Mental Health Flashcards

Question

Pharmacologic intervention for BPD

Answer 1

Acute vs Maintenance treatment Lithium (Lithobid)- most common mood stabilizer - Valproic acid (Depakene) - Divalproex sodium (Depakote) - Carbamazepine (Tegretol, Equetro, others) - Lamotrigine (Lamictal) Side effects: weight gain, sedation, skin rash, blurred vision, sun sensitivity Poor adherence, why?

Answer 2

Electroconvulsive therapy (ECT) - “shock” therapy - Historically used - Resistant to pharmacologic intervention - Now used in conjunction with anesthesia *Induces a seizure, not sure how it works - Risks * Memory loss * Death Repetitive Transcranial Magnetic Stimulation (rTMS) - Fewer side effects - Doesn’t require sedation - Side effects * Tingling in face * Light headed * Headaches * Mania

Answer 3

ADLS - Basic hygiene - Maintaining routines - Taking meds IADLS - Budgets - Childcare - Paying rent Health Management - Poor outcomes without support - Weight gain Education - Less likely to get a degree or complete training Work - Less likely to work outside the home Play, Leisure, Social Participation Difficulty maintaining relationships

Answer 4

Chronic and lifelong disorder - 21 million people world wide - Less than 1% of the population but rising Genetic link Alteration in Neurotransmitters - Dopamine Brain Structure - Smaller hippocampus, amygdala and thalamus - Larger lateral ventricle volume Prenatal and Birth Complications - O2 loss - Infections and drugs Trauma Urban vs rural settings Substance Use

Answer 5

Delusions Hallucinations Disorganized speech Abnormal motor behavior

Answer 6

Persecutory: Out to get me Referential: That song is about me Somatic: I have cancer Grandiose: I am Elvis’ child Erotomatic: Beyoncé loves me Religious: I am the favorite Nihilistic: The world is going to end

Answer 7

Auditory, visual, tactile, gustatory or olfactory

Answer 8

Tangential thoughts-barely related Loose association-not on topic Incoherence (word salad)- no sense at all

Answer 9

Catatonic, rigidity Agitation Odd or silly Mimicking Echolalia – repeat something they heard over and over

Answer 10

Diminished Emotional Expression (affect is flat) Avolition-lack of motivation to do something with an end goal Alogia-diminished speech output Anhedonia-lack of ability to experience pleasure Asociality-lack of socialization Anosognosia-no insight or awareness of the disease

Answer 11

No single test or assessment Usually follows a “psychotic break,” usually in late adolescence or early adulthood - Two Positive or negative symptoms - Which includes delusions, hallucinations or disorganized speech - For 6 months - Impact to at least one major life area of occupation

Answer 12

1. Premorbid: no or few symptoms 2. Prodromal: subtle symptoms, mild cognitive decline but doesn’t meet the criteria 3. Syndromal: worsening of symptoms, functional decline, FORMAL diagnosis - With treatment 60-80% respond and go into remission or partial remission - Others progress - Up to 30% are treatment resistant and often end up hospitalized *Intervention is predominantly medication based 4. Progressive: individuals who relapse repeatedly 5. Chronic or residual: continual decline but less than syndromal

Answer 13

Pharmacological - Most common - Severe side effects - Typicals: been around for 20 years; patients will start with these; acute extrapyramidal side effects (EPS) * Tremors, psychomotor slowing, pill rolling (roll fingers as if there's a pill between them) - Atypicals: weight gain, sexual dysfunction, cardiac issues, dry mouth * Clozapine: lowers white blood cell levels to the point that pt will almost end up with leukemia Neuromodulation - Electric shock (ECT) and magnetic therapies (TMS) OT: A mind busy and occupied can help create a better outcome

Answer 14

CBT-Cognitive Behavioral Therapy - Self monitoring - Coping skills - Requires insight Self Management programs - Similar to CBT, includes goal setting and planning Skills Training - Role modeling, goals setting, rehearsal, practice Cognitive Rehabilitation - Focus on rehabilitation of the cognitive deficits (symptomatic) * Memory, attention Family Psychoeducation - The key - If they don't have this and no services are available, they are doomed. Social Skills Training - Like CBT or skills training just focus on Social Skills - Important in early diagnosis Importance of Early Intervention

Answer 15

- 1 or more delusions for more than one month - No other symptoms

Answer 16

- Just like Schizophrenia but lasts 1 day to 1 month - Sometimes drug or disease induced

Answer 17

- “Pre-Schizo” - Symptoms last 1-6 months

Answer 18

- Same symptoms plus a major episode of depression or mania - Function is not always affected - Hallucinations are present

