Term
|
Definition
- Amitriptyline
- Imipramine
- Doxepine
- Desipramine
- Nortriptyline
- Protriptyline |
|
|
Term
| TCAs that block reuptake of NE: |
|
Definition
- Desipramine
- Nortriptyline
- Protriptyline |
|
|
Term
| TCAs that block serotonin reuptake: |
|
Definition
AID
- Amitriptyline
- Imipramine
- Doxepin |
|
|
Term
| antidepressants useful in chronic pain: |
|
Definition
|
|
Term
| common side effects of TCAs: |
|
Definition
- sedation
- orthostatic hypotension
- constipation
- urinary hesitancy
- dry mouth
- blurred vision
- weight gain
- arrhythmias |
|
|
Term
|
Definition
- headache
- malaise
- nausea
- anxiety |
|
|
Term
|
Definition
- Fluoxetine
- Sertraline
- Paroxetine
- Fluvoxamine
- Citalopram
- Escitalopram |
|
|
Term
| TCA most likely to cause sleepiness: |
|
Definition
|
|
Term
| TCA likely to cause initial agitation: |
|
Definition
|
|
Term
| SRRI that may cause initial increase in agitation: |
|
Definition
|
|
Term
| SSRI that may cause sleepiness: |
|
Definition
|
|
Term
| first line drugs for unipolar mood disorders like major depression: |
|
Definition
|
|
Term
| SSRIs indicated for PTSD: : |
|
Definition
|
|
Term
| SSRIs indicated for premenstrual dysphoria: |
|
Definition
- Fluoxetine
- Paroxetine
- Sertraline
FPS for premenstrual dysphoria |
|
|
Term
| SSRIs indicated for Generalized Anxiety Disorder: |
|
Definition
- Paroxetine
- Escitalopram
PE relieves GAD. |
|
|
Term
| SSRIs indicated for Panic Disorder: |
|
Definition
- Fluoxetine
- Paroxetine
- Sertraline
FPS for premenstrual dyshporia and panic disorder. |
|
|
Term
| SSRIs indicated for social phobias: |
|
Definition
- sertraline
- paroxetine
(also escitalopram and citalopram) |
|
|
Term
|
Definition
- Fluoxetine
- Fluvoxamine
- Sertraline
- Paroxetine |
|
|
Term
| SSRIs indicated for bulimia nervosa: |
|
Definition
|
|
Term
| what antidepressant would you use for withdrawal of drugs/alcohol: |
|
Definition
- TCA first choice
- SSRI second choice |
|
|
Term
| MAO-Is inhibit reuptake of ___ , causing ___ of ___ receptors, and others including ___ and __. |
|
Definition
- serotonin
- down-regulation
- dopamine
- norepinephrine |
|
|
Term
| common side effects of SSRIs: |
|
Definition
- initial nausea, loose stools, anxiety, headache, sweating, and insomina usually diminish over time and are sometimes dose dependent
- anxiety/hyper stimulation
- persistent insomeina
- weight gain
- vivid dreams (especially fluoxetine)
- sexual dysfunctions
- side effects lessen with time |
|
|
Term
| Reasons SSRIs have a good safety profile: |
|
Definition
- no cardiac side effects
- few significant drug drug interactions although SSRIs increase TCA blood levels
- low risk in overdose
- low risk in pregnancy |
|
|
Term
| Tolerance to effect aka Poop out effect seen after 6 months in some patients on ____. To overcome this, what should you do? |
|
Definition
- SSRIs
- increase dose for a short period of time to increase the effectiveness, then can go back to original dose |
|
|
Term
| Abrupt withdrawal from high doses of SSRIs may cause ___ __ including __, __, and ___ symptoms. |
|
Definition
- discontinuation syndrome
- somatic
- neurological
- psychological |
|
|
Term
| When pt is getting off SSRIs, taper no more rapidly than ___ per week and monitor for recurrence of depression. |
|
Definition
|
|
Term
| Serotonin syndrome is caused by taking __ doses or multiple SSRIs or an SSRI with a ___. This can lead to ___ __ and __! |
|
Definition
- large
- MAO-I
- renal failure and death |
|
|
Term
| Symptoms of Serotonin Syndrome: |
|
Definition
- lethargy
- restlessness
- myoclonic jerking
- tremor
- mental confusion
- diaphoresis
- flushing |
|
|
Term
|
Definition
|
|
Term
| what antidepressant is used to help with smoking cessation: |
|
Definition
|
|
Term
| Buproprion is NOT indicated to treat __ ___. |
|
Definition
|
|
Term
| Buproprion is indicated in ___ __ and may be useful in ___. It has a minimal effect on __ __, ___ ___, and ___ ___. Thus it is often given to patients who have decreased libido from SSRI to try to increase libido. |
|
Definition
- major depression
- ADHD
- minimal effects on weight gain, cardiac conduction, and sexual dysfunction |
|
|
Term
| Buproprion is a ___, __, and ___ reuptake inhibitor. |
|
Definition
dopamine
norepinephrine
serotonin |
|
|
Term
| Contraindications for Buproprion: |
|
Definition
- seizure disorders
- eating disorders may lower seizure threshold |
|
|
Term
| Common side effects of Buproprion: |
|
Definition
- headaches
- nausea
- anxiety
- tremors
- insomnia
- increased sweating
These subside with time and are dose dependent |
|
|
Term
| Duloxetine is an ____ that is indicated in the following conditions: |
|
Definition
- SSNRI
- depression
- Diabetic neuropathy
- urinary incontinence
- fibromyalgia |
|
|
Term
| Duloxetine Contraindications: |
|
Definition
- MAOIs> dietary restrictions
- hepatic insufficiency
- severe renal impairment
- end stage renal disease (ESRD) |
|
|
Term
| Duloxetine has same side effects as : |
|
Definition
|
|
Term
| Venlafaxine is an ___ used in treatment of ___, ___, ___, and ___. It also cannot be given with MAO-I and has same side effects as SSRIs. |
|
Definition
- SSNRI
- depression, anxiety, OCD, and pain |
|
|
Term
| Trazodone is a ____. It is a weak inhibitor of ___ and blocks the ___ receptors. It is not really great as an antidepressant, but useful for ___ side effect to use with SSRI. |
|
Definition
- MAO-I
- serotonin reuptake
- 5-HT2
- sedative |
|
|
Term
|
Definition
- sedation
- orthostatic hypotension
- dry mouth
- dizziness
- rare side effect of priapism> immediate medical attention (contrainidcation for use in adolescents)
- use sparingly in elderly due to dizziness |
|
|
Term
