Term
| How is generalized anxiety different from separation and social anxiety? |
|
Definition
| In contrast to separation and social anxiety, which generally have one anxiety triggering experience (i.e., separation and social humiliation, respectively), generalized anxiety disorder is characterized by excessive and uncontrollable worry about a number of anxiety-provoking events. |
|
|
Term
| What type of signs can you determine if pt has generalized anxiety disorder? |
|
Definition
| As with other anxiety disorders, generalized anxiety must cause marked distress, interfere with social, emotional, and educational functioning, and is not simply a reaction to recent stressors |
|
|
Term
True or False.
Generalized anxiety disorder is NOT simply a reaction to recent stressors
|
|
Definition
|
|
Term
| What population is mostly affected by generalized anxiety disorder? |
|
Definition
|
|
Term
| What is the hallmark feature of generalized anxiety disorder? |
|
Definition
| excessive worry that is difficult to control |
|
|
Term
| What is VERY important to consider when determining if pt has generalized anxiety disorder? |
|
Definition
| the worry and associated symptoms must interfere with daily functioning, and the anxiety is not triggered by recent stressful events |
|
|
Term
| What is treatment for generalized anxiety disorder? |
|
Definition
CBT and SSRI treatment
Zoloft (SSRI)
Effexor (SNRI)
Buspirone (BuSpar), a nonbenzodiazepan, nonantidepressant anxiolytic |
|
|
Term
| How do you define cyclothymic disorder? |
|
Definition
| mild, chronic mood disorder with numerous depressive and hypomanic episodes over the course of at least two years. The depressive periods never meet criteria for a major depressive episode, and the hypomanic periods never meet criteria for mania though they may or may not meet criteria for hypomania. |
|
|
Term
| mild, chronic mood disorder with numerous depressive and hypomanic episodes over the course of at least two years. |
|
Definition
|
|
Term
| Insidious onset in pt who is 21 years old. They are demonstrating frequent short cycles of subsyndromal depression and hypomania. What could it be? |
|
Definition
|
|
Term
| Name four behavioral manifestations of cyclothymic disorder. |
|
Definition
Introverted self-absorption versus uninhibited people seeking
Taciturn versus talkative
Unexplained tearfulness versus buoyant jocularity
Psychomotor inertia versus restless pursuit of activities |
|
|
Term
| What is medication for cyclothymic disorder? |
|
Definition
|
|
Term
| Cyclothymic disorder is under the umbrella of what disorder? |
|
Definition
|
|
Term
How do you diagnose major depressive disorder?
What is time criteria? |
|
Definition
| is depressed mood or loss of interest or pleasure in usual activities. The diagnosis of major depressive disorder requires the presence of at least five of nine symptom criteria for at least 2 weeks, one of which is depressed mood or loss of interest. All symptoms must be present nearly every day, except suicidal ideation or thoughts of death, which need only be recurrent. |
|
|
Term
What does this describe?
mild, chronic form of depression that lasts at least two years during which, on the majority of days, the individual experiences depressed mood for most of the day and at least two other symptoms of depression. |
|
Definition
|
|
Term
What is dysthymic disorder?
