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168 Cards in this Set
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waxing and waning LOC
rapid decrease in attention span and level of arousal acute changes in mental status disorganized thinking hallucinations illusions misperceptions disturbance in sleep-wake cycle cognitive dysfunction |
delirium
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what is the most common psychiatric illness on med and surg floors?
abnormal EEG |
delirium
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gradual decrease in cognition
characterized by memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement pt is alert no change in LOC increase w/ age most often gradual onset normal EEG |
dementia
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is memory loss in dementia reversible?
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no, usually irreversible
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periods of psychosis and disturbed behavior w/ a decline in functioning lasting >6 months
associated w/ increased dopaminergic activity |
schizophrenia
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subtypes of schizophrenia
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1.paranoid - delusions
2. disorganized - with regard to speech, behavior, affect 3. catatonic - automatism 4. undifferentiated 5. residual |
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brief psychotic disorder
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<1 month
usually stress related |
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schizophreniform disorder
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1-6 months
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schizoaffective disorder
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at least 2 wks of stable mood w/ psychotic symptoms, plus a major depressive, manic, or mixed (both) episode
2 subtypes: bipolar or depressive |
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fixed persistent nonbizarre belief system lasting more than 1 month
functioning otherwise not impaired often self-limited |
delusional disorder
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development of delusions in a person in a close relationship w/ someone with delusional disorder
often resolve upon separation |
delusional disorder
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dissociative fugue
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abrupt change in geographic location with inability to recall past, confusion about personal identity, or assume new identity
associated with traumatic circumstances (natural disaster) leads to significant distress or impairment |
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manic episode
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distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least 2 wk
often disturbing to pt Distractibility Irresponsibility Grandiosity (hedonistic) Flight of ideas increase in goal-directed Activity/psychomotor Agitation decrease need for Sleep Talkativeness and pressured speech DIG FAST |
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like manic episode except modd disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization
no psychotic features |
hypomanic episode
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defined by presence of at least 1 manic or hypomanic episode
depressive symptoms always occur eventually pt's mood and functioning usually return to normal between episodes use of antidepressants can lead to increased mania |
bipolar disorder
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milder form of bipolar disorder that lasts for at least 2 yrs
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cyclothymic disorder
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tx for bipolar disorder
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mood stabilizers: lithium, valproic acid, carbamazepine
atypical antipsychotics |
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characterized by at least 5 of following for 2 wks:
1. sleep disturbance 2. loss of interested (anhedonia) 3. guilt or feeling of worthlessness 4. loss of energy 5. loss of concentration 6. appetite/weight changes 7. psychomotor retardation or agitation 8. suicidal ideations 9. depressed mood |
major depressive episode
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MDD, recurrent
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requires 2 or more MDD episodes with symptoms-free interval of 2 months
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milder form of depression lasting at least 2 yrs
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dysthymia
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associated w/ winter season
improves in response to FULL-SPECTRUM LIGHT EXPOSURE |
seasonal affective disorder
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1-decreased slow wave sleep
2-decreased REM latency 3-increased REM early in sleep cycle 4-increase in total REM 5-repeated nighttime awakenings 6-early morning awakening |
sleep patterns of depressed pts
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hypersomnia
overeating mood reactivity - the ability to experience improved mood in response to positive events vs persistent sadness associated with weight gain sensitivity to rejection |
atypical depression
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risk factors for suicide completion
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SAD PERSONS
Sex-male Age-teenager of elderly Depression Previous attempt Ethanol or drug use loss of Rational thinking SIckness - medial illness, 3 orsmore presciprtion meds Organized plan No spounse Social support lacking women try more often men succeed more often |
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presence of recurrent periods of intense fear and discomfort peaking in 10 min. w/ 4 of following:
palpitations paresthesias abnominal distress nausea intense fear of dying or losing control light headedness chest pain chills choking disconnectedness sweating shaking shortness of breath |
panic disorder
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how do you treat panic disorders
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tx cognitive behavioral therapy (CBT), SSRIs, TCAs, BDZs
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fear that is excessive and unreasonable
interferes with normal function cued by presence of anticipation of a specific object of situation person recognizes fear is excessive can tx with systematic desensitization |
specific phobia
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exaggerated fear of embarrassment in social situations
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social phobia
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recurring intrusive thoughts, feelings or sensations (obsessions) that cause severe distress
relieved in part by performance of repetitive actions (compulsions) |
OCD
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OCD is associated with what other disorder?
