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Mental health Flashcards

1
Q

Generalized anxiety disorder:

  • excessive worrying occurring _______ over a period of ______
  • impairs functioning in _______
A
  • more days than not
  • over a period of 6 or more months
  • impairs functioning in social, work, home environment
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2
Q

Generalized anxiety disorder:

Examples of medical conditions with similar symptoms:

Examples of substances with similar symptoms:

A

hyperthyroidism, pheochromocytoma, hyperparathyroidism; tumour, hypoglycemia, Cushing’s, epilepsy

Substances:
-caffeine, albuterol, levothyroxine, decongestants, substance withdrawal

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3
Q

Generalized anxiety disorder:

Two specific areas to assess during history

Two specific ROS for physical exam

A
  • safety risk every visit
  • substances
  • CVS
  • thyroid
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4
Q

Generalized anxiety disorder:

First line treatment drug class and example

A

SSRI

Fluoxetine (Prozac), paroxetine (Paxil), Sertraline (Zoloft), Escitalopram, Citalopram (Celexa), Venlafaxine (Effexor)

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5
Q

Generalized anxiety disorder:

Patient education points

  • meds:
  • lifestyle:
A
  • medications can take 4-6 weeks to take effect
  • should not stop meds abruptly, need gradual taper if stopping
  • self-calming: deep breathing, mindfulness, relaxation
  • sleep hygiene
  • management of stress and triggers (caffeine, nicotine, stimulants)
  • smoking cessation
  • exercise
  • avoid ETOH with benzos
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6
Q

Generalized anxiety disorder:

Prescribing benzos: limit use to prevent ______

Two considerations for safe prescribing of benzos:

A

-tolerance, dependence, side effects (sedation, confusion)

  1. Check Pharmanet every time
  2. Pt education re: concurrent use of alcohol and/or opioids
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7
Q

Generalized anxiety disorder:

Follow up in ________
Assess ______ during every follow up

A
  • f/u in 1-2 weeks

- safety assessment (suicide risk) every visit

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8
Q

ADHD

Symptoms of persistent _____, _____ and/or _______

Negatively affects:

A
  • hyperactivity (speech/motor)
  • impulsivity (risk taking, impatience)
  • inattention (daydreaming, doesn’t finish tasks, concentration)

Poor school performance
Poor peer relationships

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9
Q

ADHD

Risk factors: (3 categories)

A

ADHD Risk factors

  • family hx
  • environmental exposure (lead, organophosphates)
  • perinatal (hypoxia, maternal smoking/substance use, prolonged labour, low birth weight)
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10
Q

ADHD

History components:

A
  • duration of symptoms
  • settings in which symptoms are present (home/school/work)
  • complete developmental hx: prenatal and perinatal events, motor/language/social milestones, behaviour
  • substance use
  • Family, social, school, lifestyle (sleep, exercise, screen time)
  • Academic progress: report cards
  • Meds: theophylline, prednisone, albuterol
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11
Q

ADHD

Physical exam:
-special focus on:

-focused exam on 4 systems:

A

wt and ht (especially for children, side effects of anorexia and growth suppression for meds)

CVS, resp, thyroid, neuro exam

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12
Q

ADHD

First line management drug class and example

A

Stimulants

Methylphenidate (Ritalin), Dextroamphetamine (Dexedrine), Amphetamine-dextroamphetamine (Adderall)

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13
Q

ADHD

Precaution with prescribing of stimulants

A
  • assess CV risk (family hx)
  • monitor BP and HR

Caution with:
-hx of substance use, anxiety, renal impairment, epilepsy (monitor plasma level of meds), Raynaud’s, family hx of Tourettes (can worsen tics)

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14
Q

ADHD

Contraindications to prescribing stimulants

A
  • MAOIs
  • glaucoma
  • hx of mania/psychosis
  • untreated hypertension or symptomatic CVD
  • untreated hyperthyroidism
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15
Q

ADHD

Common side effects of stimulants

A
  • appetite suppression
  • insomnia
  • growth suppression
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16
Q

