Behavioral Health / Psych Flashcards
MOA of THC
Partial agonist of cannabinoid 1 and cannabinoid 2 receptors
Mania mnemonic
DIGFAST Distractibility Impulsivity Grandiosity Flight of ideas Activities (psychomotor agitation) Sleep (decreased) Talkativeness, pressured speech
Question to always ask if patient presents with major depression
any hx of mania
- bipolar more likely to present for help when depressed, during mania feel “well”
MC symptoms associated with bulimia
- fatigue
- abd pain
- bloating
- constipation
- irregular menses
- tachycardia
- reduced BP
- dry skin
- parotid gland enlargement
- dental caries
- renal enamel erosion
Bulimia
- what lab value is usually increased?
amylase: hypersecretion from salivary glands
Bulimia
- electrolyte imbalances
- hypocalcemia
- hypomagnesemia
- hypokalemia
- vomiting
Bulimia
- Time requirement for dx
1 episode of binge eating with inappropriate compensatory behavior per week for min 3 months
Anorexia
- cardiovascular effects
- myocardial atrophy
- MV prolapse
- pericardial effusion
- bradycardia
- dysrhythmia
- etc
Anorexia
- Renal/electrolyte changes
- dec GFR
- renal calculi
- dehydration
- hypokalemia
- hypomg
Anorexia
- lipid panel changes
increased total cholesterol
- dt increased protection of cardio protective HDL
Anorexia
- treatment
behavioral therapy
What is a barrier to treatment in pts with paranoid personality disorder
fragile self-concept = pt misinterprets phrases used by therapist as personal threats…
Obsessive-compulsive personality disorder
- treatment
- psychotherapy
- Working Alliance Inventory: useful tool to determine goals for treatment
- med treatment not recommended (unlike in OCD)
Panic disorder
- RF
- genetic
- childhood trauma
- stressful life experiences
- childhood exposure to abuse
- childhood smoking
Lithium
- overview
- indications
- MoA (4)
- mood stabilizer
- bipolar I, depression
- inhibits dopamine receptors
- inhibits NMDA receptors
- promotes GABA (reducing dopamine and glutamine)
- increases brain-derived neurotropic factor (neuroprotective)
Refeeding syndrome
- overview
- timing
- fatal fluid/electrolyte shift secondary to nutritional rehab
- usu during first two weeks of supplementation
Refeeding syndrome
- process
- starvation = depleted phosphate
- feed > insulin release > cellular uptake of phosphate > low serum phosphate levels > myocardial dysfunction and respiratory failure
- can also cause volume overload from increased renal Na retention
Refeeding syndrome
- three electrolyte abnl
- hypophosphatemia
- hypomg
- hypokalemia
Conduct Disorder
- overview
repetitive behaviors that violate societal norms and others’ basic rights.
- serious physical aggressions
- Exhibit little guilt/remorse
Conduct Disorder
- RF
- Unstable home env
- hx of child abuse/neglect
Conduct disorder
- mgmt
- provide consistent boundaries
- positive reinforcement for good behavior
- Family counseling
- meds: methylphenidate
Conduct Disorder
- pharm mgmt
- stimulants: methylphenidate and dextroamphetamine
- +/- antidepressants, lithium
Conduct Disorder
- what other psych condition is often comorbid
ADHD
*ADHD also frequently comorbid with ODD
Phobia
- nonpharm mgmt
- CBT
- Desensitization
- Breathing techniques
- exposure therapy
Phobia
- pharm mgmt
initial: benzos such as lorazepam
Social anxiety disorder
- pharm mgmt
- SSRIs: paroxetine, sertraline
- SNRI: venlafaxine
Schizoid personality disorder
- mgmt
- psychotherapy
- rarely respond to pharm
Schizoid personality disorder
- overview
enduring pattern of behavior with four of the following symptoms:
- no desire for close relationships
- no desire for sexual intimacy
- preference for solitary activities
- anhedonia,
- flattened affect or emotional detachment
- no close friends or confidantes apart from first-degree relatives
- no regard for praise or criticism
- ** NO sx of psychosis (like schizophrenia)
Illness Anxiety Disorder
- overview
- preoccupation with having or acquiring a serious, undiagnosed illness
- 0-mild somatic sx
- substantial anxiety
Illness Anxiety Disorder
- mgmt
- regular PCP visits
- 1st line: CBT
- 2nd line: other psychotherapy
- 3rd line: antidepressants
DSM V term for alcoholism
Alcohol Use Disorder
- Not alcohol abuse
- mild: 0-3 features
- moderate: 4-5 features
- severe: >5 features
Alcohol Use Disorder features
- recurrent drinking resulting in failure to fulfill obligations
- recurrent drinking in hazardous situations, recurrent drinking despite adverse interpersonal consequences
- evidence of tolerance
- evidence of withdrawal or use of alcohol to avoid withdrawal symptoms
- drinking in larger amounts over longer periods than intended
- alcohol craving
- spending a great deal of time in alcohol-related pursuits
- continued drinking despite knowledge of the problems caused by alcohol
- replacing important activities with drinking.