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Tourette's
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how do you tx OCD?
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SSRIs, clomipramine (TCA)
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persistent reexperiencing of a previous traumatic event
may involve nightmares or flashbacks intense fear, helplessness, horror leads to avoidance of stimuli associated w/ trauma and persistently increased arousal |
PTSD
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lasts between 2 days and 1 month
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PTSD
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disturbance lasts >1 month and causes significant distress and/or impaired functioning
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PTSD
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pattern of uncontrollable anxiety for at least 6 months
unrelated to specific person, situation, event associated with sleep disturbance, fatigue, difficulty concentrating |
generalized anxiety disorder
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tx for generalized anxiety disorder
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BDZ
buspirone SSRIs |
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consciously fakes or claims to have a disorder in order to attain a specific gain
avoids tx by medical personnel, complaints cease after gain |
malingering
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creates physical and/psychological symptoms in order to assume sick role and to get medical attention
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factitious
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chronic factitious disorder with predominantly physical signs and symptoms
characterized by history of multiple hospital admission and willingness to receive invasive procedures |
Munchausen's
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disorders characterized by physical symptoms w/ no identifiable physical cause
illnes production and motivation are unconscious drives symptoms not intentionally produced or feigned more common in women |
somatoform disorders
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variety of complaints in multiple organ systems over a period of years
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somatoform disorders
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motor or sensory symptoms(paralysis, blindness, mutism) often following in acute stressor
LA BELLE INDIFFERENCE |
conversion
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preoccupations with and fear of having a serious illness despite medical evaluation and reassurance
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hypochondriasis
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preoccupation w/ minor or imagined defect in appearance leading to significant emotional distress or impaired functioning pts often repeatedly seek cosmetic surgery
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body dysmorphic disorder
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prolonged pain w/ no physical findings
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pain disorder
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cluster A personality disorders
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ODD or ECCENTRIC
inability to develop meaningful social relationship no psychosis genetic association w/ schizophrenia TYPES: Paranoid Schizoid Schizotypal |
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pervasive distrust and suspiciousness projection in majore defense mechanism
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paranoid
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voluntary social withdrawal, limited emotional expression, content w/ social isolation (vs avoidant)
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schizoid
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eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
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schizotypal
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cluster B personality disorder
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dramatic emotional erratic genetic association w/ MOOD disorders and SUBSTANCE ABUSE
Types: antisocial borderline histrionic narcissistic |
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antisocial
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disregard for and violation of rights of others
criminality males>females conduct disorder if < 18 yrs |
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borderline
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unstable mood and interpersonal relationships
impulsiveness sense of emptiness females > males splitting is a major defense mechanism |
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histrionic
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excessive emotionality and excitability
attention seeking sexually provocative overly concerned w/ appearance |
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narcissistic
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grandiosity, sense of entitlement, lacks empathy, requires excessive admiration
often demands best and reacts to criticism with rage |
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Cluster C personality disorders
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anxious or fearful, genetic association w/ ANXIETY disorders
avoidant OCD dependent |
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hypersensitive to rejection, sociall inhibited
timid, feelings of inadequacy desire relationships with others |
avoidant
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preoccupations with order, perfectionism and control
ego syntonic behavior consistent with one's own beliefs and attitudes |
OCD
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submissive and clinging
excessive need to be taken care of low self-confidence |
dependent
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what drug intoxciation?
psychomotor agitation impaired judgement pupillary dilation hypertension tachycardia euphoria prolonged wakefulness and attention cardiac arrhythmias delusions hallucinations fever |
amphetamines
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euphoria, psychomotor agitation, impaired judgement, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, sudden cardiac death
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cocaine
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what drug intoxciation?
psychomotor agitation impaired judgement pupillary dilation hypertension tachycardia euphoria prolonged wakefulness and attention cardiac arrhythmias delusions hallucinations fever |
amphetamines
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w/d of what ?
crash--> depression, lethargy, headache, stomach cramps, hunger, hypersomnolence |
amphetamines
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euphoria, psychomotor agitation, impaired judgement, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, sudden cardiac death
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cocaine
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w/d of what
crash-> depression, suicidality, hypersomnolence, fatigue malaise, sever psychological cravings |
cocaine
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w/d of what ?