What is criteria? |
|
Definition
| mild, chronic form of depression that lasts at least two years during which, on the majority of days, the individual experiences depressed mood for most of the day and at least two other symptoms of depression. |
|
|
Term
| When do you exclude the diagnosis of dysthmia? |
|
Definition
| The disorder is excluded if there is a history of mania, hypomania, or cyclothymia. |
|
|
Term
| What is the necessary feature to diagnose bipolar I? |
|
Definition
The necessary feature of bipolar I disorder is a history of a manic or mixed manic and depressive episodes
Mania requires euphoric or irritable mood for at least 1 week (or any duration if the individual is hospitalized) and at least three (if mood is euphoric) or four (if mood is irritable) of seven symptom criteria. |
|
|
Term
What is the disorder:
excitable and emotional and behave in a colorful dramatic, extroverted fashion. |
|
Definition
| histrionic personality disorder |
|
|
Term
True or False,
In manic depressive disorder you must have the sxs everyday- is this true for Bipolar I as well? |
|
Definition
|
|
Term
| What is bipolar II disorder? |
|
Definition
| Bipolar II disorder is characterized by a history of hypomanic and major depressive episodes. The symptom criteria for a hypomanic episode are the same as those of a manic episode, though hypomania only requires a minimum duration of 4 days. |
|
|
Term
| What is the typical age of onset of bipolar disorders? |
|
Definition
|
|
Term
joy, sadness, anger, and fear
are examples of what? |
|
Definition
|
|
Term
| Moods convey sustained emotions; their more enduring nature means that they are experienced long enough to be felt inwardly. |
|
Definition
|
|
Term
| What are the nine mood disorders? |
|
Definition
1. Major Depressive Disorder
2. Dysthymic Disorder
3. Bipolar I Disorder
4. Bipolar II Disorder
5. Cyclothymic Disorder
6. Recurrent brief Depressive Disorder
7. Premenstrual Dysphoric Disorder
8. Mood disorder due to general medical condition
9. Substance-induced mood disorder |
|
|
Term
| What population is most affected by mood disorders? why? |
|
Definition
women
1. hormonal differences, childbirth effects, differing psychosocial stressors and learned helplessness
2. Manic more common in men, but women rapid recyclers (4+x a year) |
|
|
Term
| What are biological factors causing mood disorders? |
|
Definition
1. Norepineprine
2. Serotonin
3. Dopamine
4. Other neurochemical factors
5. Neuroendocrine regulation- adrenal, thyroid and growth hormone axes
7. Sleep abnormalities
8. Kindling
9. Brain imaging
10. Neuroanatomical considerations |
|
|
Term
What is criteria for major depressive disorder?
are sxs daily? nearly every day?
what might pt complain about? |
|
Definition
Five or more of symptoms for 2 weeks and represents a change from previous functioning.
1. Depressed mood most of day, nearly every day
2. Markedly diminished interest/pleasure in all/almost all activities
3. Significant weight loss or gain (5%) or decrease/increase in appetite
4. Insomnia or hypersomina
5. Psychomotor agitation or retardation observable by others
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think/concentrate, or indecisiveness
9. Recurrent thoughts of death or suicidal ideation with/without plan; suicidal attempt |
|
|
Term
What is this:
1. Depressed mood for most of day, for more days than not, indicated by subjective experience or observation for at least 2 years
2. Presence of 2+ symptoms:
poor appetite or overeating
insomnia or hypersomina
low energy or fatigue
|
|
Definition
|
|
Term
| What constitutes a manic episode? |
|
Definition
1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least a week
2. Three+ symptoms present to a significant degree
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or feel thoughts are racing
Distractibility
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in pleasurable activities that have high potential for negative consequences |
|
|
Term
| How does hypomania differ from manic episode? |
|
Definition
1. Unequivocal change lasting 4 days
2. The change in mood and functioning is observable by others
3. Not severe enough to cause marked impairment in social or occupational functioning |
|
|
Term
| a milder form of bipolar is often referred to as... |
|
Definition
|
|
Term
For at least 2 years, the presence of numerous periods with hypomanic and depression symptoms
Not been without these symptoms for more than 3 months at a time
No MDD or manic episode for 2 years of the disturbance
|
|
Definition
|
|
Term
| Meds for major depression |
|
Definition
1. SSRIs- Agents of choice
2. Newer agents- Wellbutrin, Effexor
3. Tricyclic- Elavil and Tofranil
4. Tetracyclic- Remeron and Ludiomil
5. MAO- used less frequently-hypertensive
6. Sympathomimetic- Ritalin |
|
|
Term
| What are clinical guidelines for using antidepressants? |
|
Definition
1. Antidepressant drug gradually raised to maximum level for at least 4-5 weeks before considered unsuccessful
2. Do not raise drug dose, if clinically improving
3. If patient does not improve in 2-3 weeks, then test for plasma concentration, if available
4. Maintain for at least 6 months
5. Taper off over 1-2 week period |
|
|
Term
| Never use an SSRI with what? why? |
|
Definition
MAOi
causes serotonin syndrome |
|
|
Term
What are bipolar meds?
