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March Exams > CPI > Flashcards

CPI Flashcards

0
Q

Implications of alcohol misuse

A
  • economic (cost, decreased production, job loss)
  • criminal justice system
  • health care system
  • HIV
  • social
  • individual development
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1
Q

Areas of impact of substance misuse

A
  • social
  • medial
  • psychological
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2
Q

Spectrum of substance misuse

A
  • acute intoxication
  • at-risk use
  • harmful use
  • dependence
  • withdrawal
  • complicated withdrawal
  • substance-induced psychosis
  • cognitive impairment disorders
  • residual disorders
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3
Q

Progression to disease (alcohol)

A
  • experimental use
  • recreational use
  • harmful use
  • dependence
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4
Q

Things classified under substance use disorders

A
  • alcohol abuse

- alcohol dependence

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5
Q

Things classified under substance induced disorders

A
  • intoxication
  • withdrawal
  • substance induced mental disorders
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6
Q

Definition of alcohol abuse

A 
Within a 12 month period
Recurrent use:
- resulting in failure to fulfill obligations
- resulting in recurrent legal problems
- hazardous situation

Continued use despite recurrent or persistent social or interpersonal problems related to abuse

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7
Q

Definition of alcohol dependence

A
  • Tolerance
  • withdrawal or persistent use to prevent symptoms of withdrawal
  • compulsive use/loss of control/increase salience
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8
Q

Definition of addiction

A

A condition which causes a person to continue behaviors demonstrated as harmful to that person

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9
Q

Possible pathways to addiction

A
  • genes and family history of addiction
  • brain reward mechanism
  • psychosocial factors
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10
Q

Mood altering drugs (MAD)

A

Drugs that acutely increase dopamine levels in the mid brain

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11
Q

Pattern across all MADs

A

Use
Repetitive loss of control
Return

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12
Q

Drug classes

A
  • depressants (downers)
  • stimulants (uppers)
  • hallucinogens (psychedelics)
  • narcotics
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13
Q

What increases the risk of a drug being abused?

A
  • psychoactive
  • fast effect
  • wears off quickly
  • easy to administer
  • passes easily through blood-brain barrier
  • cheap
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14
Q

Effects of substances

A
  • intoxication
  • tolerance
  • withdrawal
  • craving
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15
Q

Possible substance induced disorders

A
  • delirium
  • dementia
  • amnestic disorder
  • psychotic disorder
  • mood disorder
  • anxiety disorder
  • sexual dysfunction
  • sleep disorder
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16
Q

Definition of a unit of alcohol

A

10ml alcohol, 8g of alcohol

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17
Q

How to calculate the number of units in drink

A

Alcohol % x volume of alcohol (ml)/1000

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18
Q

Symptoms of uncomplicated withdrawal

A

Few hours to 5 days after:

  • sweating
  • tremor
  • anxiety/restlessness
  • nausea and vomiting
  • tachy and HT
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19
Q

How to treat uncomplicated withdrawal

A

Diazepam for 3 days

- thiamine and B complex vitamin

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20
Q

Signs of delirium tremens (complicated withdrawal)

A
  • 48-72 hours after
  • May be preceded by withdrawal seizures
  • increased autonomic hyperactivity
  • delirium:
  • impaired attention
  • fluctuating consciousness
  • psychomotor activity
  • disorientated
  • hallucinations
  • risk to self and others
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21
Q

Types of alcohol induced psychiatric disorders

A
  • delirium
  • dementia
  • amnestic disorder (korsakoff psychosis)
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22
Q

How to manage alcohol induced mood and anxiety disorders

A
  • treat addiction as priority
  • review symptoms after 2-4 weeks of abstinence
  • use agents with low abuse and self harm potential
  • check regularly for compliance
  • preferred agents (SSRIs, mood stabilisers)
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23
Q

Four stage model for managing addcition

A
  • identify
  • motivate
  • treat/ rehabilitate
  • prevent relapse
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24
Q

Problems with awareness of doctors

A

– failure to detect

  • few have treatment plan/management
  • much blaming and enabling
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25
Q

How to identify misuse

A
  • quantity/ frequency questionnaire
  • cage
  • audit
  • physical, psychiatric, social problems
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26
Q

Stage of change model

A
  • pre contemplation
  • contemplation
  • preparation
  • action
  • maintenance
  • relapse
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27
Q

Definition of a brief intervention

A

5-10 minute intervention aimed at providing patient information in a caring and empathic manner
- in order to create ambivalence and motivate change

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28
Q

Frames

A
  • feedback
  • responsibility
  • advice
  • menu
  • empathy
  • self-efficacy
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29
Q

Soape

A
  • support
  • optimism
  • absolution
  • plan
  • explanatory model
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30
Q

Basic treatment strategies

A
  • use doctor patient relationship
  • establish goals in concrete terms
  • retain family perspective
  • engage patient in self monitoring
  • balance emphasis
  • stopping alcohol should be worthwhile
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31
Q