crash--> depression, lethargy, headache, stomach cramps, hunger, hypersomnolence |
amphetamines
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what drug?
restlessness insomnia increased diuresis muscle twitching cardiac arrhythmias |
caffeine
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w/d of what
crash-> depression, suicidality, hypersomnolence, fatigue malaise, sever psychological cravings |
cocaine
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what drug?
restlessness insomnia anxiety arrhythmias |
nicotine
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what drug?
restlessness insomnia increased diuresis muscle twitching cardiac arrhythmias |
caffeine
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w/d of what?
headache lethargy depression weight gain |
caffeine
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what drug?
restlessness insomnia anxiety arrhythmias |
nicotine
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w/d of what?
irritability headache anxiety weight gain craving |
nicotine
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w/d of what?
headache lethargy depression weight gain |
caffeine
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what drug?
euphoria anxiety paranoid delusions perception of slowed time impaired judgement social withdrawal increase appetite dry mouth hallucinations |
cannabis
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w/d of what?
irritability headache anxiety weight gain craving |
nicotine
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w/d from what?
irritability depression, insomnia nausea anorexia most sx peak in 48 hrs and last for 5-7 days can be detected in urin up to 1 month after last use |
cannabis
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what drug?
euphoria anxiety paranoid delusions perception of slowed time impaired judgement social withdrawal increase appetite dry mouth hallucinations |
cannabis
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w/d from what?
irritability depression, insomnia nausea anorexia most sx peak in 48 hrs and last for 5-7 days can be detected in urin up to 1 month after last use |
cannabis
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belliegernce
impulsiveness fever psychomotor agitation vertical and horizontal nystagmus tachycardia ataxia homicidality psychosis delirium |
PCP
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w/d of PCP
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depression
anxiety irritability restlessness anergia disturbances of though and sleep |
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marked anxiety or depression
delusions visual hallucinations FLASHBACKS pupillary dilation |
LSD
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MOA of methylphenidate (ritalin)
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increase presynaptic NE vesicular release (like amphetamines(
mech for relieving ADHD sx is now known |
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clinical use of methylphenidate
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ADHD
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MOA of lithium
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not established
possibly related to inhibition of phosphoinositol cascade |
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clinical use of lithium
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mood stabilizer for bipolar disorder
blocks relapse and acute manic events |
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toxicity of lithium
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tremor
hypothyroidism polyuria (ADH antagonist causing nephrogenic DI) teratogenesis: Ebstein anomaly, malformation of great vessels narrow therapeutic window requires close monitoring of serum levels |
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mech of buspirone, use
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stimulates 5HTA1a receptors
generalized anxiety disorder, no sedation, addiction, tolerance, does not interact with EtOH |
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Bupropion
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used for smoking cessation
increases NE and dopamine via unknown mechanism toxicity: stimulant effects (tachycardia, insomnia), headache, seizure in bulimic pts not sexual side effects |
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SNRIs
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Venlafaxine, duloxetine
inhibit serotonin and NE uptake used for depression, van for generalized anxiety disorder, duloxetine for diabetic peripheral neuropathy se: increased BP, stimulant effects, sedation, nausea |
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Maprotiline
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atypical antidepressant
alpha2 antagonist, increased release of NE and serotonin, potent 5-HT2, and 5-HT3 receptor antagonis SE: sedation, increased appetite, weight gain, dry mouth |
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trazodone
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primarily inhibit serotonin reuptake
used for insomnia as high doses are needed for antidepressant effects SE: sedatio, nausea, priapism, postural hypertension |
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MAOIs
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phenelzine
tranylcypromine isocarboxazid selegiline |
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mech of MAOI
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nonselective MAO inhibition --> increased levels of amine neurotransmitters
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clinical use of MAOI
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atypical depression
anxiety hypochondriasis |
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MAOI may cause what side effects?
