Behavioral Health Flashcards
Characterized by excessive, uncontrollable and often irrational fear about everyday issues and not about a specific thing or at specific time
Symptoms have been occurring for more than 6 months.
Generalized anxiety disorder
Generalized anxiety, panic attack treatment
CBT SSRIs SNRIs TCAs Benzodiazepines - short term therapy Pregabalin (Lyrica) Gabapentin
Examples of SSRIs
fluoxetine (Prozac) sertraline (Zoloft) paroxetine (Paxil) citalopram (Celexa) escitalopram (Lexapro)
Examples of SNRIs
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Benzodiazepine that is commonly used for short term treatment of anxiety disorders
Alprazolam (Xanax)
extreme anxiety which typically lasts less than an hour =
panic attack
Symptoms of panic attack
tachycardia, palpitations excessive perspiration dizziness SOB sensation of choking fear of next panic attack
What is cognitive behavior therapy (CBT)?
teaches a person different ways of thinking, behaving, and acting to situations to help patient feel less anxious and fearful
A ________ is an overwhelming, persistent and unreasonable fear of an object or situation that poses little real danger.
phobia
fear of other people or social situations such as performance anxiety or fears of embarrassment by scrutiny of others
social phobia
What are the fears involved in agoraphobia?
generalized fear of leaving home
fear of having panic attack in place where patient can’t escape or get to safety
Diagnostic criteria of PTSD:
Symptoms for + 1 MONTH
Exposure to traumatic event
Persistent re-experiencing of the event
Persistent avoidance and emotional numbing
Hyperarousal symptoms not present before (hypervigilance, hyper startle reflex)
Feeling of detachment from other people
Significant Impairment
How to treat PTSD?
CBT SSRIs, TCAs Prazosin for nightmares Clonidine or propranolol for hyperarousal and sleep problems Anti-convulsants, mood stabilizers Exercise
Key features of anorexia nervosa
Intense fear of gaining weight
Distorted body image
Unable to maintain healthy body weight
Depression and anxiety around food
Risks associated with having anorexia nervosa
Iron-deficiency anemia Abd pain, constipation, diarrhea Loss or disturbance of menses Kidney failure Osteoporosis Compromised immune system Bradycardia, or other arrhythmia
Treatment of anorexia nervosa
Monitored nutrition plan
Psych therapy
Anti-depressants
Eating disorder characterized by binging and purging
bulimia nervosa
DSM diagnostic criteria for bulimia are:
- Repeatedly binge eating
- Post-binge vomiting, excessive exercise, fasting, or misuse of laxatives, diuretics, enemas
- Bingeing and purging at least 2x per week for at least three months
- Body shape and weight influence feelings of self-worth
- No presence of anorexia, extremely restrictive eating behaviors
Signs of purging in bulimia nervosa
Russell’s sign: calluses on knuckles
Broken blood vessels in eyes
Poor dentition
Hypokalemia
Clinical dx of obesity
BMI > 30
Certain medications that may cause weight gain
Antidepressants Anti-seizure meds Antipsychotic meds Corticosteroids Beta blockers
Lab workup of obesity
Cholesterol LFTs Fasting blood glucose Thyroid ECG
Popular prescribed weight loss med and how it works
Orlistat - lipases inhibitor, unabsorbed fat is eliminated in stool
Age of Autism onset? when is it usually diagnosed?
Before age 3
Dx’d 3-4 yo
Signs of Autism
Repetitive behaviors Likes strict routines Communication difficulties Poor social interaction Inappropriate responses to sensory info Prefers to play alone Short attention span Narrow interests
7 yo boy with severe temper outbursts out of proportion to situation. Reckless disregard for others and aggressive/irritable behavior nearly every day. What dx are you thinking?
Disruptive Mood Dysregulation disorder (DMDD)
Criteria in diagnosing ADHD
Diagnosis is made clinically with input from teachers and parents
At least 6 separate symptoms for at least 6 months
Must occur in multiple settings (ie. home and school)
An adult must have had symptoms as child to be dx’d
Symptom categories of ADHD
Inattentive
Hyperactive
Impulsive
Medications to treat ADHD
Stimulant Medications - Ritalin (methylphenidate) Non-stimulant medications that are used as alternatives - Atomoxetine - Bupropion - Guanfacine - Clonidine
For an adjustment disorder to be diagnosed, the following criteria must be met:
Having emotional or behavioral symptoms within three months of a specific life stressor
Experiencing more stress than would normally be expected in response to stressor
An improvement of symptoms within six months after stressful event ends
Symptoms are not the result of another diagnosis
Bipolar I vs Bipolar II
I: one or more manic episodes, +/- major depression episode
II: one or more major depressive episodes + at least one hypomanic episode NO MANIC
What is cyclothymic disorder?
