Exam 3 - week 7 Flashcards
1
Q
Major components of a mental status exam
A
AAA, speech, mood/affect, thoughts, cognition, insight/judgment
2
Q
3 As of mental status exam
A
appearance, attitude, activity
3
Q
components of thought element of mental status exam
A
thought process, thought content, perceptions
4
Q
what is pressured speech
A
so fast that it is uninterruptable by examiner
5
Q
what is prosody
A
musical quality of speech
6
Q
pressured speech represents
A
mania or stimulant
7
Q
what is speech latency
A
when there’s a long pause before answering a question
8
Q
what are neologisms
A
made up words
9
Q
what is clanging
A
rhyming or musical speech, often seen in mania
10
Q
what is echolalia
A
repetition of interviewer’s words
11
Q
mood vs affect
A
mood is how the patient feels, affect is the outward expression of one’s mood that is observable
12
Q
what is restricted affect
A
when the affect does not change throughout interview ( eg depressed appearing throughout interview)
13
Q
what is flat affect
A
absence of all range of affect
14
Q
what is circumstantial thought process
A
includes too much information and detail
15
Q
what is flight of ideas
A
thought process includes ideas that are barely connected
16
Q
what are delusions
A
fixed false beliefs
17
Q
what are illusions
A
misperception of an actual stimulus
18
Q
what is derealization
A
the feeling that the world is not real
19
Q
what is depersonalizations
A
feeling as thought you are not real
20
Q
what is insight
A
ability to objectively recognize one’s problems and/or need for treatment
21
Q
what is judgment
A
capability of making good decisions based upon the information at hand and ability to understand consequences of one’s behavior
22
Q
MDD demographics
A
more likely in females and young adults with peak incidence in 20s
23
Q
risk factors for MDD
A
neuroticism, ACEs, life stress, family history
24
Q
MDD diagnostic criteria
A
5 or more of the following during 2 weeks, with one of them being either depressed mood or loss of interest:
Depressed mood, loss of interest or pleasure in activities, changes in weight/appetite, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue, worthlessness/guilt, diminished ability to think/indecisiveness, recurrent thoughts of death/SI/suicide attempt
Ssx must be distressing or impair function and must not be attributable to another condition
25
1st line treatments for MDD
CBT and SSRIs
26
alternative treatments for MDD
SNRIs, atypical antidepressants, ECT, ketamine
27
ssx of grief
sadness, rumination, insomnia, poor appetite, with predominant feelings of emptiness and loss
28
how to distinguish grief from MDD
emptiness and loss predominate in grief (depressed mood in MDD), dysphoria in grief comes in waves and decreases over time (more constant in MDD), preoccupation with thoughts of the loss (worthlessness and self-loathing in MDD)
29
definition of MDD with psychotic features
delusions and/or hallucinations present at any time in episode that are mood congruent
30
MDD with psychotic features tx
antidepressants with atypical antipsychotics, ECT
31
what is MDD with seasonal pattern
regular temporal relationship between onset of major depressive episodes and a particular time of year. Remissions also occur during a characteristic time of year. Pattern must last for 2 years with no nonseasonal depressive episodes, and seasonal episodes substantially outnumber nonseasonal episodes during lifetime
32
MDD with seasonal pattern tx
standard MDD tx plus light therapy
33
persistent depressive disorder aka
dysthymia
34
MDD with atypical features features
(must predominate during most recent major depressive episode) mood reactivity plus two or more of the following: weight gain/increase in appetite, hypersomnia (at least 10 hours), leaden paralysis, interpersonal rejection sensitivity
35
treatment for MDD with atypical features
CBT, SSRIs, MAOIs (not first line)
36
mean age of onset for bipolar I
18
37
definition of rapid cycling bipolar I
4 or more mood episodes within 1 year
38
risk factors for bipolar 1
high income country, separated/divorced/widowed, family history
39
Bipolar 1 criteria
at least one manic episode, ssx not better explained by another disorder
40
manic episode criteria
ssx at least 1 week, nearly every day for most of the day. Must include 3 or more of the following: Inflated self-esteem, decreased need for sleep, more talkative, flight of ideas, distractibility, increase in goal-directed activity/psychomotor agitation, activities with high potential for painful consequences.
