CR - Psychobehavioral Disorders Flashcards
What are the factors associated with an increased likelihood of suicide?
Elderly (or adolescent) & male
Unmaried
Recent loss of loved one (usually within 6 months)
Family history of suicide
Past suicide attempts or a suicide plan
Unemployment or severe financial difficulties
Severe family stress
Recent major illness, chronic intractable pain or chronic illness
History of major depression, bipolar disorder, schizophrenia, alcoholism, drug abuse, or loss of a parent in early childhood or adolescence
History of bullying, social isolation
Recent psychiatric admission or suicide attempt within the past month
Transgender or LGBTQAI+
Veteran
What drugs are contraindicated in patients taking MAO inhibitors because of the occurrence of a severe hyperpyrexic reaction?
Meperidine (Demerol)
Tramadol
Methadone
Dextramethorphan
Linezolid
Methylene Blue
Diagnosis of malingering may be considered if
- Medicolegal context of presentation (a lawyer sends the client for evaluation or the patient presents for care in the midst of criminal charges)
- There is a “marked discrepancy” between the individual’s “claimed stress or disability” and “objective findings and observations”
- Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen
- The presence of antisocial personality disorder
Remember: malingering is not a mental illness
The patient suffering from a ______ is often inappropriately calm in the setting of a devastating chief complaint such as acute blindness or paralysis
Conversion disorder
A patient presents with severely agitated, violent behavior.
What is the most appropriate management?
First step is defusing or talking the patient down
Second step is physical restraints with addition of chemical restraint followed by administration of medication
Mild agitation - Ativan 2mg PO
Moderate agitation - Droperidol 5mg IM or zyprexa (olanzapine) 5mg - 10mg IM
Severe agitation - ziprasadone (geodon) 10mg-20mg IM
Can consider additional medication with benzodiazepine of Versed 5mg IM
Droperidol preferred over haldol due to less extrapyramidal effects
A patient who has an acute disturbance of consciousness, cognition, and perception has what type of illness?
Acute delirium
Which neuroleptic agent reduces agitation, is not very sedating, has a rapid onset, but is associated with extrapyramidal side effects?
Haloperidol (haldol)
Newer neuroleptics e.g. olanzapine, risperidone, ziprasidone, have less risk of extrapyramidal side effects
What are the symptoms of depression?
Sleep disturbance
Change in appetite
impaired concentration and memory
Reduced level of activity
Dysphoria
lack of concern for personal appearance
Suicidal thoughts
Feelings of hopelessness / helplessness
Recent significant weight changes
Fatigue or loss of energy
Feelings of worthlessness or guilt
Psychomotor agitation or retardation
Which organic brain syndrome is characterized by progressive impairment of cognitive function
Dementia
Which drugs should never be used for behavior control in the agitated delirious patient?
The opioids, morphine and meperidine, can induce dysphoria, exacerbate respiratory depression and cause hepatic encephalopathy
Monoamine oxidase inhibitors (MAOIs) have serious food and drug interactions. What are those interactions?
MAOIs + food containing tyramine (aged cheese, chianti wine) or sympathomimetic drugs (pressors, OTC stimulants/decongestants) -> acute hypertensive crisis
MAOIs + meperidine (Demerol) -> coma, hyperthermia and hyper/hypotension
MAOIs + SSRIs -> confusion, diaphoresis, shivering and myoclonus (serotonin syndrome)
Patients who present with vague symptoms such as weakness, fatigue, headache, or pain may have ___
Masked or hidden depression
What are the two types of anorexia?
Restrictive: limit food intake
Binge/purge: compensate for unacceptable intake with diuretics, laxatives, enemas, and vomiting