| Mertazapine aka ___ enhances ___ and ___ neuro-transmission through blockade of ___ ____ and ___ receptors. It has a __ response rate. Can be used with significant __ componenet. Used as a ___. Causes significant ___ __. |
|
Definition
- Remeron
- serotonergic and noradrenergic neurotrasmission
- blockade of post-synaptic 5-HT2 and 5HT3 receptors
- rapid
- anxiety
- sedative
- weight gain |
|
|
Term
| In ___ of patients, depression fails to remit with the initial antidepressant. Controlled trial studies have shown improved response after augmentation of antidepressants with other ___, __, or ___ __. |
|
Definition
- 2/3
- antidepresants
- lithium
- thyroid hormone |
|
|
Term
| first line depression treatment: |
|
Definition
| - monotherapy with SSRI, SSNRI, or SDNRI |
|
|
Term
| second line depression treatment: |
|
Definition
- monotherapy agent of different class
- augmentation for partial responders |
|
|
Term
| third line depression treatment: |
|
Definition
- augmentation
- combination |
|
|
Term
| fourth line depression treatment: |
|
Definition
|
|
Term
| Fifth line depression treatments: |
|
Definition
- ECT
- vagus nerve stimulation
- other combinations |
|
|
Term
|
Definition
- apprehensive anticipation of future danger
- experienced as unpleasant
- with somatic symptoms like muscle tension |
|
|
Term
|
Definition
| - more appropriate term for real threat of danger |
|
|
Term
|
Definition
| persistant, excessive or irrational fear of specific object, activity, or situation |
|
|
Term
| Steps in the normal fear response: |
|
Definition
- Cognitive appraisal: recognize and remember real threat
- Physiological arousal: signal danger, enhance alertness, prepare body for action
- Behavior: fight/flight/freeze |
|
|
Term
| The normal fear response is the neural alarm system for rapid alerting to sources of threat. With the normal fear response there is absense of ___ ___. |
|
Definition
| - absense of cortical stimulation |
|
|
Term
| Hypothalamic Pituitary Axis (HPA): |
|
Definition
| hypothalamus> CRH(corticotropin releasing hormone)> anterior pituitary> ACTH (adrenocorticotropic hormone)> adrenal cortex> cortisol |
|
|
Term
|
Definition
- chronic, excessive, unrealistic worry (health, money, career)
- trembling
- muscle aches
- insomnia
- gastric distress
- dizziness
- irritability
- restlessness
- feeling on edge
- easy fatigueability
- muscle tension |
|
|
Term
| general medical conditions that mimic panic attacks: |
|
Definition
Cardiopulmonary disorders:
- mitral valve prolapse
- silent MI> diabetic females
- recurrent pulmonary emboli
- paroxysmal arterial tachycardia
Hypoglycemia
Pheochromocytoma
Temporal lobe epilepsy
Substance abuse/dependence |
|
|
Term
| endocrine disorders that mimic GAD: |
|
Definition
- hyperthyroidism
- hypoglycemia |
|
|
Term
| Hypoglycemia may look like ___ or ___ __. |
|
Definition
|
|
Term
| Temporal lobe epilepsy may look like __ attack. It causes behavioral disinhibition. Look for head injury in proximity of onset. |
|
Definition
|
|
Term
| Post-concussion syndrome may look like ___ or ___. |
|
Definition
|
|
Term
| Organic solvent syndrome may look like ___. |
|
Definition
|
|
Term
| Delirium may look like ___ ___ with waxing and waning levels of consciousness. |
|
Definition
|
|
Term
| ___ is very useful in treating anxiety, know this! |
|
Definition
|
|
Term
| The psychodynamic theory of anxiety believes that the __ are expressions of underlying ___. This theory utilizes the ___ ___ technique. There are no empirical studies of support. |
|
Definition
- symptoms
- conflict
- free association |
|
|
Term
| Behavior therapy can be used as treatment of anxiety as well. This uses ___ conditioning, ___ conditioning with __ and __ reinforcements and punishing, and ___ ___. |
|
Definition
- classical conditioning
- operant conditions for maintenance of avoidance behaviors
- positive and negative
- observational learning |
|
|
Term
| Cognitive behavior therapy is also useful in treatment of anxiety. This uses systematic desensitization and/or graded exposure. |
|
Definition
|
|
Term
| For PTSD, Panic Disorder, and Anxiety what type of cognitive behavioral therapy should be used? |
|
Definition
| Systematic Desensitization (in vitro only, pt only imagining stressful event) |
|
|
Term
| For OCD and Panic Disorder, ___ __ can be used in which you actually expose the patient to stressor hieararchicaly w/o relaxation training and do NOT allow them to go through with compulsion. |
|
Definition
|
|
Term
|
Definition
actual IMMEDIATE exposure (not hierachicical) to exaggerate situation
- good with specific phobias |
|
|
Term
|
Definition
- convert immediate exposure exaggerated situation
- specific phobia |
|
|
Term
|
Definition
learning desired behavior through demonstrations and observations
(put child in room with dog and other child playing with dog and have kid move closer and closer) |
|
|
Term
| panic attacks are not specific to panic disorder, they also occur with __ __, ___, and ___. |
|
Definition
- social phobia
- OCD
- PTSD |
|
|
Term
| Most pts with panic disorder/attacks have underlying ___. |
|
Definition
|
|
Term
| Panic disorder definition: |
|
Definition
- Recurrent unexpected panic attacks, followed by one or more of the following:
- anticipation and fear of additional attacks
- worry about implications of attacks
- change in behavior, ususally withdrawal |
|
|
Term
| Panic attacks are __ times more common in ___. |
|
Definition
| 3 times more common in women |
|
|
Term
| Panic disorder patients are at increased riks of abuse of drugs, such as __ ___ like alcohol or ___ ___ ____. |
|
Definition
CNS depressants
long acting benzodiazepines |
|
|
Term
| Panicogenic substances include: |
|
Definition
- sodium lactate infusion
- 35% carbon dioxide |
|
|
Term
| Panic attacks occur due to disturbances of overall function of ___, ___, or ___ systems. |
