Exam 3 Flashcards
1
Q
what is considered an emergency?
A
any condition, physical or psychiatric that threatens the life of the patient or the life of others
2
Q
when is self mutilation, like cutting, considered an emergency?
A
with infection or deep laceration
3
Q
when MUST you disclose information regarding mental health clients
A
risk of harm or neglect to someone vulnerable or under 18
you believe you are in immediate danger
disclosure of intent to harm self or others
4
Q
true or false: risk assessment tools are an effective way to predict future suicide or repetition of self harm
A
false
5
Q
if caring for a person who has self harmed in an outpatient setting, what things should you do as the primary care provider
A
have regular appointments
do a medication review
inform the client about social supports
care for coexisiting mental health and refer as needed
6
Q
when should you consider admitting a person to hospital
A
concerns about their safety
safeguard planning needs to be completed
person is unable to engage in psychosocial assessment (too distressed, intoxicated, etc)
7
Q
when should you administer syrup of ipecac and what is it?
A
an emetic
can be used to induce emesis after poisoning if ingested within the last hour
8
Q
what are the two steps for suicide screening
A
assess for risk factors
ask about suicidal ideation
9
Q
when asking about suicidal ideation and there are children in the home, what other question must you ask
A
any thoughts of harming the children
10
Q
when is attempted suicide typically treated in an outpatient community setting
A
does not result in serious injury
11
Q
what is the strongest predictor of completing suicide
A
previous attempts
12
Q
what is the role of lithium in suicidal patients
A
decreases suicide attempts in patients with mood disorders
13
Q
what is the role of olanzepine in suicidal patients
A
may be helpful in patients with psychotic disorders
14
Q
what is the first priority for a patient presenting after an attempted suicide
A
medical stabalization
15
Q
which medication has restricted use due to the risk of agranular cytosis
A
clozapine
16
Q
true or false: if suicidal gestures become chronic, you do not need to do a full assessment each time
A
false, even if chronic, every suicidal gesture should be taken seriously as they may become lethal
17
Q
suicide prevention contracts are not effective. What is a better alternative?
A
crisis plan
18
Q
what should be included in a crisis plan?
A
coping strategies, reasons to live, people to contact as the support system, emergency after hours contacts
19
Q
if someone is depressed but does not need hospitalization, what must you do in addition to starting medication if needed
A
you must offer resources for if things come to a crisis like after hours on call, same day appointments, and crisis lines
20
Q
what is the timeline to consider depression being related to pregnancy
A
any time during pregnancy and up to 1 year after delivery
21
Q
what are risk factors for developing peripartum depression
A
mood disorder or history of depression
depression symptoms during pregnancy
poor social support
family history of psychiatric disorders
22
Q
what is the DSM5 criteria for peripartum depression
A
at least 5 symptoms, with either depressed mood or anhedonia being one, for at least two weeks:
significant change in weight or appetite
insomnia/hypersomnia
psychomotor agitation/retardation
fatigue
feeling worthless/excessive guilt
impaired concentration
SI
23
Q
what physical cause should be ruled out for peripartum depression?
A
thyroid disease
24
Q
which SSRI is preferred for pregnant and breastfeeding women? Which SSRI carries a slightly higher risk?
A
Sertraline is preferred
Fluoxetine carries a slightly higher risk when taken in 3rd trimester
25
what is a way mothers can reduce exposure in breast milk when taking antidepressants
pump and dump 8-9 hours after taking the medications
26
true or false: St. Jons wort may be an effective treatment for peripartum depression
false, there is little evidence so it should be avoided during pregnancy and lactation
27
what are the 3 categories of postpartum psychiatric disorders
postpartum blues
postpartum psychosis
postpartum depression
28
what is postpartum blues
common condition with symptoms during the first week postpartum and usually resolved by day 10
29
true or false: postpartum blues may progress to postpartum depression if it lasts beyond 2 weeks
true
30
to be diagnosed with postpartum psychosis, symptoms must begin within ____ months postpartum
within 3 months postpartum
31
what are the symptoms of postpartum psychosis
Symptoms of psychosis which may or may not include hallucinations and delusions
32
what are risk factors for postpartum psychosis
family history of mood disorder or schizophrenia, bipolar disorder, perinatal death, C-section, lack of social support, previous postpartum psychosis
33
does post partum depression increase the risk for future depression?
