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577 Cards in this Set
- Front
- Back
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What personality disorder is characterized primarily by a profound defect in the ability to form personal relationships or to respond to others in any meaningful, emotional way?
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Schizoid Personality Disorder
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Amitriptyline
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Generic
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How is antisocial personality disorder characterized?
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It is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a disregard for the rights of others (similar to conduct disorder in kids)
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First mood stabilizer approved
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LITHIUM
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What disorder is characterized by a pattern of intense and chaotic relationships, with affective instability and fluctuating attitudes towards other people?
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Borderline personality disorder.
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fluoxetine
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Prozac, Sarafem
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A person with ____ has an exaggerated sense of self-worth. They lack empathy, and are hypersensitive to the evaluation of others.
a) borderline personality disorder b) avoidant personality disorder c) narcissistic personality disorder d) histrionic personality disorder |
c) narcissistic personality disorder
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Pervasive pattern of detachment from social relationships and a restricted range of expression of emotion in interpersonal settings
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Schizoid Personality Disorder
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A patient with ____ is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships.
a) borderline personality disorder b) avoidant personality disorder c) narcissistic personality disorder d) histrionic personality disorder |
d) histrionic personality disorder
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These are the most widely-used antidepressants
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SSRI's
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What characterizes a patient with avoidant personality disorder?
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They are so sensitive to rejection that they lead a very socially withdrawn life to prevent it.
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Untreated episode of Major Depression usually lasts _______
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9-12 months
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What are some of the key findings in manic episodes?
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- grandiosity, decreased need for sleep, racing thoughts, speech, distractable, risky behavior
- manic episodes=marked disturbance in social/occupational situations - DIGFAST - distractability - increased psychomotor agitation - grandiosity - flight of ideas - activities that are dangerous - decreased need for sleep - talkative - need 3/7 |
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What is dependent personality disorder?
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A excessive need to be taken care of that leads to submissive and clinging behavior and fear of separation.
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What is personality?
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a totality of an individual's behavioral and emotional characteristics
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Patients with OCD have an intense fear of:
a) abandonment b) rejection c) making mistakes d) change |
c) making mistakes: This leads to difficulty with decision making.
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The idea of splitting is an ego defense mechanisms that holds the idea that all people and life situations are:
a) either all good or all bad b) either benefit them or will harm them c) can be categorized as black or white d) are positive or negative |
a) are either all good or all bad
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Action of MAO
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MAO breaks down monoamines. MAO is analagous to cholinesterase.
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Compared to Major Depression, Dysthymic Disorder is:
-less or more severe? -longer or shorter in duration? |
Dysthymic Disorder is less severe (often undiagnosed) and longer-lasting (>2 yrs)
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True or False: Initially it is appropriate to offer sympathy to the borderline personality patient who has a cutting episode when admitted on your unit.
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False: If self-mutilation occurs, care for client's wounds in a matter-of-fact manner. Do not give positive reinforcement to this behaviors by offering sympathy or additional attention. Lack of attention to the maladaptive behavior may decrease repetition of its use.
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Desipramine
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Norpramin
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Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
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Avoidant Personality Disorder
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What is the treatment of choice for individuals with histrionic personality disorder?
a) medication b) psychotherapy c) group therapy d) personal refection through journaling |
b) psychotherapy
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Predictors of positive response to Li
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Mania
Lack of neurological or psychotic symptoms or substance abuse Non-rapid cycling |
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What type of treatment is especially appropriate for individuals with antisocial personality disorder?
a) medication b) psychotherapy c) group therapy d) personal refection through journaling |
c) group therapy
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sertraline
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Zoloft
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What is a personality disorder?
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a variant of those character traits that goes beyond the range in most people. These traits become inflexible and maladaptive and cause SIGNIFICANT FUNCTIONAL IMPAIRMENT or SUBJECTIVE DISTRESS.
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What type of medications are most useful in decreasing impulsivity and self-destructive acts in clients with borderline personality disorder?
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SSRIs and MAOIs
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What is bipolar 1?
What is bipolar 2 |
1. presence of manic episodes w/ major depressive episodes
2. presence of hypomanic episodes w/ major depression- hypomania means pt will not have severe social and occupational impairment |
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The patient with antisocial personality disorder is given lithium carbonate and propanolol (Inderal). These medication prevent:
a) violent episodes b) depression c) anticholinergic effects d) extrapyramidal effects |
a) violent episodes
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Doxepin
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Sinequan
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The most striking gender difference among the personality disorders appears in______ personality disorder, where men are five times more likely to be diagnosed with the disorder than are females.
a) schizotrypal b) antisocial c) obsessive-compulsive d) narcissistic |
b) antisocial
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extinction (in reference to conditioning)
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discontinuation of reinforcement eliminates behavior
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Which of the following is false about antisocial personality disorder?
a) They are more likely to have low levels of education b) The tendency to engage in antisocial behaviors tends to begin in childhood and is one of the most stable personality characteristics c) they have difficulty in inhibiting impulsive behaviors d) they have high levels of arousability, which leads them to avoid stimulation through impulse dangerous acts and to experience punishment as less severe |
d) they have high levels of arousability, which leads them to avoid stimulation through impulse dangerous acts and to experience punishment as less severe: This is typical of borderline personality disorder
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paroxetine
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Paxil
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The personality disorder characterized by instability and "splitting" is:
a) paranoid b) dependent c) borderline d) histrionic |
c) borderline
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Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsiveness.
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Borderline Personality Disorder
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The personality disorder that is diagnosed more often in woman than in men and is characterized by rapidly shifting emotions, unstable relationships, and highly dramatic and seductive behaviors performed to gain the attention and approval of others, is known as:
a) narcissistic b) dependent c) histrionic d) antisocial |
c) histrionic
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What are the main adverse events of Li therapy
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GI upset
Fine tremor POLYURIA, POLYDIPSIA - IATROGENIC DIABETES INSIPIDUS Also weight gain, worsening of dermatologic conditions, cognitive, hypothyroidism |
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What disorders are considered cluster A disorders?
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paranoid, schizoid, and schizotypal
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People with antisocial personality disorder exhibit all of the following except:
a) deficits in the parietal lobes of the brain b) poor impulse control c) deficits in executive functions d) difficulty inhibiting impulsive behaviors |
a) deficits in the parietal lobes of the brain
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What is a mixed episode?
What is rapid cycling? |
1. mania and depression episodes occurring withing 24 hrs- have poorer prognosis
2. when 4 major depressive or manic episodes occur in 12 mos |
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People with ____ are heavy users of mental health services, in contrast to people with other personality disorders.
a) borderline b) antisocial c) avoidant d) narcissistic |
a) borderline
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citalopram
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Celexa
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Kim manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except:
a) refusal to stay in her room alone, stating, "It's so lonely" b) asking the nurse for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour c) stating "I really like having you for my nurse. You're the best one around here" d) Cutting arms with razor blade after discussing discharge plans with the doctor |
a) refusal to stay in her room alone, stating, "It's so lonely"
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Imipramine
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Tofranil
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"Splitting" by the client with borderline personality disorder denotes:
a) evidence of precocious development b) a primitive defense mechanism in which the client see objects as all good or all bad c) a brief psychotic episode in which the client loses contact with reality d) two distinct personalities within the borderline client |
b) a primitive defense mechanism in which the client see objects as all good or all bad
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Pervasive and excessive emotionality and attention-seeking behavior.
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Histrionic Personality Disorder
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transference
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patient projects feelings onto physian
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Jack was arrested for breaking into a jewelry store and stealing thousands of dollars worth of diamonds. At his arraignment, the judge ordered a psychological evaluation. He has just been admitted by court to the locked unit. Based on a long history of maladaptive behavior, he has been given the diagnosis of antisocial personality disorder. Which of the following characteristics would you expect to assess in Jack?
a) lack of guilt for wrongdoing b) insight into his own behavior c) ability to learn from past experiences d) compliance with authority |
a) lack of guilt for wrongdoing
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Typical age of onset for Major Depression
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All ages, including children and the elderly
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What disorders are considered cluster B disorders?
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Antisocial, borderline, histrionic, and narcissistic
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In evaluating Jack's progress(he has antisocial personality disorder), which of the following behaviors would be considered the most significant indication of positive change?
a) Jack got angry only once in group this week b) Jack was able to wait a whole hour for a cigarette without verbally abusing the staff c) On this own, Jack sent a note of apology to a man he had injured ina recent fight d) Jack states that he would no longer start any more fights |
c) On this own, Jack sent a note of apology to a man he had injured ina recent fight
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What labs should you monitor in people on lithium
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RENAL FUNCTION - possibility of nephrotoxicity - relatively rare
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Donna and Katie work in the secretarial pool of a large organization. It is 30 min until quitting time when a supervisor hands Katie a job that will hake an hour and sys he wants if before she leaves. She says to Donna, "I can't stay over, be a doll Donna and do it for me?!?" Donna agrees, although silently she is furious at Katie because this is the third time this has happened. Donna says to herself, "This is crazy. I'm not finishing this job for her. Let's see how she like getting in trouble for a change." Donna leaves without finishing the job. This is an example of which type of personality characteristic?
a) antisocial b) paranoid c) passive-aggressive d) obsessive-compulsive |
c) passive-aggressive
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Greater risk of developing Major Depression if:
-female (1.5x) -history of MDD in 1st degree relative (8x) -history of anxiety and/or substance dependence |
Greater risk of developing Major Depression if:
-female (1.5x) -history of MDD in 1st degree relative (8x) -history of anxiety and/or substance dependence |
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Carol is a new nursing graduate being oriented on a med/surg unit by the head nurse Mrs Carey. When Carol describes a new technique she has learned for positioning immobile clients, Mrs. Carey states, "What are you trying to do...tell me how to do my job? We have always done it this way on this unit, and we will continue to do it this way until I say differently!" This is an example of what type of personality characteristic?
a) antisocial b) paranoid c) passive-aggressive d) obsessive-compulsive |
d) obsessive-compulsive
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Id
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primal urges, food, sex, aggression, instinct
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Which of the following behavioral patterns is characteristic of individuals with histrionic personality disorder?
a) belittling themselves and their abilities b) overreacting inappropriately to minor stimuli c) suspicious and mistrustful of others d) a lifelong pattern of social withdrawal |
b) overreacting inappropriately to minor stimuli
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imipramine
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Tofarnil
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Is Li safe for pregnant women?
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NO - TERATOGENIC
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Nortriptyline
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Pamelor
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Pervasive pattern of disregard for, and violation of, the rights of others.
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Antisocial Personality Disorder
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What disorders are considered cluster C disorders?