|
Definition
- serotonergic
- noradrenergic
- GABAergic |
|
|
Term
| For treatment of panic attacks you should start with an ____, full response may take 3 months. Benzos can be used for temporary fast releif, but have problems with neuroadadaptations. |
|
Definition
|
|
Term
| Benzodiazepines for panic attacks: |
|
Definition
- Alazopam .75-1.5, titrate up to 6 mg
- Clonazepam .5 to 1.5, titrate up to 4 mg
- Iorazepam 1 to 2, titrate up to 6
- Diazepam 4 to 10, titrate up to 10-60 mg
Divided doses except for extended release alprazolam |
|
|
Term
|
Definition
FPS and FCE
- fluoxetine
- paroxetine
- sertraline
- fluvoxamine
- citalopram
- escitalopram |
|
|
Term
|
Definition
|
|
Term
| _% of men and _% of women have specific phobias. |
|
Definition
|
|
Term
| Lifetime prevalence of social phobia is __%. It is more common in women. Social phobia has high comorbidity with __ and __ __. |
|
Definition
2.6%
depression
alcohol abuse |
|
|
Term
| OCD has a lifetime prevalence of ___%, childhood onset is greater than __%. Men and women are ___ affected. There is a ___ component. There is disturbed ___ transmission. |
|
Definition
- 2-3%
- 50%
- equally
- familial
- disturbed serotonergic transmission |
|
|
Term
| With OCD, __ is present. Symptoms cause __ __, are ___ ___, or __ with function. |
|
Definition
- insight is present
- subjective distress
- time consuming
- interfere with function |
|
|
Term
|
Definition
|
|
Term
| Lifetime prevalence of PTSD: |
|
Definition
|
|
Term
|
Definition
- intense fear
- helplessness
- horror
- difficultly sleeping
- irritability
- poor concentration
- trauma persistently reexperienced
- avoidance behaviors
- emotional numbing
- loss of enjoyment in life
- sense of no future
- feeling detached/emotionally aloof
- chronic hyperarousal |
|
|
Term
| GAD is ___,___, ___ worry (health, money, career). Accompanied by __ __, ___,___, __ __, ___, and ___. It is __ times more common in women. Often a comorbid condition. |
|
Definition
- chronic, unrealistsic, excessive worry
- muscle aches
- trembling
- insomnia
- gastric distress
- dizziness
- irritability
- twice |
|
|
Term
|
Definition
- restlessness
- feeling on edge
- easy fatigability
- trouble concentrating
- irritability
- muscle tension
- sleep disturbances |
|
|
Term
| Tricyclics can also be used for panic disorder, thes include ___, __, ___, ___. |
|
Definition
imipramine 150-200 mg
nortriptyline
desipramine
clomipramine |
|
|
Term
| Agoraphobia should be treated with ___ ___ __, specifically ___ ___ or ___ ___. Medication is/is not helpful with agoraphobia. |
|
Definition
- Cognitive Behavioral Therapy
- Systematic Desensitization
- Graded exposure
- Medication is NOT helpful, but may help with panic disorder if this is comorbid |
|
|
Term
| Specific phobias should be treated with __ ___ __, specifically __ ___ or ___ __ with children. Medication should only be used for __ __ situations like a closed MRI, use ___ 20 mg. |
|
Definition
- cognitive behavioral therapy
- systematic desensitization
- participant modeling with children
- one time
- paroxetine |
|
|
Term
| Social phobias should be treated with an ___, specifically __, __, or ___, but NOT __. ___ (SNRI), ___ (benzo), and the MAOI ___ , or ___may also be used. ___ ___ may also work with these patients. |
|
Definition
- SSRI
- flovoxamine, paroxetine, sertraline
- NOT fluoxetine
- Venlafaxine
- Clonazepam
- Phenelzine
- Gabapentin
- Systematic Desensitization |
|
|
Term
| OCD should be treated with ___ therapy and ___ therapy. __ may be used. The SSRIs that can be used include: |
|
Definition
- behavior therapy
- cognitive therapy
- Clomipramine
- Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Escitalopram, Citalopram |
|
|
Term
| PTSD should be treated with __ ___ __, specifically ___ ___. The SSRIs include __, __, and ___. Imipramine the tricyclic or phenelzine can also be used. Also Cyproheptadine can be used. |
|
Definition
- Cognitive Behavior Therapy
- systematic desensitization
- fluoxetine, paroxetine, sertraline |
|
|
Term
| For GAD treatment, Cognitive Behavior Therapy should be used, specifically __ ___. Medications are equally effective as the therapy. Should start with an ___ or ___, __ as second choice, ___ for fast effect. |
|
Definition
- relaxation techniques
- SSRI or buspirone
- benzodiazepine as second choice
- hydroxyzine for fast effect |
|
|
Term
| Herbals for anxiety, many pts will take these and they can interact with other medications: |
|
Definition
- Valerian root
- Kava Kava
- Passion Flower
- Ashwaghanda root
- B complex vitamins |
|
|
Term
| For GAD, start first on SSRI such as ___ or ___, can also do ___. These may initially increase anxiety, but then get better. |
|
Definition
- paroxetine
- escitalopram
- venlafaxine |
|
|
Term
| The Cochrane review found the ___ extract to be an effective treatment of GAD, but doses are not consistent across manufacturers. This is safe for __ to ___ weeks. |
|
Definition
|
|
Term
| Cochrane review found ___ to help with core PTSD symptoms |
|
Definition
|
|
Term
| Cochrane review developed __ ___ __ __ especially for PTSD, very effective. |
|
Definition
| trauma focused cognitive therapy |
|
|
Term
| Fluoxetine is contraindicated for ___ __ |
|
Definition
|
|
Term
| FFPSEC for OCD and panic disorder, but just FPS for PTSD but different FPS for social phobia: |
|
Definition
fluoxetine
fluvoxamine
paroxetine
sertraline
escitalopram
citalopram |
|
|
Term
| Cochrane review found that __, ___, and ___ help with GAD. |
|
Definition
- imipramine
- venlafaxine
- paroxetine |
|
|
Term
| Dissociative disorders are disturbances in the organization of __, __, __, or __. |
|
Definition
- identity
- memory
- perception
- consciousness |
|
|
Term
| Dissociative amnesia is the separation of ___ from access to ___. |
