39 yo F agitated BIBNYPD after assaulting pedestrian. Says she has unusual powers and sent on a special mission by God. What type of thinking is this?
Grandiose Delusion
What is magical thinking?
Magical thinking is the belief that one’s thoughts can control events in a manner not explained by natural cause and effect. It also includes the attribution of casual incident to supernatural forces
What is flight of ideas?
Flight of ideas refers to loosely associated thoughts that rapidly move from topic to topic
What is perseveration
Perseveration = Repetition of words or ideas during a conversation
Repetition of words or ideas during a conversation = ?
Perseveration
loosely associated thoughts that rapidly move from topic to topic =?
Flight of ideas
Belief that one’s thoughts can control events or the attribution of casual incident to supernatural forces = ?
Magical thinking
What are first-line treatments for acute mania (2 gen)?
Antipsychotics and mood stabilizers
Which works faster to treat acute mania and would be used in cases of psychosis and escalating agitation - antipsychotics or mood stabilizers?
Antipsychotics (1st or 2nd gen), bc mood stabilizers need gradual titration over days.
Name 3 examples of mood stabilizers used to treat acute mania.
Lithium, valproate, carbamazepine
Monotherapy with atypical antipsychotics is used for what disease process?
mild-to-moderate mania
combinations of antipsychotics plus Li or valproate are used for what disease process?
severe mania (severe agitation, psychosis)
Severe mania (severe agitation, psychosis) is treated with what drugs?
A combo of an antipsychotic plus Li or valproate
mild-to-moderate mania is treated w/ what group of drugs?
Monotherapy with atypical antipsychotics
Benzodiazepines are used adjunctively to treat what?
agitation and insomnia
What group of drugs can be added as an adjunct to treat agitation and insomnia?
Benzodiazepines
Escitalopram is what type of medication?
Selective Serotonin Reuptake Inhibitor
Escitalopram is used to treat what?
Depression and anxiety disorders
Antidepressants can do what in the setting of mania?
They can precipitate and worsen manic episodes and should be discontinued if taken by a pt presenting w/ mania
Lamotrigine is what type of medication?
Anticonvulsant
Lamotrigine has greatest efficacy in treating what?
Bipolar DEPRESSIVE episodes (not manic episodes)
What is a significant adverse effect of lamotrigine?
Rash that can dev into a life-threatening mucocutaneous rxn (ie Stevens-Johnson syndrome)
What are the requirements for adjustment disorder?
Adjustment disorder requires the dev of emotional or behavioral symptoms in response to an identifiable stressor within 3 months of the onset of the stressor –> impairment in the pt’s life but doesn’t meet criteria for other psych illnessess
Symptoms must start within what time frame for a diagnosis of adjustment disorder?
dev of emotional or behavioral symptoms in response to an identifiable stressor within 3 months of the onset of the stressor
dev of emotional or behavioral symptoms in response to an identifiable stressor within 3 months of the onset of the stressor –> impairment in the pt’s life = ?
Adjustment disorder
Acute stress disorder’s symptoms last for how long?
No longer than 1 month
Experience or witness an event that threaned death or serious harm –> anxiety symptoms for 3weeks. Likely what diagnosis?
Acute stress disorder bc
What is acute stress disorder?
Anxiety symptoms that develop after experiencing or witnessing an event that threatened death or serious harm that lasts for 1 month or less
Anxiety symptoms that develop after experiencing or witnessing an event that threatened death or serious harm that lasts for 1 month or less = ?
Acute stress disorder
What are common symptoms of generalized anxiety disorder?
fatigue, restlessness, difficulty concentrating, irritability, and sleep disturbance
What is generalized anxiety disorder?
Excessive worry or anxiety over many aspects of one’s life for at least 6 months
What is the time frame for generalized anxiety disorder?
Excessive worry or anxiety over many aspects of one’s life for at least 6 months
What is obsessive-compulsive disorder?
OCD is characterized by multiple obsessions or intrusive thoughts that cause significant anxiety or forced engagement of repetitive compulsions in an attempt to avoid otherwise significant psychological stress
Do OCD pts recognize their unreasonable behavior?
Yes, pts often recognize unreasonable nature of their thoughts or behaviors but are unable to stop them due to increasing anxiety
Do obsessive compulsive personality disorder pts recognize their unreasonable behavior?
No, they often do not see their behavior as a problem
What is a major diff between OCD pts and obsessive compulsive personality disorder pts?
OCD pts - recognize their behavior or thoughts are unreasonable
OCPD pts - do NOT see their behavior as a problem
obsessive compulsive personality disorder = ?
Obsessive compulsive personality disorder pts have a preoccupation with orderliness and perfectionism that negatively impacts their functioning.
Pt is 25 yo devoted to his work, but has issues with coworkers. They describe him as inflexible, stubborn, and unforgiving. His last relationship ended because of his “need for perfection.” What is likely diagnosis
Obsessive compulsive personality disorder
- obsession w/ perfection
- stubborn, belief there is only 1 way to do things
- devotion to work
- need to follow rules precisely
What is paranoid personality disorder?
Life-long pattern of distrust and suspiciousness of others that does not reach level of a delusion
Suspicious, bear grudges, read into things too much, accuse other of trying to harm them, but NOT delusional - this might describe what disorder?
Paranoid personality disorder
To diagnose PTSD symptoms must last how long?
> 1mo
Symptoms of PTSD include?
hypervigilance, insomnia, detachment, avoid stimuli related to trauma, flashbacks, nightmares
Social phobia is?
Persistent fear of social or performance situations accompanied by unreasonable fears they will be humiliated.
Social phobics do or do not realize their fears are excessive?
Often the DO realize they are excessive or unreasonable, but if forced into these situations will often still –> panic attacks