Term
| What is the Mental Status exam used for? |
|
Definition
| It is the psychiatry's equivalent of the physical exam. |
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Term
| What are the components of the mental status exam? |
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Definition
Appearance
Level of alertness
Orientation
Psychomotor
Speech
Affect
Mood
Thought Process
Thought content
Cognitive function (concentration, memory)
Insight, Judgment
Reliability |
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Term
| What are the components of the Psychiatric Interview? |
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Definition
designed to diagnose psychiatric disorders
Ask specific questions related to psychiatric diagnoses. |
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Term
| What are the functions of the psychiatric interview? |
|
Definition
To diagnose psychiatric disorders.
To determine the mental status of the patient. |
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Term
| Describe the uses of the mini mental status exam. |
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Definition
| It can identify patients with cognitive problems, and follows the progress of patients with cognitive problems. It can be used to screen for dementia. |
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Term
| What is a limitation of the Mini Mental Status exam? |
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Definition
| It does not diagnose cognitive problems, and it relies on verbal, reading, and writing ability. This could cause problems with those who cannot read or right. There could also be language barriers. |
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Term
| What are the symptoms of bereavement? |
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Definition
Symptoms overlap with depression, but it is uncommon to have sustained suicidal ideation, or feelings of worthlessness in uncomplicated bereavement.
Symptoms: Insomnia, depressed mood, guilt, decreased concentration, lack of motivation, fatigue. |
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Term
| How do you diagnose major depressive disorders? |
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Definition
| Other conditions can cause or mimic depressive diseases. Lab tests cannot diagnose depression, but can rule out other diseases. Do a patient interview to determine if there is substance abuse, personality disorders, demential or depression due to medical conditions or medications. |
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Term
|
Definition
| Chronic depression. The patient often says they have always been depressed. usually begins in childhood. Insidious onset. Now known to have genetic and social etiology. |
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Term
| How do you diagnose dysthymia? |
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Definition
Must have depressed mood for most of the day for at least 2 years. (1 year in children)
Presence of 2 or more of: Poor appetite or overeating, insomnia or hypersomnia, low energ or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.
Has never been without sx for mor than 2 months
no major depressive episode in the last 2 years
Cause clinically significant impairment |
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Term
|
Definition
Premenstrual Dysphoric DIsorder: Occurs in about 3-8% of women.
Symptoms: depression, irritability
PMDD sx only occur during luteal phase
Sx remit soon after onset of menses |
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Term
| What is the treatment for PMDD? |
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Definition
| Same as PMS: bloating, breast tenderness, food cravings, moodiness, anxiety, depression, insomnia, headache, fatigue |
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Term
| What is a postpartum mood disorder? |
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Definition
extremely rare
typically begins 2-3 days after delivery
affected woman at risk of suicide or infanticide.
They are often embarrassed of their symptoms.
Hospitalization usually necessary. |
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Term
| How do you diagnose major depressive disorders? |
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Definition
* 5 of 9 symptoms present for 2 weeks
* 1 must be persistent, or they must have anhedonia (loss of interest or pleasure in living) |
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Term
| What are the 9 possible symptoms of major depressive disorders? |
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Definition
1. depressed mood
2. anhedonia
3. sleep disorder
4. change in apetite or wight
5. fatigue or loss of energy
6. psychomotor retardation or agitation
7. trouble concentrating or making decisions
8. low self esteem or guilt
9. recurrent thought of death or suicidal ideation |
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Term
| What are other less common symptoms in depressive diseases? |
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Definition
| delusions, hallucinations, mood congruent, loss of libido, somatic symptoms. |
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Term
| How do you treat major depressive disorders? |
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Definition
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Term
| What are the screening questions for Depressive disorders? |
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Definition
1. "over he past 2 weeks have you ever felt down, depresed or hopeless?