(6) |
|
Definition
1. Lithium
2. Divalproex (Depakote)
3. Valproate (Depakene) Valproic acid
4. Carbamazepine (Tegretol)
5. Olanzapine (Zyprexa)
6. Gabapentin (Neurontin) - Rx resistant |
|
|
Term
Pts taking lithium. How often do you check them?
What are side effects? |
|
Definition
LITHIUM TOXICITY- LITHIUM- DETERMINE LEVELS EVERY 2-6 MONTHS 1-1.5 mEq/L MANIA AND .4-.8 FOR MAINTANENCE
EARLY SIGNS=NEUROLOGICAL OF COARSE TREMOR, DYSARTHIA AND ATAXIA; GI SX(NVD) AND CARDIAC CHANGES( LOOKS LIKE HYPOKALEMIA ON EKG) AND RENAL DYSFUNCTION (POLYURIA AND POLYDIPSIA) |
|
|
Term
| What is tx for dysthymic disorder? |
|
Definition
Pharmacotherapy- SSRIs and bupropion
Cognitive or behavior therapy- New ways of thinking to replace negative ways that decrease self-esteem + Increase pleasant experiences + Assertiveness + Deal with harsh inner voice |
|
|
Term
| What is the best predictor of a current suicide risk? |
|
Definition
| A PAST SUICIDE ATTEMPT IS THE BEST PREDICTOR OF PRESENT SUICIDE RISK |
|
|
Term
| Suicidal questions to ask: |
|
Definition
1. Do you have thoughts of killing yourself?
2. What is your plan?
3. Do you have the means?
4. What has stopped you from acting on your thoughts?
5. What type of stressors are you experiencing that have led you to consider suicide at this time?
6. Have you tried to kill yourself in the past?
7. Are you willing to give me the means? |
|
|
Term
|
Definition
| abnormally and persistently elevated, expansive or irritable modd lasting for at least one week, or less if a pt must be hospitalized |
|
|
Term
| What's the difference btw mania and hypomania? |
|
Definition
mania: elevated, expansive or irritable mood lasting for at least one week
hypomanic episode: lasts at least 4 days and is similar to a manic episode except that is is not sufficiently severe to cause impairment in social or occupational functioning and no psychotic features are present |
|
|
Term
| What is the age of onset of bipolar disorder? |
|
Definition
|
|
Term
| What are signs of manic episode? |
|
Definition
inflated self esteem or grandiosity
decreased need for sleep
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility
increase in goal-directed activity
excessive involvement in pleasurable activities that have a potential for painful consequences |
|
|
Term
| How long does it take for antidepressants to work? |
|
Definition
|
|
Term
| Antidepressant therapy should be maintained for at least how many months? |
|
Definition
|
|
Term
| If pt wants to stop an antidepressant. How do you do it? |
|
Definition
| taper gradually over 1 to 2 weeks, depending on the half life |
|
|
Term
| What is the therapeutic lithium level range? |
|
Definition
|
|
Term
| Lithium is typically used with what other class of drug when treating manic episode? |
|
Definition
| atypical antipsychotics, modd stabilizing anticonvulsants or high potency benzo |
|
|
Term
| What has suprassed lithium in use for acute mania? why? |
|
Definition
valproate or Depakote
bc of propylactic effects |
|
|
Term
| How do you treat extrapyramidal symptoms? |
|
Definition
diphenhydramine 25 to 50 mg IV in adults; 0.5 to 1 mg/kg in children
Although the IV route is preferred, both diphenhydramine and benztropine may be given IM or orally.
If initial treatment is successful, therapy is continued orally for 2 to 3 days to prevent recurrence. |
|
|
Term
| What causes extrapyramidal symptoms? |
|
Definition
|
|
Term
What are extrapyramidal sxs?
