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93 Cards in this Set

  • Front
  • Back
Age-Associated Cognitive Impairment (AACI) (3) (DEMENTIA)
1)recent memory for important events intact
2)occasional difficulties w/ word finding
3)ADLs intact, normal performance on MSE
Mild Cognitive Impairment (MCI) (3) (DEMENTIA)
1)memory complaints only
2)ADLs intact; minimal changes in other areas
3)high risk of progression to dementia (50% progress to dementia in 5yr)
Alzheimer's Disease (DEMENTIA) (8)
1)slow onset and continued cognitive decline
2)short term memory impairment
3)language difficulties
4)loss of executive fxning (thinking, reasoning, planning)
5)impaired learning and won't remember even w/ prompting
6)mood and personality changes
7)EPS and psychotic s/sx in late stages
8)MOST COMMON DEMENTIA****
Vascular Dementia (6)
1)pt aware of deficits
2)focal neurologic signs
3)temporal relationship w/ "event" or vascular pathology and risks (HTN/DM, etc)
4)pt can learn, but won't remember unless prompted
5)abrupt deterioration w/ stepwise progression****
6)ED, depression, apathy more prevalent than in alzheimer's
Lewy Body Dementia (4)
1)Intracellular inclusions in substantia nigra (DA and ACh deficits)
2)B-amyloid/senile plaques occur, BUT NOT neurofibrillary tangles
3)combined dementia w/ EPS (like Parkinson's w/ dementia)****
4)tx w/ neuroleptic (antiDA/antipsychotics) may worsen s/sx or cause life-threatening ADRs*****
Frontotemporal Dementia (compared to Alzheimer's) (4)
1)early/more rapid deterioration in social skills w/ disinhibition and apathy common
2)drawing/calculation spared
3)language diminished BUT not as aphasic as w/ alzheimer's
4)variable memory deficits
Genetic factors involved in Dementia (5)
1)amyloid precursor protein
2)Presenilin 1 & 2
3)apolipoprotein E4 incr risk
4)apolipoprotein E2 DECR RISK
5)tau gene 17 (associated w/ rare frontotemporal dementia)
Structural changes in Alzheimer's (5)
1)cortical/limbic atrophy
2)degeneration of cholinergic neurons
3)Neurofibrillary tangles from intracellularly of aggregates of tau protein (number of NTFs correlate w/ severity of disease****)
4)Amyloid/senile plaques are extracellular masses of broken neurites and glial cells = incr inflammation
5)# of plaques NOT correlated w/ severity of Alzeheimer's
Other things involved in Alzheimer's (3)
1)inflammatory mediators
2)cholinergic hypothesis
3)other NTs/mediators
Clinical Presentation of Alzheimer's (7)
1)memory loss (losing items, poor recall)
2)dysphasia
3)disorientation (impaired perception of time, location, other persons)
4)impaired calculation, judgment, problem solving skills
5)decr ADLs/IADLs
6)psychotic s/sx (hallucinations)
7)nonpsychotic disruptive behaviors
Delirium vs Dementia vs age-associated memory impairment
Delirium is ACUTE confusional state w/ altered consciousness AND is REVERSIBLE

Dementia is CHRONIC and PROGRESSIVE deterioration affecting cognitive abilities, mood, behavior

AAMI- associated w/ normal aging but should not affect social/occupational fxning (mostly slip of tongue/word searching)
Monitoring response to cognitive enhancing agents (w/ these tests) (3)
ADAS-Cog (Alzheimer's Disease Assessment Scale Cognitive Portion)- will incr by 5% (4points) over 6mon or 10% (7pts) over 1yr if untreated

CIBIC (Clinical Interview-Based Impression of Change)- healthy elderly incr by under 1% over 6mon vs. 2-11% incr in alzheimer's

