Boone- Psychosomatic medicine Flashcards
____ affects the body and brain; and these patients have higher risk of developing diabetes, osteoporosis, and stroke
depression
higher _____ in someone’s life leads to higher risk for medical and psychiatric illness
stress
____ leads to activation of hypothalamus and causes release of CRH, activates pituitary to release ACTH, then activates adrenal cortex to release cortisol
stress
patients who are at highest risk of psychological stress
surgical/renal dialysis/ICU/HIV/chronic pain
patients with chronic pain can benefit from what
CBT
Cardiac arrhythmias
Chronic infection with fever
Hyperadrenalism (Cushing’s disease)
Hyperthyroidism
Hypo/Hyperglycemia
Pheochromocytoma
these are associated with what behavioral symptom
anxiety
AIDS
L frontal lobe brain lesions
chronic pain
hypothyroidism
MS
cancer
Parkinsons
these are associated with what behavioral sx
depression
Dementia
Huntington’s Disease
Temporal lobe epilepsy
Tertiary syphyilis
Wilson’s Disease (e.g. explosive anger)
these are associated with what changes
behavioral
these are associated with what
mania/psychosis
what is rly important in determining medical vs psychological condition
age
65 yr old pt with new onset psychosis
medical condition NOT schizophrenia
age for schizophrenia onset
late teens-early 20’s
Agitation, anxiety, insomnia, sexual dysfunction
(psychiatric symptoms of what psychotropic medication)
antidepressants
Agitation, anxiety, insomnia, psychosis
(psychiatric sx’s of what psychotropic medication)
stimulants
Sedation, poor focus, depression, sexual dysfunction
(psychiatric symptoms of what psychotropic medication)
anti-anxiety (benzo)
anti-asthmatic that can cause confusion/anxiety
albuterol
cause drowsiness, lack of concentration, delirium
anticholinergics/antihistamines
SE’s include depression, fatigue, sexual dysfunction, mask hypoglycemia
beta blockers
can cause anxiety, agitation, psychosis, mania
L-dopa
CCB’s that can cause depression
Nifedipine and verapamil
insulin can have psychiatric symptoms of what
anxiety and confusion
SE of aggressiveness, agitation
androgens (steroid hormones)
hypomania, confusion, psychosis from what use
corticosteroid USE
fatigue, depression, HA, vomiting from what withdrawal
corticosteroid
progestins can have SE of ____ and fatigue
depression
_____ hormones can have SE’s of anxiety and psychosis
thyroid hormones
vitamin A
deficiency of this includes:
confusion, ataxia, nystagmus (CAN)
vitamin B1 (thiamine)
deficiency of this includes:
psychosis, mania, depression
vitamin B12 (cobolamin)
toxicity of this includes:
Numbing, tingling, and burning sensations in the extremities
vitamin B12 (cobolamin)
deficiency of this vitamin can cause depression
vitamin D
toxicity of this vitamin can cause:
Apathy, nausea, weakness, confusion, poor appetite, thirst
vitamin D
IV hydration + CCS or bisphosphonates
(to treat _____ toxicity)
vitamin D
deficiency of this vitamin causes:
Neuro deficits (ataxia, decreased DTRs), poor blood clotting
vitamin E
deficiency of this vitamin causes increased bleeding
vitamin K
iron
deferoxamine used to treat what
iron toxicity
Depression, HA, memory loss, fatigue, slurred speech.
Hyperactivity & aggression in kids
lead toxicity
EDTA used to treat _____toxicity
lead
copper
d-penicillamine used to treat what
copper toxicity
deficiency of this causes:
Alopecia, fatigue, diarrhea, night blindness, irregular menstrual cycles
zinc
toxicity of this includes:
Nerve damage—-> tingling, burning sensation, and numbness in the hands & feet; weakness in the face & extremities
zinc
to treat _____ toxicity, use EDTA and supportive therapy
zinc
____ conduct for physicians is a standard based on moral principles or practices and matters of social policy involving moral issues
ethical
_____conduct is behavior that conforms to written law and to the regulations that interpret and set standards for such law
legal
_____standards characteristically exceed legal standards
ethical
It is always ______and in some circumstances illegal for physicians (or physicians-in-training) to practice medicine when their judgment or abilities are impaired
unethical
Occurs when a patient is harmed because of a physician’s actions or inactions
medical malpractice
the 4 D’s of malpractice (for it to be substantiated)
Funds given to reimburse the patient for medical bills or lost salary AND to compensate the patient for their pain & suffering.
Covered by most medical malpractice insurance carriers
compensatory damages
punitive (exemplary) damages
_____error (either an unintended act or an omission) must be disclosed to the patient
physician
Romantic or sexual relationships with current or former patients are inappropriate and _____ by most specialty boards
prohibited
Accepting valuable gifts (e.g. jewelry) from patients is/is not appropriate
is not
are you as a physician required to help someone in public outside of work setting
no
if physician does decide to help someone outside of work setting, what laws should be met
good samaritan laws (only help within scope of practice)
universal decision making
competence
specific decision making
capacity
Age ____ usually considered competent BUT NOT in Alabama and a few other states
18
if doubt exists for competence, what to do
go to a judge (the court)
generally all adults are assumed legally competent unless ____, ____, or _____
psychotic, suicidal, or in coma
ability to make a specific medical decision at a specific point in time
capacity
elderly man w/ resectable brain tumor; surgeon wants to remove it
surgery live 1 ½ in facility
without surgery: live for 6-12 months at home
pt says I appreciate this but id rather live at home with my family for my last months
(capacity or no)
has capacity
Pt says he wants to leave hospital to kill his nephew b/c he is involved with FBI (delusional)
(capacity or no)
no
Pt says he wants to leave hospital to kill his nephew b/c he is involved with FBI; they lack capacity due to psychosis (delusional)
then a week from then he is doing well on his antipsychotics and wants to leave hospital
(capacity or no)
yes
Required for medical or surgical treatments, except in life-threatening emergencies
informed consent
informed consent
Jehovah’s witness parents refusing to give blood transfusion to patient that would save their life
(what to do if emergent)
give transfusion
situations where parental consent is not required
Physicians must maintain confidentiality of patients, even after a patient’s death
T or F
true
when physician can breach confidentiality
reportable illnesses
If a health care provider is exposed to the body fluids of a patient, that patient can be tested for HIV even if patient _____ to consent to such testing
refuses
Exception to patient ______ occurs if an HIV+ patient habitually puts others in danger by engaging in high-risk behavior without informing others (e.g. having unprotected sex with a partner who does not know about the patient’s HIV status)
confidentiality
Aka health care proxy
A legal document in which a competent person designates another person as their legal representative to make decisions about their health when they can no longer do so
durable power of attorney
Instructions given by patients in anticipation of the need for a medical decision in the future should they become incapacitated
advance directives
A document in which a competent person gives directions for their future health care if they should become incompetent to make decisions when they need care in the future
living will
order of surrogates if pt is incompetent w/ no advanced directive
spouse
adult children
parents
siblings
If a patient wishes to donate organs, legal death must be determined by >_____ doctor other than the recipient’s doctor
1
euthanasia ethical or unethical in the US
unethical
recommending ____ behavioral change at a time increases patient adherence
1
