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Behavioral Flashcards

1
Q

Patient engagement techniques (3)

A

5 A’s
TTM (transtheoretical model)
MI (motivational interviewing)

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2
Q

5 A;’s

A

Ask
Assess
Advise
Agree
Arrange/Assist

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3
Q

What is TTM (transtheoretical model)

A

= framework for understanding process of behavior initiation, change, cessation
-integrative bio-psycho-soc
-conceptualize process of behavior change
-RECOGNIZE current stage and tailor guidance

** occurs in increments
** stages of change = key component

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4
Q

TTM stages of change (6)

A

“PCP AM(R)”

-Pre-contemplation (unaware or no intentions to change, 60% of ppl)
-Contemplation (within 6 mos)
-Preparation (plan to change now)
-Action
-Maintainence
-(Relapse)

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5
Q

Motivational Interviewing

A

-collaborative, pt-centered
-evocation of pts own motivation
-encourage autonomy to own soln

** be a “detective” of motivation

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6
Q

MI skills: OARS

A

Open-ended questions
Affirmations
Reflections (repeat back)
Summaries (plan)

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7
Q

MI key processes (4)

A

EFEP

Engage
-build connection, ID goals

Focus
-pt ideas, single topic, small changes

Evoke
-their “why”
-goal is **change talk > sustain talk
-listen for DARN (desire, ability, reasons, needs)
-how ready 1-10? Why not less?

Plan
-what changes ready to make today?
-SMART goals, “Rx”
-explore barriers
-facilitate & assess confidence

** OARS for all

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8
Q

SMART goals

A

Specific
Measurable
Achievable (realistic!)
Relevant (important to pt)
Timed

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9
Q

FITTE

A

Freq
Intensity
Time
Type
Enjoyment

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10
Q

MI: 4 guiding principles

A

RULE

-Resist the Righting Reflex
-Understand their motivation & use that
-Listen reflectively & summarize
-Empower- w their own ideas & decisions!

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11
Q

Additonal MI principles: EDRS

A

-Empathy
-Develop discrepency btw actions & goals
-Roll w resistance- “sound like you’ve struggled”
-Support self-efficacy, affirmations

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12
Q

Psychotx

A

CBT & others

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13
Q

CBT

A

thoughts - behaviors - actions

** central component of obesity tx
** also 1o for BED, bulimia
-also component for anorexia, pre-pub ob

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14
Q

CT addresses…

A

-maladaptive thinking –> maladaptive behav
-automatic thoughts (link to neg feelings)
-distortions
-catastrophizing

  • teach setback as temporary lapse
  • positive thinking to replace undermining thoughts
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15
Q

BT concepts

A

-change behavior and feelings will follow

-reinforce or extinguish behaviors (ribbons, stars / orlistat aversive), RESTRUCTURE ENV

-relaxation training

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16
Q

10 components of BT

A
  1. Self-monitor (diet, ex, wts)
  2. Stimulus control
  3. Problem solving
  4. Goal setting (SMART)
  5. Contingency management
  6. Social supports
  7. Relapse prevention
  8. Stress mgmt, alts to food
  9. Reward for goals
  10. Ongoing contact
17
Q

Other types of tx

A

-DBT (form of CBT, tx BED & others)

-Interpersonal (component of MI, tx LOC-ED girls)

-FRAMES (?)

18
Q

Eating disorders (most to least common, 6)

A

-BED (LOC-ED in kids <12yo)
-NES
-Grazing (not DSM-V)
-BN
-AN
-Sleep-related ED (parasomnia, not ED)

*50% genetic component in twin studies

19
Q

1 most common eating disorder (2-3.5% of pop)

BED criteria

-esp in p/w obesity
(50% of pts w severe obesity!)

