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Psych Block 12
KYCOM Block 12
321
Psychology
Graduate
12/17/2013

Additional Psychology Flashcards

 


 

Cards

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
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
Term
define seperation anxiety disorder
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to concern with seperation from figures
onset in childhood
Term
define panic disorder
Definition
symptoms of anxiety, fear, avoidance, or increased arousal with unexplained panic attacks and worry about attacks or change in behavior
Term
who gets panic disorder
Definition
more common in females
Term
define agoraphobia
Definition
anxiety about being in places from which escape might be difficult or embarassing in the event of a panic attack
Term
define PTSD
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+
Term
what if someone shows PTSD signs for less than a month
Definition
its called acute stress disorder
Term
who gets PTSD
Definition
more common in females
Term
define OCD
Definition
symptoms of anxiety, fear, avoidance, or increased arousal with complusions or obsessions
Term
who gets OCD
Definition
equal in male and females
Term
define GAD
Definition
symptoms of anxiety, fear, avoidance, or increased arousal with 6mo+ of excessivel worry plus associated symptoms
Term
who gets GAD
Definition
more common in females
Term
define social phobia
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to specific object or situation (if social consider avoidant personality disorder)
Term
who gets social phobia
Definition
equal in males and females
Term
who gets phobias
Definition
more common in females
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
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
Term
signs of panic disorder
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
Term
define depersonalization
Definition
being detached from self
Term
define paresthesias
Definition
numbness or tingling
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
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
Term
signs of agoraphobia
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
Term
tx acute agoraphobia
Definition
BDZ
Term
tx first steps agoraphobia
Definition
CBT
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
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)
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
comotbidities with PTSD
Definition
depression, OCD, panic, phobia
Term
first step in PTSD tx
Definition
education and CBT focusing on negatice/catastrophic thoughts, exposure to behavorial tx, anxiety/anger, group therapy
Term
medicals for PTSD
Definition
SSRI > SNRI > TCA
Term
prognosis PTSD
Definition
often symptomatic for decades
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
Term
first step in OCD tx
Definition
CBT, education, graded exposure
Term
OCD meds
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
prognosis of OCD
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
tx GAD
Definition
CBT, relaxation therapy, psychodynamic therapy, breathing therapy

SNRI/SSRI (venlafaxine XR DOC)

may adjust for individual symptoms or metabolic profile
Term
comorbidities GAD
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
tx social phobia
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
1:88
Term
how many pediatric patients per practice are autistic
Definition
10
Term
what prcent of docs have autistic patients, what percent routinly screen for autism
Definition
44%
8%
Term
what demographic has higher rates of autism
Definition
males
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
what are 5 causes of ASD
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
<10%
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
5 signs of fragile X
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
CHAT, CHAT-M, PDDST II
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
define ADHD
Definition
poor ability to attend to a tast, impulsitivity, over activity
Term
cause of ADHD
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
5 yo
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
tx conductive disorders
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
what is enuresis
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
tx noctournal enuresis
Definition
behaviorial modification
fluid restruction
conditioning devices
imipramine
DDAVP nasal spray or tablets
Term
signs of encopresis
Definition
chronic constiation, fecal impaction, overflow incontenence

effects self esteem

loss of toilet training after 4 yo
Term
who gets encopresis
Definition
mostly males
low socio-eco
anger
Term
tx encopresis
Definition
supportive
resolve constipation
Term
define nacrolepsy, when is it seen
Definition
frequent daytime naps, cataplexy, sleep paralysis, hynogogic hallucinations