ADHD

Pt education

A
  • Promoting structured life/home: priorities, reminders, timers/apps for deadlines
  • Classroom/work management
  • Regular exercise (mod to large effect on core symptoms)
  • Psychoeducation for parents
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17
Q

ADHD Rx

Recommended options if concurrent/hx of substance use:

Recommended options if co-morbid depression

A

Substance use:
-Vyvanse, Bupropion, Strattera

Co-morbid depression:
-Bupropion, Venlafaxine

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18
Q

ADHD

Follow up in ____
What to review in follow up:

A

F/U in 2-4 weeks

  • sleep
  • compliance with meds
  • side effects
  • BP and HR
  • ht and wt
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19
Q

GAD

Common somatic symptoms

A 
dizziness
GI upset/nausea
chest pain/SOB
fatigue
sweating
chronic headaches
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20
Q

What are the 5 stages of grief?

A
  • denial
  • anger
  • bargaining
  • depression
  • acceptance
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21
Q

Acute grief reaction

Specific areas to assess during visit:

Diagnostic tools:

A

SWIGECAPS

  • personal hx of moment of loss
  • relationship to deceased
  • significant anniversary dates
  • substance use
  • supports
  • safety risk assessment

Mental health exam
GAD-7 , PHQ-9

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22
Q

What is the first line treatment for acute grief reaction?

A
  • acute grief will resolve on its own without intervention
  • encourage supports from family, friends, community resources
  • psychotherapy NOT routinely recommended if no underlying MH conditions
  • prescriptions are NOT routinely recommended
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23
Q

Intimate partner violence

  • what is the key risk factor?
  • other risk factors?
A

key risk: female gender :(

BIPOC
pregnancy
history of violence (childhood, family of origin)
lack of social supports
poverty
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24
Q

Intimate partner violence often presents with chronic physical somatic concerns such as:
(3 broad systems)

A
  • neuro (headaches, dizziness)
  • GI (IBS, ulcers)
  • GU (STIs, UTIs, unwanted pregnancies, pelvic pain)
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25
Q

Health consequences of insomnia:

A

Increased risk of CVD, HTN, depression, anxiety

Affects mental functioning, efficiency
Cause of accidents

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26
Q

Insomnia

What drug classes can cause insomnia?

A
  • steroids
  • methylphenidate
  • ephedrine
  • decongestants
  • bronchodilators
  • thyroid
  • MAOIs
  • weight loss/diet pills
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27
Q

Chronic insomnia (defined by DSM-5) is associated with ______ and impairment of ______ lasting ____ months for _____ nights/week despite ________

A
  • associated with distress
  • impairs daytime functioning
  • lasts 3+ months
  • 3+ nights/week
  • despite adequate opportunity for sleep
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28
Q

What do you assess for with insomnia history?

A
  • thorough history of sleep issue: sleep diary for 1-2 weeks
  • sleep hygiene
  • meal and exercise time
  • trouble falling asleep vs staying asleep vs early morning wakening
  • substance use
  • stressors
  • snoring and apneic periods (collateral from partner)
  • CVS: orthopnea, PND, nocturnal angina
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29
Q

Insomnia

Always screen for: (3 conditions)

In geriatrics, assess for (3 conditions)

A
  • OSA
  • Depression (PHQ-9)
  • Anxiety (GAD-7)

Geriatrics:

  • depression
  • chronic pain
  • polypharmacy
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30
Q

What is the first line treatment for acute and chronic insomnia?