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avoidant, dependent, obsessive/compulsive, and personality disorders NOS (passive aggressive and depressive personality type)
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A client who has been living with her family after her boyfriend of 4 weeks told her to leave is admitted to the subacute unit complaining of feeling empty and lonely, being unable to sleep, and hardly eating for the past week. Her arms are scarred from frequent self-mutilation. The nurse interprets these findings as indicating which of the following personality disorders?
a) antisocial b) avoidant c) borderline d) compulsive |
c) borderline: remember they are impulsive, self mutilating and have intense relationships
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4 treatment options for Major Depression in addition to antidepressant medications
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-psychotherapy
-electroconvulsive therapy (ECT) -vagal nerve stimulation (VNS) -transcranial magnetic stimulation (TMS) |
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amitriptyline
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Elavil
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A diabetic client admitted to a medical floor for medication stabilization has a history of antisocial personality disorder. Which documented behavior would support this diagnosis?
a) labile mood and affect and old scars noted on wrists bilaterally b) appears younger than stated age with flamboyant hair and makeup c) began cursing when confronted with drug-seeking behaviors d) demands foods prepared by personal chef to be delivered to room |
c) began cursing when confronted with drug-seeking behaviors
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Distrust and suspiciousness of others such that their motives are interpreted as malevolent
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Paranoid Personality Disorder
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A client diagnosed with borderline personality disorder is admitted with recent self-inflected cuts to both arms. Which of the following would explain this behavior? CATA: Self mutilation:
a) is a manipulative gesture designed to elicit a rescue response b) is often attempted when a "safety" plan has been established c) proposes that feeling pain is better than feeling nothing d) results from feelings of abandonment following separation from significant others e) is attempted when voices tell the client to do self-harm f) is always done in an attempt to commit suicide |
Self mutilation:
a) is a manipulative gesture designed to elicit a rescue response b) is often attempted when a "safety" plan has been established c) proposes that feeling pain is better than feeling nothing d) results from feelings of abandonment following separation from significant others |
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ego
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mediator between unconscious mind and external world; ego resists
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Which of the following are diagnostic criteria for borderline personality disorder? CATA
a) arrogant, haughty behaviors or attitudes b) frantic efforts to avoid real or imagined abandonment c) recurrent suicidal and self-mutilating behaviors d) unrealistic preoccupation with fears of being left to take care of self e) chronic feelings of emptiness |
b) frantic efforts to avoid real or imagined abandonment
c) recurrent suicidal and self-mutilating behaviors e) chronic feelings of emptiness |
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Name drugs which increase Li levels
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NSAIDS
DIURETICS ACE INHIBITORS |
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A client diagnosed with OCD has a nursing diagnosis of anxiety R/T interference with hand washing AEB "I'll go crazy if you don't let me do what I need to do" Which short-term outcome is appropriate for this client?
a) the client will wash hands only at appropriate intervals: that is bathroom and meals b) the client will refrain from hand washing throughout the night c) the client will refrain from hand washing during a 3 hour period after admission o the unit d) the client will verbalize signs and symptoms of escalating anxiety within 72 hours of admission |
d) the client will verbalize signs and symptoms of escalating anxiety within 72 hours of admission
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These drugs are used in refractory cases of anxiety and depression
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MAOIs
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What factors form personality?
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genetics, tempermental factors, biological factors
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bupropion
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Wellbutrin
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True or False: Personality disorders can be successfully controlled with medication.
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False: Hospitalization, group therapy...are also needed as there is no medication therapy that will fix their behavioral abnormalities.
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Preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
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Obsessive-compulsive Personality Disorder
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A client diagnosed with paranoid personality disorder is prescribed Risperdal. The client is noted to have restlessness and weakness in lower extremities and is drooling. Which nursing intervention would be most important?
a) hold the next dose of Risperdal, and document the findings b) monitor vitals, and encourage the client to rest c) give the ordered PRN dose of trihexyphenidyl (Artane) d) get a fasting blood sugar |
c) give the ordered PRN dose of trihexyphenidyl (Artane)
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Rank classes of antidepressants in order of preference for use:
-MAOIs -3rd generation -TCAs -SSRIs -SNRIs |
1) SSRIs
2) SNRIs 3) 3rd generation 4) TCAs 5) MAOIs |
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Stimulant medications reduce the ___ symptoms of ADHD by increasing the client's ability to focus on tasks.
a) negative b) positive c) unacceptable d) abnormal |
a) negative
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superego
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moral values, conscience, can lead to self-blame
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All stimulant medications release what two neurotransmitters into the CNS and inhibit the reuptake of those two hormones?
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Norepinephrine and dopamine.
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This drug can cause hypertensive crisis with tyramine containing foods
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MAOIs
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Trimipramine
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Surmontil
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What are the characteristics of paranoid personality disorder?
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long-standing suspiciousness and mistrust of people
hostility, irritability, and anger questioning of loyalty or trustworthiness of friends logically defended illusions are common |
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What effect results if Ritalin or Concerta is combined with Dilantin, Coumadin, or phenobarbital?
a) hypertensive crisis b) life threatening hypotension c) dizziness and decreases LOC d) causes increased serum levels of Dilantin, Coumadin, or phenobarbital |
d) causes increased serum levels of Dilantin, Coumadin, or phenobarbital
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What is a priority concern for children taking ADHD medications?
a) inappropriate selling of the drug to their friends b) appropriate growth c) fluid intake d) concurrent OTC medication use |
b) appropriate growth: monitor height and weight, and for appropriate growth at specified intervals
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1st generation of antidepressants (introduced in 1960s) included ____ and ____
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-TCAs
-MAOIs |
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A client who has taken methylphenidate (Ritalin) daily for 5 years decides to stop taking it altogether. Which of the following symptoms should the nurse expect to see a few days after the client discontinues the medication?
a) insomnia, irritability b) increased ability to concentrate c) depression and exhaustion d) generalized anxiety and possible panic attacks |
c) depression and exhaustion
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Citalopram
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Celexa
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Li- Use
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1. acute manic episode - in which full therapeutic benefit seen in greater than 3 wks
2. prophylaxis-- helps reduce high relapse rate for bipolar mania and depression, prevents suicide and self injury - gold std for bipolar disorder - pts w/ rapid cycling or mixed states may NOT respond as well to Li monotherapy - avoid in pts w/ unstable renal disease |
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What are the three clusters of personality disorders?
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Cluster A: Odd or eccentric
Cluster B: Dramatic,emotional, or erratic Cluster C: Anxious or fearful |
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What personality disorder is characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility?
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Antisocial personality
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Name drugs that may increase Li toxicity
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Methyldopa
Carbamazepine Ca channel blockers SSRI's Antipsychotic agents |
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What personality disorder is characterized by instability of affect, identity, and relationships, fear of abandonment, splitting behaviors, manipulation, and impulsiveness, often tried to self-mutilate and may be suicidal?
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Borderline personality disorder.
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Pervasive pattern of grandiosity, need for admiration, and lack of empathy
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Narcissistic Personality Disorder
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What cluster do Antisocial and Borderline personality disorder fall under?
a) Cluster A b) Cluster B c) Cluster C d) Cluster D |
b) Cluster B: Dramatic, emotional or erratic traits
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shaping vs. modeling
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shaping: behavior achieved following reward of closer and closer approx of desired behavior; modeling: behavior acquired by watching others
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What cluster do paranoid, schizoid and schizotypal personality disorder fall under?
a) Cluster A b) Cluster B c) Cluster C d) Cluster D |
a) Cluster A: Odd or eccentric traits
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This class of drugs can cause hypotension and wt gain
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MAOIs
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What cluster do avoidant, dependent and obsessive-compulsive personality disorder fall under?
a) Cluster A b) Cluster B c) Cluster C d) Cluster D |
c) Cluster C: Anxious or fearful traits
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venlafaxine
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Effexor
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What is the course and prognosis of paranoid personality disorder?
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lifelong and sufferers have problems with work and living with others
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A patient with which personality disorder is likely to engage in splitting?
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Borderline personality disorder
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displacement
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process whereby avoided ideas and feelings are transferred to some neutral person or object (mother yells at child because she is mad at child)
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A client with antisocial personality disorder is admitted to a chemical dependency unit.The nurse should be alert for which of the following characteristic behaviors: CATA
a) anxious b) indecisive c) exploitative d) submissive e) aggressive f) impulsive |
c) exploitative
e) aggressive f) impulsive |
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Does Li have narrow or wide therapeutic index
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NARROW - lab levels need to be drawn to monitor for toxicity
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duloxetine
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Cymbalta
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Escitalopram
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Lexapro
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How do you treat paranoid personality disorder?
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psychotherapy is TOC
paranoid PD patients do NOT do well in group therapy anti-anxiety agents are sufficient. may sometimes use an antipsychotic |
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Mechanism of action of SSRIs
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Selective blockade of serotonin transporter (SERT), thereby inhibiting reuptake of serotonin (5-HT)
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This drug is used to treat refractory depression with atypical features
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MAOIs
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atomoxetine
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Strattera
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fixation
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partially remaining at a more childish level of behavior (vs. regression); ex: men fixating on sports event
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Fluoxetine
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Prozac
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How many types of receptors do SSRIs affect?
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Only 1, the serotonin (5-HT) receptor.
-SERT is blocked, inhibiting reuptake of serotonin |
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Patients with schizoid personality disorder have a lifelong history of what?
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social withdrawal
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This class of drugs is used to treat generalized social phobias
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MAOIs
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Which drug is 1st line therapy in mixed or rapid cycling episodes (also in patients with high BP and history of substance abuse)
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VALPROIC ACID
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Fluvoxamine
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Generic
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How do benzodiazepines work?
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they depress the CNS & reduce anxiety to effects on limbic system, and promote sleep by effects on cortical areas and induce muscle relaxation by effects on supraspinal motor areas
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identification
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modeling behavior after another person who is more powerful, though not necessarily admired (abused child becoming an abuser)
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MAOI's can be used in these special cases
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Social phobia, atypical depression, refractory cases of panic, mixed anxiety/depression
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phenelzine
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Nardil
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What are the characteristics of schizoid PD?
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eccentric, isolated or lonely
give an impression of being "cold and aloof" history reveal solitary interrests and success at non-competitive, lonely jobs inability to express anger excessive day-dreaming |
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What are the common side effects of valproic acid
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Sedation, tremor, nausea, diarrhea, weight gain, alopecia, mild LFT increase
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While pts may experience GI upset, CNS stimulation, and restlessness w/in a few hours of beginning SSRI therapy, therapeutic effects usually take _____ to develop.
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2-6 weeks (true for most antidepressants)
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carbamezepine
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Tegretol
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isolation of affect
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separation of feelings from ideas and events (describing murder in graphic detail with no emotional response)
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Paroxetine
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Paxil
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This antidepressant is used in the treatment of enuresis (bed wetting)
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TCA's
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What are the rare serious side effects of valproic acid
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HEPATOTOXICITY
AGRANULOCYTOSIS |
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What is the course and prognosis of schizoid personality disorder?
