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Flashcards in psychiatry Deck (54):
1

panic attack

rapid onset of severe anxiety
last

2

generalized anxiety disorder

excessive anxiety over general life events > 6 months

dx criteria: > 3
-restless or hypervigiliance
easy fatigue
irritability
sleep disturbance
mm tension
difficulty concentrating
( present with HA or fatigue)

-onset in 20s
-r/o medical disorders ( substance abuse, thyroid issues, over use of caffeine

tx: behavior therapy+meds
-ssri, snris, buspirone
-benzols as short term- for severe sxs.
-TCAS may help 2nd line.

3

PTSD

exposure to traumatic event

sx: last greater than 1 month
-develop in as little as one a week
-
3 major elements:
reliving trauma, detachment, and hyperarousal

men-combat experience
women-rape/assualt

dx:
reliaient event- memories/ flashback
-avoids places/people to remind of event
-increased arousal - sleep issues and anger
-exagerated started response

tx: 1st line SSRI ( sertaline/ paroxetine)
benzos, trazodone for insomnia

crisis counseling

4

phobias

most common mental disorder in US
-irrational fever/ persistent excess anxiety when present with object/situation
has to appear functioning

5

specific phobia
fear of specific object/

animal/ insects
natural phenomena
blood, needles,
situational


onset in childhood

tx: desensitization /exposuretherapy
-short term bentos

6

social phobia

fear of social situations in which embarrassment to humiliation may occur
Inciting events:
public speaking, using restrooms, eating in public



7

agoraphobia

anxiety about placing self in situation in which a problem may occur and help

Inciting events:
outside the home
on a buse/ train

sx: panic attack
F>M

tx; SSRI, SNRI ( effexor)
2nd line- benzos, TCA

-beta blockers can help with tremor and performance situations

-insight therapy, gradual exposure.


8

OCD

thoughts, images that are intrusive and inappropriate resulting in activity

-ego distonic- causes distres to pt

types: contamination, worry about doing things, intrusive thoughts, need for symmetry, religious, compulsive hoarding, pull out hair, counting/ repeating phrase
tx: behavioral /relaxation therapy
SSRI- higher doses

TCA
in refaratcoty cases: gabapentin, effexor, zypreza , lithium

9

attention deficit disorder

20-50 percent have dysfunctional sxs as adults

M>F , first born son

dx;
hyperactivity, impulsivity, or inactiveness before age 7

occurs> 2 settings
> 6 sxs of inattention, hyperactive, developmentally inappropriate and present for > 6 months.
sx: fights/squims, leaves seat often, restlessness, talking excessively
inattention sxs: IOWA Connors rating scale
careless mistakes , forgetful, easy distracted

tx: 1st line- Ritalin, Concerta, Daytran ( watch for weight loss and growth retardation)
-adderall
2nd line- anti depressants
behavior modification

10

autism

> 6 sxs
impaired social interaction( need 2)
- lack of eye contact by 18 months


impaired communication( need 1)
- don't progress with language ( 12-18 months)
-repetitive language

repetitive behvoir/ activities
- intense ritual
-upset by change in routine
-preoccupation with parts of objects

tx: therapy - behavior

EEG- 25% have seizure disorder

risperdole/ abilify
haldol
SSRI- help with repetitive behavior

11

anorexia nervosa

common in developed countries, ballet, 15-30, females
- self-imposed starvation
- less than 85% of expected wt for height( > 15% below norma)
-egocentonic, not distressing to patient

restrictive- eat very little, odd food-related obsessions

binge eating/purging- eat in binding--> purging

- complications:
- electrolyte abn
-hypothermia
-orthrostatic hypertension
-lanugo
- loss of tooth enamel, cavities

tx: restore nutritional state
hospitalize > 20% below expected wt

out pt-
behavoir/ family therapy
supervised wt gain

-use antidepressants but make sure weight loss not a SE
Wellbutrin CI

12

buleimia nervosa

high achievers
binge eating
- tend to maintain a normal body weight or overweight
-purging--> self-induced vomiting
-excessive exercise or fasting

ages 15-30

physical findings:
dental erosions, calluses on hands, esophagitis
electrolyte deficiencies

tx; restore nutritional state
SSRI help
Wellbutrin CI
behavoir/ family/ group therapy