What are risk factors? |
|
Definition
rigidity and akinesia
temor in the head and face muscles or limbs
akinesia or bradykinesia
rigidity
Risk factors: high potency neuroleptics, increasing age and prior epirode of EPS |
|
|
Term
| What causes serotonin syndrome? |
|
Definition
concurrent admin of SSRI with an MAOI, L-tryptophan or lithium
**raises plasma serotonin concentrations to toxic levels |
|
|
Term
| What is the progression of serotonin syndrome? |
|
Definition
1. diarrhea
2. restlessness
3. extremem aditation, hyperrefflexia
4. autonomic instability with possible rapid fluctuations in vital signs
5. myoclonus, seizures, hyperthermia, uncontrollable shivering, and rigidity
6. delirium, coma, status epilepticus, cardiovasc collapse, death |
|
|
Term
| How do you treat serotonin syndrome? |
|
Definition
remove offending agents
promptly start nitroglycerine, cyproheptadine, methysergide, cooling blankets, thorazine, dantrium, benzos, anticongulsants, mechanical ventilation and paralyzing agents. |
|
|
Term
| Which SSRIs have been asssoicated with SSRI withdrawal? why? |
|
Definition
paroxetine and fluvoxamine
bc of short half life |
|
|
Term
| What are SSRI withdrawal symptoms? |
|
Definition
| dizziness, weakness, nausea, headache, rebound depression, anxiety, insomnia, poor concentration, upper resp sxs, parethesias and migraine like sxs. |
|
|
Term
When can you typically start to see SSRI withdrawal sxs?
When do they resolve? |
|
Definition
| do not appear until at least 6 weeks of tx and usually stop spontaneously in 3 weeks |
|
|
Term
| What drug is least likely to cause SSRI withdrawal? why? |
|
Definition
| fluoxetine bc half life is more than one week an dit effectively tapers itself |
|
|
Term
| When does schizophrenia typically start? ie age range |
|
Definition
|
|
Term
| Whats the difference between delusions and illusions? |
|
Definition
delusions: no stimulus
illusions: misinterpretation of actual stimulus |
|
|
Term
| What is the most effect tx for phobias? |
|
Definition
|
|
Term
|
Definition
| repetition of the same response to different stimuli, as in repetition of the same verbal response to different questions |
|
|
Term
What is the defense mechanism of borderline personality disorder?
what does it mean? |
|
Definition
projection
intolerable aspects of the self are projected onto another, the other person is induced to play the projected role |
|
|
Term
| How does the DSM IV classify borderline personality disorder? |
|
Definition
pervasiv pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity beginning by early adulthood and present in a varity of contexts
diagnosis made by showing five of the criteria |
|
|
Term
| When does pt with borderline personality disorder typically present? |
|
Definition
| about age 40 when pts are typically making major life decisions ie. marriage, occupation |
|
|
Term
What is this:
somewhere btw neurosis and psychosis and characterized by extraordinarily unstable affect, mood, behavior, object relations and self image. |
|
Definition
| borderline personality disorder |
|
|
Term
| What is tx for borderline personality disorder? |
|
Definition
psychotherapy: ie. DBT
Pharmacotherapy: used with dealing with specific personality features
antipsychotics: anger, hostility, brief psychotic episodes
antidepressants: improve depressed mood
MAO: impulsive behavior
benzo: ie Xanax for anxiety
anticonvulsants ie carbamazepine for global functioning |
|
|
Term
|
Definition
| thorazine typical antipsychotic |
|
|
Term
| What is the boxed warning for thorazine? |
|
Definition
| Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death compared to placebo. |
|
|
Term
| What type of labs do u want to draw on pt taking thorazine? |
|
Definition
| Vital signs (especially with parenteral use); lipid profile, fasting blood glucose/Hgb A1c; BMI; mental status; abnormal involuntary movement scale (AIMS); extrapyramidal symptoms (EPS); CBC in patients with risk factors for leukopenia/neutropenia |
|
|
Term
| What type of behavior do you see in histrionic personality disorder? |
|
Definition
| attentions eeking behavior |
|
|
Term
What type of disorder could this be?
