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Behavioral Medicine > Final > Flashcards

Final Flashcards

1
Q

sleep recommendations for adults

A

at least 7 hours each night

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2
Q

definition of sleep

A

physiological state of relative unconsciousness and inaction of voluntary muscles

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3
Q

REM sleep

A
  • 4-6 episodes per night
  • period almost total muscle atonia
  • nocturnal erections
  • dreaming
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4
Q

NREM stage 1

A
  • slow rolling eye movements

- theta waves

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5
Q

NREM stage 2

A

spindles and K complexes

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6
Q

NREM stage 3 and 4

A
  • delta waves
  • recovery, growth hormone secretion, immune function
  • blood perfusion, metabolic rate, and temperature drop
  • sleep walking and night terrors
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7
Q

sleep regulation

A
  • circadian biological clock regulates timing of sleep and wakefulness
  • diurnal
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8
Q

sleep efficiency and aging

A
  • efficiency decreases with age

- efficiency defined as time asleep versus time in bed

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9
Q

effects of sleep deprivation

A
  • decreased cognition
  • decreased performance
  • decreased perceptions
  • increased carbohydrate cravings
  • possible insulin resistance
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10
Q

insomnia criteria

A
  1. dissatisfaction with sleep quality or quantity
  2. causes significant distress or impairs function
  3. sleep difficulty at least 3 nights per week
  4. sleep difficulty present at least 3 months
  5. not caused/explained by another condition
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11
Q

three different types of insomnia

A
  • inability to fall asleep
  • inability to maintain sleep
  • early morning awakening
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12
Q

psychophysiological insomnia

A
  • somatized tension and learned sleep preventing associations
  • associated decreased functioning during wakefulness
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13
Q

insomnia history and physical

A
  • complete sleep history
  • medical and psych assessment
  • substance use
  • labs
  • sleep diary
  • possible sleep study/actigraphy
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14
Q

polysomnography (sleep study)

A
  • indicated if suspected sleep apnea, periodic limb movements, or parasomnias; insomnia treatment failure
  • not indicated for routine insomnia because of insomnia variability
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15
Q

diphenhydramine/doxylamine sleep aid

A
  • no prescription and inexpensive

- limited studies, residual effects from long T1/2, probable tolerance with repeated nightly use

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16
Q

melatonin

A
  • questionable hypnotic effect
  • not regulated by DEA
  • reports of depression
  • better at affecting circadian patterns
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17
Q

sedating antidepressants

A
  • no defined hypnotic dose
  • few studies on efficacy in treated insomnia unrelated to depression
  • poor side effect profile
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18
Q

benzodiazepines for sleep

A
  • good hypnotic effects
  • potential for abuse
  • reduces stage 3/4
  • rebound insomnia
  • elderly ADE: anterograde amnesia, cognitive/psychomotor degradation
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19
Q

zolpidem (ambien)

A
  • rapid sleep onset
  • does not affect sleep architecture
  • half life 2.5 hours
  • minimal side effects and drug interactions
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20
Q

zaleplon (sonata)

A
  • rapid onset
  • half life one hour
  • no effect on sleep architecture
  • can be used if 4 hours left to sleep
  • unknown habit forming potential
  • minimal side effects and drug interactions
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21
Q

eszopiclone (lunesta)

A
  • rapid sleep onset
  • longer half life
  • good for chronic use and maintenance insomnia
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22
Q

narcolepsy

A

excessive sleepiness associated with

  • cataplexy
  • sleep paralysis
  • hypnagogic hallucinations
  • nocturnal sleep disruption
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23
Q

narcolepsy testing

A
  • multiple sleep latency test shows low sleep onset latency and 2+ sleep onset REM
  • low hypocretin in CSF
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24
Q

narcolepsy treatment

modafinil (provigil)

A
  • no effect on total sleep time

- no suppression of REM

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25
Q 
narcolepsy treatment
sodium oxybate (xyrem)
A
  • anti cataplexy