|
Definition
| - separation of memories from access to consciousness |
|
|
Term
| Dissociative fugue or dissociative identity disorder results from ___ of ___. |
|
Definition
| fragmentation of identity |
|
|
Term
| fragmentation of identity causes: |
|
Definition
- dissociative fugue
- dissociative identity disorder |
|
|
Term
| Depersonalization disorder results from __ ___. |
|
Definition
|
|
Term
| Disintegrated perception is characteristic of ____ ___. |
|
Definition
| depersonalization disorder |
|
|
Term
| Dissociation of aspects of consciousness results in __ ___ __, ____ ___, and ___ ___. |
|
Definition
- acute stress disorder
- dissociative trance
- possession states |
|
|
Term
| Dissociation disorders are more of a disturbance in ___ of mental contents rather than the contents themselves. |
|
Definition
|
|
Term
| Memories in dissociative amnesia aren't really bizarre, they are just separated from one another. Specialized- like remembering the people involved but not the event. |
|
Definition
|
|
Term
| With DID and fugue the problem results from fragmentation of identity, so it is a __ ___ problem, meaning the information fails to ___ , not that the information is wrong. |
|
Definition
- information processing
- fails to integrate |
|
|
Term
| Dissociative identity is aka: |
|
Definition
| multiple personality disorder |
|
|
Term
| Dissociative fugue example: |
|
Definition
| have no recollection of how you got to be where you are |
|
|
Term
| In repression, information is ___ and ___. |
|
Definition
|
|
Term
| In dissociation, information is ___ __ in ___ manner. |
|
Definition
discretely stored
untransformed |
|
|
Term
| Retrieval of repressed information requires ___ b/c it is ___. Retrieval of dissociated information is ___. |
|
Definition
- translation
- disguised
- direct |
|
|
Term
| ___ information is NOT discretely organized temporarily, but ____ information is for a sharply delimited time. |
|
Definition
|
|
Term
| ___ is less tied to trauma. __ is a defense used to deal with physical threats not fantasies. |
|
Definition
Repression less tied to trauma
Dissociation |
|
|
Term
| What Axis I disorders have dissociative symptoms? |
|
Definition
BPAP
- Bipolar disorder
- PTSD
- Acute stress disorder
- Panic Disorder |
|
|
Term
| What Axis II disorders have dissociative symptoms? |
|
Definition
| Borderline personality disorder |
|
|
Term
| Dissociative amnesia is the classical functional disorder of ___ memory NOT involving ___ __ or problems in ___ __. It is ___ and may ___ ___. |
|
Definition
- NOT involving procedural memory or problems in memory storage
- reversible
- spontaneously remit |
|
|
Term
| With dissociative amnesia, memory loss is ___ . It has a ___ structure, meaning it is ___ not ___, and there is loss of __ periods of time. Types of events forgotten are ___ and ___ events including disavowed behavior like sexual acting out, suicide attempts, death of a relative, or criminal activity. |
|
Definition
- episodic
- temporal structure
- retrograde not anterograde
- discreet
- traumatic and stressful |
|
|
Term
| Differential for dissociative amnesia: |
|
Definition
- CNS disorders: cerebral infection, cerebral neoplasms, CVA
- Metabolic disorders: uremia, hypertensive encephalopathy, hypoglycemia
- Transient global amnesia
- Anoxia (usually anterograde amnesia)
- head trauma- lack of recall immediately before and after
- ECT: transient loss of recall
- Temporal lobe epilepsy |
|
|
Term
| what Axis I disorders have high co-moribidity with dissociative amnesia? |
|
Definition
ABCD comorbid with dissociative amnesia:
- Alcohol abuse
- Bulemia
- Conversion disorder
- Depression |
|
|
Term
| What Axis II disorders have high co-morbidity with dissociative amnesia? |
|
Definition
- Histrionic PD
- Dependent PD
- Borderline PD |
|
|
Term
| Dissociative fugue characteristics: |
|
Definition
- amnesia for aspects of personal memory
- loss of customary identity
- automatisms of behavior- person doesn't behave like they normally do
- sudden, purposeful travel
- assumption of new or partial identity
- rare
- usually following trauma or bereavement
- alcohol abuse frequently involved
- personality predisposing factor (espcially cluster B)
- spontaneous remission may occur
- hypnosis and psychotherapy |
|
|
Term
| Dissociative identity disorder is the presence of __ or __ __ __ that ___ take control of the person's behavior along with occurence of ___ ___ __. |
|
Definition
- 2 or more distinct personalities
- dissociative amnestic states |
|
|
Term
| DID accounts for __ to __% of psychiatric admissions. It is more common in __. Usually diagnosed in the __ __ or __ __. If left untreated it is __ and ___. Majority of these patients report a history of ___ __ and __ __. |
|
Definition
- 0.5-2.0%
- women
- late adolescents or early adulthood
- chronic and recurrent
- early physical and sexual abuse |
|
|
Term
| Pts with DID are unaware of existence of other personalities but is aware of blackouts or loss of time. May be told about behavioral episodes by others. These patients hear voices that are perceived as ___ head rather than outside of self. These patients use the term __ to refer to self in conversations. |
|
Definition
|
|
Term
| Axis I disorders that are comorbid with DID: |
|
Definition
DPS with DID
- depressive disorders
- PTSD
- substance abuse disorders |
|
|
Term
| Axis II disorders that are comorbid with DID: |
|
Definition
| - borderline personality disorder |
|
|
Term
| Primary treatment modality for DID is ___. What are some guidelines for this. |
|
Definition
- psychotherapy
- setting consistent boundaries
- focus on gaining mastery
- maintain therapeutic alliance
- be consistent with alters
- abreaction not retraumatization
- correct cognitive errors |
|
