Adult - Psychosocial Flashcards
dysthymia defined
depression of long term standing
Three areas of causality for depression?
psychodynamic - anger directed inward
cognitive - negative belief system
biochemical
Depression mnemonic
IN SAD CAGES
INterest
Sleep disturbance
Appetite change
Depressed mood
Concentration difficulties Activity alteration - hypo hyper Guilty feelings Energy loss Suicidal ideaion
Important lab to order to rule out significant differential for depression:
TSH - R/O hypothyroid
Categories of feelings
mad sad glad afraid ashamed
Stages of grief
DABDA
denial anger bargaining depression acceptance
Most commonly prescribed antidepressant class
SSRIs
SSRI examples
paroxetine (Paxil) fluoxetine (Prozac) sertraline (Zoloft) citalopram (Celexa) flovoxamine (Luvox)
What are the advantages of SSRIs?
low overdose danger
fast symptom response
no postural hypotension
Risk of SSRI?
seratonin syndrome
high fever
Major concerns of tricylic antidepressant?
anticholinergic
suicide
prolonged QT
Examples of tricyclic antidepressants
amitriptyline (Elavil)
imipramine (Tofranil)
doxepin (Sinequan)
Dietary concerns with MAOi
wine + cheese = hypertensive crisis
Examples of MAOi
phenelzine (Nardil, Nardelzine)
Antianxiety medication classes
benzodiazepines antihistamines beta blockers tricyclics and MAOi buspirone (Buspar)
First rule out in anxiety
TSH to r/o hyperthyroid
What is the only anti-anxiety that is not classified as a tranquilizer?
buspirone (Buspar)
Groups in which suicide risk is particularly high?
adolescents and early adulthood
white males > 45 years
those > 65 years
Suicide mnemonic
SUICIDAL
Sex (men more successful if attempted) Unsuccessful attempts Identified family members with suicide attempts CI chronic Illness Depression, drug abuse, drinking Age of patient Lethal method available
Alcoholism mnemonic
CAGE
ever felt the need to Cut down?
have people Annoyed you by criticizing your drinking?
have you ever felt Guilty about your drinking?
have you ever had an Eye-opener drink in the morning to steady your nerves or get rid of a hangover?
What is the focus of the mental status assessment?
cerebral function
Mini-mental status exam mnemonic
ORAL 23 RWD
Orientation Recognition Attention Recall Language
2 - names of 2 objects
3 - follow 3 step command
Reading
Writing
Drawing
sudden, transient onset of clouded sensorium
delirium
“they’ll be back”
Common causes of delerium
toxins alcohol anesthesia trauma poor nutrition
gradual memory loss with decreased intellectual functioning
dementia
“they will not be back”
Common cause of dementia
Alzheimer’s
Dementia rule out mnemonic
DEMENTIA
Drug reactions Emotional disorders Metabolic / endocrine disorders Eye and ear disorders Nutritional problems Tumors Infection Arteriosclerosis
Dementia – Development of multiple cognitive defects characterized by both memory impairment and one or more of what?
aphasia
apraxia
agnosia
inability to plan, organize, sequence
Aphasia
difficulty with speech
Apraxia
inability to perform previously learned task
no idea how to brush teeth or tie shoes; prompting them to do so does not help
Agnosia
inability to recognize an object
as tested by STEREOGNOSIS test (eyes closed, object in palm)
“O in agnOsia, Object, and stereOgnosis”
What is the underlying cause of Alzheimer’s?
acetylcholine deficiency
Mainstay of medications used in Alzheimer’s?
acetylcholinesterase inhibitors
donepezil (Aricept)
galantamine (Razadyne)
rivastigmine (Exelon)
What is an adjunt medication used in Alzheimer’s?
NMDA blockers
memantine (Namenda)
What is the cerebellum responsible for?
balance and coordination
What are three techniques for assessing cerebellar function?
Romberg
Finger to Nose test
Heel to Shin test
