Ch 1 MDT Flashcards
1
Q
A feeling or emotion manifested by facial expression or body language
A
Affect
2
Q
Absence of interest in or pleasure from performance of acts that would ordinarily be enjoyable
A
Anhedonia
3
Q
Medication designed to treat anxiety
A
Anxiolytic
4
Q
Excessive eating beyond amount necessary to satisfy normal appetite
A
Binge
5
Q
Syndrome of psychomotor retardation characterized by periods of physical rigidity and lack of response to outside stimuli
A
Catatonia
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
7
Q
A false belief or wrong judgement held with conviction despite inconvertible evidence to the contrary
A
Delusion
8
Q
Behavior that is neither goal directed or guided by rational or preconceived plan
A
Disorganized Behavior
9
Q
Speech in which the statements are not logically connected to each other
A
Disorganized Speech
10
Q
An unconscious separation of a group of mental processes from the rest of the conscious awareness
A
Dissociation
11
Q
Disturbance in amount, quality, or timing of sleep
A
Dyssomnia
12
Q
Higher levels of cognitive/mental functioning including planning, abstraction, inductive reasoning, and organizing
A
Executive Functioning
13
Q
Subjective perception of an object or an event when no such stimulus or situation exists
A
Hallucination
14
Q
A misinterpretation or false perception of a real sensory stimulus
A
Illusion
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
16
Q
Inability to fall or stay asleep in absence of external impediments during the period when sleep should occur
A
Insomnia
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
18
Q
State in which the individual interprets and regards everything in relation to himself and not to others
A
Narcissism
19
Q
Recurrent and persistent idea, thought or impulse to carry out an act
A
Obsession
20
Q
A belief system that includes extreme suspiciousness and mistrust of others
A
Paranoia
21
Q
Abnormal increase in physical and emotional behavior
A
Psychomotor Agitation
22
Q
Abnormal slowing in physical and emotional activity
A
Psychomotor Retardation
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
24
Q
To cause copious evacuation of the bowels and stomach by induction of vomiting, use of enemas, or laxatives
A
Purge
25
An event or situation that induces psychological, emotional or behavioral distress
Stressor
26
The complex somatic, cognitive, affective, and behavioral effects of psychological trauma
PTSD
27
PTSD has a strong correlation with ____ regarding armed conflict and combat
TBI
28
Pathophysiology of PTSD
Studies using MRI have shown decreased volume in several areas of the brain:
- Left amygdala (Fear center)
- Hippocampus (Memories)
- Anterior Cingulate cortex
29
Pathophysiology of PTSD
Reported findings in studies include increased levels of:
Central norepinephrine
30
PTSD responses to trauma
Affective dysregulation (anger common)
Cognitive impairment
Behaviors in response to regular stimuli
31
PTSD
Responses to trauma lead to _______ behaviors
Compensatory (avoidance)
32
PTSD
The focus for the IDC is:
Screening
33
PTSD
Symptoms must be present for at least ____ weeks following trauma for psychiatry to make the diagnosis
4 weeks
34
Treatment for PTSD
Psychotherapy
SSRI (Sertraline)
35
PTSD medication for nightmares
Prazosin
36
PTSD medication for tremors and sympathetic responses
Beta Blockers
37
PTSD medications for comorbid psychosis
Antipsychotics
38
PTSD Medication to avoid due to safety and dependency issues
Benzodiazepines
39
PTSD
Different types of psychotherapy
Exposure therapy
Cognitive Behavioral Therapy
Eye movement desensitization and reprocessing
40
Screening tool for psychiatric causes that differentiate between an eating disorder and other causes of weight loss
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
41
Ratio of Anorexia Nervosa, Women to men
10-20:1
42
Pathophysiology of Anorexia
