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CMN 568 Unit 5 > Psych Disorders > Flashcards

Psych Disorders Flashcards

(96 cards)

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1
Q

Adjustment Disorder

A
  • Occurring within 3 months of an identifiable stressor
  • Inability to concentrate
  • Sleep disturbances
  • Often self-medicated with ETOH, CNS depressants
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2
Q

Adjustment Disorder Medication

A
  • Lorazepam (up to 3x/day PO) for a LIMITED TIME

- Short-term SSRI

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3
Q

Generalized Anxiety Disorder (GAD)

A
  • Chronic Disorder
  • Persistent anxiety/fear
  • Symptoms present more days than not over a 6 month period
  • Triggered by a number of everyday activities
  • Often self-medicated with ETOH
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4
Q

GAD Medications

A

1st line

  • SNRIs (venlafaxine, duloxetine)
  • SSRIs (escitalopram, paroxetine)
  • PRN Benzodiazepines (lorazepam, diazepam, clorazepate, triazolam, flurazepam) HIGH RISK FOR DEPENDENCE

SNRI/SSRI medications may have 2-4 week delay before taking effect. EDUCATE PATIENTS ON THIS!

2nd/3rd line
- TCAs/MAOIs

Others

  • Aminoketones (bupropion)
  • Anticonvulsants (gabapentin)
  • Beta-blockers (propranolol)
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5
Q

Panic Disorder

A
  • Panic attacks that includes chronic fear with changing behavior to avoid triggers of the attack
  • Agoraphobia may be present
  • Increased risk for major depression and suicide attempts
  • Often associated with ETOH abuse and/or dependence on sedatives
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6
Q

Panic Disorder Medications

A

1st line

  • SNRI (venlafaxine)
  • SSRIs (fluoxetine, paroxetine, sertraline)

SNRI/SSRI medications may have 2-4 week delay before taking effect. EDUCATE PATIENTS ON THIS!

Others

  • Benzodiazepines (lorazepam, midazolam)
  • Beta-blockers (propranolol)
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7
Q

Phobia Disorder

A
  • Chronic fear of a specific object or situation (spiders, heights, etc.) that are out of proportion to the actual danger posed
  • Includes social phobia and agoraphobia

Treatment
- CBT

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8
Q

Phobia Disorder Medications

A

1st line

  • SNRI (venlafaxine)
  • SSRIs (paroxetine, sertraline, fluvoxamine)
  • Anticonvulsants (gabapentin)
  • Beta-blockers (propranolol)
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9
Q

Obsessive-Compulsive Disorder (OCD)

A
  • Ritualistic/repetitive behaviors that are distressing to the patient
  • Often co-morbidity with major depression
  • Affects young, divorced, separated, or unemployed
  • Treat with
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10
Q

Obsessive-Compulsive Disorder (OCD) Medications

A

Medications

  • SSRIs and clomipramine (can take up to 12 weeks to take effect)
  • May need to add antipsychotics and topiramate in resistant cases
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11
Q

Obsessive-Compulsive Disorder (OCD) Treatment

A
  • CBT - patient learns to identify maladaptive cognitions associated with obsessive thoughts and challenge those cognitions
  • Thought-stopping when OCD thought begins
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12
Q

OCD Treatment - Clomipramine concerns

A
  • Check plasma levels/metabolites every 2-3 weeks to keep level <500 ng/mL (above 500 leads to toxicity)
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13
Q

Conversion Disorder

A
  • Psychic conflict converts into physical symptoms

- Usually occurs alongside panic disorder or depression

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14
Q

Treatments for Somatic Symptom Disorders

A
  • Behavioral
    • working on recognizing symptoms, providing biofeedback
  • Social
    • Family member involvement
    • Peer support groups
  • Medical
    • Provider must accept that the patient’s distress is real
    • Maintain empathetic, realistic, optimistic approach
  • Psychological
    • Group therapy
    • Possible psych referral if other treatment does not show changes
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15
Q

Chronic Pain (Psych) Disorders

A
  • Symptoms frequently exceed physiological signs
  • Minimal relief with standard pain tx
  • Hx of “doctor shopping” or ED “frequent flier”
  • Frequent use of several nonspecific medications
  • It is counterproductive for FNP to speculate about whether or not pain is “real”
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16
Q

Chronic Pain (Psych) Disorder

A
  • All relationships suffer
  • Combination of behavioral, medical, social, and psychological treatment
  • Referrals should not be allowed, care to remain in PCP hands
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17
Q