yes
34
true or false: health promotion does not change the risk for peripartum depression
false, health promotion can reduce the risk of peripartum depression
35
what is poor neonatal adaptation syndrome and when should you look for it
may happen for babies exposed to SSRI/SNRI
includes poor muscle tone, tremors, jitteriness, irritability, seizures, feeding difficulties, sleep disturbances, hypoglycemia, resp distress
36
what education should you provide for mothers with babies who has PNAS
it is usually mild and self limiting and usually resolves within days - 2 weeks
keep infant in a quiet environment, swaddled, skin to skin, breast feed, frequent small meals
37
what is persistent pulmonary hypertension of the newborn and what medication may it be rarely associated with
persistent hypoxia
rare complication of SSRI use by mothers
38
what should you be aware of in regards to prescribing women valproate
should not be prescribed to women of childbearing age unless there is no other option and a pregnancy prevention plan is in place
39
are benzos safe for use in pregnancy
no, should only be used for emergency
40
what is the risk with taking antipsychotic medications during pregnancy
excessive weight gain and GDM
41
why might a woman taking antipsychotic medication have trouble getting pregnant
if the medication is elevating her prolactin level this can hinder getting pregnant
42
should you continue antipsychotic medication in pregnancy if a woman is stable but likely to relpase without the medication
yes
43
if a woman is stable on valproate and becomes pregnant, should you continue the drug
no, risk of fetal malformation
44
is carbamazepine safe in pregnancy
no, do not use as it has risk of fetal malformation
45
what should you be aware of if a woman is on lamotrigine and pregnant
check levels more frequently as the levels may fluctuate substantially while pregnant and postnatally
46
what is the risk of using lithium while pregnant? while breastfeeding?
may cause fetal heart malformations if taken in the first trimester
may be high levels in breast milk causing toxicity for babies
47
when would you consider weaning off lithium if pregnant? when would you not?
consider weaning off if already well and low risk of relapse
otherwise, keep on with frequent monitoring Q4 weeks or consider taking off during first trimester only
48
if a woman presents with only mild perinatal depression but has a history of severe depression should you offer pharmacotherapy?
yes
49
what medication class should be offered for a pregnancy woman who develops mania
antipsychotics
50
which pregnant women should be offered antipsychotis as a prophylaxis
bipolar and plans to stop lithium or plans to breast feed
51
if sleep is a problem during pregnancy and sleep hygeine is not helping, what medication can be used
promethazine
52
true or false: breast feeding may decrease risk for PPD
true
53
what is the biggest risk factor for postpartum psychosis
bipolar
54
what is the triphasic pattern of postpartum psychosis
manic phase
delirium
psychotic depression
55
what is treatment for postpartum psychosis
usually hospitalization
medications same as for bipolar (lithium, valproic acid, carbamazepine)
56
what phase of the menstrual cycle does premenstrual dysphoric disorder occur
luteal
57
what is the DSM5 criteria for premenstrual dysphoric disorder
symptoms occur in relation to most menstrual cycles within the week before onset and improve within a few days of menses starting
symptoms mostly absent the week after menses
5 symptoms with at least one from A and one from B
A - lability, irritability, anger, depressed, anxiety
B - anhedonia, cant concentrate, fatigue, change in appetite, hypersomnia/insomnia, overwhelmed, physical symptoms
Causes significant distress and no other explanation
minimum of 2 symptomatic cycles in 1 year
58
what lab work should be done if suspecting PMDD
TSH
CBC
FSH
59
true or false: suicide is less likely during the premenstrual period
false, suicide often occurs during this time
60
what are some herbal treatments for PMDD and what are the possible side effects
Vitamine B6 (too much can cause peripheral neuropathy)
Calcium
Chasteberry
St Jons wort (proserotonergic, dont use with SSRI)
61
what condition responds to intermittent cyclical SSRI therapy
PMDD
62
if a patient with PMDD has regular periods and is going to take cyclical SSRIs, when should they start the medication
a day or 2 before symptom onsent
63
why should serotonin antidepressants only be used for PMDD
because the condition is caused by an abrupt decrease in availability of serotonin