- taken at bedtime and reduces daytime sleepiness

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26
Q

parasomnia

A
  • unwanted events during sleep
  • nightmare disorder
  • non REM: sleepwalking, sleep terrors
  • REM: acting out dreams
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27
Q

restless legs criteria

A 
"urge"
Urge to move legs
Rest exacerbates symptoms
Getting up improves symptoms
Evening brings worsening onset
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28
Q

Sleep apnea types

A
  • obstructive (most common)

- non obstructive

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29
Q

sleep apnea criteria

A

-sleep study shows
5+ apneic episodes with symptoms
or
15+ episodes without symptoms

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30
Q

sleep apnea treatment

A
  • lose weight
  • avoid alcohol, nicotine, sleep Rx
  • CPAP
  • dental appliance
  • surgery
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31
Q

paraphilic disorder

A

individual primarily seeks sexual gratification through means considered abnormal by society

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32
Q

disorders of sexual orgasm

A
  • female orgasmic disorder
  • premature ejaculation
  • delayed ejaculation
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33
Q

disorders of sexual arousal

A
  • erectile disorder
  • dyspareunia (pain associated with intercourse)
  • vaginismus (involuntary muscle contraction of outer 1/3)
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34
Q

disorders of sexual desire

A

-male/female hypoactive sexual desire disorder

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35
Q

paraphilic disorder criteria

A 
-feel personal distress about desire
or
-have desires that cause other's distress; involve unwilling persons; involve persons who can't give consent
and
occurred over a period of 6 months
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36
Q

exhibitionist

A

compulsive exposure of genitals

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37
Q

fetishistic

A

sexual gratification through objects

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38
Q

frotteuristic

A

touching/rubbing against another person

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39
Q

pedophilic

A

activity with prepubescent child

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40
Q

sexual masochism

A

arousal from being made to suffer

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41
Q

sexual sadism

A

arousal from another person’s suffering

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42
Q

voyeuristic

A

observing another who is naked or engaged in sexual activity

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43
Q

child development

A

biological and psychological changes that occur in human beings between birth and end of adolescence that progresses from dependency to increasing autonomy

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44
Q

ADHD criteria

A
  • persistent pattern of inattention and/or hyperactivity (6 symptoms and 6 months)
  • symptoms present before age 12
  • symptoms in 2 or more settings
  • symptoms interfere with functioning
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45
Q

ADHD stimulants

A
  • ritalin, focalin, dexedrine, adderall, vyvanse
  • schedule II
  • dopamine reuptake blockers
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46
Q

ADHD non stimulant

A

-strattera

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47
Q

stimulant adverse effects

A
  • loss of appetite
  • anorexia
  • insomnia
  • increased BP
  • psychosis
  • sudden cardiac death
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48
Q

autism spectrum disorder screening

A

18 and 24 months

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49
Q

autism spectrum criteria

A
  • persistent deficits in social communication and interaction
  • restricted repetitive patterns of behavior, interests, or activities
  • symptoms present in early development
  • symptoms cause significant impairment
  • no other better explanation
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50
Q

intellectual disability

A
  • deficits in intellectual functioning
  • deficits in adaptive functioning
  • classed as mild, moderate, severe, or profound
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51
Q

oppositional defiance disorder criteria

A
  • pattern of angry/irritable mood, argumentative/defiant behavior, vindictiveness
  • lasts at least 6 months
  • at least 4 symptoms
  • causes impairment in social, academic, or occupational functioning
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52
Q

conduct disorder

A

repetitive and persistent violation of age-appropriate societal norms, rules, or basic rights of others