Medication used in PTSD to decrease nightmares and sleep disturbances
prazosin: alpha-adrenergic blocker
PTSD
- RF
- female
- low socioeconomic status
- young age
- childhood adversity exposure
- intensity of initial reaction to traumatic event
PTSD
- treatment
- CBT: trauma-focused
- Serotonergic antidepressants: mood and cognitive disturbances
- 2nd gen antipsychotics: hyperarousal and re-experience sx
- prazosin for sleep
MDD
- RF for recurrence
- childhood maltreatment of MDD
- prior history of recurrent sx after treatment
- repeated exposure to adversity
- younger age at time of initial sx
- usu occurs in first few months after treatment
MDD
- mneumonic
SIG E CAPS Sleep disturbance Interest (anhedonia) Guilt / worthlessness Energy, lack of concentration Cognition/Concentration reduction Appetite: inc or dec - Psychomotor retardation or aggitation - Suicidality
Screening necessary prior to starting stimulates for ADHD
- complete cardiac evaluation, PE, Fam hx
- bp
- hr
- drug abuse screening
Delusional Disorder
- definition
- 1+ delusions for 1+ months
- persecutory MC
- not schizophrenic / acute psychosis
- functioning not very impaired
- behavior is not bizarre or odd
Delusional Disorder
- mgmt
- antipsychotics: aripiprazole or ziprasidone
Treatment for male with pedophilic disorder
medroxyprogesterone IM: blocks testosterone synthesis and = reduced libido
Antidepressant CI in patients with bulimia
buproprion
Bulimia
- tx
- nutritional rehab
- psychotherapy
- first line meds: SSRI Fluoxetine**
Cannabis detection in urine
- mod to heavy use
- light use
- 1 month
- 1 week
First line med for benzodiazepine withdrawal
diazepam: long-acting benzo
Benzo withdrawal sx
- n/v
- agitation
- tachycardia
- diaphoresis
- tremor
- fever
- insomnia
- anxiety
- restlessness
- delirium
- psychosis
- seizures
- death
OCD
- mgmt
- serotonergic antidepressants
- psychotherapy
Cyclothymic disorder
- def
- hypomania sx but not hypomania and mild depression not major depressive episode
- min 2 year
- never gone more than 2 consecutive months
GAD
- mgmt
- 1st line: CBT + serotonergic antidepressants
- positive problem solving
- muscle relaxation
ODD
- define
- Recurrent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness
- > 6 months
- 50% comorbid ADHD
ODD
- treatment
- psychotherapy
- parent management therapy: train parents to change behavior which help alter child’s behavior at home
- group therapy for adolescents can be helpful too
Conduct disorder vs. oppositional defiant disorder
CD is complication of untreated ODD, CD is more severe
Solvent inhalation
- three types
- sniffing: fumes that leave a container of a volatile substance
- huffing: enhancing evaporation by inhaling through a soaked rag
- bagging: creating an atmosphere in a bag before inhaling *most potent
Solvent inhalation
- common PE
- erythematous rash around the mouth: contact dermatitis
- Mood swings
- HA
- Facial flushing
- n/v
- anorexia
- unusual body odor/breath
- coughing
- tachycardia
- slurred speech
- chronic neurological changes
Solvent inhalation
- mgmt
- acute: symptom support
- psychiatric care/CBT
Solvent inhalation
- common substances
- gasoline
- cleaners
- paint
- fuels
Solvent inhalation
- patient experience
hallucination
euphoria
Delusions
- nihilistic
- grandiose
- believe world, body, or body part have ceased to exist or there is an impending catastrophic event
- patient believes have abilities that are beyond what is expected of the individual such as claims of wealth or fame
MDD
- when should perform laboratory testing?