64
true or false: buproprion is not effective for PMDD
true, it is not a serotonergic medication and so not effective for this condition
65
what age group has the highest rate of IPV
24-34 closely followed by 15-24
66
true or false: there is no need for routine screening of domestic violence
false, you should routinely screen everyone for domestic violence
67
what should you do if someone discolses domestic violence
create a safety plan
connect them to a victim service professional
provide with crisis line and other resources
68
When someone discloses IPV, when are you legally obligated to report it
if there are children in the house
if it involved vulnerable adults (seniors or those with disabilities)
69
what is the main objective of the abuser in domestic violence
power and control over the victim
70
what is the most common kind of abuse in elders
financial and emotional
71
what is the most common disorder for canadian armed forces members
depression
72
what is the main barrier to military personell seeking mental health support
stigma
73
what is the biggest predictor of PTSD and other mental illness post deployment
the presence of PTSD symptoms pre deployment with a history of concerning life stressors and previous traumatic experiences
74
what is the biggest factor that correlates to the development of PTSD in military personel
ADHD
75
men or women in the military are more likely to have PTSD
women
76
men or women in the military are more likely to commit suicide
men
77
what is perceived burdensomeness in military personel
believing that their death will be more beneficial to the group than their life leading to suicide
78
what is crimanilization of mental illness
over representation of people with mental illness in the justice system
79
what could help stem the over representation of mentally ill people in the justice system
more access to treatment and housing
80
what is the biggest thing associated with the crimaniliztion of the mentally ill
lack of access to appropriate treatment and support
81
what mental illness has the highest risk of commiting homicide
schizophrenia
82
an approach to mental health in the justice system may include an opportunity for people with a mental illness who commit a crime to be diverted where?
into the mental health system instead of the justice system
83
men or women in prisons are more likely to have a mental health diagnosis?
women
84
what are some aspects of people with FASD
memory impairment, poor judgement and abstract reasoning, low adaptive functioning, ADD or ADHD, poor frustration tolerance, substance abuse, difficulty understanding consequences
85
what may help people with FASD to avoid the justice system
a favorable environment and early interventions
86
what are the most common mental illness seen in adolescents in the prison sysem
depression
anxiety
PTSD
ADHD
substance abuse
87
is solitary confinement still used? why or why not
not in federal prisons, sometimes in provincial
it is considered a form of torture and may hinder reintigration into society
88
what are some psychological effects of solitary confinement
anxiety
depression
anger
confused thought process
perception distortion
paranoia and psychosis
89
what are some physical effects of solitary confinement
lethargy
insomnia
palpitations
anorexia
90
does solitary confinement increase or decrease risk of self harm and suicide
increase
91
true or false: symptoms from solitary confinement may be lifelone
true
92
who is most likely to be put in solitary confinement
violent offenders
young offender
mental disorder or substance abuse
aboriginal
93
what is isolation syndrome
delirium characterized by decreased alertness, EEG abnormalities, perceptual and cognitive disturbances, fearfulness, paranoia and agitation and self destructive behavior
94
which groups of people are most vulerable to the negative effects of solitary confinement
pre existing medical condition
children and young people
detainees on remand
95
why does childhood trauma often lead to addiction
trauma causes the internal endorphin connections to not develop properly so people look for these endorphins externally
96
a common dual diagnosis with ADHD is
smoking
97
a common dual diagnosis with depression, anxiety or PTSD is
alcohol or susbtance use
98
what is the number one priority when considering screening a patient for mental health or substance use
safety of yourself and your client
99
what is the ABC method of screening for dual diagnosis
appearance
behavior
cognition
100
when should screening for concurrent disorders occur? when should it be postponed?
