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Rotation 4: FMI > PSYCH > Flashcards

PSYCH Flashcards

1
Q
A
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2
Q

specific phobia

what is this?

timelife of development?

what does it cause?

2 tx techniques?

A

very common!!

objects or situations that invoke anxiety

this restricts their lifestyle because of this

animal phobia starts CHILDHOOD

blood injections injurt starts in ADOLESCENCE

others start in 20s

exposure results in immediate anxiety and can cause panic attacks

TX:

  1. SYSTEMATIC DESENSITIZATION feared sitmuli are paired with something relaxing (coachroach and music)
  2. FLOODING massive exposure to a feared stimulus until anxiety subsides (sitting in a plane)
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3
Q

social anxiety disorder

“social phobia”

what is this highly correlated with?

6 presentations?

3 tx options?

A

can results from having an avoidant personatliy disorder or dx of avoidant personality disorder and often socially isolate themselves as result

presentations:

  1. fears of speaking or performing in public “stage fright”
  2. public speaking
  3. speaking in classrooms
  4. eating or writting in public
  5. urinating in public restrooms
  6. attending social events

(highlighted are 3 most common)

TX:

  1. cognitive behavioral therapy assertiveness training
  2. SSRIs, SNRIs, benzos PRN
  3. propanolol for stage fright

Example: 28-yo-woman complains of being lonely. She says that she longs to have a close circle of friends, but is terrified in social situations and avoids all invitations from co-workers to attend social events. She worries that others will notice her social withdrawal and talk about her.

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4
Q

panic disorder

what is this?

11 possible sxs?

what is key that the patient must feel?

2 tx options?

A

reccurent or unexpected panic attacks of abrupt surges of intense fear and discomfort that peaks in about 1 minute or so and during and experiences 4 of the following:

1. sweating

2. palpitations

3. chest pain

4. nausea

SOB, lightheaded, chills or heat sensations, parenthesias, derealizations, fear of dying, fear of loosing control

must also be worried about the recurrance of these sxs and can occur unexpectedly or by trigger

TX:

  1. benzo PRN acute
  2. SSRI for maitenance
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5
Q

generalized anxiety disorder

what is this and how long do yo uhave to have it?

6 presentations?

3 tx options?

A

excessive poorly controlled anxiety about routine life circumstances that continues for more than 6 months where person cant’ control the worry and always worrying about different things CONSTANT

1. restlessness

2. easily fatigued

3. poor concentration

4. irritability

5. muscle tension

6. sleep disturbances

TX:

  1. SSRI
  2. anxiolytic
  3. CBT with relaxation training and biofeedback

Example: 21-year-old male worries excessively about his performance in school; he states that he knows that he is a good student and does well, but is not able to “shut down my mind” when it comes to worrying about schoolwork. He also seems to worry a great deal about money and the condition of his house. He has no issues with money and his house is in a good state of repair. He also experiences trouble concentrating and muscle tension and being easily fatigued.

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6
Q

post traumatic stress disorder

how long must ou have sxs to have dx?

when do sxs develop? get worse with?

3 feelings that take over?

3 presentations of this?

2 comorbid

A

MUST OCCUR OVER 1 month!!!

exposure or witnessing a traumatic event where sxs of PTSD can develop 1 week to years after event and can flutuate in severtiy and become worse with stress

SXS: OVERWHELING FEAR, HELPLESSNESS, HORROR that impair social or occupational functioing

Presentatiosn:

  1. sense of reliving the event (flashbacks)
  2. intrusive memories or disturbing dreams (increased arousal)

3. experience distress when exposed to trigger for event causing avoidance/vumbing

high comorbidity with substance use and depression

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8
Q

PTSD

how long does this typicall last?

4 tx options?

2 tx?

A

most cases resolve in 3 monts but can last a lifetime

tx:

  1. group psychotherapy for similar trauma stimuli
  2. SSRIs and anxiolytics
  3. immediate therapy/cousleing may help prevent PTSD from develop NOT DEBRIEFING
  4. prazosin BP med for nightmaires

Example: 34-yo-female is unable to sleep at night and is troubled by intrusive thoughts of her automobile accident 6 weeks ago in which her girlfriend was killed. She avoids driving and has become socially withdrawn. She has nightmares about the incident almost nightly, and then awakens screaming. She feels guilty about surviving and feels chronically depressed.

