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Flashcards in Psych/behavioral Deck (28)
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1

Generalized Anxiety Disorder presentation

Palpitations, diaphoresis, dizziness, trembling, SOB or choking sensation, tingling of extremities, somatic complaints such as muscle tension

2

Generalized Anxiety Disorder tx

Psychotherapy and pharmacotherapy

1st line: CBT or SSRI/SNRI w/ 6-8 wk trial for at least a year

2nd line: Buspirone, benzos, TCA

3rd line: hydroxyzine, pregabalin, quetiapine

For insomnia: trazodone, mirtazapine

3

Panic Disorder presentation

Shaking and trembling, choking sensation, SOB, diaphoresis, hot flashes, or chills

Derealization and depersonalization

Chest pain and palpitations

Persistent concern about having another attack

Fear of dying or losing control

Abd pain, paresthesias

4

Panic Disorder tx

Acute: benzo

CBT± pharmacotherapy

1st line LT: SSRI/SNRI (will be panic free after >4 wks

2nd line: benzos (alprazolam)

5

Panic Disorder pathophys

Caused by overreaction to stimulation of amygdala and adrenal gland

6

Posttraumatic Stress Disorder tx

1st line: CBT

2nd line: SSRI/SNRI

Refractory → atypical APS

Prazoin for sleep disruption or nightmares

7

Obsessive-Complusive Disorder tx

1st line: CBT using exposure and response prevention and/or SSRI (may need HIGH doses!)

Augment nonresponders with an antipsychotic or TCA

Deep brain stimulation for refractory cases is showing promising results

8

Phobias tx

Pharmacologic tx of specific phobias is not effective

Systemic desensitization ± benzos during session

Supportive psychotherapy

Paroxetine effective for social anxiety disorder

β-blockers for performance anxiety

9

ADHD tx

1st line: methylphenidate, dexmethylphenidate, and amphetamine/ dextroamphetamine

Atomoxetine for ADD

Antidepressants, including bupropion, venlafaxine, clonidine, and imipramine, can be used as adjuncts

10

Autism spectrum presentation

Markedly impaired eye contact (red flag: lack of joint attention)

Failure to develop peer relationships

Not seeking to share enjoyment or interests (red flag: doesn’t look up for approval by 2-3 years)

Lack of social or emotional reciprocity

Delayed or absent spoken language w/o attempt to compensate with gestures or mime (red flags: no words by 18 mo, no strings of words by 2 years)

Repetitive language

Inability to initiate and sustain conversation

Lack of spontaneous make-believe play appropriate for developmental level

Repetitive motor mannerisms (rocking, spinning)

Preoccupation w/ parts of objects, strong fixations to objects or restricted interests (“little professor”)

Inflexible adherence to rigid routines

May also exhibit sensory seeking or avoidant behavior

Tantrums set off by noise or changes in routine

Comorbid mental retardation or seizure disorder

11

Autism Spectrum test

MCHAT

12

Autism Spectrum tx

Goals are to maximize fn, move child towards independence, and improve quality of life

Applied behavioral analysis is the best tested method of autism treatment

Language therapy: focuses on pictures and visual communication

Social skills groups

Occupational therapy to aid stimuli sensitivity

Gluten and casein-free diet

Consider meds to target specific symptoms: methylphenidate for inattention or hyperactivity, risperidone for aggression and self-injury, fluoxetine for repetitive behaviors or anxiety or depression, atypical antipsychotic or SSR for dysregulated mood, melatonin for sleep disturbance

13

Conduct Disorder

Persistent pattern of behaviors that deviate sharply from norms and violate rights of others Serious violations of laws, aggressive/cruel to animals, deceitful ness, destruction of property

14

Oppositional DefiantDisorder

Persistent pattern of negative, hostile and defiant behavior towards adults At least 6 mo of angry/irritable mood, argumentative/defiant behavior, vindictiveness

15

Oppositional DefiantDisorder tx

Psychotherapy, behavioral therapy

16

Anorexia Nervosa tx

Inpatient if <20 below ideal bw Family therapy Once weight restored: atypical APS, TCA, SSRI, Li, anxiolytics before eating

17

Bulimia Nervosa tx

Psychotherapy,SSRIs or TCAs

18

Binge-Eating Disorder tx

Psyhotherapy, strict diet and exercise program Pharm to support weight loss: stimulants, orlistat or sibutramine

19

MDD

At least 5 depressive sx for at least 2 wks

20

Bipolar I

At least 1 manic episode (has to be at least 1 wk)

21

Bipolar II

Mania sx lasting for 4 days without impairment in social or occupational fn

22

Cylothymic Disorder

"numerous periods with depressive sx and hypomanic sx that do not meet full criteria lasting for 2 years cannot be without sx for >2 mo"

23

Persistent Depressive Disorder (Dysthymia)

depressed mood with 2 depressive sx lasting for 2 years and never a period >2 months without sx

24

Conduct Disorder tx

Behavior modification, family and community involvement Parent Management Training medications to target comorbid sx and aggression (SSRI,, guanfacine, propranolol, mood stabilizers, APS)

25

MDD tx

Refer to psych Psychotherapy + pharm Exercise SSRI, SNRI, bupropion, TCAs, MAOI for at least 4-9 mo if 1st ep

26

Bipolar tx

mood stabilizers- lithium (dec suicide risk), carbamazepine, valproic acid Atypical APS Antidepressants w/ mood stabilizers for depression ECT for manic episodes

27

Signs of Child abuse and neglect

Femoral or skull fx, clavicle, rib fx in infant Subdural hematoma or retinal hemorrhage- shaken baby Burns that would be hard to get independently such as dunk burns on feet, ankles, butt only, or circular cigarette burns Any STD in child EVER Not crying in presence of care-giver, running from caregiver, receiving comfort from HCP and not caregiver

28

RF for Child abuse and neglect

RF of child: intellectual or cognitive disability, premature birth RF of abuser: those who were abused, single or young parent, low SES, non-biological caregiver