should occur at initial point of access to health system
not appropriate to screen if:
immediate risk of harm to self or others or harm from others
acute and severe mental symptoms
intoxication
will negatively impact the pt engagement
in need of emergency care, pain or urgent medical issue
101
do youth or adults have higher rates of concurrent disorders
youth
102
what is the difference between level 1 and level 2 screening for concurrent disorders
level 1 is informal, takes little time and usually not research based but still can be useful
level 2 is formal and research based
103
what is the CAGE questionnaire used for and what are the questions
screen for alcohol abuse
have you ever felt you ought to cut down
have people annoyed you by criticizing your usage
have you felt bad or guilty about your use
have you ever used first think in the morning
104
what is the role for ALP in screening for alcohol use
non specific but used as a comparision to GGT for screening
105
what is the role of AST and ALT in alcohol screening
to screen for hepatocellular injury
106
if AST is greater than ALT by 2:1, what does this indicate? what if the ALT is greater than the AST?
if AST>ALT 2:1 = alcoholic hepatitis
ALT>AST = viral or chronic hepatitis
107
what are some other reasons besides hepatitis an alcoholic pt may have increased AST
DTs or a seizure from skeletal muscle damage
108
what LFT is most sensitive for screening for alochol use
GGT
109
what is the GGT/ALT ratio that would be suggestive of alcohol use
>2.5
110
what is a GGT >3.5X the upper limit indicative of?
alcoholic hepatitis
111
when is a serum ethanol done
only if requested by police or suspected alcohol poisoning with neuro deterioration
112
if depression is present with alcohol abuse, what should you treat first and why?
depression because treating the depression will also lower the usage
113
what antidepressants work best for concurrent alcohol use
TCAs, SNRIs, and buproprion may work better than SSRIs
114
why must you start low and go slow with antidepressant pharmacotherapy when there is concurrent alcohol misuse
transient symptoms at the start of treatment may mimic withdrawal and cause distress to the patient
115
what are the symptoms of alcohol withdrawal
tremors, agitation, nausea, sweating, vomiting, hallucinations, insomnia, tachycardia, HTN, delirium, seizures
116
why are benzos still used instead of antipsychotics for treating alcohol withdrawal if antipsychotics have less risk of misuse
they do not prevent seizures or DTs
117
when might you consider alcohol dependence in women? in men?
more than 1 drink a day in women (or average of 7 a week) and more than 2 drinks a day in men (or average of 14 a week)
118
what is delirium tremens
severe hyperadrenergic state from alcohol withdrawal causing hyperthermia, diaphoresis, tachypnea, tachycardia, disorientation, impaired consciousness, hallucinations
119
what screening tools can be used for alcohol withdrawal
CIWA or SAWA
120
true or false: DTs does not increase risk of death
false
121
what are risk factors for developing DTs
sustained heavy drinking
older than 30
increased days since last intake
prior DTs
122
why is thiamine given to patients in alcohol withdrawal
nutritionally deplete and to prevent wernicke encephalopathy
123
what vitamins should be given to people in alcohol withdrawal
thiamine
folic acid
B12
124
can dilantin be used to prevent seizures in patients with alcohol withdrawal
no
125
what is acamprosate and why is it used
reduces symptoms that persist from alcohol use after detox including sweating, anxiety, and sleep disorders
126
when should yous tart acamprosate
as soon as possible after alcohol detox and continue using even if relapse, although no effect on acute withdrawal symptoms
127
what are the main possible side effects to watch for with acamprosate
depression and SI
128
what is disulfiram and what education should you give patients about it
creates an intense physical response when alcohol is ingested used as a deterrant for alcohol abuse
beware of any food or other subtances that might have alcohol in it
129
what is naltrexone
opioid agonist to reduce cravings for alcohol and opioids
130
how long do symptoms of alochol withdrawal typically last
7 days
131
how soon after last drink do symptoms occur
6-24 hours
132
what is the difference between mild, moderate, and severe alcohol withdrawal
mild symptoms with no abnormal vitals
moderate sypmtoms with abnormal vitals
severe with DTs
133
why systems in the body are affected by alochol withdrawal
central nervous system
autonomic nervous system
cognitive function
134
what are contraindications for outpatient treatment of alcohol withdrawal
abnormal lab results
absence of support network
acute illness
high risk of DT
history of withdrawal seizures
long term intake of large amounts of alcohol
poorly controlled chronic medical condition
serious psychiatric condition
severe alcohol withdrawal symptoms
urine screen positive for other substances
135
what medication reduces cravings for alcohol
acamprosate
136
For an ADHD diagnosis, symptoms must have been present no later than age ____
12
137
what is one of the biggest risk factors for developing ADHD
first degree relative with ADHD
138
what are the 3 types of ADHD
inattentive
hyperactive-impulsive
combined
139
what are characteristics of ADHD
motor hyperactivity
restlessness
inattentinon
poor planning
impulsivity
140
what neurotransmitters are involved in ADHD
dopamine and norepi
141
what is the relationship between anxiety and ADHD
anxiety may just be undiagnosed ADHD related to anxiety of their symptoms impairing their daily function
142
is universale screening for ADHD recommended in childhood?
