Class: As we have not finished all the material covering disorders, I wanted to give you and overview of some disorders we have not had a chance to discuss. I feel you are well prepared in different types of therapy (behavior, cognitive, cognitive behavioral, family therapy, group therapy) and for psychosomatization and most forms of anxiety. General helpful hints for boards: I had the rewarding experience of sitting on the ACS section of Part II for 4 years. I found the committee members to be faculty members from all the colleges who were committed to writing a fair and thorough examination, not evil ogres who are trying to mess with you. Keep in mind conditions and case presentations that are: Classic Common Contraindicated For example, you likely remember terms like chancre and chancroid, but do you remember with which conditions they are associated? Or how about something with a frothy green discharge? Perhaps a question stem describes someone with polyuria, polydipsia, and recent weight loss. What would you choose? The exam is not easy, but you will find some of the questions easy if you remember those CLASSIC descriptions and associations. Think like a TEST WRITER if you had to write questions about STDs, shapes of the female pelvis, and legal issues, what would you choose? You d choose to write about COMMON conditions, CLASSIC descriptions and associations, or CONTRAINDICATIONS so you would be confident your future colleagues wouldn t harm a patient. So, should you stick a tongue depressor in the mouth of a toddler who is running a fever, drooling, and sitting in a forward leaning- neck extended position (one version of a tripod sign)? Of course you wouldn t because you are recognizing the CLASSIC signs for a child with epiglottitis. BACK TO PSYCHOLOGY: There are a few other forms of therapy we haven t covered worth mentioning: 1. Interpersonal therapy: a. Some psychological disorders present great challenges to family relationships. The illness may put the family s financial resources at risk and may hinder the development of trust between family members. Interpersonal therapy focuses on interpersonal issues, which may be creating and/or maintaining psychological distress. The targets of IPT are symptom resolution, improved interpersonal functioning, and increased social support. 2. Exposure therapy: a. A type of behavioral therapy, similar to systematic desensitization, which exposes the patient to the feared stimulus (phobia) in a graduated method. This method involves in vivo exposure rather than imaginary exposure. Treatment with Medication: Medications for mental illness are often referred to by the symptoms they treat (e.g. anti- anxiety medications or anti- depressant medications) or may also be broadly called psychotropic or psychotherapeutic medications. The most common types of medications are listed below each condition.
Disorders: The following is not a substitute for class lectures or notes, but hopefully will serve as a quick study of the key factors of the most common disorders we haven not yet discussed. Anxiety: Anxiety is an umbrella terms that includes the following: 1. Generalized Anxiety Disorder (GAD): Excessive unrealistic worry about things such as family, work, finances, and other daily pressures, affecting 6.8 million adults in the U.S. 2. Panic disorder and panic attacks: Unexpected and debilitating panic attacks associated with frequent anxiety affecting 6 million adults in the U.S. 3. Social anxiety disorder: Fear of being judged by others in social situations, affecting 15 million adults in the U.S. (Common self- treatment/self medication is alcohol) 4. Post- Traumatic Stress Disorder (PTSD): Physiological responses and behaviors associated with anxiety after exposure to a psychologically traumatic event, affecting 5.2 million adults in the U.S. Medications used to treat anxiety include: Anti- depressants: Antidepressants were developed to treat depression, but they also help people with anxiety disorders. o SSRIs (selective serotonin reuptake inhibitors) fluoxetine (Prozac) sertraline (Zoloft) escitalopram (Lexapro) paroxetine (Paxil) citalopram (Celexa) o SNRIs (selective norepinephrine reuptake inhibitors) venlafaxine (Effexor) duloxetine (Cymbalta) o Tricyclic antidepressants imipramine (Tofranil) clomipramine (Anafranil) Buspirone (Buspar/Wellbutrin): An anti- anxiety medication that works on dopamine and may take several weeks to become effective and often causes lightheadedness. Benzodiazepines: Sedatives for short- term relief (because they are habit- forming) of anxiety symptoms. Benzos include: o lorazepam (Ativan) o diazepam (Valium) o chlordiazepoxide (Librium) o alprazolam (Xanax) MAOIs (monoamine oxidase inhibitors) o phenelzine (Nardil) o tranylcypromine (Parnate) o isocarboxazid (Marplan). People who take MAOIs must avoid certain food and medicines that can interact with their medicine and cause dangerous increases in blood pressure. Beta- blockers control some of the physical symptoms of anxiety, such as trembling and sweating. Propranolol (Inderal) is a beta- blocker usually used to treat heart conditions and high blood pressure. The medicine also helps people who have physical problems related to anxiety.