Possible public health interventions

A
  • restrict availability
  • drink-driving laws
  • price and taxation
  • advertising and sponsorship restrictions
  • alcohol free environments
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32
Q

Unmet challenges of depression

A
  • incomplete neurobiological understanding
  • stigma
  • under recognition
  • under treatment
  • no evidence in decline of incidence
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33
Q

Conceptual issues with depression

A
  • normal vs pathological
  • gender
  • culture
  • ethical and legal considerations
  • mood disorders and creativity
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34
Q

Types of depressive disorders

A
  • major depressive disorder
  • persistent depressive disorder
  • pre-menstrual dysphoric disorder
  • disruptive mood dysregulation disorder
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35
Q

Definition of a depressive episode

A
  • depressed mood and/or loss of interest
  • accompanied by 3-4 typical symptoms
  • somatic, psychomotor, cognitive, behavioral
  • persists for more than 2 weeks
  • functional shift
  • exclusion criteria
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36
Q

Typical symptoms of a depressive episode

A
  • depressed mood
  • loss of interest
  • disturbed sleep
  • disturbed appetite/ weight
  • disturbed psychomotor behavior
  • disturbed energy
  • poor concentration
  • thoughts of worthlessness/guilt
  • thoughts of death/ suicide
37
Q

Complications/ markers of severity for depression

A
  • anxiety/ agitation
  • melancholia
  • catatonia
  • psychosis
  • suicide
38
Q

Spectrum of depressive disorders

A
  • adjustment disorder
  • lifespan
  • bipolar/ atypical depression
  • seasonal affective disorder
  • reproductive cycle
  • depression associated with medical conditions
39
Q

Difficulties specific to primary care (depression)

A
  • high patient volumes
  • co morbidity
  • atypical presentations
  • cumbersome standard diagnostic tools
  • screening questionnaires
  • unique opportunities
40
Q

Principles of depression management

A
  • secure diagnosis
  • assess severity
  • co-morbidities
  • risk assessment
  • therapeutic alliance/family involvement
  • best practice based on evidence
41
Q

Issues with antidepressants

A
  • most common first line treatment
  • delayed therapeutic effect
  • high rates of relapse especially with residual symptoms
42
Q

How long do patients need to maintain use do antidepressants

A
  • 6-9 months after first episode
  • 2 years after relapse
  • indefinitely with recurrent episodes
43
Q

Describe the use of psychotherapy

A
  • cognitive behavioral therapy
  • problem-solving
  • can be first line for mild non-psychotic
  • useful as adjunct therapy
44
Q

What is the most powerful antidepressant

A

ECT

45
Q

Other types of therapy

A
  • phototherapy (SAD)
  • repeated trans cranial magnetic stimulation
  • vagus nerve stimulation
  • neurosurgery
46
Q

Possible complementary treatments for depression

A
  • St. John’s wort
  • omega 3 fatty acids
  • tryptophan
47
Q

Definition of inquest

A
  • judicial inquiry into a death other than due to natural causes
48
Q

What is determined by an inquest

A
  • identity of the deceased
  • time and place of death
  • cause of death
  • whether any person may be liable for the death
49
Q

Definition of clinical forensic medicine

A
  • practiced by medical practitioners or forensic nurses
  • medial examination of living victims of violent crimes
  • medial examination of people accused of crimes
50
Q

Definition of forensic pathology

A
  • practiced by forensic pathologists and medical officers
  • media cal examination of suspicious scenes of death
  • postmortem examination of unnatural deaths
51
Q

Doctors obligations (death)

A
  • be aware of the process of dying
  • be able to diagnose death
  • distinguish between natural and unnatural death
  • complete and sign a death notification form
  • know when an autopsy may or must be performed
52
Q

What happens when person dies of natural cause

A
  • medical practitioner who attended to person before death May issue DNF
  • medical practitioner who did not attend patient may examine the corpse and issue DNF
53
Q

What happens when person dies of unnatural cause

A
  • if medical practitioner suspects death due to other than natural cause
  • inform police
  • autopsy must be done
  • medical practitioner performing autopsy will issue DNF
54
Q

Death documentation

A
  • declaration of death
  • notification of death form
  • death certificate
55
Q

Definition of natural death

A

Result of disease processes which are not the result of:

  • another persons act
  • another persons omission
  • violence
  • acts of God
56
Q

Definition of unnatural death

A
  • application of force, physical, chemical or other factors
  • act of omission or commission
  • procedure-related death
  • unexpected or unexplained death
57
Q

Two acts of autopsy legislation

A
  • inquest act (investigation of unnatural death)

- national health act (medical investigation of natural deaths - contagious disease)

58
Q

Difference between medico-legal autopsy and hospital autopsy

A

Need consent for hospital autopsy

Hospital needs to be authorized by medical practitioner in charge

59
Q

5 periods of psychosocial support for family with sick child

A
  • at diagnosis
  • in remission
  • at relapse
  • end of life care
  • after death
60
Q

Emotions possible at diagnosis of child

A
  • rejection/rationalization
  • guilt
  • disbelief
  • depression and helplessness
61
Q