|
Term
| Depersonalization disorder is persistent feeling of ___, __, or ___ from oneself or one's body. Usually with the feeling of being an __ __. Reality testing remains intact, but the feeling is uncomfortable and __ ___. |
|
Definition
- unreality, detachment, or estrangement
- outside observer
- ego dystonic |
|
|
Term
| ___ as a symptom refers to perception that body or self is strange and unreal. ___ as a symptoms refers to perception that objects in external world seem strange and unreal. Transient and isolation cases of depersonalization are common |
|
Definition
- Depersonalization
- Derealization |
|
|
Term
| when depersonalization is normal: |
|
Definition
- bereavement
- emotional shock
- sensory deprivation
- boredome
- exhaustion |
|
|
Term
| Treatment for depersonalization disorder: |
|
Definition
- tincture of time
- reassureance and support
- brief psychotherapy
- hypnosis is contraindicated |
|
|
Term
| hypnosis is contraindicated for tmt of what disorder? |
|
Definition
|
|
Term
| Somatoform disorders are disorders in which patients have a __ ___ that cannot be fully explained by ___ ___ or known ___ __, or if there are medical findings, the complaints or impairment ___ __ __. |
|
Definition
- physical symptom
- medical findings or known physiological mechanisms
- exceed the expected |
|
|
Term
| Somatoform disorders are likely caused by ___ of ___ ___ ___ and ___ to more acceptable manner of expression. Example: someone has depression but presents to doctor with headaches. |
|
Definition
- repression of emotional conflicts/anxieety
- conversion |
|
|
Term
| 6 Major Somatoform Disorders: |
|
Definition
Some Can Hike But Pedal Unwell.
- Somatization disorder
- Conversion disorder
- Hypochondriasis
- Body dysmorphic disorder
- Psychogenic pain disorder
- Undifferentiated somatoform disorder |
|
|
Term
| DSM IV criteria for somatization disorder: |
|
Definition
44211
- 4 pain symptoms in 4 different locations (fibromyalgia would have more pain locations)
- 2 G.I. symptoms
- 1 sexual symptom (irregular menses)
- 1 pseudoneurological symptom (double vision and blindness) |
|
|
Term
| key features of somatization disorder: |
|
Definition
- begin during teens or early 20s
- total absorption in physical symptoms and health care professionals
- exaggerating and over-dramatizing symptoms
- history of significant interpersonal conflict |
|
|
Term
| Somatization disorder is commonly associated with ___ ___ __. There are often ___ ___. __ and ___ defenses are used. |
|
Definition
- histrionic personality disorder
- iatrogenic complications
- Repression and conversion |
|
|
Term
| Conversion disorder key features: |
|
Definition
- sudden, dramatic appearance of symptom
- usually single prominent symptom
- neurological inconsistencies
- significant interpersonal conflict
- symptom provides partial resolution of conflict
- unusual to have single episode
- in children prsents with family problem
- commonly have a personality disorder
- la belle indifference
- primary reason: money
- secondary reason: time off work or don't have to do something
- want some sort of gain |
|
|
Term
| Defenses used with Conversion disorder: |
|
Definition
- reaction formation
- denial
- displacement |
|
|
Term
| Treatment of conversion disorder: |
|
Definition
- tincture of time
- suggestion (hypnotic, authoritative, caring, lorazepam, sodium amytal interview)
- discover underlying problem and address |
|
|
Term
| Treatment of somatization disorder: |
|
Definition
Minimize iatrogenic complications
Single primary physician
Schedule visits on a non-contingent basis
Assist patient with interpersonal problems
Psychotherapy to develop insight and coping skills
Avoid psychotropics |
|
|
Term
| Hypochondriasis features: |
|
Definition
- triad of disease conviction, fear, and preoccupation
- anxiety/compulsive preoccupation
- fear of particular serious illness
- EPISODIC AND RECURRENT
- exacerbations with identifiable life stress
- may be associated with OCD
- may transfer belief to another disease |
|
|
Term
| Defenses used in Hypochondriasis: |
|
Definition
- repression
- displacement |
|
|
Term
| Body dysmorphic disorder features: |
|
Definition
- complaint is out of proportion
- history of visits to doctors about complaint
- chronic
- repeated visits to plastic surgeons/dermatologists
- secondary depression |
|
|
Term
| Defenses used in body dysmorphic disorder: |
|
Definition
- repression
- distortion
- symbolization
- projection |
|
|
Term
| Treatment of Body Dysmorphic Disorder; |
|
Definition
- serotonergic drugs (chlomipramine, fluoxetine)
- these help to decrease obsessive rumination and depression
- anti-anxiety agents of little use
- psychotherapy good to develop insight, address feelings of inadequacy |
|
|
Term
| Differential diagnosis for body dysmorphic disorder: |
|
Definition
- mood disorders (if symptoms limited to mood episode)
- panic disorder (symptoms circumscsribed to attack)
- GAD (focus of worry not limited to physical symptom)
- pscychotic disorders |
|
|
Term
| Malingering is ___ production of ___ or ___ symptoms in order to accomplish an __ __. |
|
Definition
- voluntary
- physcial or psychological
- external goal |
|
|
Term
|
Definition
- many vague or poorly localized symptoms
- presented in GREAT DETAIL
- easily irritated by skepticism
- history reveals secondary gain issue
- chronic
- associated with antisocial PD |
|
|
Term
| 3 external motivators for malingering patients: |
|
Definition
- to avoid difficult situations
- to receive compensation
- retaliate when patient feels guilt or suffers financial loss |
|
|
Term
| Malingering patients usually want one of 6 external gains: |
|
Definition
- avoidance of criminal responsibility, trial/punishment
- avoidance of military service or particulary hazardous duties
