Psych Flashcards
What is the complex somatic, cognitive, affective, and behavioral effects of psychological trauma
Post-traumatic stress disorder (PTSD)
What are the types of trauma that may vary with PTSD
Sexual trauma
Trauma to someone in close interpersonal network
Interpersonal violence
Participation in organized violence
Other types of violent events
What are examples of sexual trauma
Rape
Childhood sexual abuse
Intimate partner violence
What are examples of trauma to someone in close interpersonal network
Death of a loved one
Critically ill child
What are examples of interpersonal violence
Assault
Childhood physical abuse
A serious threat of violence
What are examples of participation in organized violence
War
Witnessing death
Witnessing dead bodies
What are other types of violent events
Motor vehicle accident
Natural disasters
Studies using MRI have shown decreased volume in several areas of the brain such as where
Left amygdala - fear center
Hippocampus - memories
Anterior cingulate cortex
What are some sx of PTSD
Affective dysregulation (anger common)
Cognitive impairment
Several behavior responses in response to regular stimuli: flashbacks, severe anxiety sx, fleeing, combative behaviors
Sx must be present for how long following psychiatry to make dx
4 weeks
What is the treatment for PTSD
Therapy and medication are both useful and can be used either alone or in combination
What are examples of psychotherapy
Exposure therapy
CBT (cognitive behavioral therapy)
EMDR (eye movement desensitization and reprocessing)
What medications are used in PTSD
Antidepressant medications (SSRIs)
What are the first line therapy choice of medications
SSRIs - Sertraline
What medication can be given to a patient with PTSD that suffers from nightmares
Prazosin
What medication can be given to a patient with PTSD that suffer from tremors and sympathetic responses
Beta blockers
What medications can be given to a patient with PTSD that suffer from comorbid psychosis
Antipsychotics
Why do we NOT give a patient with PTSD benzodiazepines
Due to safety and dependency issues
What is the prognosis for patients with PTSD
Sooner therapy leads to better prognosis
Do NOT wait to refer if PTSD is suspected
What are the primary dx of patients that experience persistent disturbance of eating that impairs both health and psychological functioning
Anorexia nervosa
Bulimia nervosa
What acronym can be used as a screening tool for psychiatric causes that can help differentiate between an eating disorder and other causes of weight loss
SCOFF
What does the “S” in SCOFF stand for
Do you make yourself SICK because you feel uncomfortably full
What does the “C” in SCOFF stand for
Do you worry you have lost CONTROL over how much you eat
What does the “O” in SCOFF stand for
Have you recently lost more than ONE stone (14 pounds) in a three month period
What do the “F”s in SCOFF stand for
Do you believe yourself to be FAT when others say you are thin
Would you say that FOOD dominates your life
Who is anorexia nervosa more common in
Women
What is the median age of onset of anorexia nervosa
18 years old
What are the specific deficits in dopaminergic function and serotonergic function
Dopamine: eating behavior, motivation and reward
Serotonin: mood, impulse control, obsessive behavior
What screening tool is used for anorexia nervosa
DSM V
What are common physical exam findings
BMI less than 17.5
Emaciation
Hypothermia
Bradycardia
Hypotension
Hypoactive bowel sounds
Xerosis (dry and scaly skin)
Brittle hair and nails
Lanugo body hair
Abdominal distention
Who is bulimia nervosa more common in
3X more common in women than men
What is the median age of onset of bulimia nervosa
18 years old
What are some diagnostic criteria for bulimia nervosa
Recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain such as: self induced vomiting
Misuse of laxatives
Diuretic use
Enemas
Fasting
Excessive exercise
How long does this behavior have to last to meet diagnostic criteria
Occurring on average at least once per week for 3 months
What are some clinical findings of bulimia nervosa
Dehydration
Menstrual irregularities
Mallory-Weiss syndrome
Pharyngitis
Erosion of dental enamel
ECG changes may occur
What are some other eating disorders
Binge eating disorder
PICA
Rumination disorder - repeated regurgitation of food
What is the management of eating disorders
Once recognized, eating disorders require referral - NEVER force feed
What labs are indicated for patients with eating disorders
CBC
Thyroid studies
Metabolic panel
Who do patients with eating disorders get referred to
Psychiatry
Nutrition consult
What is the triad for substance abuse
Psychological dependence or craving
Physiologic dependence
