first including alcohol cessation, increased structure of daily routine, elimination of daytime naps, and treatment of underlying medical conditions that may be exacerbating sleep problems. If sedative-hypnotics must be perscribed, medications such as hydroxyzine (vistaril) or zolpidem (ambien) are safer than the more sedating benzos
255
definition of mental retardation
significantly subaverage intellectual functioning with an IQ of 70 or below. Deficits in adaptive skills appropriate for the age group. onset must be before the age of 18.
256
genetic causes of mental retardation
down syndrome, fragile X syndrome
257
conduct disorder
pattern of behavior that involves violation of basic rights of others or of social norms and rules with at least three acts within these categories during past year: aggression toward people and animals, destruction of property, deceitfulness, serious violations of rules
258
most common diagnosis in outpatient child psychiatry clinics
conduct disorder
259
tx of conduct disorder
individual psychotherapy focusing on behavior modification and problem solving skills is often useful. adjunctive pharmacotherapy may be helpful including antipsychotics or lithium for aggression and SSRIs for impulsivity, irritability, and mood lability
260
oppositional defiant disorder
Diagnosis is at least 6 months of negativistic, hostile, and defiant behavior during which at least four of the following have been present: frequent loss of temper, arguments with adults, defying adults' rules, deliberately annoying people, easily annoyed, anger and resentment, spiteful, blaming others for mistakes or behaviors
261
three subcategories of ADHD:
predominantly inattentive type, predominately hyperactive- impulsive type, combined type
262
diagnosis of ADHD
at least 6 symptoms involving inattentiveness, hyperactivity, or both have persisted for at least 6 months: inattention (problems listening, concentrating, paying attention to details or organizing tasks, easily distracted, often forgetful), hyperactivity-impulsivity. onset before age 7, behavior inconsistent with age and development
263
what % of ADHD kids have symptoms that persist into adulthood
20
264
etiology of ADHD is multifactorial, including:
Genetic factors (higher incidence in monozygotic twins than dizygotic), prenatal trauma/toxin exposure (fetal alcohol syndrome, lead poisoning, etc), neurochemical factors (dysregulation of peripheral and central noradrenergic systems), neurophysiological factors, psychosocial factors (emotional deprivation)
265
Tx of ADHD
Pharm: CNS stimulants (methylphenidate [ritalin] is first line, dextroamphetamine [dexedrine] and pemoline [cylert], SSRIs/TCAs for adjunctive
266
Diagnosis of Autism
problems with social interaction, impairments in communication, repetitive and stereotyped patterns of behavior and activities,
267
difference between autistic and asperger's
asperger's children have normal language and cognitive development
268
diagnosis of aspergers
impaired social interaction, restricted or stereotyped behaviors, interests, or activites
269
Rett's Disorder
normal prenatal and perinatal development, normal psychomotor development for first 5 months. normal head circumference at birth but decreasing rate of head growth btwn ages 5 and 48 months. loss of previously learned purposeful hand skills between ages 5 and 30 months. early loss of social interaction, problems with gait or trunk movements, severely impaired language and psychomotor development, seizures, cyanotic spells
270
rett syndrome gene mutation
MECP2 on X chromosome
271
Childhood disintegrative disorder
normal development in first 2 years of life, loss of previously acquired skills in at least two of the following areas: language, social skills, bowel/bladder control, play, motor skills. at least two: impaired social interaction, impaired use of language, restricted, repetitive, and stereotyped behaviors and interests
272
tx of tourettes or tic syndrome
haloperidol or pimozide (dopamine receptor antagonists)
273
diagnosis of enuresis
involuntary voiding after age 5. occurs at least twice a week for 3 months or with marked impairment.
274
when is bowel control usually achieved
by the age of 4
275
Diagnosis of encopresis
involuntary or intentional passage of feces in inappropriate places, must be at least 4 years of age, has occurred at least once a month for 3 months.
276
dissociative disorders
defined by loss of memory, identity, or sense of self. amnesia and feelings of detachment often arise suddenly and may be temporary in duration.
277
dissociative amnesia
amnesia is the only dissociative symptom present. they are aware that they are having difficulty remembering but are not very troubled by it
278
diagnostic criteria of dissociative amnesia
at least one episode of inability to recall important personal information, usually involving a traumatic or stressful event. Amnesia cannot be explained by ordinary forgetfulness. symptoms can cause significant distress or impairment in daily functioning and cannot be explained by another disorder, medical condition, or substance use
279
treatment of dissociative amnesia
hypnosis or administration of sodium amobarbital or lorazepam during the interview may be helpful.
280
Abreaction
strong reaction patients often get when retrieving traumatic memories
281
Dissociative fugue
sudden unexpected travel away from home, accompanied by the inability to recall parts of one's past or identity. often assume an entirely new identity and occupation after arriving in the new location. Unaware of their amnesia and new identity, and they never recall the period of the fugue.
