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EORs > Behavioral Health / Psych > Flashcards

Behavioral Health / Psych Flashcards

1
Q

MOA of THC

A

Partial agonist of cannabinoid 1 and cannabinoid 2 receptors

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2
Q

Mania mnemonic

A 
DIGFAST
Distractibility
Impulsivity 
Grandiosity
Flight of ideas
Activities (psychomotor agitation)
Sleep (decreased)
Talkativeness, pressured speech
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3
Q

Question to always ask if patient presents with major depression

A

any hx of mania

- bipolar more likely to present for help when depressed, during mania feel “well”

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4
Q

MC symptoms associated with bulimia

A
  • fatigue
  • abd pain
  • bloating
  • constipation
  • irregular menses
  • tachycardia
  • reduced BP
  • dry skin
  • parotid gland enlargement
  • dental caries
  • renal enamel erosion
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5
Q

Bulimia

- what lab value is usually increased?

A

amylase: hypersecretion from salivary glands

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6
Q

Bulimia

- electrolyte imbalances

A
  • hypocalcemia
  • hypomagnesemia
  • hypokalemia
    • vomiting
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7
Q

Bulimia

- Time requirement for dx

A

1 episode of binge eating with inappropriate compensatory behavior per week for min 3 months

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8
Q

Anorexia

- cardiovascular effects

A
  • myocardial atrophy
  • MV prolapse
  • pericardial effusion
  • bradycardia
  • dysrhythmia
  • etc
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9
Q

Anorexia

- Renal/electrolyte changes

A
  • dec GFR
  • renal calculi
  • dehydration
  • hypokalemia
  • hypomg
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10
Q

Anorexia

- lipid panel changes

A

increased total cholesterol

- dt increased protection of cardio protective HDL

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11
Q

Anorexia

- treatment

A

behavioral therapy

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12
Q

What is a barrier to treatment in pts with paranoid personality disorder

A

fragile self-concept = pt misinterprets phrases used by therapist as personal threats…

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13
Q

Obsessive-compulsive personality disorder

- treatment

A
  • psychotherapy
  • Working Alliance Inventory: useful tool to determine goals for treatment
  • med treatment not recommended (unlike in OCD)
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14
Q

Panic disorder

- RF

A
  • genetic
  • childhood trauma
  • stressful life experiences
  • childhood exposure to abuse
  • childhood smoking
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15
Q

Lithium

  • overview
  • indications
  • MoA (4)
A
  • mood stabilizer
  • bipolar I, depression
  • inhibits dopamine receptors
  • inhibits NMDA receptors
  • promotes GABA (reducing dopamine and glutamine)
  • increases brain-derived neurotropic factor (neuroprotective)
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16
Q

Refeeding syndrome

  • overview
  • timing
A
  • fatal fluid/electrolyte shift secondary to nutritional rehab
  • usu during first two weeks of supplementation
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17
Q

Refeeding syndrome

- process

A
  • 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
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18
Q

Refeeding syndrome

- three electrolyte abnl

A
  • hypophosphatemia
  • hypomg
  • hypokalemia
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19
Q

Conduct Disorder

- overview

A

repetitive behaviors that violate societal norms and others’ basic rights.

  • serious physical aggressions
  • Exhibit little guilt/remorse
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20
Q

Conduct Disorder

- RF

A
  • Unstable home env

- hx of child abuse/neglect

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21
Q

Conduct disorder

- mgmt

A
  • provide consistent boundaries
  • positive reinforcement for good behavior
  • Family counseling
  • meds: methylphenidate
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22
Q

Conduct Disorder

- pharm mgmt

A
  • stimulants: methylphenidate and dextroamphetamine

- +/- antidepressants, lithium

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23
Q

Conduct Disorder

- what other psych condition is often comorbid

A

ADHD

*ADHD also frequently comorbid with ODD

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24
Q

Phobia

- nonpharm mgmt

A
  • CBT
  • Desensitization
  • Breathing techniques
  • exposure therapy
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25
Q

