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CLASS 22005 PSYCH > Ch 1 MDT > Flashcards

Ch 1 MDT Flashcards

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1
Q

A feeling or emotion manifested by facial expression or body language

A

Affect

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2
Q

Absence of interest in or pleasure from performance of acts that would ordinarily be enjoyable

A

Anhedonia

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3
Q

Medication designed to treat anxiety

A

Anxiolytic

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4
Q

Excessive eating beyond amount necessary to satisfy normal appetite

A

Binge

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5
Q

Syndrome of psychomotor retardation characterized by periods of physical rigidity and lack of response to outside stimuli

A

Catatonia

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6
Q

Uncontrollable impulses to perform an act, often repeatedly, as an unconscious mechanism to avoid unacceptable ideas or desires, which by themselves arouse anxiety

A

Compulsion

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7
Q

A false belief or wrong judgement held with conviction despite inconvertible evidence to the contrary

A

Delusion

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8
Q

Behavior that is neither goal directed or guided by rational or preconceived plan

A

Disorganized Behavior

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9
Q

Speech in which the statements are not logically connected to each other

A

Disorganized Speech

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10
Q

An unconscious separation of a group of mental processes from the rest of the conscious awareness

A

Dissociation

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11
Q

Disturbance in amount, quality, or timing of sleep

A

Dyssomnia

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12
Q

Higher levels of cognitive/mental functioning including planning, abstraction, inductive reasoning, and organizing

A

Executive Functioning

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13
Q

Subjective perception of an object or an event when no such stimulus or situation exists

A

Hallucination

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14
Q

A misinterpretation or false perception of a real sensory stimulus

A

Illusion

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15
Q

Sudden, often unreasonable, determination to perform some act, the performance of which often provides a sense of relief or a release of tension

A

Impulse

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16
Q

Inability to fall or stay asleep in absence of external impediments during the period when sleep should occur

A

Insomnia

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17
Q

Pervasive feeling, tone, or internal emotional state which, when impaired, can markedly influence virtually all aspects of a person’s behavior or perception of external events

A

Mood

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18
Q

State in which the individual interprets and regards everything in relation to himself and not to others

A

Narcissism

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19
Q

Recurrent and persistent idea, thought or impulse to carry out an act

A

Obsession

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20
Q

A belief system that includes extreme suspiciousness and mistrust of others

A

Paranoia

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21
Q

Abnormal increase in physical and emotional behavior

A

Psychomotor Agitation

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22
Q

Abnormal slowing in physical and emotional activity

A

Psychomotor Retardation

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23
Q

Mental and behavioral disorder causing gross distortion or disorganization of a person’s mental capacity; A defective response and capacity to recognize reality, communicate and relate to others to the degree of interfering with the person’s capacity to cope with ordinary demands of everyday life

A

Psychosis

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24
Q

To cause copious evacuation of the bowels and stomach by induction of vomiting, use of enemas, or laxatives

A

Purge

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25
Q

An event or situation that induces psychological, emotional or behavioral distress

A

Stressor

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26
Q

The complex somatic, cognitive, affective, and behavioral effects of psychological trauma

A

PTSD

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27
Q

PTSD has a strong correlation with ____ regarding armed conflict and combat

A

TBI

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28
Q

Pathophysiology of PTSD

Studies using MRI have shown decreased volume in several areas of the brain:

A
  • Left amygdala (Fear center)
  • Hippocampus (Memories)
  • Anterior Cingulate cortex
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29
Q

Pathophysiology of PTSD

Reported findings in studies include increased levels of:

A

Central norepinephrine

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30
Q

PTSD responses to trauma

A

Affective dysregulation (anger common)

Cognitive impairment

Behaviors in response to regular stimuli

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31
Q

PTSD

Responses to trauma lead to _______ behaviors

A

Compensatory (avoidance)

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32
Q

PTSD

The focus for the IDC is:

A

Screening

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33
Q

PTSD

Symptoms must be present for at least ____ weeks following trauma for psychiatry to make the diagnosis

A

4 weeks

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34
Q

Treatment for PTSD

A

Psychotherapy

SSRI (Sertraline)

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35
Q

PTSD medication for nightmares

A

Prazosin

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36
Q

PTSD medication for tremors and sympathetic responses

A

Beta Blockers

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37
Q

PTSD medications for comorbid psychosis

A

Antipsychotics

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38
Q

PTSD Medication to avoid due to safety and dependency issues

A

Benzodiazepines

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39
Q

PTSD

Different types of psychotherapy

A

Exposure therapy

Cognitive Behavioral Therapy

Eye movement desensitization and reprocessing

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40
Q

Screening tool for psychiatric causes that differentiate between an eating disorder and other causes of weight loss

