Mental Disorders
Describe the characteristics of Intermittent Explosive Disorder (IED)
Rage is disproportionate to predicament at hand, unpremeditated and impulsive, majority are males, they later feel remorse, regret, and embarrassment
- Anger management included in treatment plan
What are some treatments for ODD? what about some medications?
Treatments: Family therapy and parent training programs, CBT, behavioral modification w frequent rewards
Medications:
Define Eustress and Distress. Name the 4 categories of symptoms for PTSD
*Bonus: What is the major difference between Acute stress disorder and post traumatic stress disorder
Eustress: healthy motivating
Distress: Unhealthy "stressed out"
Symptoms of PTSD: Intrusive reexperiencing of initial trauma, Avoidance (anything that can trigger the memory), Alteration in arousal, Persistent neg alteration in mood and cognition
Acute stress disorder: resolution of symptoms within 1 month
PTSD: duration is more than 1 month
Give a bit of insight on child sexual abuse
Provide some symptoms seen in child who has been abused
CPS finds evidence of claim every 8 minutes, increase rates of PTSD, SUD, MDD, distorted self-concept sense of worth, confusion
Symptoms: fear of bring alone, going to sleep, outburst of anger, increase isolation, somatic symptoms, regression to early behavior, inappropriate sexual behavior
Define Tolerance and Cross Tolerance. Name the 3 areas that enhance the compulsive alcohol/drug use of addiction (Neurobiology)
*Bonus: what are the most used addictive substances? What neurotransmitter floods the reward circuit? What chemical is used to breakdown acetaldehyde?
T: larger amount of drug needed to get high. Pt needs drug just to feel normal
CT: Build up of tolerance for one drug at the same time as another in the same or similar class
Brainstem, Limbic (reward) system, cerebral cortex
#1 Alcohol, #2 Nicotine.... Dopamine... acetaldehyde dehydrogenase
Describe the characteristics of ADHD and symptoms
Difficulty concentrating/remaining focused, careless mistakes, trouble following through/finishing, easily distracted, poor organization and time management, forgetful
Symptoms: inattention, impulsivity, hyperactive
What are some interventions and medications used for ASD?
Intervention: Applied behavioral analysis, support pt, address bullying issues immediately
Medication: Antipsychotics for aggression and irritability - risperidone (risperdal), ariprprazole (abilify)
SSRIs for anxiety or obessive traits - fluoxetine (Prozac), sertraline (Zoloft)
Or Beta Blockers for anxiety and obsessive behaviors
Describe the characteristics of dissociative disorder. Explain the difference between Depersonalization and Derealization disorder.
Occur after significant adverse experiences/traumas, individuals respond to stress w sever interruption of consciousness, unconscious defense mechanism, overlapping aspects w PTSD, protects individual against overwhelming anxiety through emotion separation, identity memory, consciousness disturbed or altered due to extreme stress/trauma
Depersonalization: detachment from mind, body, self
Derealization: detach from surrounding
They are recurrent periods of feeling unreal, detached, outside the body, numb, dreamlike, or a distorted sense of time or visual perception
Name some of the vulnerable populations
*Bonus: what population is heavily underreported?