Answer 19

- Delusional Disorder - Brief Psychotic Disorder - Schizophreniform Disorder - Schizoaffective Disorder - Substance or Medication Induced - Due to another medical disorder - UTI: strong urine odor, dark urine * become septic

Answer 20

- Stigma of the disease “crazy” - Depends on the environment, what factors - Response to meds - ADLs: may not be dressing or eating depending on the level - IADLS: may not be paying bills - Health Management - Rest and Sleep - Under education - Under employed - Social and Leisure

Answer 21

Fear - Emotional response - Autonomic arousal - Escape behaviors Anxiety - Causations or avoiding behavior - Muscle tension - Active preparation for danger 6 months or longer with impact to functional domains

Answer 22

- General Anxiety - Obsessive-compulsive and related disorders - Trauma and stress related disorders

Answer 23

1. Panic Disorders 2. Specific Phobias 3. Social Anxiety Disorder 4. Agoraphobia 5. Generalized Anxiety Disorder 6. Separation Anxiety 7. Selective Mutism

Answer 24

Recurrent, unexpected panic attacks, fear and anxiety 1 attack within the previous month, with at least one month of - Worry - Additional panic attacks - “Heart attack” or “going crazy” - Avoiding behavior

Answer 25

Intense, irrational fear of something Provokes instant fear and anxiety that is out of proportion Last at least 6 months, often have more than one - Situational Phobias: more common in adulthood - Natural Environment Phobias-common in childhood - Blood or Injection Phobias - Animal Phobias: more common in adulthood - Other Phobias

Answer 26

- Speaking - Performing - Anxiety and over judgement of one's performance in a social setting Vs Shy??

Answer 27

Not just a fear of leaving the house, but also comes with excessive anxiety and panic - Public transportation - Open spaces - Enclosed spaces - Crowds - Alone outside of the home

Answer 28

- Excessive worry and anxiety for at least 6 months without a cause - Worry about everything

Answer 29

6 months in adults, 4 months in children At least 3 of the following symptoms: - Anxiety about the possibility of separation - Wish to stay close for fear of death - Worry that some thing bad is going to happen to them to keep them from the other person - Refusal to go out alone - Excessive fear of being home alone - Refusal to spend the night away - Recurring nightmares of separation - Physical reactions to being separated-hysteria, vomiting, shaking

Answer 30

Must have all 5 - Won't speak in certain situations - Failure to speak is impacting function (school) - The failure to speak continues after 1 month in the situation - There are no language deficits - Not due to another diagnosis (autism) or communication disorder

Answer 31

40 million people in the US at least 1 x per year - Women more than men - Panic Disorders: women more than men, diagnosed early 20’s - Phobias: most common mental disorder in US, usually start at age 7 Likely biological or neurochemical component Psychosocial factors - Trauma * Divorce, death - Abuse - Conditioning * Food, war etc.

Answer 32

Meet the specific criteria for each condition

Answer 33

Medications - Benzo’s (addictive) - Side effects Names like: Zoloft, Lexapro, Prozac, konini, Xanax OT: - Sensory Integration - CBT - Mindfulness - Metacognition - Exercise - Nutrition - Systematic Desensitization (heavy exposure therapy) * Virtual exposure - Relaxation Training - Deep breathing - Visualization - Family and Group Therapy - Yoga - Energy Work: working out, free weights, riding a horse - Meditation

Answer 34

Neurocognitive disability resulting from an underlying neurological cause Delirium - Short term disorientation or psychosis - Can be brought on by high fever and UTI Hypoactive (stunned), Hyperactive (agitated) or Mixed Diagnosis: many assessments MMSE Prognosis: resolves with the issue

Answer 35

Mild Major (also called dimentia)

Answer 36

One or more declines in: - Complex attention - Executive function - Learning and memory - Language - Perceptual motor - Social cognition Modest decline that requires compensatory strategies and accommodations - May or may not turn into Major NCD

Answer 37

Significant decline in one or more of the above areas Interferes with independence in every day activities

Answer 38

Alzheimer's Frontotemporal Lobe Degeneration (formally called Pick Disease) Lewy Body Disease Vascular Traumatic Brain Injury Substance Induced Human Immunodeficiency Virus

Answer 39

No clear cause - Family history - Mutation of chromosome or gene - High cholesterol, BP - Insulin Resistant Diabetes - Decrease in neurotransmitters

Answer 40

Rule out other causes MRI and PET scans (60-90%) BIO markers: Amyloid Betadeposits in brain, Hyperphosphorylation of protein, and neuroinflammation of glial cells 5.8 Million Americans, risk increases as we age