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9
Q

what are the MC PTSD causes for men and women?

A

men: combat
woment: assault/rape

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10
Q

anorexia nervosa

explain the two types?

4

3

A

Two Types:

  1. binge eating/purging type
  2. unable to refrain from binge eating and purging
  3. often self destructive, impulsive dramatic, emotional
  4. frequently abuse other substance
  5. evident by condintued weight loss

CYCLE: Binge, purge, guilt, restrict, feel deprived, binge *repeat*

  1. restricting type
  2. limit calories to 300-600 a day
  3. limit food selection
  4. obesessive and compuslive regarding food habits
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11
Q

anorexia nervosa

what are the 3 DSM5 requirements?

3 sxs?

2 tx options?

A

DSM-5

  1. restriction of energy leading to LOW WEIGHT
  2. instense fear of gaining weight or becoming fat
  3. disturbance in ones self vision of weight or shape

SXS:

  1. weight loss most obvious
  2. believes they are overweight despite BMI
  3. underweight

TX:

  1. SSRI
  2. atypical antipsychotics (olanxapine/zyprexa)
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13
Q

bullemia nervosa

what are 3 qualifications of dx?

4 sxs?

1 tx?

A

DX:

  1. at least once a week for 3 months
  2. not associated with anorexia nervosa, self image induced body shape and weight
  3. severity based on the COMPENSATORY BEHAVIORS

SXS:

  1. lack of control of eating
  2. inappopriate compensatory behavior
  3. typically normal weight
  4. sneaky and good at hiding behaviors

TX: SSRI

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14
Q

bulimia Nervosa

what is there reccurent episodes of?

what are the compensatory behavior?

A

recurrent episodes of:

  1. overeating (different than binge eating I believe) within a discrete period of 2 hours
  2. sense of lack of control ovr eating during episode

Includes COMPENSATORY behavior in order to prevent weight gain:

  1. purging
  2. laxative use, diuretics, fasting, exercise
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16
Q

somatoform disorder

what is this?

intentional?

4 reasons to suspect?

A

patient presents with medical complaint that cant be explained by medical testing or substance use

sxs aren’t intentional! they’re subconcious! NOT FAKING IT!!!

suspect if:

  1. multiple, dramatic, peculiar complaints
  2. profound anxiety or complete lack of anxiety about condition
  3. multiple workups without findings
  4. PE or lab studies inconsistent with story
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17
Q

what are the three somatoform disorders?

A
  1. somatic symptom disorder
  2. hypochondriasis
  3. conversion disorder
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18
Q

somatoform symptom disorder

what is this?

what does patent present with?

A

variety of complaints in more than on body system

excessive and persistent thoughts about sxs that can present with medical sxs

aka….presence of a subconcious stressor sparks physical appearance of sxs like swollen face

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19
Q

somatoform disorder

hypochondriasis

another name for this?

what is this? key sign?

how long does this occur?

what do these patients often do?

A

“illness anxiety disorder”

extensive fear of having a serious medical condition despite evidence suggesting there isn’t any “ checkerboard abdomen”

episodic but chronic over time and stimulated by a stressor

often these patients jump from DR to DR and willing to go through many procedures and even the extreme to figure out what is wrong

WANT EXTENSIVE WORKUP!!!

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20
Q

somatoform disorder

conversion disorder

what is this? 3 MC sxs?

WHEN DOES THIS OCCUR?

how does the patient appeare?

who is this MC in?

when do sxs improve?

A

sudden loss of sensory or motor function following a acute stressor MC paralysis, mutism, blindness, involuntary movement, tics, deafness

pt show unexpected lack of concern over sxs

medical tests are unconclusive!! indicate nothing is wrong!

Most common:

military involvement or catastrophic event like death

BUT SXS IMPROVE ONCE THE TURMOIL IS IMPROVED

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21
Q

what is important to remeber about both malingering and facticious disorders?

