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Primary > Diagnosis and Managment of Psychosocial Disorders > Flashcards

Diagnosis and Managment of Psychosocial Disorders Flashcards

1
Q

Mood state characterized by a diminished interest in normal activity, fatigue, feelings of sadness, and impaired concentration nearly every day

A

Depression

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2
Q

Chronic form of depression lasting at least 2, and frequently many more, years

A

Dysthymia

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3
Q

Depression is the ____ common psychiatric disorder: Maybe undertreated

A

most

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4
Q

Estimated ______ million Americans are affected by depression.

A

9 to 16

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5
Q

_____ as many women as men have major depression worldwide

A

Twice

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6
Q

With Depression, there is anger directed ____ instead of being directly expressed

A

inward

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7
Q

Decrease/loss of self-esteem related to feelings of

not having lived up to expectations common with what psychiatric condition?

A

Depression

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8
Q

Depression:

Reactions to loss and _______

A

deprivation

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9
Q

In Depression:

A person possesses a ____ world view, influencing future perceptions of events

A

learned

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10
Q

In Depression:

_____ belief systems and dysfunctional thinking

A

Negative

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11
Q

In Depression:

Stable causality: “It will _____ be this way.”

A

always

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12
Q

In Depression:
Global thinking: “Everything is _____.”
Internal vs. external causes: “It’s my fault.”

A

ruined

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13
Q

Biochemical theories for depression:
a. Neurotransmitter imbalance (e.g., _____ /serotonin/
epinephrine/norepinephrine)

A

dopamine

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14
Q

Signs/Symptoms of Depression:
DSM-5 criteria state that a person must have ____ or more of the following symptoms for the same two-week period and represent a change in the previous functioning.

A

five

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15
Q

Biochemical theories for depression:

b. _______ dysfunction

A

Thyroid

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16
Q

Biochemical theories for depression:

c. _______ side effects
d. Other

A

Medication

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17
Q

One of the symptoms marked with an asterisk (*) must be present for the diagnosis of depression :

  1. *Depressed mood ____of the day, nearly every day
  2. *Markedly diminished interest or pleasure in almost all
    activities (anhedonia)
  3. Weight loss/gain: Changing > 5%
  4. Inson~fia/hypersomnia
  5. Psychomotor agitation/retardation
  6. Fatigue/loss of energy
  7. Lack of concentration/indecisiveness nearly every day
  8. Excessive guilt or feelings of worthlessness
  9. Recurrent thoughts of death/suicide ideation without a plan or attempt
A
  1. *Depressed mood most of the day, nearly every day
  2. *Markedly diminished interest or pleasure in almost all
    activities (anhedonia)
  3. Weight loss/gain: Changing > 5%
  4. Insomnia/ hypersomnia
  5. Psychomotor agitation/ retardation
  6. Fatigue/loss of energy
  7. Lack of concentration/indecisiveness nearly every day
  8. Excessive guilt or feelings of worthlessness
  9. Recurrent thoughts of death/suicide ideation without a plan or attempt
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18
Q 
Acronym for Depression" 
"\_\_\_ \_\_\_ \_\_\_\_"
INterest: Loss of pleasure 
Sleep disturbances 
Appetite changes 
Depressed mood
Concentration difficulty
Activity: Agitation/retardation
Guilt feelings or low self-esteem
Energy, loss
Suicidal ideation
A 
"In Sad Cages"
INterest: Loss of pleasure 
Sleep disturbances 
Appetite changes 
Depressed mood
Concentration difficulty
Activity: Agitation/retardation
Guilt feelings or low self-esteem
Energy, loss
Suicidal ideation
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19
Q

Laboratory/Diagnostics for Depression:

  1. Initial laboratory tests normal (i.e., ___, BMP, CBC, LFTs, U/A, VDRL, B 12, etc.)
  2. Depression screening instruments
A

TSH

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20
Q

In Depression:
a. Therapeutic communication to encourage verbalization of _____, fears, losses that have occurred, and cognitive errors in thinking

A

feelings

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21
Q

In Depression:

Refer patients with hallucinations, delusions, loss of reality contact, and _________ thoughts

A

suicidal

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22
Q

_________ depression: Weekly appointments with contact by phone for backup

A

Mild

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23
Q

Categories of feelings with depression include: mad, sad, glad, ______, and ashamed

A

afraid

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24
Q

____ patients during stages of grief: Denial, anger, bargaining, depression, acceptance (DABDA)

A

Support

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25
Q

Encourage alternative coping methods, interaction with people, planned/regular activity, ______ techniques with depression

