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54 Cards in this Set
- Front
- Back
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What are mood disorders? |
Depressive disorders Bipolar disorders |
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What are anxiety disorders? |
Screening for PTSD |
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What is the definition of depression? |
Unipolar mood disorder causing significant distress & impairment in functioning |
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Does depression occur with or without mania or hypomania? |
WITHOUT |
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What is the familial association with depression? |
STRONG 1.5-3 times more common than than the general population if st degree relative has diagnosis
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Major depressive disorder (MDD) |
Most common must meet criteria |
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Dysthymic disorder a.ka. Chronic persistent depressive disorder |
chronic symptoms present for more days than not in a 2 year period |
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In order to be diagnosed with major depression, what is the diagnostic criteria? |
At least 5 symptoms must be present during a 2 week period & represent a change from previous functioning |
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What are the major depression diagnostic criteria? |
+Depressed mood +loss or interest or pleasure in most activities (anhedonia) +significant weight loss/gain or appetite change +insomnia/hypersomnia +psychomotor agitation or retardation +loss of energy or fatigue +feelings of worthless or excessive guilt +diminished concentration or indecisiveness +recurrent thoughts of suicide or death +impaired social, occupational or other functioning |
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What are the neurotransmitters that make up the neurobiological changes associated with depression? |
DEPLETION or DEFICIENCY Serotonin Norepinephrine Dopamine |
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What is the basis of pharmacological treatment of depression? |
Manage the relationship between the synaptic levels of neurotransmitters Serotonin Norepinephrine Dopamine |
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What changes in the hypothalamus may lead to depression? |
Pituitary - Adrenal axis dyregulation Increased levels of corticotrophin releasing factor and cortisol |
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What areas of the brain have shown structural and metabolic differences in a depressed brain? |
Hippocampus Amygdala Prefrontal cortex |
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What parts of the clinical presentation of a depressed person require careful attention? |
AFFECT (intense, constricted) MOOD (frustration, sadness) SPEECH (soft, low, lack of spontaneity) tearful, poor eye contact, inattention to personal appearance |
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Before referring a suicidal patient for emergency psychiatric evaluation, what FOUR questions should be asked? |
1. Do you ever think of hurting yourself or ending your own life? 2. Do you find yourself dwelling on these thoughts? 3. Do you feel that you might act on these thoughts? 4. Do you have a plan? |
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What are suicide risk factors? |
H/O prior attempt stressful life events social isolation substance abuse helplessness |
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What is considered suicide - low risk and what is the plan of action? |
No current thoughts No major risk factors Action: continue follow up visits & monitoring |
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What is considered suicide - intermediate risk and what is the plan of action? |
Current thoughts but NO PLAN with or without risk factors Action: Assess suicide risk carefully at each visit Contract w/ pt to call if suicide thoughts become more prominent consult with an expert as needed |
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What is considered suicide - high risk and what is the plan of action? |
Current thoughts WITH PLAN Action: emergency management by qualified expert |
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Which patient populations are referred for management of depression? |
SUICIDAL PATIENTS PREGNANT PATIENTS TREATMENT FAILURES |
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For the management of depression, what medical causes need to be ruled out? |
- HYPOTHYROID
- HYPOXIA - HYPO-PARATHYROIDISM - B12 DEFICIENCY - DEMENTIA - HYPO-ADRENOCORTICISM - MEDICATION EFFECT |
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What is bipolar disorder? |
vacillation between depression & mania characterized by 1 or more manic episodes |
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What is the presentation of bipolar disorder? |
age of onset 15-30 yr affects men & women equally 2/3 also have substance abuse disorder |
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What are characteristics of mania in bipolar disorder? |
--heightened mood, sexuality, impulsivity --increased energy, decreased need for sleep, faster speech & physical activity --increased irritability, paranoia, suspicion possible |
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What are characteristics of hypomania in bipolar disorder? |
--euphoric mood --self confident --increased productivity, creativity, energy |
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What parts of the clinical presentation of bipolar mania require careful attention? |
-Cognition & perception may become psychotic -delusions & hallucinations -patients highly distracted -flight of ideas -behavior bizarre, inappropriate, disorganized -suicidal or homicidal (violent, destructive) |
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What parts of the clinical presentation of bipolar depressive episode require careful attention? |