MMSE (Mini-Mental Status Exam)- untreated pt has average decline of 2-4 points per year
Tx's NOT recommended for Alzheimer's (8)
1)VitE
2)Selegiline
3)Estrogens
4)antiinflammatory's (NSAIDs/steroids)
5)statins
6)Gingko
7)Curry
8)HuperazineA (has AChEI properties so if using w/ those drugs get incr ADRs)
Cholinesterase Inhibitors (ALZHEIMER'S)
a)general info (6)
b)drugs (4)
a)"palliative tx" w/ small but measurable benefits in cognition
a)ADRs vary considerably
a)efficacy established in mild to mod disease (severe for donepezil)
a)tx often dc due to ADRs or lack of efficacy
a)long half-life
a)stalls cognition decline for 6mon; then resumes normal decline pattern

b)Tacrine (cognex)
b)Donepezil (Aricept)
b)Rivastigmine (Exelon)
b)Galantamine (was Reminyl now Razadyne)
Tacrine (ALZHEIMER'S)
a)characteristics (2)
b)PK (2)
c)ADRs (2)
d)Efficacy (2)
a)nonselective/reversible
a)requires compassionate use approval to use

b)2-4 half-life requires QID dosing
b)food decr absorption

c)elevated transaminases
c)n/v/d

d)6% decr in ADAS-Cog
d)BUT 55% drop out due to ADRs
Donepezil
a)characteristics
b)PK (3)
c)ADRs (3)
a)reversible/selective for AChE

b)70h half-life w/ minimal peripheral AChE activity
b)P450 metabolism
b)HS dosing

c)URINARY INCONTINENCE
c)n/v/d
c)somnolence BUT 15% had insomnia (so may need am dosing)
Rivastigmine
a)dosing (3)
b)ADRs (2)
a)bid-tid dosing
a)requires extensive titration
a)BUT patch/XR available

b)GI (@ higher rate than other AChEI BUT attributed to rapid titration)
b)think decr GI ADR w/ patch/XR
Galantamine
a)dosing (3)
b)ADRs (4 of many)
c)Drug interaxns (5 of many)
a)extensive tiration
a)take w/ breakfast and dinner
a)requires 2-3 daily doses (but XR is available)

b)n/v/d
b)anorexia/wt loss
b)dizzyness
b)fatigue or insomnia

c)anticholinergics antagonize it
c)cimetidine
c)NSAIDs
c)digoxin
c)BB
NMDA Inhibitors (ALZHEIMER'S)
a)drug
b)indication
c)considerations (2)
d)ADRs (4)
a)Memantine (Namenda)

b)mod to SEVERE dementia

c)does not prevent or slow neurodegeneration
c)dose reduce in renal impair

d)dizzy/confusion
d)cough/dyspnea
d)incr BP/HR
d)incr seizure risk
AChEI's ADR's (common to all) (3)
1)sedation
2)incr GI motility
3)bradycardia
Behavioral s/sx seen in 90% of pts (NONCOGNITIVE S/SX OF DEMENTIA)-- (ALZHEIMER'S) look over (7)
1)psychosis (delusions, hallucinations)
2)agitation/purposeless activity (wandering, pacing, screaming)
3)aggression (verbal/physical)
4)decr self regulation (disinhibition--uncooperative or inappropriate)
5)psychomotor retardation
6)mood disorders (depression, anxiety, elation, apathy)
7)neurovegetative dysfxn (sleep, eat, cardiac disorders)
Drug Selections for these Noncognitive s/sx of Dementia
a)anxiety
b)acute psychosis
c)subacute/chronic psychosis (4)
d)aggitation w/ psychosis
a)SSRI's

b)haloperidol (0.25-2mg/d)

c)Risperidone (0.25-2mg/d)
c)Quietiapine (25-200mg/d)
c)Olanzipine (2.5-5mg/d)
c)Clozapine (use if refractory, CIs, and good in parkinson's dementia)

d)same as c)
Drug Selections for these Noncognitive s/sx of Dementia
a)Aggression and anger (WITHOUT PSYCHOSIS) (8)
Mild/acute
a)trazodone

Mild/longer term
a)divalproex
a)SSRI
a)buspar
a)trazodone

Severe/acute
a)haloperidol

Severe/longer term
a)divalproex
a)risperidone
a)haloperidol
Conventional ANTIPSYCHOTIC agents used for AGITATION IN DEMENTIA (3)
a)haloperidol (but has EPS/TD and sedation, high risk of EPS/TD in chronic use*******)
b)Chlorpromazine, others- have intense anticholinergic, cardiac, sedative and EPS ADRs
c)only 18% effective but used a lot
Atypical antipsychotics agents used for AGITATION IN DEMENTIA (4)
1)Risperidone- sedation is major ADR (incr sedation @ lower doses AND may produce disabling EPS @ lower doses in elderly)