Gender - Female
Age: 8-12, 16-19
Older adults
Hx of sexual assault
Substance users
Increase risk sexual behavior
Poverty
Indigenous women
Answer: Spousal (or marital) rape, Military and prisions
Describe the effects substance use has on pregnancy
Alcohol: Miscarriage, preterm birth, and still birth (especially in first trimester), Fetal alcohol syndrome - mental retardation, delayed growth and development, distinctive facial abnormalities, life long physical, mental and behavior disabilities
Opioids: increase risk of intrauterine fetal/newborn infant death, may be addicted at birth, withdrawal symptoms
Nicotine: low birth weight, increase risk of SIDs, Increase risk of developmental issues, congenital abnormalities
Stimulants: preterm delivery, low Apgar, neonatal mortality
Describe the characteristics of ASD (Autism Spectrum Disorder) and the 3 levels
ASD - presents w deficits in social and communication interactions, repetitive patterns of behaviors, interest or activities, and may gain a profound amount of knowledge of specific academic and topics of interest
- often loners, dislike physical affection and contact, may be upset w deviation from routine
Level 1 - social deficit, normal speech and language, difficulty w planning and organization
Level 2 - deficit in verbal and nonverbal communication skills, repetitive behavior, distressed by change
Level 3 - limited, needs based communication, behaviors interfere w functioning, aggression towards self or most likely others
Name some ADHD treatment approaches and Medications used (Stimulants and Non-stimulants)
* Bonus - name some side effects of stimulants
Treatment: Parent education (early recognition/treatment), teaching the child coping skills, rewards for positive behaviors (short term rewards), clear limits and clear consequences, structure and routine in Childs environment, environmental modifications; school accommodation, modify nutrition, promote sleep, provide opportunities for large muscle activity
Medications: Stimulants - methylphenidate (Ritalin), amphetamine (adderrall), Vyvanse lisdexamfetamine (Vyvanse), work within 30 minutes
Second line meds: Nonstimulants - atomoxetine (Strattera) SNRI (takes 2-4 weeks to acheive steady state, guanfacine (tenet) alpha antagonist, viloxazine (Qelbree) antidepressant
SE: bitterness, stomach upset, decreased appetite and insomnia ... tics may occur (motor and vocal)
Explain dissociative amnesia and dissociative amnesia w fugue.
DA: inability to recall information about self usually r/t traumatic event
DA w Fugue: inability to recall identity/autobiographical information and pt starts new life in new location
Describe the two phases of Rape Trauma Syndrome
Acute phase: shock, numbness, disbelief, they may appear calm and contained. At other times a range of emotions... trouble concentrating, impaired cognition, agitated, eating and sleep disturbance, cry/laugh, disorganized anger, fear, anxiety, guilt, self-blame.
Long term phase: flashbacks, nightmares, phobias, somatic and GYN symptoms. Depression, panic disorder, suicidal ideation, substance abuse, PTSD is long term consequence. Delayed, month to years later
Describe Wernike-Kersakoffs Syndrome, Wernickes Encephalopathy, Korakoffs Psychosis
*Bonus: what is the treatment used?
WKS: Long term alcohol use may lead to thiamine deficient (Vitamin B1)
WE: Neurological disorder w confusion, abnormal eye movements (nystagmus), unsteady gait (ataxia). A medical emergency, If treated early can be reversible. w/o treatment it can lead to chronic dementia and death
KP: impaired ability to learn new info, and remember recent events and the development of long-term memory gaps
Treatment: Thiamine replacement
Describe characteristics of Oppositional Defiant Disorder (ODD) and name the symptoms
* Bonus: what often co-occurs w this disorder? and name 4 out of the 8 needed for diagnosis.
Enduring, persistent pattern of disobedience, angry outburst, argumentativeness, low frustration tolerance, blaming others, hostility towards authority figures, "Not cruel," child goes beyond normal limit testing
Symptoms: angry/irritable mood, argumentative/defiant behavior, vindictiveness
Co-occurs: w ADHD, depressed mood, anxiety, and impulse control disorders
4 out of 8: Often loses temper, easily annoyed, angry, argues w authority, defies/refuses rules, deliberately annoys others, blames others for mistakes/misbehvior, vindictive
Treatments: Limit setting, clear consequences, safety in milieu, social skills, anger management, behavior therapy and psychotherapy, "Be fair, be consistent, be available", CBT, responds better to reward than punishment
Meds: Hyperactivity: ADHD meds, Anger/Irritability: Antidepressant/antipsychotics
Explain the characteristics of Dissociative Identity Disorder (DID)
Name some treatments
*Bonus: what does DID co-occur w?
