- Shuffle
Toggle OnToggle Off
- Alphabetize
Toggle OnToggle Off
- Front First
Toggle OnToggle Off
- Both Sides
Toggle OnToggle Off
Front
How to study your flashcards.
Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key
Up/Down arrow keys: Flip the card between the front and back.down keyup key
H key: Show hint (3rd side).h key
PLAY BUTTON
PLAY BUTTON
82 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
(H/P) =
Diagnosis requires presence of five of the following symptoms, including either depressed mood or anhedonia (i.e., loss of interest in previously pleasurable activity) lasting >2 wk: Depressed mood or anhedonia Change in sleep patterns (e.g., insomnia, hypersomnia) Feelings of worthlessness Fatigue Inability to concentrate Changes in appetite (usually reduction) Psychomotor disturbances (i.e., impaired motor ability related to mental state) Suicidal ideation |
Major depressive disorder
Experience of significant depression that Is not attributable to drug use, medical conditions, or bereavement Has an impact on the patient's ability to function Lasts >2 wk Following resolution, these depressive episodes have a 50% chance of recurring Infrequently, patients may show signs of psychosis Pathology not fully understood, but related to central nervous system (CNS) serotonin activity; CNS norepinephrine and dopamine may also be involved SIG E CAPS: Sleep disturbances (insomnia), Interest loss, Guilt, Energy reduction (fatigue), Concentration impairment, Appetite changes, Psychomotor disturbances, Suicidal ideation. |
Treatment = Psychotherapy (i.e., cognitive or behavioral counseling and instruction designed to provide insight into condition and modify behavior) and pharmacologic therapy are initial treatments (combined or alone) Electroconvulsive therapy (ECT) can be used for refractory or severe cases to decrease frequency of major depressive episodes |
|
H/P = Diagnosis requires depressed mood plus two or more of the symptoms below for most days for >2 yr and no history of major depressive episodes:
Feelings of hopelessness Change in sleep patterns Change in appetite Fatigue Inability to concentrate Low self-esteem |
Dysthymic disorder
Feelings of depression on more days than not for >2 yr with no history of major depressive episodes Milder but more chronic than major depressive disorder |
Treatment = psychotherapy is initial treatment; pharmacologic agents can be used for continued depressive symptoms |
|
H/P = depressive episodes are similar to those seen with major depressive disorder
Elation or irritability lasting >1 wk Three or more of the following symptoms: grandiosity, pressured speech, decreased need for sleep, flight of ideas, easy distractibility, increased goal-oriented activity, increased risky pleasurable activity Episodes cause significant impairment of ability to function |
Bipolar disorder
Cyclic depression and mania (or hypomania) that impairs the patient's ability to function during episodes; patient is able to function normally between episodes Types Bipolar I: depression with the history of at least one manic episode h/p=Manic episodes Episodes cannot be caused by substance use or a medical condition Diagnosis requires history of at least one manic or hypomanic episode and recurrent major depressive episodes DIGFAST: Distractibility, Insomnia, Grandiosity (feelings of), Flight of ideas, Activity (increase in goal-oriented), Speech (pressured), Taking risks. |
Patients should be hospitalized if psychotic or judged to be a risk to themselves or others until they can be stabilized Mood stabilizers (e.g., lithium, carbamazepine, valproic acid, gabapentin, topiramate) are used to control and prevent manic and hypomanic episodes Antidepressants are used to treat depression Antipsychotic medications may be required for some patients with rapid cycling or refractory disease |
|
H/P = depressive episodes are similar to those seen with major depressive disorder
Elation or irritability lasting >3 days Three or more of the following symptoms: grandiosity, pressured speech, decreased need for sleep, flight of ideas, easy distractibility, psychomotor agitation, engaging in risky pleasurable activity Episode does not cause significant impairment of ability to function |
Bipolar disorder
Cyclic depression and mania (or hypomania) that impairs the patient's ability to function during episodes; patient is able to function normally between episodes Bipolar II: depression occurs with at least one hypomanic episode Episodes cannot be caused by substance use or a medical condition Diagnosis requires history of at least one manic or hypomanic episode and recurrent major depressive episodes DIGFAST: Distractibility, Insomnia, Grandiosity (feelings of), Flight of ideas, Activity (increase in goal-oriented), Speech (pressured), Taking risks. |