when suspect medical causes for depressioN”
- hypothyroidism
- hypercalcemia
- cancer
- SLE
Body Dysmorphic Disorder
- first line therapy
fluoxetine (SSRI)
+ CBT
Body Dysmorphic Disorder
- mgmt after first line
- treatment resistant: add buspirone
- treatment refractor: DC SSRI and start clomipramine or venlafaxine
- severe illness: poss hospitalization, pharmacotherapy, CBT
Buproprion MoA
inhibits dopamine and norepinephrine reuptake
Three major causes of smoking-related mortality
- atherosclerotic CV disease
- COPD
- Lung cancer
Tobacco
- effects of use
- restlessness
- insomnia
- anxiety
- increased GI motility
5 As of smoking cessation
Ask Advise Assess Assist Arrange
Common ADR of second generation antipsychotics
metabolic syndrome: weight gain, dyslipidemia, DM
- monitor: weight, bp, lipid profile, fasting glucose, waist circumference.
Which two second-get antipsychotics have highest risk for metabolic syndrome
olanzapine and clozapine
PTSD
- self-report checklist known as PCL-5
used for screening purposes and to monitor symptom severity over time in PTSD
When would you use ECT in Bipolar I disorder?
- usually not used in bipolar I, more common in MDD
- patient with episode of MD and malignant catatonia = ECT first line
Methemoglobinemia
- definition
- oxidation of heme
- changes physiologic form of iron from ferrous to ferric
- oxidized heme has sig reduced oxygen carrying capacity
Methemoglobinemia
- common drug cause
Aml nitrite
Methemoglobinemia
- common findings
- sudden cyanosis
- low pulse ox
- hypotension
- dark discoloration of blood on phlebotomy (chocolate brown)
- normal partial pressure of O2 on ABG
Methemoglobinemia
- treatment
- O2
- IV dextrose
- methylene blue
- exchange transfusion
Bipolar I
- when patient is stabilized on drug, when wean off?
you don’t : should receive lifelong maintenance therapy - regardless of number of mania episodes they have had
Factitious disorder
- define
Intentionally fabricated medical or psychiatric symptoms in the absence of any external benefit to the patient
- often comorbid with depression, substance-abuse, personality disorders
Factitious disorder
- should routinely assess
- suicide risk
- self-injury behavior
Factitious disorder
- treatment
Psychotherapy
Schizophrenia
- dx
2+ for >6 months:
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative sx
Schizophrenia
- mgmt
- antipsychotic medications: best on positive symptoms
Akathisia
generalized motor restlessness, not relieved with movement
- MC EPS of antipsychotic medications
How to treat akathisia
- reduce antipsychotic dose, trying to avoid exacerbation of psychotic sx
- if dose cannot be reduced, bb, benztropine, benzos
PCP
- name
Phencyclidine
- hallucinogenic drug
- insufflated, smoked, ingested, injected
- similar to ketamine
- glutamate (NMDA) receptor antagonist
PCP
- use symptoms
- violent/bizarre behavior
- horizontal and vertical nystagmus
- disorientation
- auditory hallucinations
- HTN, tachycardia, hyperthermia
PCP
- mgmt
- mild: supportive care
- > mild: benzos (midazolam preferred due to rapid onset and short half-life)
- haloperidol if psychotic features present
- GI cleansing/charcoal not indicated
Methamphetamine
- S/sx
- pupillary dilation
- dry mouth > dental carries
- dec need for sleep
- inc talkativeness
- inc energy
- inc bowel sounds
- irritability/mood change
- tachycardia
- diaphoresis
- euphoria
- inc libido
- n/v/d
- pruritis
- loss of appetitie
Methamphetamine
- high risk of death due to what
cardiac death
- drug = cardiac stimulation
Two psychotropic drugs approved by FDA for use in child or adolescent dx with autism spectrum disorder
Risperidone
aripiprazole
Autism Disorder
- mgmt
- Atypical antipsychotics: risperidone, aripiprazole,
- stimulants: methylphenidate, dextroamphetamine
- SSRIs
- alpha 2 adrenergic agonists
- valproic acid
- atomoxetine
- melatonin
- mood stabilizer: lithium
Antisocial personality disorder
- how to dx
patient history
Antisocial personality disorder
- dx
- must be at least 18 yo
- evidence of CD before age of 15
