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Flashcards in psych packet 2 Deck (14)
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1
Q

Anorexia Nervosa

TREATMENT
*** 3 BASIC TX GOALS FOR ED PTS:
1) Restore a normal _______ state in pts with anorexia this means restoring weight within a normal range
2) Modify patients disturbed eating behaviors this will get pt maintain _____ within a normal range and reverse or lessen abnormal eating behaviors
3) Help change the patients erraneous beliefs about ____, weight loss, and body shape/size
- Use a multidisciplinary team approach
o May need acute medical intervention to correct fluid and electrolyte disorders, cardiac problems, and organ failure
- _________ = primary therapy used in INPATIENT centers
o Weight restoration = central goal
o Patients are encouraged to eat a greater amount of calories to earn specific _______ (activities, family visits, etc.)
 Goal directed, positive reinforcement
o During behavioral therapy, patients also have individual and family therapy (to work on agreement and cooperation on their goals) and group psychotherapy
 _______ psychotherapy: focus on education about the illness & later on in therapy it is used to help the patient resolve problems and conflicts that contributed to or reinforced abnormal eating behavior
• What triggered this? How did it get to the point where you viewed your body image like this?
 Can do family or couples therapy
o Usually done in outpatient clinics
o Some pts can benefit from additional supervision and support from in-day treatments (partial hospital – they go for the day then come home)
o Serious disorders will need to be in-patient:
 Severe starvation and weight loss
 Hypotension or hypothermia
 Electrolyte imbalances
 Suicidal ideations or psychosis
 Failure of outpatient treatment
- INCREASING WEIGHT:
o Reintroducing foods at modest caloric levels (1500-1800 kcal/d)
 Gradually increase by 400 kcal every 2-3 days
 Goal is to achieve weight gain rate of 1-2 kg per week (take in generally 3,500-4000 kcal/d)
o Monitor patients after feeding (to prevent purging)
o Can use stool softeners or bulk laxatives to alleviate severe constipation
o Possible need for tube feedings (if they cant eat)
o Vitamins are also given (since they are lacking)
o Monitor serum electrolytes and liver enzymes
o ECG to assess palpitations with hypokalemia
- ADJUNCTS to behavioral therapy:
o _____
o 2nd gen antipsychotics: OLANZAPINE showed that anorexia pts gained more weight than those taking placebo (can stimulate appetite but it has no effect on cognitive distortions / body image)
- For maintenance à cognitive behavioral therapy and psychotherapy are helpful, often for > 1 yr

A

nutritive
weight
food

behavioral therapy
privileges
individual
SSRI’s

2
Q

Bulimia Nervosa

  • Sometimes inpatient is necessary, but generally outpatient tx is adequate
    o Day treatments often used
  • Most effective = high intensity tx 40 hours per week
    o __________ and individual psychotherapy are also effective
    o ______ is very effective
    o No nutritional rehab is needed because patients are of normal weight
    o Overeaters anonymous (OA) is helpful
    o Antidepressants of every class are effective
     ____ 60 mg FDA approved à works best with cognitive behavioral therapy
     TCA & MOA can ↓ binge and purge cycles but are not considered first line
     AVOID ______ (Wellbutrin) potential for seizures
    o Try other drug therapies when accompanied by psychosis, MDD, bipolar disorder, or an anxiety disorder (to treat psych disorder AND bulimia)
A

CBT
group therapy
prozac
bupropion

3
Q

binge eating disorder

TREATMENT

  • Lisdexamphetamine (______ ) as a stimulant is FDA approved to treat binge-eating disorder
  • ________ and interpersonal psychotherapy
A

VYVANSE

CBT

4
Q

PICA

TREATMENT = consists of ________

A

behavior modification

5
Q

rumination disorder

TREATMENT

  • ____________
  • Habit reversal using special _____ techniques (diaphragmatic breathing) to compete with the urge to regurgitate
A

behavioral modification

breathing

6
Q

avoident/restrictive food intake disorder

  • Behavioral management programs are recommended: ___ and family-based approaches have been recommended
A

CBT

7
Q

panic disorders

TREATMENT:
- _____ therapy that tries to change very negative thoughts that accompany panic attacks are an effective tx for panic disorder
o Teach pt. that panic is unpleasant but not dangerous, and it will end soon
- BEHAVIORAL THERAPY:
o Use exposure therapy
o Instruct pt to stop hyperventilation, and use diaphragmatic breathing
o Visualization
o Systematic desensitization
- DRUG THERAPY:

o Substantially reduce frequency and severity of panic attacks or prevent them:
o The primary medications used today for panic disorder are several types of antidepressants, including ______ , and the _____(sometimes in combination with these SSRIs)
 Often start benzodiazepines because they work immediately, then load SSRIs
 ________: work immediately (short acting)
• Work by potentiating effects of gamma-aminobutyric acid (GABA) a major inhibitory neurotransmitter
• Drugs in the class all work similarly but differ in duration of action
• Side effects: include ______, potential for drug abuse and addiction
• Use with caution in patients with a history of substance abuse
• Rapid discontinuation can lead to ____ effects
• Low toxicity in overdose situation (but can cause respiratory depression)
• Risk of falls, especially in elderly patients
• Can be dosed PRN anxiety symptoms
àLong Acting (1/2 life >20 hours):
 ______ (Valium) – effective for muscle spasms (also used for musculoskeletal disorders)
 Clonazepam (Klonopin)
àIntermediate Acting (1/2 life 6-20 hours):
 Aprazolam (_______) – causes euphoria, high abuse potential
 Lorazepam (Ativan) – seizure treatment, alcohol detox
 Oxazepam (Serax)- used in alcohol detox
 Temazepam (Restoril) – primary indication was for insomnia
àShort acting (1/2 life < 6 hours):
 Triazolam (Halcion) – insomnia
 Midazolam (Versed) – very short ½ life. Mainly used in surgical settings (pre-surgery)
- ADJUNCTIVE THERAPY:
o The serotonin-norepinephrine reuptake inhibitor (SSNR) = venlafaxine (Effexor) has also been shown to help control panic attacks
o _____ (BuSpar) – non-BDZ anxiolytic: slower onset of action than BDZ (takes 1-2 weeks to take effect)
 Need to dose daily
 ___ addiction potential
o Hydroxyzine (Atarax) – antihistamine: short-acting PRN med for anxiety
 Causes sedation (like Bendadryl), dry mouth, constipation, urinary retention
o Beta-blocker (Propranolol) – treats the autonomic effects of panic attack (palpitations, sweating, tachycardia)
àwith all antipanic drugs, start low and go slow until effective dosage is achieved
o Relapse is common when the drug is discontinued
o Long term use is safe
o Most efficacious = medication plus cognitive-behavior therapy

A
cognitive
SSRI's, benzos
 benzodiazepines
sedation
rebound
diazepam
xanax
buspirone
low
8
Q

agoraphobia

TREATMENT

  • When panic is present —> ___ tx is often employed
  • Absence of panic –> exposure therapy alone is okay
  • Can’t desensitize —> ______ does not generalize to an undrugged state
A

drug
exposure
anxiolytics

9
Q

social phobias

TREATMENT:
- Most people deal with problem by avoiding the feared stimulus
o Not always possible
o Familial or possible dopaminergic pathways play a role in social anxiety

  • Can use a combo ___ and ____ or Venlafexine XL (approved by FDA)
    o MAOIs , Benzos, Beta blockers
    o CBT: systematic desensitization
A

CBT, SSRIs

10
Q

GAD

TREATMENT

  • __________ Clonazepam or Diazepam): return of symptoms when drugs discontinued
  • _______ (Buspar): non-addictive, takes weeks to be effective
  • TCAs used less these days
  • _____
  • Behavioral or psychotherapy
A

BENZODIAZEPINES

BUSPIRONE

11
Q

OCD

TREATMENT
- _______ : 60-80% reduction in symptoms for 75% patients who comply with tx
- Drug therapy:
o Antidepressants: ____ = clomipramine (Anafranil)
o _____ first line: ______ (Prozac), fluvoxamine (Luvox), sertraline (Zoloft)
o Anxiolytics: limited role
o Antipsychotics: unlikely to be beneficial, except with recurrent tics

A

CBT
TCAs
SSRI’s
fluoxetine

12
Q

PTSD

TREATMENT
- Symptoms of mood and anxiety disorders, impulsivity, and substance abuse are often found together
- _____ help with re-experiencing, avoidance and numbing, hyperarousal
o Also help with depression, impulsivity, obsessive thinking, substance abuse and suicidal ideation
o FDA approved SSRI’s: sertraline (____), paroxetine (Paxil)
 Use these although other SSRIs likely are effective
 They ↓ depressive symptoms & ↓ intrusive symptoms such as nightmares and flashbacks and normalize sleep
o _______ (antidepressant): appears effective
o _____: reduce anxiety à short term use (habit forming)
- ____ help reexperiencing and sleep disturbance
o Prazosin = alpha-receptor antagonist targets nightmares and hypervigilance
- ___: use for reexperiencing
- Establishing a sense of safety and separation from trauma is an important first step in treating PTSD
o ______ : preferred treatment modality - effective in reducing PTSD symptoms by providing patients skills to control anxiety and counter dysfunctional thoughts
 Patients often engage in avoidance behavior: miss appts, cognitively disconnect, use substances, etc.
o Group and family therapy
o Eye movement desensitization and reprocessing (EMDR) therapy, but research suggests that its efficacy is driven by its exposure component, not eye movements

A
SSRI's
ZOLOFT
venlafaxine
benzos
MAOI
TCA's
CBT
13
Q

Acute Stress Disorder

TREATMENT

  • ____ involving exposure and anxiety management (e.g., relaxation training, re-breathing) has been shown to help prevent the progression to full-blown PTSD
  • Anxiety is severe, short course of a ____-
  • ____ immediately after the trauma my reduce the later development of symptoms of PTSD
A

CBT
benzo
beta blockers

14
Q

Adjustment Disorders

TREATMENT
- _____ (supportive, group) = mainstay of treatment
o _____ psychotherapy: help patient adapt to the stressor when it is ongoing or to better understand the stressor once it has passed
o Group psychotherapy: supportive atmosphere for persons who have experienced similar stressors
- Use pharmacotherapy to target additional symptoms (depression, anxiety, insomnia)
o Medications to target the patient symptoms: ____ for sleep, ____ for anxiety
o If condition persists à reconsider the diagnosis.
 IE: adjustment disorder with depressed mood might develop into a major depressive disorder that would respond to antidepressant medication

A

therapy
supportive
hypnotic
benzo