A

relaxation

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26
Q

In depression avoid making ______ or blaming

A

judgments

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27
Q

In depression think to consult regarding ______ and possible antidepressants

A

psychotherapy

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28
Q

In Depression Antidepressants:
a.___ ____ ____ ___ (___) : Most commonly prescribed [e.g., paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox)] due to low overdose danger, fast symptom response, and no postural hypotension; sexual dysfunction (delayed ejaculation) •

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

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29
Q

In depression use of Selective Serotonin Reuptake Inhibitors (SSRIs), there is a Potential for ___ _____, indicated by cognitive changes, neuromuscular changes, and autonomic hyperactivity (e.g., high fever)

A

serotonin syndrome

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30
Q

In depression:

Tricyclics and MAOI preparations not used as often because of increased side effects and high _____ potential

A

overdose

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31
Q

In depression:

Tricyclics: Major concerns include anticholinergic effects such as the dry mouth and _______

A

constipation

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32
Q

Another medication less commonly used in depression is

MAOIs known for side effects if wine + cheese = ______ crisis

A

hypertensive

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33
Q

Other means for managing depression include:

1) Psychotherapy
2) 5. _____ therapy (ECT): Controversial

A

Electroconvulsive

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34
Q

The unpleasant feeling of dread, apprehension, or tension resulting from an unexpected threat to one’s feeling of self-esteem or well-being; may present as a symptom in many disorders

A

Anxiety

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35
Q

Cause/Incidence of anxiety:

  1. Caused by an emotionally _______ response to stress
  2. Various theories: Psychodynamics, biologic causes (i.e., genetics), and family dynamics (i.e., dysfunctional systems)
A

learned

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36
Q

Morbid dread of seemingly harmless object/situation; may lead to agoraphobia

A

Panic Disorder

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37
Q

____% of the American population will experience an anxiety disorder in their lifetime/ anxiety disorder

A

3%

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38
Q

Excessive worry/anxiety about life Circumstances

A

Generalized Anxiety Disorder

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39
Q

Repetitive thoughts (obsession) that a person is unable to control and/urge to perform an act that cannot be resisted without great difficulty (compulsio.n),~which interferes with normal ADLs

A

Obsessive/Compulsive Disorder (OCD):

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40
Q

Having anxiety for at least six months after a severe trauma/event perceived as a threat to one’s integrity–characterized by flashback, nightmares, and intrusive thoughts

A

Post-traumatic Stress Disorder (PTSD)

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41
Q

Diagnostics

  1. ______
  2. serum drug analyses
  3. glucose
  4. ECG –> normal
A
  1. TSH
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42
Q 
Management of anxiety: 
1. Depends on category
2. Assess coping mechanisms
3. Therapeutic communication to identify emotional and 
     physical feelings
4. Keep the focus of responsibility on the patient
5. \_\_\_\_\_\_\_ techniques
6. Antianxiety medications:
A

Relaxation

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43
Q

Benzodiazepines: Most commonly used [e.g., _____ (___) 1 mg HS)]

A

Lorazepam (Ativan)

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44
Q

Patients with anxiety/ medication treatment:

________: For those with COPD or potential for abuse

A

Antihistamines

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45
Q

Patients with anxiety/ medication treatment:

____ ___: To reduce tachycardia, palpitations, and breathlessness

A

Beta-blockers

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46
Q

Patients with anxiety/ medication treatment:

____ and ____: May be beneficial for panic attacks but less, efficacious for generalized anxiety

A

Tricyclics and MAOIs

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47
Q

Patients with anxiety/ medication treatment:
_____ (___): Only antianxiety medication not classified as a tranquilizer, takes 3 to 4 weeks to reach full therapeutic effects

A

Buspirone (Buspar)

48
Q

Successful or unsuccessful attempts to kill one’s self

Incidence/Causes

A

Suicide

49
Q

Approximately ___% of depressed patients commit

suicide.

A

15

50
Q

___% of those who state intent to commit suicide DO!

A

80%

51
Q

The second leading cause of death among

adolescents

A

Suicide

52
Q

Incidence suicide increases with age; peak age > ___ years

A

65

53
Q

Adolescents and white males > 45 years of age have a

______ incidence.

A

higher

54
Q

Overdose is used in > ___% of attempted suicides.

A

> 70%

55
Q

Approximately ___% of completed suicides involve the use of a firearm.

A

60%

56
Q

In the United States, women attempt more often, but men are ____-fold more likely to succeed.

A

three

57
Q

Hanging is the ______ most common method of completed suicide.

A

second

58
Q

Mental or substance abuse disorders account for > ___% of all suicides.

A

90%

59
Q

The co-existence of > ____condition (depression, anxiety, alcohol abuse, etc.) greatly increases risk.

