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RR Prep > Behavioral Health > Flashcards

Behavioral Health Flashcards

1
Q

What is first-line treatment for this condition for PMS?

A

Fluoxetine

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2
Q

When do symptoms of PMS or PMDD occur?

A

later luteal phase
four or five prior to menses
and remit after menses

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3
Q

MC affective/behaviroal sx PMS/PMDD

A

MC mood swings

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4
Q

Lab testing that should be done when working up possible PMS/PMDD

A

Thyroid studies

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5
Q

First line tx PMS/PMDD

A

SSRIs can be administered either

  1. continuously
  2. only during the luteal phase (start on day 14 of cycle)
  3. monthly only when symptomatic
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6
Q

Second line tx for PMS/PMDD

A

Oral contraceptives that contain drospirenone (progestin) best
Can also be used in adjunct with SSRI

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7
Q

What PMS is suggested when someone fails SSRI/oral contraception combo tx

A

Gonadotropin releasing hormone agonist tx such as
LEUPROLIDE
When this is done the provider usually then will “add-back therapy” with estrogen and progestin to avoid menopausal sx and osteoporosis

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8
Q

What is the last line tx for PMS/PMDD

A

surgery with oophorectomy

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9
Q

Tx for moderate to severe PMS/PMDD

A

SSRI
Oral contraceptives containing drosperinone
Continuous contraceptive containing any progestin
Alprazolam
GrRH

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10
Q

Ineffective tx for PMS/PMDD

A

progesterone
vitamin supplements
dietary restriction

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11
Q

What are the adverse effects of GnRH agonists?

A

bc of hypoestrogenism:

hot flashes, vaginal atrophy, decreased BMD

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12
Q

Name a med that can be used when someone with schizophrenia has an acute psychotic episode

A

Olanzipine

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13
Q

RF for schizophrenia

A 
living in urban area
immigration
obstetric complications
late winter or early spring birth (poss. exposure to influenza during neural tube development)
increased paternal age at conception
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14
Q

Schizophrenia positive sx

A 
Added to the personality:
hallucinations
delusions
disorganized speech
disorganized behavior
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15
Q

Schizophrenia negative sx

A 
Take away from the personality:
blunted/flat affect
alogia or impoverished speech
anhedonia (lack pleasure)
social withdrawl
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16
Q

Dx of schizophrenia can be made by…

A

when at least two or more of the characteristic symptoms, including delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms, are present most of the time for at least one month (or less if treated)

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17
Q

Dx of schizophrenia is confirmed at 6 months by….

A

Signs of disturbance must persist for at least six months (with at least one month of two of the five symptoms) to confirm the diagnosis. During the remainder of the six month period, the clinical manifestations may be limited to only negative symptoms or less severe positive symptoms that are not causing social or occupational dysfunction

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18
Q

Do antipsychotics work better on positive or negative sx of schizophrenia

A

positive

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19
Q

Which antipsychotic has the best efficacy and why is it not used first

A

clozapine
causes agranulocytosis
reserved for those who fail to improve or can not tolerate the other antipsychotics

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20
Q

Which antipsychotic is the only one effective for the negative sx of schizophrenia

A

cariprazine

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21
Q

Which generation of antipsychotics cause the least extrapyramidal SE

A

Second generation

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22
Q

What are the extrapyrimidal SE

A 
akathisia
rigidity
bradykinesia
tremor
acute dystonic rxns
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23
Q

How long does it take for an antipsychotic to improve positive sx of schizophrenia

A

Most effect seen in first 2 weeks

Continues to improve over months

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24
Q

What initial intervention should you do if an antipsychotic isn’t working for your schizophrenic pt

A

increase the dose
Or
switch to a different antipsychotic

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25
Q

How do you treat a person with schizophrenia having agitated psychosis

A

usually works in minutes
antipsychotic med like risperidone, olanzapine, haloperidol
w/ or w/o
benzo like lorazepam

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26
Q

Why would benztropine of diphenhydramine be given to someone experiencing agitated acute psychosis?

A

To blunt the extrapyramidal SE of the antipsychotic meds

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27
Q

With what and for how long should you treat someone who has had a psychotic event (even just one)

A

antipsychotic med at lowest dose possible indefinitely

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28
Q

Name the first gen antipsychotics
MOA
SE

A

MOA: dopamine antagonists
haloperidol, fluphenazine, chlorpromazine
SE: extrapyramidal sx, sedation, anticholinergic, orthostatic hypotension, agranulocytosis, tardive dyskinesia, hyperprolactenemia, NMS, prolonged QT interval, metabolic syndromes

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29
Q

Define tardive dyskinesia

A

involuntary choreoathetoid movements of the mouth, tongue, face, extremities, or trunk

