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279 Cards in this Set

  • Front
  • Back
What is personality?
a totality of an individual's behavioral and emotional characteristics
What is a personality disorder?
a variant of those character traits that goes beyond the range in most people. These traits become inflexible and maladaptive and cause SIGNIFICANT FUNCTIONAL IMPAIRMENT or SUBJECTIVE DISTRESS.
What disorders are considered cluster A disorders?
paranoid, schizoid, and schizotypal
What disorders are considered cluster B disorders?
Antisocial, borderline, histrionic, and narcissistic
What disorders are considered cluster C disorders?
avoidant, dependent, obsessive/compulsive, and personality disorders NOS (passive aggressive and depressive personality type)
What factors form personality?
genetics, tempermental factors, biological factors
What are the characteristics of paranoid personality disorder?
long-standing suspiciousness and mistrust of people
hostility, irritability, and anger
questioning of loyalty or trustworthiness of friends
logically defended illusions are common
What is the course and prognosis of paranoid personality disorder?
lifelong and sufferers have problems with work and living with others
How do you treat paranoid personality disorder?
psychotherapy is TOC
paranoid PD patients do NOT do well in group therapy
anti-anxiety agents are sufficient. may sometimes use an antipsychotic
Patients with schizoid personality disorder have a lifelong history of what?
social withdrawal
What are the characteristics of schizoid PD?
eccentric, isolated or lonely
give an impression of being "cold and aloof"
history reveal solitary interrests and success at non-competitive, lonely jobs
inability to express anger
excessive day-dreaming
What is the course and prognosis of schizoid personality disorder?
onset usually in childhood
long lasting but not necessarily lifelong
How do you treat schizoid personality disorder?
psychotherapy
pharmacotherapy (antipsychotics, antidepressants, psycho-stimulants)
What are the characteristics of schizotypal personality disorder?
strikingly strange: magical thinking, peculiar ideas, ideas of reference, illusions and derealizations are part of their everyday world
may be superstitious or claim clairvoyance
believe they have special powers or special insight
isolated, may have borderline PD
can have psychotic symptoms
severe cases anhedonia and depression may be present
What is the course and prognosis for schizotypal personality disorder?
10% commit suicide
can be functional despite oddities
What is the treatment of schizotypal personality disorder?
psychotherapy: need be handled with care because some are involved with cults or the occult
pharmacotherapy: antipsychotics (dealing with ideas of reference, illusions) antidepressants
What characterizes obsessive-compulsive personality disorder?
emotional constriction, orderliness, perseverance, stubborness, and indecisiveness.
perfectionism and inflexibility
What is the course and prognosis of patients with obsessive-compulsive personality disorder?
variable and not predictable
some can be normal, others progress to schizophrenia.
How do you treat obsessive-compulsive personality disorder?
free-association and non-directive therapy are highly valued
group therapy has certain advantages, like sharing coping skills
pharmacotherapy: clonazapam and nother anti-anxiety agents; Clomipramine (Anafranil) and SSRI's may also be used.
What characterizes dependent personality disorder?
patients subordinate their own needs to those of others, get others to assume responsibility for major areas of their lives, lack self-confidence, and may experience emotional discomfort when left alone for more than a brief time
dependent and submissive behaviors
avoid positions of responsiblity
pessimism, self-doubt, passivity, low self-esteem, and fears of expressing sexual and aagressive feelings
What is the course and prognosis of a patient with dependent personality disorder?
impairment in occupational functioning as patients have inability to perform independently and without close supervision
tend to suffer physical or mental abuse
high risk of major depression if they lose the person they are dependent on
How do you treat dependent personality disorder?
insight-oriented psychotherapy can enable patients to understand their behaviors and with proper therapy they can learn to be more assertive
*a pitfall of treatment may appear when therapist encourages the patient to change the dynamics of a pathological relationship: patient will become anxious and unable to cooperate.
Pharmacotherapy: BZP's and SSRI's
Do antipsychotics have a role in treating dependent personality disorder?
Nope
What are the characteristics of avoidant personality disorder?
show an extreme sensitivity to rejection, which may lead to a socially withdrawn life.
go to great lengths to avoid embarrassment
may have a great desire for companionship, but are very shy
What else is avoidant personality disorder called?
inferiority complex
What is the course and prognosis of avoidant personality disorder?
can function, provided they are in a protected environment
if support fails, subject to depression, anxiety, and anger
What sort of phobia is common with avoidant personality disorder?
social phobia
How do you treat avoidant personality disorder?
psychotherapy: solid alliance required
-failure may reinforce patient's poor self-esteem
Pharmacotherapy: beta-blockers for autonomic nervous system hyperactivity
What characterizes narcissistic personality disorder?
heightened sense of self-importance and grandiose feelings that they are unique.
arrogance, haughtiness, lack of empathy
handle criticism poorly or are indifferent
prone to depression
What is the course and prognosis of narcissistic personality disorder?
chronic and difficult to treat
aging is poorly handled
more vulnerable to mid-life crises than are other groups
How do you treat narcissistic personality disorder?
treatment is difficult
pharmacotherapy: lithium, antidepressants
What characterizes histrionic personality disorder?
colorful, dramatic,extroverted behavior in excitable, emotional persons
inability to maintain deep, long-lasting attachments
exaggerate, making everything sound more important
display temper tantrums, tears, and accusations if they are not the center of attention
seductive behavior, coy, flirtatious
overly trusting and gullible
What is the course and prognosis for histrionic personality disorder?
