Divided attention

Classified in Psychology and Sociology

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***20. Affective disorder Tx  Principle:

^^Depression wthout Psychosis
I-Give Antidepressent  SSRIS
(citalopran/ fluoxetine)
II-Psychotherapy 
III-Mixed

1st line therap is AD
IF only partial response  ---->ad Lithuim
Maitain  continue therapy til end , 
if reoccurance give prophylaxis


^^ Depression with Psychosis :
-psychotherpay
-combine AD+ AP
-olanzapine - Fluzxentine

Combination AD + AP is better


^^  Dysthymia:
-X : SSRI , TCA, MAO
-Psychological : Mania
-othr X:( olnzapin/ Qiuteipine/ resperidone 

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***21. Suicide: RF & urgent Help :


^^RF :
-previous attmept
-psychaitric disorders
-family history 
-substance  abuse
- History of impule or reckless bahvior 
-Age 20-28 , or >60
-Gender
-Loss ( family . Job )
-Chronic illness

^^ Urgent help 
-Stabilie the person in the ER
-If pts takenX --->wash Stomach 
-If bleeding---------> Stop It
-Tx lifethreathining /acute condition  
- pts is ztable -----> relocate to psychiatry

^^Q to ask:
-why now
-what can be solved by commiting suicide

 Be Direct/  empahtic/ Dont argue/understanding/ 


Check for other pscyhiatric condition:
-Depreion
-Schizophrenia
-check for terminal illness

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***22. Panic disorder: CF , principle of Tx

-Acute spontenous Far with respiratory  & ANS Sx!!


^^ CF :
-Acute & spontaenous Fear
-Somatic Sx
( dyspnea/ palpitation /AP / Temor/ Fainess/ Chocking)
-Cardinal Featueres
( fear of drying , going mad)
-Duration <30 min peak at min 10
-Development of phobias

^^ Tx:
I-Psychological(CBT)
-Cognitive restruction 
-Techniques
-Sitationsl


***23. Phobic anxiety disorder main clinical forms & principle of Tx:

^^ Main clinical forms:
-specific phobia :
-Angoraphobia: fear of open or public spaces
-Social phobias: Fear of eing humliated/ embaresed

^^Tx:
I-PSychological (CBT)
(behaviortherapy / exposure techniques) 
II-X :
1- BzDz : ↓ phovia , Alprazolam 0.5 mg
2-SSRI : floxmine (5-10 mg)
 for agrophobia & social phobia
3- MAOI - Hydrazne
4- TCA : clomipremine- if depressed!

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***24. Acute Reaction to Stess: CF & Dx(PTSD):

-occur in people who have experienced trauamtic event(war ,sexual aseualt) 
-or have themself participated in it


^^ CF:
-No age dep
-Sx apper 3-6 Months after trauma
-Disrupted Sleep
-flashbacks
-vivid dreams
-social withdrawl
-PArtial amnesia of evens 
-Hyper aorusaed upon -reexposure to similar situation


^^Dx: 
-past traumatic event
-intrusion :of dreams , memories, flashbacks, 
-avoidance of things similar to traumatic event
-(-) memory of truma / -ve emotion
-arousal : irirtaiblity aggresion  

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***. Adjustment disoder : CF and Prciniple of Tx:


-Emotional response to stressful event
-sx begin 3 M after Stressful event

^^ CF: 
-Depression
-anxiety
-mixed depression & anxiety
-Drinking
-risky behavior
-suicidal behavior
-physical Sx


^^Tx principle:
-psychotherpay : grouop therpay with similar pts

-Crisis intvention
 ( Hospitalization / resolving fast by enviroment change)

-Xtherapy:
No specific Tx , Depends on main Sx , anti depressent antixiolytic lithium )


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***26 .Dissociative(conversion) disorder: CF, Principles of Tx:

-unconcious denfece mechanism that involes disruption of mental function such as memory ID . Perception , consiouneess


^^Forms:


1- Dissociative ID disroder :

 2 + distinct peronality states with (-)
 2 + distinct peronality states with (-)
2- Dissoaciative amnesia:

temporary loss of recall memory due to trauma
temporary loss of recall memory due to trauma
3- Dissociative :

where basic self caei peserve but past is forgotten
: where basic self caei peserve but past is forgotten
4- Dissociative Stupor:

No  voluntary movement , respond normal to external stimuli
No  voluntary movement , respond normal to external stimuli
5- Depersonlization:
persistent feeling of deatachment from oneself!
persistent feeling of deatachment from oneself!