pt is not comfortable if they're not center of attention
interaction with others if often characterized by inappropriate sexually seductive or provocative behavior |
|
Definition
|
|
Term
| What are the major defenses of histrionic personality disorder pts? |
|
Definition
| dissassociation and repression |
|
|
Term
| What is the tx for histrionic personality disorder? |
|
Definition
psychotherapy: psychoanalysis
pharmacotherapy: SSRI for depression, antianxiety for anxiety
antipsychotics for derealization and illusions |
|
|
Term
What type of disorder:
pt has a heightened sense of self importance and grandiose feelings of uniqueness |
|
Definition
| narcissistic personality disorder |
|
|
Term
| What is tx for narcisstic personality disorder? |
|
Definition
psychotherapy: group therapy
pharmacotherapy: lithium if mood swings are present, antidepressants such as serotonergic drugs |
|
|
Term
| What is the most common mental disorder in women? |
|
Definition
|
|
Term
| What is the difference between specific phobia and social phobia? |
|
Definition
specific phobia:strong, persisting fear of an object or situation
social phobia:strong, persisting fear of situations in which embarassment can occur |
|
|
Term
| WHen is the peak onset of social phobias? |
|
Definition
|
|
Term
| Name four types of specific phobias. ie. examples |
|
Definition
animal type
natural environment type (ie heights, storms, water)
blood injection injury type
situational type
other: fear of choking, contracting illness |
|
|
Term
| What is tx specifically for specific phobia vs social phobia? |
|
Definition
specific phobia: exposure therapy
social therapy: SSRI and behavioral/cognitive therapy |
|
|
Term
| How do you differentiate PTSD from acute stress disorder? |
|
Definition
acute stress disorder- within four weeks of the event and remits in 2 to 4 weeks
PTSD: sxs must las for more than one month after the event and must signficantly affect imp areas of life, such as family and work. |
|
|
Term
Epidemiology:
what type of person is more prone to develop PTSD? What type of everyday situation? |
|
Definition
| single, divorced, widowed, socially withdrawn or of low socioeconomic status |
|
|
Term
| What are the different subtypes of PTSD? |
|
Definition
acute: less than 3 months
Chronic: more than 3 months
With delayed onset: onset is at least 6 months after the stressor |
|
|
Term
|
Definition
SSRI (Zoloft) and Paxil are first line for PTSD
support, encouragement to discuss event and education about coping mechanisms(ie. relaxaction)
destigmative mental illness and PTSD
behavioral therapy, cognitive therapy and hypnosis |
|
|
Term
| What are detox orders for alochol? |
|
Definition
1 – Date
2 – Admit to Detox unit
3 – Attending PA
4 – Dx → ETOH w/d
5 – Allergies + rxn
6 – Activities
7 – Diet → low sodium/low fat + fluids
8 – VS parameters
9 – Medications (Ativan, Thiamine, Folic acid)
10 – Labs (LFT, electrolytes, CBC with diff)
11 – Sign & provide contact info |
|
|
Term
| Tx of choice for Bipolar II disorder? |
|
Definition
|
|
Term
| What's the difference between 302 and 201? |
|
Definition
- 302: Involuntary commitment, take a patient against their will and commit them
- 201: Voluntary commitment |
|
|
Term
| What labs do you want for anorexic pt? |
|
Definition
• CBC w/diff → dehydration, anemia, vit deficiency
• ABG → hypokalemic alkalosis (from vomiting)
• TSH
• CHEM 12 → BUN/Creatinine, BG, AP, ALT, albumin
• Lytes → Mg & K
• Lipids → increased
• Hormone tests →endocrine disorders
• EKG → bradycardia
• BP → hypotensive due to hypovolemia
• UA → preg, ketones
• CPK → cardiac enzymes
• CXR |
|
|
Term
| What labs do you want for bulimic pt? |
|
Definition
• CBC w/diff
• ABG → hypokalemic alkalosis (from vomiting)
• UA → drug screen
• Chem 12
• Lytes
• TSH
• EKG
• Amylase |
|
|
Term
| What is included in the substance abuse hx? |
|
Definition
• Substance currently taking
• Substance previously taking
• First use, last use, frequency, route of admin, amounts (WITHDRAWAL SYNDROMES)
• Periods of sobriety
• Previous D&A treatment
• Screen for psychiatric disorders
• Ask CAGE questions
o C -> Cutdown
o A -> Annoyed
o G -> Guilt
o E -> Eye-opener |
|
|
Term
| Excess of sleep is also called |
|
Definition
|
|
Term
| What classifies someone as hypersomnia? |