Answer 41

Formally called pick disease Behavioral Variant - Loss of sympathy, apathy or inertia - Compulsive/ritual behavior - Extreme behavioral changes - Decline in social cognition and executive ability Language Variant - Decline in language * Speech production * Word finding * Object naming * Grammar * Comprehension Both retain learning, memory and perceptual motor skills Diagnosis - Behavior changes/legal issues/firings-as early as 40 - CT or MRI * Atrophy * Quick decline, quicker death

Answer 42

Abnormal deposits of alpha-synuclein protein called Lewy bodies - Blocks dopamine and acetylcholine Onset is 50’s, more men than women 2nd most common cause of dementia Changes in attention, emotions, movement and sleep Hallucinations Learning difficulty, memory later Misdiagnosed as Alzheimer's or Parkinson's

Answer 43

Due to decreased vascular supply - Other types ruled out - Not as aggressive CVA, Vascular Disease, other

Answer 44

Evident on MRI

Answer 45

Mild to major Alcohol abuse causes cortical thinning Meth causes microhemorrhages

Answer 46

Mild to major No other explanations

Answer 47

1. Decline in one or more cognitive domains - Complex attention - Executive function - Learning and memory - Language - Perceptual motor abilities - Social cognition 2. Occupational Impairment 3. Not delirium 4. Not something else

Answer 48

Assure appropriate diagnosis Psychoeducation of patient and family is key in association with medical management. Manage behavior and cognitive decline - Routines, adaptations, reactions of others Promoting ADLS Caregiver support Pharmacology

Answer 49

Obsessive Compulsive Disorder (OCD) Body Dysmorphic Disorder (BDD) Hoarding disorder Hair-pulling disorder Skin picking disorder

Answer 50

Fear of harm/checking disorders Sexual/religious thoughts Contamination concerns/washing rituals Symmetry/ordering behaviors

Answer 51

Genetic variations Environmental factors Physical damage to the brain Psychosocial Trauma PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) - Don't know why or who is more likely to get it - comes after a strep infection

Answer 52

Pt’s may go a long time before diagnosis Self report of the repetitive or obsessive thoughts Management or Intervention - Complex - Pharmacological * Anxiety meds - Psychotherapy - Occupational therapy - Cognitive Behavioral Therapy (CBT) A lot of the same interventions as addicts.

Answer 53

Physical appearance Often starts in adolescence Not due to injury Excessive surgery, shame, failure to leave home, suicide With anorexic pt. you ask them to draw a picture of themselves, they often draw themselves bigger than they are, when they are really skin and bones.

Answer 54

Discard unnecessary possessions, clutter that interferes with life Animal hoarding Little insight - don't recognize that it's a mess

Answer 55

Trichotillomania Pull and sometimes eat one's hair

Answer 56

Skin lesions Amount of time picking Triggers Can lead to infection and amputation in diabetic patients

Answer 57

Symptoms may occur in childhood (men more) or adulthood (women more)

Answer 58

Emotional Shock following a stressful or distressing event - Can be a single event (trauma) * PTSD - Multiple Events (complex trauma) * C-PTSD Experiencing, witnessing, learning about, violence, abuse, neglect - Especially if directed at them or a loved one Event can be: - Physical - Sexual - Emotional/psychological - Neglect (one of the worst things that can happen; higher death and injury rates) Often transgenerational (that's how I was raised, so why should it be any different with my kids) - Neglect is most dangerous - Death

Answer 59

Young/single parents Lack of education Large number of dependents Adults with psychiatric disorders Unrealistic expectations for children - Toilet training Childhood history of abuse (80%) Substance abuse Lack of family support Children with issues or disabilities (fussy babies) Socioeconomic status - Ability to hide it? "I don't think poor people are more likely to abuse their children, I think wealthy people are better at being able to hide it" Poor bonding in infancy Nonbiologic/transient caregivers living in the home - mom's boyfriend who won't stick around Adopted and foster children This risk factors can be cumulative

Answer 60

Of cases reported 60% are neglect (social or medical), 11% are physical abuse and 7-8% are sexual abuse Children under the age of 1 Boys and Girls about equal overall (75% of sexual abuse cases are girls) Neglect most commonly associated with women Sexual abuse most commonly associated with men 92% of the time it’s a parent Women most often and Mom’s the highest group

Answer 61

There are 7 domains of impairment 1. attachment and relationship 2. thinking and learning 3. physical health: body and brain 4. behavior 5. self-concept and future orientation 6. emotional responses 7. dissociation

Answer 62

Diagnosis requires and intervention - Interviews - Observations: especially in how children play - Surveys - Standardized assessments Prognosis - Related to extend of exposure - Resiliency factors * Executive function * Nurturing environment * Maternal health * Consistent and health home routines * Understanding of the trauma (not sweeping it under the rug)

