Behavioral Flashcards
The major inhibitory neurotransmitter in CNS
GABA
Drugs potentiating GABA
Benzodiazepines
Receptor for 1st generation antipsychotics
D2
Receptor of 2nd generation antipsychotics
5HT2
Carbamazepine mechanism of action
Blockade of Na channels
Advance care planning time
Should begin in the outpatient setting as a conversation between the patient and the primary care provider.
When a patient is hospitalized it is essential to inquire about advance directives in the event that the patient becomes unable to make decisions.
Effective discharge planning requirement
Collaboration of physician, nurse, social worker
How much information can be shared if a patient is incapacitated to not present?
Basic/minimal information if it’s in the Patient’s best interest
Cardiac complications of anorexia nervosa
Cardiac atrophy
cardiomyopathy
arrhythmias
Clues to low level of literacy
Fewer years of education
Impaired cognitive function
History of incarceration
Poor or near poor income status
Ephedra: use, side effects, interactions
Use: diet pill, energy booster
Adverse effect: increased BP, MI, CVA
Interaction: caffeine
Appropriate question at the start of Hx taking?
Open-ended questions: What brings you in today? How can I help you? Tell me more about your condition/pain Please continue
Signs of medication misuse
Not taking medication as prescribed, early refill requests, accessing drugs from multiple doctors or illicit sources, requesting higher doses and refusing alternate pain management strategies.
How to inquire about the patient’s sexual partners?
Be neutral, open, non-judgmental
Ask direct and specific questions
Emancipated minor
Homeless Parent Married Military Financially independent High school graduate
SPIKES Protocol for delivering bad news
Set the stage Perception Invitation knowledge Empathy Summary and strategy
Effects of alcohol on neurotransmitters
Potentiates the effects of GABA leading to sedation
Inhibit excitatory NMDA receptors in the brain
The most common initial finding of alcohol withdrawal
Tremor
Goal of therapy for somatic symptom disorder
Functional improvements rather than symptom elimination by promoting stress reduction and healthy behaviors Such as diet, exercise, return to productive activities
PCP receptor
NMDA receptor antagonist
Secondary mechanism of action: inhibit re-uptake if NE, Dopamine, serotonin
Receptor for analgesic affect of opioids
Mu
PCP effects
Psychosis, severe agitation, violent behavior, ataxia, horizontal and vertical nystagmus, delirium
The first step in root cause analysis
Collecting data mainly through interviewing multiple individuals involved in the steps leading to the outcome
Social anxiety in schizotypal personality versus avoidant personality
Individuals with avoidant personality disorder desire relationships but fear rejection and do not exhibit eccentric behaviors of schizotypal personality disorder l.
People with schizotypal personality have social anxiety despite familiarity.
Functional/social status in adjustment disorder
Impaired
First line medications for bipolar maintenance treatment
Lithium valproate quetiapine
Triazolam Duration of action
Short
Lorazepam Duration of action
Intermediate
Symptoms that might occur initially when an SSRI is prescribed
Increased agitation and anxiety
Treatment: Benzodiazepine
The strongest single risk factor for suicide
Previous suicide attempts
Negative symptoms
Affective flattening Avolition Alogia Anhedonia Asociallity
Factors associated with better treatment adherence rates among adolescents
Close peers with complementary behavioral practices
Positive family functioning
Physician empathy
Immediate benefits of treatment
Buspirone onset of action
Slow onset
Up to 2 weeks
Agonist of the 5HT
Tolerance dependence withdrawal with buspirone
None
Who uses undoing defense mechanism?
OCDs
Methylphenidate Onset of action
Rapid
The most common adverse effect of methylphenidate
Decreased appetite, weight-loss and insomnia
Panic attack management
If vital signs are stable/no symptom: SSRI, SNRI
If symptomatic/abnormal vital signs: benzodiazepine
Panic attack DDx
Arrhythmia Hyperthyroidism Hyperparathyroidism Pheo COPD Pulmonary embolus Vestibular dysfunction Seizure disorders
Criteria for narcolepsy
Recurrent lapses into sleep or napping multiple times within the same day occurring at least three times weekly for three months.
Plus one of :cataplexy, hypocretin-1 deficiency in CSF, REM latency less than 15 minutes.
