Term
define anxiety due to general medical condition |
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to direct effect of general medical condition |
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Term
define substance induced anxiety disorder |
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to direct effect of medication, drug abuse, or toxin |
|
|
Term
define psychotic or mood disorder |
|
Definition
not an anxiety disorder
symptoms of anxiety, fear, avoidance, or increased arousal with 6mo+ of excessive worry and associated symptoms occuring exclusivley during a mood or psychotic episode |
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Term
define seperation anxiety disorder |
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to concern with seperation from figures onset in childhood |
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Term
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Definition
symptoms of anxiety, fear, avoidance, or increased arousal with unexplained panic attacks and worry about attacks or change in behavior |
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Term
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Definition
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Term
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Definition
anxiety about being in places from which escape might be difficult or embarassing in the event of a panic attack |
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Term
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to severe traumatic event with re-experiencing of event, arousal, and avoidance of associated stimuli for 1 mo+ |
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Term
what if someone shows PTSD signs for less than a month |
|
Definition
its called acute stress disorder |
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Term
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Definition
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Term
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal with complusions or obsessions |
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Term
|
Definition
equal in male and females |
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Term
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal with 6mo+ of excessivel worry plus associated symptoms |
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Term
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Definition
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Term
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to specific object or situation (if social consider avoidant personality disorder) |
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Term
|
Definition
equal in males and females |
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Term
|
Definition
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|
Term
define adjustment disorder with anxiety |
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal that does not meet criteria for other anxiety disorders and developed from response to stressor |
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|
Term
define anxiety disorder not otherwise specified |
|
Definition
symptoms of anxiety, fear, avoidance, or increased arousal that do not meet criteria for specific anxiety disorder |
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Term
|
Definition
intense fear and discomfort with 4+ of these... palpitations, increased HR sweating trembling or shaking SOB/smothering feeling of choking nausea or abdominal distress dizzy, unsteady, lt headed, faintness de-realization, depersonalization fear of loosing control or going crazy fear of dying paresthesias chills or hot flashes reoccuring unexpected attacks w/ or w/o agorophobia |
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Term
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Definition
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Term
|
Definition
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Term
to diagnose panic disorder the attack must be followed by 1mo+ of one of these |
|
Definition
persistent concern of additional attacks worry about implications of attack or consequences change in bahavior related to attacks |
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|
Term
panic disorder cannot have association with |
|
Definition
substance abuse, medication, hyperthyroidism, other medical condition, mental disorder, social phbia, phobia, OCD, PTSD, seperation enxiety |
|
|
Term
what are the comorbidities with panic disorder |
|
Definition
depression other enxiety disorders |
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Term
|
Definition
avoidance of situation where escape is difficult safety or stress reducing behaviors in crowded situations like finding escape, going with friends
periods of exacerbation and remission |
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Term
|
Definition
|
|
Term
tx first steps agoraphobia |
|
Definition
|
|
Term
tx second steps in agoraphobia |
|
Definition
SNRI/SSRI (+BDZ if needed) > BDZ > TCA |
|
|
Term
how do you tx someone with agoraphibia and comorbid depression |
|
Definition
use antidepression with different mechanism (SSRI + buproprion) |
|
|
Term
what are the goals of CBT for agoraphobia |
|
Definition
focus on negative/irrational thoughts give homework or joirnaling and imagry and talk about event, thoughts, emotions, and behaviors
situational or graded exposure to feared stimuli
incorporate: exercise, relaxation, techniques (breathing), spirituality
psychodynamic therpay: talks about defense mechanisms |
|
|
Term
what is the prognosis of agoraphobia |
|
Definition
33% recover 50% have limited impairment 20% have major impairment |
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|
Term
what are predictors of poor prognosis for agorphobia |
|
Definition
more severe, initial panic attacks or agoraphobia longer duration of illness comorbid depression hx seperation from parent (death, divorce) high interpersonal sensitivity single marital status |
|
|
Term
what signs are requided for all PTSD diagnosis |
|
Definition
symptoms for 1mo+, acute <3mo, chronic >3mo may be delayed onset >6mo
social occupational other impairment due to experiencing, witnessing, confronting event with threatened death or injury to self or others with response of intense fear, helplessness, horror (agitation and disorganized behavior in kids) |
|
|
Term
for PTSD the pt must have at least 1 rexperiencing sign, what are they |
|
Definition
recurrent distressiing recollections(images, thoughts, perceptions) (kids may occur with theses from trauma)
recurrent dreams of event in kids they may not have no recollection and will dream and wake up scared
feeling as if the event were reoccuring(reliving, hallucinations, illusions, flash backs) awake or intoxicated
psychological distress on exposure to event cues
psysiological reactivity to event cues |
|
|
Term
to diagnose PTSD they need to have 3+ avoidance or numbing symptoms, what are they |