282
diagnostic criteria for dissociative fugue
sudden unexpected travel away from home or work plus inability to recall one's past. confusion about personal identity or assumption of new identity. not due to dissociative identity disorder or the physiological effects of a substance or medical disorder
283
Dissociative identity disorder
aka multiple personality disorder. presence of two or more distinct identities, at least two of the identities recurrently take control of person's behavior, inability to recall personal information of one personality when the other is dominant. not due to substance of medical condition
284
diagnostic criteria for depersonalization disorder
persistent or recurrent experiences of being detached from one's body or mental processes. Reality testing remains intact during episode. causes social/occupational impairment
285
somatization disorder
present w/multiple vague complaints involving many organ systems. at least two GI symptoms, at least one sexual or reproductive symptom, at least one neurological symptom, at least 4 pain symptoms, onset before age 30, cannot be explained by general medical condition or substance use
286
diagnostic criteria for conversion disorder
at least one neurological symptom, psychological factors associated with initiation or exacerbation of symptom, symptom not intentionally produced, cannot be explained medically, causes significant distress or impairment, not accounted for by somatization disorder or other mental disorder, not limited to pain or sexual symptom
287
timeline of hypochondriasis
fears present for at least 6 months
288
difference between somatization and hypochondriacs
hypochondriacs worry about disease, somatization disorder is about symptoms
289
intermittent explosive disorder
failure to resist aggressive impulses that result in assault or property destruction. level of aggressiveness is out of proportion to any triggering events.
290
treatment of intermittent explosive disorder
SSRIs, anticonvulsants, lithium, and propanolol. individual psychotherapy is difficult and ineffective.
291
kleptomania
failure to resist urges to steal objects that are not needed for personal or monetary reasons.
292
most effective tx for pathological gambling
gamblers anonymous.
293
trichotillomania
recurrent pulling out of one's hair, resulting in visible hair loss, usually involves scalp but can involve eyebrows, eyelashes, and facial and pubic hair.
294
what distinguishes anorexia from bullemia
anorexia involves low body weight and distinguishes it from bullemia
295
anorexia diagnostic criteria
body weight at least 15% below normal. intense fear of gaining weight or becoming fat. disturbed body image, amenorrhea (not in DSM V)
296
electrolyte abnormalities in anorexia
hypochloremic hyperkalemic alkalosis, hypercholesterolemia, arrhythmias, cardiac arrest, lanugo, melanosis coli, leukopenia, osteoporosis
297
antidepressants useful as adjunctive treatment in anorexia to promote weight gain
paroxetine, mirtazapine
298
diagnostic criteria of bulemia
recurrent episodes of binge eating, inappropriate attempts to compensate for overeating and prevent weight gain. The binge eating and compensatory behaviors occur at least twice a week for 3 months. perception of self worth is excessively influenced by body weight and shape.
299
diagnostic criteria for binge eating
at least 2 days a week for 6 months and is not associated with compensatory behaviors (vomiting/laxative use, etc).
300
pharm tx for binge eating
phentermine and amphetamine, orlistat (xenical) inhibits pancreatic lipase, thus decreasing amt of fat absorbed from GI tract. sibutramine (meridia) inhibits reuptake of NE, serotonin and dopamine
301
elevated dopamine or NE can do what to sleep
decreased total sleep time
302
elevated Ach does what to sleep
increased total sleep time and increased proportion of REM sleep
303
serotonin affect on sleep
elevated serotonin causes increased total sleep time and increased proportion of delta wave sleep
304
two categories of primary sleep disorders
dyssomnias (disturbances in the amount, quality, or timing of sleep and parasomnias (abnormal events in behavior or physiology during sleep)
305
diagnosis of primary insomnia
difficulty initiating or maintaining sleep, resulting in daytime drowsiness or difficulty fulfilling tasks. occurs three or more times per week for at least 1 month
306
short term pharm tx for insomnia
benadryl, zolpidem, zaleplon, trazodone
307
diagnosis of hypersomnia
at least 1 month of excessive daytime sleepiness or excessive sleep not attributable to medical condition, medications, poor sleep hygiene, insufficient sleep or narcolepsy
308
circadian rhythm sleep disorder
mismatch btwn circadian sleep-wake cycle and environmental sleep demands. subtypes- jet lag, shift work, delayed sleep or advanced sleep phase type
309
what do TCAs do to REM sleep
suppress
310
treatment of night terrors
usually none but small doses of diazepam at bedtime may be effective
311
Somnambulism
Sleepwalking disorder.
312
stages of the sexual response cycle
desire, excitement, plateau, orgasm, resolution
313
what do dopamine and serotonin do to libido
dopamine enhances libido, serotonin inhibits libido
314
Id
unconscious, involves instinctual sexual/aggressive urges and primary process thinking
315
Ego
serves as a mediator btwn id and external environment and seeks to develop satisfying interpersonal relationships; uses defense mechanisms
316
sublimation
satisfying socially objectionable impulses in an acceptable manner (thus channeling them rather than preventing them)
317
free association
say whatever comes to mind during therapy sessons to bring forth thoughts and feelings from the unconscious