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onset usually in childhood
long lasting but not necessarily lifelong |
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Which side effect of SSRIs does not tend to improve over time?
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Sexual dysfunction, such as decreased libido and anorgasmia
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divalproex
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Depakote
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Does valproic acid have narrow or wide therapeutic index
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NARROW - need to draw blood levels to monitor for toxicity
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How are SSRIs metabolized?
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CYP3A4 oxidation, then glucuronidation
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How do you treat schizoid personality disorder?
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psychotherapy
pharmacotherapy (antipsychotics, antidepressants, psycho-stimulants) |
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projection
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an unacceptable internal impulse is attributed to an external source (man who wants another woman thinks his wife is cheating on him)
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Sertraline
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Zoloft
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Is valproic acid safe for pregnant women"?
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NO - TERATOGENIC
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lamotrigine
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Lamictal
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Mechanism of TCA's
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NE and 5-HT reuptake inhibitor; postsynaptic effects on NE, 5-HT, ACh, HA
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reaction formation
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process whereby a warded off idea or feeling is replaced by an emphasis on its opposite (pt with libidinous thoughts enters a monostary)
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What are the characteristics of schizotypal personality disorder?
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strikingly strange: magical thinking, peculiar ideas, ideas of reference, illusions and derealizations are part of their everyday world
may be superstitious or claim clairvoyance believe they have special powers or special insight isolated, may have borderline PD can have psychotic symptoms severe cases anhedonia and depression may be present |
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How is valproic acid eliminated?
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HEPATIC ELIMINATION
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Phenelzine
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Nardil
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repression
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INVOLUNTAY witholding of an idea or feeling from conscious awareness
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SSRIs have long half-lives usually exceeding 24 hrs. What is a consequence of this?
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Long half-life means fewer withdrawal symptoms following discontinuation
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topiramate
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Topamax
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Uses of TCA's
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Depression (severe), anxiety, panic, sleep (maintenance), pain, enuresis, ADHD
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What are benzodiazapenes used for?
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anxiety, insomnia and seizure disorders, pre-op meds and to treat muscle spasms, panic disorders and withdrawal from alcohol
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What is the course and prognosis for schizotypal personality disorder?
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10% commit suicide
can be functional despite oddities |
|
|
lithium
|
Eskalith, Lithonate
|
|
|
splitting
|
belief that people are either all good or all bad at different times due to intolerence of ambiguity
|
|
|
This class of antidepressants can cause ACh and HA blockade
|
TCA
|
|
|
VPA may increase levels of _
|
Lorazepam
WARFARIN |
|
|
What are side effects of benzodiazapenes?
|
CNS depresion, anterograde amnesia, sleep driving, abuse
|
|
|
What is the treatment of schizotypal personality disorder?
|
psychotherapy: need be handled with care because some are involved with cults or the occult
pharmacotherapy: antipsychotics (dealing with ideas of reference, illusions) antidepressants |
|
|
Which SSRI is available in a weekly formulation?
|
Fluoxetine (it has a really long half-life)
-norfluoxetine, an active metabolite, has an even longer half-life |
|
|
Bupropion
|
Wellbutrin
|
|
|
Mechanism of action of SNRIs
|
Block SERT (inhibiting serotonin reuptake at 5-HT receptors) and, at medium-to-high doses, also block NET (inhibiting norepinephrine reuptake).
|
|
|
Name drug that is a 2nd line therapy, effective in acute mania and maintenance therapy, good response in mixed mania, neurologic disease, no family history of mood disorders
|
CARBAMAZEPINE
|
|
|
Name meds used for Anxiety
|
Alprazolam (Xanax), Chlordiazepoxide (Librium), Clorazepate (Tranxene), Diazepam (Valium, Diastat),
Lorazepam (Ativan), Oxazepam (Serax) |
|
|
olanzapine/fluoxetine
|
Symbyax
|
|
|
This class of antidepressants can cause cardiac conduction delay, and is therefore very dangerous in OD
|
TCA
|
|
|
what are the 4 mature ego defenses
|
altruism, humor, sublimation, suppression
|
|
|
What characterizes obsessive-compulsive personality disorder?
|
emotional constriction, orderliness, perseverance, stubborness, and indecisiveness.
perfectionism and inflexibility |
|
|
Are benzodiazapenes safe in pregnancy?
|
readily crosses placenta - Pregancy category D & some as category X. Should not be used during 1st trimester. Avoid in nursing mothers
|
|
|
diazepam
|
Valium
|
|
|
Mirtazapine
|
Remeron
|
|
|
SSRIs may cause CNS stimulation, anxiety, sexual dysfunction, GI problems, headache, and akathisia (motor restlessness). Will SNRIs also produce these effects?
|
Yes, SNRIs also produce side effects of SSRIs b/c both drugs block SERT (thereby inhibiting serotonin reuptake).
|
|
|
sublimation
|
process whereby one replaces an unacceptable wish with a course of action that is similar but does not conflict with ones value system (agressive impulses used to succeed in business)
|
|
|
Symptoms of ACh and HA blockade
|
Dry mouth, orthostasis, constipation, sedation, wt gain
|
|
|
What are the common side effects of carbamazepine
|
Sedation, headache, ataxia, nausea, leukopenia
|
|
|
What is the course and prognosis of patients with obsessive-compulsive personality disorder?
|
variable and not predictable
some can be normal, others progress to schizophrenia. |
|
|
How do you treat obsessive-compulsive personality disorder?
|
free-association and non-directive therapy are highly valued
group therapy has certain advantages, like sharing coping skills pharmacotherapy: clonazapam and nother anti-anxiety agents; Clomipramine (Anafranil) and SSRI's may also be used. |
|
|
Side effect of SNRIs that is not associated w/ SSRIs
|
Hypertensive effect at high doses
|
|
|
suppression
|
VOLUNTARY witholding of an idea or feeling from conscious awareness (vs. repression)
|
|
|
Trazodone
|
Desyrel
|
|
|
What are serious but rare side effects of carbamazepine
|
STEVENS JOHNSON SYNDROME
SIADH HEPATITIS |
|
|
What shoudl not be mixed iwth benzodiazapenes?
|
other CNS drugs or alcohol - would produce profound resp depression coma or death
|
|
|
Compared to SSRIs, is the half-life of Venlafaxine (along with its active metabolite, desvenlafaxine) shorter or longer?
|
SNRIs have shorter half-lives (8-15 hrs) than SSRIs, meaning that there is greater risk of withdrawal symptoms upon discontinuation.
|
|
|
How to decrease withdrawal effect of benzodiazapenes?
|
discontinue treatment gradually over several weeks or months
|
|
|
Is carbamazepine safe for pregnant women
|
NO - TERATOGENIC
|
|
|
lorazepam
|
Ativan
|
|
|
Venlafaxine
|
Effexor
|
|
|
What characterizes dependent personality disorder?
|
patients subordinate their own needs to those of others, get others to assume responsibility for major areas of their lives, lack self-confidence, and may experience emotional discomfort when left alone for more than a brief time
dependent and submissive behaviors avoid positions of responsiblity pessimism, self-doubt, passivity, low self-esteem, and fears of expressing sexual and aagressive feelings |
|
|
clonazepam
|
Klonopin
|
|
|
conduct disorder
|
repetitive and pervasive behavior violating social norms (theft, physical aggression), after 18 is antisocial
|
|
|
How is carbamazepine eliminated
|
HEPATIC ELIMINATION
|
|
|
Lithium
|
Lithonate
|
|
|
This is one of the biggest challenges of prescribing SSRI's
|
They cause sexual dysfunction
|
|
|
What is the course and prognosis of a patient with dependent personality disorder?
|
impairment in occupational functioning as patients have inability to perform independently and without close supervision
tend to suffer physical or mental abuse high risk of major depression if they lose the person they are dependent on |
|
|
What is the principal determinant of whether to prescribe an SSRI vs. an SNRI?
|
The individual patient's preference.
-subjective differences in efficacy perhaps due to genetic polymorphisms in genes encoding for serotonin receptor or CYP450 enzymes |
|
|
Divalproex sodium
|
Depakote
|
|
|
How do you treat dependent personality disorder?
|
insight-oriented psychotherapy can enable patients to understand their behaviors and with proper therapy they can learn to be more assertive
*a pitfall of treatment may appear when therapist encourages the patient to change the dynamics of a pathological relationship: patient will become anxious and unable to cooperate. Pharmacotherapy: BZP's and SSRI's |
|
|
Out of Fluoxetine, Sertraline, and Venlafaxine, which is associated w/ some drug-drug interactions?
|
Fluoxetine, due to inhibition of CYP2D6
|
|
|
propanolol
|
Inderal
|
|
|
This antidepressant is notable for its lack of sexual side effects and wt neutrality
|
Buproprion
|
|
|
Valproic Acid- Use
|
- good for rapid cyclers, mixed mania, and acute mania
- better for mania than depression |
|
|
What are the 3 Benzodiazapene-like drugs and what are they used for?
|
Zolpidem (Ambien), Zaleplon (Sonota) & Eszopiclone (Lunesta) - insomnia
|
|
|
Which drugs can decrease carbamazepine levels
|
Phenytoin
Phenobarbital |
|
|
buspirone
|
BuSpar
|
|
|
Carbamezepine
|
Tegretol
|
|
|
Do antipsychotics have a role in treating dependent personality disorder?
|
Nope
|
|
|
Higher SSRI doses than normal are needed to treat this condition
|
OCD
|
|
|
How does Zolpidem work
|
For short term management of insomnia, rapdi onset, helps people with difficulty falling asleep - no rebound insomnia
|
|
|
Which antidepressant class do the following drugs belong to?
-Fluoxetine -Amitriptyline -Buproprion -Venlafaxine -Trazadone |
-SSRI
-TCA -3rd generation -SNRI -3rd generation |
|
|
Chronic, low-grade depression
|
Dysthymia
|
|
|
Lamotrigine
|
Lamictal
|
|
|
Name drug that is possible 2nd line therapy option for acute mania and depression
|
OXCARBAZEPINE
|
|
|
What are the characteristics of avoidant personality disorder?
|
show an extreme sensitivity to rejection, which may lead to a socially withdrawn life.
go to great lengths to avoid embarrassment may have a great desire for companionship, but are very shy |
|
|
Which antidepressant class do the following drugs belong to?
