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58 Cards in this Set
- Front
- Back
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What are 3 medications that can be helpful with Primary insomnia?
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-Benzodiazepines
-Zolpidem -Zaleplon |
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How long should meds be given for primary insomnia and why?
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No longer than 2 weeks - tolerance and withdrawal can result
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What are the diagnostic criteria for Primary Insomnia?
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-Problems sleeping for at least ONE MONTH
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How do problems with sleeping often present in Primary insomnia?
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-Difficulty falling asleep
-Multiple awakenings during the night |
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What often increases the inability to sleep in Primary insomnia?
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Frustration and preoccupation with not being able to fall asleep
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How is the diagnosis of primary insomnia really made?
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By exclusion of all other possible causes
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What is the treatment for Primary insomnia when negative conditioning has occurred?
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Deconditioning
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What does Deconditioning for treatment of Primary Insomnia include?
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-Only use beds for sleeping
-If can't fall asleep, get up and do something else |
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What pharmacotherapy is useful for treating Primary Insomnia?
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-BDZ's
-Zolpidem -Zaleplon |
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What are the 4 main diagnostic criteria for Somatization Disorder?
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-Many physical symptoms that began before age 30 and persist
-4 pain, 2 GI, 1 sexual, 1 neuro -Not intentionally produced |
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How does somatization disorder affect patients in general?
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It is chronic and debilitating and causes much social and occupational impairment
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What is the best treatment for Somatization disorder?
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-Identify one primary physician for care
-Schedule regular, brief visits monthly -Psychotherapy if acceptable to the patient |
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How is Hypochondriasis different from Somatization disorder?
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Patient is convinced they have ONE SPECIFIC ILLNESS
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How is Pain disorder different from Somatization disorder?
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Patient has predominantly PAIN symptoms
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How is Conversion disorder different from Somatization disorder?
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Patient only has NEUROLOGIC symptoms
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What is the prognosis for somatization disorder like in general?
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Poor
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What would you call it if a post-partum woman developed acute psychotic symptoms and depression 24 hrs after her delivery, lasting >1d, but <1month?
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Mood disorder NOS
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How long would these sx need to be present to be able to diagnose Major Depressive Disorder w/ Psychosis?
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2 weeks
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What are the main symptoms of psychosis?
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Hallucinations and delusions
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What is a Delusion?
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A fixed, false belief that is held to be true by the patient
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What is PostPartum Blues?
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Transient mood changes just after delivery
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How soon do symptoms of PPBlues resolve?
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7-14 days after delivery
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What % of women that develop major depression have their first episode during the first postpartum year?
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65%
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What is the incidence of PPBlues?
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49-75%
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What is the incidence of PP PSYCHOSIS?
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Only 1-2/1000 deliveries
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What symptoms tend to be seen in postpartum psychosis?
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Psychotic - hallucinations, delusions
Extreme mood labiality Confusion |
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What treatments are commonly given for PP Psychosis?
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-SSRI or TCA for depression
-Neuroleptic for psychosis |
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Because many moms breastfeed, what is probably the safer antidepressant to go with when treating postpartum psychosis?
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SSRIs
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What TCA has been shown to accumulate at elevated levels in breastmilk?
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Doxepin
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Which 2 SSRI's are LEAST detectable in nursing infants?
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-Sertraline zoloft
-Paroxetine Paxil |
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What measure can be taken to PREVENT recurrence of postpartum depression in a mother with history of it?
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Treatment with an antidepressant for several weeks prior to delivery
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What is it called when a patient experiences episodes of visual hallucinations that last several minutes and he has a past hx of mushroom use?
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Hallucinogen persisting perception disorder
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What are the 3 major medical disorders that need to be ruled on when considering hallucinogen persisting perception disorder?
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-Seizures
-Migraines -Visual system abnormalities |
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What can trigger visual hallucinations in Hallucinogen persisting perception disorder?
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Sensory deprivation - like monotonous driving
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What are the episodes in Hallucinogen persisting perception disorder typically called if they only last a few sec?
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FLASHBACKS
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What hallucinogen is known to cause flashbacks and Hallucinogen persisting perception disorder up to 40 yrs after use?
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LSD - lysergic acid diethylamine
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After how many doses of LSD can Hallucinogen persisting perception disorder arise?
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Just one!
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What are Flashbacks defined as?
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Visual symptoms that occur sporadically after hallucinogen use and last only 1-2 SEC
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What is Macropsia?
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Things seem bigger than they are
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What is Micropsia?
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The opposite
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How do the hallucinations in Hallucinogen persisting perception disorder differ from those in Schizophrenia or PTSD?
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They are VISUAL from LSD; those in schizophren or PTSD tend to be AUDITORY
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What is it called when a patient reports an entire visual field filled with vibrating dots to the point that they say they can see air?
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Aeropsia!
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What is a major way to distinguish Post-hallucinogen Persisting Perception Disorder from other psychotic disorders like schizophrenia?
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-No behavioral disturbance/delusions
-Retained insight and sense of reality |
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What are some things that can TRIGGER episodes of Post-Hallucinogen Persisting Perception disorder?
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-Amphetamines
-Cocaine -Pseudoephedrine -Methamphetamine -Even 2nd hand marijuana |
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What are the 3 major medical illnesses that can cause visual changes to rule out in diagnosing Hallucinogen Perceptual Persistance disorder?
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-Migraines
-Seizures -Visual disturbances |
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What are 2 drug types that can reduce symptoms in Hallucinogen Persisting Perception disorder?
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-Long acting benzodiazepine - Clonazepam
-Anticonvulsants - Carbamazepine or Valproic acid |
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What should NOT be given for Hallucinogen Persisting Perception disorder? Why?
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Antipsychotics - they can worsen symptoms in the first 72 hrs after administration!
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What is a Narcissistic injury?
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Refusing to cater to a narcissistic person's needs for admiration and special treatment
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What are 3 defense mechanisms often employed by patients with Narcissistic personality disorder?
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-Denial
-Devaluation -Idealization |
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What is Denial?
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Refusing to acknowling some painful aspect of external reality or subjective experience, though its apparent to others
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What is Devaluation?
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Attributing negative qualities to ones self or to others
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What does Devaluation behavior commonly alternate with?
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Idealization
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What is the main diagnostic criteria for Narcissistic personality disorder?
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A pervasive pattern of GRANDIOSITY, NEED FOR ADMIRATION, or LACK OF EMPATHY FOR OTHERS
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What do people with Narcissistic PD often have fantasies about?
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Obtaining unlimited power and success
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What are 3 ways that patients with Borderline PD differ from Narcissists?
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-More chaotic lives
-Multiple failed relationships -More suicidal |
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How do people with Narcissistic PD protect their fragile self-esteem?
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By trying to appear perfect and invincible
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How should clinicians treat patients with Narcissistic PD?
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Remain tactful and admiring if possible
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What sort of defense mechanisms are denial, devaluation, and idealization?
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Primitive (Lower functioning)
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