A

the person is making a concious decision to produce the sxs, the difference is the motivation

FAKING IT!!!

malingering: secondary external gains like money, legal responsibility etc

munchausen: they want the attention and medical care

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22
Q

malingering

what is this and why do people do it?

what are 3 things you can expect from these patients?

A

person fakes sxs to get the secondary gain or benefits, money, loss of legal responsbility, momentary compensation (lawsuit), free hospital room, or drugs

when to suspect:

  1. poor compliance with follow up tests or appointments UNLESS required to obtain the gain

2. compliance ceases after the gain

3. refuse to accept clean bill of health

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23
Q

facticious disorder

what is this and why do patients do this?

what does the patient often do and how do they react to confrontation?

2 examples of this condition?

A

persons fakes the sxs for the sole purpose of playing the sick role and getting medical attention (not external incentives)

patients often sign in with multiple names for multiple different complaints and when confronted get angry and sign out AMA think “BOY WHO CRIED WOLF”

EX:

MUNCHAUSEN AND MUNCHAUSEN BY PROXY

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24
Q

Facticious disorder

muchausen and munchausen by proxy

what are these?

A

muchausen: patient fakes illness to THEMSELVES to get medical care and attention EX: nurse gives themselves insulin to cause hypoglycemia so they can get attention

munchausen by proxy: the person fakes illness in somoene else like ELDERLY OR CHILD so that they can get medical attention and care through them EX: nurse gives insulin to child to cause them to have hypoglycemia so they can get medical attention

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25
Q

what are some clues when you should suspect a facticious disorder?

4

A
  1. peculiar complaint and CHANGING MEDICAL COMPLAINTS
  2. guard to tell about past medical conditions and have a hx of signing out AMA (think they get comfronted and get angry)
  3. framilliarity with medical tests and terminology
  4. findings inconsistent with PE
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26
Q

body dysmorphic disorder

what is this? where MC? MC population?

3 sxs?

age?

3 tx options?

A

obcession with imagined defect in physical appearance MC facial flaws, MC in homosexual patients

they can become obsessed with grooming and trying to hide the physical defect cuasing social avoidance and occupatonal difficulties

SXS:

  1. selfconsious

2. fear humiliation

3. commonly visit plastic surgeon or dermatologist

AGE 15-30 years old

TX:

  1. SSRI/SNRI (increase serotonin)
  2. antipsychotis if delusions
  3. CBT

45-yr-old man refuses to cut his shoulder-length hair for a new job and his employer threatens to dismiss him. The man admits to the employer that he wears his hair so long because he wants to cover his excessively large and pointy ears. Physical examination reveals mildly prominent ears that would not attract attention. The man fears being made fun of if the public was able to see his ears.

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27
Q

schizophrenia

is patient aware?

what is it characterized by? 2

what is onset for men and women?

what else to know? 4

A

ego-synotic-patient unaware

characterized by PSYCHOSIS and inability to think logically and maintain normal social behavior

Men onset: 18-25

women onset: 25-35

prodromal phase that can occur 1 month-1 year prior to onset:

1. subtle behavior changes

2. functional decline

3. social withdrawal

4. irritability

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28
Q

schizophrenia

what are the qualifications to dx this?

5

1

1

A

2 or more

  1. DELUSIONS: fixed false beliefs

2 hallucinations: unusual auditory/visual/olfactory sensory input

  1. disorganized speech: can’t stay on topic, can’t provide related answer, muttering
  2. grossly disorganized behavior: unpredictable behavior, decreased self care, inappropriate sexual behavior

5 negative sxs: blunted affect, poor posture, lack of goal drive activities

plus interferes with live

PLUS 6+ months!!

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29
Q

what is the tx for schizophrenia?

A

antipsychotics!!!

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30
Q

what is the difference between schizophrenia, schizophreniform, and brief psychotic episode?

A

sxs the exact same but the length of time differentiates

schizoprenia: 6+ mo
schizophreniform: 1-6 mo

bried psychotic episode: 1 day-1 month

31
Q

schizoaffective disorder

what is this characterized by?

what are 3 tx options?