Tolerance
What is the 3rd leading preventable cause of death in the United States
Alcohol use disorder
What is the consumption amount of alcohol according to the NIAAA for men to consider alcohol abuse
Men under age of 65 - more than 14 standard drinks per week on average or more than 4 drinks on any given day
Standard: 5 oz of wine, 12 oz beer
What is the consumption amount of alcohol according to the NIAAA for women considered alcohol abuse
Women and adults 65 years and older - more than 7 drinks per week on average, more than 3 drinks on any given day
What are some medical complications of alcohol use
HTN
Cardiovascular disease
Liver disease
Pancreatitis
Gastritis
Esophagitis
Neuropathy
What screening acronym is used for patients that abuse alcohol
CAGE
What does the “C” in the CAGE acronym stand for
Have you ever felt you should CUT down on your drinking
What does the “A” in the CAGE acronym stand for
Have people ANNOYED you by criticizing your drinking
What does the “G” in the CAGE acronym stand for
Have you ever felt bad or GUILTY about your drinking
What does the “E” in the CAGE acronym stand for
Have you every take a. Drink first thing in the morning (EYE OPENER) to steady your nerves or get rid of a hangover
What is a complication of alcohol use disorder
Wernicke Korsakoff syndrome
Why is wernicke Korsakoff syndrome a complication of alcohol use disorder
Due to a deficiency of Thiamine (Vitamin B1)
What is the difference between Wernicke encephalopathy (WE) and Korsakoff syndrome
Wernicke is an acute syndrome and Korsakoff is a chronic neuro condition
What presents with direct damage to the brain caused by thiamine deficiency, gait ataxia, wide based gait, slow and short spaced steps, with the most common sx of confusion
Wernicke encephalopathy (WE)
What causes anterograde and retrograde amnesia
Korsakoff syndrome
Usually a consequence of WE and it is a late neurophysciatric manifestation of Wernicke
What substance abuse disorder is a potentially life threatening problem
Alcohol withdrawal
What percentage of patients experience severe sx of alcohol withdrawal
20%
What are some mild alcohol withdrawal symptoms
Anxiety
Minor agitation
Restlessness
Insomnia
Tremor
Diaphoresis
Palpitations
Headache
Alcohol craving
How soon do sx generally begin and end for mild withdrawal to alcohol
Start within 6-24 hours of last drink
Resolves in one to two days
What sx present for severe withdrawal of alcohol
Hallucinations
Seizures
Delirium
How soon do hallucinations begin and end for severe alcohol withdrawal
Start within 12-24 hours
Resolves in 1-2 days
Hallucinations are common
How soon do seizures begin for severe alcohol withdrawal and what percentage of patients experience this
Usually tonic-clonic
Start 6-48 hours of last drink and 10-30% of patients will develop the sx
What is the kindling effect and what is it relationship to
Risk of seizures increases with repeated withdrawals for those that suffer from severe sx with alcohol withdrawal
How soon does delirium begin for severe alcohol withdrawal and what percentage of patients experience this
Begins within 72-96 hours after last drink
Occurs in 1-4% of patients hospitalized with withdrawal
What is delirium tremens
Fluctuating disturbance in attention and cognition that may include hallucinations
What is the mortality rate for severe alcohol withdrawal without treatment
20%
With treatment: 1-4%
What is the leading preventable cause of mortality worldwide
Tobacco use disorder
Smoking cessation has mortality benefit for who
Both men and women of all ages
What are the major causes of mortality for tobacco use disorder
Cardiovascular disease
Pulmonary disease
Cancer - cancer types associated with smoking are numerous
What is responsible for an estimated 33% of all cardiovascular related deaths in the US
Cardiovascular disease
What has the most important risk factor for COPD
Pulmonary disease
What are the stages that someone who is considering quitting tobacco use may be in
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
What is perhaps the greatest barrier to quitting tobacco use
Nicotine withdrawal - peaks in the first 3 days and slowly subsides over the course of about one month
What are some treatment options for those with nicotine withdrawal
Nicotine replacement therapy
Bupropion (Wellbutrin)
Varenicline (Chantix)
What is the popular option for nicotine withdrawal that includes long and short acting nicotine replacement
Nicotine replacement therapy
Long acting: nicotine patch
Short acting: gum or lozenges available
What is used for both depression and smoking cessation, considered atypical antidepressant, reduces nicotine cravings and withdrawal sx
Bupropion