-Sertraline -Desipramine -Tranylcypromine -Mirtazapine |
-SSRI
-TCA -MAOI -3rd generation |
|
|
zolpidem
|
Ambien
|
|
|
Are 3rd generation (atypical, heterocyclic) antidepressants often used in combination w/ other antidepressants?
|
Yes, especially in combination w/ SSRIs
|
|
|
Chronic, low-grade anxiety
|
GAD
|
|
|
What else is avoidant personality disorder called?
|
inferiority complex
|
|
|
Which serious side effects should you watch out for with oxcarbazepine
|
RASH AND SIADH
|
|
|
Carbamazepine/Oxcarbazepine- Use
|
- to tx acute mania, is a second or third line agent
- is not good for txing bipolar depression |
|
|
eszopiclone
|
Lunesta
|
|
|
NT changes in Depression
|
decr NE, decr 5-HT, decr DA
|
|
|
Oxcarbazepine increases metabolism of _
|
BCP's - estrogen and progesterone
|
|
|
Therapeutic effects of SSRIs and SNRIs are not apparent until 2-6 weeks after beginning therapy. How long does it take for therapeutic effects of 3rd generation antidepressants to appear?
|
Also 2-6 weeks
|
|
|
This class of antidepressants is very safe and impossible to OD on
|
SSRI
|
|
|
What is best use for Zaleplon?
|
For people who have trouble falling asleep. It is gone w/i 4-5 hours so not good for people who have trouble staying asleep.
|
|
|
What is the course and prognosis of avoidant personality disorder?
|
can function, provided they are in a protected environment
if support fails, subject to depression, anxiety, and anger |
|
|
Name adjunctive agents
|
2nd generation anti-psychotics
Benzodiazepines Novel anticonvulsants Ca channel blockers Thyroid hormone |
|
|
NT changes in Alzheimers
|
decr ACh
|
|
|
rameltem
|
Rozerem
|
|
|
What sort of phobia is common with avoidant personality disorder?
|
social phobia
|
|
|
Which side effect of SSRIs and SNRIs is rarely seen w/ 3rd generation (atypical, heterocyclic) antidepressants?
|
Sexual dysfunction (decreased libido, anorgasmia)
|
|
|
Zaleplon can be given at 3am and not effect getting up in the morning?
|
true because it is a quick acting drug and out of systme w/i 4 hours
|
|
|
diphehydramine
|
Benadryl
|
|
|
How do you treat avoidant personality disorder?
|
psychotherapy: solid alliance required
-failure may reinforce patient's poor self-esteem Pharmacotherapy: beta-blockers for autonomic nervous system hyperactivity |
|
|
Lamotrigine- MOA, Use
|
- MOA: inactivates voltage sensitive Na channels and modulates or reduces release of glutamate
- Use: minimal benefit in stablizing mania but more effective than Li for preventing depression - used as add on for tx-refractory bipolar depression - no wt gain. sedation, blood level monitoring nor cognitive dulling - but VERY slow initiation to minimize risk of rash |
|
|
NT changes in Huntingtons
|
decr GABA, decr ACh
|
|
|
What are the 1st line adjuncts which reduce anxiety, agitation and insomnia and are useful during acute treatment
|
BENZODIAZEPINES
|
|
|
3rd generation antidepressant associated w/ orthostatic hypotension and priapism (rare)?
|
Trazadone (alpha-1 antagonist)
|
|
|
methylphenidate
|
Ritalin & Concerta (sustained release)
|
|
|
Name 2 most common benzodiazepines used for treatment of BP
|
Lorazepam
Clonazepam |
|
|
NT changes in Schizophrenia
|
incr DA
|
|
|
This class of antidepressants is also very useful in treating gastric problems (abdominal pain, IBS)
|
SSRI
|
|
|
What characterizes narcissistic personality disorder?
|
heightened sense of self-importance and grandiose feelings that they are unique.
arrogance, haughtiness, lack of empathy handle criticism poorly or are indifferent prone to depression |
|
|
Mechanism of action of Buproprion
|
Blocks DAT (dopamine reuptake), NET, and SERT
|
|
|
Name anticonvulsants used for treatment of BP
|
Lamotrigine
Gabapentin Topiramate |
|
|
NT changes in Parkinson's
|
decr DA, incr ACh
|
|
|
This class of antidepressants is used to treat autistic rigidity
|
SSRI
|
|
|
What is the course and prognosis of narcissistic personality disorder?
|
chronic and difficult to treat
aging is poorly handled more vulnerable to mid-life crises than are other groups |
|
|
Which benzodiazepine-like drug is approved for long-term insomnia?
|
Exzopiclone - (Lunesta)
|
|
|
3rd generation antidepressant used in smoking cessation
|
Buproprion
|
|
|
dextroamphetamine
|
Dexedrin
|
|
|
How do you treat narcissistic personality disorder?
|
treatment is difficult
pharmacotherapy: lithium, antidepressants |
|
|
This SSRI has relatively greater anti-ACh and NE activity
|
Paroxetine (Paxil)
|
|
|
Which anticonvulsant has FDA indication for maintenance therapy for bipolar, particularly good for Bipolar II with mainly depressive episodes
|
LAMOTRIGINE
|
|
|
Which drug is most associated w/ sig wt gain? What class does this drug belong to?
|
- olanzapine
- benzodiazepines- SGA |
|
|
Which hypnotic drug to help iwth insomnia is not regualted as a controlled substance?
|
Ramelteon a melatonia agonist (Rozerem)
|
|
|
1) too little ____ causes schizophrenia
2) too little ____ causes OCD 3) too little _____ causes parkinson's 4) too little ______ causes seizures 5) too little ____ causes Alzheimer's 6) too much _____ causes chorea 7) too much ______ causes sleep 8) too much _____ causes seizures 9) too much _______ causes CNS depression 10) too much ______ causes delirium |
1) glutamate
2) Serotonin 3) Dopamine 4) GABA 5) Acetylcholine 6) Dopamine 7) Serotonin 8) Glutamate 9) GABA 10) Acetylcholine |
|
|
About 4% of patients taking Buproprion exhibit this serious side effect?
|
Seizure(s)
|
|
|
c- & l- amphetamine
|
Adderall
|
|
|
delerium
|
waxing and waning levels of consciousness, acute changes in MS, hallucinations (visual), illusions; most common psych illness on med and surg floors; abn EEG
|
|
|
How does ramelteon work?
|
Rapid onset - about 30 mintues and short duration - used to help fall asleep - no side effects or rebound insomnia - approved for indefinate use
|
|
|
What characterizes histrionic personality disorder?
|
colorful, dramatic,extroverted behavior in excitable, emotional persons
inability to maintain deep, long-lasting attachments exaggerate, making everything sound more important display temper tantrums, tears, and accusations if they are not the center of attention seductive behavior, coy, flirtatious overly trusting and gullible |
|
|
Which drug decreases clearance of lamotrigine
|
VPA
|
|
|
Blocks presynaptic inhibitory autoreceptors: alpha-2 and 5-HT1A
|
Mirtazapine
|
|
|
Clonazepam and lorazepam- Use, MOA
|
MOA: enhance GABA activity and calms the overexcited brain
Use: alleviate agitation and insomnia w/ mania and hypomania. Also improve sleep so facilitate recovery. NOT for core sx and do NOT prevent relapses - Should NOT be used for greater than 1 mo |
|
|
illusion
|
misinterpretation of actual external stimuli
|
|
|
modafinil
|
Provigil, Sparlong
|
|
|
These novel antidepressants are used in refractory cases of depression
|
Buproprion, venlafaxine, duloxetine
|
|
|
What is the course and prognosis for histrionic personality disorder?
|
Tend to show defenses of repression and dissociation
get into trouble with the law, abuse substances, and act promiscously show fewer symptoms with age |
|
|
Which anticonvulsant can lead to Stevens Johnson syndrome
|
LAMOTRIGINE
|
|
|
clozapine
|
Clozaril
|
|
|
delusions
|
false beliefs not shared with others in the culture and that are firmly maintained in spite of obvious proof to the contrary
|
|
|
How do you treat histrionic personality disorder?
|
psychotherapy: clarification of their inner feelings; TOC group or individual therapy
pharmacotherapy: adjunctive to treat depression and somatic complaints with antidepressants, anti-anxieties, and antipsychotics (for derealizations and illusions) |
|
|
This drug is also used to treat drug cravings
|
Buproprion
|
|
|
What is melatonin classified as?
|
A hormone
|
|
|
Which 3rd generation antidepressant has anticholinergic effects?
|
Mirtazapine (muscarinic antagonist)
|
|
|
olanzapine
|
Zyprexa
|
|
|
This drug is used to treat depression without anxiety
|
Buproprion
|
|
|
Trazadone, Mirtazapine, or Both?
-SERT blocker -alpha-2 and 5-HT1A antagonist -alpha-1 antagonist -muscarinic antagonist -5-HT2 antagonist -5-HT3 antagonist |
-Trazadone
-Mirtazapine -Both -Mirtazapine -Both -Mirtazapine |
|
|
What characterizes antisocial personality disorder?
|
continual antisocial or criminal acts
inability to conform to social norms lying, truancy, running away from home, thefts, fights, substance abuse and other illegal activities impress clinicians with charm and seductive aspects |
|
|
risperidone
|
Risperdal
|
|
|
This antidepressant is not effective against anxiety
|
Buproprion
|
|
|
True or False: Antisocial PD patients show exaggerated anxiety and depression that may seem grossly incongruous with their situations.
|
False: they show a lack of anxiety and depression
|
|
|
Which 2 3rd generation antidepressants are highly sedating?
|
-Trazadone
-Mirtazapine |
|
|
Which antidepressants have lower risk of precipitating a hypomanic/manic episode?
When switching antidepressants what steps should you take to reduce mania? |
- SSRIs and buppropion(NDRI) are better than TCAs
- TCAs are well documented to be really bad for bipolar pts - should make sure pt is on mood stabilizing drug |
|
|
aripiprazole
|
Abilify
|
|
|
Mechanism of action of TCAs
|
Block SERT (serotonin reuptake) and NET (norepinephrine reuptake)
|
|
|
This novel antidepressant is also used in the treatment of ADHD
|
Buproprion
|
|
|
True or False: Antisocial PD patients have a heightened sense of reality testing.
|
True
|
|
|
Can you trust a patient with antisocial personality disorder?
|
Better not. They do not tell the truth and appear to have a lack of conscience.
|
|
|
chlorpromazine
|
Thorazine
|
|
|
Schizophrenia diagnosis
|
requires 2 of the following: delusions, hallucinations (auditory), disorganized speech, disorg/catatonic behavior, negative symptoms (flat affect, social withdrawal, lack of motivation); greater than 6 months
|
|
|
These novel antidepressants are used for sleep enhancement, and like bupropion they are wt neutral and have no sexual side effects
|
Nefazodone, trazodone
|
|
|
What are some withdrawal reactions to CNS depressants?
|
weakness, restlessness, insomnia, hyperthermia, orthostatic hypotension, confusion, disorietaiont. by 3rd day majoy convulsive episodes - 75% experience psychotic delirium happens over 8 days
|
|
|
brief psychotic disorder
|
less than 1 month, usually stress related
|
|
|
haloperidol
|
Haldol
|
|
|
How does a patient's brain with antisocial personality disorder differ from normal?
|
11% reduction in grey matter of the frontal lobe
|
|
|
These are the uses of SNRI's
|
Refractive cases of depression and anxiety
|
|
|
schizophreniform
|
schizo signs but from 1-6 months
|
|
|
This antidepressant is notable because it self-tapers (due to its long t1/2); i.e., other drugs of its class must be gradually stopped, whereas this drug can be stopped "cold turkey"
|
Fluoxetine
|
|
|
What are "soft neurological signs?"
|
EEG changes suggestive of minimal brain damage in childhood
|
|
|
Do TCAs have a low or high therapeutic index?
|
Low, due to risk of arrhythmias associated w/ overdose.