A

(compulsive d/o)

-1x/wk for 3 mos

-large amounts, lack of control
-marked distress
-NO compensatory behav

Assoc w 3+:
rapid eating
uncomfortably full
eating when not hungry
hiding
feeling disgusted

20
Q

BED tx

A

** Tx 1st before obesity

-CBT first line (w topiramate may be best)
-Lisdexa can also be first line

Also off label:
Topiramate
Phentermine
Phen/Top
Phen/Fluox
Fluoxetine
Zonisamide
Buproprion
Sertraline
Citalopram

-IPT & DBT options as well

21
Q

LOC-ED

A

<12 yo
don’t meet criteria for BED

tx w IPT for girls

22
Q

NES criteria (3)

A

-AM anorexia
-PM hyperphagia*
-insomnia

** 25-50% of daily cals after PM meal, ++carbs

Often w PM worsening mood, nocturnal awakenings to eat (AWARE)

23
Q

NES tx

A

** highly responsive to sertraline

-encourage regular meals earlier in daytime
-↑ protein

24
Q

BN criteria

A

-binge eating
+compensatory behaviors
-self-eval unduly influenced by body image

*** 1x/wk x 3 mos

Some epi:
10% of women over lifetime!
us 16-22 yox
25% w h/o sexual abuse

25
Q

BN tx

** contraind

A

-CBT
-SSRI (fluox FDA, sert off label)
-combo of above

Also: topiramate, trazodone, ondansetron

**NO BUPROPRION

26
Q

AN criteria (3)

A

Must have all 3:
1. restricted ENERGY intake leading to low weight (generally BMI < 18.5)

  1. intense FEAR of wt gain OR behaviors preventing gain
  2. DISTORTED body image, denial of medical seriousness

(amenorrhea no longer nessessary)

*osteoporosis 38-50%
*10% mortality suicide, among deadliest psych dz’s

27
Q

Body image disorders (3)

Tx’s

A

-AN
-BDD (OCD)
-Body image dissatisfaction

BDD Tx: SSRI, CBT, top, lamo

28
Q

Sleep disorders (5)

A

-OSA
-OHS
-Shift-work sleep disorder (SWSD)
-Sleep-related eating disorder (SRED)
-Insomnia

29
Q

SWSD criteria

A

-chronic/recurrent disrupted sleep/wake pattern (altered circ rhythm)
-insomnia OR xs sleepiness
-causes distress/impairment

> 3 mos
*Distress/impairment

↑ incidence of obesity
20% of workers have nonstandard shifts

30
Q

SWSD tx

A

-planned sleep 7-9 hrs
-sleep hygiene
-lighting exposure

-melatonin 0.5-3 mg

-sedatives before sleep
-stimulants during work (caffeine, modafinil)

31
Q

SRED defs, epi %, assoc meds

A

= parasomnia NOT ED
“Sleep-eating” is not NES

Epi:
*1-5% of gen pop
*9-17% of pts w ED
*16% ppt by stress
*80% also have RLS, PLMS?D, somnabulisum

Assoc w sed & anti-psych:
-zolpidem
-triazolam
-amitriptyline
-olanzapine
-risperdone
-others psychotropics…

32
Q

SRED tx

A

-stop offending agent (ZOLPIDEM)

-tx related disorder: RLS, OSA, PLMD…
-pramipexole
-other DA ag (carb/levo)
-CPAP for OSA

-Other tx:
Top
SSRI
Traz

33
Q

Insomnia 2o causes & tx

A

medical disorder (eg BPH)
psych (MDD)
substance (EtOH)
another sleep disorder (RLS)

Tx: CBT #1, meds (weak rec)

34
Q

Behavior disorders/ED & exclusion from bariatric surgery(5)

A

*no absolute contraind’s
(but most experts agree there are some contraind’s)

-still, pts are screened pre-op psych eval
-5-20% of pts excluded

1- recent or active SUICIDALITY
2- problematic SUBSTANCE abuse or EtOH use disorder
3- Unstable BIPOLAR w behav’s that could impact outcome of surg/adherence
4- SCHIZO us excluded, though no shown effect on outcome
5- COMP/PURGING behaviors also no effect on 1yr loss, but usually excluded

-need psych care after surg

35
Q

BN tx

** contraind

A

-CBT
-SSRI (fluox FDA, sert off label)
-combo of above

Also: topiramate, trazodone, ondansetron

**NO BUPROPRION

36
Q

NWCR %’s
(National Wt Control Registry)

A

-est 1994, 10K ppl over 10 yrs
-30+ lb wt loss >1yr
-avg age 40’s, 80% are women

-4% w meds
-50% without a program

Long-term success assoc w:
-most w low cal low fat diet
-90% exercise 1+ hr per day (400 cal)
-75% take weekly weight
-62% <10hrs tv/wk

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