2. over the past two weeks have you felt little interest or pleasure in doing things? |
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Term
| How do you treat depression? |
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Definition
Explain it is a common disorder
instill hope: depression is curable
Explain treatment is not designed to make patients "not feel"
Discuss the natural istory of an episode of major depression
Treat mild depression without medications:
increase social support, decrease stressors, increase exercise, ensure sleep, evaluate diet/alcohol use, counseling by primar care provider, or mental health specialist |
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Term
| What are the indications for treatment of depression with psychotherapy alone? |
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Definition
Less sever depression
prior response to psychotherapy
incomplete response with medication
chronic psycosocial problems
patient preference |
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Term
| What are the types of psychotherapy for depression? |
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Definition
cognitive behavioral therapy
interpersonal therapy
psychoanalytical psychotherapy
supportive psychotherapy
family therapy
group therapy |
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Term
| What are medications for depression? |
|
Definition
| SSRIs are the "first line" of drugs due to safety, tolerabilit, and ease of administration. |
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Term
| How do you diagnose bipolar disorder I? |
|
Definition
Manic episode lasting at least a week
episodes of major depression
Bipolar I disorder can exist with just manic episodes. |
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Term
| How do you diagnose Bipolar II disorder? |
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Definition
Must be more major depressive episodes with at least one hypomanic episode.
No manic episodes. |
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Term
| What is the difference in treatment for Bipolar I vs. II? |
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Definition
| antidepressant medications can be used in Bipolar II disorder, but are usually avoided in Bipolar I. |
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Term
| What are the pharmacotherapy treatments of mood disorders? |
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Definition
Lithium is the gold standard for Bipolar I
Maintenance treatment with lithium reduces suicide.
Valproic acid and atypical antipsychotics are also first line treatments. |
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Term
| What are side effects of SSRIs? |
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Definition
| GI, headache, sleep disturbance, fatigue, agitation, weight gain, dry mouth, sexual side effects, increased suicidal ideation. |
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Term
| What are non SSRI antidepressants |
|
Definition
mirtazapine
Venlafaxine
Duloxetine |
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Term
| Mirtazapine:use and side effects |
|
Definition
Useful in elderly with decreased appetite and insomnia
can cause weight gain |
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Term
| Venlafaxine: Use and symptoms |
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Definition
serotonin and norepinephrine reuptake inhibitor
has similar side effects to SSRIs but higher incidence of hypertension, expeciallly at higher doses.
nausea and sedation
can work for ADHD, and GAD. |
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Term
| Duloxetine: what it does, side effects |
|
Definition
combined selective serotonin and norepinephrine reuptake inhibitor
sie effects similar to SSRIs. |
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Term
| What are the long term risk factors for suicide? |
|
Definition
Gender (male)
alcoholism/intoxication
psychiatric illness
age/ethnicity
chronic physical illness
lack of social support
being unmarried
loss of loved one
anniversary of important event
Explicit suicidal intent
hopelessness
well formulated plan
previous attempts |
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Term
| What are the protective factors of suicide? |
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Definition
Sense of responsibility to family, especially custodian children
fear of suicide act
fear of unknown
fear of social disapproval
religious beliefs |
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Term
| Short term risk factors for suicide? |
|
Definition
severe psychic anxiety
anxious ruminations
global insomnia
depression with delusions of gloom or doom
recent alcohol use
recent purchase of a gun |
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Term
| discuss management of suicide in a primary care setting |
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Definition
Ask about suicide, and don't take notes while you do
Ask: how does the future look to you, how bad do you feel, have you thought about ending your life, a plan? how close have you come? |
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Term
| What are the signs and symptoms of generalized anxiety disorder? |
|
Definition
Almost constant worry and anxiety
Lasts more than 6 month
interferes with normal functioning
worry and anxiety are difficult to control
Associated with 3 or more of the following:
restlessness, easily fatigued, difficulty concentrating or mind goes blank, irritability, muscle tension, sleep disturbance |
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Term
| Symptoms of post traumatic stress disorder |
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Definition
3 main categories of symptoms:
-reexperiencing (ned 1 or more for diagnosis)
-avoidance and numbing (need 3 or more for diagnosis)
-increased arousal (2 or more)
sx required from all categories. |
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Term
|
Definition
recurrent unexplained panic attacks
at least one attack has been followed by:
-persistent worry about: having another panic attack, the implications of the attack, or significant change in behavior related to the attacks. |
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Term
| What are the symptoms of social phobia? |
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Definition
Persistant fear of one or more social or performance situations.
