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24 Cards in this Set

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Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is not effective for anxiety disorders. ECT is effective for manic or depressive episodes in bipolar disorder, and it is effective and relatively safe in pregnancy. ECT is an effective treatment of neuroleptic malignant syndrome. ECT is an effective treatment of major depression with melancholic features, in persons of any age including the elderly. ECT is an effective treatment for catatonic episodes due to major mood disorders, which are the most common causes of catatonia.
ECT post-op
She will have amnesia for events surrounding the treatments, an extremely common side effect. She, like most other patients with major mood disorders, is at risk for recurrence and should receive maintenance antidepressants or ECT. ECT does not produce cytoarchitectural brain changes. Successful past treatments increase the chances of a person accepting future treatments. Transient mild headache is common; prolonged severe headache is not an ECT side effect
ECT during
The patient will inhale pure oxygen, and experience relaxation of all muscles, except in one foot, above which a tourniquet is placed very briefly to permit viewing of the seizure in the foot. Immediately after application of the current, the EEG reveals seizure activity in most or all leads
depression and ECT
The doctor should speak with the patient within a few days after discharge, since the post-discharge period carries increased risk for recurrence or suicide
Major depressive disorder
characterized by a sustained anxious and agitated mood; an omega sign; psychomotor slowing; terminal insomnia; anhedonia; impaired concentration; appetite and weight loss; diurnal mood variation; feelings of hopelessness, worthlessness and guilt; and suicidal ideation. Schizophrenia should not be diagnosed in the presence of a major mood disorder
Dysthymic disorder
should not be diagnosed in the presence of a major depressive episode, unless the major depressive episode occurred during the course of dysthymic disorder (a chronic low-grade depression lasting two years or longer), for which there is no evidence in this case. If a patient has a major depressive episode in the course of dysthymic disorder, that is termed “double depression.”
melancholic suicidal patient
Electroconvulsive therapy is the treatment of choice. Antipsychotics (neuroleptics) alone are not indicated for major depressive episodes with melancholic features.
combination of a tricyclic antidepressant and antipsychotic (neuroleptic) drug
used if he were psychotic (he is not psychotic) and melancholic
Parkinson’s disease
usually begins after 40, is characterized by rigidity, expressionless face, shuffling gait, resting pill-rolling tremor and, often, atypical depression, none of which this patient has.
Alzheimer’s disease and depression
is not characterized by melancholic depression, which can explain all the patient’s symptoms and signs including the Mini-mental State score of 22/30
succinylcholine isn’t administered
if its infusion misses the vein and infiltrates into the skin, the patient’s muscles will contract strongly during the seizure and there is a serious risk of fractur
Lidocaine
, not part of ECT in persons with normal cardiac function, is given to patients with premature ventricular contractions (PVCs) to prevent a more serious ventricular arrhythmia occurring during the seizure.
Methohexital
a short-acting general anesthetic, is standard prior to inducing the seizure. Without an anesthetic, the patient would feel the electrical current, unacceptable in modern ECT
100% oxygen
prevents hypoxia associated with succinylcholine muscle paralysis and the seizure
atropine
) If atropine, glycopyrrolate or other anticholinergic agent is not administered, there is a risk of asystole and excessive bronchial secretions.
Epidemiologically
are more likely to commit suicide than females. African Americans are less likely to commit suicide than Native Americans, for whom suicide rate is highest of any US ethnic group. Catholics are less likely than members of other religious groups to commit suicide. Smokers are more apt to kill themselves than non-smokers. Residents of Western mountain states are more likely to commit suicide than residents of any other US region. Elderly Euro-American men are much more likely than young African-American women to commit suicide. Euro-American and African-American men are more apt to commit suicide than either Euro-American or African-American women. Elderly African American men are less likely to commit suicide than elderly Euro-American men and young African American men.
Suicide risk
Histories of mania, alcohol consumption, painful general medical conditions and family history of suicide are associated with increased suicide risk, and none of these would justify discharging a suicidal patient home.
Conversion disorder
the validity of which is not well established and which you should try not to diagnose (except on exams), is a motor or sensory deficit that “suggests” a neurologic or general medical condition “due to psychological factors” (whatever that is) based on the symptom being preceded by a stressor. However, physical examination and laboratory findings do not fit any specific neurologic diagnosis. For example, a conversion disorder patient might have paralysis without hyperreflexia, Babinski sign, clonus, atrophy or fasciculations
Somatization disorder
which is well-validated, is characterized by at least four medically unexplained pain symptoms, two medically unexplained gastrointestinal symptoms other than pain, one medically unexplained sexual symptom and one pseudo-neurological symptom, occurring over several years with onset before age 30.
Factitious disorder
Factitious disorder is the deliberate production of symptoms and signs with the goal of being in the sick role. in this case, repeatedly ingesting an allergenic drug to become hospitalized—to assume the sick role
Malingering
is faking or grossly exaggerating illness for some external goal like avoiding incarceration or other punishment, avoiding an academic or work obligation or finding a place to stay. It occurs more commonly in persons with antisocial personality disorder or substance abusers.
Paranoid personality disorder
characterized by pervasive mistrust of others, like believing others are deceiving him or her, are disloyal or cannot be confided in; misinterpreting benign remarks as malevolent; bearing grudges; and wrongly suspecting romantic infidelity
Depersonalization disorder
dissociative disorder that is not well-validated, is repeatedly feeling like an outside observer of oneself, or in a dream.
somatization disorder patients and genetics
have male relatives with antisocial personality disorder