Patients should be hospitalized if psychotic or judged to be a risk to themselves or others until they can be stabilized Mood stabilizers (e.g., lithium, carbamazepine, valproic acid, gabapentin, topiramate) are used to control and prevent manic and hypomanic episodes Antidepressants are used to treat depression Antipsychotic medications may be required for some patients with rapid cycling or refractory disease |
|
H/P = symptoms of dysthymia that alternate with hypomanic episodes
|
Cyclothymia
Rapid cycling of hypomania and mild depression lasting >2 yr without a period of normal mood >2 months Mood level does not impair ability to function |
Treatment = psychotherapy or mood stabilizers |
|
H/P =
Distress in excess of what is expected following a stressful event, inability to concentrate, self-isolation, change in sleep patterns, change in appetite Symptoms begin within 3 months of stressful event and end 6 months after end of stressor |
Adjustment disorder with depressed mood
Behavioral and mood changes that occur within 3 months of a stressful event (e.g., death in family, assault, divorce) and cause significant impairment of ability to function |
Treatment = psychotherapy; antidepressants can be used if psychotherapy alone is unable to effect normal daily functioning |
|
H/P =
Recurrent panic attacks that occur without warning and last up to 30 minutes and consist of extreme anxiety, feelings of impending danger, chest pain, shortness of breath, palpitations, diaphoresis, nausea, dizziness, feeling of losing control, or chills or hot flashes Diagnosis requires a history of recurrent episodes plus a persistent fear that attacks will happen again |
Panic disorder
Experience of recurrent, spontaneous panic attacks with associated fear that these episodes will occur; typically begins in late adolescence Panic disorder: Increased incidence in patients with mitral valve prolapse Occasionally associated with agoraphobia (fear of public places) |
Treatment = Psychotherapy may help alleviate fear between attacks and decrease panic attack occurrence Selective serotonin reuptake inhibitors (SSRIs) are used for long-term therapy in patients with frequent attacks; tricyclic antidepressants (TCAs) are considered a second-line long-term treatment Benzodiazepines can be used to break attacks once they have started |
|
H/P = encountering feared subject incites panic attack, the patient makes great effort to avoid feared subject and realizes that behavior is irrational; some patients may experience vasovagal response (i.e., fainting) during episodes
|
Specific phobia
Fear of a particular object, activity, or situation that causes the patient to avoid feared subject; typically begins in childhood |
Treatment = psychotherapy involving desensitization through repeated exposure, relaxation techniques, hypnosis, or insight modification |
|
H/P = social situations (e.g., performances, conversations) cause anxiety that can be mild or severe (i.e., panic attacks); patients avoid these situations and have a persistent fear of being embarrassed
|
Social phobia
Excessive fear of social situations and anxiety that results when the patient encounters such situations; typically begins in childhood |
Treatment = Psychotherapy β-blockers can be used in mild cases to prevent tachycardia and diaphoresis SSRIs frequently are effective at reducing anxiety and permitting social interactions; monamine oxidase inhibitors (MAOIs) can be used in refractory cases Benzodiazepines are an alternative option for reducing acute anxiety |
|
H/P =
Defined recurrent obsessions and compulsions that significantly affect ability to function and may take up considerable time in daily activity Patients are aware of behaviors, but feel unable to control them Stressful events can exacerbate behaviors Diagnosis requires presence of obsessions or compulsions that significantly affect daily life |
Obsessive-compulsive disorder (OCD)
Significant, recurrent obsessions (e.g., feeling unclean, need for organization, recurrent images) and compulsions (e.g., counting, frequent or repetitive handwashing, placing items in a certain order) that affect daily life and function; typically begins in adolescence |
Treatment = psychotherapy and pharmacologic therapy (SSRIs or clomipramine) help limit and control behavior |
|
H/P =
Vivid dreams or recurrent intrusive thoughts of traumatic event Avoidance of activity or settings associated with event, anhedonia, feelings of detachment, increased state of arousal, survivor guilt, social withdrawal Diagnosis requires patient to have been exposed to a traumatic event that caused significant distress, symptoms of reliving the event through dreams or intrusive thoughts, avoidance of associations with the event, and increased arousal (e.g., insomnia, irritability, difficulty concentrating) lasting >1 month in acute cases and >3 months in chronic cases |