2)Olanzapine (sedation and wt gain are major ADRs)

3)Clozapine (AGRANULOCYTOSIS, orthostasis/sedation, recommended for dementias associated w/ parkinsons)

4)BLACKBOX: use has increase risk of death and requires GDR (gradual dose reduction)
DSM4-TR Criteria for ADHD (2)
1)s/sx must be present in atleast 2 or more setting by 7yo
2)clinicall sig impairment that affects the pt's occupation, academic, social activities
4 Types of ADHD
1)ADHD, predom inattentive type (have 6 of 9 inattention behaviors)

2)ADHD, predom hyperactive/impulse type (have 6 of 9 hyperactive-impulse behaviors)

3)ADHD combined type (have 6 of 9 inattention and 6 of 9 hyperactive-impulse behaviors)

4)ADHD not otherwise specified
9 INATTENTION behaviors
1)No attention to details or makes careless mistakes @ work/school

2)difficulty paying attention during tasks/activities

3)does NOT listen when spoken to directly

4)does NOT follow thru on instructions and does NOT finish assignments/chores

5)difficulty organizing tasks

6)avoids tasks that require sig mental effort

7)loses materials needed for tasks/chores

8)distracted by extraneous noises

9)forgetful w/ activities
9 Hyperactivity/Impulsivity behaviors
HYPERACTIVITY
1)cannot "sit still"
2)dose NOT remain seated
3)runs/climbs during inappropriate situations
4)expresses difficulty in remaining quiet during activities
5)Often "on the go"
6)talks excessively

IMPULSIVITY
1)blurts out answers b4 questioning has been completed
2)difficulty awating turn
3)interrupts others
Tx Overview of ADHD (2)
1)1st line use meds indicated for ADHD (psychostimulants and atomoxetine) and/or behavioral therapy
2)2nd line use non-FDA indicated meds w/ behavioral therapy
Psychostimulants therapy
a)MOA (3)
b)response to psychostimulants (4)
c)CI/precautions (3)
a)inhibit reuptake of DA/NE
a)incr release of DA/NE from presynaptic neuron
a)inhibit MAO

b)improved motor activity (handwriting)
b)incr attention and decr distractilbility/impulsivity
b)improved short-term memory
b)BUT no effct social/academic fxning

c)concomitant MAOI
c)avoid in mood/seizure disorders
c)underlying CV abnormalities (structural abnormalities)*****
Methylphenidate
a)characteristic
b)IR formulation (3)
c)intermediate release (2)
a)racemic mix of D and L enantiomer (50/50)

b)onset in 30-60min, duration 3-5h
b)admin bid-tid (am, noon, 1600)
b)consider change to intermediate release or LA if pt attends school or has s/sx

c)admin initial dose as previous 24h IR dose
c)acute psychotherapeutic tolerance may occur
LA Methylphenidate
a)Concerta (3)
b)Ritalin LA (3)
a)22% IR; 78% XR w/ osmotic release system
a)later peak [] w/ improved response in evening (12h duration)
a)mimics methylphenidate IR tid dosing

b)50% IR, 50% XR w/ spherical drug absorption system
b)mimics methylphenidate IR bid dosing
b)higher peak [] than Metadate CD (w/ similar PK data)
LA Methylphenidate
a)Metadate CD (3)
b)Daytrana (4)
a)30% IR, 70% XR; XR beads
a)early peak [] w/ continued Css thruout the day
a)mimics methylphenidate bid dosing

b)TRANSDERMAL
b)approved for kids 6-12yo
b)Cmax 7-8h
b)patch delivers over 9h (but is 2h b4 it starts working)
Methylphenidate
a)IR products (2)
b)Intermediate products (3)
c)XR products (4)
c)half-lives (3)
a)ritalin
a)methylin

b)Riatlin SR
b)Metadate ER
b)Methylin ER

c)Metadate CD
c)Ritalin LA
c)Concerta
c)Daytrana

d)IR is 2-3h
d)Intermediate is 3-8h
d)XR is 8-12h
Dexmethylphenidate
a)Intermediate
b)XR (and half-life)
a)Focalin (3-8h)
b)Focalin XR (8-12h)
Dextroamphetamine and Mixed amphetamine salts
a)IR (2)
b)Intermediate (2)
c)XR (2)
d)half-lives (3)
a)Dexedrine SA
a)Dextrostat SA