A

SCOFF

SICK from being too full

lost CONTROL from how much you eat

lost more than ONE stone (14 pounds) in 3 months

think you’re FAT

FOOD dominates your life

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41
Q

Ratio of Anorexia Nervosa, Women to men

A

10-20:1

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42
Q

Pathophysiology of Anorexia

Deficits of _____ function and _______ function

A

Dopamine (eating behavior, motivation and reward)

Serotonin (mood, impulse control, obsessive behavior)

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43
Q

Restriction of energy intake that leads to low body weight

Intense fear of gaining weight despite

Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s own low body weight

A

Anorexia

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44
Q

Common physical findings in Anorexia

A

Low BMI (<17.5)

Emaciation

Hypothermia

Bradycardia

Hypotension

Hypoactive bowel sounds

Xerosis (dry and scaly skin)

Brittle Hair and hair loss

Lanugo body hair

Abdominal distention

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45
Q

Bulimia

_____ times more common in women than men

A

Three

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46
Q

Recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain

Occurring at least once per week for three months

A

Bulimia

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47
Q

Disease process associated with:

  • Mild psychosocial impairment
  • Body weight usually within or above normal range
  • Neurocognitive functioning impaired
  • Emotional dysregulation
  • Self harm is often seen
  • Additional psychiatric disorders are common
A

Bulimia

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48
Q

Clinical findings with Bulimia

A

Dehydration

Menstrual irregularities

Mallory-Weiss syndrome

Pharyngitis

Erosion of dental enamel

ECG changes

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49
Q

Uncomfortably full

Eating when not hungry

Feelings of embarrassment

Feelings of disgust, depression

A

Binge eating disorder

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50
Q

Eating of nonfood substances

Inappropriate eating behavior for developmental level

Not culturally, socially normal eating

Associated with iron deficiency anemia

A

Pica

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51
Q

Repeated regurgitation of food

May be rechewed, reswallowed, or spit out

Condition is not due to any medical condition

A

Rumination Disorder

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52
Q

Management of eating disorders

A

Refer to Psych / Nutrition Consult

Labs

  • CBC
  • Thyroid studies
  • Metabolic Panel
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53
Q

Substance abuse triad

A

Psychological dependence or craving

Physiologic dependence

Tolerance

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54
Q

_____ deaths per year directly related to alcohol use

A

85,000

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55
Q

Annual economic cost from alcohol use disorder

A

$250 billion

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56
Q

1 in ___ deaths in working age adults results from excessive drinking

A

1 in 10

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57
Q

3rd leading preventable cause of death in the United States

A

Alcohol use disorder

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58
Q

Alcohol use is not so severe as to meet criteria for alcohol use disorder

May go on to develop alcohol use disorder

A

Risky Alcohol Use

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59
Q

What organization has estimated consumption amounts of alcohol that increases health risks?

A

National Institute of Alcohol Abuse and Alcoholism (NIAAA)

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60
Q

Standard drink

A

5 oz of wine, 12 oz beer

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61
Q

Men under 65

  • More than __ standard alcoholic drinks per week on average that increases health risks
  • More than __ drinks on any day
A

14

4

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62
Q

Woman under 65

  • More than __ standard alcoholic drinks per week on average that increases health risks
  • More than __ drinks on any day
A

7

3

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63
Q

Strong association between alcoholism and _______ disorders

A

Psychiatric disorders

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64
Q

Alcohol Use Disorder

Lifetime suicide attempts __%

A

7%

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65
Q

Physical exam shows:
-Tremor, agitation

-Problems with sensation, diminished DTRs, paresthesias

  • Hepatic/splenic enlargement
  • Icterus/jaundice
  • Spider angiomata
  • Palmar erythema
A

Alcohol use disorder

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66
Q

Four quick questions for unhealthy alcohol use

A

CAGE

Cut down
Annoyed
Guilty
Eye opener

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67
Q

Alcohol use disorder due to a deficiency of thiamine (Vitamin B1)

A

Wernicke Korsakoff Syndrome

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68
Q

Direct damage to the brain caused by thiamine deficiency

  • Encephalopathy
  • Oculomotor dysfunction
  • Gait ataxia

Most common symptom: Confusion

A

Wernicke encephalopathy (WE)