Tend to show defenses of repression and dissociation
get into trouble with the law, abuse substances, and act promiscously
show fewer symptoms with age
How do you treat histrionic personality disorder?
psychotherapy: clarification of their inner feelings; TOC group or individual therapy
pharmacotherapy: adjunctive to treat depression and somatic complaints with antidepressants, anti-anxieties, and antipsychotics (for derealizations and illusions)
What characterizes antisocial personality disorder?
continual antisocial or criminal acts
inability to conform to social norms
lying, truancy, running away from home, thefts, fights, substance abuse and other illegal activities
impress clinicians with charm and seductive aspects
True or False: Antisocial PD patients show exaggerated anxiety and depression that may seem grossly incongruous with their situations.
False: they show a lack of anxiety and depression
True or False: Antisocial PD patients have a heightened sense of reality testing.
True
Can you trust a patient with antisocial personality disorder?
Better not. They do not tell the truth and appear to have a lack of conscience.
How does a patient's brain with antisocial personality disorder differ from normal?
11% reduction in grey matter of the frontal lobe
What are "soft neurological signs?"
EEG changes suggestive of minimal brain damage in childhood
What is the diagnostic criteria for antisocial personality disorder?
Three of more of the following:

Failure to conform to social norms (multiple arrests)
Deceitfulness (multiple lies)
Impulsivity and failure to plan ahead
Irritability and aggressiveness (repeated fights or assults)
Reckless disregard for safety of self or others
Consistent irresponsiblity (can't keep a job)
Lack of remorse

*Must not occur exclusively during an episode of schizophrenia or a manic episode
What is the course and prognosis of antisocial personality disorder?
once developed, it runs an unremitting course with the height of antisocial behaviors occurring in late adolescence
prognosis is variable
depression, alcohol and drug abuse common
How do you treat antisocial personality disorder?
Psychotherapy: if immobilized, they are amenable
Pharmacotherapy: psychostimulants (ADHD), antiepileptics (impulsivity)
What characterizes borderline personality disorder?
extraordinary unstable affect, mood, behavior, object relations, and self-image.
always in a state of crisis
unpredictable behavior
self-destructive acts
What are risk factors for borderline personality disorder?
abandonment issues in childhood or adolescence, sexual abuse, disrupted family life, and poor communication within the family
What is the course and prognosis for borderline personality disorder?
fairly stable and shows little change over time; treatment resistant!
major depression usually present (suicide risk 3-9%)
How do you treat borderline personality disorder?
Psychotherapy: treatment of choice
Pharmacotherapy: antipsychotics (anger, hostility), antidepressants, antianxiety, anticonvulsants
What is the most common substance abuse problem?
alcohol
When is the peak blood concentration after alcohol consumption?
30-90 minutes
What receptors does alcohol work on?
nicotinic, serotonin, and GABA receptors
True or False: Alcohol before bed helps to maintain a restful sleep.
False: It decreases REM sleep and deep sleep.
Where is alcohol metabolized?
90% in the liver and 10% in the kidneys
How fast does the body metabolize alcohol?
3/4 of an ounce of 40% (80 proof) whisky an hour
True or False: Some women and Asians have lower liver enzymes than men, therefore they become intoxicated quicker.
True.
The major adverse effects of alcohol on body systems are most related to what organ?
Liver
How does alcohol affect blood pressure and the heart?
increased blood pressure, increase in MI and CVA
(also increase in cancers)
What characterizes ADHD?
a developmentally inappropriate poor attention span or age-inappropriate features of hyperactivity and impulsivity
How do you diagnose ADHD?
disorder must:
have at least six inattentive symptoms or 6 activity and impulsitivity problems
be present for a least 6 months
cause impairment in social and academic functioning
occur before the age of 7
occur in two or more settings
not be caused by any other problem
What are the three types of ADHD?
Predominately inattentive
Predominately Hyperactive-Impulsive Type
Combined Type
Do ADHD patients show abnormal CNS damage, neurophysiological, or neurochemical abnormalities?
None of them.
True or False: Siblings have twice the risk of the ADHD than the general population.
True.
True or False: Evidence has implicated norepinephrine as the single neurotransmitter responsible for ADHD.
False: No clear cut evidence implicates a single neurotransmitter.
How many settings must ADHD be present in for diagnosis?
2 settings
What comorbid conditions may occur with ADHD?
depression
anxiety
conduct disorder
learning disabilities
What is the first choice of treatment for treating ADHD?