Post-traumatic stress disorder (PTSD)
Syndrome of anxiety symptoms that occurs following exposure to a significantly stressful event; symptoms typically begin within 3 months of event |
Treatment = SSRIs, MAOIs, or mood stabilizers; psychotherapy may also be helpful in eliminating intrusive thoughts |
|
/P =
Feeling of restlessness or being on edge, inability to concentrate, restlessness, insomnia, irritability, muscle tension Diagnosis requires excessive anxiety for most days, impairment of ability to function, and three of the symptoms listed in a. for >6 months |
Generalized anxiety disorder
Excessive, persistent anxiety that impairs ability to function and occurs more days than not for >6 months; typically begins in early adulthood Risk factors = women twice as likely affected than men |
Treatment = psychotherapy and anxiolytics improve symptoms (see Table 14-3); SSRIs are emerging as a promising treatment because of their lower rate of side effects compared with benzodiazepines |
|
H/P = periodic psychotic exacerbations, with increased severity of symptoms; baseline function is generally impaired and worsens over time
Positive symptoms: delusions, hallucinations (usually auditory), disorganized thoughts and behavior, thought broadcasting (i.e., belief that others can read the patient's thoughts or that thoughts are being transmitted to others), ideas of reference (i.e., belief that hidden meanings are found in common items) Negative symptoms: social withdrawal, flat affect (i.e., displaying little emotional response to stimuli), apathy, anhedonia, lack of motivation Cognitive symptoms: attention deficits, inability to organize or form abstractions, poor memory Patterns of certain symptoms can classify disease into subtypes |
Schizophrenia
Severe psychotic disorder that causes significant limitations in ability to function; typically begins in late adolescence Risk factors = family history, maternal malnutrition or illness during pregnancy; significantly higher rate in homeless and indigent patients likely secondary to their inability to function in society Diagnosis requires presence of two or more symptoms (e.g., delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms), presence of symptoms for at least 1 month within a 6-month period, and impaired social function for >6 months |
Treatment = Antipsychotics (also known as neuroleptics) are the mainstay of therapy (see Table 14-5) Psychotic exacerbations may require hospitalization Psychotherapy may be helpful in teaching the patient how to recognize symptoms |
|
Subtypes of Schizophrenia
Excessive paranoia; hallucinations and ideas of reference may be particularly severe |
Paranoid
|
|
|
Subtypes of Schizophrenia
Rigid posturing, poor response to stimuli, poor interaction |
Catatonic
|
|
|
Subtypes of Schizophrenia
Flat affect, disorganized speech, inappropriate and disorganized behavior |
Disorganized
|
|
|
Subtypes of Schizophrenia
Does not fit into other subtype descriptions |
Undifferentiated
|
|
|
Subtypes of Schizophrenia
Previously diagnosed schizophrenia with resolution of positive symptoms but lingering negative symptoms |
Residual
|
|
|
Symptoms similar to schizophrenia but last >1 month and <6 months; patients return to normal function following resolution of psychotic episode; two thirds of patients will go on to develop true schizophrenia in future
|
Schizophreniform
|
Treatment=Antipsychotics, psychotherapy |
|
Presence of mood disorder and psychotic symptoms, but not meeting criteria for either diagnosis alone; diagnosis requires presence of psychotic symptoms during normal mood for >2 wk
|
Schizoaffective
|
Treatment=Combination of antipsychotics with mood stabilizers and/or antidepressants; psychotherapy is a useful adjunct |
|
Presence of one or more distinct realistic delusions lasting >1 month without any other psychotic symptoms; patient is able to function normally; unrealistic delusions are classified as schizophreniform disorder or schizophrenia
|
Delusional
|
treatment=Antipsychotics, psychotherapy; SSRIs are helpful when delusions are of somatic nature |
|
Sudden onset of psychotic symptoms (possibly stress-related) that last <1 month
|
Brief psychotic
|
treatment=Psychotherapy or short-term antipsychotics; hospitalization necessary if symptoms affect ability to function |
|
Second patient accepts and becomes involved in delusions of a patient with preexisting delusions
|
Shared psychotic (Folie à deux)
|
treatment=Group psychotherapy, antipsychotics; second patient's acceptance of delusions often wanes if separated from primary patient |
|
high fever, muscle rigidity, decreased consciousness, and increased blood pressure and heart rate.