A

baseline of psychosis with interepisodes of mood disorders with at least 2 week period between where return to baseline of psychosis

**psychotic and mood sxs, but flucuates between two**

TX:

  1. second generation antipsychotics DOC
  2. mood stabalizers
  3. antidepressants
32
Q

delusional disorder

what is this?

3 examples?

key thing that only applies to this condition

what are 3 things that would cause this person to seek care?

A

delusions about plausible events, that although unlikely, COULD occur

Ex:

meeting the president

having sex in dumpster

secret relationship with other

ONLY ONE IN THE DSM-5 where functioning NOT impaired

SEEK CLINICAL CARE WHEN:

  1. anxiety about delusion too much
  2. discovery of delusion by friend
  3. threats/illegal activity regarding their delusion
33
Q

what are the sxs assocaited with adjustment disorder?

7

A

tearfullness

depressed mood

vandalism

reckless driving

fighting

anxiety

BUZZ WORD: “NERVOUS BREAKDOWN”

34
Q

adjustment disorder

what is the time frame for this?

things in adolescents and adults that cause thsi?

when does it improve?

tx?

A

maladaptive behavior or emotional sxs that occur WITHIN 3 months after stressful life event and end within 6 months of the event

NOT DUE TO BEAREAVEMENT!!!

adolesencents stressors: parental rejection and divorce, problems at school, and leaving home

adult stressors; marital disocord/divroce, financial difficulties, job loss, parenthood, natural disasters, cancer dx

as stressor resolves, coping skills develop and sxs disappear

TX:

  1. CBT or psychodynamic therapy

imrove coping skills, strengthening defense mechanisms, and changing the way the person interacts with stressful situation

Example: 28-yr-old female becomes bitter and angry when her husband of 5 years leaves her for a younger man. One week later, the woman quits her job without giving notice, and begins drinking heavily. She telephones friends over the next several weeks and tells them how she has passive suicidal ideation. She also makes several threatening calls to the new boyfriend.

35
Q

major depressive disorder

what are the 3 qualifications that must be met by this?

what are the sxs associated with this?

A

2+ week time frame that MUST include

  1. depressed mood
  2. loss of interest or pleasure

**MUST HAVE 5 and is Chronic course with relapse***

Significant weight loss when not dieting or weight gain change in 5% of body weight or decrease in appetite everyday

Insomnia or hypersomnia nearly every day

Psychomotor agitation or retardation nearly every day

Fatigue or loss of energy everyday

Feelings of worthlessness or excessive or inappropriate guilt nearly every day

Diminished ability to think or concentrate, or indecisiveness

Recurrent thoughts of death, suicidal ideation, or attempt

36
Q

Major depressive disorder

2 main tx options?

A
  1. antidepressants

***must continue for 4-6 weeks and must be continued for over 6 months to prevent relapse***

A. SSRI FIRST LINE

SE: GI upset, heacahe, sexual dysfunction

B. MAOI

required tyramine free diet no BEER, WINE, cheese

  1. Electroconvulsive shock therapy

effective in all MMD but reserved for depression or those who can’t take medications

memory loss and amnesia MC but returns after 6 months

37
Q

MMD:

seasonal effective features

what is this?

MC area and patient?

2 tx options?

A

fall/winter with lessening daylight hours

remits in spring

MC cold climates and women 20-40 y/o

Tx:

  1. light therapy
  2. SSRI/buproprion
38
Q

MMD:

atypical features

4 sxs

A
  1. overeating and weight gain
  2. oversleeping
  3. reactive mood-can get cheered up with specific events
  4. oversensitivity to interpersonal rejection
  5. leaden paralysis-heavy feeling in arms or legs
39
Q

MMD:

melancholia features

4 prosentations

2 tx options?

A
  1. depression worse in Am ~2hrs prior to ususally awakening
  2. psychomotor agitation or retardation
  3. significant weight loss and anorexia
  4. excessive or inappropriate guild

***nearly complete inability to cheer them up***

TX:

  1. SSRI
  2. consider ECT because it is 50% of hospitalizaed patients
40
Q

MMD:

peripartum features

time line?

tx option?

