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PANCE 2.0 > Psych/Behavioral Health #1 > Flashcards

Psych/Behavioral Health #1 Flashcards

1
Q

A woman who leaves an abusive partner has a ____ greater risk of being killed by the abuser compared to staying

A

70%

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2
Q

What are some clues to intimate partner abuse/violence?

A 
Contusions to breast, chest, abdomen, face
MSK injuries
"accidental injuries"
Multiple injuries in stages of healing
Fatigue, headache, nonspecific symptoms
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3
Q

What are the most common ages of sexual abuse?

A

Between 9-12 years old

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4
Q

Perpetrators of sexual abuse are commonly

A

males and most are relatives to the child or known by the child

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5
Q

What are some clues for sexual abuse of a child?

A
  • Children that exhibit sexual knowledge
  • Initiate sex acts with peers
  • Bruises, pain, or pruritus in the genital or anal area
  • Evidence of an STI
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6
Q

Signs of physical abuse

A
  • Cigarette burns
  • Burns in a stocking or glove pattern
  • Healed fractures on radiographs
  • Subdural hematoma
  • Retinal hemorrhages
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7
Q

What are two common exam findings if you are suspecting shaken baby syndrome?

A

Hyphema or retinal hemorrhages

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8
Q

A panic attack usually peaks within ____ and lasts less than ______

A

Peaks within 10 minutes and rarely lasts longer than 1 hour (most end between 20-30 minutes)

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9
Q

A panic attack is characterized by at least four of the following symptoms of _______ and which symptom is hallmark?

A

Sympathetic system overdrive

Hallmark: Sense of impending doom or dread

-Other symptoms: dizziness, trembling, choking, sweating, shortness of breath, fear of dying, palpitations, nausea, depersonalization (detached from oneself), chills, hot flashes

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10
Q

What is the first line medical management of a panic attack?

A

Benzodiazepines (Alprazolam, Lorazepam, Diazepam)

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11
Q

What must you do first in a patient you suspect having a panic attack?

A

Rule out a life threatening condition (heart attack, thyrotoxicosis, etc.)

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12
Q

Risk factors for panic disorder

A
  • Females
  • Major depression history
  • 1st degree relative also affected
  • 20’s in age
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13
Q

What is agoraphobia?

A

Anxiety about being in places where escape may be difficult (open spaces, enclosed spaces, public transportation, etc.)

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14
Q

What is a panic disorder?

A

Recurrent, unexpected panic attacks (at least 2), with persistent concern about future attacks or maladaptive behavior related to the attacks

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15
Q

Management of panic disorder

A

SSRI’s

-May initiate with SSRI + Benzo and then taper off benzodiazepines

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16
Q

What is a treatment option for panic disorder if SSRI’s are not effective?

A

TCA’s (Amitriptyline, Notriptyline, Desipramine)

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17
Q

MOST effective treatment for panic disorder

A

Pharmacotherapy + CBT most effective

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18
Q

For acute panic attacks, the treatment is

A

Benzodiazepines (Alprazolam, Clonazepam)

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19
Q

Treatment for agoraphobia

A

SSRI + CBT

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20
Q

For agoraphobia, how long must the symptoms be present

A

For at least 6 months, cause social or occupational dysfunction, and not better explained by another disorder

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21
Q

Pharm therapy for generalized anxiety disorder

A
  • SSRI’s are first line

- Buspirone can be used as adjunct to SSRI (does not cause sedation)

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22
Q

Buspirone is a partial ______ receptor agonist and ______ receptor antagonist

A

Serotonin agonist and dopamine antagonist

23
Q

What are two facts about buspirone that make it a great adjunct therapy to SSRI

A
  • Does not cause sedation

- Almost negligible abuse or addiction potential

24
Q

Most common type of phobia

A

Social anxiety disorder (Social Phobia)

25
Q

Explain what social anxiety disorder is

A

Persistent (at least 6 months) intense fear of social or performance situation in which there person is exposed to the scrutiny of others for fear of embarrassment
-May cause unexpected panic attacks

26
Q

Treatment for social anxiety disorder

A
  • Psychotherapy (initial treatment of choice)

- Pharmacotherapy: SSRI

27
Q

What can be used for performance anxiety and public speaking?