Phobia

- pharm mgmt

A

initial: benzos such as lorazepam

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26
Q

Social anxiety disorder

- pharm mgmt

A
  • SSRIs: paroxetine, sertraline

- SNRI: venlafaxine

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27
Q

Schizoid personality disorder

- mgmt

A
  • psychotherapy

- rarely respond to pharm

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28
Q

Schizoid personality disorder

- overview

A

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)
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29
Q

Illness Anxiety Disorder

- overview

A
  • preoccupation with having or acquiring a serious, undiagnosed illness
  • 0-mild somatic sx
  • substantial anxiety
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30
Q

Illness Anxiety Disorder

- mgmt

A
  • regular PCP visits
  • 1st line: CBT
  • 2nd line: other psychotherapy
  • 3rd line: antidepressants
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31
Q

DSM V term for alcoholism

A

Alcohol Use Disorder

  • Not alcohol abuse
  • mild: 0-3 features
  • moderate: 4-5 features
  • severe: >5 features
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32
Q

Alcohol Use Disorder features

A
  • 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.
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33
Q

Medication used in PTSD to decrease nightmares and sleep disturbances

A

prazosin: alpha-adrenergic blocker

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34
Q

PTSD

- RF

A
  • female
  • low socioeconomic status
  • young age
  • childhood adversity exposure
  • intensity of initial reaction to traumatic event
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35
Q

PTSD

- treatment

A
  • CBT: trauma-focused
  • Serotonergic antidepressants: mood and cognitive disturbances
  • 2nd gen antipsychotics: hyperarousal and re-experience sx
  • prazosin for sleep
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36
Q

MDD

- RF for recurrence

A
  • 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
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37
Q

MDD

- mneumonic

A 
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
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38
Q

Screening necessary prior to starting stimulates for ADHD

A
  • complete cardiac evaluation, PE, Fam hx
  • bp
  • hr
  • drug abuse screening
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39
Q

Delusional Disorder

- definition

A
  • 1+ delusions for 1+ months
  • persecutory MC
  • not schizophrenic / acute psychosis
  • functioning not very impaired
  • behavior is not bizarre or odd
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40
Q

Delusional Disorder

- mgmt

A
  • antipsychotics: aripiprazole or ziprasidone
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41
Q

Treatment for male with pedophilic disorder

A

medroxyprogesterone IM: blocks testosterone synthesis and = reduced libido

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42
Q

Antidepressant CI in patients with bulimia

A

buproprion

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43
Q

Bulimia

- tx

A
  • nutritional rehab
  • psychotherapy
  • first line meds: SSRI Fluoxetine**
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44
Q

Cannabis detection in urine

  • mod to heavy use
  • light use
A
  • 1 month

- 1 week

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45
Q

First line med for benzodiazepine withdrawal

A

diazepam: long-acting benzo

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46
Q

Benzo withdrawal sx

A
  • n/v
  • agitation
  • tachycardia
  • diaphoresis
  • tremor
  • fever
  • insomnia
  • anxiety
  • restlessness
  • delirium
  • psychosis
  • seizures
  • death
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47
Q

OCD

- mgmt

A
  • serotonergic antidepressants

- psychotherapy

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48
Q

Cyclothymic disorder

- def

A
  • hypomania sx but not hypomania and mild depression not major depressive episode
  • min 2 year
  • never gone more than 2 consecutive months
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49
Q

GAD

- mgmt

A
  • 1st line: CBT + serotonergic antidepressants
  • positive problem solving
  • muscle relaxation
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50
Q

ODD

- define

A
  • Recurrent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness
  • > 6 months
  • 50% comorbid ADHD
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51
Q

ODD

- treatment

A
  • 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
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52
Q

Conduct disorder vs. oppositional defiant disorder

A

CD is complication of untreated ODD, CD is more severe

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53
Q

Solvent inhalation

- three types

A
  • 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
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54
Q

Solvent inhalation

- common PE

A
  • 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
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55
Q

Solvent inhalation

- mgmt

A
  • acute: symptom support

- psychiatric care/CBT

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56
Q

Solvent inhalation

- common substances

A
  • gasoline
  • cleaners
  • paint
  • fuels
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57
Q

Solvent inhalation

- patient experience

A

hallucination

euphoria

58
Q

Delusions

  • nihilistic
  • grandiose
A
  • 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
59
Q

MDD

- when should perform laboratory testing?