person fears acting in a way that will be humiliating or embarrassing
exposure to feared situations provokes anxiety and panic attacks
person recognizes that the fear is excessive
feared situations are either avoided or endured with distress
fear or avoidance interferes significantly with the person's functioning |
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Term
| What are the symptoms of simple phobia? |
|
Definition
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Term
| What are the symptoms of obsessive compulsive disorder? |
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Definition
Obsessions: recurrent and persistent thoughts, impulses or images, patient attempts to ignore or suppress them or to neutralize them with another thought or action, and recognizes that they are a product of his or her own mind.
Common obsessions: religious, aggression, sex.
Compulsions: repetitive behaviors like hand washing, ordering, checking, praying; patient feels driven to perform these in response to an obsession, or according o rigid rules; they are aimed at preventing or reducing distress or preventing some dreaded even or situation but they aren't connected realistically with what they're designed to prevent. |
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Term
| What are the pharmacological treatments for panic disorder? |
|
Definition
SSRIs:
Benzodiazepines
TCAs: effective but not used as much due to lack of safety in overdose.
MAOIs: Very effective but not used much due to side effects, dietary restrictions, and overdose risk. |
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Term
| What are the treatments for social phobia? |
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Definition
| Pharmacotherapy with SSRIs, venlafaxine, benzodiazepines, buspirone. Beta blockers are helpful with autonomic sx, and CBT. |
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Term
| What are the treatments of GAD (general anxiety disorder) |
|
Definition
SSRIs or venlafaxine
Benzodiazepines (often low dose effective)
Buspirone(Buspar): nonsedating, nonbenzodiazepine, not asociated with dependence
Nonpharmacological Tx: CBT, supportive psychotherapy, biofeedback, relaxation therapy. |
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Term
| What are the treatments of PTSD (Post traumatic stress disorder) |
|
Definition
Support groups, talk therapy, critical incident stress debriefing, cognitive behavioral therapy, group therapy, EMDR
Pharmacotherapy: SSRIs- early use afer a trauma may prevent or lessen the sx of PTSD
Beta blockers or clonidine (for hyperarousal)
treatment of comorbid addictions |
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|
Term
|
Definition
Pharmacotherapy: Clomipramine, SSRIs in high doses
CBT: exposure with response prevention, challenging cognitive distortions, learning alternate ways to relieve anxiety
Combined Pharmacotherapy and CBT |
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|
Term
|
Definition
| Two or more of the following has to be present for a significant portion of time during a 1 month period: Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms: emotional flatness or lack or expression, inability to start and follow through with activities, speech that is brief and lacks content, lack of pleasure or interest in life. |
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Term
| What are treatment options for specific phobias? |
|
Definition
Benzodiazepines or beta blockers
Psychotherapy is preferre treatment: Systemic desensitization, hypnosis, supportive therapy, insight oriented psychotherapy. |
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Term
| What are 3 common medical mimickers of anxiety? |
|
Definition
Coronary conditions accompanied by dread.