A

during pregnancy or within 4 weeks of delivery

Tx:

SERTRALINE SSRI SAFTEST OPTION!!!

41
Q

what is the only difference between mania and hypomania according to the DSM-5? define both

A

mania: occurs for over 7 days

hypomania: occurs for over over 4 days

**all the sxs in the DSM five are the same but the time frame and the intensitiy are different**

MANIA: they are very severe changes that caused marked impariement in social and occupational functioning and NEED HOSPITALIZATION to prevent harm to themselves or others!!! can have psychotic features

HYPOMANIA: same sxs but they cause a CHANGE IN FUNCTIONING that is UNCHARACTERISTIC of the individual…can be noticed by others

42
Q

what are the 7 sxs that are associated with a manic or hypomanic episode in bipolar?

A
  1. distractable attention easily drawn to unimportant or irrelevant stimuli
  2. Insomnia feel rested after only 3 hours of sleep
  3. Grandiosityincreased self esteem
  4. Flight of ideas racing thoughts
  5. Activities (goal directed)/ agitation

socially, at work, school or sexually

  1. sexual exploit/risky behavior

unrestrained buying sprees, many sexual partners, foolish buisness investments

  1. talkative (overly)

**keep in mind the sxs between Bipolar 1 and bipolar 2 are the same but severity is what differntiating**

43
Q

Bipolar II

what is this characterized by?

functioning level?

A

characterized by HYPOMANIA but NOT mania

HYPOMANIA: same sxs but they cause a CHANGE IN FUNCTIONING that is UNCHARACTERISTIC of the individual…can be noticed by others

44
Q

Bipolar I

what is this characterized by?

average age of dx?

keep in mind?

A

MANIA IS HALLMARK

they are very severe changes that caused marked impariement in social and occupational functioning and NEED HOSPITALIZATION to prevent harm to themselves or others!!! can have psychotic features

avg dx age: 30 y/o

**keep in mind hypomania episodes can also occur

but 1 episode of mania qualifies it as bipolar 1**

45
Q

bipolar tx

what are 2 ain drug class and drugs within?

what is a major CAUTION to keep in mind?

A
  1. MOOD STABALIZERS

LITHIUM DOC

also consider VALOPROIC ACID

  1. 2nd gernation antipsychotics for acute mania

piseridone, topiramate, lamotrigine

****CAUTION: antidepression medications if given to bipolar pt who was misdxed with depression can make mania worse!!**

46
Q

personality disorder general

what is this in general?

when does it start?

how are they organized into categories?

A

deeply ingrained inflexible pattern that are maladaptive and cause significant impairment in social or job functions

orginates in adolescence or earlier (2 yrs), broken into 3 clusters with 3 types underneath

A. don’t fit in with social norms

B. they can be ego-dystonic (AWARE)or egosyntonic (UNAWARE)

C. environmental or genetic components that drive their expression/developement

47
Q

personality disorder

ego-dystonic

what is this?

A

MOST COMMON

conflict between the person and the environment

they know they have a problem and they want to fix it “aware of condition”

48
Q

personality disorder

ego-syntonic

what is this?

A

no conflict between person and environment

aka they don’t know they have it and rarely seek help

“unaware of condition”

these people have maladaptive lives that have many legal and psychosocial consequences

49
Q

personality disorder

DSM-5 dx highlights

6 highlights

A

behavior that is markedly different than society

  • cognition
  • affect
  • interpersonal functioning
  • impulse control
  • pattern is inflexible and pervasive
  • long in duration of presence bck to adolescence, early as 2
50
Q

personality disorder

what is important to remember about the tx?

A

they are viewed as some of the most difficult to tx as they don’t have ANY medication that is FDA approved for these conditions….many are used off label for these!!

51
Q

what is the only personality disorder that has an approved therapy that can acutally influence the condition?

A

dialectical behavioral therapy used for borderline personality disorder

52
Q

how are the personality disorders broken up?