Clinical findings of Chronic Pain (Psych) Disorder

A
  • Chronic anxiety/depression and/or anger
  • Lifestyle changes
  • If chronic pain is managed incorrectly it can turn into a never-ending cycle
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18
Q

Chronic Pain (Psych) Disorder Medications

A

Use for neuropathic pain syndromes:

  • SNRIs (venlafaxine, milnacipran, duloxetine)
  • TCAs (nortriptyline)
  • Anticonvulsants (gabapentin, pregabalin)
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19
Q

Psychosexual Disorders

A
  • Paraphilias (formerly called deviations or variations) - Sexual excitement from woman’s shoe, a child, animals, torture instruments, etc.
  • Sexual Dysfunctions in men
    • ED
    • Ejaculation Disturbances
  • Sexual Dysfunctions in women
    • Orgasmic disorder - lack of sexual responsiveness
    • Hyposexual desire disorder - diminished libido
  • Gender Dysphoria - strong desire to be a different gender than assigned at birth
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20
Q

Paraphilia Treatment

A
  • Psychotherapy
  • Social - group therapy
  • Pharmacologic
    • Medroxyprogesterone acetate (MOA)
      • suppresses sex drive within 3 weeks of administration
    • SSRI (fluoxetine)
      • reduces some compulsive sexual behaviors
    • LHRH agonist
      • prevents relapse
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21
Q

ED treatment

A

Phosphodiesterase Type 5 Inhibitors
- Sildenafil, Tadalafil, Vardenafil

DO NOT USE WITH NITRATES - Risk of significant Hypotension can cause death

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22
Q

Ejaculation Disturbance treatment

A
  • SSRIs are effective for premature ejaculation
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23
Q

Gender Dysphoria treatment

A
  • Psychotherapy
  • Peer support groups
  • Hormone therapy 1 year prior to gender reassignment surgery
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24
Q

