Behavioral Health Flashcards
1
Q
Acting Out
A
Expressing unacceptable feelings through actions
2
Q
Denial
A
Behaving as if an aspect of reality does not exist
3
Q
Displacement
A
Transferring feelings to a more acceptable object
- Ex. If a mother hates her stepson, but instead of yelling and showing it towards him, she yells and displaces her anger at their dog
4
Q
Passive Aggression
A
Avoiding conflict by expressing hostility covertly
5
Q
Projection
A
Attributing ones own feelings to others
Ex. If a mother hates her stepson but instead of releasing her hate and anger on him, she accuses her husband of hating him
6
Q
Rationalization
A
Justifying behavior to avoid difficult truths
Ex. Making excuses for unacceptable feelings or behavior
7
Q
Reaction Formation
A
Responding in a manner opposite to ones own feelings
Ex. Mother that feels resentment and anger towards her stepson but masks her unacceptable emotions with declarations of love and care for him.
8
Q
Regression
A
Reverting to an early developmental state
9
Q
Splitting
A
- Seeing others as all bad or all good
- All or nothing
- Patient is unable to integrate positive and negative qualities of the self or others into a cohesive and realistic whole.
- Seen in borderline personality disorder
Ex. One day you see your parents as all mean and the next day you see your parents as all nice
10
Q
Sublimation
A
Channeling impulses into socially acceptable behavior
11
Q
Suppression
A
Putting unwanted feelings aside to cope with reality
12
Q
Define Delusional Disorder?
A
- > 1 delusions x > 1 month
- Persistent, false, fixed beliefs
- Other psychotic symptoms are absent or not prominent
- Still able to function properly, behavior is not obviously bizarre or odd
- Types:
1. Eromatic
2. Grandiose
3. Jealous
4. Persecutory
5. Somatica
13
Q
Erotomatic delusional disorder
A
Believing that someone is in love with them
14
Q
Grandiose delusional disorder
A
Believing that they have great talent, insights or achievements
15
Q
Jealous delusional disorder
A
Believing that their partner is unfaithful
16
Q
Persecutory delusional disorder
A
Believing they are being cheated, spied on, poisoned or harassed
17
Q
Somatic delusional disorder
A
Believing bodily functions and sensations are abnormal
18
Q
Brief psychotic disorder?
A
- > 1 positive psychotic symptoms x < 1 month
- Sudden onset with full return to premorbid level of functioning
19
Q
Paranoid personality disorder?
A
- Suspiciousness, distrustful, hypervigilant
20
Q
Schizotypal personality disorder
A
- Eccentric behavior, odd thoughts and perceptions
21
Q
What symptoms would you find with serotonin syndrome?
A
- Neuromuscular excitation
- Hyperreflexia, clonus, myoclonus, rigidity or tremor - Autonomic stimulation
- Hyperthermia, tachycardia, diaphoresis and vomiting/diarrhea - Altered mental status
- Agitation or confusion
22
Q
What causes serotonin syndrome and what is the precursor for serotonin?
A
- SSRIs taken in combination with MAOIs
- Excess dose of SSRIs
- Tryptophan is the precursor
23
Q
What is the treatment for Serotonin syndrome?
A
Cyproheptadine
- An antihistamine with antiserotonergic properties, has 5-HT1 and 5-HT2 receptor antagonistic properties.
24
Q
Lithium
- Indications
- Side effects
A
Indications: - Manic and depressive episodes maintenance Side effects: - Diabetes Insipidus - Hypothyroidism - Tremor - Ebstein Anomoly of tricuspid valve
25
Valproate
- Indications
- Side effects
```
Indications:
- Manic episodes maintenance
- Absence seizures
- Generalized tonic-clonic seizures
- Myoclonic seizures
Side effects
- Hepatotoxic
- Neural tube defects in pregnancy
```
26
Carbamazepine
- Indications
- Side effects
```
Indications:
- Manic episodes maintenance
- Partial seizures
- Generalized seizures
- Trigeminal Neuralgia
Side effects:
- Agranulocytosis
- SIADH (Hyponatremia)
- Neural tube defects
```
27
Lamotrigine
- Indications
- Side effects
```
Indications
-Depressive episodes maintenance
- Focal seizures
Side effects
- Benign rash
- Stevens-johnson syndrome
```
28
What are lithiums effects on the thyroid and how is it managed?
