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Primary Care I > Module 7 > Flashcards

Module 7 Flashcards

1
Q

The number of adults with any diagnosable mental disorder within the past year is estimated to be

A

nearly 1 in 5, or roughly 43 million Americans.

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2
Q

how many people have serious functional impairment due to a mental illness

A

nearly 10 million American adults (1 in 25)

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3
Q

factors leading to more frequent incidents of suicide from 1999-2014

A

the economic recession of the late 2000s and the increase in incidence of substance use

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4
Q

median reduction in life expectancy among those with mental illness was

A

10.1 years

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5
Q

The collaborative method is based on

A

Wagner’s Chronic Care Model and emphasizes behavioral change, use of information systems such as electronic health records, and a team approach, utilizing high-level expertise for illness management and strong community linkages

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6
Q

the most common psychiatric disorder in the United States

A

anxiety

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7
Q

anxiety common in

A

Anxiety most commonly presents in individuals aged 20 to 45 years and is more frequently seen in women

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8
Q

anxiety is

A

an unpleasant state of physical and psychological arousal that interferes with effective psychosocial functioning. Occasional, mild anxiety is a normal fact of life and can be positive; however, severe or chronic anxiety can become debilitating.

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9
Q

Anxiety symptoms are typically manifested in several dimensions:

A

affective,
cognitive,
behavioral,
and somatic.

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10
Q

affective component of anxiety

A

by cognitive thoughts that seek to make sense of or minimize the discomfort. Additional affective symptoms of anxiety are apprehension, fear, irritability, intolerance, frustration, and overreaction or hypersensitivity to personal feelings of shame.

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11
Q

anxiety behaviors

A

Behaviors such as avoidance, distractibility, and restlessness reflect the anxiety or may evolve in response to it. Behavioral symptoms of anxiety may include apathy, compulsions, rigidity, overreactions, preoccupation, and repetitive actions such as hair pulling or nail biting

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12
Q

Somatic symptoms of anxiety

A

range in intensity from a loss of appetite, dry mouth, and fatigue, to diarrhea, sweating, chest pain, hyperventilation, vomiting, and paresthesias.

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13
Q

Panic disorder:

A

the specific worry is focused on the symptoms of panic.

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14
Q

Social anxiety disorder (social phobia)

A

: the worry is about social situations.

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15
Q

Obsessive-compulsive disorder:

A

the worry becomes focused on a specific object or activity.

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16
Q

Separation disorder:

A

the worry is about being away from parents and caregivers.

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17
Q

Somatic symptoms disorder:

A

the worry is focused on physiologic symptoms

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18
Q

Body dysmorphic disorder:

A

the worry is focused on a perceived defect in physical appearance.

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19
Q

Post-traumatic stress and acute stress disorder

A

: the worry is focused on reminders of a traumatic event.

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20
Q

The hallmarks of major depression

A

are sadness and apathy, although symptoms presented in primary care may be fatigue, loss of appetite, and change in sleep

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21
Q

The more common patient presentation of depression in primary-care settings

A

is the person who has moderate to severe feelings of sadness or apathy that he or she may, or may not, attribute to depression. Common presentations also include complaints of unexplained fatigue, insomnia, irritability, anger, anxiety, and hyperactivity. Many deeply depressed persons are unaware of the level of impairment resulting from their illness.

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22
Q

two severe symptoms of depression

A

Slowed thinking and emotional numbness——can contribute to minimal self-awareness of depression

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23
Q

Depression belongs to a broad category called

A

mood (affective) disorders

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24
Q

Organic causes of depression

A

endocrine change, hyperthyroidism, menopause, myxedema, Cushings disease, syphilis

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25
Q

Brief psychotic disorder:

A

occurs without a clear episode of depression; may resolve quickly and be a response to stress.

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26
Q

Persistent depressive disorder (dysthymia):

A

depressive symptoms are milder than those of major depressive disorder but may persist for years.

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27
Q

It is well documented that grief is accompanied by

A

impaired immune function, specifically decreased lymphocyte proliferation and impaired functioning of natural killer cells

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28
Q

stages of grieving

A
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
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29
Q

Grief consists of three distinct phases:

A

avoidance, confrontation, and accommodation.

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30
Q

The risk factors for a more complicated grief reaction include

A

(1) sudden and/or violent death, (2) social isolation, (3) individuals who believe that they are in some way responsible for the death (real or imagined), (4) individuals with a history of traumatic losses, and (5) individuals who had an intensely ambivalent or dependent relationship with the deceased.

