Psychopharmacology Wilkes n552 exam |42 questions and answers

Dissociation defense mechanism that protects a person from overwhelming anxiety by emotionally separating Depersonalization unreality or detachment from one's body, thoughts, feeling and actions Derealization: unreality or detachment from one's surroundings Body dysmorphic disorder Preoccupation with one or more perceived defects or flaws in physical appearance Spends significant time trying to correct perceived flaw with makeup, dermatological procedures or plastic surgery Txt: SSRI and or CBT Hoarding disorder Persistent difficulty discarding possessions regardless of actual value Results in accumulation of possessions that compromise living space or inability to function Patients who remain resistant to psychosocial interventions, or who lack access to them, can be provided a trial of a serotonin-reuptake inhibitor, particularly if they have a comorbid affective or anxiety disorder; Trichotillomania Recurrent pulling out one's hair despite repeated attempts to stop. Txt: SSRI, Clomipramine; atypical antipsychotics, lithium Excoriation Disorder Recurrent skin picking that results in lesions despite attempts to stop. Cognitive-behavioral therapies may be beneficial for patients accepting psychiatric referral Txt: SSRIS, antipsychotics, anxiolytics Posttraumatic Stress Disorder (PTSD) Re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and avoidance of stimuli associate with the trauma. PTSD treatment 1st line: SSRIS (Zoloft, Celexa) or SNRIS (Venlafaxine) FDA approved meds: Sertraline (Zoloft) and Paroxetine (Paxil) Alpha-1 agonist (Prazosin)= targets flashbacks; nightmares and hypervigilance Psychotherapy (CBC- exposure therapy etc.) • PTSD is a potentially debilitating disorder that can occurs after a traumatic event. Commonly described in war veterans • Can also present in those experiencing non- war events PTSD • Clinical syndrome is characterized by 4 clusters of symptoms: Re-experiencing the trauma (with intrusive thoughts, nightmares, or flashbacks) • Emotional numbing • Avoidance behaviors • Persistent hyperarousal and mood symptoms (depression, irritability, anger) Difference between Acute Stress Disorder and PTSD: When an individual experiences a traumatic event and displays anxiety symptoms that lasts for only a short duration, the condition is opposed to PTSD. For the diagnosed as ASD as condition to be diagnosed as ASD, symptoms must occur within one month of trauma and last for not more than one month. The symptoms of ASD, however, are similar to those observed in PTSD. Comorbidity Assessment: PTSD It is important to look for: Substance use disorders (avoid benzodiazepines) Depression Bipolar disorder Psychosis Nonpharmacologic Treatment in PTSD: СВТ Supportive Group Therapy Relaxation therapies Eye Movement Desensitization and Reprocessing (EMDR) ***Benzodiazepines may interfere with the psychological processes needed to benefit from СВТ PTSD patients experience insomnia? up to 90% experience insomnia PTSD and nightmares 70% experience more than 5 a week Sleep Assessment PTSD Sleep impairment is a core symptom of PTSD PTSD Common sleep disturbances include: hyperarousal linked to difficulties initiating or maintaining sleep, trauma-related nightmares, disturbed awakenings without nightmare recollection, prolonged sleep latency (often due to fear of nightmares) For many patients, improving sleep symptoms can improve core daytime PTSD symptoms (hypervigilance, avoidance, re-experiencing). Look for other causes of insomnia: sleep apnea, restless legs syndrome, periodic limb movements of sleep, sleep hygiene issues, excess caffeine consumption, medical problems PTSD Treatment: 1st Line **SSRIS are a first-line FDA recommended treatment: Paroxetine and Sertraline are FDA-approved From the FDA perspective, all other medication uses are "off label", though there are differ levels of evidence supporting their use. While SSRIS are typically the first class of medications used in PTSD treatment, exceptions may occur for patients based upon their individual histories of side effects, response, comorbidities, and personal preferences. PTSD Treatment: 2nd Line SNRI (Venlafaxine; Duloxetine) PTSD-related psychosis: Try SSRI first. If that doesn't help, add a second-generation antipsychotic like risperidone. PTSD: Sleep Disturbance Prazosin: • Increased noradrenergic activity during sleep is found in patients with PTSD (increased adrenaline; flight or fight). The adrenergic blockers, such as Prazosin, target the impaired sleep in PTSD patients. Reports exhibit improvement daytime symptoms of PTSD. • Used "off-label" for nightmares or disturbed awakenings. • Recommended for hyperarousal and nightmares in patients with PTSD. Should be titrated down when no longer needed because of the risk of rebound hypertension. PTSD: Sleep Disturbance off label Non-benzodiazepine hypnotics (Lunesta, etc.): No notable development in dependence or tolerance seen in studies up to 6 months. May be preferred over benzodiazepines because of the rapid onset, short duration of effect and safety profile. They generally do not affect REM sleep. Tricyclic antidepressants (weight gain), cardiac (not safe in case of overdose)- helps chronic pain and may be considered in (Doxepin, Amitriptyline)- Adverse effects: Anticholinergic, antihistaminic patients with chronic pain (migraines; nerve pain; etc.). Benzodiazepines. High potential for abuse in PTSD in patients with or without comorbid substance mususe. Not effective for primary PTSD symptoms. May reduce effectiveness of psychotherapies. Can cause rebound insomnia.