Generalized Anxiety Disorder (GAD):
Presentation:
- Excessive worry, feelings of apprehension, panic or dread regarding general life events
accompanied by physiologic arousal
- Symptoms persist for at least 6 months, occurring most days
- Person reports little control of symptoms
- Impairs social, occupa
Generalized Anxiety Disorder (GAD):
Diagnosis and Treatment -
Diagnosis:
- R/O physical cause (hyperthyroidism, stimulant abuse, caffeine, drug/alcohol withdrawal/abuse, cardiac arrhythmias)
- At least 3 of the following:
- Restlessness
- Hypervigilance
- Easy fatigability
- Irritability
- Sleep disturbance
- Muscle
Panic Disorder:
- Characterized by recurrent, unexpected panic attacks
- Panic Attack= period of extreme anxiety usually peaking within 10 minutes and rarely lasts more than 1 hour
- May have a trigger
- Physical symptoms of impending doom
Presentation:
- Can present at
Obsessive Compulsive Disorder (OCD)
- Irrational idea or impulse intrudes into awareness
- Obsessions
- Constantly recurring thoughts
- Compulsions
- Repetitive actions
- Anxiety
- Alleviated by ritualistic performance of the
repetitive actions
- Affects 2-3% of the population
Presentation
Post Traumatic Stress Disorder (PTSD)
- Complex neuropsychological syndrome that results in dysfunction of the prefrontal
cortex and the amygdala and neurotransmitters (dysfunction
affecting fear and memory)
- May have a genetic component
- Begins with exposure to a severely traumatic event o
List 4 Mood Disorders:
- Grief/Bereavement
- Depression
- Bipolar Disorder
- Acute Suicide Risk
List 4 Anxiety & Stress Disorders:
- Generalized Anxiety Disorder
- Panic Attacks/Panic Disorder
- Obsessive-Compulsive Disorder
- PTSD
Grief/Bereavement:
- The human response to the loss of a loved one
- Both emotional & physiological response Impairs immune response
- Mourning - The normal, healthy process of resolving the grief
- Bereavement: The state of mourning
- In 2003, 3 million Americans died, lea
Depression:
Types of Major Depression
- Major Depression with atypical features
- Major Depression with seasonal onset
- Major Depression with postpartum onset
- A complex mood disorder lasting at least 2 weeks, with a sad mood and/or a loss of interest in pleasurabl
Name 3 Types of Major Depression:
- Major Depression with atypical features
- Major Depression with seasonal onset
- Major Depression with postpartum onset
Bipolar Disorder:
- Recurrent mood disorder featuring one or more episodes of mania, hypomania, or a mixed episodes of mania & depression
- Occurs along a spectrum
- BD1 One episode of mania w/ or w/o
depression
- BD2 Recurrent depression and hypomania - Cyclothymic
- Depr
Acute Suicide Risk
- Self-inflicted death
- 30,000 Americans commit suicide yearly; 11th leading cause of death; 4th leading cause of death for adolescents
- 50% of suicides males 25-65
Risk Factors:
- Single, widowed, white or native
- American male, living alone, adolesce
Psychotic Disorders:
Many types:
- Schizophrenia, Mania with psychosis, Schizoaffective disorder
- Basically disturbances of thought which results in a departure from reality; delusions/hallucinations
- It is NOT delirium (which usually has a physical source)
- We will focus
List 3 types of Psychotic Disorders:
- Schizophrenia
- Mania with psychosis
- Schizoaffective disorder
Substance Abuse:
- Addiction is repeated, chronic behaviors despite negative consequences
- Can be taking any substance (legal or
illegal) or repeating negative behaviors
(gambling, shopping, eating,
hypersexuality)
- Use Sporadically taking a substance with no adverse co
Addiction:
- Chronic illness characterized by craving, inability to control use, compulsive use, and use despite negative consequences
Pathophysiology:
- Use dysregulates neurotransmitters (GABA & dopamine) and affects the mesolimbic pathway:
- Limbic system affects
Tobacco Use Disorder:
- Nicotine stimulates release of dopamine; giving relaxation & stimulation
- Half life 2 hours
- Withdrawal: Starts in 2 hours, peaks at 48 hrs, lasts weeks
Symptoms:
- Severe cravings, irritability, decreased
concentration, drowsiness, insomnia,
decrease
Alcoholism
- Genetic/familial link
- Younger you start, more likely it becomes
problem
- Maladaptive behavior
- ETOH = CNS depressant
- Alcohol intoxication worsens as the rate of
consumption increases
- Insidious disease
- Causes: HTN, cardiomyopathy, afib,
dyslipi
Opiate Abuse:
- This includes legally and illegally obtained opiates such as oxycodone, hydrocodone,
fentanyl and illegal opiates such as heroin
- HUGE problem here in Florida;