What to do when telling parents of diagnosis

A
  • be explicit
  • emphasize what can be done
  • never deny hope
  • reassure them that good therapy is avail
  • be honest about therapy limitations
  • reassure that you will always be honest
62
Q

Definition of reasonable hope

A
  • relational
  • practice
  • recognizes that future is uncertain
  • seeks goals and pathways
  • accommodates doubt, contradiction and despair
63
Q

Things that may influence understanding of diagnosis

A
  • language
  • cultural issues
  • religious considerations
  • socio-economic issues
64
Q

What to tell patients younger than6

A
  • simple explanation
  • warn before procedures
  • reassure that parent will be there
65
Q

What to tell patient 6-11

A
  • name illness
  • point out that there is treatment
  • emphasize hope
66
Q

Issues that sick children may have at school

A
  • difficulty adjusting
  • problems with concentration
  • make contact with teacher
  • beware changes in body image
  • prepare for more absent days
67
Q

Pitfalls of remission

A
  • problems with siblings or marriege may arise

- SES issues

68
Q

What to tell patients when time for palliative care

A
  • no further treatment will help
  • team will care for child and keep them free of pain
  • not possible to say when child will die
  • they will know when end is near and will be supported
69
Q

Stages of grief

A
  • denial
  • anger
  • bargaining
  • depression
  • acceptance
70
Q

Advantages of dying at home

A
  • familiar surroundings and possessions
  • no routine
  • easier on family
71
Q

Disadvantages of dying at home

A
  • increased responsibility
  • May be lonely
  • often very tiring
  • May have difficulty getting to hospital in an emergency
72
Q

Recurring themes (child death)

A
  • privacy
  • protected time and space
  • preparation
  • simplicity
  • authenticity
  • honesty
  • openness
  • patience
  • planning
  • practicality
  • team worm
73
Q

Definition of domestic violence

A

The use of physical, sexual, economic and/or emotional abuse by one person in an intimate relationship in order to establish and maintain power and control over the other person

74
Q

What types of psychological abuse found

A
  • threats
  • intimidation
  • emotional abuse
  • isolation
75
Q

Characteristics of batterers

A
  • sense of entitlement
  • controlling
  • manipulative
  • frequently charming
  • show contempt for others
76
Q

What is DV is not caused by

A
  • illness
  • genetics or gender
  • alcohol or other drugs
  • anger
  • stress
  • victims behavior
  • relationship problems
77
Q

What makes batterers powerful

A
  • isolation of the victim
  • societal denial
  • use of religious issues
  • use of cultural issues
  • threats of retaliation
78
Q

How are children traumatized in DV

A
  • physical injuries
  • psychological injuries
    Witnessing violence
    Increased risk of battering or being battered
79
Q

Effects of DV

A
  • severe injury and death
  • chronic pain syndromes
  • suicide
  • IBS
  • alcohol abuse
  • anxiety
  • depression
  • PTSD
80
Q

Why leaving DV is a process

A
  • safety issues
  • threats of retaliation
  • fears of talking about abuse to others
  • breaking isolation
  • access to resources
  • survival strategies
  • batterer accountability
81
Q

Why we don’t ask about domestic violence

A
  • not enough time
  • fear of offending patient
  • powerless to intervene
  • no control over patient behavior
  • too close for comfort
82
Q

What increases incidence of DV

A
  • under 35
  • single, divorced, separated
  • alcohol and drug abuse
  • smoke
  • pregnant
  • poor
  • recent restraining order
  • childhood abuse
83
Q

Characteristics of abuser

A
  • alcohol use
  • abused as a child
  • seen mother abused
  • low self esteem
  • unmet dependency needs
  • jealous
  • different personas
  • deeply held beliefs about masculinity
84
Q

Why don’t abusive men ask for help?

A
  • acceptance of violence
  • notions of masculinity
  • ignorance
  • fear and shame
85
Q

Why do women stay in abusive relationships?

A
  • rear of leaving greater than fear of staying
  • economic factors
  • perceived needs of the children
  • expectations of others
  • self blame
  • hope abuse will stop
  • concern for welfare of spouse
  • learned helplessness
  • beliefs
86
Q

Approach to helping women in abusive relationships

A
  • identify the abuse
  • listen and believe her
  • assure that she is not alone and not to blame
  • defend her right to live without fear of violence
87
Q

Legal options for DV

A
  • restraining order
  • lay a charge
  • sue the abuser
  • legal aid
88
Q

Risk factors for injury and death (DV)

A
  • increased severity and frequency of abuse
  • available weapon
  • threats to kill her, children or himself
  • previous attempts to kill her children or himself
  • suicidical attempts by patient
  • stalking
89
Q

Steps in applying for protection order

A
  • applying
  • finalizing
  • using
90
Q

Duties of police in acute situation

A
  • get immediate protection order
  • take for medical attention
  • protect while collect personal belongings
  • inform of rights
  • arrest abuser if evidence
  • remove weapons

March Exams (14 decks)

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