b)Dexedrine LA
b)Adderall (mixed)

c)Adderall XR (mixed)
c)Vyanase (Lisdexamfetamine)

d)IR is 3-5h
d)Intermediate is 5-8h
d)XR is 8-12h
Dexmethylphenidate
a)general info (2)
b)IR vs XR (4)
a)clinical evidence suggests that D-isomer of methylphenidate is more effective that L-isomer
a)PK profile similar to methylphenidate

b)IR is D-isomer of methylphenidate which allows for lower initial dose
b)XR is 50% IR, 50% XR
b)XR has bimodal release profile similar to bid dosing of IR dexmethylphenidate
b)XR has less HA/GI than racemic mix
Dextroamphetamine and mixed amphetamines general info (4)
a)similar PK profile as methylphenidate
a)approved for kids as young as 3yo
a)incr ADRs (incr cardiotoxicity, etc)
a)better for kids under 6yo
Dextroamphetamine and mixed amphetamines
a)Intermediate release dosing
b)LA dosing (Vyananse) (3)
a)add 1st two IR doses and give as an equal spansule amount in the am

b)decr potential for abuse
b)pro-drug of dextroamphetamine (activated in GI NOT CYP)
b)approved for pts 6-12yo
Amphetamine/dextroamphetamine mix
a)general info
b)dose equivalents
a)10mg= 2.5mg dextroamphetamine sulfate, 2.5mg dextroamphetamine saccharate, 2.5mg amphetamine asparate, 2.5mg amphetamine sulfate

b)Adderall daily = methylphenidate IR bid (so 5mg Adderall = 10mg IR divided bid)
Psychostimulants ADRs
a)common (2)
b)CV (2)
a)CNS- insomnia, ticks, HA
a)GI- appetite suppression, nausea

b)sudden cardiac death
b)screen pt's PMH, wt, ht, BP, HR
Managing ADRs of Psychostimulants
a)wt loss/anorexia
b)insomnia (4)
c)tics
d)HTN
e)linear growth impairment
a)incr calorie intake @ breakfast or bedtime

b)give dose early in the day
b)lower last dose of the day
b)give last dose earlier in the day
b)consider giving clonidine/guanficine @ bedtime

c)reduce dose or consider alternative stimulant

d)reduce dose or consider alternative medication

e)consider alternative med or drug holiday
Medication Guides for Psychostimulants (2)
1)FDA requires that all meds approved for ADHD must be dispensed w/ a Medication Guide
2)MUST discuss CV manifestations, psychiatric manifestations (manic, hallucinations)
Pt counseling on Psychostimulants
a)general info (3)
b)oral psychostim's (2)
c)transdermal psychostim's (3)
a)initiate em on weekends to assess efficacy and ADRs
a)parents/guardians must inform teachers/schools about stimulant tx
a)drug holidays not effective for everyone

b)for IR drugs, start qd and then incr to bid
b)do NOT chew IR, intermediate, or XR

c)apply to clean/intact area of skin on HIP
c)apply to different area daily
c)fold over patch and dispose of in toilet or in lidded container
Atomoxetine (ADHD)
a)general info (3)
b)dosing/efficacy (2)
c)ADRs (4)
d)MOA
a)NON-STIMULANT approved for ADHD
a)black box warning for suicidal ideation
a)low abuse potential

b)onset of behavioral effects is 2-4wks (vs 1h for methylphen)
b)unclear evidence for comparable efficacy w/ methylphen

c)CNS- less insomnia
c)liver- hepatotoxicity (in 2 kids)
c)metabolized by 2D6
c)appetite suppression and wt loss (similar to methylphen)

d)selective inhibitor of NE reuptake in presynaptic neurons
Clonidine/Guanfacine ADHD
a)general info (4)
b)MOA
c)ADRs (3)
a)useful in pt's w/ Tourette's and aggressive behavior
a)alternative or adjunct agents to stimulant therapy to reduce disruptive behavior, control aggression or improve sleep
a)less effective in controlling attention*****
a)takes much longer time to achieve max effect compared to methylphen

b)central alpha2 agonist, decr release of NE from presynaptic neurons

c)sedation/depression
c)hypotension and rebound HTN
c)bradycardia
a)TCAs and ADHD (2)

b)Buproprion and ADHD (3)
c)Buproprion ADRs (2)
a)used clinically in pts w/ concomitant diseases
a)less effective @ controlling attention and for tic disorders

b)decreases hyperactivity and aggression
b)improves cognition
b)used clinically in pts w/ concomitant mood disorders

c)HTN
c)exacerbates tics/seizures
Herbals that:
a)incr [] (3)
b)incr sedation (3)

