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41 Cards in this Set
- Front
- Back
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Chronic Anxiety disorders are often mixed with what other disorder? Which Axis of diagnosis does this fall under?
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Anxiety disorders are often mixed with Depression. Depression falls under Axis I conditions.
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What types of organ systems may be affected in anxiety disorders? What types of physical presentations are there?
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The types of physical presentations for patients with anxiety disorders are vast- there can be symptomology of the lungs, heart, GI, CNS, or any other organ system.
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Explain the diagnostic approach that one needs to take when evaluating whether or not a patient has an anxiety disorder.
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The diagnostic approach for anxiety disorders is to look for clusters of characteristic symptoms, age of the patient, prevalence of the anxiety disorder in the population, and use a "rule in" approach.
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Describe the key characteristic of Adjustment Disorder with Anxious Mood. About how long after an event will a patient present with this? How long is the duration of this disorder and its symptoms?
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This disorder is characterized by a maladaptive reaction to an identifiable stressor. This will present within 3 months of the stressful event occurring and will usually last less than 6 months, however, there can be continuous symptoms.
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What types of events are key triggering events for Adjustment Disorder with Anxious Mood? What is the first-line of treatment in patients with this disorder?
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There can be a wide variety of psychosocial stressors that can trigger this disorder, especially those that are medically related (e.g. chronic illness, hospitalization). Other non-medical include marital problems, job discord, etc. First-line treatment is counseling to talk about the problems and develop strategies to relieve stress. Could also try brief course of benzos or antidepressants if disorder becomes severe.
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Describe the three symptom cluster that is used to diagnose Generalized Anxiety Disorder (GAD). Is this usually an acute disorder or a chronic disorder? What is the treatment that is prescribed?
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Generalized anxiety disorder is the "worry wart" syndrome. 1) Motor Tension (eg. stiff neck) 2) Autonomic hyperactivity (sweating, diarrhea, etc) 3) Vigilance and scanning (hyper-aware of surroundings) are the three cluster symptoms of this disorder. The duration of this disorder is long (greater than 6 months). First line treatment involves counseling or therapy if the disorder is mild. There can also be some self-regulatory therapies, and EXERCISE which can help in this group of patients.
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What are some of the pharmacologic approaches that may be helpful to patients with GAD?
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For pharmacologic approaches, benzos are a possibility, but since it is mostly a chronic condition, these need to be used sparingly. Anti-depressants are a possibility (SSRIs) or a non-benzo.
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What are the symptoms that qualify a patient as having Panic Disorder? What are the parameters of these symptoms? How do you treat this disorder?
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Four panic attacks in one month or one attack followed by persistant fear (eg. you had an attack in a specific store and you won't go back to the store due to fear/anxiety), qualifies you for this disorder.
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How would you treat a patient with severe Panic Disorder? What two medications would you use and in what capacities?
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A patient with SEVERE Panic Disorder may need to be put on low dose benzos and an antidepressant, and then discontinue the benzos as the patient gets the antidepressant level built up in their blood.
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Describe the pharamcological and behavioral therapy approaches for treating OCD.
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Treatment for OCD is SSRIs, MAOIs, benzos (for a short course). These treatments can reduce symptoms in as much as 60% of patients. Therapies are often combined. Behavioral therapy (exposure and response prevention) attempts to uncouple the behavior from the obsessive thoughts and compulsions.
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What is PTSD (post traumatic stress disorder)? Describe the non-pharmacological approaches to treatment.
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PTSD is a stress disorder that occurs following a traumatic event. A person afflicted with this disorder may re-experience the trauma and avoid associated stimuli. There can be arousal symptoms associated (cardiac, sweating, etc.) Non-pharmacological approaches to treatement are support groups, psychotherapy, relaxation techniques, biofeedback. It may be important to include the family in counseling.
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Describe the features common to both Anxiety and Depression.
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Sleep disturbances, appetite changes, cardiopulmonary and GI complaints, irritability, and fatigue.
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Contrast Anxiety from Depression.
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Anxiety: has an earlier age of onset; patients may have trouble falling asleep, but once they do they sleep fine; they may be tired when they wake up, but this is because it took them a long time to fall asleep.
Depression: do not feel well in the morning and are exhausted at night, which allows them to fall asleep; once asleep they tend to wake up and not fall back asleep, which is why mornings are so miserable; they tend to feel better as the day goes on. |
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What is the main positive symptom associated with Schizophrenia? Which receptors seem to be overactive in Schizophrenia?
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Auditory Hallucinations. Schizophrenia involves increased levels of D2 receptors.
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Describe the symptoms that are often noted prior to the onset of the psychotic symptoms associated. with Schizophrenia.
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Inattention/attentional impairment, memory impairment, impaired executive funciton, language disturbance. These symptoms are often noted prior to the onset of the psychotic symptoms and have the highest correlation with the functional impairment.
