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