|
Neuroleptic malignant syndrome
An uncommon complication of antipsychotic medications that starts within DAYS of usage and carries a high mortality rate. |
Treated by immediately stopping use of the drug and administering dantrolene |
|
Persistent distrust of others, others' actions consistently interpreted as harmful or deceptive, reluctant to share information, frequent misinterpretation of comments, frequent angry reactions, common suspicions of partner fidelity
|
Paranoid
|
Treatment Supportive, nonjudgmental psychotherapy, low-dose antipsychotics |
|
Inability to form close relationships, social detachment, emotionally restricted, anhedonia, flat affect, lack of sexual interests
|
Schizoid
|
Treatment Antipsychotics initially to resolve behavior, supportive psychotherapy focusing on achieving comfortable interactions with others |
|
Paranoia, ideas of reference, eccentric and inappropriate behavior, social anxiety, disorganized speech, odd beliefs
|
Schizotypal
|
Treatment Supportive psychotherapy focusing on recognition of reality, low-dose antipsychotics or anxiolytics |
|
Aggressive behavior toward people and animals, destruction of property, illegal activity, pathologic lying, irritability, risk-taking behavior, lack of responsibility, lack of remorse for actions; patient >18 yr of age, history of conduct disorder prior to 15 yr of age; more common in men
|
Antisocial
|
Treatment Structured environment, psychotherapy with defined limit-setting may be helpful in controlling behavior |
|
Unstable relationships, feelings of emptiness, fear of abandonment, poor self-esteem, impulsivity, mood lability, suicidal ideation, inappropriate irritability, paranoia, splitting (seeing others as either all good or all bad); much more common in women
|
Borderline
|
Treatment Extensive psychotherapy using multiple techniques combined with low-dose antipsychotics, SSRIs, or mood stabilizers |
|
Dire need for attention, inappropriate seductive or theatrical behavior, emotional lability, shallow relationships, dramatic speech, uses appearance to draw attention to self, easily influenced by others, believes relationships more intimate than they are
|
Histrionic
|
Treatment Long-term psychotherapy focusing on relationship development and limit-setting |
|
Grandiosity, fantasies of success, manipulation of others, expectation of admiration, arrogance, sense of entitlement, believes self to be “special,” lacks empathy, envious of others
|
Narcissistic
|
Treatment Psychotherapy focusing on acceptance of shortcomings |
|
Fear of criticism and embarrassment, social withdrawal, fear of intimacy, poor self-esteem, reluctance to try new activities, preoccupied by fear of rejection, inhibited by feelings of inadequacy
|
Avoidant
|
Treatment Psychotherapy (initially individualized then group therapy later) focusing on self-confidence combined with antidepressants or anxiolytics |
|
Difficulty making decisions, fear of responsibility, difficulty expressing disagreement, lack of confidence in judgment, need for others' support, fear of being alone, requires constant close relationships
|
Dependent
|
Treatment Psychotherapy focusing on developing social skills and development of decisive behavior |
|
Preoccupied with details, perfectionistic, excessively devoted to work, inflexible in beliefs, miserly, difficulty working with others, hoarding of worthless objects, stubbornness
|
Obsessive-compulsive
|
Treatment Psychotherapy focusing on accepting alternative ideas and working with others |
|
H/P = body weight <85% ideal body weight, fixation on prevention of weight gain, severe body image disturbance, amenorrhea, cold intolerance, hypothermia, dry skin, lanugo hair growth (i.e., fine, short hair similar to that in the newborn), bradycardia
|
Anorexia nervosa
Eating disorder in which patients refuse to maintain normal body weight through fasting, excessive exercise, or purging Patients have distorted body image and believe that they are overweight Risk factors = adolescence, high socioeconomic status; 90% of cases are women Complications = electrolyte abnormalities, arrhythmias (especially ventricular types), refeeding syndrome |
Treatment = Inpatient treatment is frequently required to aid in weight gain Psychotherapy involving family that focuses on body image, weight gain; sufficient caloric intake is needed to maintain long-term control Pharmacologic therapy has not been proved beneficial, but anxiolytics before meals may help decrease anxiety associated with eating Patients with anorexia nervosa should be screened for depression, and SSRIs should be included in treatment if depression is diagnosed. |
|
H/P =
Episodes of binge eating accompanied by a sense of loss of control Episodes of binging are followed by some type of compensatory behavior (e.g., purging, excessive exercise, laxative use) Binging-compensation episodes occur at least two times per week for >3 months Dissatisfaction with weight and body shape Dental enamel erosion (from repeated vomiting), scars on hands (from inducing vomiting), parotid enlargement, oligomenorrhea |
Bulimia
Eating disorder in which patients feel lack of control over eating behavior and engage in binge eating, but maintain normal body weight through purging, excessive exercise, or laxative use |
Treatment = psychotherapy directed at body image and reduction of binging–compensation cycles; SSRIs, TCAs, or buspirone help in behavior modification |
|
hypophosphatemia, cardiovascular collapse, rhabdomyolysis, confusion, and seizures.