Answer 63

ADLS - Bathing and hygiene - Over or under in any area - High stress Toileting - Encopresis: pooping in places you shouldn't - Enuresis: peeing in places you shouldn't * Both are often in response to sexual abuse Feeding and Eating - Bottle rot (dental issue; teeth and gums will rot) and poor eaters or messy - Eating disorders: control - Food hoarding Sexual Activity - Sexualized or age-inappropriate activities - Drug and alcohol use IADLS - Parentifications: when the children become the parents - Under achievers - Academic issues - Difficulty with own health issues - Abnormal sleep and rest * Night terrors Work - Disinterest in work - Underemployment - Difficulty keeping job - Difficulty with interpersonal skills Play and Leisure - Lack of explorative play - Symbolic play may imitate their environment - Difficulty connecting with others * Rage * Avoidance Social - Isolation - Feelings of worthlessness - Deviant affiliations - Persistent conflicts (emotional or physical) - Unsafe acts - Court involvement - Avoiding or aggressive

Answer 64

Disorders of perception - Excessive or disproportionate thoughts and feelings and behaviors - Disrupt life for 6 months or more - Regardless of medical etiology - Perception is real Somatic Symptoms - Associated with the senses, usually pain - Could also be itching, dizziness, chest pain, irritable bowel Not explained by medical or other psychologic issue Malingering-intentional production of a problem for gain Hypochondriasis- over attention but can be swayed

Answer 65

- Somatic Symptom disorders - Illness Anxiety disorder - Conversion Disorder - Psychological factors impacting other medical conditions - Factitious Disorders

Answer 66

Usually a physical symptom Headaches, chest pain, joint pain Fixated on it They believe it!

Answer 67

Fear of getting a disorder Insist on X-Ray, MRI, Blood work Previous illness or family illness Hypochondriasis- over attention but can be swayed

Answer 68

Also called Functional Neurological Symptom Disorder or Psychogenic Disorder Tremors, tick, dystonic movements "cause and effect" - begins shaking when husband gets mad and thinks she has parkinson's

Answer 69

Overeating, overworking, ignoring symptoms, stress

Answer 70

Knowingly report or even create false symptoms Munchausen or Munchausen by proxy (this is intentional, malingering, not always considered a somatic disorder)

Answer 71

Don’t know what causes it - History of Trauma - Idiopathic Often difficult to diagnose - Doctor shopping More likely to occur in Women

Answer 72

Unnecessary and unneeded surgery and tests is common CBT Pain management techniques - Imagery - Stress management - Family training - Relaxation techniques - Engagement in health Occupations Meds - Anxiety - Prozac, Paxil, Zoloft, others Impact to FUNCTION - Impaired ADLS - Inability to care for children - Over attention to health management - Rest and sleep –impaired, too much not enough - Education-high drop out rate - Work-unable to concentrate, do physical work or attendance issues - Play and Leisure-same as education and work - Social-focus on themselves and illness, withdrawal from al other

Answer 73

Has nothing to do with the feeding process (Dysphagia) Anorexia Nervosa Bulimia Nervosa Binge Eating Pica Rumination Avoidant/Restrictive food intake disorder

Answer 74

Distorted body image Failure to maintain body weight Fear of gaining weight Calorie restrictors, exercise anorexia, geriatric anorexia Atrophy, bone loss, loss of menstruation, men and women 1%-men and women, all ages, most deadly

Answer 75

Distorted body image Binging and purging Laxatives or diet pills Vomiting Issues: teeth, ulcers young adults 1.5%, 10 x the diagnosis in women, mostly young adults and adolescents

Answer 76

Like bulimia but don’t purge or use laxatives Leads to obesity 1.6 %, more women than men, all ages and races

Answer 77

Eating non foods Chalk, ash, dirt, hair all ages and cultures, small percentage, difficult to study, more common in southeast

Answer 78

Rarest eating disorder Like a bird Regurgitation and reswallow Not able to control very rare, no real numbers

Answer 79

This area is expanding May be due to sensory issues May severely limit the type of food Not weight driven - Sensory, emotional, unpleasant experience, belief Start as perfectly normal diets 1.5-5% youth to adults Biggest eating disorder in the US

Answer 80

Complex mix of: - Cognitive, emotional, genetic, environmental, trauma and other factors - Link to other Psychological issues * OCD, Depression Over 30 million people in the US

Answer 81

Diagnosis - Difficult-shame-manipulation - For all-symptom appearance (dental issues or nutritional insufficiency) Interventions - Psychological * CBT and Family based therapy * Role of occupational therapy

Answer 82

ADLS and IADLS-every thing focus on food, may end of with NGT Poor Health management Education/Work -lower academic and work performance Play and Leisure-over exercise, avoid places of food, impact to family and friends