|
Definition
avoiding thoughts, feelings, or conversation associated with event
avoiding activities, places, or people associated with event
cannot recall important aspects of event
diminished interest in significant activities
feeling detached from others
restricted range of affect (unable to love)
sense of fore shorted future (no expectation of career, marriage, children) |
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|
Term
to diagnose PTSD they need to have 2+ increased arousal symptoms, what are they |
|
Definition
difficulty falling or staying asleep iritability or ourbursts of anger difficulty concentrating hypervifilence exaggerated starte response |
|
|
Term
what are the risk factors for PTSD |
|
Definition
post trauma prior to initiating trauma hx PTSD, depression, anxiety disorder family hx of anxiety or parental PTSD cormorbid axis II disorder disrupted parental attachments high premorbid intelligence may be protective |
|
|
Term
|
Definition
depression, OCD, panic, phobia |
|
|
Term
|
Definition
education and CBT focusing on negatice/catastrophic thoughts, exposure to behavorial tx, anxiety/anger, group therapy |
|
|
Term
|
Definition
|
|
Term
|
Definition
often symptomatic for decades |
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|
Term
perdictors for bad prognosis PTSD |
|
Definition
greater number of symptoms psychiatric hx of ther anxety/mood disorder
higher numbing or hyperarousal to stress
cormobid medical illness
female, childhood teauma, alcohol abuse |
|
|
Term
what are the required obsessive symptoms of OCD |
|
Definition
reicrrent rhoughts, impulses, or images that are intrusive and inappropirate causing anxiety or distress
thoughts, impulses, images not just excessive worry about real life problems
attmpt to neutralize thoughs, imulses, images with actions or thoughts
recognizes impulses, thoughts, or images are a product of their own mind |
|
|
Term
what are the required compulsion symptoms of OCD |
|
Definition
repetitive behaviors or mental acts in response to obsession or according to rules
acts are to reduce distress or prevent some event but are not connected in realisit way and are more to neutralize thoughts |
|
|
Term
define OCD with poor insight |
|
Definition
some point in time the person does not realize obsessions and compulsions are excessive or unreasonable |
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|
Term
|
Definition
CBT, education, graded exposure |
|
|
Term
|
Definition
SSRI high doses, clomipramine, both add anti-psychotic if severe |
|
|
Term
what percautions need to be taken with clomipramine |
|
Definition
requies EKG, BP, HR, blood level monitoring esp in combo with other meds |
|
|
Term
|
Definition
50% progressive disease 80% improve in 40 yrs 25% fluctuating course 15% phasic course with periods of complete remoission |
|
|
Term
what are signs of worse OCD prognosis |
|
Definition
ealy age of onset, longer duration obsessions and compulsions poor baswline social function magical thinking |
|
|
Term
GAD must have 3+ of these symptoms for _____ |
|
Definition
6 mo+
rstlessness or on edge easily fatigued difficulty concentrating or mind blands irritability muscle tension sleep disturbance
no other axis 1 disorder, general medical condition, mood disorder, psychotic disorder, developmental disorder
impairment in social, occupational, or other areas of functioning |
|
|
Term
|
Definition
CBT, relaxation therapy, psychodynamic therapy, breathing therapy
SNRI/SSRI (venlafaxine XR DOC)
may adjust for individual symptoms or metabolic profile |
|
|
Term
|
Definition
major depression other anxiety disorders |
|
|
Term
symptoms of social phobia |
|
Definition
anxiety of unfamillar people, possible scrutiny, showing anxiety, doing something embarassing (kids unable to have relationships with famillar people, peers, adults)
exposure to situation causes anxiety (in kids causes crying, tantrum, freezing, shrinking)
recognizes fear is excessive (except in kids)
social situations or performance avoided interfering with normal routine, occupation, or relationships
>6mo if under 10yo
not due to substances, general medical condition, other mental disorder or is unrelated to it |
|
|
Term
comorbidities with social phobia |
|
Definition
2x risk of alcohol dependence 6x risk of mood disorders |
|
|
Term
|
Definition
CBT > SNRI/SSRI > BDZ > TCA B blockers for acute/performance
social skills training (role play, rehersal, imagry, visualization) |
|
|
Term
prognosis of social phobia |
|
Definition
if onset is early it is chronic course 50% recovery by 25 yo |
|
|
Term
signs of poor prognosis in social phobia |
|
Definition
onset before 8-11 yo psychiatic or medical comorbidity more symptoms oat baseline low education status |
|
|
Term
what are signs of a phobia |
|
Definition
cured by object or situational removel exposure inavairably provokes immediate anxiety
children: crying, tantrums, freezing, clinging
recognition that fear is excessive
avoiding phobia, interferes with reoutine, occupation, relationship
if <18 yo lasts more than 6mo
not explained by OCD, PTSD, seperation anxiety, social phobia, panic disorder, agoraphobia |
|
|
Term
what are the types of phobia |
|
Definition
animal natural: heights, storms blood injection situational: airplane, elevator choking vomiting illness loud sounds costumed characters |
|
|
Term
comorbidities with phobia |
|
Definition
depression somatoform disorders |
|
|
Term
how many kids have autism |
|
Definition
|
|
Term
how many pediatric patients per practice are autistic |
|
Definition
|
|
Term
what prcent of docs have autistic patients, what percent routinly screen for autism |
|
Definition
|
|
Term
what demographic has higher rates of autism |
|
Definition
|
|
Term
how has the definition of autism recently changed |
|
Definition
used to be autism, aspergers, pervasive developmental disorder NOS, downs, CHARGE syndrome (NOT RETT)
now combined into autism spectrum disorders and social communication disorder |
|
|
Term
what are the advances that have been made in autism prevention and tx in history |
|
Definition
obligated ASD children to be provided with education and therapy in school increased awareness, screening requires sibling screening |
|
|
Term
5 bullets that must be checked to fulfill the social communication / interaction deficiency of the autism diagnosis |
|
Definition
problems reciprocating social or emotional interaction. Difficulty establishing or maintaining back and forth conversation. problem with shared attention or sharin of emotions and interests
severe problems maintaining relationships due to lack of interest, pretend play, age appropirate activities, and problems adjusting to social expectations
nonverbal communication problems: eye contact, posture, facial expression, tone of voice, gestures, inability to understand them
lack of general developmental delay |
|
|
Term
to be diagnosed with autism a child needs 2/4 criteria in restricted and repetitive behaviors, what are the 4 criteria |
|
Definition