- financial gain
- transfer from prison to hospital
- admission to hospital
- drug seeking |
|
|
Term
| Malingering is more common in settings of only men. 1% incidence in mental health patients. 5% in military. 10-20% during interviews with criminal defendents. |
|
Definition
|
|
Term
| treatment of malingering: |
|
Definition
- monitor as if real
- offer NO TREATMENT
- identify secondary gain
- encourage voluntary release of symptoms |
|
|
Term
| Factitious disorders seek ___ gain, while malingering seeks ___ gain. |
|
Definition
|
|
Term
| With somatoform disorders, pt is ___ of it, with malingering pt is ___ of it. With factitious disorders consciousness is somewhere in between. |
|
Definition
|
|
Term
| Factitious d/o patients may have physical and psychotic symptoms, but mostly physical signs and symptoms. |
|
Definition
|
|
Term
|
Definition
- travel from hospital to hospital
- dramatic presentation aka "pseudologia fantastia"
- classic symptoms
- gridiron abdomen/multiple surgeries
- health care workers
- narcotics
- "orders" lab tests and procedures
- demanding, difficult
- experts at deception
- increased insistence with suspicions, new symptoms
- threats of litigation with confrontation
- leaves AMA
- several psychotic symptoms inconsistent with known psychotic d/o
- highly suggestible
- symptoms worsen with observation
- factitious mourning- dramatic events of death, no means of corroboration
- Ganser syndrome- be vague and give approximate answers |
|
|
Term
| possible etiology of factitious disorder: |
|
Definition
- extensive tmt for real illness during youth
- abusive past relationships with physician
- grudge against medical professionals
- massochistic tendencies
- history of childhood dperivation abuse neglect
- dependent roles to make up for lost parenting
- sense of mastery and control |
|
|
Term
| What personality disorders may prsent with factitious disorders? |
|
Definition
- Borderline PD
- Dependent PD |
|
|
Term
| Treatment of factitious disorder: |
|
Definition
|
|
Term
| Schizophrenia population prevalence is ___. This condition is __ between males and females. Males are more likely to have ___ ___. Females more likely to have ___ ___. |
|
Definition
- 1%
- equally
- negative symptoms
- better outcomes |
|
|
Term
| schizophrenia onset in males vs females: |
|
Definition
males 10-25 years old
females 25-35 years old or 40-50 years old |
|
|
Term
| Schizophrenia rarely ever has an onset before age 10 or after age 60. |
|
Definition
|
|
Term
| ___ is leading cause of death in schizophrenics due to __. 15% die of this. |
|
Definition
|
|
Term
| risk factor for schizophrenia: |
|
Definition
smoking
- 3/4 of all schizo patients smoke
- smoking related to decrease in antipsychotic drug induced parkinsonism
- smoking increases metabolism of antipsychotic drugs
- smoking may decrease hallucinations |
|
|
Term
| 30-50% of schizophrenics abuse alcohol> poor prognosis |
|
Definition
|
|
Term
| schizophrenia shows a __% discordance rate among monozygotic twins, so this is ___ ___. |
|
Definition
50% discordance rate
incomplete penetration |
|
|
Term
| Diathesis stress hypothesis: |
|
Definition
| genetically predisposed to stressed phenotype> may develop schizophrenia, life events play a roll too |
|
|
Term
| Dopamine theory of schizophrenia: |
|
Definition
- schizophrenia results from too much dopaminergic activity: supported by efficacy of dopamine receptor antagonists (blockers) related to D2 antagonists, drugs that increase dopamine cause psychotic symptoms
- increased levels of homovanillic acid
- likely involves multiple transmitters, especially GABA |
|
|
Term
| Diagnostic criteria for schizophrenia: |
|
Definition
- presence of 2 or more DISORGANIZED FUNCTIONING SYMPTOMS during a 1 MONTH period with PERSISTENCE OVER 6 MONTHS:
- delusions (thoughts)
- hallucinations
- disorganized speech
- disorganized/catatonic behavior (stupor, rigidity, excitement, posturing)
- negative symptoms |
|
|
Term
| negative symptoms of schizophrenia: |
|
Definition
- affective flattening (most commonly seen)
- alogia
- avolution/apathy
- anhedonia/asociality
- attention |
|
|
Term
| positive symptoms of schizophrenia: |
|
Definition
- hallucinations
- delusions
- bizarre behavior
- formal thought disorder |
|
|
Term
| 5 subtypes of schizophrenia: |
|
Definition
- Paranoid
- Disorganized
- Catatonic
- Undifferentiated
- Residual |
|
|
Term
| Paranoid schizophrenia has an __ __ and has __ __ functioning and prognosis. |
|
Definition
- older onset
- premorbid functioning and prognosis |
|
|
Term
| Disorganized schizophrenia has __ __ aka __ __ and __ __ __ ___ __ and a __ __. |
|
Definition
- disorganized speech aka word salad
- disorganzied non-goal directed behavior
- flat affect |
|
|
Term
| Catatonic schizophrenia is __ or __ with ____ of voluntary movements. They may have ___ or ___ where they repeat back sounds or movements. |
|
Definition
- stuperous or excited
- pecularities of voluntary movements
- echolalia or echopraxia |
|
|
Term
|
Definition
repeating back of sounds/movements
seen with catatonic schizophrenia |
|
|
Term
| undifferentiated schizophrenia have very mixed symptoms. |
|
Definition
|
|
Term
| Residual schizophrenia patients once met the criteria, now there is __ ___ __ or __ that do NOT meet criteria. |
|
Definition
| - new odd behaviors or beliefs |
|
|
Term
| Stages of shizophrenia (3): |
|
Definition
- prodromal- weird behavior prior to onset
- active- characteristic behaviors
- residual- behavior that not longer meets initial subtype criteria |
|
|
Term
| good prognosis of schizophrenia indicators: |
|
Definition
- acute onset
- late onset
- short duration
- FHx of mood disorder
- mood symptoms
- married
- good premorbid hx
- positive symptoms- can be treated |
|
|
Term