A

when suspect medical causes for depressioN”

  • hypothyroidism
  • hypercalcemia
  • cancer
  • SLE
60
Q

Body Dysmorphic Disorder

- first line therapy

A

fluoxetine (SSRI)

+ CBT

61
Q

Body Dysmorphic Disorder

- mgmt after first line

A
  • treatment resistant: add buspirone
  • treatment refractor: DC SSRI and start clomipramine or venlafaxine
  • severe illness: poss hospitalization, pharmacotherapy, CBT
62
Q

Buproprion MoA

A

inhibits dopamine and norepinephrine reuptake

63
Q

Three major causes of smoking-related mortality

A
  1. atherosclerotic CV disease
  2. COPD
  3. Lung cancer
64
Q

Tobacco

- effects of use

A
  • restlessness
  • insomnia
  • anxiety
  • increased GI motility
65
Q

5 As of smoking cessation

A 
Ask
Advise
Assess
Assist
Arrange
66
Q

Common ADR of second generation antipsychotics

A

metabolic syndrome: weight gain, dyslipidemia, DM

- monitor: weight, bp, lipid profile, fasting glucose, waist circumference.

67
Q

Which two second-get antipsychotics have highest risk for metabolic syndrome

A

olanzapine and clozapine

68
Q

PTSD

- self-report checklist known as PCL-5

A

used for screening purposes and to monitor symptom severity over time in PTSD

69
Q

When would you use ECT in Bipolar I disorder?

A
  • usually not used in bipolar I, more common in MDD

- patient with episode of MD and malignant catatonia = ECT first line

70
Q

Methemoglobinemia

- definition

A
  • oxidation of heme
  • changes physiologic form of iron from ferrous to ferric
  • oxidized heme has sig reduced oxygen carrying capacity
71
Q

Methemoglobinemia

- common drug cause

A

Aml nitrite

72
Q

Methemoglobinemia

- common findings

A
  • sudden cyanosis
  • low pulse ox
  • hypotension
  • dark discoloration of blood on phlebotomy (chocolate brown)
  • normal partial pressure of O2 on ABG
73
Q

Methemoglobinemia

- treatment

A
  • O2
  • IV dextrose
  • methylene blue
  • exchange transfusion
74
Q

Bipolar I

- when patient is stabilized on drug, when wean off?

A

you don’t : should receive lifelong maintenance therapy - regardless of number of mania episodes they have had

75
Q

Factitious disorder

- define

A

Intentionally fabricated medical or psychiatric symptoms in the absence of any external benefit to the patient
- often comorbid with depression, substance-abuse, personality disorders

76
Q

Factitious disorder

- should routinely assess

A
  • suicide risk

- self-injury behavior

77
Q

Factitious disorder

- treatment

A

Psychotherapy

78
Q

Schizophrenia

- dx

A

2+ for >6 months:

  • delusions
  • hallucinations
  • disorganized speech
  • disorganized or catatonic behavior
  • negative sx
79
Q

Schizophrenia

- mgmt

A
  • antipsychotic medications: best on positive symptoms
80
Q

Akathisia

A

generalized motor restlessness, not relieved with movement

- MC EPS of antipsychotic medications

81
Q

How to treat akathisia

A
  • reduce antipsychotic dose, trying to avoid exacerbation of psychotic sx
  • if dose cannot be reduced, bb, benztropine, benzos
82
Q

