Psychiatry Notes (EOR Exam) – Flashcards

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Substance Abuse
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A maladaptive pattern of substance use leading to clinically significant impairment or distress and is manifested by *1* or more of the following criteria occurring in a 12-mnth period: - recurrent substance use resulting in failure to fulfill major obligations at work, school, or home - recurrent substance use in situations that could be physically hazardous (ie driving) - recurrent substance-related legal problems - continued substance use despite having persistent, recurrent social or interpersonal problems caused or exacerbated by the substance
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2 hallmarks of dependence
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- Tolerance (need for increasing amt of substance) - Withdrawal (unpleasant s/s experienced when concentrations of substance in body decrease)
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Substance Dependence
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A maladaptive pattern of substance use leading to clinically significant impairment or distress and is manifested by *3* or more of the following criteria occurring in a 12-mnth period: - tolerance is experienced - withdrawal is experienced - substance is often taken in larger amts or over a longer period than intended - there is a persistent desire or there are unsuccessful efforts to cut down or control use of substance - a great deal of time is spent in activities necessary to obtain the substance - an important social occupation or recreational activities are given up or reduced b/c of the substance - the substance is used despite knowledge of its negative consequences
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Dependence
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Substance abuse plus evidence of physiological dependence (ie tolerance, withdrawal)
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What are some of the AEs of SSRIs?
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- nausea - anxiety - drowsiness - insomnia - sexual dysfunction - drug interactions - Serotonin Syndrome (esp when taken w/MAOIs) - Discontinuation Syndrome (pt should be tapered off slowly)
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SSRIs black box warning label
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Antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents with MDD
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Serotonin Syndrome
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- Can result from taking SSRIs (esp w/MAOIs) - Most s/s occur w/n mins to hrs of taking meds
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How do you Dx Serotonin syndrome?
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Pt must be taking a serotonergic drug and have at least 3 of the following s/s: - Agitation - Diarrhea - Heavy sweating - Fever - Mental status changes - Muscle spasms (myoclonus) - Hyperreflexia - Shivering - Tremor - Ataxia
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Tx of Serotonin syndrome
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- Benzos [ie diazepam (Valium) or lorazepam (Ativan)] to decr agitation, seizure-like movements, & muscle stiffness - Cyproheptadine (Periactin), a drug that blocks serotonin production - IV fluids - W/drawal of meds that caused syndrome
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Examples of SSRIs
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- Citalopram (Celexa) - Escitalopram (Lexapro) - Fluoxetine (Prozac) - Fluvoxamine (Luvox CR) - Paroxetine (Paxil) - Sertraline (Zoloft)
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What is the only SSRI indicated for bulimia nervosa?
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Fluoxetine (Prozac)
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Half-life of SSRIs
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- Most: 16-36 hrs with peak levels occurring 2-8 hrs on avg - Fluoxetine's half-life is ~ 50 hrs
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Which SSRIs are FDA approved to Tx children with OCD?
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- Fluoxetine (Prozac) - Sertraline (Zoloft) - Fluvoxamine (Luvox CR)
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Which SSRI is FDA approved to tx childhood depression?
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Fluoxetine (Prozac)
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Axis I
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All mental disorders & major syndromes, including substance abuse & developmental disorders
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Axis II
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Personality disorders & mental retardation
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Axis III
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Any general medical conditions or physical disorder
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Axis IV
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Psychosocial & environmental situations that contribute to the disorder (ie homelessness, economic difficulties)
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Axis V
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Global Assessment of Functioning (GAF) score
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Global Assessment of Functioning (GAF)
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A rating system designed to assess the level of daily functioning based on social, occupational, and psychological assessment. Maximum score is 100; serious impairment scores 50 or less, 0 indicates inadequate information
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(+) symptoms
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- Hallucinations - Bizarre behavior - Delusions
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(-) symptoms
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- Flat affect - Apathy - Poor grooming - Social w/drawal - Anhedonia - Poor eye contact - Poverty of speech
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Paranoid schizophrenia
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- Most common form - Characterized by persecutory or grandiose delusions or auditory hallucinations
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Disorganized schizophrenia
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- Characterized by disorganized speech or behavior and flat or inappropriate affect
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Catatonic schizophrenia
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- Very rare - Manifested by at least 2 of the following: -- motor immobility -- excess motor activity that is w/o purpose -- extreme negativism or mutism -- peculiarly voluntary movement -- echolalia -- echopraxia
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Undifferentiated schizophrenia
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- 2nd most common form - Delusions and hallucinations are prominent; paranoid, disorganized, and catatonic symptoms are absent
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Residual schizophrenia
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Pts no longer have prominent psychotic symptoms but do have blunted affect or odd behavior
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Paranoid personality disorder
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- Characterized by a pervasive and suspicion of others beginning by early adulthood - Blame their own problems on others and seem hostile and angry - Suspicion that others are exploiting or deceiving him/her - Doubts regarding the loyalty or trustworthiness of others - Reluctance to confide - Persistence of grudges; quick to counterattack - Tx: individual psychotherapy
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Schizoid personality disorder
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- Lifelong pattern of voluntary social w/drawal - Eccentric and reclusive - Quiet and unsociable - No desire for close relationships and prefer to be alone; *loner* - Neither enjoy nor desire close relationships - Solitary activities - Not interested in sexual activity - Indifferent to praise or criticism - Emotional coldness, detachment, or flattened affect - Tx: group therapy and psychotherapy
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Schizotypal personality disorder
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- Pervasive pattern of eccentric behavior and peculiar thought patterns - Most likely to progress to schizophrenia - Strange and eccentric - Have few, if any, friends - Ideas of reference - Display odd thoughts, speech, beliefs, or *"magical thinking"* inconsistent w/cultural norms; may include belief in clairvoyance or telepathy, bizarre fantasies or preoccupations, and belief in superstitions or the occult - Suspiciousness and excessive social anxiety - Tx: psychotherapy
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Antisocial personality disorder
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- Inability to conform to social norms and a strong tendency to commit unlawful acts - Disregard for the rights and feelings of others - Extremely manipulative, deceitful, impulsive, and totally lacking empathy or remorse; can seem charming and "normal" in interview - May begin in childhood; Hx of physical and/or sexual abuse, starting fires, or harming animals - Deceitfulness, lying, and conning others for personal gain - Irritability and aggressiveness - Irresponsible and unable to sustain work - Tx: psychotherapy
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Borderline personality disorder
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- Unstable and unpredictable mood, affect, and behavior - Mood swings and impulsivity are common - Appears to always be in a state of crisis - Self-mutilation and manipulative suicide attempts are common - Desperately attempts to avoid abandonment - *Cannot be alone* - Inappropriate anger or difficulty controlling anger - Tx: dialectical behavior therapy (DBT); pharmacotherapy in addition to psychotherapy yields better results
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Histrionic personality disorder
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- Overly emotional, dramatic, and seductive - High degree of attention-seeking behavior - Exaggerate their thoughts and feelings - Flamboyant and extrovert - Unable to maintain deep, long-lasting relationships - Need to be center of attention - Inappropriately seductive or provocative - Revert to acting like a child - Tx: psychotherapy
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Narcissistic personality disorder
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- Inflated self-image - Grandiosity, need for admiration, and lack of empathy - Arrogant, haughty attitude - Their shit doesn't stink - Entitled - Tx: psychotherapy
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