Milder form of bipolar hypomania and depression not severe enough to meet bipolar criteria
Symptoms of manic episode
4-7 days of at least 3 mood elevation sx’s
Euphoria Racing thoughts Inflated self-esteem Poor judgment Rapid speech Aggressive behavior Agitation or irritation Increased physical activity Risky behavior Spending sprees or unwise financial choices Increased drive to perform or achieve goals Decreased need for sleep Delusions or a break from reality (psychosis) Poor performance at work or school
Medications for bipolar disorders
Mood stabilizers - Lithium - Valproic acid - Carbamazepine Antipsychotics - Risperidone Acute manic episode - Haloperidol - Benzodiazepines
A mental disorder characterized by a pervasive and persistent low mood and low self-esteem and by a loss of interest or pleasure in normally enjoyable activities
Depressive disorder
DSM Criteria for Major Depressive Disorder
5 or more of these sx’s during same 2 week period (* = required)
- *depressed mood most of day
- anhedonia most of day
- Unintentional weight loss/gain or appetite change
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- fatigue or loss of energy
- worthlessness or excessive guilt
- suicidal ideation
Caution with using Lithium therapy
narrow therapeutic window
check serum level every 4-8 wks
Med that is a norepinephrine and dopamine reuptake inhibitor
Bupropion (Wellbutrin)
Less severe depression that occurs over at least a 2 years, and never asymptomatic longer than 2 consecutive months
Persistant depressive disorder
Persistent depressive (or dysthymic) vs major depression
Persistent depressive only needs 2 sx’s instead of 5 and does not include suicide ideation, weight changes, or guilt
What BMI indicates hospitalization for anorexic patient?
less than 15
A patient has seen several plastic surgeons and no less than three dermatologists in the past 6 months. Which somatoform disorder might she be suffering from?
Body dysmorphic disorder
Two diagnostic criteria for schizophrenia that must be met over most of a month with significant changes in social functioning over the past 6 months.
Delusions Hallucinations Disorganized speech Catatonic behavior Negative symptoms
Duration of symptoms that differentiate different schizophrenia spectrum disorders?
Brief psychotic disorder – less than 1 month
Schizophreniform – 1 to 6 months
Schizophrenia – over 6 months
What is Conversion disorder?
Sx’s of altered motor or sensory function that are incompatible with any recognized neuro or medical pathology
Causes significant distress and impairment
How old to be dx’d with a personality disorder?
18 yo
Very suspicious of others.
Patients tend to blame problems on others.
Preoccupied with the trustworthiness and loyalty of others
Feels threatened by others
Holds grudge
Paranoid Personality Disorder
Voluntary social withdraw with no desire for close relationships
They will choose to be alone and have no interest in others
No interest in praise or criticism.
Schizoid Personality Disorder
Patients exhibit “magical thinking” – believing in telepathy, clairvoyance and other fantasies
Most likely personality disorder to progress to schizophrenia
Severe social anxiety
Schizotypal Personality Disorder
Cluster A vs B vs C
A = mad/weird; paranoid, schizoid, schizotypal B = bad; antisocial, borderline, histrionic, narcissistic C = sad; avoidant, dependent, OCPD
antisocial vs conduct disorder
antisocial dx patient must be at least 18 yo, otherwise conduct disorder
Pattern of disregard for the rights of others
No empathy
Manipulative – may appear charming
Often a criminal pattern emerges
History of child abuse
History of starting fires, abusing animals etc.
Patient over 18
Antisocial Personality Disorder
Intense mood swings, impulsive behaviors, and severe problems with self-worth
Emotionally unstable and intense
Cannot tolerate being alone, but intense anger towards friends
Self-mutilation and manipulative suicide attempts
Borderline Personality Disorder
Long standing pattern of attention-seeking behavior and a tendency to exaggerate thoughts and feelings
Affected individuals are exuberant and extroverted
Easily influenced by others
Somatization and substance-use disorders are very common
Self-indulgence
Persistent manipulation
Histrionic Personality Disorder
Inflated self image, pattern of grandiosity, need for admiration and lack for empathy
Long to be special, with arrogance and haughty attitude
Fragile self-esteem, prone to depression
Exploitative and takes advantage of others
Narcissistic Personality Disorder
Intense sensitivity to rejection
Feel inferior and as though no one would want to be around them
Hunger for company, but may completely avoid social situations due to fear of rejection.
Self loathing
Avoidant Personality Disorder
Patients can not make decisions for themselves
Feel helpless
Clingy, submissive
Fear responsibility due to low self esteem
Fear being alone and need to form relationships for survival
Dependent Personality Disorder
Difference between OCD and OCPD
OCD ego-dystonic (patient doesn’t want this behavior)
OCDP ego-syntonic (patient thinks behaviors are acceptable)
Fixation on minute details and rules Obsession with lists and schedules Extreme perfectionism Inflexible and change in routine may cause significant anxiety Obsessive cleanliness or hoarding
Obsessive-Compulsive Personality Disorder (OCPD)
How long do symptoms have to occur for the diagnosis of acute stress reaction to change to PTSD?
1 month
What is a life-threatening alcohol withdrawal symptom and when do they start?
Delirium tremors (DTs) begin 2-3 days after last drink
1st line medication for acute stress disorder
SSRI
DSM-5 criteria for conduct disorder
aggression to people and animals
destruction of property
deceitfulness or theft
serious violation of rules
Red flags of child abuse on PE
Injuries not consistent with history
Spiral fractures from twisting
Burns of perfect shapes
Hyphema (blood in anterior chamber)
Natural response to a loss with eventual recovery =
grief reaction
What is factitious disorder? What are 2 types?
Falsification of physical or psychological symptoms, or induction of injury/disease, with evidence of DECEPTIVE INTENT
* Not a malingerer who is wanting external gain
Munchausen: illness imposed on self
Proxy: illness imposed on another
Symptoms of REM vs non-REM sleep behavior disorders?
REM: failure of muscle inhibition, eyes closed, act out dreams
Non-REM: sleep walking and subtypes, sleep terror, eyes open
Current first line meds for tobacco cessation
- Nicotine Replacement Therapy; 5 routes (lozenge, gum, patch, nasal spray, inhaler)
- Bupropion (Wellbutrin)
- Varenicline (Chantix)