Deficits of _____ function and _______ function
Dopamine (eating behavior, motivation and reward)
Serotonin (mood, impulse control, obsessive behavior)
43
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
Anorexia
44
Common physical findings in Anorexia
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
45
Bulimia
_____ times more common in women than men
Three
46
Recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain
Occurring at least once per week for three months
Bulimia
47
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
Bulimia
48
Clinical findings with Bulimia
Dehydration
Menstrual irregularities
Mallory-Weiss syndrome
Pharyngitis
Erosion of dental enamel
ECG changes
49
Uncomfortably full
Eating when not hungry
Feelings of embarrassment
Feelings of disgust, depression
Binge eating disorder
50
Eating of nonfood substances
Inappropriate eating behavior for developmental level
Not culturally, socially normal eating
Associated with iron deficiency anemia
Pica
51
Repeated regurgitation of food
May be rechewed, reswallowed, or spit out
Condition is not due to any medical condition
Rumination Disorder
52
Management of eating disorders
Refer to Psych / Nutrition Consult
Labs
- CBC
- Thyroid studies
- Metabolic Panel
53
Substance abuse triad
Psychological dependence or craving
Physiologic dependence
Tolerance
54
_____ deaths per year directly related to alcohol use
85,000
55
Annual economic cost from alcohol use disorder
$250 billion
56
1 in ___ deaths in working age adults results from excessive drinking
1 in 10
57
3rd leading preventable cause of death in the United States
Alcohol use disorder
58
Alcohol use is not so severe as to meet criteria for alcohol use disorder
May go on to develop alcohol use disorder
Risky Alcohol Use
59
What organization has estimated consumption amounts of alcohol that increases health risks?
National Institute of Alcohol Abuse and Alcoholism (NIAAA)
60
Standard drink
5 oz of wine, 12 oz beer
61
Men under 65
- More than __ standard alcoholic drinks per week on average that increases health risks
- More than __ drinks on any day
14
4
62
Woman under 65
- More than __ standard alcoholic drinks per week on average that increases health risks
- More than __ drinks on any day
7
3
63
Strong association between alcoholism and _______ disorders
Psychiatric disorders
64
Alcohol Use Disorder
Lifetime suicide attempts __%
7%
65
Physical exam shows:
-Tremor, agitation
-Problems with sensation, diminished DTRs, paresthesias
- Hepatic/splenic enlargement
- Icterus/jaundice
- Spider angiomata
- Palmar erythema
Alcohol use disorder
66
Four quick questions for unhealthy alcohol use
CAGE
Cut down
Annoyed
Guilty
Eye opener
67
Alcohol use disorder due to a deficiency of thiamine (Vitamin B1)
Wernicke Korsakoff Syndrome
68
Direct damage to the brain caused by thiamine deficiency
- Encephalopathy
- Oculomotor dysfunction
- Gait ataxia
Most common symptom: Confusion
Wernicke encephalopathy (WE)
69
Late neuropsychiatric manifestation of Wernicke's
Causes anterograde and retrograde amnesia
Korsakoff syndrome
70
Alcohol use disorder
Approximately ____ of patients experience some form of withdrawal
Half
71
Alcohol use disorder
Usually mild but estimated ___% experience severe symptoms
20%
72
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
Mild Withdrawal Symptoms
73
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
Severe alcohol withdrawal
74
Occur within about 6-48 hours of last drink
Generalized tonicclonic
10-30% of patients with withdrawal
Seizures to to alcohol withdrawl
75
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
Delirium due to alcohol withdrawal
76
Leading preventable cause of mortality worldwide
Major causes of Cardiovascular disease, Pulmonary disease, Cancers
Tobacco
77
Tobacco Use Disorder
Responsible for estimated __% of all cardiovascular related deaths in the U.S.