| Bad prognosis indcators for schizophrenia: |
|
Definition
- no precipitants
- young onset
- long duration
- FHx of schizophrenia
- withdrawn
- autistic
- single
- multiple relapses
- negative symptoms |
|
|
Term
| Schizophrenia is treated with ___ ___ __, which are particularly effective with the __ ___. |
|
Definition
dopamine receptor antagonists (blockers)
positive signs |
|
|
Term
| drugs for tmt of schizophrenia: |
|
Definition
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol) |
|
|
Term
| Chlorpromazine for tmt of ___. May cause the ___ __, a broad base shuffle, not as severe of lean foward as Parkinsons. This shuffle shows up after long term tmt. Drug tmt of schizophrenia helps __% of patients. |
|
Definition
- schizophrenia
- thorazine shuffle
- 25% |
|
|
Term
| Side effects of cholorpromazine (thorazine) and haloperidol for tmt of schizophrenia: |
|
Definition
- thorazine shuffle (long term tmt)
- akathisia, rigidity, tremor
- tardive dyskinesia> abnormal involuntary movement of tongue/mouth/limbs
- neuroleptic malignant syndrome> medical emergency, mortality of 10-20% |
|
|
Term
| Neuroleptic Malignant Syndrome can be caused by chlorpromazine (thorazine) and/or haloperidol for tmt of schizophrenia. What are the symptoms of this condition? |
|
Definition
- rigidity
- high fever
- delirium
- autonomic instability
- increased liver enzymes and Cr |
|
|
Term
| dopamine receptor blockers used to treat schizo include: |
|
Definition
- chlorpromazine
- haloperidol |
|
|
Term
| Atypical antipsychotics are ___ ___ ___, they improve __ and __ symptoms with less risk for developing __ ___. These are used for __ and control of ___ __ behaviors with schizophrenia. |
|
Definition
- serotonin-dopamine antagonists (blockers)
- positive and negative
- extrapyramidal symptoms
- used for agitation and control of acting out behaviors |
|
|
Term
| Atypial Antipscyhotics(4): |
|
Definition
- Risperidone (Resperadal)
- Olazepine (Zyprexa)
- Quetiapine
- Ziprasidone
ROQS for schizo. |
|
|
Term
| Side effects of atypical antipsychotics: |
|
Definition
- concerns with Diabetes
- orthostais (especially in elderly)
- seizures
- dehydration
- hyperlactinemia
- cognitive impairement
- weight gain |
|
|
Term
| Partial dopamine agonists can also be used to treat schizophrenia, name one: |
|
Definition
|
|
Term
| Aripiprazole/abilify is a ___ __ __ and is good for treatment of __ and __ and ___schizophrenia symptoms. It has __ side effects and results in __ weight gain thant other atypicalys especially Olanzapine. There is no __ __ with extended treatment and no increased in incidence of ___ . |
|
Definition
- partial dopamine agonist
- positive and negative and depressive
- few
- less
- NO tardive dyskinesia with extended tmt
- no increased incidence of DMII |
|
|
Term
| lifetime incidence of bipolar disorders when considering the full spectrum is ___. While lifetime prevalence when just considering bipolar I and II is ___. |
|
Definition
|
|
Term
| onset for Bipolar I ranges from ___ to __ __ with rare onset in ___ __ . |
|
Definition
- childhood to 50 years old
- rare onset in old age |
|
|
Term
| Mean age of onset for bipolar disorders: |
|
Definition
|
|
Term
| Are bipolar disorders more prevalent in men or women? |
|
Definition
| BIPOLAR DISORDERS HAVE EQUAL PREVALENCE BETWEEN MEN AND WOMEN |
|
|
Term
| Men with bipolar disorders are more likely to have ___ episodes, while women are more likely to have ___ episodes. |
|
Definition
|
|
Term
| Women are more likely to have __ episodes when experiencing ___. |
|
Definition
|
|
Term
| Women are more likely to be ___ ___, having __ or more manic episodes a year. |
|
Definition
|
|
Term
| Bipolar __ is more frequent in divorced and separated males. |
|
Definition
|
|
Term
| Bipolar II patients have high levels of conflict in their marriage |
|
Definition
|
|
Term
| Bipolar __ is more common in persons who did not graduate college, likely effect of early onset on functioning. |
|
Definition
|
|
Term
| If you are first degree relative of a Bipolar proband (first affected family member who seeks medical attention for general disorder), you are __ to ___ __ more likely to have __ ___. |
|
Definition
- 8 to 18 times
- Bipolar I |
|
|
Term
| If one parent has Bipolar d/o, there is a ___ chance of any child having a ___ ___. |
|
Definition
|
|
Term
| If both parents have bipolar disorder, there is a ___ chance of any child having a __ ___. |
|
Definition
|
|
Term
| Alcohol dependence is frequently co-morbid with Bipolar Disorders, with __ __ having somewhat higher risk of alcohol abuse. |
|
Definition
|
|
Term
| Substance abuse may precipitate episodes in Bipolar or may be attempt to self medicate. ___ are primary drug of choice. |
|
Definition
|
|
Term
| Bipolar __ patients are at a higher risk for attempting and completeing suicid than ___ __ or ___ __ __ patients. |
|
Definition
- Bipolar II
- Bipolar I or Major Depressive Disorder |
|
|
Term
| Bipolar I is a mood disorder in which a complete set of __ ___ occurs during the course of the illness. |
|
Definition
|
|
Term
| Bipolar II is a mood disorder in which __ __ and ___ ___ occur during the course of the illness. |
|
Definition
- depressive
- hypomanic episodes |
|
|
Term
| Is rapid cycling found in bipolar I, II, or both? |
|
Definition
|
|
Term
| Cyclothymic disorder is a disorder in which there are periods of __ and episodes of ___ that do not meet ___ criteria. |
|
Definition
- hypomania
- depression
- MDD |
|
|
Term
| A manic episode is a distinct period of ___ ___, ___, or ___ mood that lasts for at least __ __ with at least __ or more manic symptoms persisting throughout the episode. The manic symptoms include: |
|
Definition
- abnormally elevated, expansive, or irritable mood
- one week
- 3 or more symptoms