Hyperthyroidism
systemic lupus
eurythematosis
Anemia
Asthma
COPD |
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Term
Management of the suicidal patient |
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Definition
Establish Safety: Medical diagnosis/treatment for suicide attempt. Diagnosis/treatment for substance intoxication Establish Diagnosis: Underlying pyschiatric disorder Management Plan: Admission? Follow up |
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Term
| Some mistakes in the emergency management for Suicidal Patient |
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Definition
Not recognizing/treating medical condition. Not waiting for patient to become sober prior to making referral decision. Confusing self injurious behavior with suicide attempt. Assuming a patient w/ personality disorder won't kill themself. Not arranging reasonable follow up. |
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Term
| Some causes for the Violent Patient |
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Definition
Psychosis Antisocial Delirious Intoxication Medical: Head Trauma, Cerebrovascular Disease, Metabolic Abnormalities, Medications Behavior: Frustration, Response to Provocation |
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Term
Risk Factors for the Violent Patient |
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Definition
Past history of unprovoked violence Psychotic state Arousal states Under the influence of drugs Ignoring danger signals Patient feels threatened Demographic risk factors Psychiatric diagnoses Psychosocial stressors |
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Term
| Emergency Management for the Violent/psychotic Patient |
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Definition
Your safety Patient's safety Atmosphere clam and Nonconfrontational Don't challenge the delusions/hallucinations Lower the patient's stress level Do workup after the above are taken care of |
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|
Term
Clinical presentation of Intoxicated Patient |
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Definition
Aggression/agitation Trauma/abuse Suicidal ideation/attempt Homelessness/run away Self injury Dangerour or "at risk" behavior |
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Term
| Common Mistakes when treating the intoxicated patient |
|
Definition
Not interviewing collateral sources Not testing for pregnancy or drug/alcohol intoxication Over or underestimating risk due to lack of understanding of development |
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|
Term
|
Definition
A distrubance of consciousness and change in cognition Cannot be better accounted for by a dementia Occurs over Short perior of time Symptoms fluctuate during day/night Usually caused by general medical condition: substance intoxication or withdrawal, CNS disease, Systemic disease |
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Term
| Clinical Presentation of Delirium |
|
Definition
Sudden onset of symptoms Fluctuation of symptoms Problems w/ memory, attention Can have psychiatric symptoms: psychosis, mania, disorganized thought...etc |
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Term
| Risk Factors for Delirium |
|
Definition
Age Illness: such as AIDS, terminally ill Poor Nutritional Status Post Surgery, especially cardiac surgery Preexisting Brain Damage Semsory Impairment Alcohol Dependence |
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|
Term
Emergency Management for Delirium |
|
Definition
Treat underlying cause Provide support: physical, sensory, social Pharmacotherapy for: Psychosis/agitation, Insomnia |
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Term
| Common Mistakes made by ER Practitioners |
|
Definition
Not doing a good medical assessment Not taking a good history Not interviewing collateral sources Not reading the old chart Prematurely assuming it is a psychiatric problem Not treating the medical illness in psychiatric patient |
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Term
| Clinicial presentation of Paranoid |
|
Definition
Distrust and suspiciousness of others, such as their motives are interpreted as malevolent |
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|
Term
Paranoid: why is it hard for them to seek help? |
|
Definition
Fear that physician or others may harm them Misinterpretation of innocuous or even helpful behavior Increased likelihood of argument or conflict w/ staff |
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Term
Paranoid Diagnostic Criteria |
|
Definition
Suspects that others are exploiting, harming or deceiving them, w/o sufficient basis Preoccupied w/ unjustified doubts about loyalty or trustworthiness of friends Reluctant to confide in others b/c of unwarranted fear that the info will used against them Reads hidden demeaning or threstening meanings into benign remarks Presistently bears grudges, unforgiving of insults, injuries, or slights Perceives attacks on their character or reputation that aren't apparent to others, quick to react angrily Recurrent suspicions w/o justification tha their sexual partner is unfaithful |
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Term
Schizoid...the "loner" who don't like intimacy or emotions what are their clinical presentations? |
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Definition
Pattern of detachment from social relationships and restricted range of emotional expression They usually avoid close friendship or sexual relationships They prefer dealing w/ technical or abstract concepts...such as computers, mathematical games |
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Term
Schizoid why it's hard for them to get help? |
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Definition
May delay seeking care until symptoms become several, out of fear of interacting w/ others May appear detached and unappreciative of help Illness may give rise to strong emotions, that they can't deal w/ |
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Term
Schizoid Diganostic Criteria... |
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Definition
Neither desires nor enjoys close relationships Most always chooses solitary activities Have little interest in sexual experience takes pleasure in few activities Lacks close friends or confidents, other then 1degree relatives Appears indifferent to the praise or criticism of others Show emotional coldness, detachment, or flattened affectivity |