CNS Stimulants: methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert)
What are the side effect of stimulant treatments for ADHD in children?
Stomach ache, headache, nausea, and insomnia
Ritalin may cause growth suppression
May exacerbate tic disorders
What antidepressants can be used in children with ADHD? What is the blackbox warning?
imipramine (Tofranil), desipramine (Norpramine), and nortriptyline (Pamelor) have been used with some success.
Black box warning: sudden death with children being treated with desipramine (Norpramine) -- a TCA that inhibits reuptake of norepinephrine
When is clonidine most useful in treating children with ADHD?
ADHD with a tic disorder
What is the only non-stimulant medication approved by the FDA for ADHD? What is the benefit of this drug?
Strattera
Low abuse potential
What are common features of autism?
impaired social interactions
impaired verbal and nonverbal communication
problems processing information from the senses,
restricted and repetitive patterns of behavior
What are two mild conditions associated with autism?
Asperger Syndrome
"pervasive development disorder not otherwise specified"
True or False: Autism is found more frequently in girls than boys, but boys are more severely affected.
False: Autism is found more frequently in BOYS than girls, but GIRLS are more severely affect.
Rett's syndrome is exclusive to who?
Girls
What notable conditions is autistic disorder associated with?
congenital rubella, PKU, tuberous sclerosis, and Rett Disorder.
Are siblings more likely to have autism than the general population?
Yes, 50 times more likely.
True or False: The American Academy of Pediatrics and the CDC have reported that is no proven link between autism and the MMR vaccine.
True
Know the features of autism.
There are simply too many to type.
What is Asperger syndrome?
a condition marked by impaired social interactions and limited repetitive patterns of behavior.
-is very similar to or may be the same as high functioning autism
-is more common in boys
Is there a cognitive delay in children with Asperger syndrome?
No. Many are above-average intelligence.
What is the focus of treatment for children with autism?
therapy: an early intensive treatment program will greatly improve the outlook
What medicines can be used in children with autism?
Medicines used to treat behavior or emotional problems that people with autism have
Only risperidone (antipsychotic) is approved for treatment of children ages 5-16 with irritability and aggression associated with autism
What diet may help autistic children?
gluten-free or casein-free
What is anorexia nervosa?
an eating disorder in which a person refuses to stay at even the minimum body weight considered normal for their age and height
What group of people are more likely to have anorexia nervosa?
Caucasian women who are high academic achievers and have a goal-oriented family or personality.
What are the symptoms of anorexia nervosa? (need to know)
-weight loss of 15% or greater below the expected weight (body weight less than 85% of expected weight)
-inappropriate use of laxatives, enemas, or diuretics to lose weight
-self-imposed food intake restrictions
-amenorrhea, skeletal muscle atrophy, loss of fatty tissue, low blood pressure, blotchy or yellow skin, depression
What are the subtypes of anorexia nervosa?
1. restricting type: restricts intake
2. Binge Eating-Puring Type: engages in binge eating or purging through self-induced vomiting or the use of laxatives or diuretics
What biochemical changes result from starvation?
hypercortisolemia, thyroid function suppression, lowered hormonal levels of LH, FSH, and gonadotropin-releasing hormone (amenorrhea)
What EKG changes do you see on a patient with anorexia nervosa?
Flat or inverted T-waves
ST segment depression
Prolonged QT
What imbalance often causes the death of anorexia nervosa patients?
hypokalemia
When is an anorexic patient recommended for hospitalization? When are they required psychiatric hospitalization?
20% below expected weight;
30% below expected weight
-can range from 2-6 months
What medications can be used in the treatment of anorexia nervosa?
Cyproheptadine (Periactin) - antihistamine properties
Amitriptyline (Elavil)
Fluoxetine (Prozac)
ECT for patients with MDD
Megace
What medications is FDA approved to treat anorexia and cachexia?
Megace, a synthetic derivative of the naturally occurring steroid hormone, progesterone
What is bulimia?
Binge eating and purging, laxative use, or diuretic use, fasting, or excessive exercise
What is the big difference between bulimia nervosa and anorexia nervosa?
those with bulimia maintain a normal body weight
According to the DSM-IV, how long must the binge eating and compensatory behaviors of bulimia occur?
an average of at least twice a week for three months
True or False: Many people with bulimia may also suffer from anorexia.
True
True or False: Anorexia has a better prognosis than bulimia.
False: Bulimia has a better prognosis.
How do you treat bulimia?
Cognitive-behavioral therapy, group therapy, family therapy, and psychopharmacology.
Pharmacotherapy: antidepressants (reduce binge eating and purging) are successful in the same doss as those used to treat depression.
What is obesity?
A body weight that is much greater than what is considered healthy;
adults with a BMI greater than 30 are obese;
adults more than 100 lbs overweight or with BMI greater than 40 is morbidly obese
What is the number 1 eating disorder in adolescents and children?
Obesity
How do you treat obesity?