|
Refeeding syndrome results from the sudden shift from fat to carbohydrate metabolism in severe anorexics who resume eating
|
|
|
H/P = diagnosis requires pain in four unrelated regions:
Two gastrointestinal (GI) symptoms: nausea, vomiting, diarrhea, indigestion One sexual symptom: decreased libido, erectile dysfunction, menorrhagia One pseudoneurologic symptom: ataxia, weakness, urinary retention, paresthesias, hallucinations Pain at multiple body regions Symptoms cannot be explained by medical conditions and are unintentional |
Somatization disorder
Multiple recurrent physical symptoms that are unintentional and cannot be explained by any medical condition; typically begin in young adulthood Risk factors = women five times more likely than men |
Treatment = psychotherapy focusing on maintenance of function may help alleviate symptoms; patients may be resistant to psychiatric treatment |
|
H/P = onset of sensory (e.g., paresthesias, blindness, deafness) or motor (e.g., paralysis, loss of voice) deficits or pseudoseizures that generally follow Stressful situationS; symptoms cannot be linked to any findings on examination but cannot be shown to be intentional
|
Conversion disorder
Development of sensory or motor deficits Following StresS without associated medical conditions or intention |
Treatment = psychotherapy helps identify stressors with reactions and encourages normal responses to stressful situations; frequent self-resolution of symptoms |
|
H/P =
Preoccupation with fear of having a serious illness that persists, despite a healthy medical evaluation; fear impairs ability to function normally Symptoms consistent with patient's perception of disease (not necessarily consistent with true symptoms of condition) Diagnosis requires above-mentioned symptoms lasting >6 months |
Hypochondriasis
Excessive fear that a minor symptom represents a serious illness that limits daily function; typically begins in middle age |
Treatment = Regular physician visits help to alleviate fears Group psychotherapy for support and cognitive psychotherapy focusing on realistic beliefs about disease; patient frequently resistant to psychiatric treatment Treatment of comorbid mood and anxiety disorders with antidepressants and anxiolytics can improve patient concerns Primary care physician should work with psychiatrist to review therapies |
|
H/P = pain in a focused site that becomes the focal complaint and cannot be shown to be intentionally produced; presence of stressors somehow related to occurrence of pain
|
Pain disorder
Development of a specific pain complaint that cannot be explained entirely by a medical condition |
Treatment = psychotherapy with biofeedback can reduce symptoms; hypnosis may be useful for eliminating symptoms; TCAs and SSRIs may be helpful Analgesic medications will not relieve the pain symptoms when a genuine pain disorder exists |
|
H/P = patient imagines physical defect in distinct body region, frequently presents to dermatologist or plastic surgeon to “improve” defect, and continues to imagine defect following treatment
|
Body dysmorphic disorder
Preoccupation with an imagined defect in appearance that limits ability to function; typically begins in adolescence |
Treatment = Psychotherapy addressing self-perception Antidepressants may help in refractory cases Avoid performing needless surgery |
|
H/P =
Patient reports symptoms or signs of a given disease and attempts to induce disease process (e.g., self-injections of insulin or excrement, attempts to become infected by a pathogen, induction of GI illness, etc.) Diagnosis requires intentional production of symptoms or signs by patient, denial of intention, wandering of patient from one physician to another, and no clear incentive for patient's actions |
Factitious disorder (Münchhausen syndrome)
Intentional induction of disease symptoms or signs by a patient that has no clear benefit to patient Can involve any organ system |
Treatment = Patient denial makes treatment difficult No unnecessary therapies should be administered Attempt to limit medical care to one physician and one hospital If patient is willing, psychotherapy involving family may be beneficial |
|
H/P = patient reports symptoms for a certain disease to realize a personal gain (e.g., time off from work, financial compensation, particular therapy, etc.); patients will frequently leave site of care if they are confronted or realize that a goal is unattainable
|
Malingering
Intentional induction of disease or reporting of symptoms by a patient who will benefit from appearing ill |
Treatment = avoid necessary treatment; report suspicious activity to higher authority (e.g., psychiatrist, hospital patient data base, ethics committee) |
|
/P =
Key features (see Table 14-9) Altered level of consciousness with inattentiveness and confusion Change in cognition is not caused by preexisting dementia Changes in cognition develop quickly and fluctuate over course of day Changes are related to disease, medication, or drug use Psychomotor agitation or retardation, disturbance of sleep patterns Emotional instability Mini-mental state examination (MMSE) can be used to test cognitive function (a score <25 indicates dysfunction) |
Delirium