-use caution when prescribing TCAs to potentially suicidal pts |
|
|
schizoaffective disorder
|
at least 2 weeks of stable mood with psychotic symptoms plus a major depressive, mani or mixed episode
|
|
|
This novel antidepressant is used mainly for sleep enhancement
|
Mirtazapine
|
|
|
What is the diagnostic criteria for antisocial personality disorder?
|
Three of more of the following:
Failure to conform to social norms (multiple arrests) Deceitfulness (multiple lies) Impulsivity and failure to plan ahead Irritability and aggressiveness (repeated fights or assults) Reckless disregard for safety of self or others Consistent irresponsiblity (can't keep a job) Lack of remorse *Must not occur exclusively during an episode of schizophrenia or a manic episode |
|
|
delusional disorder
|
fixed, peristent nonbizarre belief system lasting >1 month, functioning otherwise not impaired
|
|
|
Major effects of antagonism of given receptor by TCAs:
-alpha-1 adrenergic -H1 histamine -muscarinic |
-orthostatic hypotension
-increased appetite, weight gain -dry mouth, constipation, impotence, sedation |
|
|
This antidepressant is notable for having a very long half-life
|
Fluoxetine
|
|
|
What is the course and prognosis of antisocial personality disorder?
|
once developed, it runs an unremitting course with the height of antisocial behaviors occurring in late adolescence
prognosis is variable depression, alcohol and drug abuse common |
|
|
diagnosis of manic
|
period of at least a week, requires 3 or more: distractibility, irresponsibility, grandiosity, flight of ideas, incr in goal directed activity/pscyhomotor agitation, decr need for sleep, talkativeness
|
|
|
How do you treat antisocial personality disorder?
|
Psychotherapy: if immobilized, they are amenable
Pharmacotherapy: psychostimulants (ADHD), antiepileptics (impulsivity) |
|
|
Metabolism of TCAs
|
-CYP450 (esp. CYP2D6) followed by glucuronidation and renal excretion
|
|
|
rules for sleep fitness
|
establish regular time to go to bed and wake up, sleep only as long as needed, insulate bedroom from noise and light, keep temp moderate - high temp disturb sleep., avoid naps, avoid caffeine, avoid alcohol, tobacco and fluids in evening, light snack before bed, leave problems behind,
|
|
|
cyclothymic disorder
|
milder form of bipolar, lasts at least 2 years
|
|
|
How does half-life of TCAs compare to half-life of SNRIs (8-15 hrs)?
|
TCAs have longer half-life (usually >24 hrs), as do their active metabolites
|
|
|
Mechanism of benzodiazepines
|
GABA agonist
|
|
|
What are psychologic s/s of anxiety?
|
fear, apprehension, dread and uneasiness
|
|
|
What characterizes borderline personality disorder?
|
extraordinary unstable affect, mood, behavior, object relations, and self-image.
always in a state of crisis unpredictable behavior self-destructive acts |
|
|
Benzodiazepines are used mainly to treat this class of disorders
|
Anxiety
|
|
|
major depressive episode
|
5 of SIGECAPS along with depressed mood or anhedonia for 2 weeks
|
|
|
What are physiologic s/s of anxiety?
|
tachycardia, palpitations, trembling, dry mouth, sweating, weakness, fatigue & SOB
|
|
|
What are risk factors for borderline personality disorder?
|
abandonment issues in childhood or adolescence, sexual abuse, disrupted family life, and poor communication within the family
|
|
|
major depressive disorder
|
2 or more major depressive episodes with a symptom free interval of 2 months
|
|
|
What are the classes of anxiety disorders?
|
generalized anxiety, panic disorder, obsessive-compulsive disorder, phobic disorder, post-traumatic disorder, & acute stress disorder usually occompanied with depression
|
|
|
What is the course and prognosis for borderline personality disorder?
|
fairly stable and shows little change over time; treatment resistant!
major depression usually present (suicide risk 3-9%) |
|
|
dysthymia
|
milder form of depression, lasting 2 years
|
|
|
How do you treat borderline personality disorder?
|
Psychotherapy: treatment of choice
Pharmacotherapy: antipsychotics (anger, hostility), antidepressants, antianxiety, anticonvulsants |
|
|
This class of drugs replaced barbiturates because of safety issues
|
Benzodiazepines
|
|
|
important screening question about sleep in depression
|
early morning awakenings
|
|
|
These are the benzodiazepines
|
Diazepam, chlordiazepoxide, lorazepam, alprazolam, clonazepam, temazepam
|
|
|
Which 2 classes of antidepressants are preferred treatment options for "Atypical" Depression (mood reactivity, reverse vegetative symptoms--weight gain, increased appetite, hypersomnia, leaden paralysis)?
|
-SSRIs
-MAOIs |
|
|
Main reason that MAOIs are only considered 3rd-line treatment for Major Depression
|
Dangerous drug & food interactions
|
|
|
suicide
|
women try more often, men succeed more often
|
|
|
These are the non-benzodiazepine benzodiazepine receptor agonists
|
Zolpidem, zalaplon, eszopiclone
|
|
|
What is generalized Anxiety Disorder
|
unrealistic or excessive anxiety about several events or activiites that last 6 months or longer, includes reslessness, fatigue, sleeplessness, diff concentrating, muscle tension, irritability
|
|
|
OCD pts have incr activity where
|
in caudate and prefrontal cortex
|
|
|
Patient taking SSRIs experiences hyperthermia, muscle rigidity, myoclonus, akathisia, hyperreflexia, fluctuating vital signs & mental status.
-what do these symptoms indicate? -is this patient probably taking SSRIs only? |
-"Serotonin Syndrome" resulting from SSRI overdose
-Patient is likely on combination therapy of SSRIs + another antidepressant, probably an MAOI |
|
|
These are the TCA's
|
Amitriptyline, imipramine, nortriptyline, desipramine
|
|
|
What is Buspirone (BuSpar)
|
An anxiolytic drug - not a CNS depressant, good as no abuse potential, doe snot intesify effect of CNS depressants like alcohol - acts slowly response takes weeks to develope
|
|
|
generalized anxiety disorder
|
uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event
|
|
|
These are the MAOI's
|
Phenelzine, tranylcypromine
|
|
|
adjustment disorder
|
emotional symptoms causing impairment following an identifiable psychosocial stressor, < 6 months
|
|
|
These are the SSRI's
|
Fluoxetine, sertraline, citalopram, fluvoxamine, paroxetine
|
|
|
Is there much evidence of drug abuse w/ antidepressants?
|
No
|
|
|
somatoform disorders
|
characterized by physical symptoms with no identifiable physical cause, symptoms not intentionall produced (unconscious), more common in women
|
|
|
These are the SNRI's
|
Venlafaxine, duloxetine
|
|
|
What 4 SSRI's are approved for anxiety?
|
Venafaxine (Effexor XR), Paroxetine (Paxil), Escitalpram (lexapro) & Duloxetine (Cymbalta)
|
|
|
Is there any evidence of tolerance to therapeutic effects of antidepressants?
|
No
|
|
|
somatitization disorder
|
variety of complaints in mult organ systems over a period of years
|
|
|
These are the novel antidepressants
|
Buproprion, nefazodone, trazodone, mirtazapine
|
|
|
conversion
|
motor or sensory symptoms (paralysis, blindness, etc), often following an acute stressor
|
|
|
These are the therapeutic effects of benzodiazepines
|
Anxiety, depression (with incremental effects), hypnotic, muscle relaxant, anti-convulsant
|
|
|
Which side effect of TCAs does not diminish over time?
|
Cardiac toxicity
-just like sexual dysfunction due to SSRIs and SNRIs |
|
|
cluster A personality disorders
|
odd or eccentric, inability to develop meaningful social relationships, no psychosis; includes paranoid, schizoid and schizotypal
|
|
|
These drugs carry the risk of dependency
|
Benzodiazepines
|
|
|
When see panic attacks?
|
onset late teens or ealry 20's, more women than men, often agoraphobia accompanies panic attacks, being in situation where escape is difficult - crowds, elevators
|
|
|
schizoid
|
voluntary social withdrawal, limited emotional expression, content with social isolation, cold, fear closeness
|
|
|
Sympathomimetics, SSRIs, SNRIs, TCAs, Trazodone, Meperidine, Dextromethorphan, and Tyramine all may exhibit drug-drug interactions w/ which class of antidepressants?
|
MAOIs, b/c MAO is (at least partly) responsible for detoxification of these drugs
|
|
|
This drug is the classic barbiturate
|
Phenobarbital
|
|
|
What characterizes ADHD?
|
a developmentally inappropriate poor attention span or age-inappropriate features of hyperactivity and impulsivity
|
|
|
All antidepressants require how long for complete clinical effect?
|
2-6 weeks
|
|
|
cluster B personality disorders
|
dramatic, emotional or erratic; includes antisocial, borderline, histiotronic and narcissistic
|
|
|
How do you diagnose ADHD?
|
disorder must:
have at least six inattentive symptoms or 6 activity and impulsitivity problems be present for a least 6 months cause impairment in social and academic functioning occur before the age of 7 occur in two or more settings not be caused by any other problem |
|
|
This alternative to benzodiazepines does not carry the risk of dependency
|
Buspirone
|
|
|
What drugs treat panic disorders?
|
SSRI, tricyclic antidepressants and MAO inhibitors - take 6-12 weeks to see full benefits, SSRI perfered and tolerated better
|
|
|
"5 Ds" to consider if antidepressant therapy is not effective
|
-Dose adjustment
-Duration 2-6 weeks -Diagnosis validity -Drugs need to be added (adjunct or another antidepressant) -Different therapies (psychotherapy, ECT, TMS, VNS) |
|
|
antisocial
|
disregard for and violation of rights of others, M>F
|
|
|
What are the three types of ADHD?