no
143
what other differentials should you screen for when suspecting ADHD
adrenal tumors
substance abuse or addiciton
autism
hyperthyroid
PTSD
sleep disturbances
sleep deprivation
144
is counselling a good choice for monotherapy for ADHD
no, it is best used in conjunction with medcations
145
what neurotransmitter do stimulants act on
dopamine
146
what baseline assessments should be done before starting ADHD medication
full physical, social and medical history
height and weight for BMI
any cardiovascular risk
LFTs
147
what are the first line options for adults for treating ADHD
lisdexamfetamine
methylphenidate
148
what is second line for treating ADHD
the SNRI atomoxetine
149
what should you be watching for in people on stimulants for ADHD
weight loss as it reduces appetite
150
a patient being treated for ADHD reports a sustained erection for the past 5 hours? what is this and what should you recommened?
pripaism - a possible rare side effect of ADHD meds
go to emergency if lasts longer than 4 hours as can cause permanent damage to penis
151
which antidepressants may be used in treating ADHD
atomoxetine
viloxazine
buproprion
venlafaxine
imipramine
152
true or false: people with untreated ADHD are more likely to be in car accidents
true
153
how can the insomnia caused by ADHD medication be managed
taking medication in the morning
154
what are the common adverse effects of ADHD medication
appetite suppression and weight loss
headaches
mood effects
worsening of any present tics
155
which stimulant may slightly increase risk for acute psychosis
amphetamine
156
true or false: stimulants used to treat ADHD may increase risk for substance abuse in the future
false
157
when might you consider suggesting to the psychiatrist that ADHD medication be switched or stopped
sustained tachycardia
orthostatic HoTN
sexual dysfunction
seizures
possible medication diversion
158
are there any natural supplements currently recommended for the treatment of ADHD
possibly free fatty acid supplementation but generally no
159
what is the most commonly diagnosed disorder in children
ADHD
160
true or false: of mood/mental comorbidities are common in children with ADHD
true
161
true or false: a nurse practitioner can independently diagnose a child with ADHD
false, refer all suspected ADHD in children to peds
162
how many symptoms have to be present and for how long for a pediatric diagnosis of ADHD
at least 6 symptoms present for at least 6 months and present before the age of 12
163
what are some negative outcomes that untreated ADHD is associated with
lower educational outcomes
difficulties in personal relationships
increased car accidents
increased incidence of substance use
164
are any labs or DI indicated in assessing children for ADHD? If so, which ones?