- It interferes with normal thyroid functioning by decreasing thyroid hormone synthesis and release.
- Leads to hypothyroidism and goiter.
- Causes weight gain, dry skin, hair loss, constipation and bradycardia.
- Periodically measure TSH
- Treat with T4, do not have to discontinue Lithium
29
What are lithiums effects on the kidney?
- Nephrogenic diabetes insipidus
- Chronic tubulointerstitial nephropathy
- Requires regular monitoring of Lithium, BUN and creatinine
30
What causes lithium toxicity?
1. Overdose
2. Volume depletion such as decreased GFR
3. Drug interactions with:
- Thiazide diuretics
- NSAIDs besides aspirin
- ACE inhibitors
- Tetracyclines, metronidazole
31
What are the clinical features of acute and chronic lithium toxicity?
```
Acute
- Nausea, vomiting, diarrhea
- Late neurologic sequelae
Chronic
- Confusion
- Agitation
- Ataxia
- Tremors/Fasciculations
```
32
How do you treat lithium toxicity?
Hemodialysis
33
Major Depressive Disorder
- Which criteria must be present and which are required?
- What is the time frame?
```
Five of the following
- Sleep disturbances
- Appetite change
- Low energy
- Psychomotor changes
- Low mood **
- Anhedonia (lack of feeling pleasure)**
- Guilt
- Focus/concentration difficulty
- Suicidal ideation
** Indicates must be present
Duration > 2 weeks
Social and occupational dysfunction
Suicidality related to hopelessness and worhtlessness
```
34
Specific Phobia
- Anxiety about a specific object or situation for more than 6 months
- Ex. fear of flying, heights, animals, injections, blood
- Patient usually tries to avoid the situation
- Common (10% of the population)
- Usually develops in childhood after a traumatic event
35
What is the most effective treatment for a specific phobia?
- Cognitive behavior therapy with systematic, repeated exposure
- Usually performed in a gradual, stepwise manner
- Decreases anxiety over time as habituation and extinction occur
- Confrontation with stimulus in a safe, controlled manner can be accomplished through in vivo, imaginal and virtual reality
- Short acting benzodiazepines may be used with a limited role in acute treatment if therapies are unavailable or there is insufficient time
36
What medication can be used to treat performance anxiety?
Propanalol
37
Escitalopram
- MOA
- Uses
- Selective Serotonin Reuptake Inhibitor
| - Used for panic disorder, generalized anxiety disorder and social anxiety disorder
38
Benzodiazepines
- MOA
- Uses
- Sedative hypnotic drugs with anxiolytic, muscle relaxant and anticonvulsant actions
- Bind and modulate GABA receptor chloride channel in CNS neurons increasing its frequency of opening
- Increase in chloride permeability hyperpolarizes and stabilizes the membrane making it less likely to depolarize
39
What is the treatment for OCD?