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Term
Schizotypal...the "eccentric" person clinical presentations? |
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Definition
Patient behave in an odd and eccentric manner Socially inept and isolated They have unsafe beliefs or perceptions Their psychotic symptoms worsen w/ stress May dress in unusual manner, affect often odd Odd beliefs, Inappropriated affect, perceptual distortions and desire for social isolation |
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Term
Schizotypal Diagnostic Criteria |
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Definition
Ideas of reference Odd beliefs or magical thinking that influcences behavior, inconsistent w/ sub cultural norms Odd thinking and speech Suspiciousness, paranoid ideation Inappropriated or constricted affect Behavior or appearance that is odd, eccentric, peculiar Lack of close friends or confidants other then relatives |
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Term
Schizotypal why is it hard for them to seek help? |
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Definition
They may present for medical attention late in the course of illness due to odd ideas about the illness or it's management Don't like to interact w/ others Can become paranoid or even psychotic under stress of having to interact w/ medical providers May appear odd and eccentric and paranoid toward others |
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Term
Antisocial...the charmer w/o conscience or remorse clinical presentations? |
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Definition
Deceitfulness, lying, conning others for personal gain Irritability and Aggressiveness Often repeated physical aggression toward others Physical complaints, substance abuse, and depression are common "Reckless disregard" fro safety of others Irresponsible Often unable to sustain work |
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Term
General Characteristics of ANTI-Social disorder |
|
Definition
Disregard for and violation of the rights of others, beginning in adolenscence Inability to conform to social norms Repeatedly performs acts that are grounds for arrest Extremely manipulative, deceitful, impulsive, and totally lacking empathy or remorse may have abnormal EEG Males 3 times more than female more common in urban than rural areas |
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Term
Anti-social...ASPD why is it hard for them to seek help? |
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Definition
They may cover up fear about illness w/ hostile, privileges, or excessively self-assured manner Dangerous health behavior may help them deny their vulnerability May manipulate the medical provider by exaggerating their illness or malingering to get drugs, inappropriated disability benefits...etc May become antagonistic if they don't get the response they want |
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Term
Bordeline Personality Disorder... rapidly changing, unstable person who is always in crisis what are the clinical presentations? |
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Definition
Unstable and unpredictable mood, affect, and behavior Marked impulsivity in areas that are self damaging, such as financial, sex, driving...etc. Identity disturbance: Poorly established self image Transient psychotic episodes or dissociation can occur under times of stress Recurrent self multilations and/or suicide threats Chronic feelings of emptiness Difficulty distinguishing fantasy from reality Rapid "mood swings" lasting few hrs. Patient afraid abandonment and desperately attempts to avoid being abandoned Can Not tolerate being alone, but afraid of closeness |
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Term
Borderline... why is it hard for them to seek help? |
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Definition
May have terrifying fantasies about illness May deny the presence of illness or be convinced they are terribly ill even when they aren't
Mistrust and fear of caregivers
Idealize and devalue the medical practitioner "splitting" Idealization can change if patient becomes angry or feels abandoned |
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|
Term
Histrionic Personality Disorder...the flamboyant, emotional, attention seeker. what are the clinical presentations? |
|
Definition
Excessive attention seeking and emotionalism Dramatic, theatrical Sexually provocative dress and manner Shallow and inconsistent emotions Prefer "feelings" to "thoughts", intuitive impressions over logic Often have somatice complaints w/ dramatic and inconsistent presentation |
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|
Term
Histrionic PD... how does it impact them seeking health care |
|
Definition
Since they get much of their self esteem from physical attractiveness, therefore illness can be particularly threatening to them May be flirtatious w/ medical provider feeling weak and vulnerable may make them more histrionic and dramatice in effort to get close to medical provider They focus on feelings not facts may result in inconsistent or dramatic presentations of symptoms May give answers that they think the physician wants to hears, and not the truth Tendency to somatize |
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|
Term
Narcissistic PD...the grandiose person w/ lack of sensitivity to other's feelings what are clinical presentations? |
|
Definition
Excessive need for praise and attention Exaggerated sense of self importance Likes to associate w/ important people Entitled Envious and devaluing of people who have more accomplishments then they do Symptoms cover up underlying sense of insecurity that the patient finds intolerable |
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Term
Narcissistic PD, what makes it hard for them to seek help? |
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Definition
Illness threatens their sense of superiority An attempt to defend against this threat, they may minimize illness or deny it Often demand special treatment from, or ridicule, medical provider May demand referral to specialist or to well known treatment center |
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Term
Avoidant...the shy person who is anxious in social situations but longs for intimacy what are the clinical characteristics? |