Mood Disorders (Depression, Dysthymia, Bipolar Disorder, Cyclothymia): Affect is another term for mood. Depression is a mental illness marked by sad or anxious feelings. Many people experience the first signs of depression while in college. Although it s normal to feel sad or anxious occasionally, depression does not pass easily. It affects your life on a daily basis. Untreated depression is also one of the leading risk factors for suicide. There are three common types of depressive disorders (NOTE: the root word thymic means mood, in this case. It is not the same as the thymus, the lymphatic tissue in the chest) Major depressive disorder: Involves disabling symptoms that make it difficult to eat, sleep and study. Some people have one major depressive episode in their lifetime but it can be a chronic disorder. Dysthymia/dysthymic disorder: Mild, chronic depression with symptoms that last at least 2 years. It is not as severe as major depression but is still a serious disorder. Having dysthymia puts you at risk of experiencing major depressive episodes later on. Minor depression: Less severe and shorter lasting than major depression and dysthymia. However untreated minor depression can lead to major depressive disorder. Depression Symptoms: There are a wide range of symptoms associated with depression including: Sadness Anxiety Hopelessness Guilt Irritability Restlessness Tired Sleep difficulties Loss of appetite Suicidal thoughts Unexplained aches and pains Tearfulness Medications used to treat depression include: See anti- depressant medications under the Anxiety discussion.
Bipolar Disorder: Bipolar is an affective disorder involving unusual shifts in mood, energy and behavior. It is common to have dramatic fluctuations between a normal mood and depression or elation. Bipolar disorder makes it difficult for people to perform well cognitively and has a strong effect on personal relationships. Bipolar I: Repeated episodes of depression and mania a severely elevated mood state that causes disruption to the individual s functioning Bipolar II: Recurrent depressive episodes with at least one episode of hypomania less severe than a manic episode Symptoms of manic and hypomanic episodes may include: Excessively euphoric mood Extreme irritability Inability to focus Rapid speech and jumping between topics Decreased need for sleep Aggressive behavior Provocative behavior (sexual promiscuity) Risky behavior (sexual promiscuity and lack of safety concerns) Denial there is a problem Symptoms of the depressed phase of bipolar disorder include: Sadness Social withdrawal Lack of interest or pleasure in any activity (anhedonia) Loss of appetite Physical complaints Agitation Fatigue Hopelessness Neglect of hygiene Suicidal thoughts Sometimes people with bipolar disorder experience a mixed episode, which includes symptoms of mania and depression at the same time. Feelings can include sadness and hopelessness together with agitation and high energy. If bipolar disorder becomes severe, it is possible to have symptoms of psychosis, such as delusions and hallucinations (see Psychotic disorders below). Bipolar I and II Treatment There is no cure for bipolar disorder, but it is possible to manage symptoms with treatment and lead a healthy productive life. Ignoring bipolar disorder will likely worsen symptoms and cause rapid- cycling between manic and depressive episodes. Medications used to treat bipolar disorder include: Mood stabilizers (Lithium and Depakote an anticonvulsant medication) Anti- depressants (may be used with mood stabilizers, but patients must be closely monitored to ensure they don t trigger manic or hypomanic episodes).