^^ Principle of Tx:
-Psychotherpay : CBT
-Hyponosis
-X : SSRI, Beta blocker, MAO 
-ECT
-Group psychotherapy

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***27. Obessive compulsie disorder(OCD) Dx , PRinciples of Tx:


^^DX:
-more then 1 hours/day
-obsession reccurent thoughts which are supposed ot be acted out
-Compulsion : repetitive  behavior in order to neutralize obession .

^^Tx:
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***28 Dx criteria of specific Personality disorder:

1-Changes in one personality that is different then that of society!
2-Steriotypic behavior that affect social & occuptaional function
3- stereorypic features begins
4- May cause distress!


***29.Antisocial & Emotional unstable personality isorder: Sx& Diff Dx:

PD : personality disorder

^^ PSychopathic PD : ignoring and violating the right of others

^^SX:
-Apathy to others
-Ignore social norms
-cant maintain long term relationship
-Low threshold of frustration
-Inability to feel guilt 
-blame surrounding

^^ Diff Dx:
-Parcissitic PD - No impulsiveness / agression
-Histrionic PF - Seeking attention / psychopathic powerseek
-Psychotic Or manic epidosdes- spcific Trigeer

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***30 Paranoid Personality disorder :sx & Diff Dx

Paranoid - constrant distruct & suspicion of others!

^^ Sx: 
-interprestation of other action as delibrate
-OVersesntivity, suspticion
-jealousing
-blaming other
-overvaue ones ability
-Hold Grudges
-Problems with colleagues & Authority

^^ Diff Dx:
-Schizophrenia: (PPD do not lose it & have no hallucination)

-Schizoid PF-  (PPD the speech is normal)

-use of X !

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***31. Schizoid Peronality disordr: Sx & Diff Dx:

^^Schizoid PD :
-High dissociation from social relation
-poor emotional reaction


^^Sx:
-Emotional coldness
-Limited ability to love, Anger
-ignore criticism
-Low interest in sex
-No Cose friend
-ignore social norm
-odd pseech

^^ Dif Dx:
-Schizophrenia: 
----->SPD have-ve sx but not +ve Sx
-Anxiety disordeR
-------->SPD no criticism Fear
-Medical disordr


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****32. Anankastic personality disoder Sx & diff dx:

^^ Def:
Anakastic ( obsessive - compulsive) PD-pursuit of pefection

^^Sx:
-preoccupaton 
 -devotion to work activities & productivity
-Inflexibile about other opinion & houghts
-unable to discard object or money 
-cant work in group

^^Diff Dx:
-OCD--->anxiety disorder sudden onset ,no need for protection

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***33. Avoidant perosnality disorder : Sx& Dif Dx:

^^ Def(Anxious PD):
-social isomfort
-self conciouss
-fear of rejection 
-ve evaluation
-hesitant


^^Sx: 
-restricted lifestyle
-Avoiding activities due tofear
-failing to develop relationship

^^Diff Dx:
-Depended PF 
---> APD no need to have them taken care of
-NEurotic disorder: no suddent onset , trigger
-Schizoid PF----> solcial isolation but no low self esteem

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***34, Histroinic personality disorder Sx, Diff x:

^^Histrionic PD:
-ecesisve emotional
-ateention seeking
-drama Queen

^^Sx: 
-center of attention
-acting like a victim
-interpersonal relationship with dorment partner
-excessive concern about physical activity

^^Diff Dx: 
-Narcissisitc PD -desperately Looking for attention 

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