PSYCH Flashcards
What is a complex somatic, cognitive, affective, and behavioral effects of psychological trauma?
PTSD
What are some specific considerations of PTSD regarding armed conflict and combat?
- strong correlation to TBI
- develops over several months
Pathophysiology of PTSD is unknown. Studies using MRI have shown decreased volume in what areas of the brain?
- Left amygdala
- Hippocampus
- Anterior cingulate cortex
- increased central norepinephrine levels
Where is the fear center of the brain?
Left amygdala
Where are memories stored in the brain?
Hippocampus
How long must symptoms be present following trauma for psychiatry to make diagnosis of PTSD?
4 weeks
What are the 3 types of psychotherapy for PTSD?
- Exposure therapy
- CBT (Cognitive Behavioral Therapy)
- EMDR (Eye Movement Desensitization and Reprocessing)
How does psychotherapy work and what is the goal in regards to PTSD?
Helps the patient integrate the events in and adaptive way
What medication is the first line treatment of choice in regards to PTSD?
Antidepressant Medications
- SSRIs (Sertraline)
What medication is used for nightmares?
Prazosin
What medication is used for tremors and sympathetic responses?
Beta blockers
Why should benzodiazepines be avoided?
safety and dependency issues
What is the screening tool for eating disorder?
SCOFF
What does SCOFF stand for?
S- Do you make yourself SICK because you feel uncomfortably full?
C- Do you worry you have lost CONTROL over how much you eat?
O- Have you recently lost more that ONE Stone(14 pounds) in the last 3 months?
F- Do you believe yourself to be FAT when others say your are thin?
F- Would you say that FOOD dominates your life?
Anorexia is more common in men or women?
women
What is the median age of onset for anorexia?
18
Neuroimaging studies of have shown structoral brain changes in patients with anorexia to inlcude?
- Dopaminergic dysfunction
- Serotonergic dysfunction
Deficits in what will result in changes of eating behavior, motivation and reward?
Dopamine
Deficits in what will result in changes in mood, impulse control, and obsessive behavior?
Serotonin
BMI requirement for anorexia?
<17.5
What are some common physical findings for anorexia?
- low BMI <17.5
- emaciation
- hypothermia
- bradycardia
- hypotension
- hypoactive bowel sounds
- Xerosis (dry scaly skin
- brittle nails
- langugo body hair
- abdominal distension
Bulimia is 3 times more common in men or women?
women
What is the median onset of age for bulimia?
18
What is recurrent episode of binging and purging and inappropriate compensatory behavior to prevent weight gain?
Bulimia
What are some of the diagnostic criteria for bulimia?
- self induce vomiting
- misuse of laxatives
- diuretic use
- enemas
- fasting
- excessive exercise
What is the occurance criteria for bulimia?
At least once per week for 3 months
What are some clinical findings of bulimia?
- dehydration
- menstrual irregularities
- mallory-weiss syndrome
- pharyngitis
- erosion of dental enamel
- ECG changes may occur
What eating disorder presents with uncomfortably full, eating when not hungry, feeling of embarrassment, feeling of disgust and depression?
Binge eating disorder
What eating disorder presents with eating of nonfood substances, inappropriate eating behavior for developmental level, not culterally or social normal eating, associated with iron deficiency anemia?
PICA
What eating disorder involves repeated regurgitation of food that may be rechewed, re-swallowed or spit out?
Rumination disorder
What labs should be ordered for eating disorders?
- CBC
- Thyroid
- Metabolic panel
Where do you refer eating disorders?
- psychiatry
- nutrition
What is the triad of substance abuse?
- psychological dependence or craving
- physiological dependence
- tolerance
What is the 3rd leading preventable cause of death in the US?
Alcohol use disorder
What is referred to as the consumption of alcohol that puts patients at risk for health consequences and may develop in to alcohol use disorder?
Risky alcohol use
How many requirements must be met in order to diagnose mild alcohol use disorder?
2-3
What are some medical complications of alcohol use?
