Name the 5 axis
1. Axis I- Clinical Disorders
2. Axis II- Personality Disorders/ Mental retardation
3. Axis III- General Medical conditions
4. Axis IV- Psychosocial and environmental problems
5. Axis V: Global assessment of functioning
examples of Axis I
depression, anxiety, bipolar, ADHD, autism, schizophrenia
examples of axis II
all the personality disorders and mental retardation
examples of axis III
pain, hyperthyroidism, brain injuries, UTI, stroke
examples of axis IV
social issues, educational problems, financial difficulties, death
For GAD, how must symptoms last?
at least 6 months
Treatment for GAD
self help, CBT (long term benefits), SSRI, benzodiazepines (for short term only)
Treatment of choice for panic disorder
CBT. SSRI for pharmacological option
Fear of public places or having a panic attack in a place with no escape such as in public
Treatment for agoraphobia
CBT, SSRI, benzodiazepines, MAOI, TCA
Treatment for OCD
-Behavioral treatment known as exposure and ritual prevention (ERP). Involves learning to tolerate the anxiety associated with not performing the ritual. Combine this therapy with a medication (SSRI, benzodiazepine)
- ECT used for severe cases
-Psychosurgery (last resort)
What are the PTSD criteria?
Symptoms must last more than 1 month and cause significant impairment in social, occupational, and other areas of functioning.
Treatment for PTSD
-CBT (standard of care), EMDR, exposure to reminders of trauma, SSRI, benzodiazepines, MAOI, TCA
- use psychotherapy and medications
What is the primary purpose of EMDR?
to treat PTSD
Barbiturates, benzodiazepines, GHB, rohypnol, quaalude
LSD, Mushroom, Mescaline
Codeine, heroin, morphine, opium, oxycodone, hydrocodone
amphetamine, cocaine, MDMA, methamphetamine, nicotine, ritalin
Delirium tremens characteristics
Body tremors and ALOC 72 hours after last drink. Medical emergency
Thiamine deficiency issues due to alcohol
Wernicke's encephalopathy and Korsakoff's syndrome
Wernicke's encephalopathy triad
confusion, ataxia, and ophthalmoplegia. (often reversible)
Korsakoff's syndrome presentation
When persistent learning and memory deficits are present also. (usually irreversible)
medication to reduce EtOH and opiate cravings
Counteracts life threatening CNS depression from opoid overdose
Leading cause of disability ages 5 and over
What is melancholic depression?
loss of pleasure in most or all activities
What is atypical depression?
mood reactivity and positivity. weight gain, too much sleep, and heaviness in limbs (leaden paralysis), social impairment
What is catatonic depression?
depression involving disturbances of motor behavior
What is seasonal affective disorder?
depression associated with the seasons
What is major depression?
depression in people who have no ability to cheer themselves up
What is unipolar depression?
Depression with no manic episode.
What is primary depression?
Depression alone with no other medical illness / disorder.
What is the biological cause of depression?
Low levels of monoamines
inhibiting serotonin and norepinephrine re-uptake rate
there are food restrictions
it is a NDRI and blocks norepinephrine and dopamine
Depression assessment dimensions
Physical, functional, intrapersonal, interpersonal, spiritual care
Triggers of bipolar
stressful situation, heredity, substance abuse, other
Bipolar I characteristics
Long episodes of mania and depression. Suicide is high
Bipolar II characteristics
Hypomanic and depressive episodes. Less severe. People usually only seek treatment for the depression
irregular short cycles of depression and hypomania
bipolar NOS characteristics
some symptoms of bipolar disorder but doesn't in any category
What is rapid cycling?
At least 4 cycles completed in a 12 month period. Cycles can be completed in days
Cause of bipolar late in life?
stress or substance abuse
Treatment for bipolar disorder
-First choice antidepressant is Zoloft or Wellbutrin
-Lithium (mood stabilizer). Don't use lithium when you have cardio, renal, or brain damage and debilitation, dehydration, or sodium depletions.
- Anticonvulsants, Anti-psychotics
- ECT for severe manic depression (very effective)
Most used medication for depression in children and teens and the name?
SSRI's, fluoxetine is the only SSRI approved for use in children
Mood stabilizer of choice for bipolar in teens
Lithium. Requires thyroid supplements
Loosening of associations
A disturbance of thinking shown by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first.
a new word or condensed combination of several words coined by a person to express a highly complex idea not readily understood by others
Imitation of a heard phrase, word or word fragment is characteristic of mental disorders such as Tic Disorders, Dementia, and catatonic disorders
imitation of movements associated with catatonic schizophrenia
A sudden obstruction or interruption in spontaneous flow of thinking or speaking, perceived as an absence or deprivation of thought
The delusion that certain of one's thoughts are not one's own, but rather are inserted into one's mind.
The delusion that one's thoughts are being broadcast out loud so that they can be perceived by others
is the delusion that thoughts have been 'taken out' of the patient's mind
Blunted/ flat affect
range of affective expression is reduced
excessive, purposeless movement or rigidity in some cases
state on unresponsiveness in the case of brain injury
(involuntary, repetitive movements) manifesting as a side effect of long-term or high-dose use of dopamine antagonists, usually antipsychotics
state of motor restlessness ranging from a feeling of inner disquiet to inability to sit still or lie quietly.
A neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures
spasm of eyeballs in a fixed position, usually upward
Neuroleptic malignant syndrome
is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic instability and cognitive changes such as delirium
What is process schizophrenia?
chronic and progessive organic brain changes are the cause of schizo. Prognosis is poor and process is gradual
What is reactive schizophrenia?
caused by environmental factors. Onset is rapid
Phases of schizophrenia and characteristics
-Prodromal- losing interest in usual pursuits and withdrawal from friends. May not develop further
-Active- experiencing hallucinations and delusions
- Residual- similar to prodromal
What is schizophrenia disorganized type?
Schizophrenia where all criteria are met
- flat effect
-criteria for catatonic type not met
What is catatonic schizophrenia?
-excessive motor activity
- peculiar voluntary movement
- echolalia or echopraxia
What is schizophrenia paranoid type?
-preoccupation with delusions or hallucinations
-no disorganization, flat effect, or catatonia
What is schizophreniform disorder?
- criteria A met
- schizoaffective disorder and mood disorder ruled out
- substance abuse ruled out
- last at least 1 month but not 6 months
What is schizophrenia residual type?
- no delusions, hallucinations, disorganization of speech or behavior, catatonic behavior
- odd beliefs, unusual perceptual experiences
What is schizoaffective disorder?
- uninterrupted period of illness with major depression, mania, mixed episodes with criterion A
- not due to substance
- meet criteria for mood episodes for the majority of duration
- specify if it is a bipolar type or depressive type
What is schizophrenia undifferentiated?
-meets criterion A but none of the other schizophrenia criteria
What is criterion A for schizophrenia?
- disorganized speech
- catatonic/ disorganized behavior
- negative symptoms
What is delusional disorder?
- nonbizarre delusion of at least 1 month
- does not meet criterion A
- functioning not impaired
What is brief psychotic disorder?
- At least 1 symptom of criterion A but lasts less than 1 month
What are the codes for delusions and hallucinations?
- 293.XX due to (Medical condition)
-Delusions .81 if dominant symptom
- hallucinations .82 in dominant symptom
Genes that increase risk of schizophrenia?
DISC1, dysbindin, neuroreglin, G72
What neurotranmitter is associated with schizophrenia?
What are the side effects of antipsychotics?
tardive dyskinesia, akathisia, dystonia, oculogyric crisis, neuroleptic malignant syndrome