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CLASS 22010 PSYCH > CLINICAL CARE OF PSYCHIATRIC DISORDERS > Flashcards

CLINICAL CARE OF PSYCHIATRIC DISORDERS Flashcards

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1
Q

What is the complex somatic, cognitive, affective, and behavioral effects of psychological trauma?

A

PTSD

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2
Q

True or False

PTSD has a strong correlation with TBI

A

True

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3
Q

PTSD

One study of hospitalized soldiers showed an increased prevalence of ____% at one month versus _____% at 4 months of exposure

A
  1. 4.2%

2. 12.2%

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4
Q

True or False

A study of 1648 US marines showed that experiencing a TBI during deployment was a strong predictor of PTSD symptom development

A

True

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5
Q

PTSD

Studies using MRI have shown decreased volume in several areas of the brain such as what?

A
  1. Left amygdala (fear center)
  2. Hippocampus (memories)
  3. Anterior cingulate cortex
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6
Q

The following can be common clinical manifestations of what psychiatric disorder?

  1. Affective dysregulation (anger common)
  2. Cognitive impairment
  3. Several behavior responses in response to regular stimuli:
    a. flashbacks
    b. severe anxiety symptoms
    c. fleeing
    d. combative behaviors
A

PTSD

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7
Q

True or False

Clinical manifestations of PTSD can lead to compensatory behaviors in the individuals affected. (avoidance of triggering experiences)

A

True

Avoidance leads to furthering of symptoms such as emotional numbing, diminished interests in activities and detachment from others

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8
Q

Symptoms of PTSD must be present for at least how many weeks following trauma for psychiatry to make the diagnosis?

A

Four weeks

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9
Q

True or False

The focus of the IDC for PTSD is screening

A

True

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10
Q

What are some forms of psychotherapy that are useful in the treatment of PTSD?

A
  1. Exposure Therapy
  2. CBT (cognitive behavioral therapy)
  3. EMDR (Eye Movement Desensitization and Reprocessing)
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11
Q

True or False

Since marital problems and substance abuse are commonly seen in patients with PTSD should also consider referral sources for counseling

A

True

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12
Q

What is the first line therapy of choice for PTSD?

A

Antidepressant Medications (SSRIs)

Example: Sertraline

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13
Q

PTSD

What adjunctive medication can be used for nightmares?

A

Prazosin

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14
Q

PTSD

What adjunctive medication can be used for tremors and sympathetic responses?

A

Beta Blockers

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15
Q

PTSD

What adjunctive medication can be used for comorbid psychosis if needed?

A

Antipsychotics

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16
Q

What is a persistent disturbance of eating that impairs both health and psychological functioning?

A

Eating disorders

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17
Q

What are some examples of eating disorders?

A
  1. Anorexia nervosa
  2. Bulimia nervosa
  3. Binge eating disorder
  4. Pica
  5. Rumination disorder
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18
Q

In regards to eating disorders, you should consider a broad differential when evaluating a patient for weight loss, examples include but are not limited to what?

A
  1. Hyperthyroidism
  2. Malignancy
  3. Disease of the GI tract
  4. Chronic Infectious Diseases
  5. Affective disorders (depression)
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19
Q

What is the estimated lifetime prevalence of Anorexia Nervosa and is likely higher due to the concealment of the illness?

A

0.6%

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20
Q

Who is Anorexia Nervosa more common in?

A

Women

Ratio ranges from 10-20:1

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21
Q

What is the median age of onset for Anorexia Nervosa?

A

18 years old

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22
Q

In what psychiatric condition is there an intense fear of gaining weight or becoming fat or persistent behavior that prevents weight gain, despite being underweight?

A

Anorexia Nervosa

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23
Q

What is the 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 Nervosa

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24
Q

These are all common physical exam findings of what psychiatric condition?

  1. Low BMI (<17.5)
  2. Emaciation
  3. Hypothermia
  4. Bradycardia
  5. Hypotension
  6. Hypoactive bowel sounds
  7. Xerosis (dry and scaly skin)
  8. Brittle hair and hair loss
  9. Lanugo body hair
  10. Abdominal distention
A

Anorexia Nervosa

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25
Q

What eating disorder has an estimated lifetime prevalence of 1.0% and is three times more common in women that in men (1.5% vs 0.5%)?

A

Bulimia Nervosa

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26
Q

What is known as recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain?

A

Bulimia Nervosa

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27
Q

What psychiatric disorder is characterized by the following?

  1. Self-induced vomiting
  2. Misuse of laxatives
  3. Diuretic use
  4. Enemas
  5. Fasting
  6. Excessive exercise
    * *7. Occurring on average at least once per week for three months
A

Bulimia Nervosa

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28
Q

Bulimia Nervosa

There is a mild psychosocial impairment seen in about ____% and severe impairment in ___%

A
  1. 78%

2. 16%

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29
Q

Are additional psychiatric disorders common with bulimia nervosa?

A

Yes

Anxiety, depression, PTSD, substance abuse, ADHD, conduct disorders, personality disorders

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30
Q

You may see the following in what psychiatric condition?

  1. Dehydration
  2. Menstrual irregularities
  3. Mallory-Weiss syndrome
  4. Pharyngitis
  5. Erosion of dental enamel
  6. ECG changes may occur
A

Bulimia Nervosa

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31
Q

True or False

Binge Eating Disorder

Eating is associated with: uncomfortably full, eating when not hungry, feelings of embarrassment, feelings of disgust and depression

A

True

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32
Q

What psychiatric disorder is characterized by the eating of non-food substances and can be associated with iron deficiency anemia?

A

PICA

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33
Q

What eating disorder is associated with repeated regurgitation of food?

A

Rumination Disorder

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34
Q

True or False

Once recognized eating disorders require referral

A

True

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35
Q

What psychiatric disorder is characterized by the following triad?

  1. Psychological dependence or craving
  2. Physiologic dependence
  3. Tolerance
A

Substance Use Disorder

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36
Q

What psychiatric disorder has a huge impact on our society with more than 85k deaths per year directly attributable to it and an annual economic cost of $250 billion?