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69
Q

Late neuropsychiatric manifestation of Wernicke’s

Causes anterograde and retrograde amnesia

A

Korsakoff syndrome

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70
Q

Alcohol use disorder

Approximately ____ of patients experience some form of withdrawal

A

Half

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71
Q

Alcohol use disorder

Usually mild but estimated ___% experience severe symptoms

A

20%

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72
Q

Symptoms generally begin with 6 to 24 hours of last drink and resolves in one to two days

Anxiety, minor agitation, restlessness, insomnia, tremor, diaphoresis, palpitations, headache, alcohol

Tachycardia, Hypertension, Tremor

A

Mild Withdrawal Symptoms

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73
Q

Hallucinations can be a consequence of alcohol withdrawal

Begins 12-24 hours and resolves in 1-2 days

Seizures due to alcohol withdrawal

Delirium due to alcohol withdrawal

A

Severe alcohol withdrawal

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74
Q

Occur within about 6-48 hours of last drink

Generalized tonicclonic

10-30% of patients with withdrawal

A

Seizures to to alcohol withdrawl

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75
Q

72-96 hours after last drink

1-4% of patients with withdrawal

Mortality rate high without treatment

  • No treatment: 20%
  • Benzos and support: 1-4%

Cardiovascular complications, hyperthermia, aspiration, severe electrolyte abnormalities

A

Delirium due to alcohol withdrawal

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76
Q

Leading preventable cause of mortality worldwide

Major causes of Cardiovascular disease, Pulmonary disease, Cancers

A

Tobacco

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77
Q

Tobacco Use Disorder

Responsible for estimated __% of all cardiovascular related deaths in the U.S.

A

33%

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78
Q

Nicotine withdrawal peaks in the first ____ days and slowly subsides over the course of a month

A

3 days

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79
Q

Nicotine withdrawal treatment

A

Nicotine replacement therapy

  • Long acting: Nicotine Patch
  • Short acting: Gum or lozenges

Bupropion

Varenicline

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80
Q

Inhibits reuptake of norepinephrine and dopamine as well as act as nicotinic receptor antagonist

A

Bupropion

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81
Q

Stimulates dopamine activity but to a much smaller degree than nicotine

Partial nicotine agonist

Reduces cravings and withdrawal symptoms

A

Varenicline (Chantix)

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82
Q

Source of marijuana

A

Cannabis sativa

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83
Q

Marijuana effects occurs in 10-20 minutes and last ___ hours

A

23 hours

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84
Q

Joints contain __ grams

A

0.3

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85
Q

0.3 grams of marijuana contains __ mg of tetrahydrocannabinol with a half-life of __ days

A

20 mg

7 days

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86
Q

Marijuana is detected in urine ___ days in short term users

___ days in long term users

A

4-6 days

20-50 days

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87
Q

With moderate dosage, marijuana produces two phases:

A

Mild euphoria followed by sleepiness

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88
Q

Withdrawal from marijuana can cause:

A

Insomnia, nausea, myalgia, and irritability

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89
Q

Long term marijuana use can lead to respiratory problems such as:

A

Pulmonary tree abnormalities, laryngitis, rhinitis, and chronic obstructive pulmonary disease

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90
Q

Has emerged as the most widely used approach to psychotherapy in treating patients with substance use disorders, especially cannabis dependence

A

Cognitive Behavioral Therapy

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91
Q

In 2018, ___ million people misused prescription pain relievers

A

9.9 million

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92
Q

In 2018, ______ people used heroin

A

808,000

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93
Q

Approximately ___% of abused opioids are obtained from friends or family

A

55%

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94
Q

Vital signs changes in heart rate (decreased or increased) and decreased blood pressure, respiratory rate, and temperature

Decreased bowel sounds

Sedated neuro exam

Miosis

A

Opioid use

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95
Q

What should always be checked in a suspected opioid intoxication?

A

Serum glucose

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96
Q

Not uncommon, rapidly correctable and easily confused with acute opioid intoxication

A

Hypoglycemia

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97
Q

Many opioids are formulated as a mix of ______ and ______

A

Narcotic and Acetaminophen

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98
Q

Opioid use disorder

What lab, when found down, would indicate Rhabdomyolysis?