seen in adolescence
Term
tx nacrolepsy
Definition
contraceptives
anti-depressants
Term
what causes nightmares
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
night terrors tx
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
cause of sonambulism
Definition
anxiety
Term
what are habit disorders
Definition
teeth grinding/bruxism
thumb sucking
stuttering
tics
tourettes
Term
what is the cause of habit disorders
Definition
anxiety
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
stranger anxiety
phobias
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
ECT
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
<> 21 yo
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
what NT do TCA act on
Definition
5HT, NE, a1, M, H1
Term
what NT do SSRI act on
Definition
5HT
Term
what NT do SNRI act on
Definition
NE, 5HT
Term
what NT to bupropion act on
Definition
NE, D1
Term
what NT do nefazodone act on
Definition
5HT, a1, NE
Term
what NT do mirtazapine act on
Definition
a1, 5HT, H1
Term
what NT do reboxetine/atomoxetine act on
Definition
NE
Term
what NT do fluoxetine act on
Definition
5HT
Term
what NT do paroxetine act on
Definition
5HT
Term
what NT do sertaline act on
Definition
5HT
Term
what NT do fluvoxamine act on
Definition
5HT, NE
Term
what NT do citalopram / escitalopram
Definition
5HT
Term
use of TCA
Definition
major depression, enuresis
Term
use of SSRu
Definition
major depression, anxiety, impulse control, bulimia
Term
use of MAOI
Definition
major depression, social phobia
Term
use of SNRI
Definition
major depression,GAD
Term
use bpropion
Definition
major depression, smoking cesation
Term
use nefazodone
Definition
major depression
Term
use mirtazapine
Definition
major depression
Term
use reboxetine/atomoxetine
Definition
major depression, ADD, ADHD
Term
use fluoxetine
Definition
major depression, anxiety, impulse control, bulemia
Term
use paroxetine
Definition
major depression, panic, GAD, OCD
Term
use sertaline
Definition
major depression, PTSD
Term
use fluvoxamine
Definition
OCD, depression
Term
use citaopram/escitalopram
Definition
major depression, panic, agoraphobia
Term
SE TCA
Definition
dry mouth, constipation, urinary retention, blurred vision, hypotension, cradiac toxicity, sedation
Term
SE SSRI
Definition
agitation, insomnia, headache, nausea, vomiting, sexual dysfunction, hyponatremia
Term
SE MAOI
Definition
HTN, insomnia, nausea, agitation, confusion
Term
SE SNRI
Definition
HTN, nausea, insomnia, dry mouth, sedation, sweating, agitation, headache, sexual dysfunction
Term
SE buporpion
Definition
agitation, insomnia, deaache, nausea, vomiting, seizure
Term
SE nefazodone
Definition
dizzy, hepatotoxicity, sexation, hypotension, paresthesia, priapism
Term
SE mitrazapine
Definition
weight gain, sedation, dizzy, headache, sexual dysfunction (rare)
Term
SE reboxetine/aotomexitine
Definition
dizzy, sweating, insomnia, dry mouth, constipation, urinary hesitency, tachycardia
Term
SE fluoxetine
Definition
long half life, protein bound
Term
SE paroxetine
Definition
sedation, anti-cholinergic, short half life
Term
SE citalporam/escitalopram
Definition
CP450 inhibition
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
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
Term
what are the severity levels of bipolar
Definition
mild
moderate
severe without psychosis
severe with psychosis
Term
what are the 6 descriptors of bipolar
Definition
catatnic, melancholic, atypical, post-partum, seasonal, rapid cycling
Term
what is the most important part of bipolar tx
Definition
CBT, interpersonal therapy
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)
Term
medication for bipolar depressive episode
Definition
atypical anti-psychotic, lithium, lamotrigine
Term
medication for bipolar manic episode
Definition
atypical anti-psychotic, valproic acid, carbamezpine
Term
medications for agitated bipolar pt
Definition
BDZ, Im injections
Term
what caution do you need to use when medicating a bipolar pt
Definition
careful antidepressants can induce mania
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
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
Term
what are the 5 categories of causes od delirum
Definition
metabolic/endocrine
substance intoxication and withdrawl
medications
infection
other
Term
what are 10 metabolic/endocrine causes of delirum
Definition
Na, K, Mg, Ca, anoxia, ketoacidosis, hepatic and uremia encephalopathy, thyroid/parathyroid disorders
Term
what are 6 intoxication/withdrawl causes of delirium
Definition
alcohol, sedatives, opoid OD, cocaine, amphetamines, phencyclidine intoxication
Term
what 9 medicatiosn can cause delerium
Definition
anticholinergics, BDZ, sedatives, opiates, anti-psychotics, anti-epileptics, seronergics, anti-virals, anti-fungals
Term
what 10 infections can cause delirium
Definition
pneumonia, encephalitis (viral or bacterial), sepsis, AIDS encephalopathy, TB, mycosis, toxoplasmosis, CMV, UTI esp with dementia
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
Term
what are the 8 risk factors for delirium
Definition
age, dementia, sleep deprivation, opiates, sedatives, restraints, rapid decline in function, severe illness (polypharmacy)
Term
what are the types of delirium and their prevelence
Definition
mixed 46%
hyperactive 30%
hypoactive 24%
Term
what are the 6 general signs of delerium
Definition
confusion
disorientation
short term memory loss
visual hallucinations and agitations
acute onset
rapid deterioration
Term
if someone has myoclonus their delerium could be from (3)
Definition
low N
low Mg
uremia
Term
if someone has asterixis their delirium could be freom (2)
Definition
hepatic enceophalopathy
hypoxia
Term
if someone has hyporeflexia their delirium could be from (2)
Definition
low K
high Mg
Term
if someone has ataxia and nystagmus their delirium could be from
Definition
wernicke's encephalopathy
Term
if someone has lateralizing or focal signs their delirium could be from (2)
Definition
CVA, subdural hematoma
Term
if someone has tremor, ragidity, bradykinesia their deirium could be from (3)
Definition
NMS, meds, LBD
Term
what does a mini mental status exam include
Definition
person, time, place
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
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
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
Term
what will an EEG show in delirium
Definition
diffuse slowing
Term
what does a CMP include
Definition
Na, K, glucose, BUN/CR, liver enzymes, bilirubin
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
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
Term
what are alternate medications for delirium
Definition
risperidone
quetiapine + ativan PO

