Psychiatric Disorders Flashcards
(53 cards)
1
Q
depression is more common in:
A
elderly, teenagers and chronic pain patients
2
Q
major depression is a serious:
A
potentially life threatening situation
3
Q
what are the diagnostic criteria for major depression
A
- at least one of the symtpoms is either
- low mood
- anedonia (no longer enjoys pleasureable activities)
- 5 or more of the following symptoms for more than 2 weeks:
- low energy
- sleep changes: daily insomnia or hypersomnia
- significant weight loss/decreased apetite
- suicidal thoughts
- pscyhomotor agitation/retardation
- poor concentration
- irritability
- feeling worthless or inappropriate guilt
4
Q
major depression =
A
5 out of 9 symptoms for longer than 2 weeks
5
Q
major depression affects:
A
social function
6
Q
what is the physiology of major depression
A
- locus ceruleus- produces NE
- raphe nucleus - produces serotonin
- left frontal cortex and brainstem
- brain is either firing too fast or too slow in releasing NE and serotonin
7
Q
what is the physiology of depression vs anxiety
A
- depression: less serotonin, more postsynaptic receptors, firing rates of neurons are faster because they have a hypersensitive neurosynaptic junction. causes upregulation
- anxiety- firing rates of neurons are too slow
8
Q
_______ of people with depression have anxiety
A
100%
9
Q
depression is more common in individuals who as children experiences:
A
- abuse
- shyness
- high rejection sensitivity
- eagerness to please
- introverts
10
Q
people in alpha personality positions have increased:
A
serotonin
11
Q
describe SSRIs
A
- prozac and paxil
- inhibit reuptake of serotonin at nerve junction
- initially this increases firing rate for 2-3 weeks
12
Q
_____ of people feel worse with SSRIs
A
30%
13
Q
SSRIs take _____ to work to down regulate neurons
A
4 weeks
14
Q
SSRIs reduce:
A
rejection sensitivity
15
Q
what are the depression symptoms
A
- ask patient how long they have been feeling down, if they have problems with sleep and apetite
- early morning dysphoria
16
Q
what is early morning dysphoria
A
waking up in the morning feeling down regularly. this is the worst and pathognomonic symptom
17
Q
grieving individuals usually have their worst symptom in:
A
the evening
18
Q
the most sensitive symptom is:
A
mild depression
19
Q
what is the main symptom of depression
A
irritability
20
Q
mild depression begins to act like:
A
a chronic stressor
21
Q
cortisol affects:
A
NMDA receptor -> neuronal firing -> kills brain cells in amygdala and hippocampus
22
Q
depression symptoms cause decreased _______ if patient does not get immediate treatment
A
brain mass
23
Q
what happens to platelets
A
they spike causing clotting over time
24
Q
what happens to BP in depression
A
increased which destroys lining of blood vessels and cause plaques
25
what happens to immune system with depression
spikes initially then decreases
26
what are the 5 killers
- bacteria
- viral
- fungus
- cancer
- parasites
- depression is a major killer of immune system
27
describe psychotherapy as treatment for depression
- lifestyle changes- 5-10% compliance
- regular sleep - REM sleep replenishes NE, dopamine, replenishes mood, preserves NT
- regular exercise
- sun in the morning
28
what are the meds for depression
- SSRIs: Prozac, lexapro, zoloft, paxil, luvox
- SNRIs: effexor, cymbalta- work better in severe depression
29
what is ECT in depression
- electroconvulsive therapy
- helps in meds fail
- releases NT
- down regulates post synaptic neurons
30
generalized anxiety disorder is diagnosed when:
a person has persistent and excessive anxiety or worry for 6 months or more
31
generalized anxiety disorder is at least 3 of the following symptoms:
- restlessness
- fatigue
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbanc
32
_______ of the orofacial pain population may be experiencing generalized anxiety disorder
10-3%
33
describe panic disorder
- affects 3% of the population
- ages 20s-30s
- worsens with age
- environmental stress may precipitate it
- brain: locus ceruleus fires spontaneously
- 15% suicide among panic disorder patients
- post anxiety spells last days
34
what are the diagnostic critera for panic disorder
- recurrent unexpected panic attacks
- at least 1 attack has been followed by 1 month or more of 1 or more of the following:
- persistent concerns about having additional attacks
- worry about the implications of the attack or its consequences
- panic attacks are not due to substances or a medical condition
- may or may not have associated agoraphobia
35
when caffeine consumption climbs to 250-700mg per day people may experience:
restlessness, anxiety, sleep disturbances and digestive issues
36
what is caffiene toxicity
- nausea, headaches, sleep difficulties or increased anxiety
- heart palpitations, arrhythmias, seizures with more than 1000mg
- can be dangerous in adolescents even requiring hospitalization
37
what are the diagnostic critera for a panic attack
- a discrete period of intense fear or discomfort with 4 or more symptoms developing abruptly and peaking within 10 mins
- palpitations, pounding heart, accelerated heart rate
- sweating
- trembling or shaking
- sensations of shortness of breath or smothering
- feeling of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy or faint
- derealization or depersonalization
- fear of losing control or going crazy
- fear of dying
- paresthesias
- chills or hot flashes
38
what is the psychotherapy for panic disorder