A

Serum CPK

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99
Q

Treatment of choice for acute opioid intoxication

A

Naloxone

100
Q

Stimulant drugs that activate the CNS with resulting strong rewarding effects (euphoria, “rush” and “high”) that contribute to high abuse liability

A

Cocaine and amphetamines

101
Q

Ice is a methamphetamine (crystal meth) that is ___% pure

A

80%

102
Q

Speed is a methamphetamine that is ___% pure

A

10-20%

103
Q

Cocaine is a stimulant made from the _____ plant

A

Coca plant

104
Q

A free base, purer derivative of cocaine, prepared by the extraction from cocaine hydrochloride

A

Crack

105
Q

Activates stimulant effects on mood

A

Serotonin

106
Q

Mediates cognitive arousal and cardiovascular activation in response to stimulants, as well as stress response including stress-induced drug use/relapse

A

Norepinephrine

107
Q

Believed to mediate the reinforcing effects on stimulants

A

Increased dopamine levels

108
Q

Increased sociability that is associated with acute intoxication may be mediated at least in part by acute release of the neuropeptide ________

A

oxytocin

109
Q

Blocks voltage-gated sodium ion channels, which underlies its anesthetic effects

A

Cocaine

110
Q

Moderate usage of any stimulants produces:

A

Hyperactivity

Sense of enhanced physical and mental capacity

Sympathomimetic effects

111
Q

The clinical picture of acute stimulant intoxication includes:

A

Sweating

Tachycardia

Elevated Blood Pressure

Mydriasis

Hyperactivity

Acute brain syndrome with confusion and disorientation

112
Q

Nasal bleeding, headaches, fatigue, insomnia, anxiety, depression, and chronic hoarseness

A

Cocaine use

113
Q

Sudden withdrawal from stimulants is not life threatening but usually produces:

A

Cravings, sleep disturbances, hyperphagia, lassitude, and severe depression lasting days to weeks

114
Q

Estimated lifetime prevalence in the US is around 1-2%

18th leading cause of disability in the US

Unknown pathogenesis

A

Bipolar Disorder

115
Q

Bipolar disorder is characterized by what three mood states?

A

Mania

Hypomania

Major depression

116
Q

A distinct period of abnormally of persistently elevated, expansive or irritable mood persistently increased activity or energy, lasting at least one week and present moods of the day, nearly every day

A

Mania

117
Q

Three or more of the following symptoms

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual or pressured speech
  • Flight ideas/racing thoughts
  • Distractibility
  • Increased goal directed activity
  • Involvement in activities that carry negative potential
A

Mania

118
Q

Acronym is used to remember the symptoms of mania

A

DIGFAST

Distractibility
Indiscretions
Grandiosity
Flight of ideas
Activity increase
Sleeplessness
Talkativeness
119
Q

Similar characteristics of mania only far less severe

No delusional grandiosity

Thought form is more organized
-Quick and creative thinking, more productive thinking

Easier to engage in conversations

Less risky behavior

No psychotic symptoms

No hallucinations

A

Hypomania

120
Q

5 or more of the following symptoms present during the same 2-week period

  • Depressed mood
  • Diminished interest in pleasurable activities
  • Weight loss or gain
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Decreased energy
  • Guilt or feelings of worthlessness
  • Impaired concentration
  • Thoughts of death or suicide
A

Major Depression disorder

121
Q

Depression is diagnosed after what time frame?

A

2 weeks

122
Q

Management of Bipolar Disorder

A

Immediate refer and manage acute symptoms

Haloperidol if needed prior to MEDEVAC

123
Q

Maintenance therapy for Bipolar Disorder employed by a psychiatrist

A

Lithium (Gold Standard)

Valproic acid

Lamotrigine

Quetiapine

124
Q

Most common psychiatric disorder in the general population

Lifetime prevalence 16%

A

Depression

125
Q

Risk factors for depression

A

Family history

Female gender

Childbirth

Childhood trauma

Stressful life events

Poor social support

Serious medical illness

Substance abuse

126
Q

Changes in mood
-Sadness, numbness, anxiety, irritability

Cognitive problems
-Changes in work performance

Neuro-vegetative symptoms
-Loss of energy, changes in sleep, appetite, or weight gain

Somatic symptoms
-Headache, abdominal pain, pelvic pain, back pain, other physical complaints

A

Depression

127
Q

Depression questionnaire

A

PHQ-9

128
Q

Pneumonic used by primary care clinicians to quickly screen for depression when forms such as PHQ-9 are not utilized

A

SIGECAPS

  • Sleep changes
  • Interests
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor agitation
  • Suicide
129
Q

