Mental Health Issues for Primary Care Flashcards
ADHD Characteristics
Inattentiveness to work or school - distractibility, carelessness at work, poor follow through, inability to concentrate, rapid shifts in conversations
Hyperactivity expressed through fidgetiness, restlessness, impulsivity - impatience, frequently interrupt conversation, frequently make decisions causing them to be in dangerous situations without thinking about consequences
ADHD Etiology
Multifactorial
Smoking/ETOH abuse/toxin exposure during pregnancy, IUGR, lead exposure as a young child
Common co-morbidities: Tourette’s, Genetic disorders - Downs, psych disorders, other LDs
NOT thought to be d/t food additives, colorings, preservatives
ADHD Differential Dx
Hearing impairment Thyroid dz Lead toxicity Hepatic dz Sleep apnea Fe deficiency Drug interactions Other mental health issues Med rxn's
ADHD Eval
R/O metabolic disorders c labs: CBC, Fe, TSH, Pb
Clinical decision - Key is to get good hx from pt, fam, work, school
Assess level of fxnal impairment at home, work, school, social - be suspicious if school and home report don’t match
Physical exam to r/o physical cause
Observation during exam
Baseline wt
ADHD Meds
Stimulants: Adderall, Vyvanse, Ritalin, Concerta - all scheduled drugs - can only Rx 1 month at a time
Non-Stimulant: Strattera very effective
Welbutrin - stimulating antidepressant, also used for smoking cessation
Note: all have side effects that are common and may require change in doses
ADHD Issues c Med Regimen
Need close supervision for a while
All have significant possible side effects
Can only fill one month at a time
Run high risk for misusing drugs - do not Rx drugs to pt’s who do not truly need them
OCD
=Obsessions (recurrent or intrusive thoughts) or compulsions (conscious, standardized, recurrent behaviors) severe enough to cause distress
Most cases occur p significant stressful event
May be response to anxiety
OCD Presentation
Can keep it under control for a long time and then an event or stressor will send it out of control
Common obsessions: concern with bodily waste, germs, fear of death, need for symmetry
Common Compulsions: excessive handwashing/bathing, rituals, checking locks, touching, counting, or hoarding
OCD Dx Criteria Obsessions
Recurrent thoughts or impulses that are intrusive and cause anxiety or distress
Try to suppress them with some action or thought
Recognize the problem
Not excessive worrying
OCD Dx Criteria Compulsions
Repetitive behaviors aimed at preventing some dreaded event
OCD Presentation
Recognition that thoughts or behaviors are excessive or unreasonable
Thoughts or behaviors are interfering with life through social functioning, work functioning, normal routine, family relationships
Can present c acute depression
OCD Tx
SSRI 1st line choice for children and adults
Cognitive tx also necessary
Suicide Risk Factors
Severe anxiety Ruminations Global insomnia Dprssn c delusions Recent ETOH/drug abuse
Suicide Eval
Ask every pt with dprssn “Are you suicidal?”
“Do you have a plan?”
NP must determine how serious they are about following through on a plan
Listen carefully - often cues are covered up well by pts
If pt is suicidal, call a screener for inpt assessment, do not leave pt alone while waiting for screener
Schizophrenia Dx
Must have sx continuously for 6 months
Before dx, consider drugs. Some meds have similar effects - Tagamet, Reglan, Dilantin, steroids
R/O hepatic issues, hypoNa+, infections, encephalitis