- HTN
- liver disease
- pancreatitis
- gastritis
- esophagitis
- neuropathy
NIAAA has estimated consumption of alcohol amounts that increase health risks for men under 65 as?
- more than 14 standard drinks per week
- more than 4 drinks on any day
NIAAA has estimated consumption of alcohol amounts that increase health risks for women under 65 as?
- more than 7 standard drinks per week
- more than 3 drinks on any day
Standard drinks are defined as?
- 5 oz of wine
- 12 oz of beer
There is a strong association between alcoholism and what psychiatric disorders?
- depression
- anxiety
- PTSD
- eating disorders
- other substance use disorders
- sleep disturbances
- suicidal ideations
Meta-analysis of alcohol disorder found a strong association with what psychiatric disorder?
SI and SA
- estimated lifetime rate of 7%
- US average of adult population much lower at 1%
What are some signs of alcohol withdrawl?
- tremors
- agitation
What are signs of peripheral neuropathy that may be present in alcohol disorders?
- problems with sensation
- diminished DTRs
- paresthesia
What are some signs of liver disease in alcohol disorder?
- hepatic/splenic enlargement
- icterus/jaundice
- spider angiomata
- palmar erythema
What is the acronym for the 4 quick questions that are used for alcohol disorder but are not a valid screening tool?
CAGE questions
What are the CAGE questions?
- Have you felt you should CUT down on your drinking?
- Have people ANNOYED you by criticizing your drinking?
- Have you ever felt bad or GUILTY about your drinking?
- Have you ever taken a drink first thing in the morning (EYE OPENER) to steady your nerves or get rid of a hangover?
2 affirmative CAGE questions results in?
- 77% sensitive, 79% specific for alcohol abuse and dependence
- 53% sensitive, 70% specific for unhealthy alcohol use
What is a complication of alcohol disorder due to deficiency of thiamine (Vitamin B1)?
Wernick Korsakoff syndrome
Wernick Korsakoff syndrome is divided into what two separate syndromes?
- Wernick encephalopathy (WE) (acute)
- Korsakoff syndrome (chronic)
What is demyelination, atrophy, hemorrhages, and vascular congestion aka direct damage to the brain caused by thiamine (vitamin B1) deficiency?
Wernick encephalopathy
What is the triad for WE?
- encephalopathy
- disorientation, inattentiveness
- oculomotor dysfunction
What is the most common finding of WE?
nystagmus
What are some other finding of WE?
- gait ataxia
- wide based gait
- slow, short, spaced steps
- confusion
Most WE patients will not have triad however what is the most common symptom?
confusion
What is a late neuropsychiatric manifestation and consequence of WE?
Korsakoff’s syndrome
What does Korsakoff’s syndrome cause?
anterograde and retrograde amnesia
- long term memory and cognitive skill impairment is less common
Mild alcohol withdrawal symptoms usually begin when?
6 to 24 hours after last drink
Mild alcohol withdrawal resolves within how many days?
1-2
What are some physical signs of mild alcohol withdrawl?
- tachycardia
- hypertension
- tremors
What are some symptoms of alcohol withdrawal?
- anxiety
-minor agitation - restlessness
- insomnia
- tremor
- diaphoresis
- palpitations
- HA
- alcohol craving
What are more severe symptoms of alcohol withdrawal?
- hallucinations
- seizures
- delirium
Hallucination in regard to alcohol withdrawal begins and resolves when?
12-24 hours and resolves in 1-2 days
What are the most common types of hallucination in regard to alcohol withdrawal?
Visual hallucinations
- insect or animals in the room
What is the typical type of seizure for alcohol withdrawal?
generalized toniclonic
When do seizures from alcohol withdrawals occur?
6-48 hours after last drink
What percentage of patients with alcohol withdrawal will develop seizures?
10-30%
What is the increased risk of seizures with repeated withdrawals called?
Kindling effect
Delirium due to alcohol withdrawal begins when when?
72-96 hours after last drink
What is a fluctuating disturbance in attention and cognition that may include hallucinations?
delirium tremens
Severe forms of alcohol withdrawal include agitation and extreme hyperactivity such as?