Most feared and most important complication of depression

A

Suicide

130
Q

Basic lab evaluation for new onset of depression

A

CBC

Chemistry

Urinalysis

TFT

HCG

131
Q

Treatment for depression

A

Psychotherapy and Pharmacotherapy

132
Q

Two classes of medications used for depression

A

SSRIs

SNRIs

133
Q

Fluoxetine

Paroxetine

Sertraline

Escitalopram

Citalopram

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

134
Q

Venlafaxine

Duloxetine

A

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

135
Q

Common side effects reported in 55% of people taking SSRIs or SNRIs

A 
Sexual dysfunction
Drowsiness
Weight gain
Insomnia
Anxiety
Dizziness
Headache
Dry mouth
Blurred vision
Nausea
Rash
Tremor
Constipation 
Abdominal pain/stomach upset
136
Q

Disorder that may look similar to a major depressive disorder but does not meet criteria

Occurs in the context of a recent stressor
-Deployment, marital problem, recruit training, financial concerns, increasing responsibilities with rank

Resolves within 6 months when the stressor is removed

A

Adjustment Disorder

137
Q

Very common disorder occurs in the context of childbirth

Usually occurs within 12 months after delivery and has the same diagnostic criteria as depression

Likely due to genetic susceptibility and hormonal changes in addition to increased stressor

A

Post-Partum Depression

138
Q

Diagnostic criteria for post-partum depression disorder

A

Depression occurring within the first 12 months after delivery

Same as major depressive disorder (5 symptoms for for at least 2 weeks):

  • Depressed mood
  • Diminished interest in pleasurable activities
  • Weight loss or weight gain
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Decreased energy
  • Guilt or feelings of worthlessness
  • Impaired concentration
  • Thoughts of death or thoughts of suicide
139
Q

Normal post-partum changes

A

Changes in sleep, energy level, and appetite can be expected

140
Q

Similar symptoms of post-partum depression but does not meet the minimum number of symptoms; milder and self-limited; typically develop within 2-3 days of delivery and resolve within 2 weeks

A

Post-partum “blues”

141
Q

Recommended scale for the work up of post-partum depression

A

Edinburgh Postnatal Depression Scale

142
Q

Treatment for Postpartum depression

A

CBT

SSRIs, Bupropion, Mirtazapine

143
Q

Medication given to postpartum patients that has the lowest adverse effects on women

A

SSRIs (Paroxetine or Sertraline)

144
Q

Episodes of postpartum depression last at least one year in ___% of patients

A

30-50%

145
Q

Suicide ideation occurs in __% of postpartum

A

3%

146
Q

Has been associated with abnormal development, cognitive impairment, and psychopathology in the children

A

Postpartum depression from the mother

147
Q

Characterized by excessive and persistent worrying that is hard to control, causes significant distress, and occurs more days than not for at least six months

A

Generalized Anxiety Disorder (GAD)

148
Q

Prevalence between 5.1% to 11.9%

Twice as common in women

Goes hand in hand with other psychiatric conditions

  • Worrying excessively about minor matters
  • Hyperarousal and muscle tension common
  • Poor sleep
  • Fatigue
  • Difficulty relaxing
  • Headaches
  • Pain in the neck, shoulder, and back
A

Generalized Anxiety Disorder (GAD)

149
Q

Common screening form for Anxiety

A

GAD 7

150
Q

Treatment for Generalized Anxiety Disorder

A

CBT, medications, or both

-SSRIs and SNRIs are the first line

151
Q

People who experience multiple panic attacks

A

Panic disorder

152
Q

Spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour

A

Panic Attack

153
Q

An abrupt surge of intense fear or intense discomfort that reach a peak within minutes. Four or more of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light headed, or faint
  • Chills or heat sensations
  • Paresthesias
  • Derealizations or depersonalizations
  • Fear of losing control or “going crazy”
  • Fear of dying
A

DSM-5 diagnostic criteria for Panic Attacks

154
Q

Multiple conditions that may mimic a panic attack

A 
Angina
Arrhythmias
COPD
Epilepsy
Pulmonary embolus
Asthma
Hyperthyroidism
Pheochromocytoma
Substance abuse
155
Q

Treatment for panic attack

A

Anxiolytics (Benzodiazepines)

-Clonazepam, Lorazepam, Diazepam, Alprazolam

156
Q

Loss of contact with reality

  • Delusions
  • Hallucinations
  • Thought disorganization
  • Agitation and aggression
A

Psychosis

157
Q

Strongly held false beliefs

Broadly classified as bizarre vs non-bizarre

A

Delusions

158
Q

Belief that one is being followed or harassed by outside entity

A

Persecutory delusions

159
Q

Belief that one is a billionaire

A

Grandiose delusions

160
Q

Believing a famous person is in love with them

A

Erotomaniac delusions

161
Q

Believing ones sinuses have been infested with worms

A

Somatic delusions

162
Q

Believing a dialog on TV is directed towards you

Such as president talking on TV is talking directly to you

A

Delusions of reference

163
Q

Believing one’s thoughts and movements are being controlled by a powerful outside force

Such as planetary overlords or government

A

Delusions of control

164
Q

Wakeful sensory experiences of content that is not actually present

A

Hallucinations

165
Q

Misinterpretations of sensory experiences

A

Illusions

166
Q

Hallucinations can occur in what sensory modalities?