Neuropeptides lacking in narcolepsy with cataplexy
Hypocretin 1 (orexin-A) Hypocretin 2 (orexin-B)
They promote wakefulness and inhibit REM sleep-related phenomena
Neurotransmitter associated with impulsive distractive behavior particularly aggression suicide and violence
Low CSF 5-HIAA
CSF protein in Creutzfeldt-Jakob
14-3-3 protein
Homovanillic acid
Metabolite of dopamine
Altered levels in CSF of: Substance use disorders psychosis mood disorders
Decreased level in CSF of Parkinson’s disease
Melatonin levels in CSF decreased in
Alzheimer’s disease
Disruptive mood dysregulation disorder
Characterized by persistent irritability and frequent developmentally inappropriate temper outbursts
Pica
Compulsive consumption of a non-food and/or non-staple food source for one months or longer
Often associated with nutritional deficiencies including Iran, zinc deficiencies and anemia of any etiology
The most ingested substance in pica
Ice
Others: earth/soil, raw starch
Mature defense mechanisms
Suppression
Sublimation
Humor
Altruism
Suppression versus repression
In suppression the individual is aware of the emotion but decided not to attend to it. In repression unacceptable thoughts or feelings are blocked from entering conscious awareness.
Symptoms of frontal lobe syndrome
Disorganized
Disinhibited
Apathetic
Damage to parietal lobe
Difficulties with spatial and visual perception, writing and calculation, left-right differentiation, object identification.
Temporal lobe injury
Language problems, difficulty with sensory interpretation, impaired memory, behavioral changes (hyperorality, hypersexuality)
Medical conditions capable of producing depression symptoms
Hypothyroidism Parkinson disease OSA MS Mononucleosis
Reason for not drinking alcohol near bedtime
Alcohol is disruptive to sleep in the second half of the night
Rett syndrome
X-linked Occurs mainly in girls Normal development until age 5 to 18 months A loss of motor and language skills Development of stereotypic hand movements Deceleration of head growth Seizures Intellectual disability Autistic features Breathing abnormalities
Lesch-Nyhan
X-linked recessive HPRT deficiency Increased uric acid levels Gout Poor muscle control Intellectual disability Writhing or repetitive involuntary movements Self mutilation
Identification defense mechanism
Modeling one’s behavior after someone who is perceived to be more powerful or prestigious. a classic example is the child of an abusive father who becomes a child abuser himself
Serotonergic neurons in brain stem
Raphe nuclei
Role: sleep-wake cycle, level of arousal
Dysfunction: insomnia, depression
Norepinephrine neurons in dorsal pons
Nucleus ceroleus
Role: activation of the “fight or flight” response
Cholinergic neurons
Nucleus basalis of Meynert
Inadequate production of acetylcholine in Alzheimer
Red nucleus
Anterior midbrain
Motor coordination of upper extremities
Caudate and putamen in striatum
Function in motor activity
Loss of cholinergic and GABA releasing neurons of striatum in Hantington
Dopaminergic neurons
Substantia nigra
Depleted in Parkinson
The second generation antipsychotic most often associated with prolongation of QT interval
Ziprasidone
Second generation antipsychotic associate with a greater risk of prolactin elevation
Risperidone
Ethics of treatment of friends
Limited to emergency situations when no other physician is available
Agents associated with increased risk of fall
Antipsychotics Benzodiazepine Antidepressants NSAIDs Anti-hypertensive
Transference defense mechanic
Unconscious shifting of emotions or desires associated with a person from the past to another person in the present
Methadone receptor
Mu-opioid agonist
Methadone characteristics
Long half-life (suppresses craving and withdrawal for >24h) Good bioavailability Potent agonist, high affinity Blocks euphoric effect of other opioids Potent analgesic effect
Methadone adverse effects
QT prolongation
Respiratory depression
Lethality in overdose
Abrupt discontinuation causes withdrawal
Buprenorphine vs methadone
Buprenorphine less likely to cause respiratory depression and mortality in overdose
Methadone is drug of choice for maintenance treatment of opioid abuse
Which drugs are rarely lethal if overdosed?