sterotyped or repetitive speech, motor movements, or use of objects
excessive adherance to routines, rituialized patterns of verbal or non-verbal behavior, excessive resistance to change
highly restricted interests that are abnormal in intensity or focus
hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment |
|
|
Term
|
Definition
genetic: 5-6% chance of inheritence, multiple genes with variable phenotypes
enivornmental modulators affect phenotypic expression
advanced maternal and paternal age
ASD gene
neurogenic syndromes with ASD |
|
|
Term
what are som environmental factors that can trigger ASD (4) |
|
Definition
prenatal period: teratogens, infections
postnatal period: MMR, mercury |
|
|
Term
what percent of ASD is associated with a syndrome |
|
Definition
|
|
Term
what syndromes are associated with ASD (5), which is the most common |
|
Definition
fragile X - most common neurocutaneous disorders phenylketonuria fetal alcohol syndrome angleman syndrome |
|
|
Term
|
Definition
MR macrocephaly large penis and testicles hypotonia hyperextensibility |
|
|
Term
what is the percent of occurance of fragile X with ASD |
|
Definition
3-4% of ASD have fragile X 30-50% of fragile X have ASD |
|
|
Term
8 neurobiological changes that occur with ASD |
|
Definition
less purkinje cells in cerebellum abnormal limbic system, frontal lobe, termporal lobe abnormal Groca's, midstem 30% macrocephaly 90% increased braiin volume |
|
|
Term
what is the typical clinical timeline of ASD |
|
Definition
typically presents at 18mo some can begin presenting since birth others can wait up to 2 yo |
|
|
Term
15 examples of impaired social interaction in autism |
|
Definition
ignore eye contact ignore company unable to connect cannot share no joint attention cant follow gaze (8mo) cant follow point (12mo) cant protoimperative point (12-14mo) cant protodeclartive point (14-16mo) selective hearing social referencing deficit no sense of personal space no group play no abstract thinking no jokes |
|
|
Term
7 examples of speech deficits in autism |
|
Definition
scripted speech echolalia (copy cat) pop-up words (own language) giant words (runs speech together) regression of speech HALLMARK reading without comprehension |
|
|
Term
what are 4 speech development red flags for autism |
|
Definition
no babbling, pointing, gesturing 12 mo no single words 16 mo no 2 word phrases 24 mo loss of language skills at any age |
|
|
Term
what are 8 behavorial signs of autism |
|
Definition
no pretend play rituialistic enjoy handheld games, toys able to memorize unusual obsessions, compulsions, attachments self-injrous behavior inability to transition from one activity to another - causes tantrums |
|
|
Term
what are 4 sensory difference in autism |
|
Definition
hyperacuis hypo and hyper sensitivity sensory motor play: prefers texture, food mouthing/licking objects |
|
|
Term
what are 3 motor differences in autism |
|
Definition
unusual motor sterotypes: hand flapping, finger movements, rocking, twriling poor coordination/clumsiness associated hypotonia |
|
|
Term
what is the AAP recomendation for screening kids for autism |
|
Definition
screened at 9, 12, 24, and 30mo no matter what standardized autism specific screen at 18mo and again at 24mo if there was refression |
|
|
Term
why can't we screen specifically for autism under 18 mo |
|
Definition
there is no screeniing tool |
|
|
Term
what is a level 1 autism screen |
|
Definition
|
|
Term
what is a level 2 autism screen |
|
Definition
EIP, developmental clinics |
|
|
Term
what do you do if you suspect autism, why |
|
Definition
refer now work up later no speech by 5 yo means no speech ever
refer to PT, OT, speech therapy, developmental intervention
audiology evaluation
neurologist (esp if hypotonic) genetisist (esp if FLK) developmentalist |
|
|
Term
what lab tests should you get for autism |
|
Definition
chromosomal analysis (fragile X testing) FISH for subtelomere screen EEG MRI brain metabolic studies |
|
|
Term
when re-categorzed who did social communication disorder pick up |
|
Definition
people who dont quite fit into ASD PPD-NOS previous diagnosis |
|
|
Term
signs of social communication disorder |
|
Definition
social difficulty pragmatic language deficit affecting comprehension and awareness no delay in congnition or language |
|
|
Term
|
Definition
poor ability to attend to a tast, impulsitivity, over activity |
|
|
Term
|
Definition
chemical imbalance: dopaminergic, noradrenergic, serotinergic |
|
|
Term
what groups or conditions is ADHD most common with |
|
Definition
males people with 1st deg relatives alcohol abuse, anti-social behavior |
|
|
Term
when does ADAH usually appear |
|
Definition
|
|
Term
what are 5 signs in pt history of ADAH |
|
Definition
repeated year of school behavorial problems at school agression poor peer relations academic difficulty |
|
|
Term
what signs of ADHD can be found on a physical exam |
|
Definition
soft neurological signs: impaired balance, mixed hand preference, dysdiadochokinesia (can't flick hands) |
|
|
Term
what are three criteria for ADHD diagnosis |
|
Definition
low education level (not IQ) higher verbal than performance scores on WISC low scores on attention concentration performances |
|
|
Term
why dosent low IQ describe ADHD, why do people associated it with ADHD |
|
Definition
low IQ is learning dissability or mental retardation. these kids may act out becase they dont want to look dumb and aernt learning |
|
|
Term
when diagnosing ADHD what do you have to rule out |
|
Definition
petit mal epilepsy (stariing spells look like zoning out and kid wont learn)
conduct disorder
learning dissability
hearing disorder/sensory impairment
medication side effects (anti-psycotic or convulsant)
gilles de la tourette syndroome |
|
|
Term
what is the relation of tourette syndrome with ADHD |
|
Definition
often seen with ADHD and is a side effect of the medication but can be seperate too |
|
|
Term
when do you start ADHD tx |
|
Definition
at or after 5 yo unless danger to self and other |
|
|
Term
what behavorial therapy do ADHD pt do |
|
Definition
behavorial modifications special ed referral to mental health professionls |
|
|
Term
what are the benifits of ADHD medication |
|
Definition
reduce over activity increase attention span improve relationships |
|
|
Term
what things do ADHD medication not improve |
|
Definition
retention information retreival anger |
|
|
Term
what are side effects od ADHD medication |
|
Definition
anxiety anorexia insomnia abd pain tics increased HR growth supression |
|
|
Term
what is a drug free holiday, what is the thought on it |
|
Definition
kids feel different learning should occur all the time |
|
|
Term
breath holding: age, complications, treatment |
|
Definition
infants and toddlers
sometimes leads to seizures. RO seizure disorder first (seizure pass out then blue, no anger)
tx: ignore |
|
|
Term
temper tantrums: age, cause, treatment |
|
Definition
10mo-3yo caused by conflict tx: verbal resolution, time out |
|
|
Term
lying: age, cause, when is it a concern |
|
Definition