|
Definition
| pts who complain of sleepiness and have a clearly demonstrable tendency to fall asleep suddenly in the waking state, who have sleep attacks, and who cannot remain awake. |
|
|
Term
| What are the two most common conditions that cause hypersomnia? |
|
Definition
| sleep apnea and narcolepsy |
|
|
Term
|
Definition
| difficulty initiating or maintaining sleep |
|
|
Term
| When does narcolepsy usually occur (ie. age)? |
|
Definition
|
|
Term
| What is the most common sx of narcolepsy? |
|
Definition
sleep attacks. pts cannot avoid falling asleep
other: cataplexy: sudden loss of muscle tone, such as jaw drop, head drop, weakness of the knees or paralysis of all skeletal muscles |
|
|
Term
| How do you differentiate primary insomnia from narcoplepsy based on DSM IV? |
|
Definition
Primary hypersomnia: predominant complaint is excessive sleepiness for at least one month
Narcolepsy: irresistible attacks of refreshing sleep that occur daily for at least 3 months (must also include one or both: cataplexy and/or recurent intrusions of elements of rapid eye movement) |
|
|
Term
| What is tx for narcolepsy? |
|
Definition
forced naps at reg times
Provigil: alpha one adrenergic agonist |
|
|
Term
What is the DSM IV criteria for facticious disorder?
What is epidemiology? |
|
Definition
Intentioal production or feigning of physical or psychological signs for sxs
Motivation for behavior is to assume the sick role
External incentive are absent
Epi: usu begins in 20's/30's; mostly women |
|
|
Term
| What is Munchausen's syndrome |
|
Definition
a severe form of facticious disorder
ie. surgeries performed on someone with fake illness |
|
|
Term
| Munchaeusen's syndrome: is it more males or women? |
|
Definition
|
|
Term
| What defines hypochondriasis? |
|
Definition
| 6 months or more of a general and nondelusional preoccupation with fears of having, or the idea that one has a serious disease based on the person's misinterpretation of bodily sxs. |
|
|
Term
Epidemiology of hypochondriasis:
who is more affected males or females?
what age? |
|
Definition
men=women
20-30 years
most common among blacks than white |
|
|
Term
| What's the difference bts hypochondriasis and somatization? |
|
Definition
hypochondriasis: fear of having a disease
somatization: focus on many sxs |
|
|
Term
| Somatization is more likely to affect ____. |
|
Definition
|
|
Term
|
Definition
frequent appts with PCP
psychotherapy: behavioral therapy, congnitive therapy, hypnosis |
|
|
Term
| What is conversion disorder? |
|
Definition
| illness of sxs or deficits that affect voluntary motor or sensory functions that suggest another med condition but is judged to be due to psychological factors because the illness is preceded by conflicts or other stressers |
|
|
Term
| What is epidemiology of conversion disorder? |
|
Definition
| late childhood to early adulthood |
|
|
Term
| What are the most common conversion sxs in conversion disorder? |
|
Definition
| paralysis, blindess and mutism |
|
|
Term
| What is tx for conversion disorder? |
|
Definition
psychotherapy
lorazepam IV or IV amobarbital |
|
|
Term
| What's so different about conversion disorder than the other somatization disorders? |
|
Definition
| pt only concentrates on one symptom |
|
|
Term
| What makes somatization disorder different than other disorders? |
|
Definition
| multiplicity of the complaints and the multiple organ systems affected |
|
|
Term
| Who is most affected with somatization disorders? |
|
Definition
|
|
Term
| What is the DSM IV criteria for somatization disorder? |
|
Definition
hx of physical complaints before age 30 that occur over several years
Must also have
4 pain sxs
2 GI sxs
one sexual sx
one pseudoneurological sx |
|
|
Term
| What three features suggest diagnosis of somatizatino disorder instead of other med disorder? |
|
Definition
1. involvement of multiple organ systems
2. early onset and chronic course without development of physical signs or structural abnormalities
3. absence of lab abnormalities that are characteristic of the suggested med condition |
|
|
Term
| What is tx for somatization disorder? |
|
Definition
| psuchotherapy-indivudla and group; learn to cope with sxs, express unerlying emotions and develop alt strategies for expressing their feelings |
|
|