A

Auditory (most common)

Visual

Tactile

Olfactory

Gustatory

167
Q

Psychosis

Evidence of thought disorganization is derived from:

A

Patients speech pattern during the interview process

168
Q

Very little information conveyed by speech

Often very sparse reply or lack of spontaneous speech

A

Alogia/poverty of content

169
Q

Suddenly losing train of thought

Characterized by abrupt interruptions in speech

A

Thought blocking

170
Q

Speech content that has ideas presented in a sequence that is not closely related or does not make sense

A

Loosening of association

171
Q

Answers to interview questions diverge from topic being asked about

Is the interview question ever answered?

A

Tangentiality

172
Q

Using words in a sentence that are linked by rhyming or sounding similar

“I fell down the well sell bell”

A

Clanging or clang association

173
Q

Real words are linked together incoherently

Real words but basically nonsense

A

Word Salad

174
Q

Repeating words or ideas persistently

A

Perseveration

175
Q

Diagnosis of exclusion in a patient with acute psychosis

A

Schizophrenia, delusional disorder, major depressive disorder with psychotic features

176
Q

Psychoses associated with medical conditions

A

Delirium

Endocrine Disorders (Thyroid, Adrenal)

Hepatic and renal disorders

Infections (HIV, syphilis, herpes encephalitis, Lyme)

Demyelinating conditions (multiple sclerosis, lupus)

Neurological (Head injury, tumors, seizure, stroke)

Vitamin deficiency (B12)

177
Q

Management of psychosis

A

Immediate referral

Haloperidol

178
Q

Side effects of antipsychotics

A

Extrapyramidal side effects
-Akathisia, Parkinsonian syndrome, Dystonia

Tardive Dyskinesia

179
Q

Two distinct phases of sleep

A

REM (rapid eye movement, Dream sleep)

NREM (non-REM)

180
Q

Often an underlying problem that exacerbates insomnia

A

Poor sleep hygiene

181
Q

Psychiatric disorders often associated with sleep difficulties

A

Depression (fragmented sleep, decreased total sleep time, earlier onset REM)

Bipolar (Insomnia sign of impending mania)

182
Q

First line treatment for sleep disorders

A

Sleep hygiene

  • No caffeine/nicotine in evening
  • Daily exercise regimen
  • Avoid Alcohol
  • Limit fluids in evening
  • Relaxation techniques
183
Q

Sleep disorder

Used when sleep hygiene is ineffective

A

Antihistamines (hydroxyzine, diphenhydramine)

Trazadone

184
Q

Enduring pattern of perceiving, relating to, and thinking about the environment and oneself

Inflexible and maladaptive personality traits across a wide range of situations

Cause significant distress and impairment in functioning in all areas of life

Problems date back to childhood typically

11% of the community

A

Personality Disorder

185
Q

Inability of interpersonal relationships, self-image, and emotions

Very impulsive behaviors

Tend to view others as all good or all bad (“Splitting”)

Tend to misinterpret other neutral events, words, or interactions as “negative”

Mood instability

Suicidal threats, gestures, and attempts more common

A

Borderline Personality Disorder (BPD)

186
Q

Pattern of socially irresponsible, exploitative, and guiltless behavior

Lifelong disorder

Wide range of symptoms with criminality being common

  • Disregard for and violation of rights of others
  • Unstable work history
  • History of arrests
  • Financial dependency on others
  • Poor school history
  • Alcohol abuse
  • Marital difficulties
  • Impulsive behaviors
  • Homelessness
  • “Wild” adolescence
  • Social isolation
  • Promiscuous sexual behavior
  • Lack of remorse
  • Use of aliases
  • Poor military performance
  • Pathological lying
  • Drug abuse
  • Suicide attempts
A

Antisocial personality disorder

187
Q

Treatment for personality disorder

A

Social, Behavioral, Psychological, Medical therapies

188
Q

Marked pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level and clearly interferes with functioning in at least 2 settings (school, home, work)

At least some of the symptoms must be present before age 7

Adults must have childhood onset (by age 12), persistent and current symptoms to be diagnosed

