psychiatry disorders Flashcards by L W

basis of cognitive behavior therapy

thoughts determine emotions
recognize unrealistic perceptions + behavior patterns
replace negative thoughts with images/actions that facilitate recovery

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journaling
challenging beliefs
mindfulness of thoughts and how affecting emotions
relaxation

cognitive behavior therapy treatment tools

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analysis of dreams, fantasies, associations, as well as verbal and physical expression of thoughts
therapist helps client to recognize and confront the inner conflicts responsible for symptoms and behavior problems

psychoanalysis

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fractures at various phases of healing
rib fractures
spiral fracture: twist arms
subdural hematoma: blunt trauma or shaking child
retinal detachment: shake baby

child abuse

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physician is legally obligated to report to CPS suspected

child abuse

child neglect

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if suspect sexual abuse

look for evidence of anal or genital trauma
if + STD = sexual abuse
sexual knowledge or behavior

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failure to provide food
shelter
supervise 
medical neglect 
failure to send to school

child neglect

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poor socialization skills
poor language skills
inability to trust others
poor feeding
weight loss
poor muscle tone

child neglect

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consequence of child neglect:
emotionally withdrawn
sadness
fearfulness
irritability

reactive attachment disorder (> 9 mo)

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onset: 3-4 yo
1) deficits in social communication and social interaction: “living in his own world”, lack of responsiveness to others, delayed language, poor eye contact, no social smile
2) restricted or repetitive behavior:
rocking, spinning, hand flapping
insistence on sameness, inflexible adherence to routine
fixation or fascination of objects: vacuum cleaner, sprinklers
hyperreactivity or hyporeacivity to sensory input (don’t notice extreme of temperature)

autism spectrum disorder

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onset must be

ADHD

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treatment of ADHD

CNS stimulants:(amphetamines ↑ release of NE)
methylphenidate (ritalin)
dexmethylphenidate
dextroamphetamine (adderall)
NE reuptake inhibitor: atomexetine

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onset: school-age
fear of separation from:
parents, home, blanket
impairs functioning: won’t go to school

separation anxiety disorder

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related to OCD
chronic, compulsive, nervous hair pulling
young girls
broken hairs of varying length
relieves stress
treatment: education (stop pulling hair) → CBT: mindful, what is the stress, deal with it → fluoxetine (SSRI) or clomipramine (TCA)

hair-pulling disorder (trichotillomania)

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impulse-control disorder
pattern of behaviors that violate social norms and RIGHTS OF OTHERS - don't care if society says its wrong to do:
aggressive
violent
threatening/bullying
destruction of property
deceitful
theft: blow up car
cruelty to ANIMALS

conduct disorder (

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impulse-control disorder
pattern of disobeying authority and hostile behavior (talk back to teacher)
hostility, annoyance, vindictiveness, disobedient, resentfulness
NO serious violations of social norms
NO disregard for rights of others (vs conduct disorder)

oppositional defiant disorder (less severe than conduct disorder)

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onset: 10-11 yo
tics: stereotyped motor
movements (facial, vocal - coprolalia = obscene speech in 20%)
tics must last >1 yr
usually resolves by 18 yo, but may persist

Tourette syndrome

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treatment of Tourette syndrome

antidopamine:
fluphenazine (high potency typical)
pimozide (high potency typical)
tetrabenazine (degrade dopamine)

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types of eating disorders

all more common in women
anorexia nervosa
bulimia nervosa
binge-eating disorder

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diagnosis of anorexia nervosa

low body weight: BMI

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excessive dieting
\+/-purging
excessive exercising
high achieving, self-conscience
body weight: BMI

anorexia nervosa

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treatment of anorexia nervosa

supportive therapy: nutritional education
CBT
counseling
treat depression: indirectly help anorexia

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diagnosis of bulimia nervosa`

BMI within normal range

1) episodes of binge eating: perceives as uncontrollable (eat faster than normal, unbearably full, large meal when not hungry, eating alone, feeling disgusted after fact)
2) inappropriate, compensatory behavior to prevent weight gain: purging or laxatives, or strict caloric restriction (for a few days), or intense exercise
3) unhealthy preoccupation with weight