A

CBT-I

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31
Q

When prescribing medications for insomnia, limit to _____ (time) with ______

A

1-2 weeks (no more than 1 month)

NO refills

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32
Q

Zopiclone

  • drug class
  • MOA
  • usual dose
  • limit rx to _____ days
  • most common side effects
  • cognitive side effects
  • precautions:
  • avoid use in:
A

Drug class: non-BZD hypnotic

MOA: GABA agonist (reduces sleep latency, increases sleep duration, decrease wakening)

Usual dose: 3.75-7.5 mg
*limit rx to 7-10 days

Side effects: bitter taste, daytime sedation

Anterograde amnesia (must be able to have a full night's sleep)
Impaired daytime functioning (driving impaired x 11 hours)

Precautions: risk of tolerance and dependence, can induce complex sleep behaviours

Avoid use in: elderly, severe resp impairment (sleep apnea), myasthenia gravis, hx of complex sleep behaviours

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33
Q

Doxepin

  • drug class
  • MOA
  • indication
  • usual dose
  • timing with food?
  • most common side effects
  • cognitive side effects
  • precautions:
  • contraindications:
A

Drug class: TCA, H1 receptor antagonist

MOA: inhibits reuptake of serotonin and norepinephrine in CNS

Indication: only for sleep maintenance

Usual dose: 3-6 mg 30 min before bedtime
-avoid within 3 hours of meals

Side effects: dry mouth, sedation, constipation, nausea, URTI
Cognitive: no impact
*minimal risk of tolerance and dependence

Contraindications: glaucoma, urinary retention, use of MAO-I x 14 days prior, acute CHF/MI

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34
Q

Trazodone

  • drug class
  • MOA
  • usual dose
  • benefits (less risk of ______ and ______)
  • common side effects: (3)
  • precautions:
A

Drug class: antidepressant

MOA: inhibits re-uptake of serotonin, also blocks H1 and alpha-1 adrenergic receptors

Usual dose: 25-100 mg
Benefits: short half life (less risk morning hangover), less risk of tolerance/dependence

Side effects: sedation, orthostatic hypotension (risk of falls), cardiac arrhythmias (serious), rare priaprism

Precautions: prolonged QT (be careful if existing cardiac condition), CYP, serotonin syndrome
always monitor suicide risk with antidepressants

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35
Q

PTSD

Predisposing risk factors:

A

Risk factors:

  • age at trauma
  • poor psychosocial support
  • previous history of trauma
  • general childhood adversity
  • lower education, lower SES
  • hx of other MH conditions
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36
Q

PTSD is often comorbid with:

  • MH conditions: (3)
  • Physical conditions: (7)
A
  • depression (high risk of suicide)
  • anxiety
  • substance use

Physical:

  • somatic symptoms
  • obesity
  • dyslipidemia
  • HTN
  • DM
  • dementia
  • IBS
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37
Q

What are the 5 cardinal symptoms of PTSD?

Symptoms must be present for _______ (length of time)

A
  • traumatic event: must be extreme
  • intrusive symptoms: re-experiencing memories that are recurrent, involuntary, intrusive and distressing
  • avoidance of people/places/things that remind of trauma
  • negative mood and thoughts associated with trauma
  • chronic hyperarousal

Symptoms must be present for over one month

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38
Q

What are the 2 thought patterns seen in dissociative PTSD?

Dissociative PTSD is linked to high rate of _____ and ______

A
  • depersonalization “this body is not mine”
  • derealization “this world is not real”

High rate of impairment, comorbidity and suicide

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39
Q

PTSD

What broad types of pts are at high risk and should be screened?

A
  • victims of sexual assault
  • military in combat zones
  • survivors of disasters
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40
Q

PTSD can be screened using a validated screening tool

Also assess for these 3 S’s

A
  • suicide risk/safety
  • substance
  • sleep
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41
Q

What is first line treatment for PTSD?

A

Trauma focused psychotherapy (first)

SSRI or SNRI

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42
Q

Give an example of first line pharmacotherapy option for PTSD

Drug class:
MOA:
Initial dose:
Precautions: (3)
Contraindications:
A

Sertraline (Zoloft)

Drug class: SSRI antidepressant
MOA: assists with intrusive thoughts, flashbacks, irritability, anger
Dosing: Sertraline 50 mg OD initial dose
Precautions: activation of mania/hypomania (if bipolar), serotonin syndrome, prolonged QT
Contraindications: use of MAOIs x 14 days
Common adverse reactions: nausea, diarrhea, dry mouth, insomnia, dizziness, sexual dysfunction (ejaculatory delay, orgasm disturbance, ED, ↓ libido)
Monitoring: will take 6-8 weeks to achieve full benefit

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43
Q

What are some common side effects with SERTRALINE?