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Definition
Excessively anxious in social situations Hypersensitive to criticism Long for relationships/intimacy but avoid them due to fear of rejection, embarrassment, or humilations Low self esteem self critical afraid of being rejected |
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|
Term
Avoidant PD, how does it impact them seeking health seeking behavior and treatment? |
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Definition
Illness increase their sense of being inept May delay care due to fears of not being liked by medical provider May be shy and not forthcoming about their sx May blame themselves for the pain and not ask for medication May be reluctant to undergo necessary procedures due to not wanting to bother providers...not feeling "worth it" |
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|
Term
Dependent PD...the "clingy" person who is afraid of abandonment what are their clinical presentations? |
|
Definition
Difficulty making everyday decisions w/o excess amount of advice and reassurance from others Need other to take responsibility for most major areas of their life Difficulty expressing disagreement w/ others Difficulty starting projects, b/c lack confidence Goes to excessive length to obtain nurturance and support from others...eg, will volunteer to do unpleasant things Feels uncomfortable/helpless when alone quick to seek relationship as source of care and support Unrealistically preoccupied w/ fears of being left to take care of themself |
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Term
| Dependent PD, how does it impact them on seeking health care? |
|
Definition
Fear that illness will lead to helplessness and abandonment by others May be needy and/or demanding w/ medical provider May blame their physical discomfort on others, including medical provider May become angry or blame medical provider, if not getting the response they want May overuse medications May prolong their illness or encourage unnecessary procedures to prolong contact w/ medical provider |
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Term
Obsessive-Compulsive Personality Disorder: OCPD:..the "perfectionist" obsessed w/ neatness, orderliness, and control... NOT the same as OCD what are the clinical presentations of OCPD? |
|
Definition
Preoccupied w/ details, rules, lists, order, organization, or schedules, to the extent that the major point of the activity is lost Perfectionism that interferes w/ task completions Excessively devoted to work and productivity to the exclusion of leisure activities and friendships Overly conscientious, scrupulous, and inflexible about matters of morality, ethics, or values Unable to discard worn-out or worthless objects even when they have no sentimental value Reluctant to delegate tasks or to work w/ others unless they submit to exactly his way of doing things Adopts a miserly spending style toward both self and others: Money is something to be hoarded for future catastrophes Shows rigidity and stubbornness |
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Term
| Obsessive-Compulsive Personality Disorder: OCPD, what impact does it have on them seeking health care? |
|
Definition
Illness threatens their sense of self control over body and emotions May feel shame and vulnerability May become angry at disruptions of daily routine Hard for them to give up control to medical provider Often feels very anxious, and deals w/ anxiety by asking repetitive questions and paying excessive attention to detail
Only one of the symptoms needs to be present if delusions are bizarre or adiory hallucinations.
illness needs to affect social functioning
continuous signs must be present for at least 6 months. |
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Term
| Treatment of scizophrenia |
|
Definition
Antipsychotic medications: typical and atypical
Psychosocial treatments are also essential: social skills training, support groups, case management, family psychoeducation/therapy, vocational therapy, individual therapy. |
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|
Term
| Symptoms of schizoaffective disorder |
|
Definition
2+ week period of scizophrenia without prominent mood symptoms
2+ week period of either major depression or mania without prominent scizophrenic symptoms
periods of both mood and psychotic symptoms |
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|
Term
| Symptoms of drug induced psychotic disorder |
|
Definition
Prominent hallucinations or delusions; symptoms occurred during or within a month of substance intoxication or withdrawal;
common substances causing psychosis: amphetamines, hallucinogens, cocaine, cannabis, alcohol. |
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Term
| Management of somatization disorder |
|
Definition
Regularly scheduled visits with a healthcare provider
minimize secondary gain
avoid medications
minimize referrals to specialists and with multiple providers
encourage mental health treatment, but patients are generally resistant to this |
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|
Term
| Treatment of body dysmorphic disorder |
|
Definition
|
|
Term
| Conversion disorder treatment |
|
Definition
| Psychotherapy, hypnosis, anxiolytics, relaxation therapy, amobarbital interviews to uncover underlying psychological factors. |
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|
Term
| Treatment of hypochondriasis |
|
Definition
Group and insight oriented psychotgherapy
regularly scheduled appointments with medical provider
treat comorbid anxiety or depressive disorder with medications/therapy. |
|
|
Term
| Treatment of pain disorder |
|
Definition
Psychotherapy
behavior therapy
pain control programs
SSRIs, and TCAs
Analgesics and sedatives are generally not helpful and can lead to dependence. |
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|
Term
| Treatment of factitious disorder |
|
Definition
Rule out genuine physical illness
need to recognize the illness early to avoid unnecessary or damaging Tests
psychotherapy is suggested, though patients are unlikely to agree to it
Treatment tends to focus on management rather than cure
view it as a cry for help rather than an effort to manipulate the clinician. |
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|
Term
|
Definition
Have a reasonably high index of suspicion when sx seem out of proportion to the situation.
