Diagnoses - Part 4 of 4 Flashcards
Risk factor for PTSD
PRIOR CHILDHOOD ADVERSITY
Psych d/o in violent people
SUBSTANCE RELATED D/O
25 y/o F is brought to ER after being severely beaten by her BF. Following medical stabilization, first step in an acute psychological intervention is:
HELP HER RECOGNIZE THAT IMMEDIATE DANGER HAS PASSED AND SHE IS IN A SAFE PLACE
14 y/o brought to ED after telling mom that she had been raped by stepdad. On psych eval, pt reports feeling “okay” and denies acute distress. Pt is calm during interview and appears generally unaffected by recent trauma. On further questioning, pt appears confused and believes she is at a friend’s house. Which is the preferable intervention?
EMPLOY GROUNDING STRATEGIES TO ORIENT PT
Which of the following is the most common psychiatric diagnosis associated with violent acts?
SUBSTANCE USE DISORDERS
One of the most common psych d/o found in individuals who commit violence against others (even more than IED, BMD, MDD, CPS):
SUBSTANCE RELATED D/O
Homicide and homicidal behaviors are most often related to which of the following factors?
EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS.
Adult male presents to clinic with broken hand due to first time DV toward his same-age spouse. Best response by psychiatrist?
TELL THE PATIENT THAT VIOLENCE IS HIS RESPONSIBILITY AND HE NEEDS TO STOP IT
M pt BIB to ED by police after he threatening to kill his wife and admits that has thoughts of harming his spouse ever since learning of her infidelity, saying “I want her to hurt like I do now.” The pt doesn’t display delusions and mood problems. He admits to drinking occasionally, but in the last week and prior to violence. Next step:
REFER PT BACK TO LAW ENFORCEMENT
What does NOT predict violence?
NON-VIOLENT CRIMINAL ACTIVITY
What is the relationship of violence to mental d/o?
MENTAL D/O HEIGHTENS RISK IN SOME, DECREASES RISK IN OTHERS
Homicide and homicidal behaviors are most often related to what factors?
EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS
70 y/o presents with fearfulness, anger and agitation after moving in with adult child. On first visit pt is resigned and timid during exam. Which is most consistent with pt’s behaviors?
PSYCHOLOGICAL ABUSE
18 y/o F in ED, just raped. Immediate intervention:
PROVIDE SUPPORT AND ALLOW TO VENT
Characteristic of women with increased risk of battery
PREGNANCY
Females have comparable rates to males for:
DOMESTIC VIOLENCE
20 y/o pt brings 2 y/o child to ER with multiple bruises. Mother says he fell down stairs. Mother has healing black eye and cut lip. Says she slipped on ice and hit head. X-ray of child’s arm show hairline fx and healing callus. What action should psychiatrist take first?
ADMIT CHILD FOR CARE AND PROTECTION DESPITE MOTHER’S OBJECTIONS
A finding that should raise a concern for child abuse?
SYMMETRICAL BRUISING IN A 24-MONTH-OLD
42yr old female with depression, Spanish speaking, usually seen by psychiatrist with interpreter, but this time bilingual husband will serve as interpreter, psychiatrist sees unexplained injuries and suspects abuse by husband, at next appointment pt comes with close bilingual friend and requests friend to join session, pt says husband is parking car and will be in shortly, what would be the best approach to clarify to clarify suspicions of abuse?
BEGIN SESSION WIT PT, INTERPRETER, AND PTS FRIEND WHILE HAVING THE HUSBAND REMAIN OUTSIDE
Pt confides to the psych MD that the pt’s spouse has been physically abusing the pt. In all cases, the psych MD should do what before the pt leaves office?
DETERMINE WHETHER THE PATIENT IS IN PRESENT DANGER
What is the first priority in ER management of a rape victim?
ESTABLISHING PSYCHOLOGICAL SAFETY
Duty as outlined by Tarasoff
PROTECT THE POTENTIAL VICTIM OF A DANGEROUS PATIENT
35 yo uninjured in an accident but witnessed deaths of co-workers. The following day reports emotional numbness, intrusive images, inability to sleep since the accident. Most appropriate intervention
NORMALIZING STRESS REACTION AND MOBILIZING RELATIONAL SUPPORTS
Mother of 2 school aged kids dies unexpectedly. What with improve psychological outcome
for the children?
ENSURING AVAILABILITY OF PSYCHOSOCIAL SUPPORTS
Across all cultures, what stressful life changes is correlated with greatest increase in death and illness in the subsequent 2 years?
DEATH OF A SPOUSE
50 y/o Cambodian woman with 2 kids suffered catastrophic trauma from the Pol Pot regime in Cambodia (rape, abuse, watched family starve, escaped refugee camp with 2 kids). Has PTSD/MDD sx that are increased when her now grown daughter dates man patient doesn’t like. Needs supportive therapy, antidepressant, AND?