What is one aspect to counsel pts about with sertraline re: effect?

A

Common adverse reactions: nausea, diarrhea, dry mouth, insomnia, dizziness, sexual dysfunction (ejaculatory delay, orgasm disturbance, ED, ↓ libido)

-will take 2-4 weeks for initial effect, 6-8 weeks to achieve full benefit

44
Q

PTSD

What is an adjunct therapy used for sleep disturbance/nightmares?

What is an adjunct therapy used for concurrent BPD?

A

Sleep: Prazosin (minipress) - alpha-adrenergic blocker

BPD: DBT

45
Q

PTSD

Medications, once stabilized, should continue for ________ to prevent relapse/recurrence

Always assess for these 3 at follow up visits

A

6-12 months

Mood
Suicide/safety
Substance use

46
Q

GAD

What are the two questions to ask during GAD-2 screen?

A

Over the last 2 weeks, how often have you been bothered by the following problems:

  1. Feeling nervous, anxious or on edge
  2. Not being able to stop or control worrying
47
Q

Grief

Prolonged/complicated grief persists for ________ (time) after the loss

A

6-12 months

48
Q

What are some risk factors for chronic insomnia?

A

Predisposing risk factors:

  • age (30-59)
  • Substances: ETOH, tolerance to hypnotic meds, stimulants (caffeine, nicotine, amphetamines, hallucinogens)
  • women with fibromyalgia and menopause
49
Q

What OTC and Rx medications commonly contribute to sleep disorders?

A

Medications:

-steroids, methylphenidate, ephedrine, decongestants, bronchodilators, thyroid meds, MAOIs, weight loss/diet pills

50
Q

Insomnia:

Early morning wakening is defined as:

A

waking up (termination of sleep) 30+ minutes before desired wake up time

51
Q

Alcohol use disorder

Binge drinking definition for
-males: ___ drinks on at least ____ in last _____ days

-females ____drinks on at least _____ in last _____ days

Heavy ETOH use = binge drinking on ___ days in last 30 days

A
  • males 5+ drinks on at least 1 day in last 30 days
  • females 4+ drinks on at least 1 day in last 30 days

Heavy ETOH: binge drinking on 5+ days in last 30 days

52
Q

Canada Low Risk Drinking Guidelines

Risky drinking is defined as:
males: __ drinks/day or ___ drinks/week

females: ___ drinks/day or ___ drinks/week

A

Males: 3+ drinks/day or 15+ drinks/week

Females: 2+ drinks/day or 10+ drinks/week

53
Q

How often should adults and youth be screened for alcohol use?

A

annually

54
Q

What does CAGE stand for?

A

Cut down
Annoyed
Guilty
Eye-opener

55
Q

What are some signs and symptoms of ETOH withdrawal?

A

n/v, tachycardia, diaphoresis, anxiety, agitation, tremors, dizziness, hallucinations (tactile, auditory, visual), paresthesia, piloerection, rhinorrhea, tremors

(think about what is asked on CIWA)

56
Q

What is the AST: ALT ratio that signifies significant ETOH use?

A

> 2:1 AST: ALT

57
Q

What are the two first line treatment options for alcohol use disorder?

  • mechanism of action?
  • treatment goal?
  • contraindications
A

NALTREXONE

  • opiate receptor antagonist
  • goal of reduction OR abstinence
  • contraindicated with opiate use, acute liver failure/hepatitis

ACAMPROSATE

  • MoA r/t GABA and glutamate
  • goal of abstinence
  • contraindicated with breastfeeding and severe renal impairment
58
Q

What are the 3 multivitamins to supplement with ETOH use disorder?

A

Thiamine 100 mg
Folic acid 1 mg
B6 2 mg

59
Q

OCD

define obsession and compulsion

A

obsession: unwanted persistent intrusive thoughts/impulses
compulsion: unwanted repetitive act that neutralizes/prevents discomfort

60
Q

What are the 4 core features of Borderline Personality Disorder?