A
  1. Cluster A-weird wacky eccentric and odd

A. paranoid

B. schizoid

C. cschizotypal

  1. Cluster B-dramatic emotional erratic and wild

A. antisocial

B. borderline

C. histrionic

D. Narcissistic

  1. Cluster C-anxious fearful and worried

A. dependent

B. obcessive compulsive

C. avoidant

53
Q

personality disorders

paranoid

6 characteristics

A
  1. distrust
  2. assume peoples motives are bad
  3. things even strangers actions are a character assasination
  4. extreme suspicion causes strained interpersonal relationship
  5. holds grudges for long time
  6. suspects exploitation

Ex:

  1. provider who doubts patients story and history, feels partners don’t have their back, tries to have microcontrol
  2. patient lacks trust in authority figure, feels provider has their own sense of agenda
54
Q

personality disorder

schizoid

5 characteristics

A
  1. blunted affect “flat and expressionless”
  2. feeling of detachmen
  3. happy being alone and don’t think anything of it
  4. don’t want relationships
  5. precieved as emotionally cold

EX:

  1. provider: true loner at heart and sole, don’t make close relationships ith coworkers or patients and feel FINE about it
  2. patient: no desitre to stay healthy for provider, often hard to read and the provider thinks “what do they think of me”?
55
Q

personality disorders

schizotypal

5 characteristics

A
  1. discomfort from the actual interaction
  2. cognitive distortion, odd speaking, experience strange preceptual occurences
  3. odd beliefs-trash can has meaning/can see the future
  4. eccentric behavior/dress
  5. magical thinking, telepathy, supersitions
  6. “seers” of medicine, sees themselves as highly intuitive
  7. patient will rely on what feels right, incapable of dealing with any stress
56
Q

personality disorders

antisocial

6 characterstics of this

A
  1. originates in childhood as misconduct like sexual physical abuse, setting fires, and harming animals
  2. need to be 18+ to dx
  3. disregard for violation of law and rights of others
  4. impulsive with lack of remorse
  5. don’t care about their or others welfare
  6. charming in interview

***often end up in jail!!**

  1. physician: norms don’t apply to them, very little regar for feelings of others and feel little to no responsibility
  2. patient: physically threatening, always someone eleses fault
57
Q

personality disorder

borderline

6 sxs of this

A
  1. instability of self image, mood, affect, behavior
  2. mood swings, impulsitivity common
  3. polarized relationships seen as either good or bad
  4. self mutilation like cutting and MANIPULATIVE sucide common–don’t want to kill themselves
  5. desperately tries to avoid abandoment and don’t tolerate being alone but lash out at friends and family
  6. evaluation/devaluation-effort to avoid feelings of emptiness or abandoment

MUST BE 18+ to dx!!

physician: marked instability of affect, mood, and responses
patient: very manipulative, will place you on pedestal then kick it out from under ou with the slightest challenge

58
Q

personality disorder

histrionic

5 sxs

A
  1. emotion and attention seeking
  2. need to be center of attention
  3. often inappropriately provative and sexual
  4. theatrical and overly dramatic
  5. shallow and exagerated
    physician: nice looking, center of attention “who package”
    patient: demands attention and will get attention through exageration, need for constant reassurance they are the best patient
59
Q

personality disorder

narcissistic

5 sxs?

A
  1. me first attitude
  2. inflated self image with need for amiration
  3. grandosity with lack of empathy
  4. arogant with sense of entitlement
  5. fantacies about unlimited success, beauty, and brillance
    physician: believes in his superiority, glory seeker “surgeon”
    patient: they are better than you, may be likeable but fragile selfesteem/ego
60
Q

personality disorders

avoidant

5 sxs of this

A
  1. want relationships but too scared because of fear of rejection (contrasts with schizoid)
  2. self-inadequate
  3. interact with others as little as possible to avoid shame, ridicule, or rejection
  4. great desire for companionship
  5. social phobia common
    physician: people pleaser, rare in clinicial because of the high degree of contact that is required
    patient: easily hurt if they feel you are critisizing them or disapprove
61
Q