2-4 yo experimenting with language, may represent fantasy
in school age its to maintain self esteem and get out of situation
concern if deliberate or stories made up after 5 yo |
|
|
Term
why is run away behavior so serious, what is the tx |
|
Definition
run rape and tox tests too many threats now |
|
|
Term
what are two childhood behaviors that suggest immediate referral to a mental health professional |
|
Definition
fire starting poor treatment of animals |
|
|
Term
what are 4 causes of agressive behavior |
|
Definition
drive theory: biological
phenomenologic approach: agression from day to day deprivation
social learning theory: learned responsein 2-5 yos (screaming, tantrums)
passive agressive behavior: throwing objects, against other kids, boys worse than girls |
|
|
Term
what are conductive disorders |
|
Definition
antisocial behaviors: lying, stealing, firesetting, poverty destruction, cruelty to animals, run away behaviors, weapon use |
|
|
Term
|
Definition
individgual and group therapy |
|
|
Term
what is a rumination disorder, who gets it |
|
Definition
Failure to thrive or weight loss due to repeated regurgitation of food
more in males, potentially fatal, 3-14 mo old |
|
|
Term
what is PICA, who gets it, tx |
|
Definition
1-2 yo ingestion of non-nutrient substances repeatedly self limited by 2 yo monitor for lead poisoning, parasites |
|
|
Term
|
Definition
frequent inability to control urine primary: never could secondary: recently acquired |
|
|
Term
what is the cause of noctournal enuresis |
|
Definition
improper toilet training regressive behavior (stress, illness, etc) |
|
|
Term
|
Definition
behaviorial modification fluid restruction conditioning devices imipramine DDAVP nasal spray or tablets |
|
|
Term
|
Definition
chronic constiation, fecal impaction, overflow incontenence
effects self esteem
loss of toilet training after 4 yo |
|
|
Term
|
Definition
mostly males low socio-eco anger |
|
|
Term
|
Definition
supportive resolve constipation |
|
|
Term
define nacrolepsy, when is it seen |
|
Definition
frequent daytime naps, cataplexy, sleep paralysis, hynogogic hallucinations
seen in adolescence |
|
|
Term
|
Definition
contraceptives anti-depressants |
|
|
Term
|
Definition
anxiety and affective disorders |
|
|
Term
night terrors: who gets them, why |
|
Definition
preschool kids
not smooth transition in sleep stages (arousal from stage 4) |
|
|
Term
|
Definition
do not stimulate child it makes it worse allow them to transition into the next stage, they do not know thier screaming |
|
|
Term
define somnambulism, who gets it |
|
Definition
sleep walking stage 3 or 4 of sleep school age kids |
|
|
Term
|
Definition
|
|
Term
|
Definition
teeth grinding/bruxism thumb sucking stuttering tics tourettes |
|
|
Term
what is the cause of habit disorders |
|
Definition
|
|
Term
what do you do if your kid has tourettes |
|
Definition
ignore it encourage them to speak slow |
|
|
Term
what are two anxiety disorders in kids |
|
Definition
|
|
Term
what do you need to ask in diagnosis of mood disorders |
|
Definition
most recent episode, past symptoms SIGE CAPS, DIG FAST, SAD PERSONS substances, medical conditions dysthmia, cyclothymic, PDD, post-partum, seasonal, catatonia, melancholia, atypical, rapid cyclind severity (symptoms, interruption with social, occupation) |
|
|
Term
when should you hospitalize someone with a mood disorder |
|
Definition
also have severe illness suicide ideation and plan intention to die recent suicide attempt multiple suicide risk factors and losses catatonic melancholia psychotic features feelings of hopelessness |
|
|
Term
what is the first line for suicidal, psychotic, agitated or tx resistant patients who cannot tolerate meds |
|
Definition
|
|
Term
depressed pt must have __+ of these 9 symptoms for ___ not due to general medical condition |
|
Definition
5+ symptoms for 2 weeks
depressed mood sleep -insomnia typical, escess atypical interests diminished guild and worthlessness low energy concentration poor appetite: poor typica, excessive atypical psychomotoe retardation or agitation suicidal ideation |
|
|
Term
13 things that show increased risk for suicide |
|
Definition
female > male in attempts male > female in completion age <24 and >65 depression current or hx prior attempt EtOH or drugs current or hx rational loss/psychosis current or hx social support lacking organized plan or intent no spouse or single sickiness, esp chronic, painful, terminal |
|
|
Term
in general what is dysthmic disorder |
|
Definition
minor depression without suicidal thoughts |
|
|
Term
what qualifies late or early dysthhmic disorder |
|
Definition
|
|
Term
what are the signs of dysthmic disorder |
|
Definition
depressed for more days but than not but without major depression in 2 years (1 in kids) never without symptoms for >2mo
no mania, mixed, hypomanic, psychosis, substances, general medical condition with impairment of social, ccupational, or other functions
2+ of the following: poor appetite or over eating insomnia or hypersomnia low energy or fatigue low self-esteem poor cognition or difficulty making decisions feelings of hopelessness |
|
|
Term
who usually gets premenstural dysthmic disorder |
|
Definition
often people with anxiety disorders |
|
|
Term
what is the criteria for diagnosis of premenstural dysthmic disorder |
|
Definition
present in menstural cycles in past year during last week fo luteal and absent post menses that interefers with work, social, relationships, productivity and is not an exacerbation of another disorder
5+ symotoms: depression, hopeless, self-depreciating andiety, tension, feeling on edge affective liability: suddenly sad anger, irritability, conflict decreased interest in activities difficulty concentrating lethargy under/over eating, cravings hypersomnia, insomnia overwhelmed feeling breast tenderness, breast swelling, headache, joint pain, bloating |
|
|
Term
what do you need to diagnose seasonal pattern depression |
|
Definition
regular relationship with time of year (usually fall and winter) without cause with full remission between seasons for at least 2 yrs
can be applied to major depression or bipolar |
|
|
Term
what are the severity levels of depression |
|
Definition
mild moderate severe without psychosis severe with pyschosis |
|
|
Term
what are the descriptive types for depression |
|
Definition
catatonic: unable to move melancholic: (typical) lack of appetite and sleep atypical: eating, sleeping too much post partum seasonal |
|
|
Term
what is the first line of tx for depression |
|
Definition
psychotherapy: CBT, interpersonal therapy |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
what NT to bupropion act on |
|
Definition
|
|
Term
what NT do nefazodone act on |
|
Definition
|
|
Term
what NT do mirtazapine act on |
|
Definition
|
|
Term
what NT do reboxetine/atomoxetine act on |
|
Definition
|
|
Term
what NT do fluoxetine act on |
|
Definition
|
|
Term
what NT do paroxetine act on |
|
Definition
|
|
Term
what NT do sertaline act on |
|
Definition
|
|
Term
what NT do fluvoxamine act on |