|
Predominately inattentive
Predominately Hyperactive-Impulsive Type Combined Type |
|
|
borderline
|
unstable mood and interpersonal releationships, sense of emptiness, F>M, splitting is major defense mechanism
|
|
|
Do ADHD patients show abnormal CNS damage, neurophysiological, or neurochemical abnormalities?
|
None of them.
|
|
|
How are benzodiazapines effective with panic attacks
|
Good initial drug as works instantly take while SSRIs taking effect which can take up to 6-12 weeks to work
|
|
|
This anxiolytic has no sedative, muscle relaxant or anticonvulsant effects
|
Buspirone
|
|
|
histiotronic
|
excessive emotinality and excitability, attention seeking, sexually provacative, unable to maintain relationships for long
|
|
|
This anxiolytic is not a CNS depressant
|
Buspirone
|
|
|
True or False: Siblings have twice the risk of the ADHD than the general population.
|
True.
|
|
|
What are characteristics of OCD?
|
Obsession: recurrent perissten thoguth, impulse or mental image that is unwanted and distressing. Compulsion: ritualized behavior or mental act that he pt is driven to perform
|
|
|
Why should physicians use caution when prescribing antidepressants for youth?
|
Should still prescribe but monitor for worsening depression and suicidal ideation
|
|
|
Bipolar disorders
-typical age of onset? -risk of women vs. men? -tendency to recur? -co-morbid w/ anxiety, substance dependence? -genetic linkage? -risk of suicide? |
-Onset usually in adolescence
-Equal risk among men and women -Highly recurrent -Often co-morbid w/ anxiety and substance dependence -Cause unknown but genetic linkage established -High risk of suicide (15%) |
|
|
narcissistic
|
grandiosity, sense of entitlement, lacks empathy, requires excessive admiration
|
|
|
These drugs are used to treat mania (bipolar disorder)
|
Lithium; AED's (divalproex, carbamazepine, lamotrigine, oxcarbazepine); antidepressants (SSRI's, MOAI's, buproprion); benzodiazepines; antipsychotics; CEB's
|
|
|
True or False: Evidence has implicated norepinephrine as the single neurotransmitter responsible for ADHD.
|
False: No clear cut evidence implicates a single neurotransmitter.
|
|
|
Characteristics of panic attacks?
|
palpitations, chest pain, SOB, feeling like choking, dizziness, nausea, derealization, feeling like losing control, dear of dying tingling of hands, flushes or chills - dissipate w/i 30 minutes
|
|
|
cluster C personality disorders
|
anxious or fearful, include avoidant, obsessive-compulsive, dependent
|
|
|
How many settings must ADHD be present in for diagnosis?
|
2 settings
|
|
|
Mechanism of AED's
|
GABA agonist, glutamate antagonist, membrane stabilizer, affect ion channels
|
|
|
What is the goal of treatment in acute manic emergencies?
|
Sedation
-antipsychotics (Olanzapine) -benzodiazepines -anticonvulsants (Sodium Valproate, Lamotrigine) -Lithium (not super-helpful acutely) |
|
|
avoidant
|
hypersensitive to rejection, socailly inhibited, feelings of inadequacy, desires relationships with others
|
|
|
Drug of choice for maintenance in pts w/ Bipolar Disorder
|
Lithium, often in combination w/ "mood stabilizers" (anticonvulsants, atypical antipsychotics)
|
|
|
This class of drugs is especially good for mixed states and rapid cycling in BPAD
|
AED's
|
|
|
What comorbid conditions may occur with ADHD?
|
depression
anxiety conduct disorder learning disabilities |
|
|
How to treat panic attacks?
|
Cognitive behavior therpy and medications, avoid caffiene and sympathomimetics, sleep deprivation and yes to exercise. Drug therapy for 6-9 months at least
|
|
|
obessive complulsive personality disorder
|
preoccupation with order, perfectionism and control; dehavior consistent with one's own beliefs and attitudes
|
|
|
This class of drugs is good for treatment of acute mania
|
AED's
|
|
|
What is the first choice of treatment for treating ADHD?
|
CNS Stimulants: methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert)
|
|
|
What is the risk of prescribing antidepressants to pts w/ Bipolar Disorder?
|
Might induce a manic or hypomanic episode
|
|
|
dependent
|
submissive and clingy, excessive need to be taken care of
|
|
|
Side effects of _____ include tremor (common), sedation, GI problems, edema (due to increased aldosterone), mild hypothyroidism, nephrogenic diabetes insipidus, polydipsia, polyuria, and skin problems (acne, psoriasis).
|
Lithium
|
|
|
This class of drugs can cause blood counts to go up
|
AED's
|
|
|
What are the side effect of stimulant treatments for ADHD in children?
|
Stomach ache, headache, nausea, and insomnia
Ritalin may cause growth suppression May exacerbate tic disorders |
|
|
What drugs treat panic disorders?
|
SSRI, tricyclic antidepressants and MAO inhibitors - take 6-12 weeks to see full benefits, SSRI perfered and tolerated better
|
|
|
Characteristics of OCD
|
Obsession rfecurrent peristent thought, impulse or mental image that is unwanted or distressing, Compulsion: ritualized behavior or mental act that the patient is driven to perform
|
|
|
Does Lithium have a high or low therapeutic index?
|
Low, risk of overdose (toxicity = >2 mEq/L) even w/ normal therapy (due to changes in renal clearance; 80% filtered in kidney is reabsorbed)
|
|
|
Side effects of AED's
|
Hepatocellular damage, blood dyscrasia, rash, risks during pregnancies
|
|
|
What antidepressants can be used in children with ADHD? What is the blackbox warning?
|
imipramine (Tofranil), desipramine (Norpramine), and nortriptyline (Pamelor) have been used with some success.
Black box warning: sudden death with children being treated with desipramine (Norpramine) -- a TCA that inhibits reuptake of norepinephrine |
|
|
substance abuse vs. dependence
|
abuse is less severe than tolerence
|
|
|
These two NT's play a significant role in ADHD
|
DA, NE
|
|
|
What drugs are used to treat OCD?
|
SSRI's first line. Fluoxetine (Prozac), Sertraline (Zoloft), Fluvoxamine (Luvox) & paroxetine (Paxil), then citaloprm (Celexa) & escitalopram (Lexapro)
|
|
|
When is clonidine most useful in treating children with ADHD?
|
ADHD with a tic disorder
|
|
|
Possible pathogenesis of ADHD
|
DA depletion due to increased DA output and increased DA receptor expression; DA suppresses irrelevant signals while NE enhances relevant signals
|
|
|
substance abuse
|
failure to fullfill major obligations, physically hazardous situations, legal probelms, continued use despite all this
|
|
|
What is the only non-stimulant medication approved by the FDA for ADHD? What is the benefit of this drug?
|
Strattera
Low abuse potential |
|
|
In addition to Lithium, _____ are becoming 1st-line for treating Bipolar II.
|
Anticonvulsants
|
|
|
substance dependence
|
3 or more of the 7 signs in 1 year: tolerence, wthdrawal, taken in larger amounts than desired, unsuccessful in cutting down, significant energy spent acquiring it, activities reduced, continued use in spite of all that
|
|
|
These drugs are used to treat ADHD
|
Stimulants (methylphenidate, amphetamine), non-stimulants (atomoxetine), off-label (TCA's, buproprion, venlafaxine, clonidine, guanfacine)
|
|
|
Social Anxiety Disorder Characteristics
|
intenese, irrational fear of situations in which may be scrutinized by others or might do something embarrassing or humilitating
|
|
|
This drug is an alpha-2 adrenergic agonist used to treat ADHD off-label
|
Clonidine
|
|
|
2 "mood stablilizers" are Valproic Acid (Sodium Valproate) and Lamotrigine.
-which has significant anti-depressant activity? -which is assoc. w/ serious rash as side effect? |
-Lamotrigine
-Lamotrigine |
|
|
How to treat social anxiety disorder
|
psychotherapy cognitive an behavioral shown just as effective as meds or can use SSIR fluvoxamine (Luvox) paroxetine (Paxil) & sertraline (Zoloft)
|
|
|
Atypical antipsychotic that may be as effective as Lithium in treating Bipolar I
|
Olanzapine
|
|
|
These are the limitations of lithium in treating bipolar disorder
|
Slow onset (7-10 d), up to 50% do not respond adequately, narrow therapeutic index (requires monitoring), high long-term failure rate
|
|
|
What is post-traumtic Stress Disorder?
|
develops after traumatice event adn eicited an immediate reaction of fear, helplesness, or horror, 3 components: re-experiencing the event, avoidig reminders of event & persistant state of hyperarousal
|
|
|
PTSD can affect witnesses as well as those associted with traumatic event T or F
|
True
|
|
|
What events can precipitate PTSD?
|
physical or sexual assult, rpae, torture, combat industrial explosions, serous accidetns, natural disasters, being taken hostage, displacement as a refugee and terrorist attacks
|
|
|
What is incidence of PTSD?
|
40% combat soldiers, rape 45% of women and 65% of men
|
|
|
3 drugs susceptible to interaction w/ Li
|
-Na+-depleting diuretics (ionic balance in blood b/t Li+ and Na+)
-ACE inhibitors -NSAIDs |
|
|
How to treat PTSD?
|
opitmal treatment not established. Only one therapy worked exposure therapy - repeated reimagine events to help make events lose their power
|
|
|
What is the action of amphetamines?
|
CNS stimulant, promote release of norepi and dopamine & prevent reuptake of these transmittors - most effect is release of NE
|
|
|
What is the pharmocologic effects of amphetamines?
|
increase wakefulness, mood and arousal, elevate mood adn augment self confidence. Increase HR
|
|
|
Do amphetamines cause a depdendance?
|
yes - must withdraw slowly
|
|
|
schizotypal
|
eccentric appearence, off beliefs or magical thinking, interpersonal akwardness
|
|
|
What are therapeutic effects of amphetamines?
|
ADHD, narcolepsy, obesity
|
|
|
ideas of reference
|
disorder of thought content; false convictions that one is the subject of attention by other people or the media
|
|
|
neuroleptic malignant syndrome
|
can occur in pts taking typical antipsychotics; rigidity, myoglobinuria, autonomic instability, fever; treat with dantrolene, bromocriptine
|
|
|
What is anorexia nervosa?
|
an eating disorder in which a person refuses to stay at even the minimum body weight considered normal for their age and height
|
|
|
What group of people are more likely to have anorexia nervosa?
|
Caucasian women who are high academic achievers and have a goal-oriented family or personality.