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with tyramine ingestion (wine, cheese) and beta agonist --> hypertensive crisis
beta-agonists --> CNS stimulation liver, brain, weight gain SE |
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Classical conditioning
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Pavlov's dogs with ringing bell
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Operant condition
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learning in which a particular action is elicited because it produces a reward
positive reinforcement - action gives reward negative - actions removes adverse stiumulus punishment - adverse stimulus extinguishes unwanted behavior extinction - removal of reinforcement eleimates behavior |
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transference
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patient projects feeling about formative or other important persons onto physician, psychiatrist viewed as parent
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countertransference
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doctor projects fellings about formative or other important persons onto patient
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Immature defenses
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acting out
dissociation denial displacement fixation identification isolation of affect projection rationalization reaction formation regression splitting |
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acting out
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unacceptable feelings and thoughts are expressed through actions - tantrums
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dissociation
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temporary, drastic change in personality, memory consciousness or motor behavior to avoid emotional stress
extreme can be dissociative identity disorder (multiple personalities) |
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denial
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avoidance of awareness of some painful reality
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displacement
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process whereby avoided ideas and feelings are transferred to some neutral object or person
mother places blame on child because she is angry at husband |
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fixation
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partially remaining at a more childish level of development
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identification
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modeling behavior after another person is more powerful (not necessarily admired)
child views self as an abuser |
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isolation of affect
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separation of feelings from ideas and events
describing murder without emotion |
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projection
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an unacceptable internal impulse is attributed to an external source
man who wants another woman thinks his wife is cheating |
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rationalization
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proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame
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reaction formation
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process whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on the opposite
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regression
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turning back at maturational clock and going back to earlier modes of dealing with world
children under stress wet bed despite being previously trained |
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splitting
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people are either all good or all bad
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Mature defenses
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altruism
humor sublimation suppression |
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altruism
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guilty feelings alleviated by unsolicited generosity toward others
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humor
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appreciating the amusing nature of an anxiety-provoking or adverse situation
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sublimation
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replacement of an unacceptable wish with a course of action that is similar but does not conflict with one's value system
son angry at father focuses to perform in sports |
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suppression
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voluntary withholding of an idea or feeling from conscious awareness
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ADHD
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onset before 7, limited attention span and poor impulse control
hyperactivity, motor impairment, emotional lability, normal intelligence up to 50% continue into adulthood associated with decreased frontal lobe volumes tx: methylphenidate, amphetamines, atomoxetine |
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conduct disorder
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repetitive and pervasive behavior violating social norms
after 18 diagnosed as antisocial personality disorder |
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oppositional defiant disorder
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enduring pattern of hostile, defiant behavior towards authority figures in absence of serious violation of social norms
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tourette's syndrome
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before age 18, sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations for greater than 1 year
coprolalia in 20% associated with OCD tx: antipsychotics (haloperidol) |
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separation anxiety disorder
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7-9 yrs, overwhelming fear of separtion from or loss of attachment figure
factitious physical complaints to avoid going to school |
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autistic disorder
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severe language impairment and poor social interactions, greater focus on objects than people, repetitive behavior and usually below-normal intelligence
more common in boys tx: behavioral and supportive therapy |
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asperger's disorder
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milder form of autism: all=absorbing intrests, repetitive behavior, problems with social relationships
children of normal intelligence, no language impairment |
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Rett's disorder
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x-linked disorder seen almost exclusively in girls
symptoms begin to present at ages 1-4, followed by regression characterized by loss of development, loss of verbal abilities, mental retardation, ataxia, and stereotyped hand-wringing |
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childhood disintegrative disorder
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age 3-4 years, marked regression in multiple areas of functioning after at least 2 years of normal development
loss of expressive or receptive language, social skills or adaptive behavior, bowel or bladder control, play or motor skills more common in boys |
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neurotransmitter changes with anxiety
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increased NE, decreased GABA, 5-HT
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neurotransmitter changes with depression
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decreased NE, serotonin, dopamine
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neurotransmitter changes with alzheimer's
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decreased ACh
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neurotransmitter changes with with huntington's
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decreased *GABA*, ACh, increased dopamine