- fever
- tachycardia
- hypertension
- drenching sweats
The mortality rate of alcohol withdrawal without treatment is?
20%
What are some cardiovascular complications of alcohol withdrawal?
- hyperthermia
- aspiration
- severe electrolyte abnormalities
What is the leading preventable cause of mortality word wide?
Tobacco use disorder
- 6 million deaths worldwide
- 400,000 deaths in the US anually
What are the major causes of mortality in tobacco use disorder?
- cardiovascular disease
- pulmonary disease
- cancer
What is the leading preventable cause of mortality word wide?
Tobacco use disorder
- 6 million deaths worldwide
- 400,000 deaths in the US annually
Cardiovascular disease from tobacco use is responsible for an estimated what percentage of death in the US?
33%
What is the most important risk factor for COPD?
tobacco use
Clear evidence suggests that less than how much time of advice on tobacco at each encounter can increase rates of quitting?
5 min
What are the stages of considering to quite tobacco?
- pre-contemplation
- contemplation
- action
- maintenance
What are some triggers to smoking that cause huge barrier?
smoking with…
- morning coffee
- while drinking
- meal times
What are some symptoms of nicotine withdrawal?
- increased appetite
- weight gain
- depression
- insomnia
- irritability
- anxiety
- restlessness
Nicotine is perhaps the greatest barrier in quitting. What are the time frames for quiting?
peaks in the first 3 days and slowly subsides throughout about one month
What is the time frame for nicotine withdrawal?
peaks in first 3 days. subsides slowly over the course on about 1 month
What is the long-acting nicotine replacement therapy?
nicotine patch
What is the short acting nicotine replacement therapy?
nicotine gum or lozenges
What is used for both depression and smoking cessation, considered an atypical antidepressant, inhibits reuptake of norepinephrine and dopamine as well as act as nicotine receptor antagonist, and reduces nicotine cravings and withdrawals?
Bupropion (Wellbutrin)
What is a partial nicotine antagonist, stimulates dopamine activity but to a much smaller degree than nicotine, and reduces cravings and withdrawal symptoms?
Varenicline (Chantix)
What is the effect time for cannabis?
10-20min and lasts 23 hours
How much does an average joint contain?
0.3 grams
- containing 20mg of tetrahydrocannabinol with a half-life of 7 days
How long can marijuana be detected in urine?
short term user - 4-6 days
long term user - 20-50 days
What are the two phases of marijuana usage?
- mild euphoria
- sleepiness
In an acute stage of marijuana usage what would the user present with?
- altered time perception
- less inhibited emotion
- psychomotor problems
- impaired immediate memory
-conjunctival injection
Long term use of marijuana can lead to respiratory problems such as?
- pulmonary tree abnormalities
- laryngitis
- rhinitis
- COPD
What effect does marijuana have on the male and female reproductive system?
- decrease plasma testosterone levels and reduced sperm in men
- abnormal menstruation and failure to ovulate in women
What is the most used approach for psychotherapy in patients with substance abuse disorder, especially cannabis dependance?
Cognitive Behavorial therapy
Cannabis use is highest between what ages?
18-25 (18.7%)
use tapers off after age 26 (7%)
Approximately what percentage of abused opioids are obtained from family or friends?
55%
What are some vitals signs and findings associated with opioid toxicity?
- HR increase or decrease
- decreased blood pressure
- decreased respiratory rate
- decreased temperature
GI: decreased bowel sounds
Neuro: sedation
Opthalmologic: miosis
What should you always check in suspected opioid intoxication?
serum glucose concentration
- hypoglycemia is not uncommon, rapidly correctable, and easily confused with acute opioid intoxication
If a patient suspected of opioid intoxication is found down what should you consider and order?
Rhabdomyolysis
- order serum CPK
What is the treatment of choice for acute opioid intoxication?