A combination of calorie restriction and exercise appear to be more effective than either one alone.
What are subutramine (Meridia) and orlistat (Xenical)?
Prescription weight loss drugs.
What is anxiety?
Feeling of apprehension caused by anticipation of danger, which may be internal or external.
What is fear?
Anxiety caused by consciously recognized and realistic danger.
What is panic?
An acute, episodic, intense attack of anxiety associated with overwhelming feelings of dread and autonomic discharge.
Anxiety has what 2 components?
1) The self-awareness of the physiological sensations
2) The self awareness of being nervous or frightened.
When does anxiety become a disorder?
When it becomes an excessive irrational dread of everyday situations
Is anxiety disorder more common in men or women?
Women
What is the fear pathway?
Thalamus sends direct info to the amygdala which blasts out alarm to brainstem & strengthens memory for event
According to the DSM-IV, what are the characteristics of generalized anxiety disorders?
-Excessive worry and anxiety, occurring more days than not for at least 6 months, about a number of events or activities
-Person finds it difficult to control the worry.
-Focus of worry is not confined to features of an Axis 1 disorder.
-Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
-Disturbance is not due to the direct physiological effects of a substance or a general medical condition.
What is the diagnostic criteria for generalized anxiety disorder?
-Anxiety and worry are associated with three or more of the following six symptoms
1) restlessness or feeling keyed up or on edge
2) being easily fatigued
3) difficulty concentrating or mind going blank
4) irritability
5) muscle tension
6) sleep disturbance
How long must you have generalized anxiety disorder for diagnosis?
6 months
Is panic disorder a codable disorder?
No
What is the diagnostic criteria for panic disorder?
A discrete peroid of intense fear or discomfort, in which FOUR or more of the following symptoms developed abruptly and reached a peak within 10 minutes:
1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling and shaking
4. sensations of shortness of breathe or smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, lightheaded, or faint
9. derealization and depersonalization
10. fear of losing control or going crazy
11. fear of dying
12. paresthesieas
13. chills or hot flushes

-individuals must suffer recurrent panic attacks
True or False: Mitral valvulopathy and panic disorder often are comorbid conditions.
True.
What other disorders have similar symptoms as panic disorder?
Mitral Valve Prolapse
Paroxysmal Atrial Tachycardia
Partial Seizures
What neurotransmitter seems to be implicated in panic attacks?
Norepinephrine
What are phobias?
an irrational fear resulting in a conscious avoidance of the feared object, activity, or situation.
What is the most common mental disorder in the United States?
Phobias
What are the most feared objects and situations in specific phobias? (list in descending order)
Animals
Storms
Heights
Illness
Injury
Death
What is social anxiety disorder?
persistent fear of showing anxiety symptoms when exposed to unfamiliar situations or people and potential scrutiny, which result in humiliation and avoidance
What is the typical age group for the onset of social anxiety disorder?
11-19 years
What is the difference between shyness (and performance anxiety) and social anxiety disorder?
Social Anxiety Disorder:
greater severity and pervasiveness
greater resultant distress and impairment
How do you treat social anxiety disorder?
Beta-Blockers
BZP
SSRI's
SNRI's
TCA's
Cognitive Behavior Therapy
What do you need to be careful with when using beta-blockers?
precautions with asthma, IDDM, CHF, hyperthyroidism, PVD, and persistant angina
How does OCD differ from addictive behavior?
OCD patients do no want to actively perform compulsive tasks and experience no pleasure from doing so.
How is OCD different from obsessive compulsive personality disorder?
OC personality disorder patients are acceptable of their obsessions and compulsions.
OCD sufferers experience anguish because of it.
What neurotransmitter plays a part of OCD?
serotonin
What characterizes OCD?
obsessions or compulsions
last at least an hour/day
interfere with normal social and occupational function
What are obsessions?
are experienced internally and are subjective. It is a recurrent and intrusive thought, feeling, idea, or sensation.
What are compulsions?
conscious standardized mental act or behaviors such as counting, checking, or avoiding.
Obsessions (increase/decrease) anxiety. Carrying out compulsions (incease/decrease) a person's anxiety.
Obsessions INCREASE anxiety.
Carrying out compulsions DECREASE anxiety.
*Failure to carry out a compulsion will increase anxiety.
What are tics?
Tics are involuntary, sudden, rapid, recurrent, non-rhythymic, sterotyped motor movements or vocalizations.
What are the four tic disorders?
1. Tourette's Disorder
2. Chronic Motor or Vocal Tic Disorder
3. Transient Tic Disorder
4. Tic Disorder, NOS
What is the diagnostic criteria for Tourette's Syndrome?
a person exhibits both multiple motor and one or more vocal tics over the period of a year, with no more than three consecutive tic-free months.
-the onset must have occurred before the age of 18 and cannot be attrbuted to the "direct physiological effects of a substance or a general medical condition.
True or False: Tourette's Syndrome is a lifelong, chronic disorder that may get worse with age.