rule out general physical illness
avoid unnecessary tests
diagnose early
make appropriate referral eg to the police. |
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|
Term
|
Definition
* refusal to maintain a minimally normal body weight
* intense fear of gaining weight
* Disturbance of body image
* Amenorrhea for at least 3 consecutive cycles
* restricting type or binge-purging type.
* distorted body image or fear of becoming fat
* self impose starvation, but have normal appetite
* < 85% of expected weight for height
* exercise excessively
* food related obsessions |
|
|
Term
| Physical signs of anorexia nervosa |
|
Definition
| emaciation, hypotension, peripheral edema, bradycardia, arrhythmias, dry skin, amenorrhea, leukopenia, electrolyte abnormalities. |
|
|
Term
| Anorexia nervosa treatment |
|
Definition
| supervised weight gain program, behavior therapy, family therapy, group therapy. |
|
|
Term
|
Definition
recurrent episodes of binge eating. binge eating and inappropriate compensatory behavior both occur, at least twice a week for 3 months. patients are unuly influenced by body shape and weight.
Types: purging-self induced vomiting, laxative, or diuretics
non purging: patient uses other compensatory behaviors such as excessive exercise or fasting. |
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|
Term
| treatment for bulemia nervosa |
|
Definition
antidepressants are useful
bupropion is contraindicated
CBT is useful
psychotherapy including group, family and behavioral therapy are helpful
hospitalization is usually not necessary unless there are medical complications or suicidal symptoms. |
|
|
Term
| what are the 3 main parts of sleep-wake cycle? |
|
Definition
wakefullness REM sleep non-REM sleep |
|
|
Term
| what is the sleep architecture for wake EEG? |
|
Definition
|
|
Term
| what is the sleep architecture for stage 1? |
|
Definition
| theta waves and slow, rolling eye movement |
|
|
Term
| what is the sleep architecture for stage 2? |
|
Definition
| k complexes and sleep spindles on a background of theta waves |
|
|
Term
| what is the sleep architecture for stage 3? |
|
Definition
| deep sleep delta wave, 20% waveforms |
|
|
Term
| what is the sleep architecture for stage 4? |
|
Definition
| deep sleep, delta wave, 50% waveform |
|
|
Term
| what is the sleep architecture for REM sleep? |
|
Definition
| wake pattern EEG, skeletal muscle paralysis, rapid, conjugate eye movements |
|
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Term
| what are the 3 classification of sleep disorder? |
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Definition
insomnia hypersomnia parasomnia |
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Term
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Definition
transient, persistent, and chronobiological insomnia. restless leg syndrome periodic leg movement mood, anxiety, alcohol and drugs, medical disorders, affecting sleep |
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Term
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Definition
sleep apnea narcolepsy idiopathic CNS hypersomnolence Delirium, advanced dementia, TBI |
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Term
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Definition
sleep terrors nightmares sleepwalking - somnambulism REM behavior disorder |
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Term
| what is the treatment for Chronic Insomnia? |
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Definition
improvement in "sleep hygeine" CBT techniques Occasionally pharmacotherapy |
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Term
| what is the treatment for delayed sleep? |
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Definition
bright light exposure in the am to phase advance the body clock. Melatonin at desired bedtime. consider short term use of sedative-hypnotic. avoid late night activity. try to keep similar schedule everyday. advancing sleep time, or decrease number of hrs of sleep over several days. |
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Term
| what is the treatment for Sleep Apnea? |
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Definition
Positive airway pressure devices (CPAP = continuous positive airway pressure. BIPAP = bilevel positive airway pressure) Surgery, dental devices (to keep tongue from falling back and occulind the airway) |
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Term
| what is the treatment for narcolepsy |
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Definition
Modafini CNS stimulants (dexedrine, methylphenidate) Cataplexy and sleep paralysis are treated w/ REM suppressant drugs...TCAs |
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Term
| what is the treatment for night terrors/sleep terrors? |
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Definition
reassurrance of parents. Benzodiazepine if severe |
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Term
| what is the treatment for nightmares |