Naloxone
- short half-life repeat doses may be required
Many opioids are formulated as a mix of narcotic and what?
acetaminophen
-order liver enzymes
What kind of drugs activated the CNS resulting in strong rewarding effects (euphoria, rush, high) that contributes to high abuse liability?
stimulant drugs
- cocaine
- amphetamine
What are the two forms of methamphetamines and they’re potency?
Ice - 80% pure
Speed - 10-20% pure
In 2018 what percentage of the population used cocaine?
2.0%
Coca leaf chewing involves roasting the leaves and chewing with alkaline material to enhance buccal absorption leading to a mild high, with an onset of?
5-10min lasting 1 hour
Intranasal use is simply snorting cocaine through a straw leading to a moderate high in about how long?
23min lasting for 30min
What is the purest and strongest derivative of cocaine that is prepared by simple extraction from the cocaine hydrochloride and can be injected, leading to intense high last how long?
Free base (Crack)
- intense high in 30 sec lasting for 15min
What drug can block voltage gated sodium ion channels giving it and anesthetic effect?
Cocaine
Moderate usage of any stimulants produces what findings?
- hyperactivity
- sense of enhanced physical and mental capacity
- sympathomimetic effects
The clinical picture of acute stimulant use includes?
- sweating
- tachycardia
- elevated blood pressure
- mydriasis
- hyperactivity
- acute brain syndrome with confusion and disorientation`
Clinicians should be alert to cocaine use in patients presenting with?
- nose bleeding
- HA
- fatigue
- insomnia
- anxiety
- depression
- chronic hoarsness
What is the 18th leading cause of disability in the US?
bipolar disorder
bipolar disorder is a mood disorder that is characterized by what three different mood states?
- mania
- hypomania
- major depression
What states of bipolar disorder is 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 every day?
Mania
What acronym is often used to remember the symptoms of mania?
DIG FAST
What does DIG FAST stand for?
D - distractibility
I - indiscretion
G - grandiosity
F - flight of ideas
A - activity increase
S - Sleeplessness
T - talkativeness
What state of bipolar disease has similar characteristics of mania only far less severe?
hypomania
What is a false sensory perception?
hallucination
What is a false fixed belief?
delusion
Bipolar disorder is an immediate referral/MEDEVAC. What can be given prior to MEDEVAC if patient is agitated??
haloperidol
What stabilizer or antipsychotic will psychiatrists use for maintenance therapy of bipolar disorder?
- Lithium
- Valproic acid
- Lamotrigine (Lamictal)
- Quetiapine (Seroquel)
What is the most common psychiatric disorder in the general population?
depressive disorder
What is the 11th greatest cause of disability and mortality in the world?
depression
What is ranked 2nd among all injuries and illnesses as a cause of disability in the United States?
major depression
What are some risk factors of depression?
- family history
- female gender
- childbirth
- childhood trauma
- stressful life events
- poor social support
- serious medical illness
- substance abuse
What is an example of a depression screening template?
PHQ-9 depression questionnaire
What is the pneumonic used by clinicians to quickly screen for depression?
SIGECAPS
What does SIGECAPS stand for?
S- Sleep changes: increase during the day or decreased at night
I- Interest: Loss of interest in activity that used to interest them
G- Guilt: Depressed people tend to devalue themselves
E- Energy: lack of energy or fatigue
C- Concentration: reduced concentration and cognition
A- Appetite: Usually declined sometimes increased
P- Psychomotor agitation: anxious or lethargic feelings
S- Suicide
What is the most feared and most important complication of depression?
suicide
What is the basic lab evaluation for new onset of depression?
- CBC
- chemistry
- UA
- TFT
- HCG
What is the mainstay therapy for depression?
- psychotherapy
- pharmacotherapy
evidence that doing both improves results the most
What are the two classes of medications typically used for pharmacotherapy of depression?
- SSRI: Selective Serotonin Reuptake Inhibitor
- SNRI: Serotonin Norepinephrine Reuptake Inhibitor
What are some examples of SSRIs?
- Fluoxetine
- Paroxetine
- Sertraline
- Escitalopram
- Citalopram
What are some examples of SNRIs?