|
Definition
|
|
Term
what NT do citalopram / escitalopram |
|
Definition
|
|
Term
|
Definition
major depression, enuresis |
|
|
Term
|
Definition
major depression, anxiety, impulse control, bulimia |
|
|
Term
|
Definition
major depression, social phobia |
|
|
Term
|
Definition
|
|
Term
|
Definition
major depression, smoking cesation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
use reboxetine/atomoxetine |
|
Definition
major depression, ADD, ADHD |
|
|
Term
|
Definition
major depression, anxiety, impulse control, bulemia |
|
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Term
|
Definition
major depression, panic, GAD, OCD |
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Term
|
Definition
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Term
|
Definition
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|
Term
use citaopram/escitalopram |
|
Definition
major depression, panic, agoraphobia |
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Term
|
Definition
dry mouth, constipation, urinary retention, blurred vision, hypotension, cradiac toxicity, sedation |
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Term
|
Definition
agitation, insomnia, headache, nausea, vomiting, sexual dysfunction, hyponatremia |
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Term
|
Definition
HTN, insomnia, nausea, agitation, confusion |
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Term
|
Definition
HTN, nausea, insomnia, dry mouth, sedation, sweating, agitation, headache, sexual dysfunction |
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Term
|
Definition
agitation, insomnia, deaache, nausea, vomiting, seizure |
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Term
|
Definition
dizzy, hepatotoxicity, sexation, hypotension, paresthesia, priapism |
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Term
|
Definition
weight gain, sedation, dizzy, headache, sexual dysfunction (rare) |
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|
Term
SE reboxetine/aotomexitine |
|
Definition
dizzy, sweating, insomnia, dry mouth, constipation, urinary hesitency, tachycardia |
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Term
|
Definition
long half life, protein bound |
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Term
|
Definition
sedation, anti-cholinergic, short half life |
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Term
SE citalporam/escitalopram |
|
Definition
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Term
what are the three types of bipolar disorder and their differences |
|
Definition
bipolar 1: one more more manic/mixed episodes with at least one major depressive episode
bipolar 2: one or more major depressive episodes with at least one hypomanic episode
bipolar NOS: symptoms do not meet criteria for either |
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|
Term
signs of bipolar disorder |
|
Definition
elevated/iritable mood for 1wk+ that does not meet criteria for mixed episode, substance abuse, medical condition that impairs occupational or social activities
3/7 for a manic episode for a week, 3/7 for a hypomanic episode 4-7d distractability insomnia grandiose inflated self-esteem flight of ideas, rapid thoughts activities goal directed speech rapid, pressured thoughtless, impulsive |
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Term
what are the severity levels of bipolar |
|
Definition
mild moderate severe without psychosis severe with psychosis |
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|
Term
what are the 6 descriptors of bipolar |
|
Definition
catatnic, melancholic, atypical, post-partum, seasonal, rapid cycling |
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|
Term
what is the most important part of bipolar tx |
|
Definition
CBT, interpersonal therapy |
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|
Term
what are the DOC for bipolar |
|
Definition
mood stabilizers: lithium, valproic A. lamotrigine, carbamazepine, oxcarbasepine
atypical anti-psychotics: olanzapine, ariprazole (can add to mood stabilizer) |
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|
Term
medication for bipolar depressive episode |
|
Definition
atypical anti-psychotic, lithium, lamotrigine |
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|
Term
medication for bipolar manic episode |
|
Definition
atypical anti-psychotic, valproic acid, carbamezpine |
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|
Term
medications for agitated bipolar pt |
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Definition
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|
Term
what caution do you need to use when medicating a bipolar pt |
|
Definition
careful antidepressants can induce mania |
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|
Term
what are the signs of cyclothymic disorder |
|
Definition
2yrs+ of hypomanic and depressive symptoms that do not qualify for major depression (1 yr in kids)
not accounted for by psychotic disorder, medication, substance, medical condition
impairment in social, occupational, and other areas of functioning |
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|
Term
why is it important to keep organic brain disorders in the ddx |
|
Definition
must exclude before diagnosing anxiety, psychotic, or mood disorders
treatment and prognosis are much different |
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|
Term
what are the 5 categories of causes od delirum |
|
Definition
metabolic/endocrine substance intoxication and withdrawl medications infection other |
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|
Term
what are 10 metabolic/endocrine causes of delirum |
|
Definition
Na, K, Mg, Ca, anoxia, ketoacidosis, hepatic and uremia encephalopathy, thyroid/parathyroid disorders |
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|
Term
what are 6 intoxication/withdrawl causes of delirium |
|
Definition
alcohol, sedatives, opoid OD, cocaine, amphetamines, phencyclidine intoxication |
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|
Term
what 9 medicatiosn can cause delerium |
|
Definition
anticholinergics, BDZ, sedatives, opiates, anti-psychotics, anti-epileptics, seronergics, anti-virals, anti-fungals |
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|
Term
what 10 infections can cause delirium |
|
Definition
pneumonia, encephalitis (viral or bacterial), sepsis, AIDS encephalopathy, TB, mycosis, toxoplasmosis, CMV, UTI esp with dementia |
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|
Term
what 13 other conditions cause delirium |
|
Definition
depression dementia dialysis dysequlibrium syndrome hyperthermia hypertensive crisis wernicke's encephalopathy - alcoholic CO poisoning heavy metal poisoning MS SLE postical confusion: partial/grand mal seizure cushing syndrome addisons disease |
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|
Term
what are the 8 risk factors for delirium |
|
Definition
age, dementia, sleep deprivation, opiates, sedatives, restraints, rapid decline in function, severe illness (polypharmacy) |
