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34 Cards in this Set
- Front
- Back
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Depression
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Depression= major depressive disorder - Dx
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Major Depressive Episode of 2 weeks
5 or more Sx: • 1 - must be anhedonia= nothing makes you happy • 4 – SIG E CAPS • Sleep Disturbance • ↓ Interest • Guilt • loss of Energy • loss of Concentration • Appetite change = usually ↓ • Psychomotor retardation or agitation (abnormally slow or restless) • Suicidal |
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Mood disorders (Depression, Bipolar)- DDx
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o Psychiatric disorders
o Medical disorders = anything that causes chronic disability, pain or fatigue o Substance induced o Reactive disorders = i.e: death in family *** Must R/O! |
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Depression -TX
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SSRI
MMRI TCA MAOi Psychosocial therapies: CBT, interpersonal psychotherapy (IPT), Behavioral activation strategy (BAS) |
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Depression episode length?
Chronic depression? |
6-9 months
Never recover |
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Dysthymia
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Minor depression
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Mixed
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Depression w/ few manic symptoms, not enough for bipolar
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Atypical depression
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some symptoms, esp neurovegatative symptoms are in opp direction
↑ appetite instead of anorexia, Hypersomnia instead of insomnia, ↑ reactivity, heavy feelings in arms, legs |
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Depression comorbidity
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o Anxiety
o Substance abuse o Psychosis o Personality disorders o Medically ill |
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Bipolar
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Bipolar (Mania) - Dx?
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• Dx
o Manic Episode of 1 week o 3 or more Sx: “DIG FAST” • Distractibility • Insomnia (Decreased need for sleep) • Grandiosity • Flight of Ideas • Increased Activity/Agitation • Pressured Speech • Thoughtlessness/ Risky Activities |
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Bipolar (mania)- Tx?
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o Manic Tx:
1) Lithium = very effective 2) Divalproex 3) Atypical Neuroleptics (Atypical Antipsychotics) 4) Carbamazepine (Tegretol) 5) ECT o Depressive Tx: 1) Lamotrigine = (-) excitatory AA (glutamate, NMDA) 2) Quetiapine |
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Bipolar II?
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Hypomania + Major depression
• Hypomania= mild episode of increased mood and activity; doesn't impair functioning |
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o Cyclothymia
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hypomania & dysthemia
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o Rapid cycling
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mania and depression at greater rate than usual
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Bipolar Comorbidity
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o Anxiety
o Substance abuse o Psychosis o Personality disorders o Medically ill Same as depression |
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Substance Abuse/ Dependence
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Substance Abuse- Dx
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o 1 year
o 1 or more Sx: • Recurrent use/ failed obligations • Hazardous use • Legal problems • Continued use despite interpsonal problems o R/O: Substance Dependence |
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Substance dependence- Dx
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o Maladaptive substance use for 1 year
o 3 or more Sx: • Tolerance • Withdrawl • Larger amts • Desire to cut down • Time Spent • Activities • Continued Use o Note: You do NOT have to have physicial dependence (i.e: tolerance or withdrawl) to have substance dependence |
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Substance dependence tx strategy
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o Assessment→ Intervention (tx)→ Detoxification (tx alcohol withdrawal) → Rehabilitation
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Alcohol dependence- Tx - detox, rehab
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o Detoxification (alcohol withdrawal)
1) Benzodiazepine= Diazepam, Lorazepam (Acts as substitute for etoh receptor) = allows GABA receptors to reset o Rehabilitation 1) Disulfram = interferes w/ breakdown of toxic acetylaldehyde →causes unpleasant rxn 2) Naltrexone= opiod antagonist → blocks alcohol reward pathways (↓dopamine) 3) Acamprosate= Glutamate antagonist, GABA agonist = helps maintain abstinence after post-acute withdrawal 4) Psychosocial therapies |
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Opiate dependence- Tx - detox, rehab
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o Detoxification:
1. Opiate substitute Methadone = controversial b/c still an opiate Buprenorphine = mu & kappa properties; agonist at low dose, antagonist at high dose 2. Alpha- blockers → manage other withdrawal symptoms o Post-detox tx? • Naltrexone = Mu opiod antagonist ; requires detox 1st, otherwise severe withdrawal symptoms |
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Opiate withdraw symptoms
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• ↑ BP
• ↑ pulse • ↑ temperature • miosis • Tremor • Insomnia • Vomit/ diarrhea • Seizures |
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Anxiety Disorders= Panic Disorder
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Anxiety Disorders
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o Generalized anxiety disorder
o Agoraphobia w/out Hx of Panic Disorder o Social Phobia= fear of social situation (i.e: humiliation) o Specific phobia= fear of specific object/ situation o PTSD o Panic Disorder o OCD |
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Panic disorder - Dx ; R/O?
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o Repeated panic attacks
o Anticipatory Anxiety o Global o Can be w/ or w/out Agoraphobia (extreme fear of being in a place that is diff to escape) o What is a panic attack? • Sudden onset (10min peak); last 5-30 min • 4 or more Sx: • Palapitations • Abdominal distress • Numbness, Nausea • Intense fear of death or losing control • Choking (SOB), Chills/sweats, Chest pain o R/O: Myocardial infarction (similar symptoms) • Use ECG & Cardiac enzymes |
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Panic Disorder- DDx
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o Endocrine disorders
o Cardiopulmonary Disorders = Myocardial infarction =Use ECG & Cardiac enzymes o Neurologic Disorders o Substance induced (w/drawal, intoxication) o Psychiatric disorders: mood, psychotic, personality, adjustment Must rule out! |
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Panic disorder (all anxiety disorders) tx, except OCD
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Symptomatic:
1) Quell the episode: 1. Benzodiazepines= GABA receptors o Longer acting= 2 keto (Dizepam/ Valium) o Shorter acting= 3-Hydroxy (Lorazepam), Triazolo (alprazolam) 2. Sedatives HT Agonists (Buspirone) o Helps w/ GAD o Not for Panic disorders! o Not a Benzodiazepine replacement! 3. Psychotherapy o Preventative • Antidepressants= SSRI • Anticonvulsant • Psychotherapy- CBT |
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Panic Disorder - Comorbidity
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o Mood disorder= Depression
o Medical Disorder= mitral valve prolapse, ulcer, hypertension o Suicidal |
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OCD
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OCD- dx
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o Obsessions= Recurrent, unwanted, unpleasant thoguhts or images causing marked anxiety or distress; recognized as product of one’s own mind
• I.e: contamination, overresponsibilty for harm, aggressive, health, sexuality, hoarding, what if statements o Compulsions= repetitive , ritualistic behaviors that a person feels driven to perform; to reduce distress or prevent dreaded event |
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OCD- DDx
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o Obsessive Compulsive Personality Disorder
o Normal/Developmental rituals- not caused by distress o Tourette’s – multiple Tics o Body Dysmorphic Disorder o Autism Must rule out! |
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OCD- tx
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o Exposure & Ritual prevention (E/RP), a form of CBT is 1st line!
• Repeat exposure w/ out consequence occurring causes extinction of anxiety response o SSRIs= Combined w/ CBT |
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OCD- comorbidity
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o Anxiety disorders
o Mood disorders |
