psychiatry Flashcards
panic attack
rapid onset of severe anxiety
last
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.
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
phobias
most common mental disorder in US
-irrational fever/ persistent excess anxiety when present with object/situation
has to appear functioning
specific phobia
fear of specific object/
animal/ insects
natural phenomena
blood, needles,
situational
onset in childhood
tx: desensitization /exposuretherapy
- short term bentos
social phobia
fear of social situations in which embarrassment to humiliation may occur
Inciting events:
public speaking, using restrooms, eating in public
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.
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
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
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
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
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
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
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
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
SAD
fall or winter onset
ofter remits in spring
more common in colder climate
tx: light therapy
SSRI
wellbutrin
melancholia
anhedonia psychomotor retardation anorexia depressed mood feelings of guilt sleep disturbance
atypical depression
overeat over sleeping reactive mood leaden paralysis oversensitive to interpersonal rejection
tx: MAOI ( marplan/ parante)
SSRI, atypical antipsychotics may help
catatonic depression
pt refuse to cooperate fo no reason
echolalia- echoing of others words
tx: benos
ECT
Valproic acid, lithium
psychotic depressio
delusions or hallucinations
tx: benzos and anti-depressants
anti-depressants + 2nd gen antipsychotic
postpartum depression
onset 4 weeks of delivery
tx: sertaline- oka with breastfeeding
estrogen may help