A

Attention-Deficit / Hyperactivity-Disorder

189
Q

Pathophysiology of ADHD

A

Neurobiological and genetic basis with catecholaminergic dysfunction

190
Q

Marked inattention, distractibility, organization difficulties, and poor efficiency

Can also have low frustration tolerance, shifting activities, difficulty organizing, and daydreaming

A

Attention-Deficit / Hyperactivity-Disorder

191
Q

Differential diagnosis for Attention-Deficit / Hyperactivity-Disorder

A

Oppositional defiant disorder

Conduct disorder

Mood disorder

Cognitive performance and learning disabilities

192
Q

Treatment for Attention-Deficit / Hyperactivity-Disorder

A

Methylphenidate (Ritalin)

Amphetamines (Adderall)

193
Q

Mild CNS stimulant; blocks the reuptake of norepinephrine and dopamine into presynaptic neurons; appears to stimulate the cerebral cortex and subcortical structures similar to amphetamines

A

Methylphenidate (Ritalin)

194
Q

Adverse reactions of Methylphenidate

A

Headache, insomnia, irritability, decreased appetite, xerostomia

195
Q

Contraindications of Methylphenidate

A

Recent or current use of MOAIs, glaucoma, Tourette syndrome or tics, marked anxiety/tension/agitation

196
Q

Non-catecholamine sympathomimetic amines that promote release of catecholamines (primarily dopamine and norepinephrine) from their storage sites in the presynaptic nerve terminals

Less significant mechanism may include their ability to block the reuptake of catecholamines by competitive inhibition

A

Amphetamines (Adderall)

197
Q

Adverse reactions of Amphetamines

A

Anorexia, hypertension, insomnia, headache, edginess, GI upset

198
Q

Contraindications of Amphetamines

A

Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, agitated states, history of drug abuse, recent or current use of MAOIs

199
Q

TBI

The _________ is especially susceptible to damage due to being near the sphenoid ridge

A

Hippocampus

200
Q

Are susceptible to countercoup injury

A

Frontal lobes

201
Q

Loss of recall for events immediately before the head trauma

A

Retrograde amnesia

202
Q

Loss of recall for events after the head trauma

A

Anterograde amnesia

203
Q

Someone repeatedly asking a question that has already been answered

A

Amnesia

204
Q

Studies done for Amnesia

A

Neuro assessments

MACE exam

EEG

205
Q

Symptoms attributed to post-concussion syndrome are greatest within the first ___ days for the majority of patients and at one month symptoms are usually improved and often resolved

A

7-10 days

206
Q

Strong desire to be or the insistence that one is a gender other than the one assigned at birth

Essential criterion is the presence of clinically significant distress or impairment of functioning in one or more important areas (social relationships, work, etc.)

A

Gender Dysphoria

207
Q

Treatment for Gender Dysphoria

A

Psychotherapy

Hormonal therapy

208
Q

Disturbance of processes in sexual functioning which causes clinically significant distress

A

Sexual dysfunction

209
Q

Delayed or absent ejaculation/orgasm occurring on almost all occasions of partnered sexual activity and persists for a minimum of 6 months

Could be due to depression or anger toward women

More likely psychological if the difficulty is situational

A

Delayed Ejaculation

210
Q

Treatment for delayed ejaculation should be tailored and may include:

A

Patient/couple psychoeducation

211
Q

Failure to obtain erections in a situation in which they were anticipated, causing embarrassment, self-doubt, and loss of self-confidence

A

Erectile Dysfunction

212
Q

ED can be caused by:

A

Increased age, depression, smoking, diabetes, hypertension, nervous tissue disorders, social anxiety and PTSD

213
Q

Treatment for Erectile Dysfunction

A

Psychological

Phosphodiesterase type 5 inhibitors
-Avanafil, Sildenafil, Tadalafil, Vardenafil

214
Q

Adverse reactions of phosphodiesterase type 5 inhibitors

A

MI, hypotension, syncope, Headache, flushing, dizziness, visual disturbance

215
Q

Contraindications for phosphodiesterase type 5 inhibitors

A

MI within 6 months, hypotension, moderate-severe aortic stenosis, concurrent use of nitrates

216
Q

Female with complaint of normal libido and sexual excitement without the capacity to reach orgasm

Marked delay in, marked infrequency of, or absence of orgasm OR marked reduced intensity of orgasmic sensation present on all or almost all sexual activity

A

Female Orgasmic Disorder

217
Q

Female Orgasmic Disorder is often related to:

A

Depression

218
Q

Treatment for Female Orgasmic Disorder

A

Cognitive-behavioral therapy involving changing of negative sexual thoughts and attitudes

