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Depression description
Mood state characterized by diminished interestin normal activity, fatigue, feelings of sadness and impaired concentrationnearly every day.
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Dysthymia description
chronic depression – at least 2 or more years. Most common psychiatric disorder
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Dysthymia causes
(pshychodynamic, cognitive, biochemical) – anger directed inward, loss of self esteem. learned world view, negative belief systems, dysfunctional thinking, neurotransmitter imbalance (dopamine,norepinephrine, epinephrine), thyroid dysfunction, medication side effects.
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Dysthymia diagnosis
- To diagnose, must have one of the 1st two, and 5 or more of the following:
- *Depressed mood most of the day, nearly every day
- *Markedly diminished interest/pleasure in almost all activities (anhedonia)
- -Weight loss/gain (>5%)
- -Insomnia/hypersomnia
- -Psychomotor agitation/retardation
- -Fatigue/loss of energy
- -Lack of concentration/indecisiveness nearly every day
- -Excessive guilt or feelings of worthlessness·
- -Recurrent thoughts of death/suicide ideation without a plan or attempt
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Dysthymia labs
TSH r/o hypothyroidism, BMP, CBC, LFTs UA, VDRL,B12
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Therapeutic Treatment for chronic depression
May need to refer (ex:hallucination,delusions). Mild depression = therapeutic communication – encourageverbalization of feelings, fears, losses & cognitive errors inthinking. Categories of feelings (mad,sad, glad, afraid, ashamed). Supportstages of grief: Denial, anger, bargaining, depression, acceptance (DABDA).
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Medications for chronic depression
SSRI, Tricyclics, MAOIs
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SSRIs
most commonly prescribed (paxil, prozac, zoloft,celexa, luvox) d/t low overdose danger, fast sx response, no posturalhypotension
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Tricyclics
Trycyclics cause anticholinergic effects = dry mouth, constipation
increased side effects and high overdose potential
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MAOIs
wine+cheese = hypertensive crisis
increased side effects and high overdose potential
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Anxiety description
Anxiety – unpleasant feeling of dread, apprehension, tension resulting from unexpected threat to one’s own feeling of self esteem or well being.
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anxiety
emotionally learned response to stress (cognitive behavioral therapy works well).
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Generalized anxiety disorder
excessive worries re: life circumstances
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Panic disorder
morbid dread of harmlessobjects/situations. May lead toagoraphobia
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Obsessive/compulsive disorder
repetitive thoughts (obsessions) and behaviors (compulsions)
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Post traumatic stress disorder
for at least 6 months after a sever trauma/eventperceived as a threat to ones integrity. Sx= flashbacks, nightmares & intrusive thoughts
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Anxiety workup
r/o hyperthyroid, serum drug analyses, glucose, ECG (normal)
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Anxiety treatment
- Benzodiazepines – most commonly used (lorazepam, xanax)
- Antihistimines – for those with COPD or potential for abuse
- Beta blockers – reduces tachycardia, palpitations and breathlessness
- Trycyclics & MAOIs – beneficial for panic attacks, less effective for generalized anxiety
- Buspirone (buspar)–only antianxiety med that’s not a tranquilizer – takes 3-4 weeks to reach full therapeutic effect
- Assess coping mechanisms, therapeutic communication, relaxation, focus responsibility on the patient, Patient education: reassurance, medications, etc
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Suicide prevalence
most common in adolescents, elderly (>65) and white males >45 years old, hx of substance abuse. Hopelessness = a common predicting variable, men>women.
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Suicide risk factors
“suicidal” - Sex, Unsuccessful attempts, Identified family hx, chronic illness, depression,drug abuse, drinking, age of patient, lethalmethod available
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Suicide treatment
hospitalization with psychotherapy, antipsychotics – caution with low therapeutic medications (lithium) – expect weight gain in atypical antipsychotics. Elderly – interventions focus on loneliness & medical disability
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Alcoholism
-prevalence
-cause
10% of population, ETOH = most common drug intoxicant, cause= genetics, alterations in opiate receptors, neurotransmitter alterations, psychosocial
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what questions are included in the CAGE questionnaire
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
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Alcoholism treatment
be direct with patient – I’m concerned about alcoholism, tell pt disease is treatable, refer to alcohol anonymous
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Mini Mental Status exam
-what does it test?
Cerebral function
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Mini Mental Status exam
-components of exam?
- O orientation to place/time
- R recognition (repeat 3 objects
- A attention (serial 7s
- R recall 3 objects 5 minutes later
- L language
- 2 indentify names of 2 objects (clock and chair)
- 3 follow a 3-step command (take paper, fold in half, put on table)
- R reading (read statement to yourself & do what it says – do not say it out loud)
- W writing – write a sentence
- D drawing – copy a design
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Mini Mental Status exam
-Scoring
- maximum=30,
- no cognitive impairment 24-30 (avg-27), delirium/dementia 18-23
- mild (0-7 severe)
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Delerium
sudden, transient onset of cloudedsensorium. Any age, often associated witha physical stressor
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Dementia
gradual mmemory loss, decreased intellectualfunction over age 60. Alzheimers – mostcommon cause.
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Dementia causes
Drugs,emotional disorders, metabolic/endocrine, eye/ear disorders, nutrition, tumors, infection,arteriosclerosis
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Aphasia
difficulty with speech
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Apraxia
inability to perform a previously learned task
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Agnosia
inability to recognize an object (paper clip) – test with sterognosis
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Alzheimers description
- multiple cognitive effects with both memory impairment and 1 or more of the following: --Aphasia – difficulty with speech
- -Apraxia – inability to perform a previously learned task
- -Agnosia – inability to recognize an object (paper clip) – test with sterognosisInability to plan, organize, sequence and make abstract differences
- -Inability to plan, organize, sequence and make abstract differences
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alzheimers earliest complaint
forgetfulness
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Alzheimers diagnostics
r/o other causes: CBC, electrolytes, glucose,BUN, CT, LFTs, B12, VDRL, CT/MRI to r/o tumors
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Alzheimers treatment
neuro consult. Meds to increase availability of acetylcholine (acetylcholinesterase inhibitors) – aricept, razadyne, Exelon (prescribed w/ namenda to improve thinking and ADLs), refer family for counseling
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