resulting in a very strict drug laws
- Assess for symptoms of abuse
Presentation of Opiate M
____ 1. The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety?
a. Acetylcholine
b. Gamma-aminobutyric acid (GABA)
c. Dopamine
d. Serotonin
b. Gamma-aminobutyric acid (GABA)
(Dunphy CH 18)
____ 2. The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more d
c. 6 months
(Dunphy CH 18)
____ 3. A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and
d. All of the above
(Dunphy CH 18)
____ 4. Which of the following is considered first-line treatment for panic disorders?
a. Benzodiazepines
b. Selective serotonin reuptake inhibitors (SSRIs)
c. Tricyclic antidepressants
d. Cognitive behavioral therapy
(Dunphy CH 18)
____ 5. Which of the following symptoms is not part of the diagnostic criteria for post-traumatic stress disorder (PTSD)?
a. Hypersomnolence
b. Blunted feelings
c. Loss of interest in significant activities
d. Intrusive recurrent recollections of the even
a. Hypersomnolence
(Dunphy CH 18)
____ 6. Which of the following neuroendocrine abnormalities is implicated in depression?
a. Decrease in adrenal size
b. Increased cortisol and corticotrophin-releasing hormone
c. An exaggerated response of thyrotropin (TRH) to infusion of thyroid-releasin
b. Increased cortisol and corticotrophin-releasing hormone
(Dunphy CH 18)
____ 7. The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants?
a. SSRIs are more effective than TCAs
(Dunphy CH 18)
____ 8. After discontinuing fluoxetine, how long must a person wait before starting a monoamine oxidase inhibitor?
a. 2 weeks
b. 3 weeks
c. 4 weeks
d. 5 weeks
d. 5 weeks
(Dunphy CH 18)
____ 9. It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period?
a. Before the initiation of treatment
b. 1 to 2 we
b. 1 to 2 weeks after the initiation of treatment
(Dunphy CH 18)
____ 10. A patient is experiencing extrapyramidal side effects from his antipsychotic medications. The clinician would most likely take which of the following approaches to treating these side effects?
a. Give the patient a "drug holiday" until the sympto
c. Treat the patient with anticholinergics.
(Dunphy CH 18)
____ 11. According to K�bler-Ross, the stages of grief occur in which order?
a. Anger, denial, depression, bargaining, acceptance
b. Anger, denial, bargaining, acceptance, depression
c. Denial, anger, depression, bargaining, acceptance
d. Denial, anger, b
d. Denial, anger, bargaining, depression, acceptance
(Dunphy CH 18)
____ 12. The clinician is educating a patient about the effects of marijuana. The patient stated she has been smoking for years and believes the use does not interfere with her life. What is a significant long-term sequelae of marijuana use that the clini
a. Memory impairment
(Dunphy CH 18)
____ 13. Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?
a. GABA
b. Acetylcholine
c. Dopamine
d. Serotonin
c. Dopamine
(Dunphy CH 18)
____ 14. What blood alcohol level corresponds with the signs of stupor and confusion?
a. 0.05
b. 0.1
c. 0.2
d. 0.3
d. 0.3
(Dunphy CH 18)