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30
Q

Name metabolic syndrome features

A

Weight gain
DM
dyslipidemia
cardiovascular disease

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31
Q

These two AE effects do not usually occur when using a second gen antipsychotic

A

extrapyramidal

tardive dyskinesia

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32
Q

Name some anticholinergic effects

A

dry mouth, constipation, urinary retention, blurred vision

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33
Q

What is the MOA of second gen antipsychotics

A

dopamine and serotonin antagonists

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34
Q

Tx for akathisia (motor restlessness)

A

benzodiazepines

35
Q

Schizophrenia rapid review

A

Schizophrenia

≥ 2 symptoms:
Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
Brief psychotic disorder: < 1 month
Schizophrenia: > 6 months
Schizophreniform disorder: 1–6 months
Schizoaffective disorder: psychosis + mania or depression

36
Q

Typical alcohol withdrawal sx 8 hours

A

anxiety 1st

37
Q

Early alcohol withdrawal typical presentation

A

anxiety, agitation, insomnia, mild tremor, nausea

38
Q

Alcohol withdrawal sx at 48 hours

A

prevalent tremor elevated BP, vital sign instability

39
Q

What med can treat alcohol anxiety

A

benzo

40
Q

Late alcohol withdrawal sx

A

autonomic instability:

seizure, delirium, LOC, altered mental status, death

41
Q

How should treat alcohol withdrawal seizures

A

IV benzos fast acting

42
Q

List the progression of alcohol withdrawal

A

6-12 h = tremulousness
12-48 h = hallucinations
12-48 h = seizure
>48 h = delirium tremens

43
Q

What is the metabolite half life of chlordiazepoxide

A

3 to 100h

sedative: It can treat anxiety, alcohol withdrawal symptoms, and tremor.

44
Q

Alcohol withdrawal syndrome

A

Alcohol Withdrawal Syndrome

Early symptoms: anxiety, nausea, restlessness
Risk of seizure
Delirium tremens may start after 48 hours
Treat with benzodiazepines
Correct nutritional deficiencies
Offer alcohol cessation support /resources

45
Q

What lab values need to monitored while on lithium

A

thyroid function

46
Q

Define bipolar manic episode

A

Must last at least one week
irritability, elation, expansiveness
along with at least 3 other sx of mania such as…
less need sleep, pressured speech, grandiosity, racing thoughts, easily distractible, increased pleasurable activities that inappropriate, increased goal focused activities

47
Q

Define Bipolar I

A

alternating periods of severe depression and severe mania which can include psychosis

48
Q

Define Bipolar II

A

alternating patterns of severe depression and a LESS severe form of mania = hypomania

49
Q

FIrst line medication tx for bipolar

A

lithium - mood stablizer

check TSH at baseline and every 6 to 12 mos bc it can cause hypothyroid, chronic autoimmune thyroiditis, goiter

50
Q

Lithium category…

A

D

51
Q

Since lithium has a narrow therapeutic range, what are the CI

A

significant renal impairment, cardiovascular ds, sodium depletion, dehydration

52
Q

Define autism spectrum disorder

A

neurodevelopmental disorder characterized by

  1. social communication difficulty
  2. intellectual disability
  3. repetitive, restricted interests and behaviors
53
Q

Autism has a strong heritable link. Name some comorbid factors.

A
  1. ADD
  2. substance abuse
  3. OCD
54
Q

What are the 2 main components of DSM-5 dx of ASD

A
  1. persistent deficits in social communication and interaction
    AND
  2. restricted, repetitive patterns of behavior, interests, or activities
55
Q

Grief rxns

A

Grief Reaction

Stages: denial, anger, bargaining, depression, acceptance
Nonpathologic symptoms: guilt, weight loss, simple hallucinations
Pathologic symptoms: >12 months, severe functional impairment, suicidal ideation, psychotic symptoms

56
Q

Anorexia nervosa: what percentage below expected body weight

A

15% or more below the expected body weight

57
Q

Anorexia nervosa: MC age and gender

A

adolescence or young adult

90% female

58
Q

What other behaviors/characteristic common for someone with anorexia nervosa

A

perfectionists
OCD
destructive relationships
parents often goal driven and over directive

59
Q

Some physical features of anorexia nervosa

A 
low body weight most obvious
muscle atrophy
loss of body fat
Hypocellular Bone Marrow
Decreased Cardiac Diameter
Amenorrhea 
Increased Lanugo
bradycardia, hypotension, constipation, dry skin
leukopenia, elevated serum creatinine, low levels of LH and FSH
60
Q

What ECG might you see in a pt with anorexia nervosa

A

hypokalemia

ST segment and T wave changes

61
Q

Which gland is commonly enlarged in anorexia nervosa

A

parotid gland

62
Q

How long does a panic attack take to peak?