Ssx must be severe enough to cause impairment or necessitate hospitalization, or psychotic features
41
Bipolar 1 tx
mood stabilizers, atypical antipsychotics
42
average age of onset for bipolar II
mid-20s
43
what happens if someone with depression has a manic episode
they get diagnosed with bipolar I
44
Bipolar II criteria
manic ssx lasting at least 4 consecutive days associated with change in functioning that is observable by others but not severe enough to cause impairment or necessitate hospitalization
45
Bipolar II tx
mood stabilizers, atypical antipsychotics
46
bipolar depression tx
cariprazine, quetiapine, olanzapine+fluoxetine, lurasidone
47
cyclothymic disorder criteria
for at least 2 years, there have been multiple episodes of hypomanic ssx that don't meet criteria for hypomania and multiple episodes of depressive ssx that don't meet criteria for major depressive episode
48
cyclothymic disorder tx
mood stabilizers (lithium, valproic acid, lamotrigine), atypical antipsychotics, psychotherapy, CBT
49
indications for ECT
refractory depression, MDD with psychotic features, catatonia, acute suicidality
50
ECT side effects
headache, disorientation, partial amnesia
51
ECT contraindications
no absolute contraindications, safe in pregnancy
52
suicide risk factors
SAD PERSONS, psychiatric hospitalization, family history of completed suicide, access to firearms
53
SAD PERSONS
sex (male), age (young adult or elderly), depression, previous attempt, ETOH/drugs, Rational thinking loss (psychosis), Sickness (mental illness), Organized plan, No spouse or social support, Stated future intent
54
most important risk factor for suicide
previous attempt
55
most common suicide method in US
firearms
56
postpartum blues onset
within a few days - 2 weeks after delivery
57
postpartum blues duration
2 weeks
58
postpartum blues characteristics
exaggerated emotionality and tearfulness but otherwise things are ok
59
postpartum blues incidence
33-50%
60
MDD-peripartum onset onset
during pregnancy or within 4 weeks of delivery
61
MDD peripartum onset duration
up to 1 year
62
MDD peripartum onset characteristics
feelings of hopelessness, lack of pleasure/interest in usual activities, poor self-care, +/- psychotic ssx, self-harm or harm to infant
63
MDD peripartum onset incidence
10-15%
64
postpartum psychosis onset
abrupt onset, 1 day - 4 weeks after delivery
65
postpartum psychosis duration
up to 1 month
66
postpartum psychosis incidence
0.1-0.2%
67
postpartum psychosis characteristics
sudden onset of psychotic ssx with increased risk of suicide and infanticide, requires hospitalization
68
causes of postpartum blues
emotional stress, changes in hormone levels
69
screening for postpartum blues
Edinburg postpartum depression scale
70
postpartum blues tx
emotional support, practical suggestions
71
MDD with peripartum onset aka
postpartum depression
72
what is the most common psychiatric disorder in the peripartum period
MDD with peripartum onset
73
most significant risk factor for MDD with peripartum onset
previous history of MDD with peripartum onset
74
characteristics of MDD peripartum onset, mild severity
mild disability but can function normally with considerable extra effort
75
characteristics of MDD peripartum onset, moderate severity
maternal dysfunction cannot be overcome with effort, but not incapacitated
76
characteristics of MDD peripartum onset, severe
inability to function in most if not all domains, +/-suicidal ideation
77
what makes peripartum MDD different from MDD
negative thoughts are mainly related to newborn, including feelings of guilt over inability to care for infant. A preoccupation over infant's well-being may obsessive
78
first line medication for peripartum MDD
SSRIs except paroxetine. Paroxetine can be used postpartum
79
paroxetine effect on fetus
primarily congenital cardiac malformations associated with first trimester use
80
non-ssri tx for peripartum MDD
brexanolone, therapy
81
SSRI MOA
selective inhibition of serotonin transporter (SERT)
82
SNRI MOA
inhibit SERT and NE transporter (NET) with greater affinity for inhibiting 5HT reuptake
83
tertiary amine TCA MOA
same as SNRI
84
secondary amine TCA MOA
relatively selective NE reuptake inhibitors
85
mirtazapine MOA
blocks presynaptic alpha-2 receptor mediated inhibition or NE release and the presynaptic 5HT2 receptor-mediated inhibition of serotonin release
86
buproprion MOA
displaces norepi stored in synapttic vesicles, pushing norepi into synaptic cleft
87
MAOI MOA
block breakdown of norepi and 5HT leading to marked increases in their cytoplasmic levels, which are then displaced into synaptic cleft
88
buspirone MOA
5HT1 receptor agonist
89
main side effects of SSRIs
GI (nausea, diarrhea), sexual dysfunction, headache, insomnia, somnolence, anxiety, agitation, weight gain
90
how to offset some side effects of SSRIs (anxiety, sexual dysfunction)
add buspirone
91
which SSRI is preferred for women who may become pregnant
sertraline
92
SNRI side effects
same as SSRIs plus agitation, elevated HR/BP
93
tertiary amine TCA side effects
same as SNRI plus H1 antagonist effects (sedation, increased appetite, etc)
94
secondary amine TCA side effects
CNS activation, increased HR/BP, alpha1 antagonist effects, antimuscarinic effects
95
mirtazepine side effects
sedation, weight gain, withdrawal
96
buproprion side effects
tremors, anxiety, seizures, psychosis
97
MAOI side effects
sexual dysfunction, restlessness, weight gain, postural hypotension with reflex tachycardia
98
serotonin syndrome ssx
delirium/coma, hypertension, tachycardia, hyperthermia, myoclonus, hyperreflexia, tremor, muscle rigidity
99
serotonin syndrome treatment
5HT2 antagonist (cyproheptadine), benzos, supportive care
