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Behavioral Med 1 > Initial Work-up > Flashcards

Initial Work-up Flashcards

1
Q

DSM-5 no longer uses the axis system, instead the _____ dx is listed first, and the ______ dx follows.

DSM-5 reorganized to reflect the _____ of disorders

If a medical problem is responsible for the mental illness, what is listed first?

A

Principal/major dx is usually listed 1st, minor dx follows

developmental timeline

The medical dx goes 1st

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2
Q

The DSM-5 is a Reference manual w/ very specific dx criteria depending solely upon _____ of specific illnesses

A

S/S characteristic

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3
Q

Aides in ___ between conditions due to its specificity.

It does NOT have any recommendations regarding ___, nor any recommended ____ or other tx

A

DDx

Rx therapy
therapy choices

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4
Q

The DSM-5 provides info on a condition’s ___, ____, ___, ____, many other important factors

A

Prevalence
Development/course
Risk/prognosis
suicide risk

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5
Q

Boundaries between disorder categories are ___over the life course and sx assigned to one d/o may occur in many other d/o

A

fluid

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6
Q

Many mental d/o are on a ___ w/ related d/o that have shared ___

A

spectrum

sx

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7
Q

D/o are organized on ___ and ___ considerations

A

developmental

lifespan

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8
Q

Important Hx questions to ask

A 
Changes in mood
sleep problems
crying episodes
excessive worry
difficulty concentrating
trouble at work/school
change in appetite
memory/relationship problems
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9
Q

___ sxs are more specific hx of onset, frequency, exacerbations and relief

A

Positive

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10
Q

It is important to consider correlations w/ new ___, ___, ____, ____

A

meds
life events
drug use
menstrual cycle

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11
Q

____: Evidence of anhedonia [inability to feel pleasure]; depressed or irritable mood

You can use ___ to screen for this.

A

Depression

“SIGECAPS”

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12
Q

____: Distractible, risky behaviors, grand ideas, poor sleep (extreme, i.e. x2 days)

You can use ____ to screen for this

A

Mania

“DIGFAST”

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13
Q

___ is described as Panic attacks, perseverative thoughts/paranoia, repetitive behaviors, obsessive cleaning or orderly behaviors, traumatic events w/ assoc. dreams/night terrors, panic

A

Anxiety

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14
Q

____ is described as Blunted/unexpressive affect, disorganized speech, hallucinations, delusions (based on something real, but misinterpreted/invented) → usually, psychosis is very easy to detect

A

Psychosis

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15
Q

What does “SIGECAPS” stand for?

A 
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psycho-motor retardation/agitation
Suicide
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16
Q

What does DIGFAST Stand for?

A 
Distractibility
Insomnia
Grandiosity
Flight of ideas
Activities
Speech
Thoughtlessness
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17
Q

What is a syndrome?

A

Collection of sx, tending to occur together, often w/ a predictable course and outcome

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18
Q

In the psychiatric interview, Dx are mostly based on what?

A

The history!

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19
Q

The Mental Status Exam gives you insight to a person’s ___ and ____

A

Thought process

Thought content

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20
Q

____ are the Themes that occupy pts thoughts/perceptual disturbances

Spontaneously expressed worries, thoughts, concerns, SI/HI, phobias

Delusions, hallucinations, illusions, depersonalization

A

Thought content:

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21
Q

_____ is the Formation/coherence of thoughts; inferred through pt’s speech and expression of ideas

Are they vague? Incoherent? Flight of ideas or loose associations?

Do they perseverate [repeat or prolong an action, thought, or utterance after the stimulus that prompted it has ceased]? Thought blocking?

A

Thought process:

22
Q

What is included in the w/u for psychiatric emergencies?

A

assessing if Pt ia a danger to self or others?

The need for dx testing for a medical illness?

communicating with Current tx providers and Family who can give helpful info

Social, environmental, cultural factors relevant to immediate tx decisions

Can pt actively participate in tx?

Specific follow up plan

23
Q

When are times that someone can be place under a Mental Health Hold

A

Someone called police w/ concerns of pt’s safety

Friend/family brings pt to hospital w/ concerns for safety

Intoxication, substance abuse, agitation, depression

24
Q

ED must ‘____’ a pt exhibiting signs of mental illness

A

medically clear

25
Q

What labs may be included in a psychiatric Work up?

(10)

A 
UA/UCx
CBC, 
CMP, 
TSH, 
Vit B12, 
folate
CMP 
renal function
liver functions
glucose level
26
Q

What screening tests may be included in a psychiatric Work up?

A

toxicology screen
blood EtOH (BAL)
pregnancy test

27
Q

What other imaging studies may be included in a psychiatric Work up?