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Definition
| refer to mental health specialist if severe... |
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Term
what are the techniques for interviewing children? |
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Definition
draw a picture draw a circle w/ sections of "sad" "mad" "scared" "happy" use puppets, dolls, action figures let child play w/ something while talking talk in the 3rd person "3 wishes" question "happiest day/ most sad day" question "if you could change 1 thing about yourself/your family" question |
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Term
| what are the techniques for interviewing adolescents? |
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Definition
discuss confidentiality and limits of confidentiality (danger to self/others) become familiar w/ state laws regarding legality of evaluating and treating adolescents w/o parental consent. ask about home, school, sexual practices, drugs and alcohol, and suicidal ideation. become familiar w/ resources for runaway teens, substance abuse, domestic violence, gay and lesbian youth. be open, respectful, and non-judgemental |
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Term
| different degree of symptoms for children/adolescents to adults w/ psychiatric illness? |
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Definition
symptoms fluctuate more. same symptoms can be sign of different illness. comorbidity. some sx that are abnormal can be normal in children at certain ages. some illnesses present differently - irritability instead of sadness in depression, rapid cycling in BPAD. |
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Term
| what are the diagnostic criteria for ADHD? |
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Definition
either 6+ inattentive symptoms or 6+ hyperactivity-inpulsivity symptoms (or both) has persisted for more than 6 months. some symptoms present before age 7. some symptoms present in 2 or more settings. clear evidence of imparment in social, academic, or occupational functioning |
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Term
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Definition
Pharmacotherapy psychoeducation of patient/family/school treat parent/family problems if present support groups school interventions: structured classroom, child at front of classroom, daily report card, rule out learnign disorder individual therapy/social skills training |
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Term
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Definition
impairment in social interaction impairment in communication restricted, repetive, and stereotyped patterns of behavior, interest, and activities |
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Term
| diagnosis for Conduct Disorder |
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Definition
Aggression to people and animals Destruction of property Deceitfulness, lying, stealing serious violations of rules |
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Term
| treatment for Conduct Disorder |
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Definition
Behavior therapy Individual therapy Family therapy parent training multisystemic therapy pharmacotherapy **treatment must be relatively long term in order to achieve lasting results** |
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Term
| Clinical features for Schizophrenia? |
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Definition
changes in cognition. attention and motivation are dimished. Cognitive problems of schizophrenia are important factors in long term outcome. Mood changes: depression, mood swing, mood instability. |
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Term
| Treatment for Schizophreniz? |
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Definition
Antipsychotic medications. Psychosocial therapy |
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Term
what are the 2 different type of antipsychotic medications for schizophreniz? |
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Definition
Typical antipsychotics Atypical antipsychotics |
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Term
clinical features for Schizoaffective Disorder |
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Definition
2+ week period of schizophrenia w/o prominent mood symptoms. 2+ 2 week period of either major depression or mania w/o prominent schizophrenic symptoms. Periods of both mood and psychotic symptoms. |
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Term
| clinical features for drug induced psychotic disorder |
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Definition
prominent hallucinations or delusions. symptoms occur during or within a month of substance intoxication or withdrawal common substances causing psychosis: amphetamines, hallucinogens, cocaine, cannabis, alcohol |
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