GROUP THERAPY OF PEOPLE OF THE PATIENT’S OWN BACKGROUND WHO SHARE THE SAME EXPERIENCE
28 y/o graduate student BIB wife and reports a change in his behavior since he witnessed a fatal motor vehicle collision 3 wks ago. Pt felt feeling of helpless, horrified at time of accident. Now pt feels like “his spirit leaves his body.” And feels numb and detached, and dreams about events. Dx:
ACUTE STRESS
A 28 yo patient presents to the ED after experiencing a sexual assault 1 week earlier. Although the patient cannot recall all aspects of the event, she remembers feeling helpless, detached, and as if her surroundings were not real during the assault. For the past week the pt has has difficulty sleeping due to nightmares about the assault and has not been able to talk about the event with any of her friends. She is also experiencing intermittent episodes of palpitations, SOB, dizziness, and nausea throughout the day. Dx?
ACUTE STRESS DISORDER
How would a social biologist describe adaptive benefit of PTSD?
HYPERVIGILANCE ALLOWS FOR QUICK SENSING OF REAL THREATS
Which group children are at greatest risk for death resulting from child abuse?
BIRTH TO 3 Y/O OLD
A patient presents to the ED after witnessing a tragic MVA in which they witnessed a death. What symptom present immediately following the event increases the individual’s risk of developing PTSD?
DISSOCIATION
What symptom commonly develops relatively late in children with PTSD?
SENSE OF FORESHORTENED FUTURE
Comorbid disorder in men with PTSD
ETOH ABUSE/DEPENDENCE
What symptom is more likely to occur in acute stress d/o than in PTSD?
REDUCTION IN AWARENESS OF SURROUNDINGS
Important determinant factor to whether an individual who was exposed to trauma will develop PTSD?
SEVERITY AND PROXIMITY OF TRAUMA
A risk factor for child abuse:
FINANCIAL STRESS
Which of the following is a risk factor for child abuse?
PRESENCE OF A STEP-PARENT
In the US, which of the following is the most common precipitant of PTSD in children and adolescents?
INTRAFAMILIAL VIOLENCE
Acute stress d/o differentiated from PTSD by
DURATION OF SYMPTOMS
29 y/o pt reports having been robbed at knifepoint almost a month ago. Pt escaped unharmed, but has been experiencing a sense of unreality, detachment, and dampened emotions that is interspersed with periods of intense physiological arousal. These symptoms are causing difficulties at work. The most likely Dx?
ACUTE STRESS DISORDER
45 y/o pt w lung cancer and depression. Physical and emotional symptoms are stable, pt worries that “family always seems on edge w me.” Family meeting shows children fear losing father, frustrated that lives seem “on hold”. Daughter feels she can’t invite friends over out of fear of “stressing her father.” Father feels guilty about this but does prefer quiet environment. Best strategic systemic approach to problem?
TASK FAMILY WITH COMING UP WITH PRACTICAL SCHEDULE
Childhood physical and sexual abuse increases the risk for which anxiety do?
PANIC DISORDER
Which of the following is the best predictor of whether or not a patient who sustained a significant trauma will develop early PTSD morbidity?
THE NATURE AND SEVERITY OF THE TRAUMA
Sx for a pt 2 months after traumatic experience:
INCREASED AROUSAL AND INTRUSIVE THOUGHTS
Adding which class of medication to an SSRI is an effective augmentation for treatment of PTSD?
ATYPICAL ANTIPSYCHOTICS
Student presents for psych eval with continued anxiety, hyperalertness, flashbacks, and social avoidance after barely escaping an attacker 1 month ago. These symptoms are expected to last no longer than ___?
4 WEEKS
An intoxicated pt in ER throws a food tray at security guard, no respond to verbal redirection and refused to take meds by po. Pt is now pacing, cursing and threatening to “hurt someone”. The most appropriate meds:
LORAZEPAM 2MG IM, REPEATED IN 45 MIN IF NO RESPONSE
35 hospitalized w/ concussion following MVC with only minor lacerations and bruises. One week later has generalized pain, dizziness, difficulty sleeping and recurrent nightmares. Now fears driving. What is most likely explanation?
CUTE STRESS DISORDER
Military veteran from war zone with memory problems. Which finding would support dissociative amnesia? Closed head injury, decreased procedural memory, anterograde & retrograde amnesia, memory deficits limited to few traumatic episodes, vague recall of all memories since childhood
MEMORY DEFICITS LIMITED TO FEW TRAUMATIC EVENTS
After child survives natural disaster, what is a protective factor to protect against developing PTSD
AVAILITY OF PEER SUPPORT