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|
Term
what are the types of delirium and their prevelence |
|
Definition
mixed 46% hyperactive 30% hypoactive 24% |
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|
Term
what are the 6 general signs of delerium |
|
Definition
confusion disorientation short term memory loss visual hallucinations and agitations acute onset rapid deterioration |
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|
Term
if someone has myoclonus their delerium could be from (3) |
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Definition
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|
Term
if someone has asterixis their delirium could be freom (2) |
|
Definition
hepatic enceophalopathy hypoxia |
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|
Term
if someone has hyporeflexia their delirium could be from (2) |
|
Definition
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|
Term
if someone has ataxia and nystagmus their delirium could be from |
|
Definition
wernicke's encephalopathy |
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|
Term
if someone has lateralizing or focal signs their delirium could be from (2) |
|
Definition
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|
Term
if someone has tremor, ragidity, bradykinesia their deirium could be from (3) |
|
Definition
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|
Term
what does a mini mental status exam include |
|
Definition
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|
Term
what are the 5 parts to initial assessment of someone with delerium |
|
Definition
is the pt safe? do they need emergency hold? do they need restraints? need observation 1:1 percautions for agitation, psychosis, suicide ICU care with monitoring of vitals, O2, fluids |
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|
Term
what are important aspects of a medical history for a delirium pt |
|
Definition
ask nurses, pt family, friends, caretakers, previous physicians
review medical records and meds
previous labs and studies |
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|
Term
what labs should you order for dilirium |
|
Definition
CBC, CMP, urinalysis and drug screen, thyroid studies
as needed: lithium levels, CT, MRI, O2 stat/AGB, LP, EEG, XR |
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|
Term
what will an EEG show in delirium |
|
Definition
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|
Term
|
Definition
Na, K, glucose, BUN/CR, liver enzymes, bilirubin |
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|
Term
what are the non-medication tx for delirium |
|
Definition
coordinate with other physicians monitor safety monitor other medical conditions environmental intervention: orientate using lighting, clocks, family, etc sleep: agv ICU <2h sleep. sedative, opiates, and ventilator pt are not sleeping, their over sedated
remove all cath, line, tube, vent, opiate, sedative asap to reduce hospital stay and prognosis |
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|
Term
when diagnosing delirium how do you determine the prefence of order in your ddx, what conditions should come first |
|
Definition
diagnose and tx conditions that are reversible first
hypoglycemia, hypoxia, hyperthermia, hypertension, alcohol/substance withdrawl, anti-cholinergic delirium |
|
|
Term
what is DOC for psychosis and agitation, how should it be administered, what are the percautions |
|
Definition
haldol and atival (lorazepam) / H2A protocol
IV haldol has better absorption, dosent depend on pt cooperation, and min effect on BP, HR, RR
stop if QTc > 500 stop if QTc > 25% baseline
ativan should be less than half haldol dose |
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|
Term
what are alternate medications for delirium |
|
Definition
risperidone quetiapine + ativan PO
acetylcholinesterase inhibitors: rivastigmine (prevents dilirium), donepezil
a2 agonists: dexmedetomidine
psychostimulatants; hypoactive types |
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|
Term
what is the prognosis of delirium |
|
Definition
15% mortality but increases with time 40% recovery (only 4% at discharge) 25% permanent cogantive impairment |
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|
Term
what is another name for delirium |
|
Definition
toxic metabolic encephalopathy |
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|
Term
what are the parts to a dementia evaluation |
|
Definition
history: patient, family, chart, nurses
Labs: CBC, CMP, TSH, B12, CT
folstein mini mental status exam
minicognative exam |
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|
Term
what is the difference between thw two mental status exams |
|
Definition
folstein: long, maybe education bias, no executive function portion
mini cog: short, less education and culture bias, measures executive functions |
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|
Term
what are the 11 steps for a folstein mini mental status exam and their scores |
|
Definition
location 5 date/season 5 repeat 3 obhects 3 sereal 7s/spell wold 5 recall 3 objects 3 name two objects 2 repeat: no ifs ands or buts 1 3 step command 3 read "close your eyes" 1 write a sentence 1 draw intersecting pentagons 1 |
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|
Term
what do the score sof a folstein exam mean |
|
Definition
18-30/30 = mild
10-18/30 = moderate
<10 / 30 = severe |
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|
Term
what are the steps to the mini cognative exam |
|
Definition
register 3 objects draw a clock at 11:10 (requires organization) recall 3 objects |
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|
Term
how is a mini mental cognative exam scored |
|
Definition
0 objects recalled = impaired 1-2 objects recalled = look at clock to decide 3 obhects recalled = not impaired |
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|
Term
what are the three steps of tx for dementia |
|
Definition
decide level of care: outpt, partial hospital, inpatient, involuntary hold
involve family, friends, caretakers
determine stage |
|
|
Term
|
Definition
memory problems and decline in social function |
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|
Term
what do you need to do in mild dementia |
|
Definition
form alliance with pt, educate family and pt, determine plan, prevent depression and suicide, driving, psychosis, falls
advise on power of attourney, financial planning |
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|
Term
treatment of mild dementia |
|
Definition
acetylcholinesterase inhibitior start slow: dnepezil, rivastigmine, galantamine
limit meds adding confusion: anticholinergics, BDZ, anti-psychotics
treat depression with ssri |
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|
Term
signs of moderate dementia |
|
Definition
progressive memory loss and impairment of executive and social function
safety issues: driving, cooking, self care, medications, wandering |