____ 15. Rapid eye movement (REM) sleep occurs how frequently during non-REM sleep?
a. Every 30 minutes
b. Every 60 minutes
c. Every 90 minutes
d. Every 180 minutes
c. Every 90 minutes
(Dunphy CH 18)
____ 16. Which of the following is a laboratory finding commonly found in patients with anorexia nervosa?
a. Hypercholesterolemia
b. Hypermagnesmia
c. Leukocytosis
d. Decreased TRH
a. Hypercholesterolemia
(Dunphy CH 18)
____ 17. Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration?
a. Sertraline
b. Fluoxetine
c. Citoprolam
d. Imipramine
b. Fluoxetine
(Dunphy CH 18)
____ 18. Which of the following would be important to monitor in a child receiving methylphenidate for treatment of attention deficit-hyperactivity disorder (ADHD)?
a. Liver function
b. Vision
c. Growth parameters
d. Renal function
c. Growth parameters
(Dunphy CH 18)
____ 19. It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the following is the most common long-term effect of sexual assault?
a. Depression
b. Obsessive-compulsive disorder
c. Substance abuse
d
d. PTSD
(Dunphy CH 18)
____ 20. Women are at the highest risk for developing postpartum depression for up to how long after childbirth?
a. 2 weeks
b. 1 month
c. 3 months
d. 6 months
d. 6 months
(Dunphy CH 18)
____ 21. Which is the most prevalent psychiatric condition in the United States?
a. Depression
b. Anxiety
c. Substance-related addictions
d. Gambling
b. Anxiety
(Dunphy CH 18)
____ 22. What is recorded as clinical category two of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision)?
a. Clinical disorder or focus of clinical attention
b. Personality or environm
c. Environmental and psychosocial stressors
(Dunphy CH 18)
____ 23. Which of the following may be used to evaluate a person's suicide risk?
a. CAGE
b. SANE
c. SAD PERSONAS
d. DIGFAST
c. SAD PERSONAS
(Dunphy CH 18)
____ 24. Assessing for adherence with prescribed medications and developing a plan for what to do if they are stopped is a major treatment issue for which of the following diagnostic groups?
a. ADHD
b. Bipolar
c. Depression
d. Anxiety
b. Bipolar
(Dunphy CH 18)
____ 25. Bipolar disorder requires differential diagnosis from all of the following except?
a. Substance abuse and medication effects
b. Medical and neurological disorders
c. Cluster B personality disorders and depression
d. Obsessive-compulsive disorder
d. Obsessive-compulsive disorder
(Dunphy CH 18)
True/False
Indicate whether the statement is true or false.
____ 1. The use of benzodiazepines in the patient with generalized anxiety disorder and comorbid depression can exacerbate depressive symptoms
TRUE
(Dunphy CH 18)
True/False
____ 2. Depressive episodes associated with bipolar disorder are treated the same as major depressive disorder.
False
(Dunphy CH 18)
true/false
____ 3. Women in abusive relationships have a greater chance of being killed by their batterers when they leave the relationship than women who stay.
True
(Dunphy CH 18)
True/False
____ 4. Adults must show childhood onset of symptoms to receive a diagnosis of ADHD.
true
(Dunphy CH 18)
____ 5. Parkinson's disease and dementing illnesses may commonly manifest depressive symptoms.
true
(Dunphy CH 18)
____ 6. The best predictor of suicide risk is a history of suicide attempts.
True
(Dunphy CH 18)
____ 7. A no-suicide contract can prevent a suicide attempt.
False
(Dunphy CH 18)
____ 8. Depression is the most chronic disabling and economically catastrophic medical disorder of the severe mental illnesses.
.
False
(Dunphy CH 18)
____ 9. Clozapine (Clozaril) requires laboratory monitoring at specified frequencies with results reported to a national registry.
True
(Dunphy CH 18)
____ 10. When combined with certain other medications, serotonin-specific antidepressants can have significant liver P450-interaction effects
True
(Dunphy CH 18)