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Name the four subtypes of Schizophrenia that have been created. Which subtype has the best prognosis to function as a member of society?
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Disorganized, catatonic, paranoid, undifferentiated. The paranoid subtype has the best prognosis to function as a member of society because they still talk linearly and logically and are often not paralyzed if it has a later onset.
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What are the three main NTs that are implicated in Schizophrenia?
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Dopamine, Serotonin, and Glutamate.
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What are some good Psychosocial methods of treatment for patients with Schizophrenia?
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Assertive community treatment teams, day hospital programs, psychosocial rehabilitation clubs, vocational rehabilitation, support groups, group homes, case managers
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Define Schizophreniform disorder.
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This is basically the same as Schizophrenia with two main differences: 1) Total duration is at least 1 month, but less the 6 months 2) Impaired social or occupational functioning during some part of the illness is NOT required.
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Describe Schizoaffective disorder. What separates it from Mood disorders?
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SAD contains psychosis and major depression, manic, or mixed episodes concurrent with symptoms of Schizophrenia. There must be delusions or hallucinations for at least two weeks in the absence of prominent mood symptoms. In Mood disorders these symptoms go away after the patient is no longer depressed. In SAD the symptoms are not relieved by treatment of depression.
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Addiction is classified as needing to fulfill what three general requirements?
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Compulsion, loss of control, continued use in the face of adverse consequences.
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Which system of the brain is thought to play the largest role in the pathogenesis of addiction?
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The DA reward system of the limbic system.
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Why should you give Thiamin to a chronic alcoholic patient.
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You must give Thiamin (Vitamin B1) before giving the patient any glucose. Glucose in a patient with Thiamin deficiency can cause Wernike's encephalopathy.
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What medication is most popular to use to treat the withdrawal symptoms of alcohol?
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Benzodiazapines.
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Describe the physiological mechanism behind the withdrawal symptoms that are associated with Opiates. What medications can be used to help a patient through withdrawal?
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Withdrawal from opiates is primarily due to excess locus ceruleus discharge of catecholamines. Clonidine and other alpha-agonists can be used effectively to treat symptoms of Opiate withdrawal.
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What is Buprenorphine and how is it used?
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Buprenorphine is a long-acting opiate that can be used for 72hrs to help treat opiate withdrawal.
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If you get one depressive episode in you life, what are the chances that you will experience another one?
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50%.
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What are the main risk factors for suicide?
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Older age, male, recent loss, bipolar depression, psychosis, comorbid substance abuse, history of attempt, family history of suicide.
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What criteria do you need to be able to diagnose a Major Depressive Episode?
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There must be the presence of 5 or more symptoms over a two week period including at least 1) Depressed mood or 2) Anhedonia.
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What does SIGECAPS stand for?
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Suicide, Interest (loss of), Guilt (excessive), Energy (loss of), Concentration (loss of), Appetite (loss of), Psychomotor issues, Sleep disturbances.
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Describe the diagnostic criteria for Dysthymic disorder.
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Dysthymic disorder requires a depressed mood "most" days for at least tow years (the depressed mood is not quite as bad as MDD), and at least two other depressive characteristics.
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Describe the components of the limbic circuit?
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Hippocampus (memory), Hypothalamus (neuroendocrine regulation), Prefrontal cortex (executive functions), Amygdala (anger), Cingulate cortex (highly affected in depressive disorders).
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What are some of the structural changes in the brain that are noted to accompany different mood disorders?
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Reduce hippocampal volume in MDD, correlates to the number of days spent depressed in depressed mood. Imaging studies consistently show decreased activity in prefrontal cortex in MDD vs. control.
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Where are the levels of NTs 5-HT, Dopamine, and NE raised in the brain in response to treatment in depression?
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Serotonin
- dorsal raphe nucleus Dopamine - locus ceroelus Norepinephrine - ventral tegemental area |
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What drug can MAOIs reverse the effects of?
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Reserpine.
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What foods must you avoid eating when taking MAOIs?
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Red wine, Aged cheeses, Smoked meats.
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How long do you have to wait before prescribing an SSRI to a patient who was taking an MAOI?
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You have to wait for a period of about 2 weeks for the MAO to regenerate in cells, because the MAOIs bind irreversibly to MAO.
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Are Tertiary TCAs more likely to inhibit 5-HT reuptake or NE? Which are Secondary TCAs more likely to inhibit?
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Tertiary TCAs = 5-HT
Secondary TCAs = NE |
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What are the two receptor type blockades that occur with TCAs that make their use much less desirable to that of SSRIs?
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Cholinergic blockade: Dry mouth, Orthostasis, Memory impairment
Histaminergic blockade |
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What Cardiac abnormalities are produced by TCAs?
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Prolonged QRS intervals, potentially leading to fatal cardiac events are associated with TCAs.
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