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|
Term
what you need to do in moderate dementia |
|
Definition
adress sagety concerns, avoidance of depression, psychosis, agitation, caregiver stress |
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|
Term
tx of moderate dementia and side effects |
|
Definition
memantine (NMDA receptor antagonis): may cause extraparymidal symptoms, tarditive dyskinesia, neuropletic malignant syndrome, metabolic syndrome |
|
|
Term
|
Definition
incapicated, dependent on others for basic needs, often psychotic or agitated |
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|
Term
what you need to do in severe dementia |
|
Definition
duscuss nursing home and preperation for death (CPR/DNR, med withdrawl, feeding tubes)
drugs not effective |
|
|
Term
what are in the ddx for dementia that must be eliminated (2) |
|
Definition
mild cognative impairment
pseudodementia: major depressive disorder |
|
|
Term
what is the first, second, and third common form of dementia, what is the prevelence |
|
Definition
50-75% alzheimers 5-35% vascular 20-30% lewy body |
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|
Term
how is alzheimers dementia diagnosed |
|
Definition
|
|
Term
what are the two types of alzheimers dementia |
|
Definition
early or late onset (before or after 65 yo) |
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|
Term
what are 3 causes of alzheimers dementia |
|
Definition
global atrophy amyloid plaques neurofibrillary tangles |
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|
Term
what are three required signs of alzheimers dementia |
|
Definition
gradual continual decline social or occupational impairment memory impairment (inability to learn new information or recall) |
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|
Term
you need one of these three symptoms to diagnoze alzheimers dementia |
|
Definition
aphasia: language disturbance agnosia: failure to recognize or identify obhects despite normal sensory functions disturbance of executive function: planning, organizing, executing |
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|
Term
what determines the prognosis of alzheimers dementia |
|
Definition
diagnose early, family and pt education, planning, and safety |
|
|
Term
who gets vascular dementia |
|
Definition
more common in men associated with HTN, cardiac, and renal disease |
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|
Term
signs of vascular dementia |
|
Definition
acute onset CT/MRI shows CVA focal/lateralizing signs |
|
|
Term
what are focal/lateralizing signs |
|
Definition
hemiparesis, hemiparalysis, hemianopia, hyperactive DTR, babinski |
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|
Term
who gets lewy body dementia |
|
Definition
|
|
Term
signs of lewy body dementia |
|
Definition
parkinsonian: tremor, bradykinesia, rigidity, gair abnormalities
visual hallucinations: auditory and delusions
agitation, varied arousal, depression, frequent falls
poor toleration to anti-psychotics |
|
|
Term
what is the cause of lewy body dementia |
|
Definition
dementia due to late stage parkinsons disease |
|
|
Term
what is another name for picks disease |
|
Definition
|
|
Term
|
Definition
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|
Term
symptoms of picks disease |
|
Definition
rapid progression personality and behavior changes apathy impaired judgement emotional blunting MRI: prominent frontal-temporal atrophy |
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|
Term
causes of substance abuse dementia |
|
Definition
years of alcoholis, relapses, delerium, falls, subdural hematoma, seizures (hypoxia), cirrhosis |
|
|
Term
tx for alcohol induced dementia |
|
Definition
stabilized with abstinence |
|
|
Term
why is it important to "know thyself" when helping a pt with a personality disorder |
|
Definition
need to understand your mental and emotional response to create effective tx and alliance and adapt to your pt personality traits |
|
|
Term
|
Definition
how pt views relationship with doctor |
|
|
Term
what is a common example of transference |
|
Definition
usually viws dr as authority figure (esp people with previous authority figure issues) |
|
|
Term
define counter-transference |
|
Definition
how you feel about the patient |
|
|
Term
what is a common example of counter-transferece |
|
Definition
dr treats pt differently due to issues they didnt deal with in their past |
|
|
Term
what are the characteristics of a personality disorder that distinguish it from other disorders |
|
Definition
pattern of inner experience that deviates from expercations of culture
inflexible, persuasive pattern of behavior across range of personal or social sitations cause distress, impairment in social or occupational or other functions
onset in adolescence or adulthood
not due to other mental disorder, substance, or general medical condition |
|
|
Term
what are 4 ways a personality disorder manifest |
|
Definition
cognition: way of percieving self, others, events
affectivity: range, intensity, liability
interpersonal functioning
impulse control |
|
|
Term
describe cluster A, what are the disorders |
|
Definition
weird, odd, eccentric
paranoid, schizoid, schizotypical |
|
|
Term
describe cluster B, what are the disorders |
|
Definition
wild, erratic, draumatic, emotional
antisocial, bordering, histrionic, narcissistic |
|
|
Term
descirbe cluster C, what are the disorders |
|
Definition
wimpy, anxious, fearful
avoidant, dependent, obsessive compulsive |
|
|
Term
signs of paranoid personality disorder |
|
Definition
distrust, suspiciousness of others exploiting, harming, or decieving them |
|
|
Term
ddx of paranoid personality disorder |
|
Definition
psychotic, mood, substance, GMC |
|
|
Term
TX goals of paranoid personality disorder |
|
Definition
develop trust, be sincere and honest obout reality of tx |
|
|
Term
signs of schizoid personality disorder |
|
Definition
isolation, detachment, restricted range of emotion, neutral toughts about close relationships |
|
|
Term
DDX of schizoid personality disorder |
|
Definition
psychotic, mood, PDD, STPD, APD |
|
|
Term
TX goals of schizoid personality disorder |
|
Definition
business approach, emotional engagement can threatn, remain neutral |
|
|
Term
signs of schizotypical personality disorder |
|
Definition
eccentric, interpersonal deficit, odd beliefs, magical thinking, odd speech (vauge, circumstantial), severe social anxiety, isolated |
|
|
Term
DDX schisotypical personality disorder |
|
Definition
|
|
Term
TX goals of schizotypical personality disorder |
|
Definition
supportive (aware of decompensation), meds to AP and anxiety |
|
|
Term
signs of antisocial personality disorder |
|
Definition
disregard, violation, exploitation, deceit, agression, impulsive, irresponsible, illegal |
|
|
Term
DDX antisocial personality disorder |
|
Definition
|
|
Term
TX goals antisocial personality disorder |
|
Definition
develop trust, straight forward, education, set boundries, refer
hardest to treat |
|
|
Term
