Other mental health disorders

Question 1

cutting

Answer 1

• not associated with suicide;
• attempt to feel something while depressed;
• typically superficial
• happens frequently in borderline personality disorders

Question 2

Physical signs and symptoms of anxiety

Answer 2

• fatigue
• headaches
• nausea
• paresthesia (usually peripheral);
• muscle tension/aches
• dysphagia
• shortness of breath
• chest pain
• diaphoresis

Question 3

mental signs and symptoms of anxiety

Answer 3

• excessive worry about both rational and irrational things;
• feeling of impending doom/disaster
• insomnia
• irritability
• restlessness;
• difficulty concentrating

Question 4

DSM-5 criteria for general anxiety disorder

Answer 4

A. excessive anxiety/worry occuring more days than not over 6 months;
B. difficult to control worry
C. worry/anxiety associated with 3 + of following sx:
- restlessness or feeling keyed up or on edge;
- being easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance
D. anxiety, worry, or physical sx cause distress or impairment in social, occupational, or other important areas;
E. disturbance not caused by substance or other condition
F. not better explained by other condition

Question 5

Cognitive behavior therapy

Answer 5

not done in primary care;

• desensitizes to anxieties and sets up coping mechanisms;
• requires referral

Question 6

Medications for anxiety in Primary care

Answer 6

• SSRIs are the mainstay

Question 7

Benzodiazepines in primary care

Answer 7

• work well with short-term anxiety or terrible panic;
• not preventatitve, act as a band-aid;
• controlled substance with addictive properties;
• avoid use as first-line med;

Question 8

5 HT1A receptor partial agonists in primary care for treatment of anxiety

Answer 8

• example is buspirone
• adjunct or substitute for benzos;
• not as effective but safer and not addictive

Question 9

Tricyclics and anxiety in primary care

Answer 9

• long-term concern: dry-mouth side effect leading to tooth decay

Question 10

non-mental health medications in primary care

Answer 10

• Propranolol;
• clonidine;
• hydroxyzine/diphenhydramine

Question 11

Propranolol for anxiety

Answer 11

• short-acting antihypertensive that slows down the heart rate for patient’s with fear of public speaking or interviewing;

Question 12

Clonidine for anxiety

Answer 12

blood pressure medication often used with patients with substance-abuse problems
- can prolong opioid high

Question 13

hydroxyzine/diphenhydramine for anxiety

Answer 13

• makes people sleepy;

- used as adjuncts for older and younger patients

Question 14

General anxiety disorder comorbidities

Answer 14

• depression
• substance use/abuse
• dysthymia
• IBS
• headaches
• ADHD

Question 15

incidence of anxiety compared to depression

Answer 15

1:2

Question 16

Who treats bipolar disorder

Answer 16

specialist only; not treated in primary care

Question 17

Bipolar disorder is referred to as

Answer 17

manic depressive disorder

Question 18

Bipolar disorder involves what 2 pones of severity

Answer 18

High: 
- extra excited
-happy
- little need for sleep
- incredibly creative;
Low:
- severe depression

Question 19

Bipolar disorder is diagnosed based on

Answer 19

cycling between highs and lows

Question 20

how is bipolar disorder different from unipolar depression

Answer 20

natures of highs (during depressed phase, virtually identical);

Question 21

Treatment of bipolar

Answer 21

antidepressants can fail if depression alone is assumed;

• can lose effect or make things worse;
• managed best with mood stabilizer plus antidepressant

Question 22

Which category of Bipolar is most severe

Answer 22

• Bipolar 1

Question 23

Mixed bipolar disorder

Answer 23

dysthymia or another disorder attached to bipolar diagnosis, with cycling

Question 24

Bipolar 1

Answer 24

true differentiation between high-highs and high-lows

Question 25

Bipolar 2

Answer 25

low-lows but not high-highs;

• may get back to normal, or a little above normal;
• not completely manic

Question 26

genetic and bipolar

Answer 26

more association with genetic association than any other mental illness;
- commonly runs in family

Question 27

Asks all depressed patients what

Answer 27

about family history of bipolar disorder

Question 28

Recurrence of bipolar

Answer 28

• recurs even if treated;

- generally requires meds for rest of life

Question 29

Bipolar is often misdiagnosed in early childhood as

Answer 29

ADHD

Question 30

Signs and symptoms of mania

Answer 30

• racing thoughts;
• lack of need to sleep;
• excess energy;
• grandiosity;
• hyperactivity;
• impulsive behavior

Question 31

Clues that a patient has bipolar disorder

Answer 31

• family history;
• input from family members {often different than pt perception};
• marked changes in mood, behavior, or productivity;
• failure of multiple antidepressants;
• on/off response to antidepressants;
• hypomanic response to antidepressants;
• mood stabilizers or bigger meds have more side effects;
• unless pt is stable, cooperation between NP and mental health provider is required