33%
78
Nicotine withdrawal peaks in the first ____ days and slowly subsides over the course of a month
3 days
79
Nicotine withdrawal treatment
Nicotine replacement therapy
- Long acting: Nicotine Patch
- Short acting: Gum or lozenges
Bupropion
Varenicline
80
Inhibits reuptake of norepinephrine and dopamine as well as act as nicotinic receptor antagonist
Bupropion
81
Stimulates dopamine activity but to a much smaller degree than nicotine
Partial nicotine agonist
Reduces cravings and withdrawal symptoms
Varenicline (Chantix)
82
Source of marijuana
Cannabis sativa
83
Marijuana effects occurs in 10-20 minutes and last ___ hours
23 hours
84
Joints contain __ grams
0.3
85
0.3 grams of marijuana contains __ mg of tetrahydrocannabinol with a half-life of __ days
20 mg
7 days
86
Marijuana is detected in urine ___ days in short term users
___ days in long term users
4-6 days
20-50 days
87
With moderate dosage, marijuana produces two phases:
Mild euphoria followed by sleepiness
88
Withdrawal from marijuana can cause:
Insomnia, nausea, myalgia, and irritability
89
Long term marijuana use can lead to respiratory problems such as:
Pulmonary tree abnormalities, laryngitis, rhinitis, and chronic obstructive pulmonary disease
90
Has emerged as the most widely used approach to psychotherapy in treating patients with substance use disorders, especially cannabis dependence
Cognitive Behavioral Therapy
91
In 2018, ___ million people misused prescription pain relievers
9.9 million
92
In 2018, ______ people used heroin
808,000
93
Approximately ___% of abused opioids are obtained from friends or family
55%
94
Vital signs changes in heart rate (decreased or increased) and decreased blood pressure, respiratory rate, and temperature
Decreased bowel sounds
Sedated neuro exam
Miosis
Opioid use
95
What should always be checked in a suspected opioid intoxication?
Serum glucose
96
Not uncommon, rapidly correctable and easily confused with acute opioid intoxication
Hypoglycemia
97
Many opioids are formulated as a mix of ______ and ______
Narcotic and Acetaminophen
98
Opioid use disorder
What lab, when found down, would indicate Rhabdomyolysis?
Serum CPK
99
Treatment of choice for acute opioid intoxication
Naloxone
100
Stimulant drugs that activate the CNS with resulting strong rewarding effects (euphoria, "rush" and "high") that contribute to high abuse liability
Cocaine and amphetamines
101
Ice is a methamphetamine (crystal meth) that is ___% pure
80%
102
Speed is a methamphetamine that is ___% pure
10-20%
103
Cocaine is a stimulant made from the _____ plant
Coca plant
104
A free base, purer derivative of cocaine, prepared by the extraction from cocaine hydrochloride
Crack
105
Activates stimulant effects on mood
Serotonin
106
Mediates cognitive arousal and cardiovascular activation in response to stimulants, as well as stress response including stress-induced drug use/relapse
Norepinephrine
107
Believed to mediate the reinforcing effects on stimulants
Increased dopamine levels
108
Increased sociability that is associated with acute intoxication may be mediated at least in part by acute release of the neuropeptide ________
oxytocin
109
Blocks voltage-gated sodium ion channels, which underlies its anesthetic effects
Cocaine
110
Moderate usage of any stimulants produces:
Hyperactivity
Sense of enhanced physical and mental capacity
Sympathomimetic effects
111
The clinical picture of acute stimulant intoxication includes:
Sweating
Tachycardia
Elevated Blood Pressure
Mydriasis
Hyperactivity
Acute brain syndrome with confusion and disorientation
112
Nasal bleeding, headaches, fatigue, insomnia, anxiety, depression, and chronic hoarseness
Cocaine use
113
Sudden withdrawal from stimulants is not life threatening but usually produces:
Cravings, sleep disturbances, hyperphagia, lassitude, and severe depression lasting days to weeks
114
Estimated lifetime prevalence in the US is around 1-2%
18th leading cause of disability in the US
Unknown pathogenesis
Bipolar Disorder
115
Bipolar disorder is characterized by what three mood states?
Mania
Hypomania
Major depression
116
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
Mania
117
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
Mania
118
Acronym is used to remember the symptoms of mania
DIGFAST
```
Distractibility
Indiscretions
Grandiosity
Flight of ideas
Activity increase
Sleeplessness
Talkativeness
```
119
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
Hypomania
120
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
Major Depression disorder
121
Depression is diagnosed after what time frame?
