Diagnosis and Managment of Psychosocial Disorders Flashcards
Mood state characterized by a diminished interest in normal activity, fatigue, feelings of sadness, and impaired concentration nearly every day
Depression
Chronic form of depression lasting at least 2, and frequently many more, years
Dysthymia
Depression is the ____ common psychiatric disorder: Maybe undertreated
most
Estimated ______ million Americans are affected by depression.
9 to 16
_____ as many women as men have major depression worldwide
Twice
With Depression, there is anger directed ____ instead of being directly expressed
inward
Decrease/loss of self-esteem related to feelings of
not having lived up to expectations common with what psychiatric condition?
Depression
Depression:
Reactions to loss and _______
deprivation
In Depression:
A person possesses a ____ world view, influencing future perceptions of events
learned
In Depression:
_____ belief systems and dysfunctional thinking
Negative
In Depression:
Stable causality: “It will _____ be this way.”
always
In Depression:
Global thinking: “Everything is _____.”
Internal vs. external causes: “It’s my fault.”
ruined
Biochemical theories for depression:
a. Neurotransmitter imbalance (e.g., _____ /serotonin/
epinephrine/norepinephrine)
dopamine
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.
five
Biochemical theories for depression:
b. _______ dysfunction
Thyroid
Biochemical theories for depression:
c. _______ side effects
d. Other
Medication
One of the symptoms marked with an asterisk (*) must be present for the diagnosis of depression :
- *Depressed mood ____of the day, nearly every day
- *Markedly diminished interest or pleasure in almost all
activities (anhedonia) - Weight loss/gain: Changing > 5%
- Inson~fia/hypersomnia
- Psychomotor agitation/retardation
- Fatigue/loss of energy
- Lack of concentration/indecisiveness nearly every day
- Excessive guilt or feelings of worthlessness
- Recurrent thoughts of death/suicide ideation without a plan or attempt
- *Depressed mood most of the day, nearly every day
- *Markedly diminished interest or pleasure in almost all
activities (anhedonia) - Weight loss/gain: Changing > 5%
- Insomnia/ hypersomnia
- Psychomotor agitation/ retardation
- Fatigue/loss of energy
- Lack of concentration/indecisiveness nearly every day
- Excessive guilt or feelings of worthlessness
- Recurrent thoughts of death/suicide ideation without a plan or attempt
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
"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
Laboratory/Diagnostics for Depression:
- Initial laboratory tests normal (i.e., ___, BMP, CBC, LFTs, U/A, VDRL, B 12, etc.)
- Depression screening instruments
TSH
In Depression:
a. Therapeutic communication to encourage verbalization of _____, fears, losses that have occurred, and cognitive errors in thinking
feelings
In Depression:
Refer patients with hallucinations, delusions, loss of reality contact, and _________ thoughts
suicidal
_________ depression: Weekly appointments with contact by phone for backup
Mild
Categories of feelings with depression include: mad, sad, glad, ______, and ashamed
afraid
____ patients during stages of grief: Denial, anger, bargaining, depression, acceptance (DABDA)
Support
Encourage alternative coping methods, interaction with people, planned/regular activity, ______ techniques with depression
relaxation
In depression avoid making ______ or blaming
judgments
In depression think to consult regarding ______ and possible antidepressants
psychotherapy
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)
Selective Serotonin Reuptake Inhibitors (SSRIs)
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)
serotonin syndrome
In depression:
Tricyclics and MAOI preparations not used as often because of increased side effects and high _____ potential
overdose
In depression:
Tricyclics: Major concerns include anticholinergic effects such as the dry mouth and _______
constipation
Another medication less commonly used in depression is
MAOIs known for side effects if wine + cheese = ______ crisis
hypertensive
Other means for managing depression include:
1) Psychotherapy
2) 5. _____ therapy (ECT): Controversial
Electroconvulsive
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
Anxiety
Cause/Incidence of anxiety:
- Caused by an emotionally _______ response to stress
- Various theories: Psychodynamics, biologic causes (i.e., genetics), and family dynamics (i.e., dysfunctional systems)
learned
Morbid dread of seemingly harmless object/situation; may lead to agoraphobia
Panic Disorder
____% of the American population will experience an anxiety disorder in their lifetime/ anxiety disorder
3%
Excessive worry/anxiety about life Circumstances
Generalized Anxiety Disorder
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
Obsessive/Compulsive Disorder (OCD):
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
Post-traumatic Stress Disorder (PTSD)
Diagnostics
- ______
- serum drug analyses
- glucose
- ECG –> normal
- TSH
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:Relaxation
Benzodiazepines: Most commonly used [e.g., _____ (___) 1 mg HS)]
Lorazepam (Ativan)
Patients with anxiety/ medication treatment:
________: For those with COPD or potential for abuse
Antihistamines
Patients with anxiety/ medication treatment:
____ ___: To reduce tachycardia, palpitations, and breathlessness
Beta-blockers
Patients with anxiety/ medication treatment:
____ and ____: May be beneficial for panic attacks but less, efficacious for generalized anxiety
Tricyclics and MAOIs
Patients with anxiety/ medication treatment:
_____ (___): Only antianxiety medication not classified as a tranquilizer, takes 3 to 4 weeks to reach full therapeutic effects
Buspirone (Buspar)
Successful or unsuccessful attempts to kill one’s self
Incidence/Causes
Suicide
Approximately ___% of depressed patients commit
suicide.
15
___% of those who state intent to commit suicide DO!
80%
The second leading cause of death among
adolescents
Suicide
Incidence suicide increases with age; peak age > ___ years
65
Adolescents and white males > 45 years of age have a
______ incidence.
higher
Overdose is used in > ___% of attempted suicides.
> 70%
Approximately ___% of completed suicides involve the use of a firearm.
60%
In the United States, women attempt more often, but men are ____-fold more likely to succeed.
three
Hanging is the ______ most common method of completed suicide.
second
Mental or substance abuse disorders account for > ___% of all suicides.
90%
The co-existence of > ____condition (depression, anxiety, alcohol abuse, etc.) greatly increases risk.
1
_________ is commonly a predicting variable for suicide
Hopelessness
Risk Factors for suicide:
- Sudden ____ or crisis
- Poor previous coping mechanisms
- Few or no significant others
- Past suicide attempts
- Family history of suicide
- Others
loss
____ specific laboratory tests; may use depression screening tests
No
Assess for suicide risk using the mnemonic, “_________”
“S-U-I-C-I-D-A-L”:
“S-U-I-C-I-D-A-L”: in the assessment, skill stands for?
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
Management suicidal patient:
- Hospitalization with _______
- Antidepressants
- Substance abuse treatment, as indicated
- Antipsychotics for psychosis
- psychotherapy
Suicidal patient’s:
Use caution when prescribing low therapeutic index medications such as ____ (___,______)
lithium (Eskalith, Lithobid)
Suicidal patient’s:
Expect significant weight gain when prescribing atypical _________ (e.g., clozapine)
antipsychotics
*In the elderly, loneliness and medical ____ are major reasons for suicide, and interventions should target these.
disability
Drug Abuse/Alcoholism
Incidence/Causes
Approximately ____% of the population is alcoholic.