False: The severity and nature of the symptoms typically come and go. Symptoms usually worsen before the mid-teen years, but most patients improve in early adulthood
What is the treatment for Tourette's Syndrome?
Antipsychotics: primiozide (Orap)
What are the symptoms of chronic motor or vocal tic disorder?
Vocalizations
Facial Grimacing
Excessive Blinking
Rapid, recurrent movement of the arms, legs, or other areas.
To be diagnosed with chronic motor or vocal tic disorder, what do you need?
Must have had the tics nearly every day for more than a year
Has not had a tic-free period for longer than 3 months
How do you treat chronic motor or vocal tic disorder?
Depends on severity and frequency of the tics
-Haldol or other antipsychotics
Are antianxiety medications useful in chronic motor or vocal tic disorder?
Nope, not successful
What is transient tic disorder?
transient tic disorder is a temporary condition that causes single or multiple motor tics, which are brief, repetitive, difficult-to-control movements or noises (vocalizations). The tics often resemble nervous behavior.
They get worse with emotional stress.
Who usually gets transient tic disorder?
children
How do you treat transient tic disorder?
You don't. Tics usually disappear over a period of months.
What are examples of Tic Disorder, NOS?
tics lasting less than 4 weeks or tics with an onset afte age 18
What are the current hypotheses for the mechanism of OCD?
Serotonin hypothesis
Dopamine hypothesis
Serotonin-dopamine hypothesis
True or False: Decrease serotonin tonic inhibitory action on dopamine neurons leads to increased dopamine function.
True.
When treating anxiety disorders, what drugs should you avoid?
CNS stimulants
What drugs are approved for the treatment of GAD?
Venlafaxine (Effexor), paroxetine (Paxel), escitalopram (Lexapro), and more
How should you choose a drug for the treatment of GAD?
side effect profile
comorbidity
patient's ability to tolerate
What is a disadvantage of antidepressants?
has delayed onset of antidepressant action
True or False: Benzodiazepines are more effective for the treatment of GAD than TCA's?
False: TCA's are shown to be as effective as benzodiazepines.
When would you use antidepressants for the treatment of GAD?
when depression is present
What SSRI's can be used for GAD?
sertraline (Zoloft) and fluvoxamine (Luvox)
What SNRI's have been effective in treating GAD?
venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq)
When do you use TCA's for the treatment of GAD?
when other agents have failed.
What is a relative contraindication of benzodiazepines?
history of alcohol or other substance abuse problems
What sort of benzodiazepines are preferred for GAD?
low potency, long acting agents
How do benzodiazepines work?
increased binding of GABA to GABA-a receptors
increased responsiveness of chloride channels to GABA binding
Is rebound anxiety more common with short-acting or long-acting benzodiazepines?
short-acting
What is posttraumatic stress disorder?
a physical reaction to a severe stressor involving intense fear, helplessness, or horror
Posttraumatic stress disorder is divided into what 3 clusters?
reexperiencing/intrusion
avoidance/numbing
hyperarousal
What is the diagnostic criteria for PTSD: avoidance and numbing?
persistent avoidance of associated stimuli and numbing of responsiveness, in greater than 3 ways:
-avoiding thoughts, feelings, or conversations with the trauma
-avoiding activities, places, or people that arouse recollections of the trauma
-inability to recall an important aspect of the trauma
-diminished interest or participation in significant activities
-feeling detached from others
-restricted emotions
-sense of foreshortened future
What is the diagnostic criteria for PTSD: hyperarousal?
Persistent symptoms of increased arousal (not present before the trauma) as indicated by TWO or more of the following:
-difficulty falling asleep or staying asleep
-irritability or outbursts of anger
-hypervigilance
-difficulty concentrating
-exaggerated startle response
What are the 10 forms of twisted thinking?
1. All or None thinking
2. Overgeneralization
3. Mental Filter
4. Discounting the Positive
5. Jumping to Conclusions
6. Magnification
7. Emotional Reasoning
8. "Should Elements"
9. Labeling
10. Personalization and Blame
Define Affect.
This is the "observed" expression of emotion. Affect can be described as - appropriate, inappropriate, blunted, restricted, flat, labile, mecurical, etc.
Define Mood.
A pervasive and sustained emotion. This is what the patient reports his emotion as being. Examples are: euthymia, elation, anger, irritable, calm, apathy, etc.
Define Depression.
a pathological feeling of sadness.
What is the diagnositc criteria for Major Depressive Disorder?
Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure:
1. depressed mood for most of the day, nearly every day
2. marked diminished interest or pleasure in all, or almost all, activities
3. significant weight loss when not dieting or weight gain
4. insomnia or hypersomnia every day
5. pyschomotor agitation or retardation nearly every day
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. diminished ability to think or concentrate, or indecisiveness, nearly every day
9. recurrent thoughts of death
What is the diagnostic criteria for Dysthymic Disorder?
an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. Persons who suffer from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:
1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficulty making decisions
6. feelings of hopelessness

-no major deprssive episode has been present during the first two years and there has never been a manic episode, a mixed episode, or a hypomanic episode
What are Axis I disorders?
all psychiatric diagnoses except personality disorders, Axis II disorders, and mental retardation.