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31
Q

the use of drugs such as tranquilizers or alcohol with grief, which numb emotions,

A

should be discouraged

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32
Q

substance use disorders

A

These disorders are considered chronic and relapsing because despite significant negative consequences, the behaviors continue.

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33
Q

Targeted treatments, often referred to as medically assisted treatments (MATs) for are now available for

A

tobacco, alcohol, and opioids

34
Q

Intimate partner violence (IPV)

A

is defined as a pattern of assaultive and coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats perpetrated by someone who is, was, or wishes to be involved in an intimate relationship with an adult or adolescent, and aimed at establishing control by one partner over the other

35
Q

Symptoms or behaviors that may signal abuse include

A

exacerbation or poor control of chronic illness, sleep disturbances, chronic pain, or frequent unexplained appointment changes

36
Q

Behavioral red flags are

A

(1) a patient who is reluctant to speak in front of her partner or gives evasive answers and (2) an overly protective or controlling partner. Any patient presenting with multiple complaints or whose symptoms are not consistent with her history should be assessed for violence at least once and reassessed if she fails to respond to therapy appropriately

37
Q

Routine screening for IPV is recommended by the USPSTF for all

A

women of childbearing age at initial visits and periodically

38
Q

The core features of SUDs include a triad of

A

behavioral, physiological, and cognitive symptoms.

39
Q

Substance withdrawal is characterized by

A

functional impairment related to the cessation or reduction of a substance, which is demonstrated in physiological, cognitive, and behavioral symptoms

40
Q

Use is defined as

A

sporadic or intermittent utilization of alcohol or drugs with no adverse consequences.

41
Q

Abuse is defined as

A

utilization of drugs or alcohol that causes the user some type of adverse consequence

42
Q

Physical dependence refers to

A

the physiological effects of withdrawal from rapid dose reduction, abrupt cessation of the drug, or administration of an antagonist.

43
Q

Psychological or behavioral dependence emphasizes

A

pathological use patterns and substance-seeking activities; it is a subjective need for the substance.

44
Q

the risk of SUD is directly related to

A

the properties of the drug of choice, such as availability, cost, how quickly the brain perceives the substance, and its ability to produce gratification or pleasure, as well as various environmental factors

45
Q

The highest prevalence rates for substance use occur in persons aged

A

18 to 24 years

46
Q

is the leading preventable cause of death and disability

A

Tobacco use

47
Q

remains the primary substance of abuse and dependence

A

Alcohol

48
Q

correlate overall with illicit substance use.

A

Male sex, ethnicity, education, employment status, and criminal justice population

49
Q

The most common comorbidities are substance abuse with more than one substance

A

and mood disorders including bipolar disorder, anxiety disorders, antisocial personality, and schizophrenia

50
Q

The susceptibility variant emphasizes that

A

genetic factors play an important role in the development of substance dependence, influencing the individual’s vulnerability

51
Q

the exposure construct holds that

A

chemicals and their actions on the brain are the primary causes of addiction

52
Q

One characteristic that all commonly abused drugs share is

A

their ability to stimulate reward centers in the brain.

53
Q

All addictive substances/behaviors involve increases in

A

dopamine levels in the mesolimbic dopamine system, the reward system of the brain.

54
Q

substance use disorders (

A

those pathological behaviors associated with substance-seeking activities)

55
Q

substance-induced disorders

A

(intoxication, withdrawal, and mental disorders caused by a medication or a substance).

56
Q

Cannabis Intoxication:

A

Intoxication typically includes euphoria, alterations in mood and judgment, and changes in sensory perception, cognition, and coordination. Driving and machine-operating skills may be impaired.

57
Q

Cannabis Withdrawal:

A

Transient symptoms occur on withdrawal, usually within 1 week of stopping after prolonged use, and include irritability, cravings, anxiety, sleep problems, and decreased appetite.

58
Q

Stimulant Intoxication:

A

Symptoms include euphoria; increased wakefulness; decreased appetite; and increased breathing, heart rate, blood pressure, and body temperature.

59
Q

Stimulant Withdrawal:

A

Symptoms occur within hours or days of last use and include severe depression, anxiety, fatigue, psychosis, and intense craving for the drug. Experienced heavy users may plan their drug use to include substances that can prevent or minimize withdrawal.