2 weeks
122
Management of Bipolar Disorder
Immediate refer and manage acute symptoms
Haloperidol if needed prior to MEDEVAC
123
Maintenance therapy for Bipolar Disorder employed by a psychiatrist
Lithium (Gold Standard)
Valproic acid
Lamotrigine
Quetiapine
124
Most common psychiatric disorder in the general population
Lifetime prevalence 16%
Depression
125
Risk factors for depression
Family history
Female gender
Childbirth
Childhood trauma
Stressful life events
Poor social support
Serious medical illness
Substance abuse
126
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
Depression
127
Depression questionnaire
PHQ-9
128
Pneumonic used by primary care clinicians to quickly screen for depression when forms such as PHQ-9 are not utilized
SIGECAPS
- Sleep changes
- Interests
- Guilt
- Energy
- Concentration
- Appetite
- Psychomotor agitation
- Suicide
129
Most feared and most important complication of depression
Suicide
130
Basic lab evaluation for new onset of depression
CBC
Chemistry
Urinalysis
TFT
HCG
131
Treatment for depression
Psychotherapy and Pharmacotherapy
132
Two classes of medications used for depression
SSRIs
SNRIs
133
Fluoxetine
Paroxetine
Sertraline
Escitalopram
Citalopram
Selective Serotonin Reuptake Inhibitors (SSRIs)
134
Venlafaxine
Duloxetine
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
135
Common side effects reported in 55% of people taking SSRIs or SNRIs
```
Sexual dysfunction
Drowsiness
Weight gain
Insomnia
Anxiety
Dizziness
Headache
Dry mouth
Blurred vision
Nausea
Rash
Tremor
Constipation
Abdominal pain/stomach upset
```
136
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
Adjustment Disorder
137
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
Post-Partum Depression
138
Diagnostic criteria for post-partum depression disorder
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
Normal post-partum changes
Changes in sleep, energy level, and appetite can be expected
140
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
Post-partum "blues"
141
Recommended scale for the work up of post-partum depression
Edinburgh Postnatal Depression Scale
142
Treatment for Postpartum depression
CBT
SSRIs, Bupropion, Mirtazapine
143
Medication given to postpartum patients that has the lowest adverse effects on women
SSRIs (Paroxetine or Sertraline)
144
Episodes of postpartum depression last at least one year in ___% of patients
30-50%
145
Suicide ideation occurs in __% of postpartum
3%
146
Has been associated with abnormal development, cognitive impairment, and psychopathology in the children
Postpartum depression from the mother
147
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
Generalized Anxiety Disorder (GAD)
148
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
Generalized Anxiety Disorder (GAD)
149
Common screening form for Anxiety
GAD 7
150
Treatment for Generalized Anxiety Disorder
CBT, medications, or both
-SSRIs and SNRIs are the first line
151
People who experience multiple panic attacks
Panic disorder
152
Spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour
Panic Attack
153
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
DSM-5 diagnostic criteria for Panic Attacks
154
Multiple conditions that may mimic a panic attack
```
Angina
Arrhythmias
COPD
Epilepsy
Pulmonary embolus
Asthma
Hyperthyroidism
Pheochromocytoma
Substance abuse
```
155
Treatment for panic attack
Anxiolytics (Benzodiazepines)
| -Clonazepam, Lorazepam, Diazepam, Alprazolam
156
Loss of contact with reality
- Delusions
- Hallucinations
- Thought disorganization
- Agitation and aggression
Psychosis
157
Strongly held false beliefs
Broadly classified as bizarre vs non-bizarre
Delusions
158
Belief that one is being followed or harassed by outside entity
Persecutory delusions
159
Belief that one is a billionaire
Grandiose delusions
160
Believing a famous person is in love with them
Erotomaniac delusions
161
Believing ones sinuses have been infested with worms
Somatic delusions
162
Believing a dialog on TV is directed towards you
Such as president talking on TV is talking directly to you
Delusions of reference
163
Believing one's thoughts and movements are being controlled by a powerful outside force
Such as planetary overlords or government
Delusions of control
164
Wakeful sensory experiences of content that is not actually present
Hallucinations
165
Misinterpretations of sensory experiences
Illusions
166
Hallucinations can occur in what sensory modalities?
