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Spring 2022 > Mental Health > Flashcards

Mental Health Flashcards

1
Q

What is a dangerous side effect to consider when prescribing trazodone monotherapy?

A

Priapism

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2
Q

Trazodone mechanism of action

A

Prevents serotonin reuptake

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3
Q

Which SSRI is most sedating?

A

Paroxetine (Paxil)

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4
Q

Lithium drug interactions

A

Diuretics

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5
Q

Side effects of lithium toxicity

A

Diarrhea, decreased LOC, weakness,

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6
Q

What labs need to be monitored when treating bipolar with lithium?

A

Lithium levels, kidney function, chemistry, thyroid

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7
Q

Side effects of SSRI

A

QTc prolongation, serotonin syndrome, angle-closure glaucoma, hyponatremia, sexual dysfunction, GI upset, diarrhea, headaches, blurred vision

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8
Q

Side effects of Tricyclic Antidepressants

A

Anticholinergic side effects: dry mouth, constipation, blurry vision, urinary retention

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9
Q

Side effects of SNRIs

A

Hypertension, QTc prolongation, serotonin syndrome, sexual dysfunction, GI upset

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10
Q

Which serotonin receptor do most antidepressants affect?

A

5-1T1A

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11
Q

Length of time for buspirone to reach peak efficacy?

A

4-6 weeks

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12
Q

Which drug class are the first therapy choices for depression, GAD, PTSD, and OCD?

A

SSRIs

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13
Q

A patient displays mania symptoms after initiating an SSRI for depression. What is the new diagnosis?

A

Bipolar Disorder

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14
Q

Lithium side effects

A

Polydipsia, polyuria

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15
Q

What are bupropion (Wellbutrin) indications, drug class, and side effects?

A

MDD, Seasonal depression, smoking cessation, ADHD*

Norepinephrine-dopamine reuptake inhibitor (NDRI)

Xerostomia, nausea, constipation, insomnia

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16
Q

What is the diagnosis?

Individual experiences stress out of proportion to stressor.
Stressors: employment, family, financial, life-transitions, death, relationships

May display mood or behavioral symptoms

Occurs within 3 months of identifiable stressor and resolves within 6 months

A

Adjustment Disorder

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17
Q

Treatment for Adjustment Disorder

A

-Supportive psychotherapy to strengthen existing coping mechanism and strengthen resiliency

  • Trazodone 12.5-25mg tid prn (anxiety)
  • Hydroxyzine 50mg prn (anxiety)
  • Lorazepam 0.5mg bid prn for short time (anxiety)
  • SSRI (short term use)
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18
Q

What is the diagnosis?

Exposure to a traumatic or life-threatening event

Experiencing flashbacks, nightmares, intrusive images, increased vigilance and avoidance symptoms

Symptoms present for at least 1 month and impair functioning

A

Post-Traumatic Stress Disorder

If symptoms present for only 3 days to 1 month following trauma, the diagnosis is Acute Stress Disorder

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19
Q

PTSD Psychotherapy Treatment Options

A

Cognitive processing therapy

Prolonged exposure therapy

Eye-movement Desensitization Reprocessing(*EMDR); 8-12 sessions ASAP

Psychological debriefing (single session)

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20
Q

PTSD Pharmacotherapy Options

A

Sertraline, paroxetine (FDA) (depression, panic attacks, sleep disruption, startle responses)

Beta-blockers Propranolol 80-160mg daily (tremors, palpitations)

Clonidine 0.1mg hs-0.2mg tid (hyperarrousal)

Prazosin 2-10mg hs (nightmares and sleep)

Trazodone 25-100mg hs (hypnotic)

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21
Q

Essentials of Anxiety Disorder Diagnoses

A

Persistent and excessive worry, anxiety, or fear with associated behavioral disturbances

Difficulty concentration, apprehension, tension, fear

Somatic symptoms: Autonomic NS symptoms; dyspnea, palpitations, paresthesia, tachycardia, hyperventilation, SOB

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22
Q

What is the diagnosis?

Cardiac, GI, neuro, and anxiety present for 6 months or longer?

A

Generalized Anxiety Disorder

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23
Q

What is the diagnosis?

Recurrent, unpredictable episodes of intense surges in anxiety with marked physiologic response (Impending doom, chest pain sweating, tachycardia, etc)

A

Panic Disorder

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24
Q

What is the diagnosis?