A 
Cardiac function CXR
EKG
ECHO
Neurological function CT or MRI
lumbar puncture (LP)
28
Q

Evidence to use diagnostic testing in psychiatric w/u show:
__% of psych pts had unrecognized medical illness
__% of psych pts had 1+ previously undiagnosed physical dz
__% of psych clinic pts had 1+ physical illnesses

A

46%
92%
43%

29
Q

What are evidence that you should not use diagnostic testing in psychiatric w/u?

A

Most testing should be abandoned in favor of a more clinically driven/cost effective process

Pts w/ primary psychiatric complaints w/ other negative findings do not need ancillary testing in the ED

Medical and substance abuse problems could be identified by initial vital signs together w/ basic H&P

30
Q

The following pts need a full work up before referring to psych: (5)

A 
Elderly
Substance abuse
No prior psych hx
Pre-existing or new medical complaint (self-evident)
Lower socioeconomic status
31
Q

Predictors of Violence include…

A

Abusive language/profanity, loud language
Verbal threats
Wide mood swings
Psychomotor agitation, uncooperative, pacing
Expresses fear for losing control
Intoxicated w/ drugs or alcohol

32
Q

What are some steps you can take to Protect the patient and yourself:

A
  • Do not make direct eye contact
  • Do not block exits
  • Have another individual (or more) in the exam area
  • Keep safe distance from violent pt (6 feet), never turn your back
  • Know your space, exits, potential weapons
  • Approach the pt in a passive, non-confrontational manner
  • Alert the pt that their behavior is scaring the staff
  • Security/police should be visible but far enough away for the pt not to feel immediately threatened/closed-in
  • Never underestimate the potential for violence
33
Q

What are a few tools you can use to De-escalating a potentially violent situation:

A
  • Use Family members or close friends, partners
  • Offer them food or drink
  • Treat them respectfully
  • Ask them if they would like something to relax, can often be honest about type of meds they will be given w/ good effects
  • If pt is not responding, alert them that if their behavior continues to be violent/dangerous, restraints will have to be used
34
Q

What are the 4 types of restraints that can be used?

A

seclusion
physical
chemical
combination

35
Q

Seclusion is no longer used in combination w/ restraints due to ____

Only an option if the pt still has the mental capacity to ____

A

poor outcomes

request it

36
Q

With the use of seclusion you must have constant ___ to ensure pts safety→ security camera, sitter outside, police/guard outside room w/ clear view of pt at all times

A

observation

37
Q 
For Physical restraint you need a 
\_\_\_-point restraint
Ideally need \_\_ individuals to assist
May also use a neck brace to protect against head banging
Face mask (surgical)
A

4

6

38
Q

Chemical restraints may be used with a Dx of

A

General medical etiology
Substance intoxication
Psychiatric disturbance

39
Q

For Physical and seclusion what is required?

A
  • Constant visual monitoring, vital sign monitoring (especially if sedated)
  • Frequent checks w/ documentation of the pt’s status/well-being
  • Careful documentation as to why the pt needed to be restrained
40
Q

Once decided, do not ____, verbalize/explain to the pt why this is happening
If physical restraint, undress pt completely to examine for ___

A

negotiate

weapons

41
Q

___ is 1st line in a disruptive pt who is willing to be cooperative

A

medication

42
Q

If verbal de-escalation is unsuccessful, their behavior is becoming unmanageable, staff feel threatened, you cannot perform dx testing you need in order to tx them, ___ and/or ____ may be necessary

A

physical

chemical restraints

43
Q

What are the 3 classes of drugs you can use for chemical restraints of an agitated pt?

A

Benzodiazepine
Typical antipsychotic
Atypical Antipsychotic

44
Q

What are examples of benzodiazepines?

What are their side effects?

A

Lorazepam
Midazolam

resp. depression, sedation

45
Q

what is the route of administration and onset of action for lorazepam?

A

Route: IV/IM/PO
Onset: 5-30 min

46
Q

what is the route of administration and onset of action for midazolam

A

Route: IV/IM/PO
Onset: 10-30 min

47
Q

What are examples of typical antipsychotics?

What are the Side effects?

A

haloperidol

extrapyramidal sxs
neuroleptic malignant syndrome

48
Q

What is the route of administration and onset of action for haloperidol?

A

Route: Iv/IM/PO
Onset: 30-60 min

49
Q

What are some examples of atypical antipsychotics ?

What are their side effects?

A

Ziprasidone
Risperidone
Olanzapine

QTc prolongation
Orthostatic hypotension

50
Q

what is the route of administration and onset of action for Ziprasidone

A

Route: IM/PO
Onset: 15-20 min

51
Q

what is the route of administration and onset of action for Risperidone

A

Route: PO
Onset: <90 min

52
Q

what is the route of administration and onset of action for Olanzapine

A

Route : IM/ PO

Onset : 15-45 min IM, 3-6 hr PO

Behavioral Med 1 (8 decks)

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