|
|
|
What are the symptoms of anorexia nervosa? (need to know)
|
-weight loss of 15% or greater below the expected weight (body weight less than 85% of expected weight)
-inappropriate use of laxatives, enemas, or diuretics to lose weight -self-imposed food intake restrictions -amenorrhea, skeletal muscle atrophy, loss of fatty tissue, low blood pressure, blotchy or yellow skin, depression |
|
|
What are the subtypes of anorexia nervosa?
|
1. restricting type: restricts intake
2. Binge Eating-Puring Type: engages in binge eating or purging through self-induced vomiting or the use of laxatives or diuretics |
|
|
What biochemical changes result from starvation?
|
hypercortisolemia, thyroid function suppression, lowered hormonal levels of LH, FSH, and gonadotropin-releasing hormone (amenorrhea)
|
|
|
What is Modafinil (Provigil) used for ?
|
promoting wakefullnes, for narcolepsy, shift-work sleep disorders and obstructive sleep apnea
|
|
|
What EKG changes do you see on a patient with anorexia nervosa?
|
Flat or inverted T-waves
ST segment depression Prolonged QT |
|
|
When is ADHD seen?
|
2 to 3 times more prevelant in boys, manifests in ages 3 to 7, persists into teens and adulthood
|
|
|
What are charcteristics of ADHD?
|
inattention, hyperactivity and impulsivity, fidgety, unable to concentrate or wait their turn, call out excessively in class, never completes tasks, switch from one actitivy to another
|
|
|
What imbalance often causes the death of anorexia nervosa patients?
|
hypokalemia
|
|
|
What is needed for diagnosis of ADHD?
|
s/s need to be present before age 7 and be present for at least 6 months
|
|
|
When is an anorexic patient recommended for hospitalization? When are they required psychiatric hospitalization?
|
20% below expected weight;
30% below expected weight -can range from 2-6 months |
|
|
What medications can be used in the treatment of anorexia nervosa?
|
Cyproheptadine (Periactin) - antihistamine properties
Amitriptyline (Elavil) Fluoxetine (Prozac) ECT for patients with MDD Megace |
|
|
What medications is FDA approved to treat anorexia and cachexia?
|
Megace, a synthetic derivative of the naturally occurring steroid hormone, progesterone
|
|
|
What is bulimia?
|
Binge eating and purging, laxative use, or diuretic use, fasting, or excessive exercise
|
|
|
What dexmethylphenidates are used for ADHD
|
Focalin & Focalin XR - short duration
|
|
|
What is the big difference between bulimia nervosa and anorexia nervosa?
|
those with bulimia maintain a normal body weight
|
|
|
According to the DSM-IV, how long must the binge eating and compensatory behaviors of bulimia occur?
|
an average of at least twice a week for three months
|
|
|
True or False: Many people with bulimia may also suffer from anorexia.
|
True
|
|
|
What amphetamine mixuture is used for ADHD?
|
Adderall twice daily 5 mg in am then 5 hours later & Adderall XR - 20 mg in am once daily
|
|
|
True or False: Anorexia has a better prognosis than bulimia.
|
False: Bulimia has a better prognosis.
|
|
|
How do you treat bulimia?
|
Cognitive-behavioral therapy, group therapy, family therapy, and psychopharmacology.
Pharmacotherapy: antidepressants (reduce binge eating and purging) are successful in the same doss as those used to treat depression. |
|
|
Name the nonstimulant med used for ADHD?
|
Strattera - once or twice daily = 80 once or 40 twice a day
|
|
|
How do stimulants work to reduce impulsiveness and hyperactivity?
|
They do not suppress rowdy behavior, but improve attention and focus. Impulsivness and hyperactivity decrease as child can concentrate on task at hand. Do no increase positive behavior, but decrease negative behavior - these must be learned
|
|
|
What is the number 1 eating disorder in adolescents and children?
|
Obesity
|
|
|
What ADHD drug is approved for use in adults?
|
Strattera (Atomoxetine) - no potential for abuse - takes 1-3 weeks for initial response to meds
|
|
|
What are anti-psychotic drugs used for ?
|
schizophrenia, delusional disorders, bipolar disorder, depressive psychoses and drug induce psychoses. Suppress emesis and to treat Tourettes syndroma dn Huntington's chorea
|
|
|
What are subutramine (Meridia) and orlistat (Xenical)?
|
Prescription weight loss drugs.
|
|
|
What is anxiety?
|
Feeling of apprehension caused by anticipation of danger, which may be internal or external.
|
|
|
How to FGA antipsychotics work?
|
block receptors for dopamine in CNS
|
|
|
What is fear?
|
Anxiety caused by consciously recognized and realistic danger.
|
|
|
What is panic?
|
An acute, episodic, intense attack of anxiety associated with overwhelming feelings of dread and autonomic discharge.
|
|
|
What is schizophrenia?
|
disordered thinking and a reduced ability to compreheand reality, hallucinatione, delucsions, agitation, paronia, social and emotional withdrawal, lack of motivation, poor insight, poor self care
|
|
|
Anxiety has what 2 components?
|
1) The self-awareness of the physiological sensations
2) The self awareness of being nervous or frightened. |
|
|
What is common side effects of FGAs?
|
extrapyrimirdal effects - seroius movement disorders
|
|
|
When does anxiety become a disorder?
|
When it becomes an excessive irrational dread of everyday situations
|
|
|
Is anxiety disorder more common in men or women?
|
Women
|
|
|
What are adverse effects of FGA's
|
extrapyramidal sypmtoms, acute dystonia, parkinsonism, akathisia: pacing & squirming - need to be in motion, tardive dyskinesia (smacking of lips, movemetn of eyes, or movement of face - involuntary - permanent)
|
|
|
What is the fear pathway?
|
Thalamus sends direct info to the amygdala which blasts out alarm to brainstem & strengthens memory for event
|
|
|
According to the DSM-IV, what are the characteristics of generalized anxiety disorders?
|
-Excessive worry and anxiety, occurring more days than not for at least 6 months, about a number of events or activities
-Person finds it difficult to control the worry. -Focus of worry is not confined to features of an Axis 1 disorder. -Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. -Disturbance is not due to the direct physiological effects of a substance or a general medical condition. |
|
|
What are dangerous side effects of SGA's
|
weight gain, diabetes, and dylipidemia
|
|
|
What is the diagnostic criteria for generalized anxiety disorder?
|
-Anxiety and worry are associated with three or more of the following six symptoms
1) restlessness or feeling keyed up or on edge 2) being easily fatigued 3) difficulty concentrating or mind going blank 4) irritability 5) muscle tension 6) sleep disturbance |
|
|
How long must you have generalized anxiety disorder for diagnosis?
|
6 months
|
|
|
Is panic disorder a codable disorder?
|
No
|
|
|
SGAs have lower risk of extrapryrimidal effecte T or F
|
true
|
|
|
What is the diagnostic criteria for panic disorder?
|
A discrete peroid of intense fear or discomfort, in which FOUR or more of the following symptoms developed abruptly and reached a peak within 10 minutes:
1. palpitations, pounding heart, or accelerated heart rate 2. sweating 3. trembling and shaking 4. sensations of shortness of breathe or smothering 5. feeling of choking 6. chest pain or discomfort 7. nausea or abdominal distress 8. feeling dizzy, unsteady, lightheaded, or faint 9. derealization and depersonalization 10. fear of losing control or going crazy 11. fear of dying 12. paresthesieas 13. chills or hot flushes -individuals must suffer recurrent panic attacks |
|
|
Which SGA is used in children
|
Risperidone - helps reduce irritabityi associated sympoms, such as tantrusm, aggression, mood swings, adn self injury
|
|
|
Name the atypical antipsychotics
|
Risperiodone, Paliperidone, olanzapine, quetiapine, ziprasidone, aripiprazole
|
|
|
True or False: Mitral valvulopathy and panic disorder often are comorbid conditions.
|
True.
|
|
|
What other disorders have similar symptoms as panic disorder?
|
Mitral Valve Prolapse
Paroxysmal Atrial Tachycardia Partial Seizures |
|
|
What neurotransmitter seems to be implicated in panic attacks?
|
Norepinephrine
|
|
|
What are phobias?
|
an irrational fear resulting in a conscious avoidance of the feared object, activity, or situation.
|
|
|
What is the most common mental disorder in the United States?
|
Phobias
|
|
|
What are the most feared objects and situations in specific phobias? (list in descending order)
|
Animals
Storms Heights Illness Injury Death |
|
|
What is social anxiety disorder?
|
persistent fear of showing anxiety symptoms when exposed to unfamiliar situations or people and potential scrutiny, which result in humiliation and avoidance
|
|
|
What is the typical age group for the onset of social anxiety disorder?
|
11-19 years
|
|
|
What is the difference between shyness (and performance anxiety) and social anxiety disorder?
|
Social Anxiety Disorder:
greater severity and pervasiveness greater resultant distress and impairment |
|
|
How do you treat social anxiety disorder?
|
Beta-Blockers
BZP SSRI's SNRI's TCA's Cognitive Behavior Therapy |
|
|
What do you need to be careful with when using beta-blockers?
|
precautions with asthma, IDDM, CHF, hyperthyroidism, PVD, and persistant angina
|
|
|
How does OCD differ from addictive behavior?
|
OCD patients do no want to actively perform compulsive tasks and experience no pleasure from doing so.
|
|
|
How is OCD different from obsessive compulsive personality disorder?
|
OC personality disorder patients are acceptable of their obsessions and compulsions.
OCD sufferers experience anguish because of it. |
|
|
What neurotransmitter plays a part of OCD?
|
serotonin
|
|
|
What characterizes OCD?
|
obsessions or compulsions
last at least an hour/day interfere with normal social and occupational function |
|
|
What are obsessions?
|
are experienced internally and are subjective. It is a recurrent and intrusive thought, feeling, idea, or sensation.
|
|
|
What are compulsions?
|
conscious standardized mental act or behaviors such as counting, checking, or avoiding.
|
|
|
Obsessions (increase/decrease) anxiety. Carrying out compulsions (incease/decrease) a person's anxiety.
|
Obsessions INCREASE anxiety.
Carrying out compulsions DECREASE anxiety. *Failure to carry out a compulsion will increase anxiety. |
|
|
What are tics?
|
Tics are involuntary, sudden, rapid, recurrent, non-rhythymic, sterotyped motor movements or vocalizations.
|
|
|
What are the four tic disorders?
|
1. Tourette's Disorder
2. Chronic Motor or Vocal Tic Disorder 3. Transient Tic Disorder 4. Tic Disorder, NOS |
|
|
What is the diagnostic criteria for Tourette's Syndrome?
|
a person exhibits both multiple motor and one or more vocal tics over the period of a year, with no more than three consecutive tic-free months.