Iron use?
a)ginkgo/ginseng
a)fatty acids (flaxseed)
a)primrose oil

b)kava kava
b)valerian
b)blue green algae

c)iron deficiency may be associated w/ behavioral problems
Nonpharma therapies for ADHD (5)
1)parental training
2)classroom interventions

3)behavioral interventions- makes social/academic behaviors better
a)must implement these b/c psychostim do NOT meet all goals in therapy
b)types are: time-out, response cost, token economy, positive reinforcement (give awards/privilidges)
Special Considerations in ADULTS w/ ADHD
a)general (2)
b)pharmacotherapy (3)
c)driving considerations
d)substance abuse?
a)70% of pts cont. w/ impulsivity/inattention in adults
a)adults do NOT display over activity (procrastonate, overreact, poorly motivated)

b)will be @ higher risk of substance abuse if NOT TX'D
b)higher risk of CV toxicity (w/ tx)
b)lack guidelines/PK data w/ psychostim's

c)incr risk of driving accidents and having licensed revoked

d)psychostim may decr risk of further substance abuse in kids/teens pts
Benefits of treating depression in elderly (5)
1)60% positive response rates
2)improved QoL for pts and caregivers
3)enhanced fxn
4)improved physical health, reduced mortality and lower HC costs
5)BUT, be sure pharmacotherapy is only one slice of tx pie
TCAs and Elderly
a)general
b)agents (2)
c)monitor (2)
1)secondary amines preferred over tertiary amines due to less anticholinergic effects
2)Desipramine, Nortriptylline preferred agents

3)monitor for anticholinergic effects, hypotension, cognition changes
4)4-6wks to effect
SSRIs and Elderly
a)vs. TCAs (2)
b)characterisitcs (4)
c)preferred agents (2) and why
1)preferred over TCAs due to improved safety profile
2)but efficacy is controversial compared to TCAs

1)variable effects on P450s
2)flat dose response curve (incr dose no improve effect, just incr ADRs)
3)elders may require several weeks of tx before effect seen
4)establish firm response parameters (GDS, HAM-d)

1)citalopram
2)escitalopram
3)short half-lives and limited CYP metabolism
Atypical antidepressants in Elderly
a)agent
b)ADRs (3)
c)characteristics (2)
a)Trazodone

b)dizzy/drowsy/orthostasis

c)slightly impaired CL in elderly
c)role is when pt has anxiety or insomnia w/ depression
SNRIs
a)agents and use (2 w/ 2/1)

NDRIs (NE/DA)
a)agent w/ (2)

IN ELDERLY
Venlafaxine
a)wide dose response curve
a)GI ADRs limit use
Duloxetine
a)added indication of pain of diabetic neuropathy

Buproprion
a)reduced hepatic/renal CL in elderly
a)decr starting dose and prolong time b/w dosing changes
Noradrenergic and specific serotonergic antidepressant
a)agent
b)use (2)

IN ELDERLY
a)Mirtazapine

b)no drug-drug interaxns
b)has highest incidence of somnolence so can be use hs in pt w/ insomnia
Antidepressants efficacy in elderly (3)

Goals
1)all agents are sig superior to placebo
2)no head to head comparisons of newer agents to establish superiority of one agent over another
3)all FDA approved antidepressant have comparable response rates in placebo-controlled, double blind clinical trials

1)remission (fxnal normality)
Approved drug therapy options in elderly for ANXIETY (5)
1)bzd's
2)buspar (azapirone)
3)imipramine (TCA)
4)escitalopram, paroxetine (SSRIs)
5)venlafaxine (SNRIs)
Management of anxiety in elderly (6)
1)bzd's are agents of choice
2)usually want oxazepam or lorazpam (SA and metabolism not affected by age)
3)NEVER use valium or chlordiazepoxide
4)imipramine has too many anticholinergic effects to make it truly safe
5)SSRIs and SNRIs represent a safer method
6)carefully define efficacy and toxicity parameters and length of tx
Sleep hygiene for the elderly (4)
1)avoid naps
2)avoid caffeine near bedtime
3)sleep environment
4)exercise regularly but NOT near bedtime
Pharmacotherapy for Insomnia in elderly (6 cats and 11 total drugs)
1)bzd/hypnotic for intermittent use only (triazolam, temazepam)

