Mood Disorders - osteopathic approach Flashcards

1
Q

what is a mneuomic for depression

A

SIGECAPS

sleep, interest, guilt, energy, concentration, ,apetitie, psychomotor, suicide

psychomotor: retardation or agitation

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2
Q

what are some mental health screening exams we should know about

A

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)

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3
Q

what are the thwo questions in PHQ-2

A

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)

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4
Q

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

A

0 to 6

3

3

PHQ-9

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5
Q

explain the PHQ-9

A

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)

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6
Q

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

A

0-4: minimal depression
5-9: mild depression
10-14: moderate depression
15-19: moderately severe depression
20-27: severe depression

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7
Q

_ must be preformed if the PHQ-9 score is _ or higher or if the patient endorses item _

A

columbia suicide severity risk

20

item 9 (thoughts they would be better off dead)

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8
Q

GAD-2 questions

A

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

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9
Q

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 _

A

integrated

pyschiatric

HPI

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10
Q

what is the psychiatric review of symptoms (PROS)

A

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

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11
Q

psyciatric review of symptoms categories

A

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)

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12
Q

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

A

diabetes

  • out of control diabetes can cause mood problems and getting diabetes under control can improve mood symptoms
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13
Q

untreated mood problems will decrease motivation and _

A

compliance ( of treating other problems)

treat both, dont have to statrt treatment at the same time but they should both be evaluated and treated

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14
Q

minimal routine exam for anxiety and depression

A

vitals
mental status exam (3)
CN 2-12
DTrs
Strength
THYROID
HEART
LUNGS

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15
Q

osteopathic structural exam of the cranium, TMJ, neck, thoracic spine, and shoulders gives highest yeild for signs and symptoms of _ related somatic dysfunction

A

stress

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16
Q

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

A

mental health changes

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17
Q

in the mental status exam you must choose 3 elements what are the options

A

this in the objective

apperance, behavior, speech, mood, affect, through process/content, cognition, perception, insight

mnemonic: AS CAPS BMT Insight

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18
Q

eye tracking dysfunction is a common behavioral deficit in

A

schizophrenia

  • behavior in MSE
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19
Q

mood is what the patient tells you they _ and should be placed in quotes

20
Q

affect is the emotional state we _

A

obsevere

(euthymic, dysphoric, euphoric, anxious)

21
Q

affect ranges?

congruency?

A

range: full, resitricted, flat, labile

congruency: the affect matches the mood reported the patient

22
Q

speech quality items

A

rate
quailty
prosody (use of timing and intonation)
volume
content

23
Q

thought process/thought content

A

prcoess: rate of thought; how they flow

content: delusions/false beliefs: Ideas of reference, suicidal or homocidal ideation

24
Q

what is ideas of reference

A

misinterpretation of incidents and events in the outside world having direct personal reference to the patient

25
in suidical or homicidal ideation is it critically important to determine passive vs. active what?
intent plan means columbia suicide severity rating scale
26
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?)
27
insight
awareness of ones own illness/situation
28
judgement
ability to anticipate the consequences of ones behavior and make decisions to safegaurd ones well being and that or others
29
the specific diagnosis and severity of symptoms will determine the treatment recommendations and if further exams, labs, and tests are indicated
!
30
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
31
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)
32
what are the 6 stages of change
precontemplation contemplation preparation action maintence termination
33
what other treatments are beneficial in patients with mood disorder
CBT, sleep hygience, OTC (melatonin, aswhagnada, L- methyfolate, N acetly cystein)
34
what labs should be ordered routinely in a mood disorder
TSH, CBC, CMP, UA ## Footnote monitoring labs: screening labs depend on problem presented
35
depression common medications
SSRI
36
psychotic depression treatmetns
augment ttreatment with atypical antipsychotics (fast onset and theraputic benefit)
37
_ is the only FDA approved for suicide risk reduction in schizophrenia
clozapine
38
anxiety + depression treatment
SSRI , benzodiazapines
39
benzodiazapines carry a risk of
cognitive dysfunction and dementia with long term use
40
bipolar disorder treatment
mood stabalizers: malproid acid
41
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
42
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 ## Footnote located in labs/exams
43
when starting and monitoring anticonvulsants what should you get (labs.exam)
pregnancy test CBC with diff, CMP, urinalysis, OPTHALMIC EXAM serum drug levels
44
when starting and monitoring lithium what should you get (labs/tests)
pregnancy test, CBC, CMP, TSH, urinalysis, serum drug levels ECG if over 40
45
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
46
ANA comprehensive panel
indicated it there is an autoimmune disorder
47
to assess or minotr for drug use the most accurate and sensitive measure is
urine tox screen using gas chromatography mass spectrometry (GC-MS)