Altered state of consciousness Secondary to Drugs (e.g., alcohol, corticosteroids, benzodiazepines, oral contraceptive pills, antipsychotics, nonsteroidal anti-inflammatory drugs [NSAIDs], chemotherapeutics, isoniazid, anticholinergics, antihistamines, antiarrhythmics) Infection, hypoxia, or CNS abnormalities It is frequently quickly reversible once the underlying cause is identified and treated it occurs in patients without a history of dementia and can be linked to a medical or substance-related cause. causes of dementia by the mnemonic MIND HATS: Metabolic (electrolytes, endocrine disorders), Infection, Nutrition (poor), Drugs, Hydrocephalus (normal pressure), Atherosclerosis, Tumors, Sensory deficits (vision, hearing). |
Labs = should address potential metabolic or pharmacologic causes Radiology = CT can be used to assess CNS insult Treatment = Treat underlying cause Reorientation through observation, reassurance, normalization of sleep–wake cycles, and decreasing excess stimuli improves behavior Avoid restraints because they frequently exacerbate delirium (use only if patient is at danger of harming self) Antipsychotics (e.g., haloperidol) can be used to decrease agitation acutely Do not use benzodiazepines or anticholinergics in the treatment of delirium- or dementia-related agitation because they can worsen symptoms. |
|
the deterioration of behavior during evening hours in patients with dementia
|
“sundowning,”
|
|
|
H/P =
Key features Impaired memory Presence of either aphasia (i.e., impaired speech), apraxia (i.e., impaired purposeful movement), agnosia (i.e., impaired recognition of objects), or impaired executive function Impaired ability to function Unrelated to delirium Symptoms are initially mild and progress gradually (weeks to months) MMSE shows impaired cognitive function |
Dementia
Chronic, progressive cognitive impairment (memory and at least one other cognitive function) without changes in consciousness that can significantly limit ability to function (see Table 14-9) Etiologies Alzheimer's disease: most common cause (>70% of cases) (see Chapter 8, Neurologic Disorders) Vascular dementia: dementia caused by multiple cerebral infarcts (15% of cases); features neurologic symptoms in addition to dementia Parkinson's dementia: dementia associated with Parkinson's disease; risk for dementia significantly higher in patients with this disease than in those without it Alcohol-induced: caused by chronic alcoholism; typically associated with aphasias Less common causes: Huntington's disease, normal pressure hydrocephalus, endocrine diseases, metabolic diseases, neoplasms, infection |
Labs = should be used to rule out endocrine or metabolic causes (glucose, vitamin B12, thyroid hormones, electrolytes) Radiology = CT or MRI of head may be useful for detecting cortical infarcts Treatment = Treat underlying cause in rare cases of reversibility (e.g., metabolic, endocrine, infectious causes) Cholinesterase inhibitors (e.g., tacrine, donepezil, rivastigmine) and memantine help to optimize remaining cognitive function; vitamin E supplementation may also help maintain cognitive function Occupational therapy and cognitive psychotherapy is helpful for extending independence, maximizing function, and preventing accidents Eventually, patient frequently require supervised care Antipsychotics can be used to treat symptoms of psychosis; antidepressants can be used to treat associated depression Frequent reorientation of patient may help optimize function Do not use benzodiazepines or anticholinergics in the treatment of delirium- or dementia-related agitation because they can worsen symptoms. |
|
H/P =
Inattention: decreased attention span, difficulty following instructions, carelessness in tasks, easily losing items, forgetful, poor listening, easy distractibility, difficulty organizing activity, avoidance of tasks requiring prolonged focus Hyperactivity: fidgetiness, inappropriate activity, excessive talking, unable to remain quiet, unable to remain seated at times when prolonged sitting is required, constantly “on the go” Impulsivity: difficulty waiting turn to speak, interrupts others, answers questions before they are completed |
Attention-deficit hyperactivity disorder (ADHD)
Disorder of inattention and hyperactivity in school-age children that causes problems both at home and at school Risk factors = four-times more common in males than females |
Treatment = Psychostimulants (e.g., methylphenidate, pemoline) or atomoxetine improve ability to focus and control behavior Bupropion, α-agonists, and TCAs are used in refractory cases Psychotherapy used to address child's self-esteem and help modify behavior Adjustments may need to be made in selecting an educational setting to optimize ability to learn and participate Limit consumption of food high in caffeine or sugar |
|
H/P = aggressive behavior to people or animals, destruction of property, deceitfulness or theft, violation of serious rules; diagnosis requires one of above behaviors before <10 yr of age and three behaviors >10 yr of age
|
Conduct disorder
Repetitive disruptive and antisocial behavior that violates others' rights and social norms Complications = increased risk of substance abuse, antisocial personality disorder Oppositional defiant disorder is similar to conduct disorder in that patients exhibit aggressive behavior, but illegal and destructive activity does not occur. |
Treatment = psychotherapy involving family and parent management training; psychostimulants are helpful when comorbid ADHD is diagnosed; mood stabilizers may be used in severe cases |
|
H/P = multiple motor (e.g., blinking, twitching, etc.) and vocal (e.g., sounds, words) tics that occur every day and worsen with stress; location, frequency, and severity of tics change over time; diagnosis requires presence of tics for >1 yr and beginning before patient is 21 yr of age
|
Tourette's syndrome