-the onset must have occurred before the age of 18 and cannot be attrbuted to the "direct physiological effects of a substance or a general medical condition. |
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True or False: Tourette's Syndrome is a lifelong, chronic disorder that may get worse with age.
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False: The severity and nature of the symptoms typically come and go. Symptoms usually worsen before the mid-teen years, but most patients improve in early adulthood
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What is the treatment for Tourette's Syndrome?
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Antipsychotics: primiozide (Orap)
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What are the symptoms of chronic motor or vocal tic disorder?
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Vocalizations
Facial Grimacing Excessive Blinking Rapid, recurrent movement of the arms, legs, or other areas. |
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To be diagnosed with chronic motor or vocal tic disorder, what do you need?
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Must have had the tics nearly every day for more than a year
Has not had a tic-free period for longer than 3 months |
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How do you treat chronic motor or vocal tic disorder?
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Depends on severity and frequency of the tics
-Haldol or other antipsychotics |
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Are antianxiety medications useful in chronic motor or vocal tic disorder?
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Nope, not successful
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What is transient tic disorder?
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transient tic disorder is a temporary condition that causes single or multiple motor tics, which are brief, repetitive, difficult-to-control movements or noises (vocalizations). The tics often resemble nervous behavior.
They get worse with emotional stress. |
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Who usually gets transient tic disorder?
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children
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How do you treat transient tic disorder?
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You don't. Tics usually disappear over a period of months.
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What are examples of Tic Disorder, NOS?
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tics lasting less than 4 weeks or tics with an onset afte age 18
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What are the current hypotheses for the mechanism of OCD?
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Serotonin hypothesis
Dopamine hypothesis Serotonin-dopamine hypothesis |
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True or False: Decrease serotonin tonic inhibitory action on dopamine neurons leads to increased dopamine function.
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True.
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When treating anxiety disorders, what drugs should you avoid?
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CNS stimulants
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What drugs are approved for the treatment of GAD?
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Venlafaxine (Effexor), paroxetine (Paxel), escitalopram (Lexapro), and more
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How should you choose a drug for the treatment of GAD?
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side effect profile
comorbidity patient's ability to tolerate |
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What is a disadvantage of antidepressants?
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has delayed onset of antidepressant action
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When would you use antidepressants for the treatment of GAD?
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when depression is present
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When do you use TCA's for the treatment of GAD?
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when other agents have failed.
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What is a relative contraindication of benzodiazepines?
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history of alcohol or other substance abuse problems
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How do benzodiazepines work?
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increased binding of GABA to GABA-a receptors
increased responsiveness of chloride channels to GABA binding |
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What is posttraumatic stress disorder?
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a physical reaction to a severe stressor involving intense fear, helplessness, or horror
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Posttraumatic stress disorder is divided into what 3 clusters?
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reexperiencing/intrusion
avoidance/numbing hyperarousal |
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What is the diagnostic criteria for PTSD: avoidance and numbing?
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persistent avoidance of associated stimuli and numbing of responsiveness, in greater than 3 ways:
-avoiding thoughts, feelings, or conversations with the trauma -avoiding activities, places, or people that arouse recollections of the trauma -inability to recall an important aspect of the trauma -diminished interest or participation in significant activities -feeling detached from others -restricted emotions -sense of foreshortened future |
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What is the diagnostic criteria for PTSD: hyperarousal?
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Persistent symptoms of increased arousal (not present before the trauma) as indicated by TWO or more of the following:
-difficulty falling asleep or staying asleep -irritability or outbursts of anger -hypervigilance -difficulty concentrating -exaggerated startle response |
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What are the 10 forms of twisted thinking?
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1. All or None thinking
2. Overgeneralization 3. Mental Filter 4. Discounting the Positive 5. Jumping to Conclusions 6. Magnification 7. Emotional Reasoning 8. "Should Elements" 9. Labeling 10. Personalization and Blame |
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Define Affect.
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This is the "observed" expression of emotion. Affect can be described as - appropriate, inappropriate, blunted, restricted, flat, labile, mecurical, etc.
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Define Mood.
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A pervasive and sustained emotion. This is what the patient reports his emotion as being. Examples are: euthymia, elation, anger, irritable, calm, apathy, etc.
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Define Depression.
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a pathological feeling of sadness.
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What is the diagnositc criteria for Major Depressive Disorder?
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Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure:
1. depressed mood for most of the day, nearly every day 2. marked diminished interest or pleasure in all, or almost all, activities 3. significant weight loss when not dieting or weight gain 4. insomnia or hypersomnia every day 5. pyschomotor agitation or retardation nearly every day 6. fatigue or loss of energy nearly every day 7. feelings of worthlessness or excessive or inappropriate guilt nearly every day 8. diminished ability to think or concentrate, or indecisiveness, nearly every day 9. recurrent thoughts of death |
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What is the diagnostic criteria for Dysthymic Disorder?
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an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. Persons who suffer from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:
1. poor appetite or overeating 2. insomnia or hypersomnia 3. low energy or fatigue 4. low self-esteem 5. poor concentration or difficulty making decisions 6. feelings of hopelessness -no major deprssive episode has been present during the first two years and there has never been a manic episode, a mixed episode, or a hypomanic episode |
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What are Axis I disorders?
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all psychiatric diagnoses except personality disorders, Axis II disorders, and mental retardation.
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What are Axis II disorders?
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developmental disorders and personality disorders
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What are Axis III disorders?
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physical conditions
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What are Axis IV disorders?
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psychosocial events (things that make axis I worse)
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What are Axis V disorders?
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the clinician rates the person's level of functioning both at the present time and the highest level within the previous year. This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected.
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What is the leading disability in the United States?
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depression
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What are the risk factors for suicide?
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Race (white), Age (elderly), medical problems, loss of spouse, diagnosis, feeling like a burden, substance abuse
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How do TCA's work?
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they reduce the reuptake of norepinephrine and serotonin and block the muscarinic acetylcholine and histamine receptors.
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What drugs don't you want to take TCAs with?
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quinidine, cimetidine, CBZ, phenothiazines, and SSRI's
(CP450) |
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What precautions must you take with TCA's when using with depression?
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-Could precipitate a manic episode
-Anticholinergic effects -Narrow angle glaucoma -Sedation, confusion, or hypertension -Orthostatic hypotension or hypertension -Tachycardia, flattened t-waves, prolonged Q-T interval, depressed ST segments -Lowered seizure threshold -Weight gain, sexual dysfunction, and suicide |
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Symptoms of a TCA overdose include what?
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agitation, delirium, convulsions, hyperactive deep tendon reflexes, bowel and bladder paralysis, temperature and blood pressure dysregulation and mydraisis, cardiac abnormalities, coma
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What is the mainstay of treatment for depression and dysthmia?
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SSRI's
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What is a disadvantage of SSRI's?
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response time is usually 3-4 weeks.
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SSRI's can't be used within 14 days of what class of drugs?
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MAOI
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Can you use SSRI's and TCA's together?
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Yes, but you must keep the TCA's dosed low since SSRI's increase serum levels of TCA's.
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Why can't SSNR's be used with SSRI's, MAOI's, or TCA's?
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They can precipitate Serotonin Storm.
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What is a downfall of Bupropion (Wellbutrin)?
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high risk of seizures
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How long do you treat the first episode of depression? The second? The third (or over 50)?
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first episode - 1 year
second episode - 2-5 years third episode - lifelong |
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When is ECT used for depression?
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when it hasn't responded to other treatment
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What is the diagnostic criteria for manic?
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A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week.
during the mood disturbance, three or more of the following symptoms have persisted and have been present to a significant degree: 1. inflated self-esteem or grandiosity 2. decreased need for sleep 3. more talkative than usual 4. flight of ideas or subjective experience that thoughts are racing 5. distractability 6. increase in goal-directed activity 7. excessive involvement in pleasurable activities. |
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What is the gold standard for treatment of Bi Polar?
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Lithium
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What is the role of antidepressants in Bi Polar?
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They are usually avoided or used with extreme caution as they may contribute to mania, hypomania, mixed, or rapid cycling.
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What is a big side effect associated with Clozapine (Clozaril) in the treatment of Bi Polar?
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agranulocytosis
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What are the contraindications for lithium?
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severe cardiovascular or renal disease and those with evidence of severe debilitation or dehydration, sodium depletion, brain damage, and pregnancy
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How do you treat lithium poisoning?
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There is no antidote for lithium poisoning.
1. Gastric lavage 2. correction of fluid and lytes 3. regulation of kidney fuction |
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What characterizes somatoform disorders?
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many symptoms that cannot be adequately explained on the basis of physical and lab findings.
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What are the four specific somatoform disorders?
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somatization disorder
conversion disorder hypochondriasis body dysmorphic disorder |
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How usually sufferers from somatization disorder?
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less educated, poor women with mental disorders
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What is the course and prognosis of somatization disorder?
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chronic and debilitating
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How do you treat somatization disorder?
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individual and group therapy
psychotropics may be helpful |
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What is somatization disorder?
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characterized by many physical complaints affecting several body organ systems
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What is body dysmorphic disorder?
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the false belief or micperception that some body part is defective
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Who usually suffers from body dysmorphic disorder?
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15-20 year old girls
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How do you treat body dysmorphic disorder?
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dermatological, surgical, dental, and other medical procedures are almost always unsuccessful.
antidepressants and antipsychotics have been helpful |
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What is the treatment of choice for delusional disorder?
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Antipsychotics
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What is the dopamine hypothesis in schizophrenia?
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hypothesizes that schizophrenia results from too much dopamine in certain areas of the brain
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What is the diagnostic criteria for schizophrenia?
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Person must display characteristic symptoms: Two or more of the following, each present for a significant portion of time during a one-month period
-delusions -hallucinations -disorganized speech -grossly disorganized behavior or catonic behavior -negative symptoms *only one of these symptoms is required if delusions are bizarre or hallucinations consist of hearing one voice participating in a running commentary *continuous signs of the disturbance persist for at least six months, with at least one month of symptoms |
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What are some traditional drugs used for schizophrenia?
What risk do they carry? |
Stelazine
Loxapine Perphenazine Chlorpromazine Haldol Prolixin *All carry a high risk of tardive dyskinesia and dystonia |
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What schizophrenia drug has a risk of agranulocytosis?
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clonzapine (Clozaril)
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What are the newer drugs used for treatment of schizophrenia?
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Clozapine
Olanzapine Risperidone Quetiapine Aripiprazole Ziprasidone |
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How do you treat dystonias?
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anticholinergics or antihistamines and life support as needed.
should resolve in 2-3 doses in a few hours |
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How do you treat neuroleptic-induced tardive dyskinesia?
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no uniformly successful treatment
switching to newer atypical may help |