- Venlafaxine
- Duloxetine
Side effects of SSRIs and SNRIs are reported in what percentage of patients?
55%
What are some common side effects of SSRIs and SNRIs?
- sexual dysfunction
- drowsiness
- weight gain
- insomnia
- anxiety
- dizziness
- HA
- dry mouth
- blurred vision
- nausea
- rash
- tremor
- constipation
- abdominal pain/ upset stomach
General consideration for SSRI is that suicidality may be increased in patients between what age?
18-24
Adjustment disorder is specifically NOT diagnosed in context of what?
bereavement
When does adjustment disorder resolve?
resolves withing six months when the stressor is removed
What are some examples of recent stressors that may cause adjustment disorders?
- deployment
- marital problems
- recruit training
- financial problems
- increased responsibilities
Post partum depression usually occurs within what time frame?
within 12 months of delivery
What is the likely cause of post-partum depression?
- genetic susceptibility
- hormonal changes
- increased stressor
What is depression that occurs within 12 months after delivery
post-partum depression
Diagnostic criteria for post-partum depression is the same for major depression and must have at least how many symptoms and lasting how long?
at least 5 symptoms for at least 2 weeks
What is a mild self-limited psychiatric disorder that typically develops within 2-3 days of delivery and resolves within 2 weeks?
post-partum blues
What is recommended for screening post-partum depression?
Edinburgh Postnatal Depression Scale
What is the initial treatment for post-partum depression?
- psychotherapy
- cognitive behavioral therapy
What SSRIs appear to have the lowest adverse effects on infants?
- Paroxetine (Paxil)
- Sertraline (Zoloft)
Episodes of post-partum depression last how long in 30-50% of patients?
1 year
- risk for reoccurrence
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 six months?
Generalized Anxiety Disorder (GAD)
GAD is twice as common in men or women?
women
GAD goes hand and hand with what other psychiatric conditions?
- depression
- specific phobias
- medically unexplained chronic pain
What are some clinical manifestations of GAD?
- hyperarousal and muscle tension
- poor sleep
- fatigue
- difficulty relaxing
- HA
- pain in neck, shoulder, and back
- most do not present with excessive worrying but when aske will admit to worrying excessively about minor matters
What is the common screening form used for GAD
GAD 7
What is the treatment for GAD?
CBT, medication or both
What is the first line medication classes for GAD
- SSRIs
- SNRIs
Panic attacks are thought to occur in about 1/3 of people in their lifetime. People who experience multiple panic attacks have what?
Panic disorder
What is the median onset of age for panic disorder?
24
Panic disorder is twice as common in men or women?
women
What is a spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour?
panic attack
What is the criteria used for panic attacks?
DSM-5
What are some somatic symptoms of panic attacks?
- chest pain
- SOB
- abdominal pain
- dizziness
What is the treatment for panic attacks?
Anxiolytics
-Benzodiazepines
What are some examples of benzos?
- clonazepam
- lorazepam
- diazepam
- alprazolam
Why should chronic use of benzos be avoided?
- risk of addiction
- risk of withdrawal
What are some long term treatments for panic attacks
SSRIs
- SNRI Venlafaxine
What is the lost of contact with reality?
psychosis
What is a strongly held false belief?
delusion
Delusions or beliefs broadly cataegorized as?
- bizarre
- non bizarre
What is the belief that one is being followed or harassed by outside entity?
persecutory delusion
What is the belief that one is a billionaire
grandiose delusion
What is the believing a famous person is in love with them?
erotomaniac delusion
What is believing a dialog on TV is directed towards you?
delusion of reference
What is believing ones’s thoughts and movements are being controlled by a powerful outside force?
delusion of control
What is a wakeful sensory experience of content that is not actually present?
hallucination
What is a misinterpretation of sensory experience?
illusion
What is the most common sensory modality for hallucinations?
auditory
- sounds and voices
What speech pattern is derived from very little information conveyed by speech and often very sparse reply or lack of spontaneous speech?