no
165
what is the most common comorbidities associated with ADHD
oppositional defiant disorder and conduct disorder
166
true or false: child with epilepsy are less likely to have ADHD
false, ADHD is higher in children with epilepsy
167
What is first line for a child with ADHD who is 4 years old
parent behavior training
168
at what age is medication recommended as first line for children with ADHD
age 6 and older
169
why should psychoeducation and other non-pharmacological methods be included in all care plans for children with ADHD
because there are often comorbidities so non-pharmacological treatment will help for overall wellness
170
what are the two most common stimulants used to treat ADHD in children
methylphenidate or dextroamphetamine
171
when assessing response to treatment of ADHD in children using standardized questionnaires, what must you keep in mind
must be obtained from two or more settings and include direct input from school
172
when starting children on ADHD medication, you should be able to determine if the medication is well tolerated with ____ weeks
2-4 weeks
173
what are the nonstimulant medications used for ADHD in children aged 6-17 and when might they be used
atomoxetine and guanfacine
second line for ADHD or if substance use is a concern as lower risk for abuse and diversion
174
what important teaching needs to be given to parents if children with ADHD are part on guanfacine?
do not stop abruptly, must be tapered, as it can cause rebound HTN and tachycardia
175
when treating ADHD in children with medication, what symptoms are targeted? what will not be targeted?
medications will treat inattention, impulsivity, and hyperactivity
but will not help if the child does not want these things improved or is intentionally disruptive like in conduct disorder
176
which ADHD medication used in children is the only one that is not possibly addictive
atomoxetine
177
as a primary care provider for a child being treated for ADHD, what aspect of the childs life should you be monitoring
growth
sleep
family and social function
178
what age does conduct disorder start?
can begin as early as preschool years but does not typically start after early adolescence
179
what are the characteristics of ODD in children
losing temper
arguing with adults
defying rules
purposely annoying people
blaming others for mistakes
being angry, resentful and spiteful
180
what kind of parenting style increases the risk for a child to have ODD
harsh, inconsistent, neglectful, authoritarian
181
what is the relationship between conduct disorder and ODD in children
untreated ODD often evolves into conduct disorder
182
for children with untreated ODD and/or conduct disorder, what disorder may evolve in adulthood
antisocial behavior
183
what is a common comorbidity of ODD in children
ADHD
184
true or false: ODD increases the risk of suicide in children
true
185
what is the difference between conduct disorder and ODD in children
conduct disorder is more severe and include aggression towards others, destruction of property, theft, or deceit
186
what major red flag should you screen for if a child presents with symptoms of ODD
abuse, neglect or sexual abuse
187
for most children, temper tantrums peak around age ___
3 years old
188
what screening should you do for children presenting with symptoms of ODD
hearing and vision impairement
189
what assessment tool is typically used to monitor the health and development of children under 5
Rourke Baby Record
190
what is first line treatment for ODD in children
parent behavior training
191
when is medication considered for ODD
ONLY if parent behavior training has been tried without effect and condition is severe
192
what are some reasons that parent behavior training may be ineffective as a treatment for ODD in children?
paticularly severe disorder
complicating comorbidity
mistaken diagnosis
complicated psychosocial environment
193
what defines "mild, moderate, and severe" ODD in children
mild - at 1 setting
moderate - at 2 or more settings
severe - 3 or more settings
194
up to 50% of children with MDD may experience this symptom specific to the pediatric population
hallucinations
195
all adolescence with MDD are considered severe if they have a minimum of 5 symptoms AND ____
clear suicidaltiy, plan or recent attempt
psychotic
first degree relative with bipolar
significant impairment
196
how might you differentiate ADHD from MDD in children
children with MDD are not usually impulsive and have normal attention spans before the symptoms begin
197
what medications are contraindicated in treating MDD in children
paroxetine and TCAs
198
what is the most common anxiety disorder in children
separation anxiety disorder
199
when is separation anxiety normal in children? when is it abnormal
normal from 7 months - end of preschool but abnormal from age 5 onwards
200
what is the mean age of presentation for children with separation anxiety disorder
age 9
201
what is treatment for separation anxiety disorder in children
family based treatment, medication not usually used
202
in children, what is the normal "age of the worrier" where children are most likely to have increased worrying that is normal for their age
age 8
203
what is the typical age range for presentation of pediatric generalized anxiety disorder
age 9-18
204
what is the preferred treatment for generalized anxiety disorder in children?