Formerly known as multiple personality disorder, at least 2 distinct personalities, alternate personalities sometimes called "alters," alters do not share memories, its "loose time" when alter is in control
Treatments: Establish trust, build rapport, health teaching and promotion, self-help strategies, CBT, DBT, EMDR, Individual/group therapy
Priorities are: safety, stabilization, symptom reduction
Co-occurs with borderline personality disorder
Name some effects of sexual assault that are physical and psychological? (can last a lifetime)
*Bonus: what ages are you not mandated to report abuse?
STI/HIV, Pregnancy, Depression, Self-destructive behavior, substance use, increase rates of suicide, eating disorders, anxiety, low self esteem
18-64
- Predicted by heavy and prolonged use
Autonomic hyperactivity (increased HR, BP, Temp), altered mental status/LOC, agitation, delusions, hallucinations, seizures, may be fatal due to heart attack or stroke, *LIFE THREATENING*
Treated in ICU w IV benzos and other treatments
Describe characteristics of Conduct Disorder (CD) and name 3 of the needed criteria for diagnosis
Describe characteristics of Tics and Tourettes Disorder
*Bonus: Name some motor and vocal examples of tics
CD: societal rules/norms disregarded, more severe
- bullies/intimidations others, initiates physical fights, has used a weapon, physically cruel to people or animals, has stolen, fire setting, deliberate property destruction, broken into a house, car, building, lies to obtain favors or avoid obligations, has broken rules of parents or run away, stealing non-trivial items
Tics: are sudden, involuntary, purposeless, repetitive motor movements or vocalizations, may be mild to severe, stress fatigue, excitement make them worse
Motor: eye blinking, shoulder shrug, or grimace
Vocal: repetitive throat clearing, spontaneous words, sounds, echolalia, coprolalia
Tourettes Disorder: motor and vocal tics, range from mild to severe, onset early childhood, most severe tic disorder
Name treatment and meds for tic/tourrettes disorder
*Bonus: when is treatment recommended?
CBT, clonidine (Catapres), low dose antipsychotic
treatment is recommended only if tics impact self image and interfere w child activities
Name some characteristics of the "batterer" and the "battered partner"
*Bonus: what are the 3 cycles of violence and describe each one. What is the #1 reason the partner stays?
B: control, power, possessive, jealous, irrational, witnessed DV growing up, attempt to isolate partner, considers their one needs more important than the needs of others, often alcohol and drug problems
BP: Fear, low self esteem, feelings of powerlessness, may start to believe insults, self-hatred, live in fear
3 cycles: Serious battery: tension becomes unbearable, serious battering incident
Honeymoon: trusting, hoping for change, loving behavior
Tension Building: feels tense and afraid, helpless, "walking on eggshells", edgy, has minor explosions, may become verbally abusive
#1: FEAR
Name some of the important hospital protocols when caring for a sexual assault victim
Don't leave the pt alone! -They need to feel safe
Rape kit, follow institutional protocol
Ned consent
Pt has the right to refuse
Be meticulous, documentation may be used in court
Name the following:
Medications for Withdrawal
Medications for Sobriety
Medications for Opiates
*Bonus: what is the opioid antagonist used for overdose?
1. Benzodiaepines: Ativan (lorazepam), Librium (chlordiazepoxide), Valium (diazepam)
Thiamine (B1), Cyanocobalamin (B12), Folic acid, Clonidine (helps w vitals stability)
2. Disulfiram (Antabuse): physical reaction if mixed w alcohol, an aversive treatment
Naltrexone (Revia, Vintrol): prevents craving got alcohol and opioids "blocks high"
Acamprosate (campral): reduce cravings for alcohol and symptoms of abstinence... restores balance of GABA and Glutamate
3. Long term treatment: Methadone (dolphin - no high feeling, usually through clinic), Subutex (buprenorphine), Suboxone (buprenorphonine w naloxone - less abuse potential)
- Also clonidine, Motrin, loperamide... Vivitrol given IM once a month
B: Naloxone (narcan)