1. Depression description
    Mood state characterized by diminished interestin normal activity, fatigue, feelings of sadness and impaired concentrationnearly every day.
  2. Dysthymia description
    chronic depression – at least 2 or more years.  Most common psychiatric disorder
  3. 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. 
  4. 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
  5. Dysthymia labs
    TSH r/o hypothyroidism, BMP, CBC, LFTs UA, VDRL,B12
  6. 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).
  7. Medications for chronic depression
    SSRI, Tricyclics, MAOIs
  8. SSRIs
    most commonly prescribed (paxil, prozac, zoloft,celexa, luvox) d/t low overdose danger, fast sx response, no posturalhypotension
  9. Tricyclics
    Trycyclics cause anticholinergic effects = dry mouth, constipation

    increased side effects and high overdose potential 
  10. MAOIs
    wine+cheese = hypertensive crisis

    increased side effects and high overdose potential
  11. Anxiety description
    Anxiety – unpleasant feeling of dread, apprehension, tension resulting from unexpected threat to one’s own feeling of self esteem or well being.
  12. anxiety
    emotionally learned response to stress (cognitive behavioral therapy works well).
  13. Generalized anxiety disorder
    excessive worries re: life circumstances
  14. Panic disorder
    morbid dread of harmlessobjects/situations.  May lead toagoraphobia
  15. Obsessive/compulsive disorder
    repetitive thoughts (obsessions) and behaviors (compulsions)
  16. 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
  17. Anxiety workup
    r/o hyperthyroid, serum drug analyses, glucose, ECG (normal)
  18. 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
  19. 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.
  20. Suicide risk factors
    “suicidal” - Sex, Unsuccessful attempts, Identified family hx, chronic illness, depression,drug abuse, drinking, age of patient, lethalmethod available
  21. 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
  22. Alcoholism
    10% of population, ETOH = most common drug intoxicant, cause= genetics, alterations in opiate receptors, neurotransmitter alterations, psychosocial
  23. 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)?
  24. Alcoholism treatment
    be direct with patient – I’m concerned about alcoholism, tell pt disease is treatable, refer to alcohol anonymous
  25. Mini Mental Status exam
    -what does it test?
    Cerebral function
  26. 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
  27. Mini Mental Status exam
    • maximum=30,
    • no cognitive impairment  24-30 (avg-27), delirium/dementia 18-23
    • mild (0-7 severe) 
  28. Delerium
    sudden, transient onset of cloudedsensorium.  Any age, often associated witha physical stressor
  29. Dementia
    gradual mmemory loss, decreased intellectualfunction over age 60.  Alzheimers – mostcommon cause.
  30. Dementia causes
    Drugs,emotional disorders, metabolic/endocrine, eye/ear disorders, nutrition, tumors, infection,arteriosclerosis
  31. Aphasia
    difficulty with speech
  32. Apraxia
    inability to perform a previously learned task
  33. Agnosia
    inability to recognize an object (paper clip) – test with sterognosis
  34. 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
  35. alzheimers earliest complaint
  36. Alzheimers diagnostics
    r/o other causes: CBC, electrolytes, glucose,BUN, CT, LFTs, B12, VDRL, CT/MRI to r/o tumors
  37. 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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