What are Axis II disorders?
developmental disorders and personality disorders
What are Axis III disorders?
physical conditions
What are Axis IV disorders?
psychosocial events (things that make axis I worse)
What are Axis V disorders?
the clinician rates the person's level of functioning both at the present time and the highest level within the previous year. This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected.
What is adjustment disorder?
an inabililty or maladaptive reactionto an identifiable stressul life event.
-must occur withinthree months of the event and persisted for no longer than six months
What is the leading disability in the United States?
depression
True or False: The suicide risk for a depressed patient is 15%.
True
What are the risk factors for suicide?
Race (white), Age (elderly), medical problems, loss of spouse, diagnosis, feeling like a burden, substance abuse
What are considered the major antidepressant medications?
TCA's and tetracyclics, MAOI's, and SSRI's.
How do TCA's work?
they reduce the reuptake of norepinephrine and serotonin and block the muscarinic acetylcholine and histamine receptors.
What drugs don't you want to take TCAs with?
quinidine, cimetidine, CBZ, phenothiazines, and SSRI's
(CP450)
What precautions must you take with TCA's when using with depression?
-Could precipitate a manic episode
-Anticholinergic effects
-Narrow angle glaucoma
-Sedation, confusion, or hypertension
-Orthostatic hypotension or hypertension
-Tachycardia, flattened t-waves, prolonged Q-T interval, depressed ST segments
-Lowered seizure threshold
-Weight gain, sexual dysfunction, and suicide
Symptoms of a TCA overdose include what?
agitation, delirium, convulsions, hyperactive deep tendon reflexes, bowel and bladder paralysis, temperature and blood pressure dysregulation and mydraisis, cardiac abnormalities, coma
What is the mainstay of treatment for depression and dysthmia?
SSRI's
What is a disadvantage of SSRI's?
response time is usually 3-4 weeks.
SSRI's can't be used within 14 days of what class of drugs?
MAOI
Can you use SSRI's and TCA's together?
Yes, but you must keep the TCA's dosed low since SSRI's increase serum levels of TCA's.
Why can't SSNR's be used with SSRI's, MAOI's, or TCA's?
They can precipitate Serotonin Storm.
What is a downfall of Bupropion (Wellbutrin)?
high risk of seizures
How long do you treat the first episode of depression? The second? The third (or over 50)?
first episode - 1 year
second episode - 2-5 years
third episode - lifelong
When is ECT used for depression?
when it hasn't responded to other treatment
What is the diagnostic criteria for manic?
A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week.
during the mood disturbance, three or more of the following symptoms have persisted and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual
4. flight of ideas or subjective experience that thoughts are racing
5. distractability
6. increase in goal-directed activity
7. excessive involvement in pleasurable activities.
What is the gold standard for treatment of Bi Polar?
Lithium
What is the role of antidepressants in Bi Polar?
They are usually avoided or used with extreme caution as they may contribute to mania, hypomania, mixed, or rapid cycling.
What is a big side effect associated with Clozapine (Clozaril) in the treatment of Bi Polar?
agranulocytosis
What are the contraindications for lithium?
severe cardiovascular or renal disease and those with evidence of severe debilitation or dehydration, sodium depletion, brain damage, and pregnancy
What is Ebstein's Anomaly and how is it caused?
It is a heart defect in which the tricuspid valve is abnormally formed. The tricuspid valve normally has three "flaps" or leaflets. In Ebstein's anomaly, one or two of the three leaflets are stuck to the wall of the heart and don't move normally.
This is caused by maternal ingestion of lithium during pregnancy.
How do you treat lithium poisoning?
There is no antidote for lithium poisoning.
1. Gastric lavage
2. correction of fluid and lytes
3. regulation of kidney fuction
What characterizes somatoform disorders?
many symptoms that cannot be adequately explained on the basis of physical and lab findings.
What are the four specific somatoform disorders?
somatization disorder
conversion disorder
hypochondriasis
body dysmorphic disorder
How usually sufferers from somatization disorder?
less educated, poor women with mental disorders
What is the course and prognosis of somatization disorder?
chronic and debilitating
How do you treat somatization disorder?
individual and group therapy
psychotropics may be helpful
What is somatization disorder?
characterized by many physical complaints affecting several body organ systems
What is conversion disorder?
characterized by one or two neurological complaints
Who most commonly gets conversion disorder?
low income, low IQ women, often with major depression, anxiety, or schizophrenia
What is the course and prognosis of conversion disorder?
vast majority recover in a few days or weeks
the longer the disorder, the worse the prognosis
How do you treat conversion disorder?
resolution is usually spontaneous
therapy that is caring and authoritative
hypnosis, anxiolytics, and behavior relaxation exercises
What is hypochondriasis?
characterized less on symptoms but more on patient belief that he/she has some specific disease.