Mood Disorders

A
  • Depression

- Mania

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25
Depression s/s
- Mood varies - Feelings of guilt, hopelessness, worthlessness - Loss of interest in normally enjoyable activities - Somatic complaints
26
Severe Depression s/s
- Psychomotor retardation - Anorexia - Insomnia - Reduced Sex drive - Suicidal Ideation
27
Mania s/s
- Mood ranging from euphoria to irritability - Sleep disruption - Hyperactivity - Racing thoughts - Grandiosity - Psychotic symptoms
28
Mood Disorder considerations
- Genetic factors (neurotransmitter dysfunction) - Developmental problems (childhood events, personality problems) - Psychosocial stresses (divorce, unemployment) - MUST RULE OUT: thyroid dysfunctions, malignancies, strokes, and medication-induced depression
29
Depressive Disorders
- Major depressive disorder - Dysthymia - Premenstrual Dysphoric Disorder - Bipolar Disorder
30
Major Depressive Disorder (MDD) S/S
- Occurs at any time of life - Loss of interest and pleasure (anhedonia) - Feelings of guilt - Withdrawal from activities - Inability to concentrate - Chronic fatigue - Somatic complaints - Loss of sexual drive - Anorexia with weight loss
31
Dysthymia S/S
- Symptoms over a period of 2 years or more with relatively persistent course is necessary for diagnosis - Symptoms are more mild, but longer lasting
32
Premenstrual Dysphoric Disorder
- Depressive symptoms during the late luteal phase (last 2 weeks) of menstrual cycle
33
Bipolar Disorder
- Mood shifts from mania, major depression, hypomania, and mixed mood states - Initial diagnosis difficult due to disorder mimicking other mental disorders and high likelihood of substance abuse with bipolar disorder
34
Types of Bipolar Disorder
- Bipolar I | - Bipolar II
35
Bipolar I Disorder
Individual has manic episodes
36
Bipolar II Disorder
Individuals who experience hypomanic episodes without frank mania
37
Complications of MDD
- MOST IMPORTANT COMPLICATION IS SUICIDE
38
Suicide Factors
- Men over age 50 are more likely to complete a suicide - Women make more attempts, but are less likely to complete - Ages 15-35 years old increases rate each year - ETOH use significant factor in many suicide attempts
39
Red Flags for Suicide
- Depressed patient may make dramatic improvement - Ask about plans, means, and what is stopping them from going through with plan - Risk factors (ETOH, family history, depression, male, older age, drug use)
40
After Suicide Attempt
- Measure patient's mood using Hamilton OR Montgomery-Asberg rating scale OR PHQ-9 - Often hospitalization is indicated - Use Columbian-Suicide Severity Risk Scale
41
MDD Treatment
- SSRIs, SNRIs, and bupropion, vilazodone, vortioxetine, and mirtazapine - TCAs - MAOI inhibitors - Stimulants - ECT - Inpatient hospitalization
42
SSRI for cardiac patients
Sertraline is medication of choice for cardiac patients
43
Risk of Serotonin syndrome
- Occurs when SSRIs are used in high doses alone or in combination with MAOI inhibitors
44
Symptoms of Serotonin syndrome
- Rigidity - Hyperthermia - Autonomic Instability - Myoclonus - Confusion - Delirium - Coma
45
SSRI Bleeding risk
Sertraline and Citalopram are drug of choice when taking warfarin
46
SSRI Indication | fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram
Use for treatment of: - Panic disorder - bulimia - GAD - OCD - PTSD
47
SNRI Indication | venlafaxine, desvenlafaxine, duloxetine, milnacipran, levomilnacipran
Use for treatment of: - Neuropathy - Fibromyalgia - Stress Incontinence
48
Atypical Antidepressant side effects | bupropion, nefazodone, trazodone, vilazodone, vortioxetine, mirtazapine
- QT prolongation - ventricular tachycardia - elevated cyclosporine levels - potential risk for liver failure - Watch for possible agranulocytosis or neutropenia
49
TCAs and similar meds
- Overuse of TCAs = serious medical emergency (quinidine-like effects) leading to intubation and ICU admission
50
TCAs and cardiac patients
DO NOT USE TCAs IN CARDIAC PATIENTS - Use SSRI or Atypical antidepressants - TCAs can cause altered HR, rhythm, and contractility - EKG changes can occur
51
"Washout time" when changing meds
- No need for washout if medication is in the same class
52
Combining several antidepressants OR Adding antipsychotic to antidepressant
Requires extreme caution, and often a psych consult
53
Combining several antidepressants OR Adding antipsychotic to antidepressant
- If combination is successful in symptom relief, continue therapy for 12 months
54
Stimulants used for depression
- Dextroamphetamine and methylphenidate can be used for short-term treatment of depression in medically ill and geriatric patients - Benefit of rapid onset (within hours)
55
ECT
- Most effective to treat severe depression - Helps control delusions - SE include memory disturbance and headache
56
Medication for Acute Mania
- Initial therapy includes: olanzapine, risperidone, aripiprazole + benzodiazepine (if indicated) - Maintenance using: olanzapine, quetiapine, ziprasidone, aripiprazole, long-acting IM risperidone
57
Medication for Mania
Valproic Acid
58
Medication for Mania Valproic Acid Side Effects
- GI symptoms - Weight gain - Teratogenic Effects - MUST RULE OUT PREGNANCY
59
Medication for Mania Valproic Acid Monitor Lab Studies
- LFTs - CBC - Glucose Levels - Weight (monitored at 2 wks, 4 wks, 3 months, and annually)