alogia/poverty of content
What speech pattern derived with suddenly losing train of thought and characterized by abrupt interruptions in speech?
thought blocking
What speech pattern is derived from speech content that has ideas presented in a sequence that is not closely related or does not make sense?
loosening of association
What speech pattern is derived from answers to interview questions diverge from topic being asked?
tangentality
What speech pattern is derived from using words in a sentence that are linked by rhymes or sounding similar?
clanging or clang association
What speech pattern is derived from real words are linked together incorrectly and make no sense?
word salad
What speech pattern is derived from repeating words or ideas persistently?
perseveration
What is the management of psychosis?
immediate referral
What can you use to treat acute agitation associated with psychosis?
haloperidol
Antipsychotic medications became available in the 1950s and the are no 2-generation classified as?
Typical - first generation (haloperidol)
Atypical - second generation (aripiprazole, risperidone, quetiapine, olanzapine)
What medications acts as postsynaptic blockade of dopamine D2 receptors?
second gen atypical antipsychotic
What extrapyramidal side effect of antipsychotics presents with motor restlessness with compelling urge to move and inability to sit still?
akathisia
What extrapyramidal side effects of antipsychotics presents with mask like facies, resting tremors, cogwheel rigidity, shuffling gait, psychomotor retardation (bradykinesia)?
Parkinsonian syndrome
What extrapyramidal side effects of antipsychotics presents with involuntary contraction of muscles?
dystonia
What extrapyramidal side effects of antipsychotics presents with involuntary movement of the face, sucking or smacking of the lips, movement of the tongue, facial grimacing, off movement of extremities, usually occurs with greater than 6 months of treatment with antipsychotics?
tardive dyskinesia
What are the two distinct phases of sleep?
- REM (rapid eye movment) AKA dream sleep
- NREM (non-REM)
What is a common cause of sleep disorder?
depression
What are some common factors of sleep disorder?
- stress
- caffeine
- physical discomfort
- daytime napping
- early bedtimes
What psychiatric disorder often associated with sleep difficulties results with fragmented sleep, decreased total sleep time, and earlier onset of REM?
depression
What psychiatric disorder often associated with sleep difficulties results with insomnia and signs of impeding mania?
bipolar disorder
What is the first line treatment for sleep disorder?
sleep hygiene
What are some examples of sleep hygiene?
- no caffeine/nicotine in evening
- daily exercise regime (avoid evening workouts)
- avoid alcohol use
- limit fluids in the evening
- relaxation techniques
What medication can be used for sleep disorders?
antihistamines
- hydroxyzine, diphenhydramine
What is a long term use medication for sleep disorders?
Trazadone
What is an enduring pattern of perceiving, relating to, and thinking about the environment and oneself?
personality disorder
Personality disorder is clustered by?
A, B, and C
What are the 2 two personality types of personality disorder that fall under cluster B
- Borderline Personality Disorder (BPD)
- Antisocial Personality Disorder (ASPD)
What type of personality disorder presents with instability of interpersonal relationships, self-image, and emotions?
Borderline Personality Disorder (BPD)
What is the most widely studied personality disorder?
Borderline Personality Disorder (BPD)
What type of personality disorder presents with patterns of social responsibilities, exploitive, and guiltless behavior?
Antisocial Personality Disorder (ASPD)
What is a marked pattern of inattention and/or hyperactivity/impulsivity that is inconsistent with development level and clearly interferes with functioning in at least 2 setting (school, work, home)?
Attention Deficit / Hyperactive -Disorder
Adult must have childhood onset by what age with consistent and current symptoms to be diagnosed?
12
- at least some symptoms need to be present before age 7
Data strongly supports that a neurological and genetic basis of what dysfunction is a central finding in ADHD
catecholaminergic
What is a disorder characterized by a pattern of negativistic, hostile, and defiant behavior?
Oppositional Defiant Disorder
What is a disorder characterized by habitual rule breaking, defined by patterns of aggression, destruction, lying, stealing, or truancy?
Conduct Disorder
What labs /studies/ECG are indicated for ADHD?