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enlarged parotid glands: induced vomiting, ↑ serum amylase (inflammation)
erosion of enamel of teeth

bulimia nervosa

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treatment of bulimia nervosa

SSRI: fluoxetine + pyschotherapy

become OBESE episodes of binge eating: at least 1/week for 3 mo may not like to eat but it soothes them - feel compelled, un controllable NO compensatory behavior: purging

binge-eating disorder

complication of purging/chronic vomitting: electrolyte imbalance

hypokalemic hypochloremic metabolic alkalosis: purge HCl → hypochloremic, ↓H+ → HCO3 in serum from gastric parietal cell without any H+ to buffer and allow for HCl reabsorption →metabolic alkalosis compensation: cells have K/H countertransporter: H+ into serum for K+ out of serum and into cells→ hypokalemic

mood disorder | episodes of depressed mood + episodes of elevated mood (manic episode)

bipolar disorder

at least 1 week of abnormally and persistently elevated, expansive, or irritable mood abnormally and persistently increased goal-directed activity or energy DISRUPTS functioning socially or occupation, may require hospitalization, may have psychotic features (delusions: thinks superhero)

manic episode

diagnosis of manic episode

at least 3 of following for at least 1 week (DIG FAST) Distractability Irresponsibility (sexual, buy) Grandiosity (↑ self-esteem) Flight of ideas Activity (goal-directed)/agitation (may be happy or irritated, due to ↑energy) Sleep (↓ need) Talkativeness (pressured speech, talk louder)

diagnosis of hypomanic episode

at least 4 days of manic symptoms (less severe) | NO IMPAIRMENT in social or occupational functioning

diagnosis of bipolar disorder

at least 1 manic episode (bipolar I disorder) or | at least 1 hypomanic episode + 1 major depression episode (bipolar II disorder)

if giving antidepressants for depression with history of mania/hypomania in past (=bipolar disorder)

antidepressant will cause mania/hypomanic episode

neurotransmitter imbalance with depression vs bipolar disorder

``` depression: ↓dopamine ↓5HT ↓NE mania: (antidepressant may ↑5HT or NE → trigger mania) ↑5HT ↑NE ```

too mild to be diagnosed as bipolar disorder | duration: at least 2 years (periods of normal mood

cyclothymic disorder

treatment of bipolar disorder

mood stabilizer for mania: lithium (severe BP) atypical antipsychotic: risperidone, aripiprazole, olanzapine antiepileptics: lamotrigine, valproic acid, carbamazepine

2 or more distinct identities (or personalities) more common in women can be associated with sexual abuse

dissociative identity disorder

persistent feelings of detachment from body/thoughts | feel like outside observer watching life go by -seems like dream

depersonalization/derealization disorder

amnesia for an event or series of events generalized amnesia of identity and personal life history +/- dissociative feud: don't know who they are, assume new identity while gone

dissociative amnesia

can loss of loved one lead to major depression

yes (even if within first 2 mo)

diagnosis of major depressive disorder (5 stars)

at least 5 or more of 9 following for at least 2 weeks (1 week for manic): 1 must be: depressed mood and/or anhedonia (lack of interest in previous interests) SIGE CAPS: Sleep disturbance (hypersomnia or insomnia) Interest diminished (anhedonia) Guilt (worthlesness) Energy loss (fatigue) Concentration impaired Appetite changes (weight gain or loss) Psychomotor retardation (mentally + physically sluggish)/agitation (antsy) Suicidal ideation (preoccupied with death)

mood reactivity: respond to positive things positively ↑ appetite and weight gain hypersomnia leaden paralysis: legs, arms weighed down hypersensitive to rejection tx: MOAi

MDD with atypical features

during pregnancy or within 4 wks after delivery 5 of 9 MDD sx for at least 2 weeks tx: antidepressant

MDD with peripartum onset (occurs around time of childbirth)

5 of 9 MDD sx for at least 2 weeks AND delusions, hallucinations (psychosis only present with depression - if psychosis at times when no mood sx = schizoaffective dx)

MDD with psychotic features

recurrent for 2 years 5 of 9 MDD sx for at least 2 weeks only during specific seasons only (fall, winter) tx: ↑ light exposure

MDD with seasonal pattern

onset 2-3 days after delivery, resolves within 10 days | tx: supportive, follow-up for postpartum depression

maternal postpartum blues