personality disorder

dependent

7 sxs

A
  1. eccessively clingy
  2. need to be cared for
  3. indecisive, need others to make decisions
  4. dislike being alone
  5. prone to domestic partnership abuse because not assertive
  6. bounce from relationship to relationship
  7. seeks excessive advice from others and need nuturance
    physician: difficulty making decisions, overly reliant on others
    patient: won’t do anything without calling you first or talkig it over with lots of other people, avoid personal responsibility
62
Q

personality disorder

obesessive compulsive

5 sxs

A
  1. Type A-rules, lists, details
  2. perfectionalism to the point of demise, interferes with life
  3. inflexibility
  4. insists others join their ways which makes relationships hard
  5. change in routine causes severe anxiety
    physician: high achiever, over devoted, everything is urgent
    patient: will often tell you in detail what they need and why and present EBM
63
Q

what is the mainstay tx for personality disorders? specifically?

A

cognitive behavioral disorder

can add medication to this but question of effectiveness

BUT for borderline personality disorder use dialectical behavior therapy and quetiapine to help with sxs

64
Q

what must you have in order to dxed with a substance use disorder?

A

2 or more of the following within a 12 month period:

  1. Large amounts over a longer period than was intended
  2. Persistent desire or unsuccessful efforts to cut down on the substance
  3. A great deal of time is spent in activities to obtain the substance or use the substance
  4. Craving or strong desire to use the substance

Failure to fulfill the major role obligations at work, school, or home

  1. Continued use despite recurrent social or interpersonal problems caused by the substance
  2. Activities are given up or reduced because of use
  3. Use is continued despite knowledge of having persistent or recurrent physical or psychosocial problems that are exacerbated by the substance
  4. Tolerance
  5. withdrawal

***Severity is determined by the number of above sxs****

65
Q

what are the two components of a substance use disorder? what are each of these?

A
  1. physical dependence

withdrawal sxs in the absence of the drug

  1. addiction

neurological disease with genetic and psychosocial contributions leading to compulsive use and craivings despite harmful consequences

***keep in mind these have genetic components, can be learned from childhood, mental illness predispostion, social forces such as peer influence, chronic pain RF*****

66
Q

substance use disorder

7 tx options

explain each one

A
  1. inpatient care-dual dx and detox
  2. residential program: sober living with peers, integrated counseling
  3. partial hospitalization program: outpatient substance abuse group therapy, couseling, vounteer groups medical monitoring and prescription withdrawal aid
  4. intensive outpatient program-group therapy, couseling, peer volunteer groups

5 outpatient visits- one on one subtance abuse counselor or combined mental health

  1. peer support groups-AA/NA
  2. medications for anti craving
    - naloxone
    - baclofen
    - antidepressants
    - opiate replacements
67
Q

when is the most important time during substance use disorder? what are 2 key things to determine success?

A

first few weeks are critical

A. relapse prevention a form of CBT helps identify at risk behavior and helps with coping responses

B. maintaining regular attendance and participating more actively at peer support groups and meetings have been associated with better outcomes

68
Q

what do you use to score alcohol withdrawal sxs?

A

CIWA scale!

69
Q

OPIATE USE DISORDER

what do you use to score this?

what are the 3 stages?

how long do they last?

what are the associated sxs?

A

COWS score

  1. stage 1- up to 8 hours

fear of withdrawing, anxiety, drug craving

  1. stage 2-8-24 hours

insomnia, restlessness, anxiety, stomach cramps, diaphoresis, mydriasis

  1. stage 3-up to 3 days

vomiting, diarrhea, fever, chills, tremors, muscle spasms, seizures, hyertension

70
Q

opiate withdrawal tx

opiate replacement

what are 3 options for replacement therapy?

A
  1. suboxone (buprenorphine/naloxone)

POSSIBLY SHORTER TAPER

maitenence requires outpatient prescriber

  1. subutex (buprenorphine)

indicated in pregnancy

  1. methadone

harder to stop

require clinical daily visits

***WITH ALL OF THESE FOR THE MOST COMFORTABLE CESSATION YOU WANT TO SLOWLY STEP DOWN FROM THE OPIATE DOSE OVER THE COURSE OF WEEKS TO MONTHS***

Rotation 4: FMI (11 decks)

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