219
Q

Female with a lack of or significantly reduced sexual interest/arousal for at least 6 months

A

Female Sexual Interest/Arousal Disorder

220
Q

Treatment for Female Sexual Interest/Arousal Disorder

A

Sex therapy and cognitive interventions

Bupropion

221
Q

Inhibits neuronal uptake of norepinephrine and dopamine

Adverse reactions: Suicidality, homicidal ideation, mania, HTN, arrhythmias, xerostomia, agitation

Contraindications: Seizure disorder, bulimia, anorexia, bipolar disorder

A

Bupropion

222
Q

Genito-Pelvic Pain / Penetration Disorder

Includes four commonly comorbid symptoms

A

Difficulty having intercourse

Genito-pelvic pain

Fear pain on vaginal penetration

Tension of the pelvic floor muscles

223
Q

Etiology
-Partner/relationship, cultural/religious, medical factors

-Hypothesized that a condition anxiety reaction results in spasm of the entrance to the vagina

Medical conditions (endometriosis, candidiasis, lichen sclerosis, pelvic inflammatory disease, vaginal dryness)

Sexual dysfunction

In adequate stimulation

Psychological factors (due to prior sexual assault, rape, etc.)

A

Genito-Pelvic Pain / Penetration Disorder

224
Q

Treatment for Genito-Pelvic Pain / Penetration Disorder

A

Multidisciplinary (psychiatric, gynecological, urological examinations)

225
Q

Male with absence of desire for sexual activity and persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies for at least 6 months

A

Male Hypoactive Sexual Desire Disorder

226
Q

Male Hypoactive Sexual Desire Disorder

May be due to:

A 
Hypogonadism 
Transient stress or interpersonal conflict
Mood disorder
Schizophrenia 
Substance abuse 
Medications
Normal age-related
227
Q

Treatment for Male Hypoactive Sexual Desire Disorder

A

CBT combined with behavioral sex therapy with major goal being to educate patient how to communicate his sexual preferences to the partner

228
Q

Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it, present for at least months, occurring all or almost all the time and be distressing

A

Premature ejaculation

229
Q

PE is more common in men with:

A

Panic disorder

Social anxiety

230
Q

Treatment for Premature Ejaculation

A

Serotonergic drugs (Paroxetine / Clomipramine)

Behavioral techniques

231
Q

Significant disturbance in sexual function which developed during or soon after substance intoxication or withdrawal or after exposure to a medication AND involved substance/medication is capable of producing these symptoms

A

Substance/Medication-Induced Sexual Dysfunction

232
Q

Most important complication in mental health, often includes some elements of aggression

A

Suicide

233
Q

In 2018, suicide rates in US population per 100,000

A
  1. 8 for males

6. 2 for females

234
Q

In individuals with depression, the lifetime risk of suicide rises to:

A

10-15%

235
Q

Patients with AIDS have a suicide over ___ times that of the general population

A

30 times

236
Q

Suicide

47% of jumpers had:

A

Schizophrenia

237
Q

Suicide is ____ times more prevalent in patients with schizophrenia than in the general population and jumping from bridges is the most common means

A

Ten

238
Q

Alcohol, hopelessness, delusional thoughts, and complete or nearly complete loss of interest in life or ability to experience pleasure are all positively correlated with:

A

Suicide Attempts

239
Q

Risk factors of suicide

A

Previous attempts

Family history of suicide

Medical or psychiatric illness

Male sex

Older age

Contemplation of violent methods

A humiliating social stressor

Drug use

240
Q

Suicide interventions:

A

Education of all personnel

Suicide Prevention Training

Heightened awareness by all hands

241
Q

Suicide prevention training should include:

A

Warning signs

Supervisors getting to know their personnel

Watching for changes in: behavior, attitude, or performance

242
Q

Suicide

MDR should, upon arrival of member:

A

Review Health Record

Interview member regarding any problems

243
Q

Guide for asking questions. Answers will help identify whether someone is at risk for suicide, assess severity and immediacy of the risk, and gauge level of support that the person needs

A

Columbia-Suicide Severity Rating Scale (C-SSRS)

244
Q

Team available for structured intervention for rescuers and survivors involved in incidents likely to produce traumatic stress

A

Special Psychiatric Rapid Intervention Team (SPRINT)

245
Q

Estimated lifetime prevalence of non-suicidal self injury (NSSI)

A

13.0% to 23.2%

246
Q

Typical NSSI falls between ___ years of age

A

12-14

CLASS 22005 PSYCH (6 decks)

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