13

obesity

> 20% over ideal body wt
-binge eating > 2 days/wk for 6 months
> 3
-eating rapidly, eating alone and eating until comfortable

tx: behavoir modification/ group therapy
food diaries
new eating patterns
tx underlying depression

adjuncts to suppress appetite: adiphex, didrex, xenical
gastric bass

14

adjustment disorders

emotional sxs in response to stressors:
- job loss, divorce, schoo/ financial problems, moving out of home,
resolves w/in 6 months

happens 3 months after stressors
sxs; depressed mood, teafullnes, anxiety

tx: 1st line -psychotherapy
sleep aides
bentos, hypnotics
SSR's

15

Major depressive disorder

chronic coure
happens more in females

dx: SIG E CAPS
Sleep, interest, guilt,energy, concentration, appetite, psychomotor

tx: acute- SSRI
if no response > 6 weeks- rethink dx--> increase dose

combine therapy
behavior
ECT- severe depression, not eating, pregnant

16

SAD

fall or winter onset
ofter remits in spring
more common in colder climate

tx: light therapy
SSRI
wellbutrin

17

melancholia

anhedonia
psychomotor retardation
anorexia
depressed mood
feelings of guilt
sleep disturbance

18

atypical depression

overeat
over sleeping
reactive mood
leaden paralysis
oversensitive to interpersonal rejection


tx: MAOI ( marplan/ parante)
SSRI, atypical antipsychotics may help

19

catatonic depression

pt refuse to cooperate fo no reason
echolalia- echoing of others words

tx: benos
ECT
Valproic acid, lithium

20

psychotic depressio

delusions or hallucinations

tx: benzos and anti-depressants
anti-depressants + 2nd gen antipsychotic

21

postpartum depression

onset 4 weeks of delivery

tx: sertaline- oka with breastfeeding
estrogen may help

22

drug tx

1st line- SSRI

need to continue for 6 months or more

may add effector, cymbals

2nd line- TCA/tetracyclines

3rd line- MAOI- lease likely

SE: SSRI- GI upset, HA, sexual issues
TCA/tetracycline: wt gain, orthrostatic hypotension, somnolence
MAOI- need tyramine- free diet ( no wine, beer, most theses, smoked meat)

serotonin syndrome: acute onset ( minutes),
disorientation, n/v, hypothermia, coma, death
tx: benozo, aggressive cooling, IV hydration

23

ECT for mood disorders

-unresponsive pt
-need a quick improvement
-elderly and pregnancy
-AE: memory loss, HA, nausea

24

suicide risks

prior attempt
white male
> 45 y/o
self-destructive pattern
recent sever loss
singel, separate

25

dysthymic disorder

chronic mild depression
dx: depressed mood most of day X 2 years
-need 2- SIG E CAPS

ts: SSRI
SNRI
wellubrin
TCA

26

bipolar 1 disorder

> 1 manic episodes and cycle with depression
manic - abrupt escalation of mood- days without sleeping/ self-inhibited

racing thought, flight of idea

tx: lithium, valproate, zyprexa
mania- gapatenin, lamictal

depressive: SSRI, zyprexa

family group/ cognitive therapy

27

bipolar 2

> 1 major depression > 1 hypomanic ( less severe)

tx: same as bipolar 1

28

psychotic disorders

tried psychotic
> 1 day

29

delusional disorder

non bizarre delusions for > 1 dos

behavior not obvious is odd

subtypes:
erotmatic
somatic
jealous
persecutor
grandiose
tx: antipsychotics

30

schizophrenia

chronic, depilating course
lack insight, don't think behaviors is abn

beter px if:
late onset
acute onset
onset before 15 or after 50 rare

subtype- paranoid most common
catatonic- rare

dx: > 2 in 1 mos periods and > 6 months
-delusions
-hallucinations
-disorganized speech/thought processes

sx: have to disrupt daily function

tx; hospitalize
therapy with 2nd generation anti-psychotic

behavior therapy


watch for side effects: extrapyramidal, parkinson sxs, neuroleptic syndrome, traduce dyskinesia

31

schizoaffective disorder

have major depressive, panic, or mixed responses
-hallucinations or delusions present for 2 ore more weeks without mood sxs
- better px than schizo

tx: -2nd gen anitpsychotics
- an add antidepressant/lithium/valproate
-ect for mania/depression

32

somatization disorder

-weakness, dizziness, and pain, joint pain, back pain, nausea
-onset before age 30
-have another mental disoorder

tx: monthly schedule appointment
resistant to see mental health provider
-avoid medication

33

conversion disorder

> 1 neuro complaints not explained by medical/neuro disorder

-unexpected lack of concern of sxs
-paralysis, blindness, mutism


sx: motor or sensory
-lump in throat
-deafness
-seizures

most common in teens and young adults
r/o medical causes

tx: therapy
short term anxiolytics

( ativan)

34

hypochondriasis

- preoccupation wth belief/fear of
medical investigation reveals not dx

tx: therapy and regular appt

SSR with depression and anxiety

35

Body dysmorphic disorder

- occupation with imagined defect in physical appeareance/exaggeratd distortion of minor flaw

-face, hair, skin, breasts, genitalia

tx: ssris reduce symptoms in > 50%, therapy

36

pain disorder

pain > 1 areas with no known cause
-sx not intentionally produced
tx: therapy, pain control program, SSRis, TCA
-analgesics/sedatives not beneficial, can lead to abuse/dependence