What is a partial nicotine antagonist, reduces cravings and withdrawal sx
Varenicline
What is detected in most urine tests for 4-6 days in short-term users and 20-50 days in long-term users
Cannabis/marijuana
What are some findings associated with acute opioid toxicity
Vital signs changes: increased or decreased heart rate, decreased blood pressure, respiratory rate and temperature
GI: decreased bowel sounds
Neuro: sedation
Eyes: miosis
What is the treatment of choice for acute opioid intoxication
Naloxone
What are some clinical findings of stimulant use disorder
Sweating
Tachycardia
Elevated blood pressure
Mydriasis
Hyperactivity
Acute brain syndrome with confusion and disorientation
What is the 18th leading cause of disability in the US
Bipolar disorder
Bipolar disorder is a mood disorder that is characterized by what different mood states
Mania
Hypomania
Major depression
What is mania
A distinct period of abnormally or persistently elevated, expansive, or irritable mood and persistently increased activity or energy, lasting at least one week and present most of the day, nearly everyday
Three or more of what sx must be present to fall under mania
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressured speech
Flight of ideas/racing thoughts
Distractability (easily distracted by stimuli)
Increased goal directed activity
Involvement in activities that carry negative potential
What acronym can be used to remember sx of mania
DIGFAST
What are the contents of DIGFAST
Distractibility
Indiscretions
Grandiosity
Flight of ideas
Activity increase
Sleeplessness
Talkativeness
What has similar characteristics of mania only far less severe and presents with no grandiosity
Hypomania
What are some sx of major depression
Depressed mood
Diminished interest in pleasurable activities
Weight loss or weight gain
Insomnia or hypersomnia
Psychomotor agitation
Decreased energy
Guilt or feelings of worthlessness
Impaired concentration
Thoughts of death or thoughts of suicide
What classifications must be met to have major depression
Five or more sx during the same 2 week period
What is the management of bipolar disorder
Immediately refer and manage acute sx
If there is an agitated patient, what can the IDC do to manage
Try to talk them down or give an antipsychotic medication for assistance
What medication can be given to a MEDEVAC bipolar patient
Haloperidol if needed
What will usually be employed by psychiatrist with a mood stabilizer or antipsychotic
Maintenance therapy
What medications could a bipolar patient be prescribed
Lithium
Valproic acid
Lamotrigine (lamictal)
Quetiapine (Seroquel)
What is the 11th greatest cause of disability and mortality in the world
Depression
Major depression ranks as what among all injuries and illnesses as cause of disability
2nd
What are some of the risk factors for depressive disorder
Family history
Female gender
Childbirth
Childhood trauma
Stressful life events
Poor social support
Serious medical illness
Substance abuse
What screening tool is used for a patient that presents with depressive disorder
PHQ-9 Depression Questionnare
What pneumonic is us used by primary care clinicians to quickly screen for depression when a PHQ-9 is not utilized or available
SIG E CAPS
What does the first “S” in SIG E CAPS stand for
Sleep changes
What does the “I” in SIG E CAPS stand for
Interest (loss)
What does the “G” in SIG E CAPS stand for
Guilt (worthless)
What does the “E” in SIG E CAPS stand for
Energy (lack)
What does the “C” in SIG E CAPS stand for
Concentration
What does the “A” in SIG E CAPS stand for
Appetite
What does the “P” in SIG E CAPS stand for
Psychomotor agitation - anxious or lethargic feelings
What does the 2nd “S” in SIG E CAPS stand for
Suicide/death preoccupation
What os the most feared and most important complication of depression
Suicide
What are the mainstays of therapy for depression
Psychotherapy
Pharmacotherapy
Or both - evidence that doing both improves results the most
What are the 2 classes of medications that can be used to treat depressive disorder
SSRIs: Fluoxetine, paroxetine, setraline, escitalopram, citalopram
SNRIs: venlafaxine, duloxetine
Medications take weeks for full effect, what is the trial time frame
4-6 weeks before becoming effective
What is the role of the IDC when managing a patient with depressive disorder
Ensure adequate F/U with mental health, typically within 2 weeks of starting meds
Continue monitoring for concerning behavior
Consider medication side effects
What are some side effects of medications used for depressive disorder
Sexual dysfunction
Drowsiness
Weight gain
Insomnia
Anxiety
Dizziness
Headache, dry mouth, blurred vision, nausea, rash, tremor, constipation, abdominal pain/upset stomach
