March 23 - Behavioral Science Flashcards
Alcohol withdrawal: four stages
Mild withdrawal: 6-24 hours; anxiety, insomnia, tremors, sweating, palpitations, GI upset, in tact orientation
Seizures: 12-48 hours
Alcoholic hallucinosis: 12-48 hours
Delirium tremens: 48-96 hours; confusion, agitation, fever, tachycardia, HTN, diaphoresis
Mania vs hypomania
Mania: more severe symptms, last at least 1 wk or require hospitalization; impair function (usually can’t work); +/- psychotic features
Hypomania: less severe, lasts at least 4 days, doesn’t cause marked impairment or require hospitalization, no psychotic features
Bipolar I vs bipolar II vs cyclothymic
Bipolar I: manic episode +/- depressive episodes
Bipolar II: hypomanic episode + major depressive episode
Cyclothymic: 2 yrs fluctuating mild hypomanis and depressive symptoms
Acute alcohol intoxication and medical decision making
Lack decision making capacity. Should reassess capacity once sober
Schizoid vs schizotypal
Schizoid: prefer to be loner, detached, unemotional
Shizotypal: eccentric, odd thoughts, perceptions, and behavior but no frank delusions or hallucinations, rarely have close interpersonal relationships because of social anxiety that doesn’t decrease with familiarity
Informed consent
Accurate description of intervention.
Alternative treatments, risks, and benefits
Assessment of patient’s understanding and preference
Need to have adequate knowledge of procedure in order to consent
OD deaths
Most common cause is opioids (prescription and heroin)
Stimulant intoxication symptoms
Paranoia, restlessness, hypervigilence, tachycardia, HTN, diaphoresis. Can get transient paranoid psychosis
Differentiating stimulant-induced psychosis from mania/psychotic disorder
Prominent physical signs, lack of psych history
Brief psychotic disorder
Diagnosis of exclusion - have to rule out substance abuse and medical conditions. Acute onset of over 1 psychotic symptom. Lasts 1 day to 1 month with complete resolution.
Delusional disorder
Over 1 delusion lasting at least a month.
Olanzapine
2nd generation antipsychotic with high risk of metabolic side effects
Lithium monitoring
Routine monitoring of BUN/Cr and thyroid function due to risk of impaired renal function and hypothyroidism
Risperidone
2nd gen antipsychotic with highest risk of increase prolactin
Acute stress disorder vs PTSD
Acute stress disorder lasts 3 days to 1 month
PTSD lasts longer than 1 month
Adjustment disorder with depressed mood
Diagnosed if don’t meet full criteria for ME=DE
Somatic symptom disorder
Preoccupation with unexplained medical symptoms and excessive healthcare use. Manage with regular visits to same provider and avoidance of unnecessary diagnostic testing and specialist visits. Refer to mental health provider only once physican-patient relationship well established
Treatment of drug-induced parkinsonism
Benztropine or trihexyphenidyl (centrally-acting anticholinergics_
PCP vs cocaine vs methamphetamine intoxication
PCP: violence, hallucinations, dissociation, amnesia, nystagmus, ataxia
Cocaine: chest pain and seizures
Methamphetamine: violence, psychosis, diaphoresis, choreiform movements, tooth decay
Different mood stabilizers and their side effects
Lithium
- treats both mania and depression
- can cause hypothyroidism, tremor, diabetes insipidus
Valproate
- hepatotoxicity, NTDs
- treats mania, seizures
Carbamazepine
- causes agranulocytosis, SIADH/hyponatremia, NTDs
- treats mania, seizures
Lamotrigine
- causes rash and SJS
- treats depressive episodes, focal seizures
Citalopram
SSRI
Trazodone MOA and side effects
MOA: serotonin modulator. Antagonizes serotonin receptors, inhibits serotonin reuptake.
Side effects: blocks alpha1 receptors caushing othostatin hypotension. blocks H1 receptors causing sedation. Most serious side effect is priapism (painful erection)- drug should be avoided in sickle cell disease and multiple myeloma which predispose to priapism
Paranoid personality disorder vs delusional disorder
Paranoid personality is pattern of suspiciousness without clear delusions
Delusional disorder is delusions over 1 month without other psychotic symptoms or otherwise bizarre behavior that impairs function
Addressing a possible opioid use disorder
- validate patient’s concern about pain control
- engage in discussion about how patient is using the med
- Explore reasons for escalting use
Reducing prescription transcription errors
Avoid abbreviations and trailing zeros
Imipramine
TCAD
Climipramine
TCAD
Duloxetine
SNRI
Fluvoxamine
SSRI
Paraxetine
SSRI
R vs L frontal lobe damag
L frontal lobe: apathy and depression
R frontal lobe: disinhibited behavior
Clozapine use
Superior in treating resistance schizophrenia
Hospice criteria
Provided to terminally ill with less than 6 mos to live when aggressive, curative treatments no longer beneficial or desired
Relationships between doctors and patients
Never ethical. Shouldn’t suggest that a relationship could exist if patient found a different doctor becuase would encourage them to stop seeing you
Effective discharge
Collaboration between social work, nurse, and physician to talk about meds, follow up, functional status
Discharge checklist with dtailed med instructions, follow up appts, pending labs, emergency contact number
Declining a gift of vale
Express gratitude, explain why can’t accept, avoid any implication that gift was given to gain preferential treatment
Provide discharge checklist to help prevent readmission
Detailed med instructions, follow up appointments, pending lab tests, emergency contact number
Capitation
Payor pays fixed, pretermined fee to over all med services. Payment structure of HMO
Global payment
Insurer pays single payment to cover all expenses associated with an incidence. Common for elective surgeries.
Point of service
PCP required, need referral for specialty consults. Allowed to see provider outside network but at higher cost (distinguishes from HMO)
Treatment of friends
Should be limited to emergencies when no other physician available
Suspected IPV
ensure privacy, nonjudgemental, empathic, open-ended questioning. No pressure to disclose, report, or leave partner. Assess safety and ask about emergency safety plan.
Schizoaffective disorder
MDE or manic episode concurrent with schizophrenia symptoms. Distinguished from depression/bipolar with psychotic features by lifetime history of delusions or hallucinations over 2wks without depression or mania (in depression/bipoarl with psychotic features, psychotic symptoms only occur during mood episodes)