What is the course and prognosis of hypochondriasis?
usually episodic.
can last from months to years
good prognosis is associated with effective treatment of anxiety or depression
How do you treat hypochondriasis?
usually resistant to psychiatric help
group therpy is more effective than group therapy (i am unsure what i mean by this)
refrain from invasive diagnostic procedures unless objective evidence warrents them
What is body dysmorphic disorder?
the false belief or micperception that some body part is defective
Who usually suffers from body dysmorphic disorder?
15-20 year old girls
How do you treat body dysmorphic disorder?
dermatological, surgical, dental, and other medical procedures are almost always unsuccessful.
antidepressants and antipsychotics have been helpful
What is pain disorder?
symptoms that are solely related to psychological factors or significantly exacerbated by psychological factors
Who most commonly gets pain disorder?
women in the fourth and fifth decades
What two disorders are commonly present in pain disorder?
major depression and dysthymic disorder
What is the course and prognosis of pain disorder?
can be chronic distressful, or disabling
may subside with treatment
patients with the poorest prognosis are usually involved in litigation or receive financial compensation
How do you treat pain disorder?
antidepressants
behavioral treatment
psychotherapy
What are the three psychotic disorders?
Delusional disorder
Schizophrenia
Schizoaffective disorder
What characterizes delusional disorder?
predominant symptoms that are delusions
How does delusional disorder differ from schizophrenia?
their delusions are non-bizarre
What are the 5 types of delusional disorder?
erotomanic type
grandiose type
jealous type
persecutory type
somatic type
What is the most common delusional disorder?
persecutory type
What is the course and prognosis of delusional disorder?
fairly stable disorder (about 50% recover)
better prognosis with high levels of occupational and social function, female sex, onset before 30, sudden onset, and short duration.

patients with persecutory, somatic, and erotic delusions are though to have a better prognosis
How do you treat delusional disorder?
hospitalization
-because a thorough medical workup is warrented
-because patients may be assessed for violent impulses
-because delusions may have affected patient's abilility to function

psychotherapy and family therapy
severely agitated should be given IM antipsychotic
What is the treatment of choice for delusional disorder?
Antipsychotics
What are the 4 A's of schizophrenia?
Associational disturbances
Affective disturbances
Autism
Ambivalence
What percentage of schizophrenics attempt suicide? How many commit suicide?
50% attempt
10-30% commit
What is the dopamine hypothesis in schizophrenia?
hypothesizes that schizophrenia results from too much dopamine in certain areas of the brain
True or False: Schizophrenia is not a bona fide brain disease.
False: It is.
What is the diagnostic criteria for schizophrenia?
Person must display characteristic symptoms: Two or more of the following, each present for a significant portion of time during a one-month period
-delusions
-hallucinations
-disorganized speech
-grossly disorganized behavior or catonic behavior
-negative symptoms

*only one of these symptoms is required if delusions are bizarre or hallucinations consist of hearing one voice participating in a running commentary
*continuous signs of the disturbance persist for at least six months, with at least one month of symptoms
What are some traditional drugs used for schizophrenia?
What risk do they carry?
Stelazine
Loxapine
Perphenazine
Chlorpromazine
Haldol
Prolixin

*All carry a high risk of tardive dyskinesia and dystonia
What schizophrenia drug has a risk of agranulocytosis?
clonzapine (Clozaril)
What are the newer drugs used for treatment of schizophrenia?
Clozapine
Olanzapine
Risperidone
Quetiapine
Aripiprazole
Ziprasidone
What EPS are medical emergencies?
oculargyric crisis and laryngeal spasm dystonias
How do you treat EPS medical emergencies?
1. Reduce or stop dose
2. Institute anti-EPS medications
3. Possibly change the medication
How do you treat dystonias?
anticholinergics or antihistamines and life support as needed.
should resolve in 2-3 doses in a few hours
How do you treat neuroleptic induced akathisia?
dose reduction
change in medication
beta-bockers
anticholinergics
benzodiazapines
How do you treat neuroleptic-induced tardive dyskinesia?
no uniformly successful treatment
switching to newer atypical may help
What is neuroleptic malignant syndrome?
a life-threatening complication of antipsychotic treatment that can occur at any time during treatment

symptoms include:
muscular rigidity and dystonia, akinesia, mutism, obtundation, agitation, high fever, sweating, and increase or fluctuating blood pressure and pulse
What medications most commonly used to treat neuroleptic malignant syndrome?
dantrolene (Dantrium)
bromocriptine (Parlodel)
amantadine
What are the symptoms of alcohol withdrawal?
autonomic hyperactivity
increased hand tremor
insomnia
nausea or vomiting
transient visual, tactile, or auditory hallucinations
psychomotor agitation
anxiety
grand mal seizures
True or False: Alcoholic delirium tremens aren't actually a medical emergency.