  • aggression to people and animals
  • destruction of property
  • deceitfulness or theft
  • serious violations of rules
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53
Q

disruptive mood dysregulation disorder

A
  • severe recurrent tantrums that are inconsistent with development level “walking on eggshells”
  • must be present in two settings
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54
Q

tourette’s syndrome criteria

A
  • multiple motor tics
  • one or more vocal tics
  • tics persisted more than 1 year
  • onset prior to 18
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55
Q

tourette’s treatment

A
  • block dopamine receptors

- habit reversal training

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56
Q

tourette’s comorbid conditions

A
  • OCD

- ADHD

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57
Q

physical child abuse signs/symptoms

A
  • unexpected injuries
  • bite marks
  • multiple fractures over time
  • antisocial behavior
  • fear of adults
  • burns with symmetrical edges
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58
Q

child sexual abuse signs/symptoms

A
  • not age appropriate interest/knowledge
  • nightmares and/or bed soiling
  • fear of a particular person
  • drastic change in appetite or behavior
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59
Q

emotional child abuse signs/symptoms

A
  • depression
  • hostility
  • eating disorder
  • social withdrawal
  • apathy or hopelessness
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60
Q

neglect child abuse signs/symptoms

A
  • dirty/unbathed
  • extreme hunger
  • unsuitable clothing for weather
  • lack of apparent supervision
61
Q

child abuse reporting

A
  • suspicion: DHHS

- serious non accidental trauma: police

62
Q

delirium

A

acute onset of a transient confused state due to an identifiable cause

63
Q

delirium criteria

A
  • disturbance of attention and awareness
  • disturbance develops over short period of time and fluctuates during the day
  • disturbance in cognition
  • evidence that cause is physiological consequence of medical condition
64
Q

delirium etiology

A

“I WATCH DEATH”

  • Infection
  • Withdrawal
  • Acute metabolic
  • Trauma
  • CNS pathology
  • Hypoxia
  • Deficiencies
  • Endocrine
  • Acute vascular
  • Toxins or drugs
  • Heavy metals
65
Q

delirium types

A
  • hyperactive (combative, agitated, restless)
  • hypoactive (lethargic, sedated, stupor)
  • mixed

Hypoactive often mistaken for depression

66
Q

diagnosis of neurocognitive disorder

A
  • cognitive decline in 1 or more domains
  • interferes with everyday activities
  • impairment documented by neuropsychological testing
  • chronic and progressive
67
Q

Alzheimer’s disease common cause

A
  • neurofibrillary tangles
  • senile plaques
  • massive loss of synapses correlates with cognitive decline
68
Q

alzheimer’s risk factors

A 
#1 age
#2 genetics
69
Q

alzheimer’s protective factors

A
  • physical activity
  • social activity
  • cognitive activity
  • diet
70
Q

alzheimer’s treatment

A
  • donepezil/aricept (stimulate cholinergic)
  • memantine/namenda (NMDA receptor agonist)
  • vitamin E

slow decline, no reversal

71
Q

somatic system disorder criteria

A

one of the following

  • disproportionate, persistent thoughts about symptom seriousness
  • persistent high anxiety about health/symptoms
  • excessive time/energy devoted to health/symptoms

state persists for >6 months

72
Q

somatic symptom disorder treatment

A
  • validate
  • biofeedback
  • regular visits
  • no narcotics
  • therapy
  • SSRI, SNRI, TCA helpful
73
Q

illness anxiety disorder criteria

A
  • preoccupation with having/acquiring serious illness
  • zero or mild somatic symptoms
  • if risk legit exists then preoccupation is excessive
  • high anxiety about health
  • care seeking or care avoiding type
  • illness preoccupation > 6 months
74
Q

illness anxiety disorder treatment

A
  • take serious
  • regular visits
  • no inappropriate tests ordered
  • CBT
  • SSRI
75
Q

conversion disorder

A
  • one or more symptoms of altered voluntary motor or sensory function
  • clinical findings incompatible with symptoms
76
Q

conversion disorder cause/treatment

A
  • often caused by stressor
  • symptoms typically resolve on their own
  • educate patient
  • CBT
  • PT
77
Q

factitious disorder criteria

A
  • pathologic lying
  • falsification of physical or psychological symptoms
  • recurrent, feigned, or simulated illness
  • deception evident even when no obvious external rewards
78
Q