signs of borderline personality disorder |
|
Definition
unstable relationships and self-identity reactive mood (irritability, rage) parasuicidal emptiness love hate fluctuations act out if shunned (abandoment issues)
"no one has hever been able to help me before! thank you!" then they hate you later for minor conflict |
|
|
Term
DDX borderline personality disorder |
|
Definition
mood disorder, substances |
|
|
Term
TX goals borderline personality disorder |
|
Definition
dont take personally adress possible hx sexual abuse (PTSD) develop trust refer to DIALECTIC BEHAVORIAL THERAPY |
|
|
Term
signs of histrionic personality disorder |
|
Definition
attention seeking uncomfourtable if not center of attention draumatic seductive often at appt provocative superficial relationships |
|
|
Term
DDX histrionic personality disorder |
|
Definition
|
|
Term
signs of narcissistic personality disorder |
|
Definition
arrogand grandiose sense of importance need for admiration entitled preoccupied with success and power defensive exoloitive lack empathy |
|
|
Term
DDX of narcissistic personality disorder |
|
Definition
|
|
Term
TX goals of narcissistic personality disorder |
|
Definition
develop trust point out self esteem issues individual/group psychotherapy meds do not feed fantasies |
|
|
Term
signs of avoidant personality disorder |
|
Definition
social inhibition avoids social activities, desires relationships afraid of rejection feels inferior |
|
|
Term
DDX of avoidant personality disorder |
|
Definition
social phobia, mood, substances |
|
|
Term
TX foals of avoidant personality disorder |
|
Definition
develop trust, SSRI, individual CBT, monitor sedative/alcohol abuse |
|
|
Term
signs of dependent personality disorder |
|
Definition
emotional dependence seeks another relationship when close to ones end fear of disapproval and expressing opinions needs reassurance and advice codependent |
|
|
Term
DDX dependent personality disorder |
|
Definition
|
|
Term
TX goals dependent personality disorder |
|
Definition
support meds CBT psychodynamic assertiveness training Alanon/ACOA |
|
|
Term
signs of obsessive compulsive personality disorder |
|
Definition
preoccupation with orderliness, perfectionism, control, rules, lists, order, organization, schedules to the extent where point of activity is lost |
|
|
Term
DDX obsessive compulsive personality disorder |
|
Definition
|
|
Term
TX goals obsessivel compulsive personality disorder |
|
Definition
|
|
Term
why is schizophrenia such a bad diagnoisis |
|
Definition
it is progressive, chronic, and relapsing costly to family, pt, and society |
|
|
Term
what is the best way to improve the prognosis of someone with schizophrenia |
|
Definition
early intervention, detection, and tx |
|
|
Term
what is the cause of schizophrenia |
|
Definition
neurodevelopmental, neurodegenerative, neurochemical nature vs nuture |
|
|
Term
what are 5 post mortom signs we see in pt with schizophrenia |
|
Definition
enlarged lateral and 3rd ventricles decreased cortical volume temporal lobe volume loss (esp hippocampus) small cortical and hippocampal nsueons fever neurons in dorsal thalamus |
|
|
Term
what is the criteria for a schizopnrenia diagnosis |
|
Definition
at least two positive/negative symptoms and scial, occupational, or self care dysfunction for 6 mo |
|
|
Term
what are 2 positive symptooms of schizophrenia |
|
Definition
hallucinations: external source, commentary, or dialouge
delusions: false beliefs, paranoid, grandiose, somatic |
|
|
Term
what are 5 negative symptoms of schizphrenia |
|
Definition
diminished emotions, apathy, amotivation
social withdrawl, lack of social interest
algoia: poverty of speech
disorganized speech (formal thought disorder)
purpousless movement or sequences of movement |
|
|
Term
what characteristics must the pt not display to be diagnosed with schizophrenia 3 |
|
Definition
schizoaffective mood disorder (schizophrenics can have some mania or depression during episodes)
substance abuse or general medical conditions causing psychological effects
developmentl disorder (autism) unless present with severe symptoms for >1mo |
|
|
Term
wat are the 3 subtypes of schizophrenia |
|
Definition
paranoied disorganized catatonic |
|
|
Term
what are the characteristics of a paranoid schizophrenic |
|
Definition
hallucinations and delusions disorganization flat or inappropirate affect catatonia |
|
|
Term
what are the caracteristics of a disorganized schizophrenic |
|
Definition
disorganized speech disorganized behavior flat or inappropirate affect NO catatonia |
|
|
Term
what are the characteristics of a catatonic schizophrenic |
|
Definition
immobility: cataplexy or stupor motor hyperactivity w/o porupose extreme negativism or mutism peculiar voluntary movement or posture prominent mannerisms or grimacing ecchophomena |
|
|
Term
|
Definition
echolia: mimicing words echopraxia: mimicing behaviors |
|
|
Term
what is the tx for schizophrenia, which is the best, why |
|
Definition
atypical anti-psychotics are better at negative symptoms like withdrawl and apathy because they interact with 5HT2A receptors
also include psychosocial therapy and education |
|
|
Term
define schizoaffective disorder, what is the main concern |
|
Definition
fits criteria of schizophrenia but due to major mood episode (unipolar or bipolar)
people are normally higher functioning so have increased risk of suicide |
|
|
Term
symptoms of mood disorder with psychosis |
|
Definition
mood changes and cingruent ideation vegetative symptoms cognative changes acute or subacute onset in response to psychosocial stressor |
|
|
Term
what is the prognosis of mood disorder with psychosis |
|
Definition
psychosis is only associated with severe mood episodes with intrepisodic recovery respond well to psychotherapy |
|
|
Term
define delusional dissorder |
|
Definition
prominent delusions with behavior and cognition organized around them without other psychosis |
|
|
Term
why is treatment od delusional disorder difficult |
|
Definition
the pt is functional and illusions are non-bizare so their are refractory to tx |
|
|
Term
what are the 6 types of delusional disorder |
|
Definition
persecutory: someone out to get them, specific to someone
jealous: usually think spouse is cheating, more common in males
smatic: believe parasite in skin
grandiose: claims to have relationship with famous person or to be gifted
erotomanic: insists someone is in love with them
shared: being affected by someone else's delusions |
|
|
Term
define schizophreniform disorder |
|
Definition
symptoms of schizophrenia before they have hit 6 mo need for diagnosis |
|
|
Term
brief psychotic disorder: timeline, cause, prognosis |
|
Definition
abrupt onset and duration <1mo due to acute stressor cognition in tact good prognosis |
|
|
Term
signs of drug related psychosis |
|
Definition
history of drug abuse and often dependence impulsitivity interpersonal, occupational, and legal history psychosis active during drug use |
|
|
Term
what drugs are most common cause of drug related psychosis |
|
Definition
|
|