60
Medication for Bipolar
- Lithium is #1 choice for maintenance - Carbamazepine or Oxcarbazepine (for patients who cannot be treated with Lithium
61
Medication for Bipolar Carbamazepine or Oxcarbazepine Side Effects
- Skin rashes - Mild drop in WBC - Sedation - Teratogenic Effects - MUST RULE OUT PREGNANCY
62
Lamotrigine
- Used for maintenance of Bipolar - Cannot combine with Valproic acid (decreased metabolism = doubles half-life of med = TOXICITY) - Lamotrigine can cause Steven-Johnson Syndrome (rash + fever = STOP MEDICATION AND SEND TO ED)
63
Best medication for maintenance of Bipolar and Manic Episodes
Lithium
64
Lithium dosing
- 2-3x daily - Trough levels checked 5 days after first dose, but 12 hours after last dose - 1-1.5 mEq/L is therapeutic (some providers use 0.6-1 mEq/L to reduce SE) - Monitor lithium levels every 1-2 months initially, then every 6-12 months in long-term, stable patients
65
Lithium treatment
- Complete full workup BEFORE initiation of treatment | - Check CBC, T4, TSH, BUN, Serum Creatinine, Electrolytes, UA, and EKG for patients >45 years w/hx of cardiac
66
Lithium SE: GI
- Mild GI (take with food)
67
Lithium SE: CNS
- fine tremors - slight muscle weakness - somnolence
68
Lithium SE: Renal
- moderate polyuria - polydipsia - administer K+ to help with this - weight gain - leukocytosis
69
Lithium SE: Thyroid
- goiter | - hypothyroidism
70
Lithium SE: Cardiac
- EKG changes - T wave flattening or inversion | - SA block in elderly
71
Lithium SE: Respiratory
- Impairs ventilatory function in patients with airway obstruction
72
Lithium SE: Skin
- May precipitate or exacerbate psoriasis | - Acne
73
Lithium SE: Toxicity
- Greater than 2 mEq/L is toxicity - Can be caused by Na+ loss (diarrhea, diuretics, excessive sweating) - Dialysis for overdose of Lithium
74
Lithium SE: S/S of Toxicity
- S/S: Diarrhea, vomiting, tremors, marked weakness, confusion, dysarthria, vertigo, choreoathetosis, ataxia, hyperreflexia, rigidity, poor coordination, myoclonus, seizures, opisthotonos, and coma
75
Autism Spectrum Disorder (ASD)
- Neurodevelopmental disorder that causes pervasive difficulties with social communication and have repetitive, restricted interests and behaviors
76
NICE guidelines to assess for ASD
Ask about: - Core ASD difficulties - Early development - Medical and Family Hx - Behavior - Education - Employment
77
Treatment for ASD
No treatment for the core symptoms of ASD have been validated
78
2 Stages of sleep
- REM (sleep dream sleep, D state sleep, | - NREM
79
REM Sleep
- 1st REM cycle starts about 80-120 mins after initiation of sleep and lasts about 10 minutes - Later REM occurs for 15-40 mins within the last several hours of sleeping - 4-5 REM cycles happen during sleep each night (approx 1.5-2 hrs each)
80
Insomnia Common Factors
- Psychiatric disorders often associated with insomnia - Depression - Mania (shortened REM)
81
Hypersomnia
- Obstructive sleep apnea most common | - Narcolepsy Hypocretin Deficiency Syndrome
82
Sleep Disturbance Causes
- ETOH abuse - Heavy Smoking - Caffeine, Cocaine, Other stimulants
83
Medications for sleep
- Benzos - Antidepressants - Research shows that CBT is as effective as Ambien after 1 year
84
Narcolepsy Treatment
- Dextroamphetamine sulfate - given once PO daily in AM - Modafinil and armodafinil - IV treatment for excessive narcolepsy - Imipramine - tx of cataplexy (Cataplexy is a sudden, brief loss of voluntary muscle tone triggered by strong emotions such as laughter) but NOT narcolepsy
85
Alcohol Abuse
AUDIT tool
86
ETOH Withdrawals | CIWA-Ar Scores
<8 = Minimal withdrawals 8-15 = Mild withdrawals 16-20 = Moderate withdrawals >21 = Severe withdrawals Max score 67
87
CIWA-Ar Score <8
- Benzos (lorazepam or chlordiazepoxide) - Check score Q6 hours - Assess sedation 30-60 mins after administering benzo
88
CIWA-Ar Score 8-15
- Check score Q4 hours - Adjust dose of meds as needed to control withdrawal symptoms - Additional doses should be given if score remains 8-15
89
CIWA-Ar Score 16-20
- Check score Q2 hours - Give chlordiazepoxide 100mg PO or Lorazapem 3-4mg QH for first 2 hours - Then chlordiazepoxide 50mg or Lorazapam 1-2mg Q2H - Max dose of chlordiazepoxide is 600mg in 24 hours - Monitor 30-60 min after each dose is given for sedation
90
CIWA-Ar Score >21
- Check score every 30 mins - IV Lorazepam (1-2mg Q15min) - If pt needs more than 8mg/hour then consider Dexmedetomidine (sedation without respiratory depression) - Then propofol if withdrawal continues
91
Opioid Dependencies
- Graded 0-4
92
Opioid Dependencies | Grade 0
- Craving | - Anxiety
93
Opioid Dependencies | Grade 1
- Yawning - Lacrimation - Rhinorrhea - Perspiration
94
Opioid Dependencies | Grade 2
- Previous symptoms plus - Myadriasis (pupil dilation) - Piloerection (goosebumps) - Anorexia - Tremors - Hot/cold flashes - Generalized aching
95
Opioid Dependencies | Grade 3 and 4
- Increased intensity of previous symptoms...plus: - Increased temp - Raised B/P, pulse, RR, and depth - Possible vomiting, diarrhea, weight loss, spontaneous ejaculation
96
Opioid Dependency Treatment
- Clonidine multiple times daily (alleviates CV symptoms) - Naltrexone used to treat patient when they have been opioid free for 7-10 days - Suboxone (buprenorphine)

CMN 568 Unit 5 (5 decks)

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