A

Alcohol Use Disorder

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37
Q

True or False

1 in 10 deaths in working age adults results from excessive drinking

A

True

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38
Q

What is the 3rd leading preventable cause of death in the United States?

A

Alcohol Use Disorder

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39
Q

What refers to the consumption of alcohol that puts a patient at risk for health consequences?

A

Risky Alcohol Use

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40
Q

What is the amount of alcohol that increases health risks in men under the age of 65?

A
  1. More than 14 standard drinks per week on average

2. More than 4 drinks on any day

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41
Q

What is considered the standard drink?

A
  1. 5 oz of wine

2. 12 oz beer

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42
Q

What is the amount of alcohol that increases health risks in women and adults 65 and older?

A
  1. More than 7 standard drinks per week on average

2. More than 3 drinks on any day

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43
Q

What are some common medical complications of alcohol use?

A
  1. HTN
  2. Cardiovascular disease
  3. Liver disease
  4. Pancreatitis
  5. Gastritis
  6. Esophagitis
  7. Neuropathy
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44
Q

There is a strong association with what disorder and the following?

  1. Depression
  2. Anxiety
  3. PTSD
  4. Eating Disorders
  5. Other substance use disorders
  6. Sleep disturbances
  7. Suicidal Ideations and attempt
A

Alcohol Use Disorder

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45
Q

What is the estimated lifetime rate of suicide attempts with patients suffering from alcohol use disorder?

A

7%

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46
Q

What are some common physical exam findings you may see in a patient with alcohol use disorder?

A
  1. May have signs of withdrawal
    a. tremor, agitation
  2. Peripheral neuropathy
  3. Features of liver disease
    a. hepatic/splenic enlargement
    b. icterus/jaundice
    c. spider angiomata
    d. Palmar erythema
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47
Q

What are the questions you can ask a patient with possible alcohol use disorder?

A

“CAGE questions”

  1. Have you ever felt you should Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt bad or Guilty about your drinking?
  4. Have you ever taken a drink first thing in the morning (Eye opener) to steady
    your nerves or get rid of a hangover?
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48
Q

What is one complication of Alcohol use disorder that is due to a deficiency of Thiamine (Vitamin B1)?

A

Wernicke Korsakoff Syndrome

actually two separate syndromes

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49
Q

What is direct brain damage due to a deficiency of Thiamine and is characterized by the triad of encephalopathy, disorientation, inattentiveness, and oculomotor dysfunction ?

A

Wernicke Encephalopathy (WE)

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50
Q

The following are common findings in what syndrome that is associated with alcohol use disorder?

  1. Gait ataxia
  2. Wide based gait
  3. Most common symptom: Confusion
A

Wernicke Encephalopathy

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51
Q

What is a chronic neuro condition that is usually a consequence of Wernicke Encephalopathy?

A

Korsakoff Syndrome

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52
Q

What is a late neuropsychiatric manifestation of Wernicke’s Encephalopathy?

A

Korsakoff Syndrome

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53
Q

What does Korsakoff syndrome cause?

A

Anterograde and retrograde amnesia

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54
Q

True or False

Alcohol Withdrawal

Potentially life threatening problem, approximately half of patient experience some form of withdrawal, usually mild but estimated 20% experience severe symptoms

A

True

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55
Q

With mild alcohol withdrawal, symptoms generally begin within 6-24 hours of the last drink and may show things such as what?

A
  1. Anxiety
  2. Minor agitation
  3. Restlessness
  4. Insomnia
  5. Tremors
  6. Diaphoresis
  7. Palpitations
  8. Headache
  9. Alcohol craving
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56
Q

Mild withdrawal symptoms usually resolve in how long?

A

1-2 days

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57
Q

Can more severe symptoms of alcohol withdrawal include hallucinations and delirium?

A

Yes

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58
Q

When do hallucinations associated with alcohol withdrawal usually begin and resolve?

A
  1. Begins within 12-24 hours

2. Resolves in another 1-2 days

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59
Q

What are the seizures typically associated with alcohol withdrawal?

A

Tonicclonic

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60
Q

When do seizures associated with alcohol withdrawal typically occur?

A

6-48 hours after last drink

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61
Q

True or False

10-30% of patients with alcohol withdrawal will develop seizures

A

True

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62
Q

What is the “kindling effect” in regards to alcohol withdrawal?

A

Risk of seizures increases with repeated withdrawals

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63
Q

Delirium due to alcohol withdrawal begins within __ to ___ hours after the last drink and occurs in __% to __% of patients hospitalized with withdrawal?

A
  1. 72-96 hours

2. 1-4%

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64
Q

True or False

The term “Delirium Tremens” refers to the fluctuating disturbance in attention and cognition, may include hallucinations

A

True

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65
Q

Severe forms of what with alcohol withdrawal in severe forms can include agitation and extreme autonomic hyperactivity? (fever, tachycardia, hypertension, drenching sweats)

A

Delirium Tremens

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66
Q

What is the leading preventable causes of mortality worldwide, causes an estimated 6 million deaths worldwide, and 400k deaths annually?

A

Tobacco Use Disorder

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67
Q

What are some major causes of mortality associated with Tobacco Use Disorder?

A
  1. Cardiovascular Disease
  2. Pulmonary Disease
  3. Cancer
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68
Q

What is responsible for an estimated 33% of all cardiovascular related deaths in the US?

A

Tobacco Use Disorder

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69
Q

What is the most important risk factor for COPD?

A

Tobacco Use Disorder

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70
Q

What is the “Pre-contemplation” stage of quitting tobacco?

A

Not ready to quit

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71
Q

What is the “contemplation” stage of quitting tobacco?

A

Considering a quit attempt

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72
Q

What is the “preparation” stage of quitting tobacco?

A

Actively planning a quit attempt

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73
Q

What is the “Action” stage of quitting tobacco?

A

Actively involved in a quit attempt

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74
Q

What is the “maintenance” stage of quitting tobacco?

