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43 Cards in this Set

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Criteria for involuntary hospitalization

mentally ill or developmentally delayed




imminent potential danger (to oneself or others)

Tx of bipolar I

manic sxs:


benzos, anti-psychotic, or valproic acid




depressive sxs:


lithium, lamotrigine (assoc with steven-johnson syndrome), quetiapine, or lurasidone (particularly in pregnant woman)



Testing prior to lithium

pregnancy test




BUN and creatinine




TSH

Bipolar type I vs II

Type I- mania




Type II- hypomania

Manic episode

distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week & present most of the day, nearly every day




can have delusions of grandeur




lack of inhibition




flight of ideas




decreased sleep

Hypomanic episode

not severe enough to cause marked impairment in social & occupational functioning




hospt not necessary




no psychotic features

Cyclothymic disorder

chronic dz (>2 yrs) of fluctuating mood disturbances involving hypomanic periods and depressive periods




does not meet criteria for major depression

Proposed mechanism of action of lithium

prevents recycling of inositol (decreasing PIP2) by blocking inositol monophosphatase and decreasing cAMP

Lithium toxicity

have to monitor levels & should be around "1.0"




initially assoc with GI sxs (n/v cramping)




can progress to tremulousness, hyperreflexia, ataxia, & cardiac dysrhythmias (T-wave flattening)




Syndrome of irreversible lithium effectuated neurotoxicity (SILENT)- cognitive impairment, sensorimotor peripheral neuropathy, & cerebellar dysfunction




nephrotoxic




can lead to hypothyroid




diabetes insipidus

Lithium & nephrogenic DI

inhibits action of ADH on distal renal tubule, impairment Na and water reabsorption




tx with amiloride

Lithium & hypothyroid

lithium is rapidly taken up in thyroid cells --> blocks thyroid hormone release from thyroglobin preventing TSH from stimulating thyroid cells via TSH receptor




also inhibits the activity of 5' deiodinase

Agoraphobia

fear of open places and open spaces




ppl with panic attacks can develop this bc they dont know when the panic attacks will occur

Panic attacks

abrupt surge of intense fear or intense discomfort that reaches a peak within minutes during which 4 or more of the following occur:




palpitations, sweating, trembling, SOB, feelings of choking, chest pain, nausea, dizziness, chills or heat sensations, paresthesia, derealization, fear of losing control, & fear of dying




freq of attacks may vary widely

Panic disorder

recurrent unexpected panic attacks




at least 1 attack followed by >1 month of 1 or both of:




1) persistent concern about the attacks or their consequences




2) significant change in behavior related to attacks

Tx of panic disorder

panic disorder --> multiple panic attacks so is a chronic dz




acute sxs --> benzos (alprazolam, lorazepam, clonazepam)




chronic sxs --> SSRIs or SNRIs & second line is TCAs or MAOIs




can also get psychotherapy

SSRI side effects

headache




GI effects




weight gain




insomnia




sexual side effects

Delusional disorder

are functional in life




delusions have occurred for at least 1 month




will not have hallucinations

Atypical antipsychotics

risperidone: less sedation, more movement side effects




ziprasidone: QT prolongation




olanzapine: more weight gain, greater risk for DM




quetiapine: fewer movements side effects




"-pine's" increase risk of DM, metabolic sxs, weight gain (particularly olanzapine)




"-dones" have more movement related side effects, tremors, increase prolactin, dystonia, cardiac issues

Schizophrenic associations

anatomic:


enlarged ventricles


areas of hypodensitities in frontal lobe




Neurotransmitter:


hyperdopaminergic activity in mesolimbic system


NE, 5-HT, & GABA are likely involved




Immune system:


overactivation of immune system may cause overexpression of inflammatory cytokines leading to an abnormal change of brain structure and function

Opiate withdrawal

flu like sxs --> fever, chills, runny nose, abd cramps, diarrhea, N/V




pupils are dilated




muscle aches




insomnia

Cocaine withdrawal

sleep disturbances




appetite disturbances




sxs of depression




suicidal thoughts

Tx of opiate withdrawal

clonidine or buprenorphine/naloxone or methadone




supportive tx for other sxs




refer to rehab once detox is complete

Tx of OCD

SSRI: fluoxetine, sertraline, paroxetine, or fluvoxamine




SNRIs can be used but can cause blurry vision & elevated BPs




TCAs are also option but can cause death in o/d & have many side effects




behavioral therapy --> exposure and response prevention

Conduct disorder

predominantly males in pre-teens - teens




pervasive pattern of disobeying rules of society




aggressive towards others




destroy property




run away from school




four categories:


1) aggression to people & animals


2) destruction of property


3) deceitfulness or theft


4) serious rule violations

Oppositional defiant disorder

predominantly males in pre-teens -teens




hostility towards authority figures




talk back to parents, teachers, etc




but do not see clear violation of society rules like in conduct disorders

Adjustment disorder

a stressor changes the behavior of a person




stressor must be within 3 months of change of behavior & behavioral change cannot be for >6 months in length




tx with supportive psychotherapy

Adjustment disorder subtypes

1) with depressed mood


2) with anxiety


3) with mixed anxiety and depressed mood


4) with disturbance of conduct


5) mixed disturbance of emotions and conduct


6) unspecified

Tx of conduct disorder

focus on relationship & develop a therapeutic alliance




if child becomes invested in therapy can use variety of techniques such as behavior modification, cognitive restructuring, etc

Grief/Bereavement

occurs within 1 yr of death of a loved one




exhibit signs of depression but does not affect functioning




tx with supportive psychotherapy, sleep hygiene techniques, behavioral modification (stimulus control)




meds usually not required but if needed --> zolpidem or eszopiclone for <2 weeks

Major depressive disorder

sxs must occur >2 weeks




sxs are severe enough to affect your functioning




freq think of suicide




helpless/hopeless/cant sleep/energy/appetite/anehedonia




tx with SSRI or SNRI (eg venlafaxine or duloxetine) with TCAs as 2nd line & MAOI as 3rd line




can also tx with bupropion

PTSD vs acute stress disorder

acute stress disorder is for >3 days but < 1 month




PTSD is > 1 month




tx with SSRIs, psychotherapy that is trauma-focused CBT

Persistent depressive disorder (dysthymia)

"mild" depression for at least 2 yrs

TCA side effects

confusion




constipation




dry mouth




cardiac abnormalities




lethal in o/d

Anorexia vs bulimia

major distinguishing feature is weight:




anorexia --> BMI <17.5




bulimia --> weight is lower than expected but not by a lot




tx with individual and family therapy & can think of SSRI if there is a dimension of depression

Eating disorder complications

endocrine:


delayed puberty


amenorrhea


increased growth hormone


hypercortisolism


low estrogen states




metabolic:


acidosis


decreased ADH


osteoporosis


hypothermia


hypokalemia


hyponatremia


hypoglycemia




CV:


cardiomyopathy


SVT & ventricular arrhythmias


long QT


bradycardia


heart failure

Specific learning disorder

child who has problems in school in reading, writing, or math




so must specify a specific difficulty in question stem

ADHD

child who has problems at home & school




have problems with attention, impulsivity, & hyperactivity




cannot follow directions




are usually fidgety, irritable, with poor grades & accident prone

Tx of ADHD

methylphenidate, dextroamphetamine, atomoxetine, or clonidine




family therapy




supportive therapy

Psychostimulants

increase dopamine & norepinephrine




methylphenidate & amphetamine are classic stimulants used in ADHD




common side effects include headaches, insomnia, GI problems

Tourette's disorder

motor tics usually start around age 7




have both motor & vocal tics




thought to be due to too high dopamine




tx with antipsychotics bc of anti-dopamine effects (eg haloperidol, risperidone, olanzapine, or pimozide) but only if sxs require it




alternative tx can include a2-agonists such as clonidine & guanfacine

Tourette's with ADHD and/or OCD

high comorbidity




if ADHD also present -> consider antidepressants bc psychostimulants will increase tics




if OCD also present then consider SSRIs

Autism spectrum disorders

children < age 3




social-interaction difficulties




communication challenges




tendency to engage in repetitive behaviors




deficits in non-verbal communicative behaviors used for social interaction




deficits in developing, maintaining, & understanding relationships




if aggressive --> tx with antipsychotic (eg risperidone or haloperidol)




w/o aggression --> behavioral & family therapy

Conversion disorder (functional neurological disorder)

a stressor induces a physical change (eg paralysis, blindness, mutism, etc)




"le belle indifference" --> "beautiful indifference" --> not concerned about the sxs




tx with supportive or behavioral therapy