Social phobias and simple phobias

A

Phobic Disorder

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25
What does the GAD-2 and GAD-7 screen for?
Anxiety GAD-2 Over the last 2 weeks how often have you been bothered by (0-3) 1-Feeling nervous, anxious, or on edge 2-Not being able to stop or control worrying
26
Treatments for GAD
SSRI, SNRI, (benzo for brief acute management only), Buspar, Gabapentin, BB (avoid alcohol as self treatment), clonidine CBT, relaxation, emotive imagery
27
Treatments for Panic Disorder
SSRI, SNRI (may use benzo for bridge until SSRI/SNRI becomes effective), trazodone CBT, relaxation, emotive imagery
28
Treatments for Phobic Disorder
SSRI, SNRI, gabapentin Propranolol 20-40mg 1 hr. prior to exposure Relaxation techniques, Desensitization, Emotive imagery, CBT
29
What is the diagnosis? Preoccupations or rituals that are distressing to individual. Symptoms are excessive or persistent beyond developmentally normal periods Anxiety relieved by ritualistic performance
Obsessive-Compulsive Disorder Screening: Yale Brown Obsessive Compulsive Screening (YBOCS)
30
Treatments for OCD
SSRI (may take 12 weeks for response) Topamax Antipsychotics Gradual exposure CBT Transmagnetic Stimulation (FDA approved)
31
What are the essentials for diagnosing Anorexia Nervosa?
Symptoms present for at least 3 months Disturbance of body image or fear of becoming fat Weight loss; Severity classified by BMI Extremely severe: body weight 15% below expected Absence of 3 consecutive menstrual cycles
32
What are the essentials for diagnosing Bulimia Nervosa?
Symptoms present for at least 3 months Overly concerned with weight and food Binge-eating and purging type: Engaged in recurrent episodes of binge-eating or purging behavior at least 2x/wk Recurrent inappropriate weight gain compensations: self-induced vomiting or the misuse of laxatives, diuretics, or enemas
33
Potential lab findings in anorexia nervosa?
Anemia, leukopenia, electrolyte imbalances, elevated BUN and creatinine, increased cholesterol, depressed LH and FSH Differentials: TB, Crohn disease, gluten enteropathy, Addison disease, DM, pan-hypopituitarism
34
Potential complications of bulimia nervosa?
Gastric dilation, pancreatitis, poor dentition, pharyngitis, esophagitis, aspiration, dehydration, electrolyte imbalances
35
What is the SCOFF questionnaire?
Screens for eating disorders In the past 3 months have you: ``` Sick because uncomfortably full? Controlling eating: Loss of control One Stone/14 lb weight loss? Fat self-image? Food dominates life? ```
36
Anorexia Nervosa Management
Co-managed by PMHNP or Psychiatrist Include family, supportive care = most important CBT, intensive psychotherapy, family therapy TCA, SSRI, lithium Parenteral nutrition? Hospital admit if signs of hypovolemia, major electrolyte imbalances, and severe protein-energy malnutrition
37
Bulimia Nervosa Management
Co-managed by PMHNP or Psychiatrist Psychotherapy, CBT, individual, group, SSRI
38
What is the diagnosis? Persistent patterns of inability to sustain attention, excessive motor activity/restlessness/impulsivity or both Symptoms interfere with daily functioning Symptoms began prior to age 12 or in at least two settings (school, work, home, with friends/family)
Attention Deficit Hyperactivity Disorder
39
What does the Vanderbilt Assessment Scale screen for?
ADHD
40
ADHD Treatments
Stimulants: Methylphenidate, amphetamine Non-stimulants: Atomoxetine, burpropion, desipramine, clonidine Start CBT after symptoms managed
41
What is the diagnosis? Persistent issues with social communication and interactions Repetitive behaviors, interests or activities Symptoms interfere with functioning May or may not have accompanying language or intellectual impairment
Autism Spectrum Disorders Needs comprehensive and multidisciplinary approach to assessment and management No treatment for core symptoms, supportive
42
What does the M-CHAT-R screen for?
Autism Spectrum Disorders
43
What is the diagnosis? Prominent physical symptoms involving one or more organ systems and associated with distress and/or impairment Occasionally able to correlate symptom development with psychosocial stress Combination of biogenetic and developmental patterns
Somatic Symptom Disorders
44
What is the diagnosis? Functional neurologic symptoms with no identifiable pathology
Conversion Disorder
45
What is the diagnosis? One or more somatic symptoms associated with significant distress or disability with no identifiable pathology
Somatic Symptom Disorder
46
What is the diagnosis? Displays intentional symptoms that can be self-induced or fabricated
Factitious Disorders (Munchausen Syndrome or by proxy)
47
Management of Somatoform Disorders
Building a therapeutic clinician-patient relationship is mainstay of treatment Regular, frequent, short appointments that are not symptom-contingent may be helpful Medications should not replace appointments Empathetic, realistic, optimistic approach Hypnosis Group Therapy Psych referral Biofeedback (Immediate feedback after learning to recognize symptoms)
48
What is the diagnosis? ``` Chronic complaints of pain Symptoms frequently exceed signs Minimal relief with standard treatment History of seeing many clinicians Frequent use of several nonspecific medications ```
Chronic Pain Disorders
49
What is the diagnosis? Anatomic changes, chronic anxiety, depression, anger, and changed lifestyle Possible secondary gains: sick role, financial compensation May become more dependent on family/friends and less active
