Mood Disorders - osteopathic approach Flashcards
what is a mneuomic for depression
SIGECAPS
sleep, interest, guilt, energy, concentration, ,apetitie, psychomotor, suicide
psychomotor: retardation or agitation
what are some mental health screening exams we should know about
PHQ-2 (patient health questionaire)
PHQ-9
C-SSRS (columbia suicide severity risk scale)
GAD-2 (generalized anxity disorder 2- item; which can be expanded to 7)
what are the thwo questions in PHQ-2
over the last 2 weeks:
little interest/pleasure?
feeling down/depressed?
patients rate these questions from not at all to nearly every dat (0-3)
a PHQ-2 score ranges from _ to _ and a score of _ is the optimal cutpoint when using PHQ-2 for depression
if the score is _ or greater major depressive order is likely
patients who screen positive should be further evaluated with the _ and other diagnostic instruments
0 to 6
3
3
PHQ-9
explain the PHQ-9
there are 9 questions that as the patient if over the last 2 weeks they have had any of the following problems rating it from not at all to nearly every day
***thoughts that you would be better off dead or huritng yourself is a critical question (includes the same 2 questionsin PHQ-2 but expands)
score of 0-4 on PHQ-9
score of 5-9 on PHQ-9
score of 10-14 on PHQ-9
score of 15-19 on PHQ-9
score of 20-27 on PHQ-9
0-4: minimal depression
5-9: mild depression
10-14: moderate depression
15-19: moderately severe depression
20-27: severe depression
_ must be preformed if the PHQ-9 score is _ or higher or if the patient endorses item _
columbia suicide severity risk
20
item 9 (thoughts they would be better off dead)
GAD-2 questions
over the past 2 weeks have you…
felt nervous/on edge?
not being able to stop or control worrying?
not at all, severy days, more than half the days, nearly everyday
the behavioral health consultant works on the health caree team utilizing a _ care model. They will go into the exam room to evaulate the patient then report to the physcian. They assist the physcian to identify, diagnose, and treeat _ problems.
their consultatant report should be included in the _
integrated
pyschiatric
HPI
what is the psychiatric review of symptoms (PROS)
this is a structured review of psychiatic symptoms that is inncluded in the HPI
you will learns which symptom category needs further evaluation: a patient may also not tell you a symptoms until you specifically mention it
psyciatric review of symptoms categories
Sleep, Homicide, Eating, Suicide, Psychosis, Mania, Anxiety, OCD (intrusive thoughts) , motor (tics, psychomotor retardation- slow movements), depression, trauma, substance use, cognition (attention deficits), sensory (overly senstitive to sensations)
the ability to preform a comprehensive physical exam can rule out competeing causes and greatly enhances psychiatric diagnosis
for example _ and a mood diosrder must be evaluated and treated simultaneously
diabetes
- out of control diabetes can cause mood problems and getting diabetes under control can improve mood symptoms
untreated mood problems will decrease motivation and _
compliance ( of treating other problems)
treat both, dont have to statrt treatment at the same time but they should both be evaluated and treated
minimal routine exam for anxiety and depression
vitals
mental status exam (3)
CN 2-12
DTrs
Strength
THYROID
HEART
LUNGS
osteopathic structural exam of the cranium, TMJ, neck, thoracic spine, and shoulders gives highest yeild for signs and symptoms of _ related somatic dysfunction
stress
MRI of the brain should be considered in patients with rapid onset of significant _ _ changes such as new onset pyschosis in a patient with no previous mental illness
mental health changes
in the mental status exam you must choose 3 elements what are the options
this in the objective
apperance, behavior, speech, mood, affect, through process/content, cognition, perception, insight
mnemonic: AS CAPS BMT Insight
eye tracking dysfunction is a common behavioral deficit in
schizophrenia
- behavior in MSE
mood is what the patient tells you they _ and should be placed in quotes
feel
affect is the emotional state we _
obsevere
(euthymic, dysphoric, euphoric, anxious)
affect ranges?
congruency?
range: full, resitricted, flat, labile
congruency: the affect matches the mood reported the patient
speech quality items
rate
quailty
prosody (use of timing and intonation)
volume
content
thought process/thought content
prcoess: rate of thought; how they flow
content: delusions/false beliefs: Ideas of reference, suicidal or homocidal ideation
what is ideas of reference
misinterpretation of incidents and events in the outside world having direct personal reference to the patient
in suidical or homicidal ideation is it critically important to determine passive vs. active what?
intent
plan
means
columbia suicide severity rating scale
Perception types a person can have in a MSE
hallucinations: seeing something not there
Ilusions: distored perception of what is there
derealization: people and things seem fake
depersonalization: detachment from ones identity (like trans?)
insight
awareness of ones own illness/situation
judgement
ability to anticipate the consequences of ones behavior and make decisions to safegaurd ones well being and that or others
the specific diagnosis and severity of symptoms will determine the treatment recommendations and if further exams, labs, and tests are indicated
!
suicide prevention precautions
provide phone number for suicide hotline and contact for safety: call on call clinican, close relative, close friend
referall to ED if idications of active suicide
how does motivational interview work in mood disorders
it helps the patient to explore and reolves ambivalance
you can ask the patient how they feel about your recommendations and have shared decision making.
(change behavior)
what are the 6 stages of change
precontemplation
contemplation
preparation
action
maintence
termination
what other treatments are beneficial in patients with mood disorder
CBT, sleep hygience, OTC (melatonin, aswhagnada, L- methyfolate, N acetly cystein)
what labs should be ordered routinely in a mood disorder
TSH, CBC, CMP, UA
monitoring labs: screening labs depend on problem presented
depression common medications
SSRI
psychotic depression treatmetns
augment ttreatment with atypical antipsychotics
(fast onset and theraputic benefit)
_ is the only FDA approved for suicide risk reduction in schizophrenia
clozapine
anxiety + depression treatment
SSRI , benzodiazapines
benzodiazapines carry a risk of
cognitive dysfunction and dementia with long term use
bipolar disorder treatment
mood stabalizers: malproid acid
when starting and moitoring atypical antispychotic get what
how frequently
CBC with diff, CMP, HgbA1C, Lipids, TSH, Urinalysis
at baseline, 2 months, 6 months, periodically
what is the abnormal involuntery movement scale AIMS
a test for sympotms of tardive dyskinesis that must be done at baseline and then every 3 months
done when starting an atypical antiphyscotic
located in labs/exams
when starting and monitoring anticonvulsants what should you get (labs.exam)
pregnancy test
CBC with diff, CMP, urinalysis, OPTHALMIC EXAM
serum drug levels
when starting and monitoring lithium what should you get (labs/tests)
pregnancy test, CBC, CMP, TSH, urinalysis, serum drug levels
ECG if over 40
pharmogenomic testing
looks for genetic polymorphisms in CYP450
(how quickly a drug is metabolized)
**consider in patients with liver dysfunction- not considered in people younger than 24 with depression of thoughts of suicide
ANA comprehensive panel
indicated it there is an autoimmune disorder
to assess or minotr for drug use the most accurate and sensitive measure is
urine tox screen using gas chromatography mass spectrometry (GC-MS)