False. They are.
When do DT's usually develop?
On the 3rd day of withdrawal
What are the symptoms of DT's?
autonomic hyperactivity
tachycardia
diaphoresis
fever
axiety
insomnia
hypertension
hallucinations
lethargy or hyperexcitability
What is the mortality rate of untreated DTs?
20%
How do you treat DT's?
PREVENTION!
patients in alcohol withdrawal who exhibit any symptoms should receive a benzo every 2-4 hours
high-calorie, high carb diet supplemented by multi-vitamins
correct dehydration
What role do antipsychotics and non-benzo anticonvulsants have in treatment of alcoholic DT's?
they have no use in preventing or treating alcohol withdrawal convulsions
What are Wernicke's and Korsakoff's syndrome?
disturbance in short term memory caused by prolonged heave use of alcohol
Wernicke's: acute condition
Korsakoff's: chronic condition
What is the pathophysiology of Wernicke's and Korsakoff's syndome?
thiamine deficiency
What are the symptoms of Wernicke's syndrome?
ataxia, vestibular dysfunction, confusion, and ocular motility abnormalities (horizontal nystagmus, lateral rectal palsy, and gaze palsy)
How do you treat Wernicke's syndrome?
large doses of parental thiamine (100mg BID or TID x 1-2 weeks)
What are the symptoms of Korsakoff's syndrome?
impaired mental condition (especially recent memory), and anterograde amnesia in an otherwise alert and attentive patient
-may or may not have confabulation (confusion of true memories with false memories)
How do you treat Korsakoff's syndrome?
large doses of thiamine by mouth (100mg BID or TID x 3-12 months)
What is the prognosis for Korsakoff's syndrome?
few recover
What is the number 1 cause of mental retardation in the USA?
fetal alcohol syndrome
What are the signs and symptoms of fetal alcohol syndrome?
microcephaly
craniofacial malformations
limb and heart defects are common
short stature
maladaptive behavior
small eyes
thin upper lip
short, upturned nose
What are two drugs used for alcohol dependence?
Disulfuram (Antabuse)
Acamprosate (Campral)
How long does disulfuram stay in the system?
2 weeks after last dose
When should you use caution in prescribing acamprosate?
in renal impairment
True or False: 90% of smoking-related deaths are from cancer.
False: 50% are from cancer. Smoking is also the major cause of heart disease, aneurysms, bronchitis, emphysema, and stroke.
How does Chantix work?
is believed to block nicotine from the receptors
What are the three stages of opioid addiction?
1. preoccupation/anticipation
2. binge/intoxification
3. withdrawal/negative affect
What are the signs of opioid use/dependence?
Drowsiness
Inability to concentrate
Apathy
Lessened physical activity
Constriction of pupils
Dilation os the subcutaneous blood vessels
Flushing of the face and neck
Constipation
Nausea and Vomiting
Respiratory Depression
What are the signs of opioid withdrawal?
Watery eyes
Runny nose
Yawning
Sweating
Restlessness
Irritability
Loss of Appetite
Nausea
Tremors
Drug Craving
Severe depression and vomiting are common
Elevated Pulse
Elevated Blood Pressure
Chills alternating with flushing and excessive sweating
Diarrhea
Pains in the bones and muscles of the back
Goosebumps
Dilated Pupils
True or False: The effects of opioid withdrawal can be very severe and are considered a medical emergency.
False: Narcotic withdrawal is not a medical emergency unless the patient is pregnant.
How do you treat opioid withdrawal?
at any point during the process, narcotics can be administered and will dramatically reverse the withdrawal symptoms.
without intervention, the syndrome will run its course in 7-10 days
Cocaine can cause heart-attacks and it's important for anyone with chest pain to get it checked out. However, there are two typical heart attack treatments than can be dangerous to those using cocaine. What are they?
Clot-busting drugs - carry an extra risk of bleeding into the brain in patients whose blood pressure is high due to cocaine use.
Beta-blockers - can raise blood pressure and squeeze cocaine-narrow arteries.
What is the most common two-drug combination that results in drug-related death?
cocaine and alcohol
What symptoms does cocaine withdrawal have?
it has no visible symptoms
the craving and depression can last for months
What are symptoms of a cocaine crash?
craving for cocaine
fatigue
lack of pleasure
anxiety
irritability
sleepiness
agitation
extreme suspicion
How do you treat cocaine withdrawal?
treat the depression or underlying disorder
diltiazem disrupts the connection between dopamine and glutamate formed during chronic cocaine use
What is the primary reinforcing ad behavioral-stimulant effect of ampthetamines?
the enhanced dopaminergic activity, primarily in the mesolimbic system
What is the most commonly used illegal drug in the US?
Marijuana
What is the most potent hallucinogen known to science?
LSD
What is the most commonly cause death with ecstacy use?
increased body temperature that causes organ failure
What are the most commonly encountered steroids on the market?
testosterone, nandrolone methenolone, stanozolol, and methandrostenolone