Benzodiazepine
Marijuana
Substance with conjunctival injection
Marijuana
Substance with inappropriate laughter
Marijuana
Marijuana metabolism
Liver
Remains in body for a long time
Can be detected in urine up to 3 days after daily use has ceased
Substances causing bradycardia
GHB
benzodiazepine
OpIate
Evaluation is when language milestone is delayed
Hearing examination
Speech and language evaluation
Red flags of prescription drugs missuse
Lost or stolen medication
Pain in consistent with physical examination
Requesting a specific medication my name
Running out of medication
Obtaining multiple opioid prescriptions from different providers
Treatment of specific phobia
Exposure-based behavioral therapy
Short-acting benzodiazepines may help acutely but have a limited role. for example therapist unavailable or insufficient time
Treatment of social anxiety disorder
SSRI or SNRI
CBT
BB or benzodiazepine for performance-only subtype
Confronting people with factitious diseases with the possibility of feigning or producing symptoms
Respond with denial
May reject medical or psychiatric care
Compensatory behaviors in bulimia
Self-induced vomiting
Fasting
Excessive exercise
Miss use of laxatives, enemas, diuretics and diet pills
Compensatory behavior in binge eating disorder
None
Management of hypothyroidism due to lithium consumption
T4
Not necessary to discontinue lithium
Closed loop communication
The sender transmitting a message to another individual who is the receiver who then repeats the message back to the sender. Sebder typically will confirm the message by saying yes
Separation anxiety duration for diagnosis
At least 4 wk in children and 6 mo in adults
Sedating antidepressant associated with priapism
Trazodome
Trazodone not to be prescribed in:
Sickle cell disease, multiple myeloma
Trazodone side effects
Antagonizes post-synaptic serotonin receptors and inhibits serotonin reuptake
Minimal effects on norepinephrine and dopamine
Alpha adrenergic blockade
Histamine H1 receptor antagonism
Substance use with dental decay
Methamphetamine
Substance with impaired time perception
Marijuana
Substance with conjunctival injection
Marijuana
Substance with nystagmus
PCP
Substance with visual hallucination
LSD
Substances with violent behavior
PCP
Methamphetamine
Substance which is NMDA receptor antagonist
PCP
Substance with an anesthetic properties
PCP
Substances that increased appetite
Marijuana toxicity and cocaine withdrawal and nicotine withdrawal
Substance with ischemic effects
Cocaine
Substance causing depersonalization
LSD
Duration of intoxication with methamphetamine
Up to 20 hours
Duration of intoxication with cocaine
Up to one hour
Denial of the problem in the stage of change model
Blaming external circumstances
Precontemplation
Acceptance of the problem in stage of change model
Not ready to make changes
Contemplation
Planning to change the behavior in stage of change model
Preparation
Hypersomnolence disorder versus narcolepsy
Persistent excessive and impairing daytime sleepiness rather than sleep attacks
They do not feel refreshed after naps
REM sleep related phenomena
Hypnagogic/hypnopompic hallucinations
Sleep paralysis
The key neurotransmitters involved in pathophysiology of ADHD
Norepinephrine
Dopamine
Reduce levels in prefrontal cortex
Methylphenidate and amphetamine mechanism of action
Increase release and black reuptake of NE and Dopamine neurotransmitters in prefrontal cortex
Acute dystonic reaction mechanism of action
D2 antagonism in nigrosriatal pathway
Flumazenil Mechanism of action
GABA antagonist
Leaving the mother alone with the infant in postpartum psychosis
Not allowed
Receptor responsible for drug-induced parkinsonism
D2 blockade in nigrostriatal pathway
Antipsychotics
Gastric motility Agents/ antiemetics
Trihexyphenidil Mechanism of action
Anticholinergic
Benztropine Mechanism of action
Anticholinergic
The best approach to a patient in denial
Determine whether the denial is interfering with medical care or significant relationships. If it is not the denial should not be confronted.
Validated patients hope, but encourage him to focus on short-term plans to maximize his participation in areas that give meaning to his life
Tardive dyskinesia mechanism
Development of supersensitivity of post synaptic D2 receptors following prolonged D2 blockade and any balance between D1 and D2 receptor mediated effects
Aggravating factors for tardive dyskinesia
Emotional stress and fatigue
Hypo or hyper reactivity to sensory input seen in:
Autism
For example extreme response to sounds or textures, indifference to pain
White coat hypertension mechanism
Classical conditioning
Eye signs of marijuana
Conjunctival injection
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