A

1

60
Q

_________ is commonly a predicting variable for suicide

A

Hopelessness

61
Q

Risk Factors for suicide:

  1. Sudden ____ or crisis
  2. Poor previous coping mechanisms
  3. Few or no significant others
  4. Past suicide attempts
  5. Family history of suicide
  6. Others
A

loss

62
Q

____ specific laboratory tests; may use depression screening tests

A

No

63
Q

Assess for suicide risk using the mnemonic, “_________”

A

“S-U-I-C-I-D-A-L”:

64
Q

“S-U-I-C-I-D-A-L”: in the assessment, skill stands for?

A 
S- Sex
U- Unsuccessful attempts
I- Identified family members with attempt history
Ci- Chronic illness history
D- Depression, drug abuse, drinking 
A- Age of patient
L- Lethal method available
65
Q

Management suicidal patient:

  1. Hospitalization with _______
  2. Antidepressants
  3. Substance abuse treatment, as indicated
  4. Antipsychotics for psychosis
A
  1. psychotherapy
66
Q

Suicidal patient’s:

Use caution when prescribing low therapeutic index medications such as ____ (___,______)

A

lithium (Eskalith, Lithobid)

67
Q

Suicidal patient’s:

Expect significant weight gain when prescribing atypical _________ (e.g., clozapine)

A

antipsychotics

68
Q

*In the elderly, loneliness and medical ____ are major reasons for suicide, and interventions should target these.

A

disability

69
Q

Drug Abuse/Alcoholism
Incidence/Causes
Approximately ____% of the population is alcoholic.

A

10

70
Q

Drug Abuse/Alcoholism
Incidence/Causes
_____ is the most common drug intoxicant; plays a role in 70% of drug overdoses.

A

Alcohol

71
Q 
Drug Abuse/Alcoholism
Incidence/Causes
Causes are multifactorial including:
     a. Genetics
     b. Alterations in opiate receptors
     c. Neurotransmitter alterations
     d. Psychosocial: Poor\_\_\_ \_\_\_\_, lower level of 
         psychosocial development, low self-esteem
A

impulse control

72
Q

Use of C-A-G-E mnemonic screening test/ alcohol use:
C: “Have you ever felt the need to ___ ___ on your
drinking?”
A: “Have people _____ you by criticizing your
drinking?”
G: “Have you ever felt _____ about your drinking?”
E: “Have you ever had a drink first thing in the morning to
steady your nerves or get rid of a hangover?” (____-____)

A

Use of C-A-G-E mnemonic screening test/ alcohol use:
C: “Have you ever felt the need to cut down on your
drinking?”
A: “Have people annoyed you by criticizing your
drinking?”
G: “Have you ever felt guilty about your drinking?”
E: “Have you ever had a drink first thing in the morning to
steady your nerves or get rid of a hangover?” (Eye-
opener)

73
Q

Management of alcohol overdose:
1. Consult regarding treatment and possible’detoxification
2. Be direct with diagnosis to patient, “alcoholism”
3. Tell the patient that he or she has a treatable disease
4. Make appropriate referrals:
a. Alcoholics _______ (very successful)
b. Behavioral approaches, rational-emotive
psychotherapy, psychodrama, and AI-Anon/Alateen
for family members

A

Anonymous

74
Q

Management of alcohol overdose:
5. Manage accompanying complications due to excessive and/or prolonged alcohol, consumption
a. ______ syndrome (chronic memory impairment
due to severe vitamin B deficiency) Cerebral
Function (Mental Status Assessment)

A

Korsakoff

75
Q

Components of the Mental Status Examination

  1. Appearance
  2. Behavior
  3. ______
  4. Thought processes
A

Cognition

76
Q

Mini-Mental Status Exam Components (11 component)

O: _______ to place AND time

A

Orientation

77
Q

Mini-Mental Status Exam Components (11 component)
R: _________- (repeat three objects; i.e., orange, dog,
pencil)

A

Recognition

78
Q

Mini-Mental Status Exam Components (11 component)

A: _______ (serial 7s counting backward from 100)

A

Attention

79
Q

Mini-Mental Status Exam Components (11 component)

R: ______ (ask to recall 3 objects 5 minutes later)

A

Recall

80
Q

Mini-Mental Status Exam Components (11 component)

L: _______

A

Language

81
Q

Mini-Mental Status Exam Components (11 component)

2: Identify names of 2 ______ (clock and chair)

A

objects

82
Q

Mini-Mental Status Exam Components (11 component)

3: Follow a ______ command (take this paper in your right hand, fold it in half, and place it on the floor)

A

3-step

83
Q

Mini-Mental Status Exam Scoring:

1. Maximum: _____

A

30

84
Q

Mini-Mental Status Exam Scoring:

2. No cognitive impairment: ________ to _____

A

24 to 30 (average: 27)

85
Q

Mini-Mental Status Exam Scoring:

3. Delirium/dementia: _____ to ______, ____ to ____

A

18 to 23 (mild impairment), 0 to 7 (severe impairment)

86
Q

Sudden, transient onset of clouded sensorium; may occur at any age associated with a physical stressor

A

Delirium

87
Q

Causes Delirium:

  1. Toxins
  2. Alcohol/drug abuse
  3. Trauma
  4. Impactions in the elderly
  5. Poor _______
  6. Electrolyte imbalances
  7. Anesthesia
A

nutrition

88
Q

Gradual memory loss with decreased intellectual functioning usually occurring over the age of 60 years

A

Dementia (Neurocognitive Disorder)

89
Q

Causes Dementia:

  1. _____________
  2. Neurotransmitter deficits
  3. Cortical atrophy
  4. Ventricular dilation
  5. Loss of brain cells
  6. Possible Viral causes
  7. Alzheimer’s disease
A

Atherosclerosis

90
Q

D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:

D: ______ reactions/interactions

A

Drug

91
Q

D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:

E: ______ disorders

A

Emotional

92
Q

D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:

M: ______/endocrine disorders

A

Metabolic

93
Q

D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:

E: __________ disorders

A

Eye and ear

94
Q

D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:

N: _________ problems

A

Nutritional

95
Q

D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:

T: _________

A

Tumors

96
Q

D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:

I: ________

A

Infection

97
Q

D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:

A: _____________

A

Arteriosclerosis

98
Q

The development of multiple cognitive defects characterized by both impairment (impaired ability to learn new information and recall previously learned information), and one or more of the following:

  1. Aphasia (difficulty with speech)
  2. Apraxia (inability to perform a previously learned task)
  3. Agnosia (inability to recognize an object)
  4. Inability to plan, organize, sequence, and make abstract differences
A

Alzheimer’s Disease

99
Q

_______ (difficulty with speech)

A

Aphasia

100
Q

__________ (inability to recognize an object)

A

Agnosia

101
Q

_____ (inability to perform a previously learned task)

A

Apraxia

102
Q

Additional Alzheimer’s Disease Findings

  1. Limb rigidity
  2. _____ posture
  3. Disorientation
  4. Recent impairment
  5. Impaired judgment
  6. Gait disturbances
  7. Others
A

Flexion

103
Q

Incidence/Cause Alzheimer’s Disease:
The most common cause of ______ (neurocognitive
disorder)

A

dementia

104
Q

Incidence/Cause Alzheimer’s Disease:
______ cause; affects over 4 million individuals in the
United States

A

Unknown

105
Q

Incidence/Cause Alzheimer’s Disease:
Earliest complaints from family: Loss of _____ term
memory

A

short

106
Q

Incidence/Cause Alzheimer’s Disease:

________ deficiency

A

Acetylcholine

107
Q

Incidence/Cause Alzheimer’s Disease:

Many causal theories: Genetic ________, abnormal protein, or slow virus theories

A

predisposition

108
Q

Diagnostics Alzheimer’s Disease:

  1. Usual lab diagnostics should be drawn to rule out other diseases: CBC, lytes, glucose, BUN/CT, LFTs, B12, VDRL, etc.
  2. CT or ____ to rule out tumors
A

MRI

109
Q

Management
1. Neurological consult
2. Medications to increase tile.availability of acetylcholine
(acetylcholinesterase inhibitors):
a. Donepezil (Aricept)
b. Galantamine (Razadyne)
c. Rivastigmine (Exelon)
• Acetylcholinesterase inhibitors are often prescribed
in conjunction with NMDA receptor antagonists
such as memantine, (________) to improve thinking
and activities of daily living
3. Refer patient/family for counseling as appropriate

A

Namenda

110
Q

Donepezil (____)

A

Aricept

111
Q

Galantamine (_____)

A

Razadyne

112
Q

Rivastigmine (_____)

A

Exelon

113
Q

The ______ _____ is responsible for balance and coordination

A

Cerebellar Function

114
Q

Assessment Techniques/ Cerebellar Function:
_____ _____: Evaluates proprioception and cerebellar function
a. Ask the patient to stand feet together, eyes closed,
and arms at the side
b. Positive Romberg: If the patient has a loss of
balance

A

Romberg test

115
Q

Assessment Techniques/ Cerebellar Function:
___ ____ ___
a. The patient alternately points from his nose to the
examiner’s finger

A

Finger to nose test (FNT)

116
Q

Assessment Techniques/ Cerebellar Function:
__ ____ ____ ___
a. The patient runs the heel of one foot along the shin
of the opposite leg

A

Heel-to-shin test

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