- Serotonin is the primary pharmacological target
- First line treatment is Selective Seretonin Reuptake Inhibitors
1. Fluvoxamine
2. Citalopram
3. Escitalopram
4. Fluoxetine
5. Paroxetine
6. Sertraline
- Second is cognitive behavioral therapy (exposure and response prevention)
40
Tourrette Syndrome
- Multiple motor and more than 1 vocal tic (doesn't have to be concurrent or greater than 1 year)
- Onset age must be before age 18
1. Motor tics
- Facial grimacing
- Blinking
- Head/neck jerking
- Shoulder shrugging
- Tongue protrusion
- Sniffing
2. Vocal tics
- Grunts
- Snorts
- Throat clearing
- Barking
- Yelling
- Coprolalia (involuntary obscene speech) 10-20% of pts
Treatment
1. Antipsychotics
- Haloperidol
- Fluphenazine
- Pimozide
2. Tetrabenzine
3. Alpha-2-adrenergic receptor agonists
- Guanfacine
- Clonodine
4. Behavioral therapy or psychoeducation
41
Schizoid personality disorder
Prefers to be a loner, detached, unemotional
42
Antisocial personality disorder
Disregard; violation of the rights of others
| - Not to be confused with avoidant personality disorder
43
Borderline personality disorder
Chaotic relationships, sensitivity to abandonment, labile mood, impulsivity, inner emptiness, self harm
44
Histrionic personality disorder
Dramatic, superficial, attention seeking
45
Narcissistic personality disorder
Grandiosity, entitlement, lack of empathy
46
Avoidant personality disorder
Avoidance due to fears of criticism; rejection
47
Dependent personality disorder
Submissive, clingy, needs to be taken care of
48
Obsessive compulsive disorder
Rigid, controlling, perfectionist
49
What are the 8 childhood and early onset behavioral disorders?
1. Attention deficit hyperactive disorder
2. Autism spectrum disorder
3. Rett syndrome
4. Conduct disorder
5. Oppositional defiant disorder
6. Separation anxiety disorder
7. Tourette syndrome
8 Disruptive mood dysregulation disorder
50
ADHD
- Onset before age 12
- Limited attention span and poor impulse control
- Hyperactivity, impulsivity and/or innatetntion in multiple settings (school, home, church, etc)
- Normal intelligence but coexists with difficulties at school
- Continues into adulthood in 50%
Treatment:
1. Stimulants
- Methylphenidate
- Adderal
2. Cognitive behavioral therapy
3. Alternatives
- Atomoxetine (SNRI): Brand name straterra
- Guanfacine
- Clonidine
51
Autism Spectrum Disorder
- Poor social interaction, social communication deficits, repetitive visualized behaviors, restricted interests
- Presents in early childhood
- May be accompanied by intellectual disability
- Rarely accompanied by unusual abilities (savants)
- More common in boys
- Associated with increased brain/head size
52
Rett Syndrome
- X-linked dominant disorder
- Seen almost exclusively in girls
- Males die in utero or shortly after birth
- De novo mutation of MECP2
- Symptoms present ages 1-4
- Regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, stereotyped hand wringing
- No longer solitary diagnosis within DSM-5
53
Conduct disorder
Repetitive and pervasive behavior violating the basic rights of others or social norms
- Such as aggression to people and animals, destruction of property, theft
- After age 18 it is reclassified as antisocial personality disorder
- Treatment is cognitive behavioral therapy
54
Oppositional defiant disorder
- Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
- Treatment is cognitive behavioral therapy
55
Separation anxiety disorder
- Fear of separation from home or attachment figure
- Can be normal behavior up to age 3-4
- May lead to factitious physical complaints to avoid school
- Treatment is cognitive behavioral therapy, play therapy or family therapy
56
Disruptive mood dysregulation disorder
- Before age 10
- Severe recurrent temper outbursts out of proportion to situation
- Child is constantly angry and irritable between outbursts
- Treatment is with psychostimulants, antipsychotics or cognitive behavioral therapy
57
Buspirone
- MOA
- Properties
- Uses
- Nonbenzodiazepine anxiolytic
- Partial agonist of 5HT1A receptor
- Has no muscle relaxant or anticonvulsant properties
- Used for treatment of generalized anxiety disorder
- Not useful in acute anxiety because of its slow onset of action (may take up to 2 weeks)
- Not effective in panic disorder
- No risk of tolerance, dependence or withdrawal
58
What is Clozapine and what are the 2 indications for its use?
- Second generation antipsychotic that has affinity for dopamine and serotonin receptors
- Treatment resistant schizophrenia
- Schizophrenia associated with suicidality
59
What are the adverse effects of clozapine?
Agranulocytosis
Seizures
Myocarditis
Metabolic syndrome