60
Q

Tobacco Withdrawal:

A

Cessation of daily tobacco use produces symptoms within 24 hours. Withdrawal symptoms include intense cravings, depressed mood, sleep problems, impaired concentration, anxiety, increased appetite, and irritability.

61
Q

Phencyclidine or Other Hallucinogen Intoxication:

A

Several behavioral symptoms occur shortly after use of phencyclidine, including hallucinations, delusions, paranoia, and a sense of being outside one’s body. For other hallucinogens, symptoms include rapid mood swings and inability to think rationally, communicate with others, or recognize reality. Physical symptoms include increased heart rate, body temperature, and blood pressure; dizziness, loss of appetite, tremors, pupil enlargement.

62
Q

Inhalant Intoxication:

A

Intoxication can include confusion, nausea, slurred speech, lack of coordination, euphoria, dizziness and lightheaded, drowsiness, lack of inhibition, delusions or hallucinations, and headache.

63
Q

Opioid Intoxication:

A

Intoxication typically includes a sudden change in behavior, which can include euphoria, drowsiness, confusion, nausea, and slowed breathing. Constipation is a commonly recognized side effect of opioid use.

64
Q

Opioid Withdrawal:

A

Withdrawal symptoms include muscle and bone pain, sleep disturbances, nausea and diarrhea, and intense cravings.

65
Q

Sedative, Hypnotic, or Anxiolytic Intoxication:

A

Symptoms include slurred speech, confusion, trouble concentrating, dry mouth, decreased blood pressure and breathing rate, dizziness and light-headedness, headache, and slowed movements and thinking.

66
Q

Sedative, Hypnotic, or Anxiolytic Withdrawal:

A

Symptoms may include seizures; shakiness; trouble sleeping; agitation; increased heart rate, blood pressure, and body temperature accompanied by sweating; hyperreflexia, and intense cravings.

67
Q

Caffeine Intoxication:

A

Symptoms include increased alertness and muscle movements, increased urination, sleeplessness, increased heart rate, and sweating.

68
Q

Caffeine Withdrawal:

A

Suddenly stopping or reducing daily caffeine use may cause withdrawal symptoms within 12–24 hours, which may include fatigue, headache, and insomnia.

69
Q

is now the leading cause of accidental death in the United States

A

Drug overdose

70
Q

Particular populations at risk for prescription opioid abuse include

A

women, adolescents and young adults, and older adults.

71
Q

AUD is a

A

chronic relapsing progressive brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using. Alcohol use disorder includes (1) alcohol abuse and (2) alcohol dependence. It is also classified as mild, moderate, and severe. It is characterized by a problematic pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by multiple psychosocial, behavioral, or physiological features

72
Q

A blood alcohol level of 0.05 causes

A

disruptions in thinking, judgment, and inhibition.

73
Q

A blood alcohol level of 0.1 produces

A

obvious intoxication.

74
Q

A blood alcohol level of 0.2 results in

A

depression of motor functioning and emotional/behavioral dysfunction.

75
Q

A blood alcohol level of 0.3 produces

A

stupor and confusion

76
Q

Blood alcohol levels of 0.4 and higher produce

A

coma.

77
Q

low-risk drinking

A

for men as less than drinks per day and no more than 14 drinks per week, and for all women and men aged 65 and older no more than 3 drinks per day and no more than 7 drinks per week.

78
Q

At-risk drinking is

A

consuming volumes greater than these guidelines.

79
Q

Harmful drinking, on the other hand, occurs when alcohol is

A

causing physical, psychological, or social harm exhibited by zero to two dependence criteria and zero to one abuse criteria, according to this agency

80
Q

pharm tx for AUD

A

Pharmacological therapy of withdrawal includes intermediate- or long-acting benzodiazepines such as lorazepam, oxazepam, diazepam, or chlordiazepoxide. Carbamazepine has also been shown to be effective in mild to moderate symptoms of withdrawal and has the added advantage to decrease craving. In addition, adjunctive medications include antipsychotic medications such as haloperidol, which is used in patients with significant hallucinations and agitation.

81
Q

the average daily caffeine U.S. consumption over the past 10 years has remained stable at

A

300 mg per person per day.

82
Q

The first goal of treatment for substance abuse should be

A

the restoration of the physical, psychological, and social well-being of the person and family

Primary Care I (7 decks)

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