- avoid stimulants - caffeine and theophylline
- regular exercisew
39
what are the meds for panic disorder
- SSRIs
- treat aggressively with SSRIs
- worsens panic for 2 weeks
- benzos
40
what are the dental care considerations for patients with anxiety
- treat xerostomia with saliva substitutes
- help the patient feel in control
- keep dental appointments short because dental phobia is the #1 fear
- watch and be aware of symptoms of panic attack during appointment
- may prescribe benzos prior to appointment if patient has a driver
41
what is agoraphobia
- fear of being alone in a crowded space
- person becomes clingy and dependent pushing family members away
- spouse feels smothered
42
what are the diagnostic criteria for agoraphobia
- anxiety about being in places or situations from which escape might be diffiuclt or in which help may not be available if panic attack occurs. agoraphobia fears include being outside of home, being in a crowd or public contact
- the situations are avoided endured with marked distress or with a companion
- the anxiety or phobic avoidance is not better accounted for by another mental disorder
43
what are the diagnostic criteria for PTSD
- a person has been exposed to a traumatic event in which both of the following were present:
- experiences, witnessed or was confronted with events that involved actual or threatened death or serious injury, OR a threat to the physical integrity of self or others
- persons response involved intense fear, helplessness or horror
- the traumatic event is experiences in.1 or more ways:
- recurrent intrusive thoughts of event
- recurrent distressing dreams of event
- reliving the experience
- intense pyschological distress when exposed to internal/external cues that resemble the traumatic event
- physiological reactivity on exposure to cues that resemble traumatic event
- persistent avoidance of stimuli associated with the trauma and numbing of general response in 3 or more ways
- avoidance of thoughts, feelings or conversations associated with the trauma
- avoidance of activities, places or people that cause recollection of the trauma
- amnesia of important aspect of the trauma
- diminished interest or participation in significant activities
- feeling detached or estranged from others
- change in affect
- sense of foreshortened future
- persistent symptoms of increased arousal in 2 or more ways:
- difficulty falling or staying asleep
-irritability or outbursts of anger
- difficulty concentrating
- hypervigilance
- exaggerated startle response
- duration of disturbance is 1 month or more
- disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
44
what are the causes of PTSD
- physical assault
- sexual assault
- sudden death of a loved one
- transportation accident
- illness/injury
- weapon assault
- accident
- natural disaster
- terrorist attack
45
what are the treatments for PTSD
- SSRIs: sertraline and paroxetine
- SNRIs: venlafaxine
- cognitive behavior therapy with a psychologist
46
how many dentist notice signs of vomiting from eating disorders
- erosion of enamel especially on lingual surfaces of maxillary anteriors
- parotid gland induration- chipmunk fac
- halitosis
- typically not identified until 5 years after onset
47
describe anorexia
- rare
- difficult to treat
- high socioeconomic family
- 90% are female
- amenorrhea is common- 3 missed periods in a row
- onset is at puberty
- "perfect family"
48
what are the symptoms of anorexia
- baby hair on arms
- dehydration
- low protein levels
- low fat levels
- malnourished appearance
- slow mental processing
- difficult to talk to especially about weight
49
what are the diagnostic criteria for anorexia nervosa
- refusal to maintain body weight at or above minimally normal weight and hieght (less than 85% for expected age and height)
- intense fear of gaining weight or becoming fat even though underweight
- disturbance in the way ones body or weight shape is experienced or denial of the seriousness of the current low body weight
- amenorrhea
50
describe bulimeia nervosa
- starts later in life
- 40% of college students will purge at some time- not necessarily bulimic
- family life is typically chaotic or abusive
- features: look for enamel erosion on lingual surface of maxillary anterior teeth - check health history for GERD- acid reflex can also cause enamel erosion
- low potassium levels
- esophageal tears due to vomiting
- impulsive behavior
- chipmunk face due to parotid gland irritation
51
what are the diagnostic critera for bulimia nervosa
- recurrent episodes of binge eating .an episode of binge eating is characterized by both of the following:
- eating in a. discrete period of time (within any 2 hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
- a sense of lack of control over eating during the episode
- recurrent inappropriate behavrio in order to prevent weight gain such as self induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting or excessive exercise
- the binge eating and inappropriate compensatory behaviors both occur on average at least twice per week for 3 months
- self evaluation is unduly influenced by body shape and weight
- the disturbance does not occur exclusively during episodes of anorexia nervosa
52
what is the treatment for bulimia
- SSRIs
- approach the patient carefully if you suspect bulimia by inquiring about depression such as asking about low energy or poor sleep
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