Chronic Pain Syndrome
50
Management of Chronic Pain Disorders
``` Intensive behavioral program Decrease medication use Positive reinforcement Partner with patient Encourage only discussing pain with provider to stabilize home life Biofeedback and hypnosis Self-rating chart ``` ``` Sees only one provider for management No referrals No opioids APAP or NSAIDs SNRI, TCA, gabapentin, pregabalin, anticonvulsants Physical therapy Acupuncture ```
51
What are the three main types of psychosexual disorders?
Paraphilia, gender dysphoria, sexual dysfunction
52
Management of Sexual Dysfunction
Social engineering - eliminate close proximity of others Sildenafil, vardenafil - ED SSRI - premature ejaculation
53
What is the diagnosis? Long history dating back to childhood Recurrent maladaptive behavior Difficulties with interpersonal relationships or society Depression with anxiety when maladaptive behavior fails
Personality Disorders
54
What is the cluster? Paranoid, schizoid, schizotypal
Cluster A
55
What is the cluster? Avoidant, dependent, obsessive-compulsive
Cluster C
56
What is the cluster? Antisocial, borderline, histrionic, narcissistic
Cluster B
57
Personality Disorder Mangement
Self-help Peer pressure to modify self-destructive behaviors CBT Dialectal behavior therapy (DBT) for chronic suicidality and borderline Maintain boundaries Medications directed at symptom clusters (schizo, anxiety/depression, etc)
58
What personality disorders have the most guarded prognosis?
Antisocial (Cluster B) Borderline (Cluster B)
59
What is the diagnosis? Social withdrawal, slowly progressive with decrease in emotional expression and/or motivation Deterioration in personal care with disorganized behaviors and/or decreased reactivity to the environment Disorganized thinking, often inferred from speech that switches topics oddly or is incoherent Hallucinations, delusions
Schizophrenia Spectrum Disorders
60
What are delusions?
Fixed false beliefs despite conflicting evidence, frequently of a persecutory nature
61
What are hallucinations in schizophrenia?
Usually auditory | Commands
62
What are positive symptoms in schizophrenia?
Hallucinations and delusions
63
What are negative symptoms in schizophrenia?
Disorganized speech, poor hygiene, lack of pleasure, withdrawal, anhedonia
64
Schizoaffective disorder
Schizoaffective symptoms without psychotic symptoms lasting >6 months
65
Brief psychotic disorder
Psychotic symptoms lasting <1m, causing psychological stress, may be precursor to schizophrenia
66
What must you order with first episode of psychosis?
MRI or CT
67
Schizophreniform disorder
Schizoaffective symptoms but lasting>1m but <6mo
68
Management of schizophrenia
CBT, cognitive remediation, family therapy, positive reinforcement Psych referral Pharmacologic: 1st Gen antipsychotics 2nd Gen antipsychotics Close monitoring of labs
69
Side effects of first generation (typical) antipsychotics
EPS (dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia) Less likely to have metabolic abnormalities
70
Side effects of second generation (atypical) antipsychotics
Metabolic abnormalities: weight gain, elevated glucose, elevated lipid Prolonged QTc
71
What must you monitor monthly if a patient is taking clozaril?
Atypical antipsychotic | CBC monthly - r/f agranulocytosis
72
What does the AIMS Scale screen for?
Movement disorders with antipsychotic treatments
73
What is the diagnosis? Chronic mood disturbance with episodes of subsyndromal depression and hypomania >2 yrs.
Cyclothymic Disorder
74
What is the diagnosis? Persistent depressed or low mood most days for 2 years
Dysthymic Disorder
75
How does bipolar 1 differ from bipolar 2?
Bipolar 1: Experienced 1 episode of mania or mixed episode Bipolar 2: Experienced at least 1 episode of hypomania and 1 episode of MDD; never manic
76
What do these tools screen for? PHQ-2, PHQ-9, SIGECAPS, MDQ
Mood Disorders
77
SIGECAPS
Sleep, Interest, Guilt, Energy, Cognition/Concentration, Appetite, Psychomotor, Suicide
78
Once depression stabilizes, how long should medications continue before considering discontinuation?
6-12 months
79
After starting an SSRI, when is lethality risk greatest?
Beginning at 1-2 weeks for 28 days
80
Management of Bipolar Disorders
Antipsychotics (Glucose, Lipids, Weight) First or Second Generation ``` Mood stabilizers (blood levels) Valproic acid Tegretol Lamotrigine Lithium (monitor levels, TSH) ``` ***Caution with use of antidepressants and stimulants in patients with mood disorders***
81
Management of Sleep-Wake Disorders
Psychological Insomnia-CBT, education re: sleep hygiene, avoid alcohol Pharmacologic Insomnia-may add medications if above are insufficient. If appropriate use for short course of 1-2 weeks. -Benzodiazepines and Barbiturates: Caution—habit forming, cognitive slowing, increased risk for falls, increased somnolence -Zolpidem caution in elderly, -Antihistamines, Trazadone, Remeron-non-habit forming Narcolepsy-Dextroamphetamine, modofinil Medical Sleep study and treatment, if indicated
82
Management of aggression
Violence Risk Screen Seriously violent or psychotic-antipsychotics q 1-2 hours until sx relief Acute agitation: atypical antipsychotics Chronic aggressive states: risperidone, tegretol, Depakote Lithium, SSRI, and Buspar helpful

Spring 2022 (14 decks)

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