37

substance use

- substance dependence

3 of the following
tolerance
withdrawal
inability to quit

not able to keep up with commitment
ETOH s/sx:
look at GGT
withdrawal- shakes, seizures
tx: valium, thiamin, MMW, folic acid, antipsychotic

disulfarim+ETOH = nausea
Detok, AA

simulations( cocaine, crack)
tx: bentos, antipsychotics

opioids( morphine, oxycodone)

tx: methadone or clonidine tapering dose

benzos for mild withdrawal

NSAIDS for mm aches

naloxone

CNS depressants-taper med over time

nicotine- zyban, chanted, clonidine, inhaler

marijuana- use anxiolytics



38

personality disorders

onset in teens/early adulthood
- rigid inflexible traits
- don't have insight into problem

39

Personality Diorders

Cluster A-odd, weird
schizoid
schizotype
paranoid

Cluster B- BAD- emotional, impulsive, dramatic
-antisocial
borderline
histrionic
narcissistic

Cluster C-SAD anxious fearful

avoidant
obsessive-compulsive


pervasive pattern of behavior

40

schizoid

>4
detached, don't want any activities with family
aloof
very constricted affect
reality testing

tx: individual cognitive, group therapy
low does ( zyprexa, risperidone)
-ssri and stimulants

41

schizotypal

weird fantasies or odd religious practices

most common to turn into schizophrenia

- strange beliefs
-bizarre appearance
- not full blown pyschosis

tx: therapy, social skills training
antipsychotics
antidepressants

42

paranoid

long standing mistrust and suspiciousness
hostile

> 4
other are deceiving them
reluctant to confide in others
persistent (bears grudges)

tx: 1st line- individual therapy
behavior techniques

low dose anxiolytics/antipsychotics

43

antisocial

failure to conform to social standards
manipulative, no empathy
more common in urban areas, prisons

begins as conduce disorder- h/o physical/sexual abuse/hurting animals, starting fires

> 3
18 or older
impulsive
irresponsible
reckless

tx: psychotherapy
ssri, lithium

44

borderline

border of neurosis or psychosis

moody, suicidal, emptiness

> 5
-unpredictable behavior
impulse spending or sexual disorder
-self harm or suicide attempts
-cannot tolerate being alone

tx: splitting- people are either all good or all bad
1st line- dialectical behavior therapy ( group therapy)

meds- antipsychotics, SSRI
short term benzos

45

histrionic

center of attention
attention seeking
exaggerate thought and feelings

-somatization, substance disorders

tx: 1st line- group therapy
+/- antidepressants/anxiolytics

( regression)

46

narcissistic

big ego
- feel they are special
-sense of self -entilment
-midlife crisis

tx: 1st line psychotherapy

pharm rarely indicated

47

avoidant

extreme sensitivity to rejection
- see themselves as unappealing

tx: therapy

48

obsessive compulsive

- perfectionism
-excessive adherence to morals
-reluctance to relate tasks

-poor social skills
-hoarding

personality- OCPD- ego syntonic
- no recurrent obsessions

OCD is ego- dystonic
+ obsessions/compulsions

tx; 1s line- cognitive-behavior therapy
SSRI help reduce anxiety

49

acute stress disorder

similar to PTSD
-differ in onset and duration
-PTSD sxs develop anytime after event and last > 1 month

- occur w/in 1 month of traumatic event

MVA

exposure to traumatic event
> 3
sense of numbing or detachment
reduce awareness of surrounds
derealization
depersonliziton

- distress of event relived in flashback/exposure to trauma

tx: therapy/support group
SSRI, TCA, anticonvulsants, anxiolytics

50

child abuse

physical signs
-any injury that cannot be explained
- spiral fx
- burns
-brusises or injuries in regular patterns ( face, back, buttocks, thighs
-internal hemorrhage

kids manifest:
anxiety, PTSD, depression, failure to thrive

neglect: an adult allows
leaving a child less than 13

common age: 9-12
male known by child
any raises
- anal, itching
- knowledge of sexual acts
-sexual knowledge

51

elder abuse

-bruises, weiht loss, lack of glasses or hearing
-s/s drugging
-lack of medical care
-threat
-refusing to let them travel-
-financial abuse
-neglect- denying them of their basic rights

wath out for caregiver wth
-don't allow pt to answer

52

domestic violence

-may close ranks with abuser
- who leaves abuser has greater risk of being killer
-suffer damage to ego defense

management:
medical attention and contact numbers to referral agencies

53

uncomplicated bereavement

-normal gried- resolve in 1 year


sxs: shock, confusion, sadness, numbness, guilt
may report illusions or deny aspect of death

tx; social contact/ reassurance
+/- bentos for insomnia

54

neuroleptic malignancy syndrome

-occur with high potency antipyschotica
lead pipe rigidity
elevated CPK


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