A

Achieved smoking cessation

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75
Q

Triggers to smoking are a huge barrier including things like smoking with the morning coffee, smoking while drinking, and around meal time; but what is perhaps the greatest barrier?

A

Nicotine Withdrawal

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76
Q

Nicotine withdrawal peaks in the first ____ days and then slowly subsides over the course of about ___ month(s)

A
  1. 3 Days

2. One month

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77
Q

What is the long acting treatment of nicotine withdrawal?

A

Nicotine Patch

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78
Q

What is the short acting treatment of nicotine withdrawal?

A

Gum or Lozenges

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79
Q

What medication used for the treatment of nicotine withdrawal has the following effects?

  1. Used for both depression and smoking cessation
  2. Considered an atypical antidepressant
  3. Inhibits reuptake of norepinephrine and dopamine as well as act as nicotinic receptor antagonist
  4. Reduces nicotine cravings and withdrawal symptoms
A

Buproprion (Wellbutrin)

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80
Q

What medication is a partial nicotine agonist, stimulates dopamine activity but to a much smaller degree than nicotine, and reduces cravings and withdrawal symptoms?

A

Varenicline (Chantix)

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81
Q

Effects from marijuana occur in ____ to ___ minutes and last ___ to ___ hours

A
  1. 10-20 minutes

2. 2-3 hours

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82
Q

Marijuana is detected in most urine tests for ___ to ___ days in short term users and ___ to __ days in long term users

A
  1. 4-6 days

2. 20-50 days

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83
Q

High doses of what produce transient psychotomimetic effects?

A

Marijuana

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84
Q

True or False

Marijuana frequently aggravates existing mental illness and adversely affects motor performance

A

True

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85
Q

True or False

It has been demonstrated that the rate of cannabis use is highest between the ages of 18 and 25 with approximately 18.7% of that population using at least once within
the past month, with use tapering off to 7% after age 26.

A

True

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86
Q

True or False

In 2018, an estimated 9.9 million people (aged 12 and older) misused prescription pain relievers and 808,000 people used heroin.

A

True

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87
Q

Approximately ___% of abused opioids ae obtained from family and friends

A

55%

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88
Q

What lab should always be checked in suspected opioid intoxication?

A

Serum Glucose

Hypoglycemia is not uncommon, rapidly correctable, and easily confused with acute opioid intoxication

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89
Q

Opioid Use Disorder

If a patient is found down you should consider rhabdomyolysis and run what what?

A

Serum CPK

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90
Q

What is the treatment of choice in the treatment of acute opioid intoxication?

A

Naloxone

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91
Q

What are some forms of 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

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92
Q

True or False

Stimulant abuse is quite common, either alone or in combination with other drugs

A

True

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93
Q

True or False

Stimulants

Increase synaptic levels of monoamines (dopamine, serotonin, and norepinephrine) by blocking the monoamine transporters (cocaine, methylphenidate) or releasing monoamines (methamphetamine)

A

True

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94
Q

True or False

Stimulants

Increased dopamine levels in the mesolimbic dopamine pathway are believed to mediate the reinforcing effects of stimulants

A

True

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95
Q

True or False

Stimulants

Serotonergic activation mediates stimulant effects on mood. Alternatively, Norepinephrine mediates cognitive arousal and cardiovascular activation in response to stimulants, as well as stress response including stress-induced drug use/relapse

A

True

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96
Q

True or False

Stimulants

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

A

True

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97
Q

True or False

Stimulants

Cocaine blocks voltage-gated sodium ion channels, which underlies its anesthetic effect

A

True

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98
Q

Moderate use of what produces hyperactivity, a sense of enhanced physical and mental capacity, and sympathomimetic effects?

A

Stimulants

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99
Q

The clinical picture of what will show the following?

  1. Sweating
  2. Tachycardia
  3. Elevated blood pressure
  4. Mydriasis
  5. Hyperactivity
  6. Acute brain syndrome with confusion and disorientation
A

Acute Stimulant Intoxication

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100
Q

True or False

Clinicians should be alert to cocaine use in patients presenting with unexplained nasal bleeding, headaches, fatigue, insomnia, anxiety, depression, and chronic hoarseness.

A

True

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101
Q

What disorder has an estimated lifetime prevalence in the US of around 1-2% and is the 18th leading cause of disability in the US?

A

Bipolar Disorder

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102
Q

What is a mood disorder that is characterized by the following three different mood states?

  1. Mania
  2. Hypomania
  3. Major depression
A

Bipolar disorder

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103
Q

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

A

Mania

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104
Q

Three or more of the following symptoms must be present to diagnose a patient as having what?

  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep
  3. More talkative than usual or pressured speech
  4. Flight of ideas/racing thoughts
  5. Distractibility
  6. Increased goal directed activity
  7. Involvement in activities that carry negative potential (spending sprees, sexual indiscretions)
A

Mania

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105
Q

True or False

Mania can be severe enough to cause marked impairment in functioning or necessitate hospitalization to prevent harm to self or others, or there are psychotic features

A

True

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106
Q

The acronym “DIGFAST” is often used to remember the symptoms of mania, what does it stand for?

A 
D- Distractibility 
I- Indiscretions 
G- Grandiosity 
F- Flight of Ideas 
A- Activity increase 
S- Sleeplessness 
T- Talkativeness
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107
Q

What has similar characteristics of mania only far less severe, there is no delusional grandiosity, thought form is more organized, there is less risky behavior, no psychotic symptoms, and no hallucinations?

A

Hypomania

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108
Q

Five or more of the following symptoms present during the same two week period could mean the patient is suffering from what?

  1. Depressed mood (sad, empty, hopelessness)
  2. Diminished interest in pleasurable activities
  3. Weight loss or weight gain
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Decreased energy
  7. Guilt or feelings of worthlessness
  8. Impaired concentration
  9. Thoughts of death or thoughts of suicide
A

Major Depression

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109
Q

What should the IDC do for the management of Bipolar Disorder?