A
  • RELATEDNESS: instability of interpersonal relationships
  • self image: unstable
  • AFFECT: labile, angry, efforts to avoid abandonment
  • BEHAVIOUR: marked impulsivity, suicidality/threats
61
Q

What are common MH co-morbidities that exist with BPD?

PESANS

A 
PTSD
Eating disorder
Substance use disorder 
Antisocial personality disorder 
Narcissistic personality disorder 
Schizotypal personality disorder
62
Q

Borderline personality disorder

describe 3 examples of behaviour dysregulation

A
  • impulsivity
  • suicidality (8-12% will die by suicide)
  • self-harm behaviour
63
Q

Borderline personality disorder

describe 3 examples of affective dysregulation

A
  • labile affect
  • excess anger
  • efforts to avoid rea/imagined abandonment
64
Q

Borderline personality disorder

describe 3 examples of impaired relationships

A
  • unstable relationship with others (intense, splitting)
  • chronic emptiness
  • transient identity disturbance (paranoid ideation/dissociative symptoms)
65
Q

What is the ideal treatment strategy when working with people with borderline personality disorder?

A
  • communication
  • collaboration between clinicians
  • clear boundaries re: relationship and behaviours
  • set limits
  • encourage pts to take responsibility for actions and problems
66
Q

What is the first line psychotherapy strategy for borderline personality disorder?
-what does it focus on?

A

DBT
-dialectical behaviour therapy

focus on increase coping skills and helping with emotional regulation

67
Q

Schizophrenia affects a person’s _____, _____ and ______

A

cognition
perception (distorted)
affect (inappropriate/blunted)

68
Q

What are some risk factors for development of schizophrenia?

A

-living in urban area
-immigration
-late winter/early spring birth??
-advanced paternal age at conception
-inflammatory conditions (eg celiac, interstitial cystitis, thyrotoxicosis)
SUBSTANCE use: cannabis and nicotine

69
Q

What is the criteria for duration of symptoms for diagnosis of schizophrenia?

A

6 months of poor functioning with one month of active symptoms

70
Q

Define

  • hallucination

- illusion

A

Hallucination:

  • can occur in any sensory modality
  • sensory perceptions in ABSENCE of corresponding external stimulus

Illusions:
-distortion of an actual stimulus
ie misinterpretation of external stimulus (common with drug induced)

71
Q

What is a delusion?

-examples of delusion?

A

Delusion: fixed false belief

• Being followed or monitored
• Being plotted against
• Having special abilities or "powers" 
• Certain songs or comments are specifically directed toward oneself or communicating a hidden message
• Being controlled by forces or other individuals
• Having one's thoughts broadcast so others can hear them Can seem 100% real to person
72
Q

What are some prodromal and soft signs of PSYCHOSIS?

A

Prodromal:

  • social withdrawal
  • reduced concentration
  • attention
  • depressed mood
  • sleep disturbance
  • anxiety -suspiciousness
  • skipping school or work
  • irritability

Soft signs: -Unusually intense affect

  • vagueness
  • very mild thought disorder
  • Preoccupation with incident from distant past
  • Expectation of familiarity from interviewer
  • latency or thought blocking
  • odd statements or beliefs
73
Q

Schizophrenia:

define negative symptoms
-give examples

A

Negative symptoms: reduction in normal function

* Blunted affect
* Emotional withdrawal
* Poor rapport
* Passivity
* Apathetic social withdrawal
* Difficulty in abstract thinking
* Lack of spontaneity
* Stereotyped thinking
* Alogia (reduced fluency or poverty of speech)
* Avolition (lack of motivation)
* Anhedonia (lack of pleasure)
* Attentional impairment
74
Q

Schizophrenia

-examples of positive symptoms

A
  • Delusions
    • Hallucinations
    • Distortions in communication
    • Disorganized speech
    • Disorganized behavior
    • Catatonic behavior
    • Agitation
75
Q

Schizophrenia

-what is the drug class (first line) for treatment? examples?

