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95 Cards in this Set
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- Back
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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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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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Olanzapine is used for
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OCD
anxiety disorder depression mania tourette's syndrome |
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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 narrow therapeutic window requires close monitoring of serum levels |
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mech of buspirone
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stimulates 5HTA1a receptors
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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 |
Bupropion
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used in generalized anxiety disorder
inhibits serotonin and NE reuptake |
Venlafaxine
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blocks NE reuptake
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maprotiline
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primarily inhibit serotonin reuptake
used for insomnia as high doses are needed for antidepressant effects |
trazodone
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MAOI - name 2
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phenelzine
tranylcypromine |
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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 and beta agonist --> hypertensive crisis
beta-agonists --> CNS stimulation liver, brain, weight gain SE |