What may look similar to a major depressive disorder but does not meet criteria
Adjustment disorder
What occurs in the context of a recent stressor and resolves within six months when the stressor is removed
Adjustment disorder
What usually occurs within 12 months after delivery
Post-partum depression
What diagnostic criteria must be met before making dx of post-partum depression
At least 5 sx for at least 2 weeks - same as those for major depressive disorder
What are some differentials for post-partum depression
Normal post-partum changes
Post-partum “blues”
Bipolar depression
What is recommended assessment used to dx post-partum depression
Edinburgh Postnatal Depression Scale (EPDS)
What is characterized by excessive and persistent worrying that is hard to control, causes significant distress, and occurs more days than not for at least 6 months
Anxiety disorder
Anxiety disorder is more common in who
Twice as common in women
Anxiety disorder goes “hand in hand” with what other psychiatric disorders
Depression
Specific phobias
“Medically unexplained” chronic pain
What is the treatment for generalized anxiety disorder
CBT, medications, or both
What are the typical first line choice of medication for treatment of generalized anxiety disorder
SSRIs
SNRIs
What is a panic attack
Spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour
What is the DSM-V diagnostic criteria for panic attack
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time FOUR OR MORE OF 13 SX OCCUR
What sx usually occur with panic attacks
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensation of shortness of breath
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed or faint
Chills or heat sensations
Parasthesia (numbness or tingling)
Derealization (feelings of unreality) or depersonalization
Fear of losing control
Fear of dying
What is agoraphobia
Fear and anxiety lead to avoidance of situations that may lead to panic
What conditions may mimic a panic attack
Angina
Arrhythmias
COPD
Epilepsy
Pulmonary embolus
Asthma
Hyperthyroidism
Substance abuse
Pheochromocytoma
What is the treatment for panic attacks
Require anxiolytics
Benzodiazepines - avoid chronic use due to addiction risk
Antihistamines - hydroxyzine
SSRIs
SNRI - venlafaxine
SSRIs/SNRIs are NOT anxiolytics, will not break an active panic attack and should be used for long term treatment
What is defined as the loss of contact with reality
Psychosis
What specific delusions accompany psychosis
Persecutors delusions
Grandiose delusions
Erotomaniac delusions
Somatic delusions
Delusions of reference
Delusions of control
What is defined as strongly held false beliefs
Delusions
What is defined as wakeful sensory experiences of content that is not actually present
Hallucinations
What are the sensory modalities that accompany hallucinations
Auditory (most common)
Visual
Tactile
Olfactory
Gustatory
What are the types of thought disorganization that are evident with psychosis
Alogia/poverty of content
Thought blocking
Loosening of association - think derailment
Tangentiality
Clanging or clang association - rhyming words
Word salad
Perseveration
What is the management of a patient with psychosis
Involves immediate referral
How do you treat acute agitation associated with psychosis, if present
Haloperidol (Haldol)
In retain scenarios may be able to simply “re-direct” the patient to help them with their agitation
What is an example of first generation antipsychotic which is older and also called “typical” antipsychotics
Haloperidol is a first generation
What are examples of second generation antipsychotics or atypical antipsychotics that are new and have improved side effect profiles
Aripiprazole
Risperidone
Quetiapine
Olanzapine
What are some side effect profiles of antipsychotics
Extrapyramidal side effects such as:
Akathisia - motor restlessness with compelling urge to move and inability to sit still
Parkinsonism syndrome - looks like Parkinson’s disease
Dystopia - involuntary contractions of muscles that is treated with Benadryl
What is Tardive Dyskinesia
Involuntary movements of the face: sucking or smacking of the lips
Movements of the tongue
Facial grimacing
Odd movements of extremities
Usually occur after greater than six months of treatment on antipsychotics
What are the two distinct phases of sleep
REM (rapid eye movement) - dream sleep
NREM - non-REM
What are some reasons that a patient may have sleep issues
Jet lag/travel and shift work can lead to temporary sleep disruptions
Circadian rhythm disorders (night owls)
Depression is a common cause of sleep disturbances
Poor sleep hygiene
What psychiatric disorders are often associated with sleep difficulties
Depression
Bipolar disorder
