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23 Cards in this Set
- Front
- Back
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Intermittent Explosive Disorder Tx
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SSRIs
Anticonvulsants Lithium Propranolol Group/Family therapy (not individual therapy |
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Kleptomania Tx
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Insight oriented psychotherapy
behavioral therapy SSRIs Naltrexone (anecdotal) |
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Pyromania Tx
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behaviour therapy
supervision SSRIs |
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Pathological Gambling Tx
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Gambler's anonymous (12 step)
Insight oriented psychotherapy after 3 months abstinence Treat comorbid mood, anxiety and substance abuse problems |
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Trichotillomania definition and Tx
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Recurrent pulling out of hair (scalp, eyebrows, eyelashes, facial, or pubic)
SSRI, Antipsychotics, Lithium Hypnosis and relaxation techniques Behavior therapy (substitution with positive reinforcement) |
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Anorexia Nervosa Defining Features (2 types)
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Restrictive: eat little with vigorous exercise (OCD traits)
Binge/Purge: eat in binges and purges, with laxatives + exercise or diuretics (Depressive / substance abuse traits) |
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Anorexia Nervosa Tx
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Hospitalization if 20% below desired weight
behavioral therapy family therapy supervised weight gain programs SSRI: Paroxetine or Mirtazepine but not weight LOSS ones |
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Bulimia Nervosa Defining features
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Can be Purging type or non-purging type
Difference from anorexia is mainly that their symptoms are ego-dystonic so they seek help more, and they tend NOT to be underweight. It's more an impulse control issue classically. |
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Binge Eating Disorder (eating disorder NOS)
Defining features and Tx |
recurrent binge eating (2h period eating excessively w/ no control)
distress over binge eating Bingeing at least 2 days/week for 6 months 3 of following: eating rapidly / until uncomfortably full / when not hungry, eating alone due to embarrassment / feeling disgusted or guilty after overeating No purge or restrictive behaviors involved here Tx: individual psychotherapy / behavior therapy / strict diet + exercise / treat comorbid mood disorders as necessary Phentermine or Amphetamines decrease appetite Orlistat inhibits pancreatic lipase decreasing fat absorbed from GI Sibutramine (meridia) inhibits reuptake of norepinephrine / serotonin / dopamine |
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Primary insomnia Tx
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Sleep hygiene (7): regular schedule, limit caffeine, avoid napping, exercise early in day, soak in hott tub HS, avoid big meals near bedtime, bedroom for sleep and sex only
Short term: Benadryl, Ambien (zolpidem), Sonata (zaleplon), Desyrel (trazodone) |
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Primary Hypersomnia Tx
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Stimulants (amphetamines)
SSRIs as second-line |
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Narcolepsy Tx
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Timed daily naps and stimulant drugs
SSRIs for cataplexy (collapse due to sudden loss of muscle tone... often with emotion or laughter) |
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Sleep disorder (Breathing related) Tx
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Could be OSA (snoring) or Central Sleep Apnea (correlated with heart failure)
OSA: nasal CPAP, weight loss, nasal surgery, uvulopalatoplasty CSA: mechanical ventilation with backup rate |
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Narcolepsy Diagnosis
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1. Cataplexy—collapse due to sudden loss of muscle tone (occurs in 70%
of patients); associated with emotion, particularly laughter 2. Short REM latency 3. Sleep paralysis—brief paralysis upon awakening (in 50% of patients) 4. Hypnagogic (as patient falls asleep or is falling asleep); hypnopompic (as patient wakes up; dream persists); hallucinations (in approximately 30% of patients) |
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Narcolepsy epidemiology
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EPIDEMIOLOGY/ETIOLOGY
Occurs in 0.02 to 0.16% of adult population Equal incidence in males and females Onset most commonly during childhood or adolescence May have genetic component Patients usually have poor nighttime sleep |
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Circadian Rhythm Sleep Disorder definition
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Disturbance of sleep due to mismatch between circadian sleep–wake cycle and
environmental sleep demands. Subtypes include jet lag type, shift work type, and delayed sleep or advanced sleep phase type. |
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Circadian Rhythm sleep disorder Tx
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-Jet lag type usually remits untreated after 2 to 7 days
Light therapy may be useful for shift work type For shift life, delayed/advanced phase is better Melatonin can be given 51⁄2 hrs before desired bedtime |
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Nightmare Disorder: Dx, Epidemiology, Tx
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DIAGNOSIS
Repeated awakenings with recall of extremely frightening dreams Occurs during REM sleep and causes significant distress EPIDEMIOLOGY Onset most often in childhood May occur more frequently during times of stress or illness TREATMENT Usually none but TCA suppress total REM sleep and can be used |
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Night Terrors: Diagnosis
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Repeated episodes of apparent fearfulness during sleep, usually beginning with
a scream and associated with intense anxiety. Episodes usually occur during the first third of the night during stage 3 or 4 sleep (non-REM). Patients are not awake and do not remember the episodes. |
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Night Terror: Epidemiology / Etiology
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EPIDEMIOLOGY/ETIOLOGY
Usually occurs in children More common in boys than girls Prevalence: 1 to 6% of children Tends to run in families High association with comorbid sleepwalking disorder |
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Night Terror Treatment
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Usually none
Small doses Diazepam at bedtime if necessary |
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Sleepwalking (Somnambulism) Diagnosis
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Repeated getting out of bed and walking
Blank stare and difficult to wake Could get dressed, talk, or scream Occurs in first 3rd of night During stage 3 and 4 Never remember events |
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Sleepwalking Epidemiology / Etiology and Treatment
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onset between 4-8
Peak prevalence at age 12 More common in boys runs in families Tx: measures preventing injury in surrounding environment |