A
  1. Immediately refer and manage acute symptoms while awaiting referral
  2. If agitated try to talk them down or give antipsychotic medication for assistance
    a. Haloperidol
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110
Q

Maintenance therapy for Bipolar Disorder will usually be employed by a psychiatrist with a mood stabilizer or antipsychotic such as what?

A
  1. Lithium
  2. Valproic Acid
  3. Lamotrigine (Lamictal)
  4. Quetiapine (Seroquel)
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111
Q

What is the most common psychiatric disorder in the general population with a lifetime prevalence of about 16% ?

A

Depression

112
Q

What in the United States ranks 2nd among all injuries and illnesses as causes of disability?

A

Depression

113
Q

The presentation of depression is variable with what sort of problems being involved?

A
  1. Changes in mood
  2. Cognitive problems
  3. Neuro-vegetative symptoms
  4. Somatic symptoms
114
Q

What is a pneumonic used by primary care clinicians to quickly screen for depression when forms such as PHQ-9 are not utilized or available?

A

SIGECAPS

115
Q

What does SIGECAPS stand for?

A

S- Sleep changes: Increased during day or decreased at night
I- Interest (loss): Of interest in activities that used to interest them
G- Guilt (worthless): Depressed people tend to devalue themselves
E- Energy (lack): Common presenting symptom is fatigue
C- Concentration: Reduced concentration and cognition
A- Appetite: Usually declined appetite. Sometimes increased
P- Psychomotor agitation: Anxious feelings or lethargic feelings
S- Suicide/death preoccupation

116
Q

What is the most feared and most important complication of depression?

A

Suicide

117
Q

What are the mainstays of therapy for depression?

A

Psychotherapy, pharmacotherapy, or both

118
Q

What are the two classes of medications typically used in the treatment of depression?

A
  1. SSRI: Selective Serotonin Reuptake Inhibitors
    a. Fluoxetine, paroxetine, sertraline, escitalopram, citalopram
  2. SNRI: Serotonin-Norepinephrine Reuptake Inhibitors
    a. Venlafaxine, duloxetine
119
Q

Side effects for the medications to treat depression ae very common are reported in up to ___% of people treated.

A

55%

120
Q

These are all common side effects for what medications?

  1. Sexual dysfunction
  2. Drowsiness
  3. Weight gain
  4. Insomnia
  5. Anxiety
  6. Dizziness
  7. Headache
  8. Dry mouth
  9. Blurred vision
  10. Nausea
  11. Rash
  12. Tremor
  13. Constipation
  14. Abdominal pain/upset stomach
A

Medications used to treat depression

121
Q

What is a mood disorder that is commonly seen in the Navy, may look similar to a major depressive disorder but does not meet the criteria, occurring in the context of a recent stressor, and resolves within six months when the stressor is removed?

A

Adjustment Disorder

122
Q

What mood disorder is very common, occurring in the context of childbirth, usually within 12 months after delivery, has the same diagnostic criteria as depression, and is likely due to genetic susceptibility and hormonal changes in addition to increased stressor?

A

Post-Partum Depression

123
Q

The time period for post-partum depression varies but is usually described as depression occurring within the first ___ months after delivery

A

12 months

124
Q

Diagnostic criteria for post-partum criteria are the same as those for major depressive disorder, must have at least ___ symptoms for at least ___ weeks

A
  1. 5 symptoms

2. 2 weeks

125
Q

What has similar symptoms to post-partum depression but does not meet the minimum criteria of symptoms; milder and self-limited; typically develops within 2-3 days of delivery and resolves within 2 weeks?

A

Post-partum “blues”

126
Q

Is the Edinburgh Postnatal Depression Scale usually used for the assessment of post-partum depression?

A

Yes

127
Q

What is the initial treatment for post-partum depression and is especially useful for breastfeeding moms as they won’t expose the children to antidepressants?

A

CBT

128
Q

If cognitive behavioral therapy is unsuccessful or depression is more severe what antidepressants are useful in the treatment of post-partum depression?

A
  1. SSRI’s (bupropion, (wellbutrin), Mirtazapine (remeron))
129
Q

What SSRI’s appear to have the lowest adverse effects on infants?

A
  1. Paroxetine (Paxil)

2. Sertraline (Zoloft)

130
Q

Episodes of post-partum depression last at least one year in __% to __% of patients, with those who recover being at a risk for recurrences?

A

30-50%

131
Q

What is characterized by excessive and persistent worrying that is hard to control, causes significant distress, and occurs more days than not for at least 6 months?

A

Generalized Anxiety Disorder (GAD)

  1. Lifetime prevalence between 5.1% and 11.9%
  2. Twice as common in women
  3. “hand in hand” with other psychiatric conditions
132
Q

The following are common clinical manifestations of what?

  1. Hyperarousal and muscle tension common
  2. Poor sleep
  3. Fatigue
  4. Difficulty relaxing
  5. Headaches
  6. Pain in the neck, shoulder, and back
A

Generalized Anxiety Disorder (GAD)

133
Q

What is the treatment of Generalized Anxiety Disorder?

A

CBT, Medications, or both

*SSRI’s and SNRI’s are the typical medication classes used as first line

134
Q

Panic attacks are thought to occur in about ___ of people in their life time

A

1/3

135
Q

Panic disorder is defined as what?

A

people who experience multiple panic attacks

136
Q

What is the median age of onset for panic disorder?

A

24 years

137
Q

Who are panic disorders more common in?

A

Women, twice as common

138
Q

What is a spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour, patients can have multiple recurrent episodes?

A

Panic attack

139
Q

DSM-5 Diagnostic Criteria

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur is diagnostic for what?

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath
  5. Feelings of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, light-headed, or faint
  9. Chills or heat sensations
  10. Paresthesia
  11. Derealization (feelings of unreality) or depersonalization (feeling detached from ones self)
  12. Fear of losing control or “going crazy”
  13. Fear of dying
A

Panic attacks

140
Q

Development of agoraphobia is common in what?

A

Panic disorders

141
Q

Panic attacks require what medications?