malingering

A

lying about medical need in order to avoid responsibility or for external gain

79
Q

dissociative identity disorder

A
  • 2 or more distinct personality states
  • gaps in recall of everyday events
  • may be caused by trauma
80
Q

dissociative amnesia

A
  • inability to recall important self-information

- can be selective or generalized information

81
Q

dissociative fugue

A
  • apparently purposeful travel or bewildered wandering

- associated with amnesia of identity

82
Q

depersonalization disorder

A

-experiences of detachment or unreality with respect to one’s thoughts, feelings, or actions

83
Q

derealization disorder

A

-experiences of detachment or unreality with respect to surroundings or own body

84
Q

adjustment disorder

A
  • situational depression
  • symptoms start < 3 months after stressful event
  • symptoms last no longer than 6 months
85
Q

grief

prolonged grief disorder

A
  • overlapping symptoms with depression
  • responds to social contact
  • not usually helped by antidepressant
  • self limited, usually 2-12 months
86
Q

remission

A
  • partial 3-12 months

- full greater than 12 months

87
Q

Lithium monitoring

A
  • narrow therapeutic index
  • level every 3 days until stable and then every 3 months
  • desirable range 0.5-1.5 but in practice 0.8-1.2 mEq/L
  • 1st line drug for bipolar
  • toxic to kidneys at high dose
88
Q

clozapine monitoring

A
  • risk of agranulocytosis (decreased WBC)

- CBC with differential weekly for first 6 months and then every 2 weeks

89
Q

diagnose MDD

A
  • constant symptoms for at least 2 weeks

- 5 of the SIGECAPS and one must be lost of interest

90
Q

CAGE questionnaire

A

Cut down on drinking
Annoyed when asked about drinking
Guilty about drinking
Eye opener in the morning

91
Q

panic disorder

A
  • recurrent, unexpected panic attacks (2 or more)
  • concern about additional attacks
  • worry about the implications of the attack or significant change in behavior related to the attacks
92
Q

panic disorder treatment

A
  1. SSRIs are first choice
  2. benzodiazepine (simultaneous with SSRI then taper)
  3. TCAs (alternative but more AE and lower safety profile)

treat 8-12 months after symptoms controlled

93
Q

OCD treatment

A

-SSRIs are first choice but higher dosages are commonly required

94
Q

persistent depressive disorder

A
  • chronic state of subclinical depression exhibited by a depressed mood for most of the days for at least 2 years
  • can’t go more than 2 months without symptoms
  • no previous manic episodes
  • don’t meet criteria for MDD
95
Q

manic episode

A

distinct period of abnormal and persistently elevated, expansive, or irritable mood lasting at least 1 week (or any duration if hospitalization is needed)

96
Q

hypomania episode

A
  • distinct period different from usual non-depressed mood lasting at least 4 days
  • does not impair functioning and no psychotic features
97
Q

Bipolar I criteria

A
  • at least one manic episode
  • symptoms not explained by another disorder
  • psychosis, marked impairment daily life, hospitalization
98
Q

Bipolar II criteria

A
  • one hypomania
  • one major depressive episode
  • symptoms not explained by another disorder
  • no psychosis or life altering impairement
99
Q

cyclothymic disorder

A
  • for at least 2 years (1 yr kids)
  • numerous periods of hypomanic symptoms that don’t meet hypomania criteria
  • numerous periods of depressive episodes that don’t meet MDD criteria
  • symptoms present at least half the time and not absent for more than 2 months
100
Q

schizophrenia diagnostic criteria

A
  • 2 characteristic symptoms of psychosis (hallucinations, delusions, disorganized speech, disorganized behavior, negative symptoms)
  • lasts at least 6 months with 1 month of characteristic symptoms
  • social and/or occupational dysfunction
  • exclude other disorders
101
Q

schizophreniform disorder

A
  • one to six months of symptoms

- social/occupational impairment not required

102
Q

schizoaffective disorder

A
  • psychotic symptoms plus prominent mood symptoms

- two week period of psychotic symptoms without mood symptoms

103
Q

delusional disorder

A
  • delusions for at least 1 month

- no other criteria met

104
Q

brief psychotic disorder

A
  • one of the characteristic symptoms

- time range one day to one month

105
Q

substance induced psychotic disorder

A

-hallucinations or delusions during or within one month of substance abuse

106
Q

SSRIs drugs

A

“Effective For Sadness Panic Compulsions”