NONE however CT/MRI have shown structural brain abnormalities.
What is the mainstay treatment for ADHD?
medications
What are the most common treatment for ADHD?
stimulants
- methylphenidate
- amphetamine
What are some examples of methylphenidates?
- Ritalin
- Concerta
- Metadate
What are some examples of amphetamines?
- Adderall
- Dexedrine
- Vyvanse
What part of the brain is especially susceptible to damage due to being near the sphenoid ridge?
Hippocampus
What part of the brain is susceptible to countercoup injuries?
frontal lobes
How can head injuries be rated?
Glascow Comal Scale (GCS)
What studies should be done on a patient with memory loss?
- neurologic assessment
- Military Acute Concussion Evaluation (MACE)
- EEG - may show brain changes after trauma
What is the strong desire to be or the insistence that one is a gender other than the one assigned at birth?
gender dysphoria
What is the disturbance of the process in sexual functioning which causes clinically significant distress?
sexual dysfunction
Delayed or absent ejaculation / orgasms occurring on almost all occasions of patterned sexual activity and persists for a minimum of how many months?
6 months
What is the treatment for psychological and organic impotence?
- Avanafil (Stendra)
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
Female sexual interest/ Arousal disorder is the lack or significantly reduced sexual intent/arousal for as least how long?
6 months
What drug has been reported to increase various indices of sexual responsiveness in women with low sexual desire?
Bupropion (Wellbutrin)
Genito-Pelvic Pain/ Penetration disorder includes what four commonly comorbid symptoms?
- difficulty having intercourse
- genito-pelvi pain
- fear of pain on vaginal penetration
- tension of the pelvic floor muscles
Male hypoactive sexual desire disorder is the absence of desire for sexual activity and persistently or recurring deficient sexual/erotic thoughts or fantasies for how many months?
6 months
What is the persistent or recurrent pattern of ejaculation occurring during partnered sexual activity approximately 1 minute following vaginal penetration and before the individual wishes it? must be present for how long?
Premature ejaculation
6 months
What is the most common treatment for premature ejaculation?
Serotonergic drugs
- Paroxetine (Paxil)
- Clomipramine (Anafranil)
What is the most important complication in mental health?
Suicide
What is a significant factor in many attempts of suicide?
alcohol
Suicide prevention training should include what three things?
- warning signs
- supervisors getting to know their personnel
- watching for changes in behavior, attitude, or performance
What can be used to help identify whether someone is at risk for suicide, assess severity and immediacy of the risk, and gauge level of support that the person needs?
Columbia-Suicide Severity Rating Scale (C-SSRS)
Who in the chain of command can offer help with suicidal patients at sea?
CMC
What is available for structured interventions for rescuers and survivors involved in incidents likely to produce traumatic stress?
Special Psychiatric Rapid Intervention Team (SPRINT)
DSM-5 distinguishes what 2 conditions for further study?
- suicidal behavior disorder
- non-suicidal self-injury
What is a self-inflicted behavior done in the expectation that will lead to death?
suicide attempt
What consist of deliberate self-inflicted bodily damage with the expectation that the injury will not be lethal, but will lead to only mild physical harm?
non-suicidal self-injury
The typical reported age of NSSI falls between what ages?
12-14
peaking in mid adolescence and decreasing in adulthood
What is the total expression of a person’s emotional response, mood, cognitive functioning?
mental staus
Body language: lack of facial expression may indicate what?
depression or neurogenic conditions
Body language: excessive energetic movements suggest what?
tension and mania
Person disorientation suggest?
- cerebral trauma
- seizures
- amnesia
Place disorientation suggest?
- psychiatric disorders
- delirium
- cognitive impairment
Time disorientation suggests?
- anxiety
- delirium
- depression
- cognitive impairment
What is a standardized brief screening tool used to test cognitive ability? Takes 10 min to administer and consists of 11 items measuring orientation, registration, attention, calculation, recall, and language?
Mini Mental State Exam (MMSE or Folstein Test)
What are some signs of impaired cognitive function?