Auditory (most common)
Visual
Tactile
Olfactory
Gustatory
167
Psychosis
Evidence of thought disorganization is derived from:
Patients speech pattern during the interview process
168
Very little information conveyed by speech
Often very sparse reply or lack of spontaneous speech
Alogia/poverty of content
169
Suddenly losing train of thought
Characterized by abrupt interruptions in speech
Thought blocking
170
Speech content that has ideas presented in a sequence that is not closely related or does not make sense
Loosening of association
171
Answers to interview questions diverge from topic being asked about
Is the interview question ever answered?
Tangentiality
172
Using words in a sentence that are linked by rhyming or sounding similar
"I fell down the well sell bell"
Clanging or clang association
173
Real words are linked together incoherently
Real words but basically nonsense
Word Salad
174
Repeating words or ideas persistently
Perseveration
175
Diagnosis of exclusion in a patient with acute psychosis
Schizophrenia, delusional disorder, major depressive disorder with psychotic features
176
Psychoses associated with medical conditions
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
Management of psychosis
Immediate referral
Haloperidol
178
Side effects of antipsychotics
Extrapyramidal side effects
-Akathisia, Parkinsonian syndrome, Dystonia
Tardive Dyskinesia
179
Two distinct phases of sleep
REM (rapid eye movement, Dream sleep)
NREM (non-REM)
180
Often an underlying problem that exacerbates insomnia
Poor sleep hygiene
181
Psychiatric disorders often associated with sleep difficulties
Depression (fragmented sleep, decreased total sleep time, earlier onset REM)
Bipolar (Insomnia sign of impending mania)
182
First line treatment for sleep disorders
Sleep hygiene
- No caffeine/nicotine in evening
- Daily exercise regimen
- Avoid Alcohol
- Limit fluids in evening
- Relaxation techniques
183
Sleep disorder
Used when sleep hygiene is ineffective
Antihistamines (hydroxyzine, diphenhydramine)
Trazadone
184
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
Personality Disorder
185
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
Borderline Personality Disorder (BPD)
186
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
Antisocial personality disorder
187
Treatment for personality disorder
Social, Behavioral, Psychological, Medical therapies
188
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
Attention-Deficit / Hyperactivity-Disorder
189
Pathophysiology of ADHD
Neurobiological and genetic basis with catecholaminergic dysfunction
190
Marked inattention, distractibility, organization difficulties, and poor efficiency
Can also have low frustration tolerance, shifting activities, difficulty organizing, and daydreaming
Attention-Deficit / Hyperactivity-Disorder
191
Differential diagnosis for Attention-Deficit / Hyperactivity-Disorder
Oppositional defiant disorder
Conduct disorder
Mood disorder
Cognitive performance and learning disabilities
192
Treatment for Attention-Deficit / Hyperactivity-Disorder
Methylphenidate (Ritalin)
Amphetamines (Adderall)
193
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
Methylphenidate (Ritalin)
194
Adverse reactions of Methylphenidate
Headache, insomnia, irritability, decreased appetite, xerostomia
195
Contraindications of Methylphenidate
Recent or current use of MOAIs, glaucoma, Tourette syndrome or tics, marked anxiety/tension/agitation
196
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
Amphetamines (Adderall)
197
Adverse reactions of Amphetamines
Anorexia, hypertension, insomnia, headache, edginess, GI upset
198
Contraindications of Amphetamines
Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, agitated states, history of drug abuse, recent or current use of MAOIs
199
TBI
The _________ is especially susceptible to damage due to being near the sphenoid ridge
Hippocampus
200
Are susceptible to countercoup injury
Frontal lobes
201
Loss of recall for events immediately before the head trauma
Retrograde amnesia
202
Loss of recall for events after the head trauma
Anterograde amnesia
203
Someone repeatedly asking a question that has already been answered
Amnesia
204
Studies done for Amnesia
Neuro assessments
MACE exam
EEG
205
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
7-10 days
206
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.)