A
  1. Anxiolytics
    a. benzos (tend to avoid these due to addiction risk)
  2. Antihistamines may be tried (hydroxyzine)
142
Q

What medications are not anxiolytics, will not break the panic attacks, but are long term treatment options that will reduce the frequency of panic attacks, severity of anxiety, and degree of phobic avoidance?

A

SSRIs/SNRIs

143
Q

What is a thought disorder that is broadly defined as a loss of contact with reality?

A

Psychosis

144
Q

Psychosis

Its estimated that ___% to ___ % of people will experience psychotic symptoms at some point in their lives and approximately ___% to ___ % will go on to meet the criteria for a psychotic disorder

A
  1. 12-23%

2. 1-4%

145
Q

What can present with a wide variety of signs and symptoms such as the following?

  1. Delusions
  2. Hallucinations
  3. Thought disorganization
  4. Agitation and aggression
A

Psychosis

146
Q

What are strongly held false beliefs that are classified broadly as bizarre vs. non-bizarre?

A

Delusions

147
Q

This is an example of what kind of delusion?

Belief that one is being following or harassed by outside entity

A

Persecutory delusions

148
Q

This is an example of what kind of delusion?

Belief that one is a billionaire

A

Grandiose delusions

149
Q

This is an example of what kind of delusion?

Belief that a famous person is in love with them

A

Erotomanic delusions

150
Q

This is an example of what kind of delusion?

Believing ones sinuses have been infested with worms

A

Somatic delusions

151
Q

This is an example of what kind of delusion?

Believing a dialog on TV is directed towards you, such as the president talking on TV is talking directly to you

A

Delusions or reference

152
Q

This is an example of what kind of delusion?

Believing one’s thoughts and movements are being controlled by a powerful outside source, such as planetary overlords or the government

A

Delusions of control

153
Q

What are wakeful sensory experiences of content that is not actually present?

A

Hallucinations

154
Q

What are misinterpretations of sensory experiences?

A

Illusions

155
Q

True or False

Psychosis and related disorders are truly disorders of thought and evidence of thought organization is derived from the patients speech pattern during the interview process

A

True

156
Q

What speech pattern in regards to possible psychosis has very little information conveyed by speech often with very sparse replies or lack of spontaneous speech?

A

Alogia/poverty of content

157
Q

What speech pattern in regards to possible psychosis is the sudden loss of the train of thought and is characterized by the abrupt interruptions in speech ?

A

Thought blocking

158
Q

What speech pattern in regards to possible psychosis where the speech content has ideas presented in a sequence that is not closely related or does not make sense?

A

Loosening of association

159
Q

What speech pattern in regards to possible psychosis are answers to interview questions diverging from the topic being asked about?

A

Tangentiality

160
Q

What speech pattern in regards to possible psychosis is the patient using words in a sentence that are linked by rhyming or sounding similar?

A

Clanging or clang association

161
Q

What speech pattern in regards to possible psychosis are real words linked together incoherently, they are real words but basically nonsense?

A

Word salad

162
Q

What speech pattern in regards to possible psychosis are the patients repeating words or ideas persistently?

A

Perseveration

163
Q

True or False

Management of psychosis involves an immediate referral and you may need to treat acute agitation associated with psychosis, if present

A

True

164
Q

True or False

Psychosis

In certain scenarios you may be able to simple “redirect” the patient to help them with their agitation. Offering reassurance and simply talking to them may be enough

A

True

165
Q

What medication may be used by the IDC to treat acute psychosis or agitation?

A

Haloperidol

166
Q

What generation of antipsychotics are also called “typical” antipsychotics?

A

First generation

Haloperidol

Older*

167
Q

What generation of antipsychotics are also called “atypical antipsychotics” and have improved side effects profiles?

A

Second generation

Aripiprazole, risperidone, quetiapine, olanzapine

168
Q

What is an extrapyramidal side effect of antipsychotics that is defined as motor restlessness with the compelling urge to move and inability to sit still?

A

Akathisia

169
Q

What are some common side effects associated with antipsychotics?

A
  1. Parkinsonian syndrome
    a. mask like facies, resting tremor, cogwheel rigidity, shuffling gait, psychomotor retardation (bradykinesia)
  2. Dystonia
    a. involuntary contractions of muscles
  3. Tardive Dyskinesia
170
Q

What side effects of antipsychotics is defined as the following?

  1. Involuntary movements of the face
  2. Sucking or smacking of the lips
  3. Movements of the tongue
  4. Facial grimacing
  5. Odd movements of extremities
  6. Usually occur after greater than 6 months of treatment on antipsychotics
A

Tardive Dyskinesia

171
Q

What are the two distinct phases of sleep ?

A
  1. REM (rapid eye movement)
    a. AKA dream sleep
  2. NREM (non-REM)
172
Q

True or False

Depression is a common cause of sleep disturbances

A

True

173
Q

True or False

No matter the cause, poor sleep hygiene is often an underlying problem that exacerbates insomnia

A

True

174
Q

Sleep issues can be defined as problems such as what?

A
  1. Difficulty getting to sleep or staying asleep
  2. Intermittent wakefulness
  3. Early morning awakening
175
Q

What are some common factors that will cause difficulty getting to sleep?

A
  1. Stress
  2. Caffeine
  3. Physical discomfort
  4. Daytime napping
  5. Early bedtimes
176
Q

What are some psychiatric disorders often associated with sleep difficulties?

A
  1. Depression
    a. fragmented sleep, decreased total sleep time, earlier onset REM
  2. Bipolar disorder
    a. insomnia sign of impending mania
177
Q

True or False

Alcohol has no effect on the sleep cycle

A

False

Abuse of alcohol disrupts the sleep cycle

178
Q

True or False

Heavy smoking can cause difficulty falling asleep

A

True

179
Q

What should the first line treatment of sleep disorders always be?

A

Sleep hygiene

180
Q

What kind of medications should be used when sleep hygiene is ineffective?

A
  1. Antihistamines
    a. beneficial and produce no dependency
  2. Trazadone
    a. long term use
181
Q

What is known as an enduring pattern of perceiving, relating to, and thinking about the environment and oneself, inflexible and maladaptive personality traits across a wide range of situations, and they cause significant distress and impairment in functioning in all areas of life ?