family based interventions or CBT
205
when is pharmacotherapy considered for pediatric GAD? what medications are used?
for older children or adolescence
duloxetine or venlafaxine
206
are benzodiazepines used for treatment of GAD in children
no
207
which childhood anxiety disorder has a strong familial/genetic component
OCD
208
what is best treatment for OCD in children
CBT
209
when is pharmacotherapy used to treat OCD in children and what medication is used?
if severe
SSRI preferred
210
what rare condition should be screened for in children presenting with OCD symptoms
do a throat culture to screen for PANDAS caused by group B strep
211
children under age ___ are usually not treated with pharmacotherapy for mood disorder
under age 6-8
212
true or false: eating disorders increase risk of suicide
true
213
true or false: if the weight is normal, there is no eating disorder
false
214
what are the 2 main types of eating disorders
anorexia nervosa
bulimia nervosa
215
for a patient with anorexia, does lose weight improve or worsen their fear of weight gain
worsen
216
what are the two types of anorexia
restriction type where purging is not used
binge purge type where they may or may not binge but have purging behavior
217
what is the criteria for the severeties of Anorexia
based on BMI but can be adjusted based on symptoms and disability
Mild BMI <17
Moderate BMI 16-16.99
Severe BMI 15-15.99
Extreme BMU <15
218
how do you differentiate OCD from anorexia
considered anorexia if the compulsions and obsessions entirely resolve around food.
Otherwise, if they revolve around anything else, OCD is a comorbidity
219
what other mental health conditions are common with eating disorders
mood disorders
anxiety disorders
bipolar disorder
borderline personality disorder
220
what are physical symptoms of anorexia nervosa
amenorrhea, constipation, abdo pain, cold intolerance, lethary, loss of muscle mass, low BP, low HR, low temp, lanugo, hypercarotenemia
221
when might you see hypertrophy of parotid glands in eating disorders
from induced vomiting
222
what is russel sign
abrasions or scars to dorsum of hand from induced vomiting
223
why are eating disorder patients at increased risk of fracture
more likely to have osteopenia and osteoporosis
224
when do anorexia patients need to be hospitalized
HR below 45-50 or grossly abnormal electrolytes
225
what is the severity of bulimia based on and what are the different severities
the frequency of inappropriate compensatory behaviors (ICP)
Mild: 1-2 ICB/week
Moderate: 4-6 ICB/week
Severe: 8-13 ICB/week
Extreme: 14 or more ICB/week
226
true or false: bulemia is common in obese people
false, although people with bulemia may be overweight, obese people do not often engage in binging
227
what eating disorder often involves eating in secret
bulimia
228
what is binge eating disorder
meets criteria for bulimia but with no purging
229
what is diabulimia and what are the possible consequences
T1DM not taking their insulin to lose weight
hyperglycemia, DKA, coma, death
230
what is EDNOS
eating disorder not otherwise specified
does not fit within another diagnosis but disordered eating present
231
true or false: EDNOS is less severe than other eating disorders
false, it is still very serious with a high mortality rate
232
what is one of the strongest predictors of a future suicide attempt in children
previous suicide attempt
233
what are the danger periods for suicide in children
recent suicide in community or group
within first 4 weeks of depressive episode
within first 4 weeks of starting antidepressant
coming out as LGBTQ
234
what is activation from SSRI and why does it increase risk of suicide
increased energy before feelings of hopelessness recover.
Feelings are still there and now have the energy to complete a plan
235
what type of psychosocial intervention is very effective at preventing suicide
CBT
236
what is the difference between men and women in terms of suicide
attempts higher in women but completions higher in men
237
what group of people have the highest rate of self harm requiring hospitalization
young and teen girls
238
true or false: occasional thoughts of suicide without plans or means is normal at sad times for all ages
false, it is normal for adults and teens but not children
239
what are the 3 aspects of suicidal ideation that need to be assessed
ideation
intent
plan and access to means
240
what is one aspect of someones mood/outlook that is a red flag for suicidality
hopelessness