- significant memory loss
- confusion
- impaired communication
- inappropriate affect
- personal care difficulties
- hazardous behavior
- agitation
- suspiciousness
Asking patient to describe analogies is testing what function?
doctor/hospital, teacher/school
Analogies (cognitive)
Asking your patient to tell you the meaning of a proverb, fable or metaphors is testing?
Abstract reasoning (cognitive)
Asking your patient to do simple arithmetic without paper or pencil within 1 minute is testing?
Arithmetic calculation (cognitive)
Asking your patient to write his/her name and address, or dictated phrase is testing?
Writing ability (cognitive)
Asking your patient to tie their shoelace or comb their hair is testing?
Execution of motor skills (cognitive)
Asking the patient to listen and repeat the sentence or numbers is testing?
Memory (cognitive)
Asking your patient to spell the word WORLD forward an backward is testing what?
Attention span (cognitive)
-ability to perform arrhythmic calculations is another test for attention span
Asking the patient to provide solutions to hypothetical situations is testing?
Judgment (cognitive)
Asking your patient to follow simple one and two step directions is testing what?
Comprehension
What is the pantomime or word substitution to avoid revealing that a word was forgotten?
Circumlocution
What is the repetition of a word, phrase, or gesture?
Preservation
What is the disordered words in a sentence?
Flight of ideas or loose association
What are word choices based on sounds so that word rhyme in a nonsensical way?
Clang association
What is the repetition of another person’s words?
Echolalia
What is a speech disorder that can be repetitive or expressive, include hesitations and other speech rhythm disturbances, can be a result from facial muscle or tongue weakness from neurologic damage to the brain regions controlling speech and language?
Aphasia
What is a feeling or emotion manifested by facial expression or body language?
affect
What is the absence of interest in or pleasure from performance of acts that would ordinarily be enjoyable?
anhedonia
What is a medication designed to treat anxiety
anxiolytic
What is the excessive eating beyond amount necessary to satisfy normal appetite?
binge
What a syndrome of psychomotor retardation characterized by periods of rigidity and lack of response to outside stimuli?
catatonia
What is the uncontrollable impulse to perform an act, often repeatedly, as unconscious mechanism to avoid unacceptable ideas or desires, which themselves arouse anxiety?
compulsion
What is behavior that is neither goal directed or guided by rational preconceived plan?
disorganized behavoir
What is speech in which the statements are not logically connected to each other?
disorganized speech
What is the unconscious separation of a group of mental processes from the rest of the conscious awareness?
dissociation
What is the disturbance in amount, quality, or timing of sleep?
dysomnia
What is the higher level of cognitive function including planning, abstraction, inductive reasoning, and organizing?
executive functioning
What is the subjective perception of an object or an event when no such stimulus or situation exists?
hallucination
What is a misinterpretation of false perception of a real sensory stimulus?
illusion
What is the sudden, often unreasonable, determination to perform some act, the performance of which often provides sense of relief or release of tension?
impulse
What is the inability to fall or stay asleep in absence of external impediment during the period when sleep should occur?
insomnia
What is a pervasive feeling, tone, or internal emotional state which, when impaired, can markedly influence virtually all aspects of a person’s behavior or perception of external events?
mood
What is the state which the individual interprets and regrets everything in relation to himself and not other?
narcissism
What is the recurrent and persistent idea, thought, or impulse to carry out an act?
obsession
What is the belief systems that include extreme suspiciousness and mistrusts of other?
paranoia
What is an abnormal increase in physical and emotional behavior?
psychomotor agitation
What is an abnormal slowing in physical and emotional activity?
psychomotor retardation
What is a mental health and behavioral disorder causing gross distortion or disorganization of a person’s mental capacity; A defective response and capacity to recognize reality, communicate and relate to others to degree of interfering with the person’s capacity to cope with ordinary demands of everyday life?
psychosis
What is the act of causing the evacuation of bowels and stomach by induction of vomiting, use of enemas, or laxitives?
purge
What is an event or situation that induces psychological , emotional or behavioral distress?
stressor