A

Personality disorder

182
Q

True or False

Personality Disorders

Problems date back to childhood typically

A

True

183
Q

What is the estimated prevalence of personality disorders in the community?

A

11%

184
Q

What are the two personality types we should be concerned about?

A
  1. Borderline Personality Disorder (BPD)

2. Antisocial Personality Disorder (ASPD)

185
Q

What personality disorder shows the instability of interpersonal relationships, self image, and emotions, patients with this show very impulsive behavior?

A

Borderline Personality Disorder (BPD)

186
Q

What is the most widely studied personality disorder?

A

Borderline Personality Disorder (BPD)

187
Q

True or False

Borderline Personality Disorder (BPD)

Associated with significant morbidity and increased mortality

A

True

188
Q

True or False

Borderline Personality Disorder (BPD)

History if childhood trauma is common but the relationship to BPD is clear

A

False

Relationship is unclear

189
Q

Do many patients with BPD suffer from abandonment issues ?

A

Yes

190
Q

People with what kind of personality disorder is there many interpersonal difficulties; they tend to view others as either all good or all bad, there is no “gray” area?

A

BPD

191
Q

People with what personality disorder tend to misinterpret otherwise neutral events, words, or interactions as “negative”; minor disagreements may elicit highly emotional responses, reaction of extreme anger or self-harm threats tend to be common?

A

BPD

192
Q

In what personality disorder may you see the following?

  1. Affective instability (unstable mood)
    a. often triggered by stressors in the environment
  2. Impulsive behaviors
    a. self damaging behaviors
  3. Tend to have poorer cognitive function
  4. Suicidal threats, gestures, and attempts are more common
A

BPD

193
Q

What personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior, this is a lifelong disorder with a wide range of symptoms with criminality being common?

A

Antisocial Personality Disorder (ASPD)

194
Q

These are all common behaviors/symptoms associated with what personality disorder?

  1. Disregard for and violation of the rights of others
  2. Unstable work history
  3. Financial dependency
  4. Poor school history
  5. Alcohol abuse
  6. Marital difficulties
  7. Impulsive behaviors
  8. Homelessness
A

Antisocial Personality Disorder (ASPD)

195
Q

These are all common behaviors/symptoms associated with what personality disorder?

  1. “wild” adolescence
  2. Social isolation
  3. Promiscuous sexual behavior
  4. Lack of remorse
  5. Use of aliases
  6. Poor military performance
  7. Pathological lying
  8. Drug use
  9. Suicide attempts
A

Antisocial Personality Disorder (ASPD)

196
Q

Treatment of Personality Disorders

Is the use of social and therapeutic environments such as day hospitals, halfway houses, and self-help communities that utilize peer pressures to modify self-destructive behavior a valid option for these patients?

A

Yes, the use of peer relationships and the repetition possible in a structured setting of a helpful community enhances the behavioral treatment opportunities and increase learning

197
Q

Treatment of Personality Disorders

True or False

Operant conditioning emphasizes the recognition of acceptable behavior and its reinforcement with praise or other tangible rewards is a valid behavioral treatment option for personality disorders

A

True

198
Q

Treatment of Personality Disorders

Psychological intervention is best conducted in what kind of setting?

A

Group setting

Peer pressure in the group tends to impose restraints on rash behavior

199
Q

True or False

Treatment of Personality Disorders

Those patients with a history of parental abuse and a family history of mood disorder tend to have the most challenging treatments

A

True

200
Q

What is known as the marked pattern of inattention and/or hyperactivity-impulsivity that is consistent with developmental level and clearly interferes with functioning in at least 2 setting (school, home, work)?

A

Attention-Deficit/Hyperactivity-Disorder

201
Q

ADHD

Several biologic factors have been proposed as contributors (food additives/diet, lead contamination, cigarette/alcohol exposure, low birth weight) as well as psychosocial adversity, but is there a real consensus on the cause of ADHD?

A

Nope

202
Q

True or False

ADHD

Data strongly suggests a neurological and genetic basis with catecholaminergic dysfunction as a central finding

A

True

203
Q

The following are clinical findings in what?

  1. Marked inattention, distractibility, organization difficulties, and poor efficiency ( academic and occupational failure)
  2. Low frustration tolerance, shifting activities, difficulty organizing, and day dreaming
  3. Symptoms often attenuate during late adolescence although a minority will experience full symptoms into mid-adulthood
  4. More frequently occurs in males
A

ADHD

204
Q

What is a differential of ADHD that is characterized by a pattern of negativistic, hostile, and defiant behavior; this is a more severe, less common disorder of habitual rule breaking defined by a pattern of aggression, destruction, lying, stealing, or truancy?

A

Oppositional Defiant Disorder/Conduct Disorder

205
Q

What is found to co-occur with ADHD in 30-50% of cases?

A

Oppositional Defiant Disorder/Conduct Disorder

206
Q

What is the mainstay of treatment for ADHD?

A

Medication

  1. Methylphenidate (Ritalin, Concerta, Metadate)
  2. Amphetamines (Adderall, Dexedrine,Vyvanse)
207
Q

Majority of children with ADHD continue to exhibit deficits in attention/activity level in adulthood with only about ____% evidencing a remission of symptoms by adolescence/adulthood.

A

30%

208
Q

Dementia due to Traumatic Brain Injury (TBI) refers to a wide range of alterations in thinking, mood, and behavior resulting from neurologic damage related to brain trauma and can result in what?

A

Memory loss

209
Q

True or False

Head trauma severe enough to cause brief loss of consciousness or post-traumatic amnesia can produce long-lasting cognitive and behavioral changes.

A

True

210
Q

What in the brain is especially susceptible to damage due to being near the sphenoid ridge?

A

Hippocampus

Frontal lobes are also susceptible to countercoup injury

211
Q

True or False

Memory loss

Biochemical alteration can also develop, as seen in chronic traumatic encephalopathy where repeated minor head injuries lead to dementia

A

True

212
Q

Can fatigue, headache, and/or dizziness occur shortly after trauma when concerned for memory loss?

