Behavioral Medicine
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| Disproportionate emotional rxn to stressor; within 3 months of event onset; sx remission usually within 6 months = | Adjustment disorder
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| Major depression defn: | Depressed mood + anhedonia; >4 clinical features; x >2 weeks; no mania or medical cause
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| Major depression clinical features: | sleep problems, guilt, low self esteem, fatigue, poor concentration, no appetite, psychomotor, suicidality, somatic complaints
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| Major depression physiology | Serotonin, epi-norepi, dopamine, acetylcholine, histamine; adrenal, thyroid, growth hormone; genetic; psychosocial / family
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| Psychopharmalogic tx for MDD must be continued for how long: | At least 6 months after sx improvement (lest relapse)
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| Defn dysthymic disorder | Chronically depressed mood for >2 years; not meet MDD criteria; intervals w/o depressed mood are <2 months
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| Dysthymic disorder mgmt | SSRI +/- SNRI; CBT
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| Defn Bipolar disorder I | 1 or more manic episodes (elevated or irritable x1 wk), poss depressive episodes; sxs not 2/2 other psych dz, med dz, substance abuse; possible psychosis
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| Bipolar disorder I clinical features | Grandiosity, little sleep, pressured speech, flight of ideas, increased goal-directed activity, risk taking
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| Bipolar disorder I mgmt | Lithium; ?antipsychotics (or Valp or CMZ); short term BZOs for hyperactivity or agitation
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| Bipolar responds to neuroleptics but these patients are at increased risk for: | neuroleptic malignant syndrome or tardive dyskinesia
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| Defn Bipolar disorder II | One or more episodes of major depression and hypomania (vs just mania); hypomania lasts 4 days
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| Bipolar disorder II mgmt | similar to Bipolar I; Lamictal if predominately depression; antidepressants may precipitate mania
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| Defn Cyclothymic disorder | Mild Bipolar II sxs; numerous episodes (depression & hypomania) over 2 years; no sx-free interval of >2 months
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| Phobia (including social phobia) tx | Beta blockers (atenolol 25-50mg or propranolol 20-40mg); SSRIs +/- Buspar; benzos
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| PTSD mgmt | SSRIs (1stline) >1 year, alt: SNRI, TCAs, trazodone, anticonvulsants, clonidine, propranolol. Eye movement desensitization reprocessing, CPT, CBT
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| Difference btw PTSD and acute stress disorder | ASD: lasts at least 2 days, resolves within 4 weeks
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| Clinical features of acute stress disorder | Sense of numbness, detachment, derealization, depersonalization, dissociative amnesia
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| Acute stress disorder mgmt | Supportive psychotherapy; short-term BZOs
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Abarnard
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