- pervasive pattern of disregard/violation of rights of others
Antisocial personality disorder
- mgmt
- CBT
- no pharm unless treating comorbidity
- possible use of 2nd gen antipsychotic if severely aggressive
MDD
- Dx requirements
Loss of interest or pleasure in most activities OR persistently depressed mood most of the day
- min 2 weeks, nearly every day
AND 4+ of the other sx
PTSD
- dx
- exposure to actual/threatened death, injury, sexual violence
- 1+ intrusion sx
- persistent avoidance of stimuli
- negative alterations cognition or mood
- marketed alterations in arousal and reactivity
- duration >1 month
- clinically sig distress/impairment
- not related to substance abuse, other mental illness
Opiate withdrawal symptoms
- adrenergic hyperactivity: CNS excitation, tachypnea, tachycardia, HTN
- GI: n/v/d abd cramp
- mydriasis (dilated)
- yawning
- lacrimation
- piloerection
- flu like sx
Sx within several hours of discontinuation, peak 24-48 hours
Alcoholism:
Lab findings
- elevated mean corpuscular volume
- elevated triglycerides
- elevated serum uric acid
- elevated liver function tests.
Phenothiazines exert their antipsychotic effects by blocking
dopamine receptors
Common early clues to impending delirium tremens
Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity
Ideas of reference
fixed beliefs that people are referring to you and about you through media
Formications
sensation of insects crawling on the skin and is commonly associated with delirium tremens from alcohol withdrawal and cocaine addiction
TCA
- well known ADR (broad)
anticholinergic
treatment of choice for benzodiazepine intoxication
Flumazenil
Lithium Toxicity
Tremor diarrhea vomiting ataxia restlessness. (Weight gain, hypothyroidism, polyuria, and exacerbation of psoriasis can occur at therapeutic lithium levels)
Lab to run prior to starting lithium
creatinine
* renal failure, hyponatremia, dehydration can all increase likelihood of lithium toxicity
Second line drug options for bipolar I and II
- Antieleptics: valproate or carbamazepine, lamotrigine
- second gen antipsychotics: risperidone first line
What medication is CI in patient with liver dz
valproate
Opioid withdrawal
- treatment
- naloxone/naltrexone (opioid receptor antagonist)
- symptomatic
- clonidine: a2 agonist
- methadone: long acting
- Suboxone
- zofran for n/v
Long term: methadone and suboxone
Sedative, hynotpic, anxiolytic withdrawal
- treatment
long acting benzo like clonazepam
stimulant
- MoA
block amine (dopamine, norepinephrine, serotonin) reuptake
stimulant
- withdrawal sx
severe depression inc suicidal ideation hyperphagia hypersomnolence fatigue malaise severe craving
For all the drugs of addiction
- DSM-5 criteria
Must have at least two of the symptoms occurring in a 12 month period
Varenicline (Chantix)
- moa
partial agonist at nicotinic receptor
- reduces sx of withdrawal
- reduces reward aspect of cigarette smoking
Delusional disorder
- timing of delusion
- describe type of delusion
> 1 month
- non-bizarre, as in things that could potentially be real like someone is stealing your stuff, being poisoned, etc.
Delusional disorder
- tx
- therapy (best for persecutory type)
- atypical antipsychotics (olanzapine and risperidone most common)
- Antidepressants 2nd line, best if somatic type
Schizoaffective disorder
- criteria
- delusion/hallucination for >2 weeks in absence major mood episode
- sx of major mood episode for majority of total duration of illness
Schizoaffective Disorder
- tx
- psychotherapy
- pharm: antipsychotics, anticonvulsants, SSRIs
Schizophrenia
- timing
major psychosis for >6 months AND difficulty functioning
Schizophrenia
- dx
2+ of the following during 1 month period
- delusions
- hallucinations
- disorganized speech/thought processes, loose associations, tangential response
- impaired daily fn
- disorganized behavior
- negative sx
- One must be first three
Schizophrenia
- treatment
- atypical antipsychotics for negative sx
- neuroleptics/dopamine antagonists for positive sx (haloperidol, chlorpromazine, etc.)