Gender Dysphoria
207
Treatment for Gender Dysphoria
Psychotherapy
Hormonal therapy
208
Disturbance of processes in sexual functioning which causes clinically significant distress
Sexual dysfunction
209
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
Delayed Ejaculation
210
Treatment for delayed ejaculation should be tailored and may include:
Patient/couple psychoeducation
211
Failure to obtain erections in a situation in which they were anticipated, causing embarrassment, self-doubt, and loss of self-confidence
Erectile Dysfunction
212
ED can be caused by:
Increased age, depression, smoking, diabetes, hypertension, nervous tissue disorders, social anxiety and PTSD
213
Treatment for Erectile Dysfunction
Psychological
Phosphodiesterase type 5 inhibitors
-Avanafil, Sildenafil, Tadalafil, Vardenafil
214
Adverse reactions of phosphodiesterase type 5 inhibitors
MI, hypotension, syncope, Headache, flushing, dizziness, visual disturbance
215
Contraindications for phosphodiesterase type 5 inhibitors
MI within 6 months, hypotension, moderate-severe aortic stenosis, concurrent use of nitrates
216
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
Female Orgasmic Disorder
217
Female Orgasmic Disorder is often related to:
Depression
218
Treatment for Female Orgasmic Disorder
Cognitive-behavioral therapy involving changing of negative sexual thoughts and attitudes
219
Female with a lack of or significantly reduced sexual interest/arousal for at least 6 months
Female Sexual Interest/Arousal Disorder
220
Treatment for Female Sexual Interest/Arousal Disorder
Sex therapy and cognitive interventions
Bupropion
221
Inhibits neuronal uptake of norepinephrine and dopamine
Adverse reactions: Suicidality, homicidal ideation, mania, HTN, arrhythmias, xerostomia, agitation
Contraindications: Seizure disorder, bulimia, anorexia, bipolar disorder
Bupropion
222
Genito-Pelvic Pain / Penetration Disorder
Includes four commonly comorbid symptoms
Difficulty having intercourse
Genito-pelvic pain
Fear pain on vaginal penetration
Tension of the pelvic floor muscles
223
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.)
Genito-Pelvic Pain / Penetration Disorder
224
Treatment for Genito-Pelvic Pain / Penetration Disorder
Multidisciplinary (psychiatric, gynecological, urological examinations)
225
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
Male Hypoactive Sexual Desire Disorder
226
Male Hypoactive Sexual Desire Disorder
May be due to:
```
Hypogonadism
Transient stress or interpersonal conflict
Mood disorder
Schizophrenia
Substance abuse
Medications
Normal age-related
```
227
Treatment for Male Hypoactive Sexual Desire Disorder
CBT combined with behavioral sex therapy with major goal being to educate patient how to communicate his sexual preferences to the partner
228
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
Premature ejaculation
229
PE is more common in men with:
Panic disorder
Social anxiety
230
Treatment for Premature Ejaculation
Serotonergic drugs (Paroxetine / Clomipramine)
Behavioral techniques
231
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
Substance/Medication-Induced Sexual Dysfunction
232
Most important complication in mental health, often includes some elements of aggression
Suicide
233
In 2018, suicide rates in US population per 100,000
22. 8 for males
| 6. 2 for females
234
In individuals with depression, the lifetime risk of suicide rises to:
10-15%
235
Patients with AIDS have a suicide over ___ times that of the general population
30 times
236
Suicide
47% of jumpers had:
Schizophrenia
237
Suicide is ____ times more prevalent in patients with schizophrenia than in the general population and jumping from bridges is the most common means
Ten
238
Alcohol, hopelessness, delusional thoughts, and complete or nearly complete loss of interest in life or ability to experience pleasure are all positively correlated with:
Suicide Attempts
239
Risk factors of suicide
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
Suicide interventions:
Education of all personnel
Suicide Prevention Training
Heightened awareness by all hands
241
Suicide prevention training should include:
Warning signs
Supervisors getting to know their personnel
Watching for changes in: behavior, attitude, or performance
242
Suicide
MDR should, upon arrival of member:
Review Health Record
Interview member regarding any problems
243
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
Columbia-Suicide Severity Rating Scale (C-SSRS)
244
Team available for structured intervention for rescuers and survivors involved in incidents likely to produce traumatic stress
Special Psychiatric Rapid Intervention Team (SPRINT)
245
Estimated lifetime prevalence of non-suicidal self injury (NSSI)
13.0% to 23.2%
246
Typical NSSI falls between ___ years of age
12-14