A

-Atypical anti-pyschotics

eg
Quetiapine (seroquel)
Aripriprazole (Abilify)
Palpiperidone (Invega)
Clozapine (clozaril)
76
Q

Atypical antipsychotics:

-3 common side effects

Clozapine has risk of ______ and _____
-monitoring?

A
  • metabolic syndrome
  • weight gain
  • prolonged QTc

Clozapine:

  • cardiac complications
  • blood dyscrasis
  • monthly CBCs and regular metabolic monitoring
77
Q

OUD

Tolerance is defined as either:

  • need for:
  • diminished effect with:
A
  • increased amt of opioids to achieve intoxication/desired effect
  • Diminished effect with continued use of same amt of opioid
78
Q

OUD

Withdrawal manifests as either:

  • characteristic:
  • same/related:
A
  • characteristic opioid withdrawal syndrome

- same/related substance to relieve/avoid withdrawal symptoms

79
Q

What question do you ask all patients to screen for opioid use disorder?

A

“how many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?”

80
Q

Signs and symptoms of opioid withdrawal

A 
• Flu-like symptoms
	• Runny nose
	• Nausea, vomiting, diarrhea, stomach cramps
	• Restlessness
	• Yawning
	• Pupil dilation
	• Tremors/shaking
	• Anxiety, irritability
Strong desire to use opioids
81
Q

Opioid use disorder

Questions to ask during detailed substance use history

A
  • current and past use of ETOH, stimulants, BZD, opioids, sedatives, Rx meds
  • amt, frequency, route of use
  • past treatment history with OAT
  • past withdrawal management
  • past treatment interventions (A+D counselling, support groups)
  • past residential treatment
  • length of sobriety
  • history of OD
82
Q

Opioid use disorder

Baseline labs?

A
  • CBC, Cr, LFT, HIV, HBV/HCV, syphilis, GC/CT
  • preg test

Lab UDS:
*need to explicitly ask for fentanyl and synthetic opioids (buprenorphine, oxy, HM)

83
Q

Requirements for home induction for suboxone?

A
  • ability to store meds safely, -reliable caregiver at home (esp for youth)
  • previous provider experience with suboxone
  • barriers to office induction
84
Q

What do you assess for in follow up visits for OUD?

A
  • Cravings
  • Withdrawal symptoms
  • med side effects, adherence
  • ongoing opioid use? last use
  • Other substances (focus on sedatives - ETOH, BZD)
  • Sleep
  • Mood/anxiety
  • home/social stability
  • Safe storage of medications
85
Q

What are some clinical situations where you would REFER to addictions specialist for OUD management?

A
  • pregnant/breastfeeding
  • concurrent chronic pain, complex comorbidities
  • switching from another type of OAT
  • previous unsuccessful inductions
  • youth
  • complex polysubstance use
86
Q

Name some harm reduction strategies for prevention of overdose in OUD

A
  • take home naloxone
  • harm reduction supplies
  • access to supervised injection sites
  • safer supply
  • testing drugs
  • education on safer use: smoking/intranasal instead of IVDU, not using alone
  • connecting to overdose outreach team
  • Lifeguard app
87
Q

Signs and symptoms of opioid overdose

A 
Opioid overdose:
	• Respiratory depression (RR<10-12/min is best clinical predictor of opioid intoxication)
	• Gurgling/snoring
	• Minimally responsive --> unresponsive
	• Constricted pupils
	• Slow erratic HR
	• Cyanosis and cool/clammy skin

Atypical opioid overdose:

  • chest wall rigidity
  • dyskinesia
88
Q

Suboxone

-ratio of buprenorphine:naloxone?

