ANXIETY INTERMITTENT - EXPLOSIVE

Inappropriate often violent

GAD (inappropriate to stressor)
6months, 3 of (irritab, muscle They feel better after doing
tension, restless, easily fatigue, act.
difficulty sleeping or concentrating) Tx. SSRI > Mood
Tx. Psychother!!! > pills stabilizers. and Group
control state with SSRI (if u are to Therapy
use pills PYROMANIA
PHOBIA Acts to v Anxiety or
SPECIFIC Pleasure (sexual arousal
CBT even).
Flooding (pills to r/o Arson
control anxiety) ** if you set fire for
Desensitation (pills revenge, its Intermittent
to control anxiety) explosive! not pyromania!
SOCIAL (its not pleasure or stress
CBT reducing)
B-Blockers! no real treatment > Jail
KLEPTOMANIA (mostly women)
PANIC ATTACKS Act to reduce anxiety
Palpitations (similar to OCD) linked to
abd pain/ distress Bulimia!
nausea Sees object = anxiety
intese fear of death Steels object= v anxiety
chest pain/tightness Dx. r/o theft!!
profound dyspnea Kleptos usually steel the
#1 r/o medical conditions: same object
(if hx of P.attacks unknown) Tx: SSRI, then CBT
ECG + troponin Trichotilomania (mostly women)
Asthma pulls out hair (v anxiety)
TSH (hyperthy) r/o fungus (KOH)
Drugs (spec r/o Allopecia
cocaine) Tx. SSRI
if hx of P.attacks known: f/u: Bezoar (abd pain) do KUB (eats
( F 20yr (no med hair, clogs bowel)
conditions))
#1 ABORT- Benzos MOOD DISORDERS
#2 CONTROL- MAYOR DEPRESSION causes loss of
SSRI!! > functioning.
psychothe(may Dx:
improve SSRI) Depressed mood or
f/u Agoraphobia loss of interest
OCD + Suicide or 4 of
OBSESSION= thought (provoke symptoms below
anxiety) Sleep,Guilt,
COMPULSIONS= action (reduce Energy,
anxiety) Concent,
TX. SSRI! or Clomipramine (tca) > Appetite/w
Desensitation eight,
PTSD psychomot
* life threatning event (seen, or or.
experienced) TYPICAL:
1-Anhedonia LESS of all,
2-hypervilance except
3-avoidance Guilt
4- Flashbacks (daydreams, typical is a shorter word, so
nightmares) is less.
> 1 month ATYPICAL
< 1 month = Acute stress Same but
disorder sleep,
Psychotherapy!!!! >SSRI (to help appetite
with anxiety) Dx. do all bellow!
TYPICAL=
IMPULSE CONTROL SSRI
 ATYPICAL=
SNRI
Therapy
very
helpful!
Best=
ECT!!
(amnesia/st
igma)
f/u hypoth, rheuma,
anemia, chronic
pain
DYSTHYMIA
no loss of function
Dx. r/o suicide and mayor
depressive
Tx. SSRI
ADJUSTMENT DISORDER:
within 3mo of stressor, lasting no
more than 6mo after stressor ends
^anxiety or ^depression or
^disturbed behavior.
If the full criteria of MDD is met, it
is NOT adjustment dis
MANIC DISORDERS
BIPOLAR
Type1: Mania
Type2: Hypomania +Mayor
Depress
Mania: DIG FAST
(Distractable, Insomnia,
Grandiosity, flight of
ideas, agitated, sexual
exploits, talkative
(extremely))
Tx of Mania: Mood
stabilizers (
Lithium best! if not
lamotrigine,
valproate
CYCLOTHYMIA (variant of Bipolar)
(no funct loss)
Hypomania + dysthymia +
NO loss of funct! (super
productive)
Dx. r/o bipolar
Tx. Mood stabilizers
SCHIZOPHRENIA
Prodromal become socially
withdrawn and irritable. May have
physical complaints and/or
newfound interest in religion or the
occult.
Psychoticperceptual
disturbances, delusions, and
disordered thought process/content
1month
ResidualIt is marked by flat
affect, social withdrawal, and odd
thinking or behavior (negative
symptoms). Patients can continue
to have hallucinations even with
treatment.
The 3 phases must total to 6m.
Two or more of the following must be
present 1month: 1. Delusions2.
Hallucinations 3. Disorganized speech 4.
Grossly disorganized or catatonic behavior
5. Negative symptoms (such as flattened
affect)
CT scan of the head- shows enlargement of
ventricles and diffuse cortical atrophy.
Schizophrenics usually have good memory
and orientation!!
concrete understanding of proverbs
Better prognosis:
presence of more positive
symptoms
Acute onset
Worse prognosis
more negative symptoms
gradual onset
family hx
antipsychotic meds = neuroleptics!!
R Schizotypal
(personality disorder)paranoid,
odd or magical beliefs, eccentric,
lack of friends, social anxiety.
Criteria for true psychosis are not
met. Schizoid(personalitydisorder)
-withdrawn, lack of enjoyment from
social interactions, emotionally
restricted
DILUSION
A firm belief that is false but
plausible (non-bizarre) does not
affect functioning.
Seen more in 40yrs, immigrants
and hearing impaired.
EATING DISORDERS
ANOREXIA:
Can have binge and
vomiting, but WILL always
have low body weight
(15% below normal)
Can be treated as
outpatients unless >20%
below ideal weight
Tx. Behavioral and family
therapy and supervised
weight programs.
Antidepressants that
hunger (paroxetine,
mirtazapine) can help.
BULIMIA NERVOSA
have normal body weight
Their symptoms are ego-
dystonic(distressing)
binge/compensate cycle
must occur 2 times a week,
for 3 months.
 Tx. psychotherapy and
SSRI
DEATH
Grief vs depression:
Grief does NOT have
Suicide ideas
Grief symptoms come and
go, are not persistent
no impaired fxn (so no
need for SSRI)
Grief lasts <1yr. although
usually <2mo
both have psychotic
features (hearing, seeing
the departed)
Grief usually has
insight, know its
impossible.
Depression- can
have conversations
with departed. no
insight.
Depression:
persistent,
+suicide, >1yr,
impaired fxn (need
SSRI)
depression should be tx
quickly cause it wont get
better and can lead to
suicide.
POST-PARTUM
BABY BLUES: Benzo intox give flumazenil
sad, but cares about baby,
w/2weeks.
Tx. reassurance
PP DEPRESSION:
does not care about baby,
will neglect, but not
actively injure. w/1mo
Tx. needs treatment!
PP PSychosis
Fear of baby, baby will hurt
me so I must kill it!!.
w/1mo
Tx. mood stabilizers(if
mayor depressive is
predominant),
antipsychotics (for
psychotic features)
ADDICTION:
Abuse: using drug inappropriately
Dependence
ALCOHOL:
Intoxication:
give Naloxone, Thiamine, D50
(glucose) (must give thiamine for
the Glucose to be used!!)
Withdrawal:
HTN + Tachycardia (1st sign)
Anxious
DX. Benzodiazepines taper, then
prn Benzos
Wiernickes: reversible
Korsakoffs= irreversible
Dx. Group therapy!
Excited