  • escitalopram (lexapro)
  • fluoxetine (prozac)
  • fluvoxamine (paxil)
  • sertraline (zoloft)
  • paroxetine (paxil)
  • citalopram (celexa)
107
Q

SSRI+ drugs

A

vilazadone (viibryd)
vortioxetine (trintellix)

SSRI and partial serotonin agonist

108
Q

SNRI drugs

A

desvenlafaxine (pristiq)
duloxetine (cymbalta)
venlafaxine (effexor)

also used for peripheral pain and neuropathy

109
Q

SSRI side effects

A
  • GI upset
  • sexual dysfunction
  • activation/akathisia (will go away)
  • mania
  • SI in younger patients
  • serotonin syndrome
110
Q

serotonin syndrome

A
  • potentially fatal
  • can be caused by combining an SSRI/SNRI with an MAOI (should separate by 5 weeks)
  • takes 24-48 hours to develop
  • variable mental status
  • increased muscle tone
  • HTN, tachycardia, tachypnea, fever
  • hyperreflexia
  • mydriasis
  • increased bowel sounds
111
Q

bupropion (wellbutrin)

A
  • atypical antidepressant
  • do not use in patient with seizure history
  • often used as adjunct with SSRI
112
Q

mirtazapine (remeron)

A
  • atypical antidepressant
  • also used as sleep aid
  • AE: weight gain
113
Q

trazodone (desyrel)

A
  • atypical antidepressant
  • also used as sleep aid
  • AE: priaprism
114
Q

esketamine (spravato)

A
  • used for treatment resistant depressant as an adjunct to other antidepressants
  • patients monitored for 2 hours after dose for hallucinations
  • not used in pregnancy
  • AE: dissociative and perceptual changes, derealization, depersonalization, HTN
115
Q

tricyclics

A
  • 2nd/3rd line for Rx resistant depression
  • OD causes fatal cardiac arrhythmias
  • be aware of suicidal ideations when prescribing
  • amitriptyline, clomipramine
116
Q

tricyclic side effects

A
  • cardiac toxicity (LBBB, V-tach)

- anticholinergic effects

117
Q

MAOI

A
  • use is very uncommon

- avoid tyramine containing foods due to HTN crisis

118
Q

SNRI side effects

A

same as SSRIs plus HTN

119
Q

benzodiazepine side effects

A
  • sedation
  • fatigue
  • disinhibition
  • depression
  • rebound anxiety
  • elderly: memory impairment, impaired performance, lowered attention span, muscle incoordination
120
Q

buspirone (buspar)

A
  • anxiolytic for anxiety only
  • don’t cross react with alcohol or benzos
  • little abuse potential
  • may take 1-2 weeks to show effect with max effect 3-4 weeks
  • mixed results on efficacy
121
Q

hydroxyzine (vistaril, atarax)