10
Drug Abuse/Alcoholism
Incidence/Causes
_____ is the most common drug intoxicant; plays a role in 70% of drug overdoses.
Alcohol
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-esteemimpulse control
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?” (____-____)
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)
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
Anonymous
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)
Korsakoff
Components of the Mental Status Examination
- Appearance
- Behavior
- ______
- Thought processes
Cognition
Mini-Mental Status Exam Components (11 component)
O: _______ to place AND time
Orientation
Mini-Mental Status Exam Components (11 component)
R: _________- (repeat three objects; i.e., orange, dog,
pencil)
Recognition
Mini-Mental Status Exam Components (11 component)
A: _______ (serial 7s counting backward from 100)
Attention
Mini-Mental Status Exam Components (11 component)
R: ______ (ask to recall 3 objects 5 minutes later)
Recall
Mini-Mental Status Exam Components (11 component)
L: _______
Language
Mini-Mental Status Exam Components (11 component)
2: Identify names of 2 ______ (clock and chair)
objects
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)
3-step
Mini-Mental Status Exam Scoring:
1. Maximum: _____
30
Mini-Mental Status Exam Scoring:
2. No cognitive impairment: ________ to _____
24 to 30 (average: 27)
Mini-Mental Status Exam Scoring:
3. Delirium/dementia: _____ to ______, ____ to ____
18 to 23 (mild impairment), 0 to 7 (severe impairment)
Sudden, transient onset of clouded sensorium; may occur at any age associated with a physical stressor
Delirium
Causes Delirium:
- Toxins
- Alcohol/drug abuse
- Trauma
- Impactions in the elderly
- Poor _______
- Electrolyte imbalances
- Anesthesia
nutrition
Gradual memory loss with decreased intellectual functioning usually occurring over the age of 60 years
Dementia (Neurocognitive Disorder)
Causes Dementia:
- _____________
- Neurotransmitter deficits
- Cortical atrophy
- Ventricular dilation
- Loss of brain cells
- Possible Viral causes
- Alzheimer’s disease
Atherosclerosis
D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:
D: ______ reactions/interactions
Drug
D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:
E: ______ disorders
Emotional
D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:
M: ______/endocrine disorders
Metabolic
D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:
E: __________ disorders
Eye and ear
D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:
N: _________ problems
Nutritional
D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:
T: _________
Tumors
D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:
I: ________
Infection
D-E-M-E-N-T-I-A mnemonic to rule out other diseases: indicative of dementia:
A: _____________
Arteriosclerosis
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:
- Aphasia (difficulty with speech)
- Apraxia (inability to perform a previously learned task)
- Agnosia (inability to recognize an object)
- Inability to plan, organize, sequence, and make abstract differences
Alzheimer’s Disease
_______ (difficulty with speech)
Aphasia
__________ (inability to recognize an object)
Agnosia
_____ (inability to perform a previously learned task)
Apraxia
Additional Alzheimer’s Disease Findings
- Limb rigidity
- _____ posture
- Disorientation
- Recent impairment
- Impaired judgment
- Gait disturbances
- Others
Flexion
Incidence/Cause Alzheimer’s Disease:
The most common cause of ______ (neurocognitive
disorder)
dementia
Incidence/Cause Alzheimer’s Disease:
______ cause; affects over 4 million individuals in the
United States
Unknown
Incidence/Cause Alzheimer’s Disease:
Earliest complaints from family: Loss of _____ term
memory
short
Incidence/Cause Alzheimer’s Disease:
________ deficiency
Acetylcholine
Incidence/Cause Alzheimer’s Disease:
Many causal theories: Genetic ________, abnormal protein, or slow virus theories
predisposition
Diagnostics Alzheimer’s Disease:
- Usual lab diagnostics should be drawn to rule out other diseases: CBC, lytes, glucose, BUN/CT, LFTs, B12, VDRL, etc.
- CT or ____ to rule out tumors
MRI
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
Namenda
Donepezil (____)
Aricept
Galantamine (_____)
Razadyne
Rivastigmine (_____)
Exelon
The ______ _____ is responsible for balance and coordination
Cerebellar Function
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
Romberg test
Assessment Techniques/ Cerebellar Function:
___ ____ ___
a. The patient alternately points from his nose to the
examiner’s finger
Finger to nose test (FNT)
Assessment Techniques/ Cerebellar Function:
__ ____ ____ ___
a. The patient runs the heel of one foot along the shin
of the opposite leg
Heel-to-shin test