2)non-bzd sedative/hyponitcs (ambien, sonata, lunesta)

3)melatonin agonist (remeron)

4)homeopathic alternatives (melatonin, valerian)

5)antidepressants (trazodone, mirtazapine)

6)avoid diphen due to anticholinergic effects
What to use in Bipolar Elderly and how

Adjuncts (2)
LITHIUM
a)use smaller/less freq doses

1)Lamotrigine and antidepressants to help manage depression
2)atypicals as "mood stabilizers"
Management of Psychotic disorders in ELDERLY (4)
1)remove or identify reversible causes

2)haloperidol- less anticholinergic, but more EPS)- neuroleptic

3)thorazine- more anticholinergic, less EPS)- neuroleptic

4)Risperidone is atypical of choice b/c has favorable ADR profile****
Atypical toxicity in elderly w/ Psychosis (3)
1)wt gain greatest w/ olanzepine
2)sudden death incr w/ both atypical and typical
3)EPS w/ risperdone and abilify (dose related)
Consequence of unregulated use of psychotropics in elderly (5)
1)falls and fractures
2)fxnal disability
3)irreversible neurological ADRs
4)overuse to quiet difficult pts
5)inconsistent effects
Intended Consequences of HCFA guidelines for use of psychotropics in elderly (4) and resulted in....
1)limit use, dose, duration of antipsychotics and other psychoactive drugs
2)NEED TO ESTABLISH A PSYCHIATRIC DX prior to tx
3)prefer SA drugs
4)define parameters for monitoring efficacy, toxicity, duration of tx

Resulted in sig improvement in use patterns
Interventions to decr Inappropriate prescribing of psychotropics in elderly (5)
1)remove agents from formularies
2)CME for MD/nurses
3)seek non-drug alternatives for behavior probs
4)improved communication b/w the nursing staff and consultant DPh (and ID/agree upon monitoring parameters to assess therapy)
5)Drug utilization review by DPh monthly
Difficulties in detection of alcohol abuse and substance abuse in the elderly (6)
1)confusion about def's and their lack of application to the elderly
2)lack of understanding about abuse patterns in the elderly
3)failure to recognize s/sx of abuse in elderly
4)failure to apply assessment tools (CAGE,MAST-G)
5)reluctance to deal w/ abuse in elderly by HC provider
6)DENIAL
CAGE Screening for Alcoholism
C ut down on drinking (have tried repeatedly w/o success)
A nnoyed by criticism about drinking habits
G uilty feelings about drinking
E ye opener drink needed in am

Answering yes to any signifies possible hazardous drinking
HC problems adversely affected by alcohol abuse in elderly (6 of many)
1)HTN/stroke
2)CA (head/neck)
3)dementia/delirium
4)sleep patterns altered
5)depression
6)cardiac arrhythmias
ELDERLY EtOH-drug interaxns (5)
1)absorption of EtOH enhanced when admin'd w/ H2
2)CNS depression enhanced w/ other CNS depressants (bzd, barbiturates, opiates, antihistamines)
3)risk of GI bleed w/ NSAIDs
4)risk of hepatoxocitiy w/ APAP
5)risk of bleeds incr w/ warfarin
PK/PD effects on drugs of abuse in elderly (3)
1)no effect on opioids
2)longer duration of bzd's due to decr hepatic metabolism (and incr fat stores=incr Vd=incr duration of axn)
3)CNS becomes more sensitive to bzd/opioids leading to enhanced pharmacological and toxic effects
Outcomes of medication abuse in elderly (5)

OTHER Drugs abused by elderly (5)
1)addiction
2)tolerance
3)falls/fractures/accidents
4)sedation, confusion, psychosis, delirium
5)relationship/socialization problems

