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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) |
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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) |
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Testing prior to lithium |
pregnancy test BUN and creatinine TSH |
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Bipolar type I vs II |
Type I- mania Type II- hypomania |
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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 |
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Hypomanic episode |
not severe enough to cause marked impairment in social & occupational functioning hospt not necessary no psychotic features |
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Cyclothymic disorder |
chronic dz (>2 yrs) of fluctuating mood disturbances involving hypomanic periods and depressive periods does not meet criteria for major depression |
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Proposed mechanism of action of lithium |
prevents recycling of inositol (decreasing PIP2) by blocking inositol monophosphatase and decreasing cAMP |
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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 |
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Lithium & nephrogenic DI |
inhibits action of ADH on distal renal tubule, impairment Na and water reabsorption tx with amiloride |
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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 |
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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 |
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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 |
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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 |
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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 |
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SSRI side effects |
headache GI effects weight gain insomnia sexual side effects |
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Delusional disorder |
are functional in life delusions have occurred for at least 1 month will not have hallucinations |
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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 |
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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 |
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Opiate withdrawal |
flu like sxs --> fever, chills, runny nose, abd cramps, diarrhea, N/V pupils are dilated muscle aches insomnia |
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Cocaine withdrawal |
sleep disturbances appetite disturbances sxs of depression suicidal thoughts |
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Tx of opiate withdrawal |
clonidine or buprenorphine/naloxone or methadone supportive tx for other sxs refer to rehab once detox is complete |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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Persistent depressive disorder (dysthymia) |
"mild" depression for at least 2 yrs |
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TCA side effects |
confusion constipation dry mouth cardiac abnormalities lethal in o/d |
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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 |
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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 |
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Specific learning disorder |
child who has problems in school in reading, writing, or math so must specify a specific difficulty in question stem |
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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 |
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Tx of ADHD |
methylphenidate, dextroamphetamine, atomoxetine, or clonidine family therapy supportive therapy |
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Psychostimulants |
increase dopamine & norepinephrine methylphenidate & amphetamine are classic stimulants used in ADHD common side effects include headaches, insomnia, GI problems |
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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 |
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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 |
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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 |
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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 |