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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= to have hallucinations even with
SNRI treatment.
Therapy The 3 phases must total to 6m.
very Two or more of the following must be
helpful! present 1month: 1. Delusions2.
Best= Hallucinations 3. Disorganized speech 4.
ECT!! Grossly disorganized or catatonic behavior
(amnesia/st 5. Negative symptoms (such as flattened
igma) affect)
f/u hypoth, rheuma,
anemia, chronic CT scan of the head- shows enlargement of
pain ventricles and diffuse cortical atrophy.
DYSTHYMIA Schizophrenics usually have good memory
no loss of function and orientation!!
Dx. r/o suicide and mayor concrete understanding of proverbs
depressive Better prognosis:
Tx. SSRI presence of more positive
symptoms
ADJUSTMENT DISORDER: Acute onset
within 3mo of stressor, lasting no Worse prognosis
more than 6mo after stressor ends more negative symptoms
^anxiety or ^depression or gradual onset
^disturbed behavior. family hx
If the full criteria of MDD is met, it antipsychotic meds = neuroleptics!!
is NOT adjustment dis
MANIC DISORDERS R Schizotypal
BIPOLAR (personality disorder)paranoid,
Type1: Mania odd or magical beliefs, eccentric,
Type2: Hypomania +Mayor lack of friends, social anxiety.
Depress Criteria for true psychosis are not
Mania: DIG FAST met. Schizoid(personalitydisorder)
(Distractable, Insomnia, -withdrawn, lack of enjoyment from
Grandiosity, flight of social interactions, emotionally
ideas, agitated, sexual restricted
exploits, talkative
(extremely)) DILUSION
Tx of Mania: Mood A firm belief that is false but
stabilizers ( plausible (non-bizarre) does not
Lithium best! if not affect functioning.
lamotrigine, Seen more in 40yrs, immigrants
valproate and hearing impaired.
CYCLOTHYMIA (variant of Bipolar)
(no funct loss) EATING DISORDERS
Hypomania + dysthymia + ANOREXIA:
NO loss of funct! (super Can have binge and
productive) vomiting, but WILL always
Dx. r/o bipolar have low body weight
Tx. Mood stabilizers (15% below normal)
Can be treated as
outpatients unless >20%
SCHIZOPHRENIA below ideal weight
Tx. Behavioral and family
Prodromal become socially therapy and supervised
withdrawn and irritable. May have weight programs.
physical complaints and/or Antidepressants that
newfound interest in religion or the hunger (paroxetine,
occult. mirtazapine) can help.
Psychoticperceptual BULIMIA NERVOSA
disturbances, delusions, and have normal body weight
disordered thought process/content Their symptoms are ego-
1month dystonic(distressing)
ResidualIt is marked by flat binge/compensate cycle
affect, social withdrawal, and odd must occur 2 times a week,
thinking or behavior (negative for 3 months.
symptoms). Patients can continue
Tx. psychotherapy and PP DEPRESSION:
SSRI does not care about baby,
will neglect, but not
DEATH actively injure. w/1mo
Grief vs depression: Tx. needs treatment!
Grief does NOT have PP PSychosis
Suicide ideas Fear of baby, baby will hurt
Grief symptoms come and me so I must kill it!!.
go, are not persistent w/1mo
no impaired fxn (so no Tx. mood stabilizers(if
need for SSRI) mayor depressive is
Grief lasts <1yr. although predominant),
usually <2mo antipsychotics (for
both have psychotic psychotic features)
features (hearing, seeing
the departed) ADDICTION:
Grief usually has
insight, know its Abuse: using drug inappropriately
impossible. Dependence
Depression- can
have conversations ALCOHOL:
with departed. no Intoxication:
insight. give Naloxone, Thiamine, D50
Depression: (glucose) (must give thiamine for
persistent, the Glucose to be used!!)
+suicide, >1yr, Withdrawal:
impaired fxn (need HTN + Tachycardia (1st sign)
SSRI) Anxious
depression should be tx DX. Benzodiazepines taper, then
quickly cause it wont get prn Benzos
better and can lead to Wiernickes: reversible
suicide. Korsakoffs= irreversible
Dx. Group therapy!
POST-PARTUM
BABY BLUES: Benzo intox give flumazenil
sad, but cares about baby,
w/2weeks. Excited
Tx. reassurance