Chronic tic disorder beginning in childhood; associated with ADHD and OCD Coprolalia (vocal tics of repeated obscenities) is only seen in a minority (40%) of cases of Tourette's syndrome. Tics typically diminish during sleep and focused activity. |
Treatment = psychotherapy with family addressing nature of tics; low-dose fluphenazine, pimozide, or tetrabenazine may reduce tic occurrence; SSRIs are useful in treating comorbid behavioral disorders |
|
H/P =
Child demonstrating otherwise normal intelligence with delays in certain academic goals Child frequently has poor self-esteem Disabilities can include language delays, impaired coordination, poor memory, inattentiveness, spatial or temporal ordering skills |
Learning disabilities
Impairment in educational development in a healthy child with no other psychiatric diagnosis or cognitive pathology (e.g., Down syndrome, fragile X syndrome) Disorder can be specific to ability to read, perform mathematics, or express thoughts |
Labs = scores on standardized tests are consistently lower than normal range Treatment = special education and therapy focusing on the specific learning disorder can help the child to improve his or her ability to learn; parent education; child's strengths should be recognized and encouraged Auditory and visual pathologies must be ruled out in a patient suspected for having a learning disorder. |
|
H/P =
Impaired social interactions: impaired used of nonverbal behaviors, failure to develop peer relationships, failure to seek social interaction, lack of social reciprocity Impaired communication: developmental language delays, poor initiation or sustenance of conversation, repetitive language, lack of imaginative or imitative play for age Restricted behavior: inflexible routines, preoccupation with a restricted pattern of interest, repetitive motor mannerisms, preoccupation with parts of objects Delays in language, imaginative play, and social interaction <3 yr of age Diagnosis requires at least six abnormal patterns of interpersonal interactions, including at least two impaired social interactions and at least one of both impaired communication and restricted behavior |
Autism
Severe, persistent impairment in interpersonal interactions, communication, and social activities; can be associated with mental retardation and schizophrenia |
Labs = metabolic and genetic analyses should be performed to rule out a medical cause of behavior Treatment = Behavior, speech, and social psychotherapy with peers and family may help improve social interaction Aggressive behavior can be treated with antipsychotics Supervised environment is usually required long term |
|
? Intoxication
Decreased inhibition, slurred speech, impaired coordination, inattentiveness, decreased consciousness, retrograde amnesia |
Alcohol
|
Supplemental nutrition, supportive psychotherapy or group counseling (Alcoholics Anonymous, etc.), naltrexone decreases cravings, disulfiram causes unpleasant nausea and vomiting if taken before alcohol consumption, benzodiazepines prevent delirium tremens during withdrawal |
|
? Intoxication
Hyperactivity, psychomotor agitation, pupillary dilation, tachycardia, HTN, psychosis |
Amphetamines (methamphetamine, methylphenidate, etc.)
|
Rehabilitative counseling, antipsychotics, benzodiazepines |
|
? Intoxication
Sedation, amnesia, slurred speech, decreased coordination |
Benzodiazepines (alprazolam, etc.)
|
Rehabilitative counseling, anticonvulsants |
|
? Intoxication
Insomnia, restlessness, tremor, anxiety, tachycardia |
Caffeine
|
Gradual reduction in usage |
|
? Intoxication
Euphoria, tachycardia, psychomotor agitation, pupillary dilation, hypertension, paranoia, grandiosity |
Cocaine
|
Reduction of hypertension, antipsychotics, benzodiazepines, rehabilitative counseling |
|
? Intoxication
Hallucinations, delusions, anxiety, paranoia, tachycardia, pupillary dilation, tremors |
Hallucinogens (LSD, mescaline, ketamine)
|
Remove patient from dangerous environment until intoxication resolves, antipsychotics |
|
? Intoxication
Euphoria, paranoia, psychomotor retardation, impaired judgment, increased appetite, conjunctival injection, dry mouth |
Marijuana
|
Rehabilitative counseling, antipsychotics |
|
? Intoxication
Restlessness, nausea, vomiting, abdominal pain |
Nicotine (and other substances found in tobacco and cigarettes)
|
Rehabilitative counseling, cutaneous (patch) or mucosal (gum) nicotine administration to reduce cravings for cigarettes, hypnosis, bupropion |
|
? Intoxication
Euphoria, slurred speech, pupillary constriction, inattentiveness, decreased consciousness, respiratory depression |
Opioids
|
Methadone therapy, inpatient rehabilitative counseling, naltrexone may prevent euphoria with use; naloxone is opioid antagonist used for acute overdose with significant respiratory depression |
|
? Intoxication
Euphoria, impulsiveness, aggressive behavior, nystagmus (vertical and horizontal), hyperreflexia |
Phencyclidine (PCP)
|
Isolated containment until after resolution of intoxication, benzodiazepines, antipsychotics, ascorbic acid |
|
? Withdrawal
Diaphoresis, tachycardia, anxiety, nausea, vomiting, tremor, delirium tremens (seizures, delirium) |
Alcohol
|
Supplemental nutrition, supportive psychotherapy or group counseling (Alcoholics Anonymous, etc.), naltrexone decreases cravings, disulfiram causes unpleasant nausea and vomiting if taken before alcohol consumption, benzodiazepines prevent delirium tremens during withdrawal |
|
? Withdrawal
Anxiety, depression, increased appetite, fatigue |
Amphetamines (methamphetamine, methylphenidate, etc.)