Psychotic Disorders/Psychoses: Schizophrenia is part of a group of psychotic disorders that alter the ability to think, respond, communicate and behave clearly. There are a number of mental illnesses considered psychotic disorders in addition to schizophrenia, including: Schizoaffective disorder: Symptoms of schizophrenia and a mood disorder Brief Psychotic disorder: Short periods of psychotic behavior usually triggered by a stressful event Delusional disorder: Delusions that involve real- life situations that could be true (i.e. being followed, having a disease, being conspired against) for an extended amount of time. The exact cause of psychotic disorders is unknown. Some experts believe the nerve cell receptors in brains of people with schizophrenia do not respond properly when interacting with glutamate, which can lead to abnormal thinking and perception. Researchers have also discovered several factors that play a role. Many psychotic disorders run in families, which suggests that there is a genetic tendency. There are also many environmental factors that are involved, including major life changes such as going away to college, stress and drug abuse. Symptoms of Psychotic Disorders Symptoms can be severe enough to make meeting the ordinary demands of life impossible. Symptoms of psychotic disorders vary and may change over time. The two major symptoms are delusions and hallucinations. Delusions are persistent organized beliefs that remain despite evidence to the contrary. For example, a person with schizophrenia may believe they are being followed, even though there is no reason to believe so and no evidence. Hallucinations are sensory perceptions of things that are not really there in real life. Examples include hearing voices, feeling like you are being touched, smelling odors or funny tastes in your mouth. Other examples of psychotic symptoms include: Mood swings and mood symptoms such as depression or mania Confused thinking Disorganized speech Poor personal hygiene Slowed movements Strange or dangerous behavior Inability to express emotion Treatment of Psychotic Disorders/Schizophrenia There are no tests for psychotic disorders such as schizophrenia. If symptoms are present, doctors will first rule out a physical reason. Mental health professionals trained to diagnose and treat mental illnesses use interview and assessment tools designed for making a diagnosis. Unless people with psychotic disorders are in danger of hurting themselves or others, or need stabilization, mental health professionals treat them as outpatients. Treatment includes antipsychotic medications and
psychotherapy. Antipsychotics are not a cure, but can help manage symptoms such as delusions and hallucinations. Medications used to treat psychoses: Antipsychotic medications are used to treat schizophrenia and schizophrenia- related disorders. Some of these medications have been available since the mid- 1950's. They are also called conventional "typical" antipsychotics. Some of the more commonly used medications include: Chlorpromazine (Thorazine) Haloperidol (Haldol) In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical" antipsychotics. One of these medications was clozapine (Clozaril). It is effective in treating psychotic symptoms, hallucinations, and breaks with reality, such as when a person believes he or she is the president. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. Therefore, people who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. Still, clozapine is potentially helpful for people who do not respond to other antipsychotic medications. Other atypical antipsychotics were developed. All of them are effective. Agranulocytosis is less likely to occur with these medications than with clozapine, but it has been reported. These include: Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega) Lurasidone (Latuda) Long- term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can't control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication. Every year, an estimated 5 percent of people taking typical antipsychotics get TD. The condition happens to fewer people who take the new, atypical antipsychotics, but some people may still get TD.
Eating Disorders: Untreated eating disorders can result in permanent physical damage including heart damage, infertility and osteoporosis. Eating disorders have the highest mortality rate of any psychiatric disorder, with a suicide rate 50 times higher than the general population. Early intervention is essential. Eating disorders affect both women and men. They are often triggered by major life transitions, such as going away to college. The three most common eating disorders are: Anorexia nervosa: Distorted image of the body that leads to dieting even when severely underweight. Bulimia nervosa: Bingeing on large amounts of food in a short amount of time followed by forced vomiting. Binge- eating disorder: Uncontrollable, obsessive eating followed by extreme feelings of shame and guilt. Does not usually involve purging and college students who have this disorder are typically overweight. People with eating disorders may have higher incidences of substance abuse and are more likely to have other psychiatric illnesses.