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95 Cards in this Set

  • Front
  • Back
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
what is the most common psychiatric illness on med and surg floors?
abnormal EEG
delirium
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
is memory loss in dementia reversible?
no, usually irreversible
periods of psychosis and disturbed behavior w/ a decline in functioning lasting >6 months
associated w/ increased dopaminergic activity
schizophrenia
subtypes of schizophrenia
1.paranoid - delusions
2. disorganized - with regard to speech, behavior, affect
3. catatonic - automatism
4. undifferentiated
5. residual
brief psychotic disorder
<1 month
usually stress related
schizophreniform disorder
1-6 months
schizoaffective disorder
at least 2 wks of stable mood w/ psychotic symptoms, plus a major depressive, manic, or mixed (both) episode
2 subtypes: bipolar or depressive
fixed persistent nonbizarre belief system lasting more than 1 month
functioning otherwise not impaired
often self-limited
delusional disorder
development of delusions in a person in a close relationship w/ someone with delusional disorder
often resolve upon separation
delusional disorder
manic episode
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
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
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
milder form of bipolar disorder that lasts for at least 2 yrs
cyclothymic disorder
tx for bipolar disorder
mood stabilizers: lithium, valproic acid, carbamazepine
atypical antipsychotics
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
MDD, recurrent
requires 2 or more MDD episodes with symptoms-free interval of 2 months
milder form of depression lasting at least 2 yrs
dysthymia
associated w/ winter season
improves in response to FULL-SPECTRUM LIGHT EXPOSURE
seasonal affective disorder
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
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
risk factors for suicide completion
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
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
how do you treat panic disorders
tx cognitive behavioral therapy (CBT), SSRIs, TCAs, BDZs
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
exaggerated fear of embarrassment in social situations
social phobia
recurring intrusive thoughts, feelings or sensations (obsessions) that cause severe distress
relieved in part by performance of repetitive actions (compulsions)
OCD
OCD is associated with what other disorder?
Tourette's
how do you tx OCD?
SSRIs, clomipramine (TCA)
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
lasts between 2 days and 1 month
PTSD
disturbance lasts >1 month and causes significant distress and/or impaired functioning
PTSD
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
tx for generalized anxiety disorder
BDZ
buspirone
SSRIs
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
creates physical and/psychological symptoms in order to assume sick role and to get medical attention
factitious
chronic factitious disorder with predominantly physical signs and symptoms
characterized by history of multiple hospital admission and willingness to receive invasive procedures
Munchausen's
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
variety of complaints in multiple organ systems over a period of years
somatoform disorders
motor or sensory symptoms(paralysis, blindness, mutism) often following in acute stressor
LA BELLE INDIFFERENCE
conversion
preoccupations with and fear of having a serious illness despite medical evaluation and reassurance
hypochondriasis
preoccupation w/ minor or imagined defect in appearance leading to significant emotional distress or impaired functioning pts often repeatedly seek cosmetic surgery
body dysmorphic disorder
prolonged pain w/ no physical findings
pain disorder
cluster A personality disorders
ODD or ECCENTRIC
inability to develop meaningful social relationship
no psychosis
genetic association w/ schizophrenia
TYPES:
Paranoid
Schizoid
Schizotypal
pervasive distrust and suspiciousness projection in majore defense mechanism
paranoid
voluntary social withdrawal, limited emotional expression, content w/ social isolation (vs avoidant)
schizoid
eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
schizotypal
cluster B personality disorder
dramatic emotional erratic genetic association w/ MOOD disorders and SUBSTANCE ABUSE
Types:
antisocial
borderline
histrionic
narcissistic
antisocial
disregard for and violation of rights of others
criminality
males>females
conduct disorder if < 18 yrs
borderline
unstable mood and interpersonal relationships
impulsiveness
sense of emptiness
females > males
splitting is a major defense mechanism
histrionic
excessive emotionality and excitability
attention seeking
sexually provocative
overly concerned w/ appearance
narcissistic
grandiosity, sense of entitlement, lacks empathy, requires excessive admiration
often demands best and reacts to criticism with rage
Cluster C personality disorders
anxious or fearful, genetic association w/ ANXIETY disorders
avoidant
OCD
dependent
hypersensitive to rejection, sociall inhibited
timid, feelings of inadequacy
desire relationships with others
avoidant
preoccupations with order, perfectionism and control
ego syntonic
behavior consistent with one's own beliefs and attitudes
OCD
submissive and clinging
excessive need to be taken care of
low self-confidence
dependent
what drug intoxciation?