1)weed
2)heroine
3)coke
4)methamphetamine
5)diphen
Essential features needed for a diagnosis of Personality disorder (3)
1)enduring pattern of inner experiences AND
2)behavior considerably different from expectation of the cultural norm AND
3)present w/ atleast 2 of the following: cognition, affectivity, interpersonal fxning, impulse control
Cluster A Personality disorders
a)essential feature
b)includes....(3)
a)odd or eccentric

b)paranoid
b)schizoid
b)schizotypal
Paranoid characteristics (Cluster A Personality) (3)
a)suspiciousness, mistrust of others
a)often hostile, irritable, angry
a)tendency to interpret axns of others as purposefully threatening or w/ mal-intent
Schizoid (Cluster A Personality) (6)
1)lifelong socially withdrawn
2)discomfort w/ interaxns w/ others
3)introspective
4)bland, constricted affect
5)viewed as eccentric, isolated, lonely
6)generally prefer jobs w/ little contact w/ others
Schizotypal (Cluster A Personality) (5)
1)generally considered odd/strange by most
2)MAGICAL THINKING, derealization
3)may claim special powers/insights
4)poor interpersonal relationships, isolate, few friends
5)odd speech (elaborate, irrelevant details)
Cluster B Personality disorders
a)essential features
b)includes...(4)
a)dramatic, emotional, erratic

b)antisocial
b)borderline
b)histrionic
b)narcissistic
Antisocial (Cluster B Personality) (5)
1)high concordance w/ substance abuse
2)inability to conform to social norms
3)may appear normal or charming
4)tension, hostility, irritability, rage
5)remorseless, no conscience
Borderline (Cluster B Personality) (6)
1)unstable, mood, affect, behavior, self-image
2)constant state of crisis presentation
3)difficult relationships
4)high rate of attempting suicide (low rate of succeeding)
5)feel dependent AND hostile
6)fMRIs do show differences
Histrionic (Cluster B Personality) (4)
1)excitable, emotional
2)attention-seeking
3)behavior also dramatic, extroverted
4)difficulty maintaining relationships
Narcissistic (Cluster B Personality) (4)
1)incr self-importance, grandiosity
2)expect special tx
3)lack empathy
4)NO handle criticism/aging well
Cluster C Personality Disorders
a)essential features
b)includes....(3)
a)anxious/fearful

b)avoidant
b)dependent
b)OC
Avoidant (Cluster C Personality) (3)
1)hypersensitive to rejection
2)althou socially withdrawn, desires companionship
3)works on the sidelines
Dependent (Cluster C Personality) (5)
1)puts needs of others first
2)allows others major control of aspects of life
3)lacks self-confidence
4)dependent, submissive
5)uncomfortable alone for sig periods of time
OC (Cluster C Personality) (6)
1)emotionally constricted
2)focuses on orderliness, rules/regs, details, perfection
3)PERSERVERANCE
4)stubborn/inflexible YET indecisive
5)limited interpersonal skills
6)only dx as OCD if recurrent obsessions/compulsions
Pharmacotherapy for Personality disorders (classes) (5)
1)primary tx modalities are psychotherapy and behavior modification
2)antipsychotics
3)antidepressants
4)anticonvulsants
5)anxiolytics
Antipsychotics and Personality disorders
a)when/how to use (4)
b)drugs (7)
1)low dose and short duration
2)reserved for severely disturbed/vulnerable to psychotic s/sx
3)target s/sx are derealization, suspicious, odd/delusional thinking, anger/hostility
4)can use depot formulations if impulsive self-harm is feature

1)haloperidol
2)resperidone/paliperidone
3)olanzapine/quetiapine
4)ziprasidone
5)aripiprazole
Antidepressants and Personality disorders
a)when/how to use (2)
b)drugs (5)
1)generally use SSRIs/SNRIs
2)target s/sx are mood lability, rejection sensitivity, inappropriate anger, anxiety, constricted affect

b)fluoxetine
b)sertraline
b)paroxetine
b)citalopram/escitalopramb
b)venlafaxine
Anticonvulsants and Personality disorders
a)use (2)
b)drugs (3)
a)used for mood lability
a)target ss/x of self harm, impulsivity, aggression

b)VPA/divalproic acid
b)tegretol
b)lamotrigine
Anxiolytics and Personality disorders
a)use (2)
b)drugs (3)
a)target s/sx is anxiety
a)consider comorbidity of substance abuse

b)primarily bzd's
b)also hydroxyzine or buspar