PCP

- name

A

Phencyclidine

  • hallucinogenic drug
  • insufflated, smoked, ingested, injected
  • similar to ketamine
  • glutamate (NMDA) receptor antagonist
83
Q

PCP

- use symptoms

A
  • violent/bizarre behavior
  • horizontal and vertical nystagmus
  • disorientation
  • auditory hallucinations
  • HTN, tachycardia, hyperthermia
84
Q

PCP

- mgmt

A
  • 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
85
Q

Methamphetamine

- S/sx

A
  • 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
86
Q

Methamphetamine

- high risk of death due to what

A

cardiac death

- drug = cardiac stimulation

87
Q

Two psychotropic drugs approved by FDA for use in child or adolescent dx with autism spectrum disorder

A

Risperidone

aripiprazole

88
Q

Autism Disorder

- mgmt

A
  • Atypical antipsychotics: risperidone, aripiprazole,
  • stimulants: methylphenidate, dextroamphetamine
  • SSRIs
  • alpha 2 adrenergic agonists
  • valproic acid
  • atomoxetine
  • melatonin
  • mood stabilizer: lithium
89
Q

Antisocial personality disorder

- how to dx

A

patient history

90
Q

Antisocial personality disorder

- dx

A
  • must be at least 18 yo
  • evidence of CD before age of 15
  • pervasive pattern of disregard/violation of rights of others
91
Q

Antisocial personality disorder

- mgmt

A
  • CBT
  • no pharm unless treating comorbidity
  • possible use of 2nd gen antipsychotic if severely aggressive
92
Q

MDD

- Dx requirements

A

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

93
Q

PTSD

- dx

A
  • 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
94
Q

Opiate withdrawal symptoms

A
  • 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
95
Q

Alcoholism:

Lab findings

A
  • elevated mean corpuscular volume
  • elevated triglycerides
  • elevated serum uric acid
  • elevated liver function tests.
96
Q

Phenothiazines exert their antipsychotic effects by blocking

A

dopamine receptors

97
Q

Common early clues to impending delirium tremens

A

Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity

98
Q

Ideas of reference

A

fixed beliefs that people are referring to you and about you through media

99
Q

Formications

A

sensation of insects crawling on the skin and is commonly associated with delirium tremens from alcohol withdrawal and cocaine addiction

100
Q

TCA

- well known ADR (broad)

A

anticholinergic

101
Q

treatment of choice for benzodiazepine intoxication

A

Flumazenil

102
Q

Lithium Toxicity

A 
Tremor
diarrhea
vomiting
ataxia
restlessness. 
(Weight gain, hypothyroidism, polyuria, and exacerbation of psoriasis can occur at therapeutic lithium levels)
103
Q

Lab to run prior to starting lithium

A

creatinine

* renal failure, hyponatremia, dehydration can all increase likelihood of lithium toxicity

104
Q

Second line drug options for bipolar I and II

A
  • Antieleptics: valproate or carbamazepine, lamotrigine

- second gen antipsychotics: risperidone first line

105
Q

What medication is CI in patient with liver dz

A

valproate

106
Q

Opioid withdrawal

- treatment

A
  • naloxone/naltrexone (opioid receptor antagonist)
  • symptomatic
  • clonidine: a2 agonist
  • methadone: long acting
  • Suboxone
  • zofran for n/v

Long term: methadone and suboxone

107
Q

Sedative, hynotpic, anxiolytic withdrawal

- treatment

A

long acting benzo like clonazepam

108
Q

stimulant

- MoA

A

block amine (dopamine, norepinephrine, serotonin) reuptake

109
Q

stimulant

- withdrawal sx

A 
severe depression
inc suicidal ideation
hyperphagia
hypersomnolence
fatigue
malaise
severe craving
110
Q

For all the drugs of addiction

- DSM-5 criteria

A

Must have at least two of the symptoms occurring in a 12 month period

111
Q

Varenicline (Chantix)

- moa

A

partial agonist at nicotinic receptor

  • reduces sx of withdrawal
  • reduces reward aspect of cigarette smoking
112
Q

Delusional disorder

  • timing of delusion
  • describe type of delusion
A

> 1 month

- non-bizarre, as in things that could potentially be real like someone is stealing your stuff, being poisoned, etc.