- therapy
Schizophreniform Disorder
- duration
> 1 month
<6 months
* no social or occupational impairment
ADHD
- time frame
- dx criteria
- Manifests <12 years old
- > 6 symptoms for >6 months
- Must occur in >1 setting
ADHD
- meds
- Methylphenidate (Ritalin)
- dexmethylphenidate (focalin)
- amphetamine/dextroamphetamine (adderall)
- atomoxetine (strattera)
- 2nd line: SSRIs
- behavior modification
3 types of ADHD
- predominantly inattentive
- predominantly hyperactive/impulsive
- combined
Autism
- 2 types of sx
- problems in social communication and social interaction
- restricted, repetitive patterns of behavior, interests or activities.
Autism
- tx
- audiology evaluation
- behavior therapy
- meds: 2nd gen antipsychotics, SSRIs
differentiation between CD and ODD
unlike children with CD, children with ODD are not aggressive towards people or animals, do not destroy property, and do not show a pattern of theft or deceit
Factitious disorder
- The patient falsifies physical or psychological symptoms or induces injury or disease to themselves
- The patient’s deceptive behavior occurs in the absence of external rewards
Illness Anxiety Disorder
- mgmt
- Goal is to improve coping skills while never dismissing their fears
- caregivers should closely follow their patients and develop a therapeutic alliance
- Group/insight-oriented therapy
- Regular appts with provider for reassurance
Antisocial Behavior personality disorder
- age/timing requirments
Must be over 18
Must have had sx since <15 (Conduct disorder)
Avoidant personality disorder
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts.
Body dysmorphic disorder
- mgmt
- SSRI first line med
- CBT
Borderline personality disorder
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood
dependent personality disorder
- overview
- behaviors demonstrating an excessive need to be taken care of
- leads to submissive and clinging behavior and fears of separation, beginning by early adulthood
Histrionic personality disorder
- overview
- excessive emotionality and attention seeking, beginning by early adulthood
- Needs to be the center of attention. Very dramatic. Dresses for attention. Very shallow. Seductive and flirtatious.
- A large concern with appearance
Narcissistic personality disorder
- overview
- Need for admiration, grandiose thoughts, concerned about what others think yet lack empathy
- Sense of entitlement
- Lacks empathy
- Reacts to criticism with rage
OCD
- overview
- obsessions: recurring, intrusive thoughts
- compulsions: repetitive actions in attempt to neutralize obsessions
- **ego-dystonic: behavior inconsistent with one’s own beliefs and attitudes (separates OCD from obsessive compulsive personality disorder)
- associated with Tourette’s disorder
OCD
- mgmt
- CBT first line
- pharm options: SSRI at higher dose than in depression, clomipramine, antipsychotics
Obsessive Compulsive personality disorder
- overview
- preoccupied with order, perfectionism, and control
- Ego-syntonic: the patient is not aware of their behavior causing issues vs. Obsessive compulsive disorder which is ego dystonic
paranoid personality disorder
- overview
persistent feelings of suspiciousness and mistrust of other people.
Schizoid personality disorder
- emotional aloofness, indifferent to praise or criticism, without bizarre or idiosyncratic thinking
- Exhibit voluntary social withdrawal (hermit)
- Content with social isolation (vs avoidant)
- Limited emotional expression
- No association with schizophrenia
- Lacks close friends or confidants other than first-degree relatives.
Schizotypal personality disorder
- overview
- eccentric behavior, magical thoughts, odd beliefs and perceptual distortion.
- Able to function in society, though struggle to maintain social relationships.
- acute discomfort with, and reduced capacity for, close relationships
- Patients may develop schizophrenia.
Anorexia
- weight
- BMI <17
- body weight <85% of ideal weight
Pedophilic disorder
- age requirements
- individual is at least 16
- individual is at least 5 years older than child/children