acetylcholinesterase inhibitors: rivastigmine (prevents dilirium), donepezil

a2 agonists: dexmedetomidine

psychostimulatants; hypoactive types
Term
what is the prognosis of delirium
Definition
15% mortality but increases with time
40% recovery (only 4% at discharge)
25% permanent cogantive impairment
Term
what is another name for delirium
Definition
toxic metabolic encephalopathy
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
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
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
Term
what do the score sof a folstein exam mean
Definition
18-30/30 = mild

10-18/30 = moderate

<10 / 30 = severe
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
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
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
signs of mild dementia
Definition
memory problems and decline in social function
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
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
Term
signs of moderate dementia
Definition
progressive memory loss and impairment of executive and social function

safety issues: driving, cooking, self care, medications, wandering
Term
what you need to do in moderate dementia
Definition
adress sagety concerns, avoidance of depression, psychosis, agitation, caregiver stress
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
signs of severe dementia
Definition
incapicated, dependent on others for basic needs, often psychotic or agitated
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
Term
how is alzheimers dementia diagnosed
Definition
diagnosis of exclusion
Term
what are the two types of alzheimers dementia
Definition
early or late onset (before or after 65 yo)
Term
what are 3 causes of alzheimers dementia
Definition
global atrophy
amyloid plaques
neurofibrillary tangles
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)
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
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
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
Term
who gets lewy body dementia
Definition
usually btwn 60-70 yo
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
frontotemporal dementia
Term
who gets picks disease
Definition
usually 30-60 yo
Term
symptoms of picks disease
Definition
rapid progression
personality and behavior changes
apathy
impaired judgement
emotional blunting
MRI: prominent frontal-temporal atrophy
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
define transference
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
schizophrenia, mood, PDD
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
SUBSTANCES, BPD, HPD
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
ASPD, BPD, mood
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
mood, substances, ASPD
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
anxiety, mood, axis 1
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
OCD, GAD, mood
Term
TX goals obsessivel compulsive personality disorder
Definition
SSRI, CBT
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
what is echophomena
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
psychostimulants
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