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative/pressured speech
- racing thoughts
- distractibility
- increased goal directed activity/psychomotor agitation
- hypersexuality, buying sprees, poor investments |
|
|
Term
|
Definition
IDMTDIH:
- inflated self-esteem, grandiosity
- decreased need for sleep
- more talkative, pressured speech
- thoughts racing
- distractability
- increased goal directed behavior/psychomotor behavior
- hypersexuality, buying sprees, poor investments |
|
|
Term
| Hypomania is a distinct period of elevated, expansive, or irritable mood lasting throughout __ days that is clearly different from the usual __ mood and includes at least __ manic symptoms. This differs from mania in the ___ or degree of behaviors and is not severe enough to cause marked __ of ___. |
|
Definition
- 4 days
- non-depressed
- 3
- severity
- NO impairment of functioning |
|
|
Term
| Bipolar lifetime suicide attempts of __ to __, and completed suicides of __ to __. |
|
Definition
|
|
Term
| Treatment of bipolar disorder with antidepressants alone may trigger a __ or ___ episode in the the undiagnosed bipolar patient. |
|
Definition
|
|
Term
| Antidpressants alone in bipolar patients may contribute to __ ___. |
|
Definition
|
|
Term
| Bipolar depression has a younger onset of younger than __ ___ with the presence of __ __ like __ ___. There is often comorbid substance abuse, usually __ __ __ like __. There is often a __ __ of bipolar disorders. There are __ __, greater than __, with ___ duration, less than __ ___, episodes. |
|
Definition
- younger than 25 years
- psychotic symptoms
- extreme anhedonia
- centrally acting depressants like alcohol
- family history
- multiple occurences, greater than 3
- shorter duration, less than months |
|
|
Term
| Since antidepressants may trigger mania in the undiagnosed bipolar patient, it is important to have them come back within the __ __ of starting antidepressants. It is still important to treat the depression, but these have poor interaction in bipolar brain. |
|
Definition
|
|
Term
| In Bipolar depression __ __ with __ during depression is common. |
|
Definition
- mixed episodes
- hypomania |
|
|
Term
| Most bipolar depressed patients have __ ___ __. Bipolar depressed should be considered in differential in anyone who presents with ___. |
|
Definition
- seasonal affective disorder
- SAD |
|
|
Term
| Half of all women with bipolar disorders have an episode following child birth. |
|
Definition
|
|
Term
| Women with postpartum depression, and no prior psychiatric history are at a higher risk for ___ ___. |
|
Definition
|
|
Term
| Lithium carbonate is __ __ used to treat __ __. Response takes __ to __ weeks so may need to initally augment with ___ or ___. |
|
Definition
- mood stabilizer
- bipolar disorders
- 1 to 3 weeks
- benzodiazepine (Clonazepam or Iorazepam)
- atypical antipsychotics |
|
|
Term
| Predictors of positive response in lithium treatment of bipolar disorders: |
|
Definition
- 80% of manic patients respond to lithium
- prior positive response
- pure mania or secondary mania
- FHx of bipolar disorders
- obsessional features
- mania followed by depression |
|
|
Term
| Predictors of negative response to lithium treatment of bipolar disorder: |
|
Definition
- BORDERLINE PERSONALITY FEATURES
- rapid cycling (at least 4 times/year)
- mixed symptoms- usually rapid cycler
- substance abuse
- psychosis
- depression followed by mania |
|
|
Term
| Lithium is effective in __% of manic patients, but is just used __ to prevent depression. |
|
Definition
|
|
Term
| ___ and ___ medications are more likely to trigger mania than ___ or ___. |
|
Definition
- Tricyclics and tetracyclics
- SSRIs and buproprion |
|
|
Term
| ___ and ___ can augment lithiums effectiveness and will not precipitate mania. |
|
Definition
- Divalproex (Depakote)
- Carbamazide (Tegretol) |
|
|
Term
| Lithium is more effective at prophylaxis for mania,so may need antidpresseant to augment for depressive episodes. Lithium is almost always indicated after __ episode of mania. Lithium maintenance reduces incidence of suicide __ fold. Patients responsive to lithium are __ __ more likely to relapse if lithium discontinued. Lithium may lose effectiveness over several years and may need augmentation with ___. |
|
Definition
- indicated after 2 episodes of mania
- reduces incidence of suicide 6 fold
- 30 times
- anticonvulsants |
|
|
Term
| Adverse effects of lithium: |
|
Definition
- minor effects that diminish over time: thirst, polyuria, tremor (due to increased calcium), diarrhea, weight gain, edema
- hypothyroidism- 5-15% of patients, more in women, monitor TSH every 6 months, managed with thyroid hormone replacement
- increased calcium levels> lethargy, ataxia, dysphoria
- exacerbation of acne, psoriasis, and hair loss
- poor memory
- distractability
- confusion |
|
|
Term
| Lithium is __ in the kidneys and ___ in the __ __ along with sodium and water. If the body becomes sodium deficient and reabsorbs more sodium, more lithium may also be absorbed resulting in ___, thus patients should avoid __ , so less time outside and more fluid intake. Also __ ___ __ should be avoided. |
|
Definition
- excreted
- reabsorbed in the proximal tubule
- toxicity
- dehydration
- sodium depleting diuretics |
|
|
Term
| 25% of patients on lithium experience a ___ ___ __ __ __ changes that are generally benign, but EKG should still be checked ___. |
|
Definition
- reversible non-specific T wave changes
- yearly |
|
|
Term
| Lithium Contraindications: |
|
Definition
- Parkinson's disease
- Diabetes
- Seizure disorders
- Renal Disease
- Myasthenia Gravis |
|
|
Term
| Lithium levels should be drawn routinely every __ to __ months, or if noncompliance is suspected or there are indications of toxicity. |
|
Definition
|
|