What is the first line of treatment for sleep disorder
Sleep hygiene
When seeking treatment, what should be avoided for patients with sleep disorders
No caffeine/nicotine in evening
Daily exercise regimen (avoid evening workouts)
Avoid alcohol
Limit fluids in evening
Relaxation techniques should be practiced
What can be given to patients with sleep disorder when sleep hygiene is ineffective: acute
Antihistamines - beneficial and produce no dependency
Hydroxyzine
Diphenhydramine
What can be given to patients with sleep disorder when sleep hygiene is ineffective: long term use
Trazadone
What are the personality types associated with Personality Disorder: Cluster B
Borderline Personality Disorder (BPD)
Antisocial Personality Disorder (ASBD)
What are distinct characteristics for BPD
Instability of interpersonal relationships, self-image, and emotions
Very impulsive behaviors
Common and most widely studied personality disorder
Interpersonal difficulties
Affective instability (unstable moods)
Impulsive behaviors
Tend to have poorer cognitive function
Suicidal threats, gestures and attempts more common
What are distinct characteristics for ASBD
Pattern of socially irresponsible, exploitative and guiltless behavior
Lifelong disorder
More prevalent in men
Wide range of sx with criminality being common
What is the definition of attention-deficit/hyperactivity-disorder
Marked pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level and clearly interferes with functioning in at least 2 settings (school, home, work)
Symptoms of ADHD must be present before what age
7 years old
Adults must have childhood onset of what age with persistent and current symptoms to be diagnosed with ADHD
By age 12
What are the clinical findings of ADHD
Marked inattention, distractability, organization difficulties, and poor efficiency
Can present with low frustration tolerance, shifting activities, difficulty organizing, daydreaming
Attenuate during late adolescence
More frequent in males
What is the mainstay of treatment and found to have similar effects when given alone than if psychotherapy was also done for ADHD
Medications:
Methylphenidate - Ritalin, concerta, metadate
Amphetamines - adderall, vyvanse
What is the definition of memory loss
Dementia due to Traumatic Brain Injury refers to a wide range of alterations in thinking, mood, and behavior resulting from neurological damage related to brain trauma
What is the pathophysiology of memory loss
Deceleration and acceleration forces act within the cranium to produce injury and the swirling movement of brain tissue causes diffuse injury to axons and contusions to cortical areas adjacent to jagged bone
What are some clinical findings of memory loss
Fatigue, headache, and/or dizziness occur shortly after trauma
Amnesia almost always involves loss of memory for the event and frequently includes loss of recall for events immediately before (retrograde amnesia) and after (anterograde amnesia) the head trauma
What is the treatment for memory loss
In mild trauma, treatment consists of determining the neuropsychological deficit and giving appropriate counseling as well as treating the sx of dizziness, headaches, and mood alteration
What is a complication/prognosis of memory loss
Symptoms attributed to post-concussion syndrome are greatest within the first 7-10 days for the majority of patients and at one month symptoms are usually improved and often resolved
What is the definition of gender dysphoria
Strong desire to be or the insistence that one is a gender other than the one assigned at birth
What is the treatment for a patient with gender dysphoria
Psychotherapy
Medical - hormonal therapy can be given to promote sexually dimorphic characteristics with the opposite sex and eventually sex reassignment surgery
What is a disturbance of processes in sexual functioning which causes clinically significant distress
Sexual dysfunction
What is a delayed or absent ejaculation/orgasm occurring on almost all occasions of partnered sexual activity and persists for a MINIMUM OF 6 MONTHS
Delayed ejaculation
What is failure to obtain erections in a situation in which they were anticipated, causing embarrassment, self-doubt, and loss of self-confidence
Erectile dysfunction
What is the essential criterion for gender dysphoria
The presence of clinically significant distress or impairment of functioning in one or more important areas (social relationships, work, etc.)
What are examples of treatment for psychological and organic impotence of erectile dysfunction
Avanafil (Stendra)
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
What is a complaint of normal libido and sexual excitement without the capacity to reach orgasm