A

Beta-blockers (Propanolol, Atenolol) 30-60 minutes before the performance

28
Q

What is the treatment of choice for specific phobias?

A

Exposure and desensitization therapy

29
Q

However, what are the medication options for specific phobias?

A

-Short-term benzodiazepines or BB can be used in some patients

30
Q

Name the SSRI’s (6)

A 
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

CEFFPS

31
Q

Risk factors for major depressive disorder

A
  • Female
  • Family history
  • Peak onset of age is 20’s
32
Q

What form(s) are used for screening for major depressive disorder?

A

PHQ-2 and then if positive, use a PHQ-9

33
Q

What is the pathophysiology of major depressive disorder?

A

Alteration in neurotransmitters: serotonin, epinephrine, norepinephrine, dopamine, acetylcholine, histamine

Neuroendocrine dysregulation

34
Q

Diagnostic criteria for MDD

A

At least 2 episodes of 5 symptoms (must include depressive mood or anhedonia) for at least 2 weeks

  • fatigue
  • insomnia or hypersomnia
  • suicidal ideation
  • changes in appetite
  • indecisiveness
  • decreased concentration
  • guilt or worthlessness feelings
35
Q

Treatment for MDD

A
  • Psychotherapy, interpersonal therapy
  • SSRI’s
  • Second line: SNRI’s
36
Q

When should you switch to another SSRI in treating MDD?

A

If no effect after 4 weeks, switch to other SSRI

37
Q

When should you use electroconvulsive therapy for treating MDD?

A

Rapid response in patients unresponsive to medical therapy, unable to tolerate pharmacotherapy (pregnant), or rapid reduction in symptoms

38
Q

What is seasonal affective disorder?

A

Presence of depressive symptoms at the same time each year (due to reduction of sunlight and cold weather)

39
Q

Treatment for seasonal depressive disorder?

A

SSRI’s, light therapy, Bupropion

40
Q

What is atypical depression?

A

Shares many of the typical depressive symptoms, but experience mood reactivity (improved mood in response to positive events)

-Weight gain, appetite increase, hypersonic, heavy feelings in arms and legs

41
Q

Treatment for atypical depression

A

MAO inhibitors (Phenelzine, Tranylcypromine, Isocarboxazid)

42
Q

What is the only antidepressant approved for treatment of Bulimia?

A

Fluoxetine

43
Q

What is significant about Fluoxetine and the half-life?

A

Has a longer half-life (2-4 days) compared to other SSRI’s (about 1 day)
-Therefore, there is a longer washout period of about 5 weeks as compared to 2 weeks to switch to a MAO inhibitor

44
Q

On average, antidepressants take how long to reach maximum efficacy?

A

4-6 weeks

45
Q

Adverse effects of SSRI’s

A
  • GI (nausea and diarrhea)
  • Sexual dysfunction
  • Weight changes
  • Increased suicidality in children and young adults (BBW)
46
Q

Which SSRI should be avoided in patients with a long QT syndrome?

A

Citalopram

47
Q

Name three SNRI’s

A

Desvenlafaxine
Venlafaxine
Duloxetine

48
Q

What SNRI may be used as a first-line agent, particularly in patients with fatigue or neuropathy pain syndrome in association with depression?

A

Duloxetine

49
Q

What are some adverse effects of SNRI’s?

A
  • Hypertension
  • Hyponatremia
  • Avoid abrupt discontinuation
50
Q

Mirtazapine, a tetracyclic, should be used in treatment for MDD when?

A
  • In patients with insomnia or significant weight loss (has appetite stimulating and sedating properties)
  • Fewer sexual side effects than SSRI’s
51
Q

Indications for use of Bupropion for treatment of MDD?

A

If patient is fearful of sexual dysfunction or weight gain

-Also good for smoking cessation

52
Q

What two neurotransmitters are inhibited with Bupropion?

A

Dopamine and norepinephrine

53
Q

Contraindications for use of Bupropion?

A
  • Epilepsy
  • Eating disorders
  • If undergoing discontinuation of alcohol, benzodiazepines
  • MAO use in the past 2 weeks

PANCE 2.0 (62 decks)

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