|
Rehabilitative counseling, antipsychotics, benzodiazepines |
|
? Withdrawal
Anxiety, insomnia, tremor, seizures |
Benzodiazepines (alprazolam, etc.)
|
Rehabilitative counseling, anticonvulsants |
|
? Withdrawal
Headaches, fatigue, inattentiveness |
Caffeine
|
Gradual reduction in usage |
|
? Withdrawal
Sedation, depression, psychomotor retardation, fatigue, anhedonia |
Cocaine
|
Reduction of hypertension, antipsychotics, benzodiazepines, rehabilitative counseling |
|
? Withdrawal
Minimal |
Hallucinogens (LSD, mescaline, ketamine)
|
Remove patient from dangerous environment until intoxication resolves, antipsychotics |
|
? Withdrawal
Irritability, depression, insomnia, nausea, tremor |
Marijuana
|
Rehabilitative counseling, antipsychotics |
|
? Withdrawal
Insomnia, weight gain, irritability, inability to concentrate, nervousness, headaches |
Nicotine (and other substances found in tobacco and cigarettes)
|
Rehabilitative counseling, cutaneous (patch) or mucosal (gum) nicotine administration to reduce cravings for cigarettes, hypnosis, bupropion |
|
? Withdrawal
Depression, anxiety, stomach cramps, nausea, vomiting, diarrhea, myalgias |
Opioids
|
Methadone therapy, inpatient rehabilitative counseling, naltrexone may prevent euphoria with use; naloxone is opioid antagonist used for acute overdose with significant respiratory depression |
|
? Withdrawal
Sudden violent behavior, variable levels of consciousness |
Phencyclidine (PCP)
|
Isolated containment until after resolution of intoxication, benzodiazepines, antipsychotics, ascorbic acid |
|
? Complications of Chronic Use
Malnutrition (vitamin B12, thiamine), encephalopathy (Wernicke-Korsakoff), accidents, suicide, cirrhosis, GI bleeding; higher incidence of abuse in patients with other psychiatric disorders |
Alcohol
|
Treatment Supplemental nutrition, supportive psychotherapy or group counseling (Alcoholics Anonymous, etc.), naltrexone decreases cravings, disulfiram causes unpleasant nausea and vomiting if taken before alcohol consumption, benzodiazepines prevent delirium tremens during withdrawal |
|
? Complications of Chronic Use
Psychosis, depression, fatigue, Parkinsonian symptoms |
Amphetamines (methamphetamine, methylphenidate, etc.)
|
Treatment Rehabilitative counseling, antipsychotics, benzodiazepines |
|
? Complications of Chronic Use
Memory loss |
Benzodiazepines (alprazolam, etc.)
|
Treatment Rehabilitative counseling, anticonvulsants |
|
? Complications of Chronic Use
GI irritation, fatigue, inattentiveness |
Caffeine
|
Treatment Gradual reduction in usage |
|
? Complications of Chronic Use
Arrhythmias, sudden cardiac death, stroke, suicidal ideation, inattentiveness |
Cocaine
|
Treatment Reduction of hypertension, antipsychotics, benzodiazepines, rehabilitative counseling |
|
? Complications of Chronic Use
Psychosis, “flashbacks” |
Hallucinogens (LSD, mescaline, ketamine)
|
Treatment Remove patient from dangerous environment until intoxication resolves, antipsychotics |
|
? Complications of Chronic Use
Amotivational syndrome, infertility, depression, psychosis |
Marijuana
|
Treatment Rehabilitative counseling, antipsychotics |
|
? Complications of Chronic Use
Cancer (many different forms), COPD, increased respiratory infections, ischemic heart disease |
Nicotine (and other substances found in tobacco and cigarettes)
|
Treatment Rehabilitative counseling, cutaneous (patch) or mucosal (gum) nicotine administration to reduce cravings for cigarettes, hypnosis, bupropion |
|
? Complications of Chronic Use
Constipation, increased risk of blood-borne infection with IV drug use |
Opioids
|
Treatment Methadone therapy, inpatient rehabilitative counseling, naltrexone may prevent euphoria with use; naloxone is opioid antagonist used for acute overdose with significant respiratory depression |
|
? Complications of Chronic Use
Psychosis, memory deficits, impaired cognitive function, inability to retrieve words |
Phencyclidine (PCP)
|
Treatment Isolated containment until after resolution of intoxication, benzodiazepines, antipsychotics, ascorbic acid |