A

Yes

213
Q

Memory Loss

After the initial onset of symptoms from a head injury, what can develop which includes slowing of information processing, impaired attention, and poor memory ?

A

Post-concussive Disorder

214
Q

Head injuries can be rated using what scale?

A

Glasgow Coma Scale

215
Q

What almost always involves loss of memory for the event and frequently includes loss of recall for events immediately before and after the head trauma?

A

Amnesia

216
Q

True or False

Amnesia can present itself in someone repeatedly asking a question that has already been answered

A

True

217
Q

What screening tool is used to assess Post-Traumatic Amnesia?

A

MACE

218
Q

What is the treatment of mild head trauma?

A
  1. Determine the neuropsychological deficit
  2. Give appropriate counseling
  3. Treat symptomatically
219
Q

Symptoms attributed to Post concussion Syndrome (headache, dizziness, neuropsychiatric symptoms, and cognitive impairments) are greatest within the first ___ to ___ days for the majority of patients and at one month symptoms are usually improved and often resolved.

A

7 to 10 days

220
Q

What is known at the 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, works, etc.) ?

A

Gender Dysphoria

221
Q

People with what experience cross-gender identification, anatomic dysphoria, and the desire to undergo treatments to align their physical appearance via cross-sex hormones and/or surgical interventions?

A

Gender dysphoria

222
Q

True or False

Gender Dysphoria

Key criterion of clinically significant distress can either be from the GD itself or a consequence of others stigmatizing discriminatory reactions

A

True

223
Q

True or False

Research shows that the best practice approach is to support a social gender transition and the initiation of biomedical treatments that permit an approximation of the phenotype of the desired gender

A

True

224
Q

Gender dysphoria

If a patient expresses confusion about their gender identity or are exploring how their gender identity relates to their emerging sexual orientation, what is the goal of therapy?

A

Help them work through these issues before making any decisions about a gender transition

225
Q

What medical treatment can be given to promote sexually dimorphic characteristics with the opposite sex and eventually sex reassignment surgery?

A

Hormonal Therapy

226
Q

What is the disturbance of processes in sexual functioning which causes clinically significant distress?

A

Sexual Dysfunction

227
Q

These are all examples of what?

  1. Delayed ejaculation
  2. Erectile dysfunction
  3. Female orgasmic disorder
  4. Female sexual interest/arousal disorder
  5. Genito-Pelvic pain
  6. Penetration disorder
  7. Male hypoactive sexual desire disorder
  8. Premature ejaculation
  9. Substance/Medication induced sexual dysfunction
A

Sexual dysfunctions

228
Q

What is known as delayed or absent ejaculation/orgasm occurring on almost all occasions of partnered sexual activity and persists for a minimum of 6 months?

A

Delayed Ejaculation

229
Q

What may be the cause of delayed ejaculation if the difficulty is situational?

A

Psychological (partner specific)

230
Q

True or False

The treatment of delayed ejaculation should be tailored and may include patient/couple psychoeducation

A

True

231
Q

What is the failure to obtain erections in a situation in which they were anticipated, causing embarrassment, self-doubt, and loss of self confidence?

A

Erectile dysfunction

232
Q

Sexual dysfunction

What can be caused by increased age, depression, smoking, diabetes, HTN, nervous tissue disorders (spinal cord injury, MS), social anxiety, and PTSD ?

A

Erectile Dysfunction

233
Q

What does the treatment for psychological and organic impotence include?

A
  1. Avanafil (Stendra) - 50-100 mg PO before sexual activity
  2. Sildenafil (Viagra) - 50-100 mg PO before sexual activity
  3. Tadalafil (Cialis) - 10-20 mg PO before sexual activity
  4. Vardenafil (Levitra) - 10-20 mg PO before sexual activity
234
Q

What sexual dysfunction in females includes the complaint of a normal libido and sexual excitement without the capacity to reach orgasm; there is a 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

235
Q

Female Orgasmic Disorder is often related to depression and what can be an effective treatment in changing negative sexual thoughts and attitudes?

A

CBT

236
Q

What is a lack of or significantly reduced sexual interest or arousal in females for at least 6 months?

A

Female Sexual Interest/Arousal Disorder

237
Q

What is the non pharmaceutical treatment of Female Sexual Interest/Arousal Disorder that has been used for desire and arousal problems?

A

Sex therapy and cognitive interventions

238
Q

Female Sexual Interest/Arousal Disorder

What medication has been reported to increase various indices of sexual responsiveness in women with low sexual desire?

A

Bupropion (Wellbutrin)

239
Q

What sexual dysfunction includes the following 4 commonly comorbid symptoms?

  1. Difficulty having intercourse
  2. Genito-pelvic pain
  3. Fear of pain on vaginal penetration
  4. Tension of the pelvic floor muscles
A

Genito-Pelvic Pain / Penetration Disorder

240
Q

The following may be etiology associated with what sexual dysfunction?

  1. Partner/relationship factors, cultural/religious factors and medical factors
  2. May be a conditioned anxiety reaction that results in spasm of the entrance to the vagina
  3. Certain Medical conditions
  4. Sexual dysfunction
  5. Inadequate sexual stimulation
  6. Psychological factors (prior assault, rape, etc.)
A

Genito-Pelvic Pain / Penetration Disorder

241
Q

True or False

Treatment of Genito-Pelvic Pain / Penetration Disorder should be multidisciplinary (psychiatric, gynecological, urological) and individualized

A

True

242
Q

What is the sexual dysfunction in men that includes the 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

243
Q

What male sexual dysfunction may be due to the following?

  1. Hypogonadism (low T)
  2. Transient stress or interpersonal conflict
  3. Mood disorder
  4. Schizophrenia
  5. Substance abuse
  6. Medications
  7. Normal age-related decline in sexual desire
A

Male Hypoactive Sexual Desire Disorder

244
Q

True or False

Male Hypoactive Sexual Desire Disorder

Most lifelong cases will be due to earlier experiences, and will be medical in etiology

A

False

Most lifelong cases will be due to earlier experiences, thus will be psychogenic in etiology

245
Q

What is the treatment of Male Hypoactive Sexual Desire Disorder?