psychomotor agitation
impaired judgement
pupillary dilation
hypertension
tachycardia
euphoria
prolonged wakefulness and attention
cardiac arrhythmias
delusions
hallucinations
fever
amphetamines
euphoria, psychomotor agitation, impaired judgement, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, sudden cardiac death
cocaine
what drug intoxciation?
psychomotor agitation
impaired judgement
pupillary dilation
hypertension
tachycardia
euphoria
prolonged wakefulness and attention
cardiac arrhythmias
delusions
hallucinations
fever
amphetamines
w/d of what ?
crash--> depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
amphetamines
euphoria, psychomotor agitation, impaired judgement, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, sudden cardiac death
cocaine
w/d of what
crash-> depression, suicidality, hypersomnolence, fatigue
malaise, sever psychological cravings
cocaine
w/d of what ?
crash--> depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
amphetamines
what drug?
restlessness
insomnia
increased diuresis
muscle twitching
cardiac arrhythmias
caffeine
w/d of what
crash-> depression, suicidality, hypersomnolence, fatigue
malaise, sever psychological cravings
cocaine
what drug?
restlessness
insomnia
anxiety
arrhythmias
nicotine
what drug?
restlessness
insomnia
increased diuresis
muscle twitching
cardiac arrhythmias
caffeine
w/d of what?
headache
lethargy
depression
weight gain
caffeine
what drug?
restlessness
insomnia
anxiety
arrhythmias
nicotine
w/d of what?
irritability
headache
anxiety
weight gain
craving
nicotine
w/d of what?
headache
lethargy
depression
weight gain
caffeine
what drug?
euphoria
anxiety
paranoid delusions
perception of slowed time
impaired judgement
social withdrawal
increase appetite
dry mouth
hallucinations
cannabis
w/d of what?
irritability
headache
anxiety
weight gain
craving
nicotine
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
what drug?
euphoria
anxiety
paranoid delusions
perception of slowed time
impaired judgement
social withdrawal
increase appetite
dry mouth
hallucinations
cannabis
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
belliegernce
impulsiveness
fever
psychomotor agitation
vertical and horizontal nystagmus
tachycardia
ataxia
homicidality
psychosis
delirium
PCP
w/d of PCP
depression
anxiety
irritability
restlessness
anergia
disturbances of though and sleep
marked anxiety or depression
delusions
visual hallucinations
FLASHBACKS
pupillary dilation
LSD
MOA of methylphenidate (ritalin)
increase presynaptic NE vesicular release (like amphetamines(
mech for relieving ADHD sx is now known
clinical use of methylphenidate
ADHD
Olanzapine is used for
OCD
anxiety disorder
depression
mania
tourette's syndrome
MOA of lithium
not established
possibly related to inhibition of phosphoinositol cascade
clinical use of lithium
mood stabilizer for bipolar disorder
blocks relapse and acute manic events
toxicity of lithium
tremor
hypothyroidism
polyuria (ADH antagonist causing nephrogenic DI)
teratogenesis
narrow therapeutic window requires close monitoring of serum levels
mech of buspirone
stimulates 5HTA1a receptors
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
Bupropion
used in generalized anxiety disorder
inhibits serotonin and NE reuptake
Venlafaxine
blocks NE reuptake
maprotiline
primarily inhibit serotonin reuptake
used for insomnia as high doses are needed for antidepressant effects
trazodone
MAOI - name 2
phenelzine
tranylcypromine
mech of MAOI
nonselective MAO inhibition --> increased levels of amine neurotransmitters
clinical use of MAOI
atypical depression
anxiety
hypochondriasis
MAOI may cause what side effects?
with tyramine ingestion and beta agonist --> hypertensive crisis
beta-agonists --> CNS stimulation
liver, brain, weight gain SE