100
what non-antidepressants can cause serotonin syndrome
ondansetron, tramadol, meperidine, sumatriptan, dextromethorphan, linezolid, MDMA
101
Roquefort cheese syndrome
hypertensive crisis caused by MAOI plus tyramine-containing foods/meds
102
what causes roquefort cheese syndrome when taken with MAOI
some cheeses, some beers/wine, soy products, decongestants
103
roquefort cheese syndrome tx
hydralazine, labetalol, or nicardipine
104
bipolar depression tx
lithium plus antiepileptic (valproate or lamotrigine) +/-atypical antipsychotic
105
how to treat tremors from lithium
atenolol
106
what is psychosis
sustained mental state of loss or impaired touch with reality
107
what are delusions
fixed false beliefs that are not amenable to change in light of conflicting evidence
108
what are persecutory delusions
belief that one is going to be harmed/harassed by an individual, organization, etc
109
most common type of delusion
persecutory
110
what are delusions of reference
belief that certain gestures, comments, environmental cues, etc are directed at oneself
111
what are erotomanic delusions
false belief that another person is in love with you
112
what are nihilistic delusions
conviction that a major catastrophe will occur
113
what are delusions of control
one's body or actions are being acted upon by some outside force
114
what are hallucinations
perception-like experiences that occur without an external stimulus
115
most common type of hallucination in schizophrenia
auditory
116
what is speech derailment
rapid switching from one topic to another
117
what are loose associations
incomprehensible flow of ideas due to lack of logical relation between individual thoughts
118
what is tangentiality
answering questions in a manner that wanders further and further away from the intended point without ever returning
119
what is circumstantiality
same as tangentiality initially but differentiated in that the speaker eventually returns to address the question presented or intended point
120
what is word salad
stringing together of words with not logical association, resembling receptive aphasia
121
what is catatonic behavior
marked decrease in reactivity to the environment
122
what are negative symptoms
characteristics or abilities that the illness takes away from a person
123
negative symptoms associated with schizophrenia
diminished emotional expression, avolition, alogia, anhedonia, asociality
124
what is avolition
decreased motivation for self-initiated purposeful activities
125
what is alogia
diminished speech output
126
schizophrenia onset in males vs females
more common in males; males onset late teens to early 20s. Females onset late 20s to early 30s
127
schizophrenia diagnostic criteria
2 or more of: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative ssx. At least one must be delusions, hallucinations, or disorganized speech. Duration of one month of ssx and 6 months of "signs of disturbance."
128
first line treatment for schizophrenia
atypical antipsychotic, psychosocial interventions, ECT if refractory
129
2 types of schizoaffective disorder
depressive and bipolar
130
clinical features of schizoaffective disorder
major mood episode concurrent with positive schizophrenia ssx, delusions or hallucinations for at least 2 weeks in the absence of major mood episode, ssx that meet criteria for major mood episode are present for the majority of the total duration of active and residual portions of illness
131
how to differentiate schizoaffective, schizophrenia with comorbid mood disorder, mood disorder with psychotic features
in schizophrenia, there are always psychotic ssx with intermittent mood disorder ssx. In mood disorder with psychotic features, there are always mood disorder ssx with intermittent psychotic ssx. In schizoaffective disorder, there can be discrete mood episodes, psychotic episodes, or combined episodes
132
schizoaffective disorder tx
atypical antipsychotics for psychotic features and acute mania, antidepressants for major depression, and psychosocial interventions
133
brief psychotic disorder criteria
same criteria as schizophrenia but only requires 1 and lasts between 1 day and 1 month with eventual full return to baseline
134
brief psychotic disorder tx
antipsychotics (1-3 months)
135
schizophreniform criteria
same criteria as schizophrenia but the episode lasts between 1 and 6 months
136
schizophreniform tx
same as schizophrenia
137
most frequent subtype of delusional disorder
persecutory
138
delusional disorder criteria
presence of at least 1 delusion with a duration of at least 1 month, without markedly impaired functioning
139
jealous type delusion
central theme of individual's delusion is that significant other is unfaithful
140
delusional disorder tx
antipsychotics, psychotherapy
141
schizotypal personality disorder criteria
pervasive pattern of interpersonal deficits marked by acute discomfort with close relationships, cognitive/perceptual distortions, eccentricities of behavior. Begins in early adulthood. Must include 5 of the following: Ideas of reference, odd beliefs or magical thinking, unusual perceptual experiences, odd thinking/speech, suspiciousness or paranoid ideation, inappropriate affect, odd/eccentric behavior or appearance, lack of close friends, social anxiety due to paranoia
142
postpartum psychosis is usually a manifestation of ____
bipolar disorder
143
postpartum psychosis is more common in ____
primiparous women
144
single strongest risk factor for postpartum psychosis
bipolar disorder
145
postpartum psychosis prophylaxis for those with previous episodes
start immediately after delivery: low-dose lorazepam or trazodone for sleep, lithium or antipsychotic to prevent psychosis