  • drug class?
  • indication?
  • MOA? (full vs partial agonist?)
A

Subxone

4:1 buprenorphine: naloxone

  • opioid agonist therapy
  • first line treatment for OUD in adults and youth 12+

buprenorphine is PARTIAL opioid agonist –> helps withdrawal and cravings, no euphoria

naloxone: prevents diversion to IVDU

89
Q

Suboxone

Common side effects

A
  • Headache
  • n/v, constipation, abdo pain
  • insomnia
  • sweating
90
Q

Suboxone

  • contraindications
  • precautions
A

CONTRAINDICATIONS:

  • severe resp depression
  • delirium tremens
  • acute ETOH
  • severe liver failure

PRECAUTIONS

  • concurrent sedatives (risk of resp depression)
  • need to be in moderate to severe withdrawal before taking first dose to avoid PRECIPITATED withdrawal
91
Q

GAD

what neurotransmitters (3) are thought to be involved?

A

norepinephrine
serotonin
GABA

92
Q

GAD

predisposing risk factors?

A
  • non-white
  • single
  • poverty
  • overanxious/shy as a child
  • excess worrying
  • early childhood trauma
93
Q

GAD panic disorder

  • panic attacks that occur:
  • rapid onset:
  • most common physical symptom:
A

occur unexpectedly without clear trigger

  • rapid onset of intense fear (peak 10 min)
  • palpitations
94
Q

GAD

common somatic symptoms:

A 
dizziness
GI upset/nausea
chest pain/SOB
chronic headaches
poor sleep
fatigue
95
Q

GAD

What are the 2 questions to ask during GAD-2 screen?

A

over last 2 weeks, how often have you

  • felt nervous/anxious/on edge?
  • not able to stop/control worrying?
96
Q

Personality disorders

Cluster A: “weird”

A
  • paranoid (suspicious)
  • schizoid (detached)
  • schizotypal (magical thinking)
97
Q

Personality disorders

Cluster B: “wild”

A
  • antisocial (no regard for others, no remorse)
  • borderline (unstable emotions and relationships)
  • histrionic (attention seeking)
  • narcissistic (ego, grandiose)
98
Q

Personality disorders

Cluster C: “worried”

A
  • avoidant (avoid conflict)
  • dependent (clingy)
  • obsessive compulsive (perfection)
99
Q

Broad signs and symptoms that you may be dealing with personality disorder

A

“it’s you, not me”

  • Frequent mood swings
  • Angry outbursts
  • Difficulty making friends
  • Attention-seeking
  • Externalizing/blaming the world
  • Ego-syntonic (“nothing’s wrong with me”)
100
Q

Risk factors for depression?

A
  • prior major depression
  • stress
  • trauma/childhood adversity
  • family hx mood disorder
  • SDOH
  • chronic medical conditions (next Q)
101
Q

Medical conditions assoc with depression?

  • Neuro:
  • Pain:
  • Resp:
  • Endo:
  • Autoimmune:
A
  • Neuro: MS, Parkinson’s, CVA, migraines, dementia, epilepsy
  • Pain: chronic pain, fibromyalgia, chronic fatigue, cancer
  • Resp: asthma, COPD
  • Endo: thyroid (hypo and hyper), DM
  • Autoimmune: SLE, RA
102
Q

Depression

Diagnostic workup?

A

PHQ-9

TSH, B12, preg test

other MH syndromes: anxiety, bipolar, psychosis, alcohol, substance use

review meds

103
Q

What is the definition of dysthymia aka persistent depressive disorder

dysphoria and __________ occurring _________ lasting _______

A

dysphoria and at least 2 other depressive symptoms occurring on more days than not, lasting 2 or more years

104
Q

Depression

first line treatment?

A

SSRI
Psychotherapy
self management

105
Q

What score on PHQ-9 indicates major depression?

What score indicates full remission?

A

score 10+

remission: <5

106
Q

Depression

  • when will people start to notice improvement with meds? full benefit?
  • how long should people continue on rx?
A

improvement in 1-2 weeks
full benefit 4-8 weeks

stay on meds for minimum of 6 months after full remission

107
Q

Depression

What are the 2 quick questions to use in screen?

A

MOOD AND ANHEDONIA

in the last month:

have you lost interest/pleasure in things you usually like to do?

have you felt sad/low/depressed/hopeless?

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