- decreased pleasure, slow speech, energy, thoughts, sexuality - mood negative, pessimistic - patient irritable, paranoid, angry - depression simple or psychotic - may have suicidal thoughts -psychotic depression - mood congruent hallucinations & delusions |
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What parts of the clinical presentation of bipolar manic symptoms require persistent questioning? |
- inflated self esteem or grandiosity -decreased need for sleep -more talkative/pressure to keep talking -flight of ideas or racing thoughts -distractibilty -increased goal directed activity or psychomotor agitation -excessive pleasurable activities, painful consequences |
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What is assessed in bipolar 1? |
Mania |
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What is assessed in bipolar 2? |
Hypomania |
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Is anxiety a normal human emotion? |
YES part of fear response fight or flight |
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What distinguished anxiety disorder from fear or normal anxiety? |
mental tension that interfere with daily function anxious most of the time, without apparent reason accompanied by physical distress fear response DOES NOT occur to a real event threatening event |
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LIST ANXIETY DISORDERS |
GAD - Generalized anxiety disorder PTSD - Post traumatic stress disorder OCD - Obsessive compulsive disorder Specific phobia Panic disorder Social phobia |
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What is the definition of Generalized Anxiety Disorder? |
Excessive worry about several areas of life associated with multiple symptoms (physical and psychological) Causes great distress or impairment of social or occupational functioning occurs nearly every day for at least 6 months |
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What are the diagnostic criteria to meet for Generalized Anxiety Disorder diagnosis? |
Restlessness Fatigue Difficulty concentrating Irritability Muscle tension Difficulty initiating sleep |
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What is panic disorder? |
Anxiety disorder exists with and without agoraphobia panic attacks |
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What are panic attacks? |
Sudden onset of intense fear or terror with feelings of impending doom Symptoms usually peaks within 10 minutes |
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What is obsessive compulsive disorder? |
Anxiety Disorder Obsessions Compulsions |
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What are obsessions? |
persistent intrusive thoughts |
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What are compulsions? |
Repetitive behaviors or mental acts a person is compelled to perform Intended to reduced anxiety |
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What is specific vs. social phobia? |
Anxiety disorder excessive & persistent fear of certain objects or situations to cause avoidance of trigger vs. excessive anxiety provoked by performance or social situations |
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What is the difference between acute stress disorder and PTSD? |
length of time within 1 month of event vs duration longer than 1 month (>3 month chronic) |
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What are similarities of PTSD & acute stress disorder? |
persistent feeling of re-living traumatic event i.e. dreams, images intense psychological distress, physiological re-activity, general hyper-vigilance |
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In anxiety clinical presentation, what are subjective key words to pay attention to? |
- Tense - Uptight - Nervous - Anxious - Dread - Jumpy |
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In anxiety clinical presentation, what are objective signs to pay attention to? |
- Tachycardia - Hyperventilation - Palpitations - Tremors - Sweating - Hyper-reflexia - Increased muscle tension` |
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What are important diagnoses to rule out before an anxiety disorder diagnosis? |
Thyrotoxicosis Alcohol withdrawal Abuse of sympathomimetic drugs (caffeine, amphetamines, cocaine) Hypoglycemia |
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What diagnostic testing would be done before a diagnosis of anxiety disorder? |
HADS (Hospital Anxiety and Depression Scale) Labs: TSH, EKG |
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If patient answers yes to any 3 items in the 4 item screen for Primary Care PTSD Screen, is this a positive screen? |
YES |
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What is the definition of alcoholism? |
Recurrent maladaptive drinking that is difficult to control and results in adverse consequences a progressive disease affecting: 1)family 2)health 3)employment |
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What are the CAGE screening questions for alcohol abuse (2 or more = positive screen)? |
have you ever felt you ought to...Cut down on your drinking? Have people...Annoyed you by criticizing your drinking? Have you ever felt bad or...Guilty about your drinking? Have you ever had an...Eye-opener drink first thing in the morning? |
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What is a good introductory question for alcohol abuse screening? |
I am concerned about your health and safety when I hear that you are drinking every day |
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List subjective symptoms that may be present in alcohol abuse evaluation |
Psychological - Emotional - Behavioral -poor nutrition -trauma -seizures -hypertension -dyspepsia -liver disease -pancreatitis -peripheral neuropathy |
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List objective symptoms that may be present in alcohol abuse evaluation |
-autonomic hyperactivity -hallucinations -disorientation -seizures |
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What lab diagnostics may be seen with alcohol abuse? |
CBC - MCV elevation / impaired folate levels LFT - rise in ALT and AST = ratio AST:ALT >1 GGT - returns to normal after 3 wks sober (abstinence tracker) |