A

10 min

63
Q

What is the prevalence of panic attacks in the population

A

11%

64
Q

Presentation of typical pt with a panic attack

A

Complains of: chest pain, dizziness, feeling choking, palpitations, shortness of breath

PE: hypotension, tachycardia, tachypnea, tremors, cool and clammy skin

65
Q

DSM-5 dx of panic attacks

A

include a sudden onset of fear or discomfort accompanied by four of the following symptoms: fear of dying, fear of losing control, derealization/depersonalization, chest pain, dizziness, a feeling of choking, flushes or chills, gastrointestinal discomfort, sweating, paresthesia, dyspnea, and tachycardia.

66
Q

Tx panic attacks

A

antidepressants; SSRIs, SNRIs

psychotherapy including CBR and exposure tx

67
Q

What are the forms of exposure therapy that can be used for panic attacks?

A

flooding and graduated exposure

68
Q

8yo, ADD, first line initial tx

A

amphetamine-dextroamphetamine and behavioral tx

69
Q

ADD:
prevalence in children
MC in boys or girls

A

8-10%

boys MC

70
Q

How many sx are needed to dx ADD

A

the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), requires at least six symptoms of hyperactivity or impulsivity or at least six symptoms of inattention to make the diagnosis of attention-deficit hyperactivity disorder in children younger than 17 years of age. Children 17 years of age and older and adults require at least five symptoms of hyperactivity or at least five symptoms of inattention. Furthermore, in children and adults, these symptoms must occur often, be present in more than one setting (e.g., school, recreational activities and home), persist for at least six months, be present before the age of 12 years, and be excessive for the developmental level of the child.

71
Q

4-5yo, ADD, first-line tx

A

behavioral tx first then can add pharm if not improved

72
Q

If medicate a 4-5yo for ADD what first line drug

A

Methylphenidate

however in school age children medicate along with behavioral tx

73
Q

Stimulants are the most effective for ADD. Name the prefered

A

dextroamphetamine-amphetamine

74
Q

Non-stimulants can also be used for ADD but are less effective. Name 3.

A

atomoxetine
guanfacine
clonidine

75
Q

ADHD rapid review

A

Attention-Deficit/Hyperactivity Disorder (ADHD)

Most common childhood behavioral disorder
Inattention + impulsivity + hyperactivity
Dx criteria:
Sx present in 2 areas of interaction
Sx must present before 12 years
Sx > 6 months
Sx maladaptive/inappropriate for child’s developmental stage
Rx: medication (most effective), behavioral modification, environmental intervention

76
Q

Name the personality disorder:

no friends, never goes out, flat affect, does not desire relationships

A

schizoid

77
Q

Describe the 3 clusters of personality disorders

A

A: odd and eccentric
paranoid, schizoid, schizotypal

B: dramatic, emotional, erratic
antisocial, borderline, narcissistic, histrionic

C: anxious or fearful
avoidant, dependent, obsessive compulsive personality disorders

78
Q

First and second line tx for personality disorders

A
  1. psychotherapy

2. pharmacologic as adjunct

79
Q

Define schizoid personality disorder per DSM-5

A

a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings beginning by early adulthood. The disorder presents in a variety of contexts, as indicated by four (or more) of the following: neither desires nor enjoys close relationships (including being part of a family), almost always chooses solitary activities, has little or no interest in having sexual experiences with another person, takes pleasure in few or no activities, lacks close friends or confidants other than first-degree relatives, appears indifferent to the praise and criticism of others, and shows emotional coldness or detachment (anhedonic). Schizoid personality disorder can only be diagnosed if the symptoms are not better characterized by another psychiatric disorder.

80
Q

Describe avoidant personality disorder

A

marked by a desire for relationships but individuals avoid those relationships due to intense feelings of inadequacy or fear of criticism. This desire contrasts with schizoid personality disorder where individuals do not desire relationships and prefer social isolation.

81
Q

Describe Major depressive disorder Des

A

is defined by a depressed mood or anhedonia (loss of pleasure) with at least five associated depressive symptoms, including fatigue, sleep disturbances (hypersomnia or insomnia), significant weight changes, feelings of guilt, loss of interest in normally pleasurable activities, decreased concentration, psychomotor retardation (slowed speech or movement), and suicidal thoughts or ideation. The symptoms must be present for at least two weeks for major depressive disorder to be diagnosed. The patient in this vignette is socially withdrawn but does not have a depressed mood or at least five of the symptoms listed above.

82
Q

Describe paranoid personality disorder

A

is marked by a pervasive pattern of distrust and suspiciousness of others. These individuals often misinterpret the actions of others as malevolent and are preoccupied with doubt regarding the loyalty of others. Paranoid personality disorder is also in cluster A.

83
Q

schizoid rapid review

A

Schizoid Personality Disorder

Detachment from social relationships
Restricted range of expression
Solitary activities
Emotionally cold/flat
Avoids close relationships
Pleasure in few activities

RR Prep (8 decks)

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