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neurotransmitter changes with schizophrenia
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increased dopamine
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neurotransmitter changes with Parkinson's
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decreased dopamine, increased serotonin, ACh
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maternal (postpartum) blues
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50-85% incidence, depressed affect, tearfulness, fatigue
usually resolves within 10 days tx: supportive monitor for postpartum depression |
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postpartum depression
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10-15% incidence - depressed affect, anxiety, and poor concentration
2 weaks to 1 year tx: antidepressants, psychotherapy |
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postpartum psychosis
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0.1-0.2% incidence
delusions, confusion, unusual behavior, possible homocidal/suicidal ideation 4-6 weeks tx: antipsychotics, antidepressants, inpatient hospitalization |
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anxiety disorder
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inappropriate experience of fear/worry with physical manifestations beyond real/appropriate concern
interferes with normal function lifetime prevalencde of 30% women, 19% men |
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adjustment disorder
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emotional symptoms causing impairment following an identifiable pyschosocial stressor and lasting <6 months (> if chronic)
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alcohol withdrawal treatment
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benzodiasepines
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bulimia treatment
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SSRIs
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anxiety treatment
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benzodiazepines, buspirone, SSRIs
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ADHD treatment
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methylphenidates, amphetamines
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atypical depression treatment
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MAO inhibitors, SSRIs
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bipolar disorder treatment
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"mood stabilizers" lithium, valproic acid, carbamazepine
atypical antipsychotics |
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depression treatment
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SSRIs, SNRIs, TCAs
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depression with insomnia treatment
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mirtazapine
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OCD treatment
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SSRIs, clomipramine
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Panic disorder treatment
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SSRIs. TCAs, benzodiazepines
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PTSD treatment
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SSRIs
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Schizophrenia treatment
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antipsychotics
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Tourette's syndrome
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antipsychotics (haloperidol, resperidone)
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social phobias treatment
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SSRIs
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Atypical antipsychotics
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olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone
used for schizophrenia olanzapine is also used for OCD, anxiety disorder, depression, mania, Tourette's it's atypical for old closets to quitely risper from A to Z |
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atypical antipsychotics MOA, toxicity
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varied effects on 5-HT2, dopanine, alpha, and H1 receptors
fewer extrapyramidal and anticholinergic effects that traditional antispychotics olanzapine/clozapine may cause weight gain |
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Clozapine toxicity
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may causes anganulocytosis, seizures
must watch clozapine clozely |
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Ziprasidone
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may prolong QT interval
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Antipsychotics
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haloperidol, + "azines"
ttrifluoperazine, fluphenazine, thioridazine, chlorpromazine |
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antipsychotics MOA, use
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block dopamine D2 receptors -> increased cAMP
schizophrenia, psychosis, acute mania, Tourette's |
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antipsychotics toxicity
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highly lipid soluble and stored in fat -> slow removal
extrapyramidal system endoncrine side effects dopamine receptor antagonism -> hyperprolactinemia side effects from blocking muscarinic )dry mouth, constipation, alpha (hypotension), histamine (sedation) receptors |
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extrapyramidal side effects
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evolves by rule of 4
4hrs - acute dystonia (spasms, sitffness, oculogyric crisis) 4 d akinesia (parkinson's) 4 wk akathisia, restlessness 4 mo tardive dyskinesia |
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Neuroleptic malignant syndrome
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rigidity, myoglobinuria, autonomic instability, hyperpyrexia
FEVER: fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles tx: dantrolene, D2 agonists (bromocriptine) |
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Tardive dyskinesia
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sterotyped oral-facial movements due to long-term antipsychotic use -> often irreversible
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What are the high potency neuroleptics and what side effects predominate with them?
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trifluoperazine, fluphenazine, haloperidol (Try to Fly High)
mostly extrapyramidal symptoms |
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What are the low potency neuroleptics and what side effects predominate with them?
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chlorpromazine, thioridazine: non-neurologic side effects (anticholinergic, histamine, alpha blockade)
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SSRIs
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fluoxetine, paroxetine, sertraline, citalopram
used for depression, OCD, bulimia, social phobias, PTSD se: GI distress, sexual dysfunction serotonin syndrome with any drug that increases serotonin - hyperthermia, myoclonus, cardio collapse, flushing, diarrhea, seizures; tx: cyproheptadine (5-HT2 receptor antagonist) |
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Tricyclic antidepressants
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amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine (all end in -iptyline, ipramine except doxepin and amoxapine)
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TCA MOA, use, SE
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block reuptake of NE and serotonin
use: major depression, bedwetting (imipramine), OCD (clomipramine), fibromyalgia se: sedation, alpha blocking, atropine-like, |
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tertiary vs. secondary TCA side effects
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tertiary are more anticholinergic
amitriptyline vs. nortriptyline |
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Toxicity of TCAs
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Tri-C's convulsions, coma, cardiotoxicity (arrhythmias)
respiratory depression, hyperpyrexia confusion and hallucinations in elderly due to anticholinergic side effects (use nortriptyline) txL NaHCO3 for CV |