A

CBT combined with behavioral sex therapy with major goal of education to the patient on how to communicate sexual preferences to partners

246
Q

What is the persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration before the individual wishes it, present for at least 6 moths, occurring all or almost all of the time and may be distressing?

A

Premature Ejaculation

247
Q

Many hypotheses regarding the etiology of what may include things such as an unconscious anger toward women, a pattern learning in adolescence and then maintained by performance anxiety, or an abnormality in spinal or central nervous system mechanisms
controlling ejaculatory threshold?

A

Premature Ejaculation

248
Q

There is some evidence that Premature Ejaculation is more common in men with what?

A

Panic Disorder and Social Anxiety

249
Q

What kind of drugs can be used in the treatment of premature ejaculation?

A

Serotonergic Drugs (Paroxetine (Paxil) and Clomipramine (Anafranil) most commonly).

250
Q

What is known as a significant disturbance in sexual function which developed during or soon after substance intoxication or withdrawal or after exposure to a medication AND the involved substance/medication is capable of producing these symptoms?

A

Substance/Medication-Induced Sexual Dysfunction

251
Q

What is the most important complication in mental health and often includes some elements of aggression?

A

Suicide

252
Q

In 2018, suicide rates in U.S. population were 22.8 for males and 6.2 for females (per 100,000), and in individuals with the depression the lifetime risk rises to ___% to ___ %

A

10-15%

253
Q

____ tend toward successful suicide, particularly in older age groups, whereas ____ make more attempts with lower mortality rates

A
  1. Men

2. Women

254
Q

What is a significant factor in many suicide attempts?

A

Alcohol

255
Q

True or False

A suicide attempt may be an impulsive or aggressive act and could be a strategy for controlling or hurting others or an attempted escape

A

True

256
Q

Suicide is ten times more prevalent in patients with what psychiatric disorder than in the general population?

A

Patients with schizophrenia

257
Q

Suicidal/Homicidal Ideation

What is the immediate goal of the psychiatric evaluation?

A

Assess the current suicidal risk and the need for hospitalization versus outpatient management

258
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 what?

A

Suicide attempts

259
Q

What are some risk factors for Suicidal/Homicidal Ideation?

A
  1. Previous attempts
  2. Family history of suicide
  3. Medical psychiatric illness
  4. Male sex
  5. Older age
  6. Contemplation of violent methods
    7 Humiliating social stressor
    8 Drug use
260
Q

True or False

Suicidal/Homicidal Ideation

The patient’s current mood status is best evaluated by direct evaluation of plans and concerns about the future, personal reactions to the attempt, and thoughts about the reaction of others

A

True

261
Q

True or False

Suicidal/Homicidal Ideation

Medication should be dispensed in normal amounts to at-risk patients

A

False

Should be dispensed in small amounts

262
Q

Should patients experiencing Suicidal/Homicidal Ideations drive?

A

no, driving should be interdicted until the patient improves

263
Q

Steps for suicide prevention must include education of all personnel and Suicide Prevention Training which includes what?

A
  1. Warning signs
  2. Supervisors getting to know their personnel
  3. Watching for changes in: behavior, attitude, or performance
264
Q

Upon arrival of a service member with Suicidal/Homicidal Ideations the SMDR should review the health record for what?

A
  1. Past psychiatric problems
  2. Indicators for impulse control
  3. Alcohol or drug dependence
  4. Concurrent Medical problems
265
Q

You should interview a patient with Suicidal/Homicidal Ideations for any problems regarding what?

A
  1. Pay
  2. Family
  3. Social isolation
  4. Helplessness or hopelessness
  5. Family history if suicide or affect disorder
266
Q

What scale can be used as a guide for asking questions to a patient who is suffering from Suicidal/Homicidal Ideations; answers from this will help identify whether someone is at risk for suicide, assess severity and immediacy of that risk, and gauge the level of support that person needs?

A

Columbia-Suicide Severity Rating Scale (C-SSRS)

267
Q

What is available for structured intervention for rescuers and survivors involved in incidents likely to produce traumatic stress (fire with loss of life, suicide of shipmate, body handling duty, hostile attack, rape)?

A

Special Psychiatric Rapid Intervention Team (SPRINT)

268
Q

DSM-5 distinguishes two proposed conditions in regards to self mutilation, what are they?

A
  1. Suicidal Behavior Disorder

2. Non-suicidal Self-Injury

269
Q

Self mutilation

A feature of what is suicide attempts defined as self-inflicted behavior done in the expectation that it will lead to death?

A

Suicidal Behavior Disorder

270
Q

Self Mutilation

In contrast to Suicidal Behavior Disorder, what consists of deliberate self-inflicted bodily damage with the expectation that the injury will not be lethal, but will lead to only mild physical harm?

A

Non-Suicidal Self-Injury

271
Q

True or False

Self Mutilation

The proposed criteria also suggest the self- injurious behavior is not motivated by a wish to die, but rather to attain some positive feeling, relief from a negative state of mind, or to achieve some interpersonal end.

A

True

272
Q

Is there a large overlap in risk factors for suicide attempts and engagement in NSSI?

A

Yes

273
Q

The estimate of the lifetime prevalence of NSSI ranges from ___% to ___%

A

13.0% to 23.2%

274
Q

Reasons for engaging in NSSI include to regulate emotion and to elicit attention but other correlations of NSSI can include things such as what?

A
  1. History of sexual abuse
  2. Depression
  3. Anxiety
  4. Alexithymia
  5. Hostility
  6. Smoking
  7. Dissociation
  8. Suicidal Ideation
  9. Suicidal Behaviors
275
Q

True or False

By definition, the presence or absence of suicidal intent is used to distinguish between NSSI and suicide attempts

A

True

CLASS 22010 PSYCH (3 decks)

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