``` disorganized thinking hallucinations delusions suicidal or homicidal ideation lasts days - 6 wks tx: atypical antipsychotic or ECT ```

postpartum psychosis

at least 2 years of chronic persistent depression may meet MDD criteria or have milder depressive sx depressive symptoms at least every 2 mo

persistent depression disorder

depression sx or irritability or anxiety or mood swings that are related to menstrual cycle severe enough to interfere with work or school or social (vs PMS)

premenstrual dysphoric disorder

major risk factors for suicide

psychiatric disorder (90% persons have one: MDD, bipolar, PTSD) feelings of hopelessness or worthlessness impulsivity: may lead to acting on thoughts increasing age (more successful): young adults make more attempts male sex (more successful): women make more attempts access to weapons history of suicide attempts

side effects of all antidepressants

worsening depression | ↑ risk of suicide

antidepressants

SSRI, SNRI: most common TCA: may be used MAOi: almost never used atypical antidepressants: buproprion (NE, dopamine reuptake inhibitor): use if sexual dysfunction on SSRI mirtazapine (α2 antagonist): use if depressed elderly, or depressed and not sleeping trazodone, nefazodone (serotonin modulators) ECT

treatment for: refractory MDD, catatonic schizophrenia, pregnancy or postpartum with depression/psychosis anesthetize patient: electric current to brain produces controlled, painless seizure SE: disorientation, amnesia, usually self-limited over couple months

electroconvulsive therapy

``` panic attacks: anxiety palpitations chest pain ab distress fear of dying feeling of impending doom worry about future attacks r/o acute MI, PE ```

panic disorder

treatment of panic disorder

CBT: address dysfunctional emotions and improve reactions SSRIs: DOC TCAs BZD: only use during acute panic attack due to abuse potential (presence can reduce likelihood of attack) ßblocker: ↓ symp tone

treatment of phobia

systematic desensitization: exposure to small amount, then increase

fear of embarrassment social situations

social anxiety disorder

treatment of social anxiety disorder

SSRI: if everyday | ßblocker: if public speaking (no ↑HR, symp tone)

phobia of open spaces or public situations (crowd, open spaces, bus)

agoraphobia

perform specific rituals to feel normal obsession: intrusive thoughts that can't be controlled compulsive: performance of task to relieve obsession

OCD

treatment for OCD

SSRI | clomipramine (TCA)

common treatment for depression or anxiety

SSRI

``` persistent re-experiencing of a previous traumatic event for >1 mo (onset can occur at anytime after event): nightmares flashbacks intense fear hypervigilent: startle easily ↑ risk of somatatization ```

post-traumatic stress disorder

persistent re-experiencing of a previous traumatic event for

acute stress disorder or normal bereavement

treatment of PTSD

psychotherapy | SSRI

uncontrollable anxiety + worry for > 6 mo | may have: insomnia, irritability

generalized anxiety disorder

identifiable psychosocial stressor (divorce, illness, death) that causes anxiety symptoms last

adjustment disorder

treatment of generalized anxiety disorder

BZD: for panic attacks or acute phobia (MRI, dentist) SSRI: DOC SNRI buspirone

consciously faking a medical problem to obtain a secondary gain (money, avoid work, obtain drugs)

malingering

consciously faking a medical problem to play a sick role

factitious disorder

severe type of factitious disorder | self harm, seek invasive procedures to play sick role

munchausen syndrome

``` symptoms of a disease but no identifiable cause (not faking) complaint in 1 or more organ systems excessive anxiety + worry lasts at least 6 mo may be predominantly pain ```

somatic symptom disorder

worried will get serious illness (ask for repeated mammograms, really worried have cancer) but NO SYMPTOMS

illness anxiety disorder (hypochondriasis)

neuro symptoms that don't fit with any pathology: usually begin after acute stressor weakness paralysis non-epileptic seizure blindness symptoms resolve in 2 wks, may persist for years

conversion disorder

concerned about minor imperfections (breast, nose, ears) want surgery - multiple distressing - see something we don't see look in mirror all the time

body dysmorphic disorder

psychiatry disorders Flashcards

(75 cards)