A
  • antihistamine
  • anxiolytic
  • treat agitation in alcohol detox
  • adjunct for insomnia
122
Q

typical antipsychotics drugs

A

-haldol

  • prolixin
  • thorazine
123
Q

atypical antipsychotics

A
  • onlanzapine (zyprexa)
  • risperidone (risperdal)
  • clozapine (clozaril)
  • aripiprazole (abilify)
  • quetiapine (seroquel)
  • ziprasidone (geodon)
124
Q

side effects of typical antipsychotics

A
  • extrapyramidal symptoms
  • tardive dyskinesia
  • sedation
  • neuroleptic malignant syndrome
  • weight gain
  • orthostatic hypotension
  • QT prolongation
125
Q

neuroleptic malignant syndrome

A
  • result of too much dopamine and occurs over few weeks/months
  • variable mental status
  • increased muscle tone
  • HTN, tachycardia, tachypnea, fever
  • hyporeflexia
  • normal pupils
  • normal bowel sounds
126
Q

atypical antipsychotic side effects

A
  • weight gain
  • hyperlipidemia
  • DM
  • clozapine = agranulocytosis
127
Q

quetiapine (seroquel)

A
  • highly sedating
  • adjunct for severe depression or bipolar
  • AE: orthostatic hypotension
128
Q

aripiprazole (abilify)

A
  • partial D2 antagonist
  • uses: schizophrenia, bipolar, agitation, MDD
  • AE: akathisia, nausea, anxiety, headache, insomnia, sedation
129
Q

lithium

A
  • mood stabilizer
  • 1st line for bipolar mania
  • narrow therapeutic index
130
Q

lithium side effects

A
  • diabetes insipidus
  • renal toxicity
  • tremor
  • hypothyroidism
131
Q

valproic acid (depakote, depakene)

A
  • 2nd line mood stabilizer

- AE: ototoxicity, teratogenic, low platelet

132
Q

paranoid personality disorder

A
  • cluster A
  • pervasive distrust of others
  • principal ego defense is projection
  • Tx: CBT
133
Q

schizoid personality disorder

A
  • detached and solitary, but well functioning

- no desire for social interaction

134
Q

schizotypal personality disorder

A
  • odd beliefs, magical thinking
  • suspicious or fearful of others
  • avoids social interaction due to fear
135
Q

antisocial personality disorder

A
  • lack of concern or remorse
  • aggressive and reckless
  • mental disorder most associated with crime
136
Q

antisocial personality disorder diagnostic criteria

A
  • at least 18
  • evidence of conduct disorder before 15
  • occurrence of behavior is not exclusively during schizophrenia or manic episode
137
Q

borderline personality disorder

A
  • unstable relationships
  • unstable self image
  • anger outburst
  • frequent SI/harm threats
  • fear of abandonment
  • Tx: dialectical behavior therapy
138
Q

histrionic personality disorder

A
  • excessive emotions, attention seeking
  • seductive and provocative behavior
  • shallow expression of emotion
  • self dramatization
139
Q

narcissistic personality disorder

A
  • grandiose sense of self importance
  • requires excessive admiration
  • sense of entitlement
  • exploits others
  • lacks empathy
  • arrogant
140
Q

avoidant personality disorder

A
  • social inhibition
  • feeling inadequate
  • hypersensitive to negative evaluation
141
Q

dependent personality disorder

A
  • need to be taken care of
  • submissive and clinging behavior
  • fear of separation
142
Q

obsessive compulsive personality disorder

A
  • perfectionism that interferes with task completion

- over conscientious, scrupulous, and inflexible

143
Q

anorexia restricting type

A
  • weight loss through dieting, fasting, excessive exercise

- no binging or purging for the last 3 months

144
Q

anorexia binge/purge type

A

in the last 3 months recurrent binge/purge episodes

145
Q

bulimia nervosa

A
  • recurrent episodes of binge/purge
  • at least once a week for 3 months
  • maintains normal or above body weight
  • dental caries, esophageal tears, parotid or salivary gland enlargement
146
Q

alcohol use disorder

A
  • presence of at least 2 symptoms
  • mild 2-3
  • moderate 4-5
  • severe 6 or more
147
Q

wernicke encephalopathy

A
  • reversible
  • acute thiamine deficiency
  • triad: delirium, ocular motor dysfunction, ataxia
148
Q

korsakoff syndrome

A
  • irreversible
  • chronic thiamine deficiency
  • anterograde amnesia and confabulation

Behavioral Medicine (5 decks)

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