113
Q

Delusional disorder

- tx

A
  • therapy (best for persecutory type)
  • atypical antipsychotics (olanzapine and risperidone most common)
  • Antidepressants 2nd line, best if somatic type
114
Q

Schizoaffective disorder

- criteria

A
  • delusion/hallucination for >2 weeks in absence major mood episode
  • sx of major mood episode for majority of total duration of illness
115
Q

Schizoaffective Disorder

- tx

A
  • psychotherapy

- pharm: antipsychotics, anticonvulsants, SSRIs

116
Q

Schizophrenia

- timing

A

major psychosis for >6 months AND difficulty functioning

117
Q

Schizophrenia

- dx

A

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
118
Q

Schizophrenia

- treatment

A
  • atypical antipsychotics for negative sx
  • neuroleptics/dopamine antagonists for positive sx (haloperidol, chlorpromazine, etc.)
  • therapy
119
Q

Schizophreniform Disorder

- duration

A

> 1 month
<6 months
* no social or occupational impairment

120
Q

ADHD

  • time frame
  • dx criteria
A
  • Manifests <12 years old
  • > 6 symptoms for >6 months
  • Must occur in >1 setting
121
Q

ADHD

- meds

A
  • Methylphenidate (Ritalin)
  • dexmethylphenidate (focalin)
  • amphetamine/dextroamphetamine (adderall)
  • atomoxetine (strattera)
  • 2nd line: SSRIs
  • behavior modification
122
Q

3 types of ADHD

A
  • predominantly inattentive
  • predominantly hyperactive/impulsive
  • combined
123
Q

Autism

- 2 types of sx

A
  • problems in social communication and social interaction

- restricted, repetitive patterns of behavior, interests or activities.

124
Q

Autism

- tx

A
  • audiology evaluation
  • behavior therapy
  • meds: 2nd gen antipsychotics, SSRIs
125
Q

differentiation between CD and ODD

A

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

126
Q

Factitious disorder

A
  • 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
127
Q

Illness Anxiety Disorder

- mgmt

A
  • 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
128
Q

Antisocial Behavior personality disorder

- age/timing requirments

A

Must be over 18

Must have had sx since <15 (Conduct disorder)

129
Q

Avoidant personality disorder

A

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.

130
Q

Body dysmorphic disorder

- mgmt

A
  • SSRI first line med

- CBT

131
Q

Borderline personality disorder

A

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood

132
Q

dependent personality disorder

- overview

A
  • behaviors demonstrating an excessive need to be taken care of
  • leads to submissive and clinging behavior and fears of separation, beginning by early adulthood
133
Q

Histrionic personality disorder

- overview

A
  • 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
134
Q

Narcissistic personality disorder

- overview

A
  • Need for admiration, grandiose thoughts, concerned about what others think yet lack empathy
  • Sense of entitlement
  • Lacks empathy
  • Reacts to criticism with rage
135
Q

OCD

- overview

A
  • 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
136
Q

OCD

- mgmt

A
  • CBT first line

- pharm options: SSRI at higher dose than in depression, clomipramine, antipsychotics

137
Q

Obsessive Compulsive personality disorder

- overview

A
  • 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
138
Q

paranoid personality disorder

- overview

A

persistent feelings of suspiciousness and mistrust of other people.

139
Q

Schizoid personality disorder

A
  • 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.
140
Q

Schizotypal personality disorder

- overview

A
  • 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.
141
Q

Anorexia

- weight

A
  • BMI <17

- body weight <85% of ideal weight

142
Q

Pedophilic disorder

- age requirements

A
  • individual is at least 16

- individual is at least 5 years older than child/children

EORs (9 decks)

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