Psych/Behavioral Health #1 Flashcards
A woman who leaves an abusive partner has a ____ greater risk of being killed by the abuser compared to staying
70%
What are some clues to intimate partner abuse/violence?
Contusions to breast, chest, abdomen, face MSK injuries "accidental injuries" Multiple injuries in stages of healing Fatigue, headache, nonspecific symptoms
What are the most common ages of sexual abuse?
Between 9-12 years old
Perpetrators of sexual abuse are commonly
males and most are relatives to the child or known by the child
What are some clues for sexual abuse of a child?
- Children that exhibit sexual knowledge
- Initiate sex acts with peers
- Bruises, pain, or pruritus in the genital or anal area
- Evidence of an STI
Signs of physical abuse
- Cigarette burns
- Burns in a stocking or glove pattern
- Healed fractures on radiographs
- Subdural hematoma
- Retinal hemorrhages
What are two common exam findings if you are suspecting shaken baby syndrome?
Hyphema or retinal hemorrhages
A panic attack usually peaks within ____ and lasts less than ______
Peaks within 10 minutes and rarely lasts longer than 1 hour (most end between 20-30 minutes)
A panic attack is characterized by at least four of the following symptoms of _______ and which symptom is hallmark?
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
What is the first line medical management of a panic attack?
Benzodiazepines (Alprazolam, Lorazepam, Diazepam)
What must you do first in a patient you suspect having a panic attack?
Rule out a life threatening condition (heart attack, thyrotoxicosis, etc.)
Risk factors for panic disorder
- Females
- Major depression history
- 1st degree relative also affected
- 20’s in age
What is agoraphobia?
Anxiety about being in places where escape may be difficult (open spaces, enclosed spaces, public transportation, etc.)
What is a panic disorder?
Recurrent, unexpected panic attacks (at least 2), with persistent concern about future attacks or maladaptive behavior related to the attacks
Management of panic disorder
SSRI’s
-May initiate with SSRI + Benzo and then taper off benzodiazepines
What is a treatment option for panic disorder if SSRI’s are not effective?
TCA’s (Amitriptyline, Notriptyline, Desipramine)
MOST effective treatment for panic disorder
Pharmacotherapy + CBT most effective
For acute panic attacks, the treatment is
Benzodiazepines (Alprazolam, Clonazepam)
Treatment for agoraphobia
SSRI + CBT
For agoraphobia, how long must the symptoms be present
For at least 6 months, cause social or occupational dysfunction, and not better explained by another disorder
Pharm therapy for generalized anxiety disorder
- SSRI’s are first line
- Buspirone can be used as adjunct to SSRI (does not cause sedation)
Buspirone is a partial ______ receptor agonist and ______ receptor antagonist
Serotonin agonist and dopamine antagonist
What are two facts about buspirone that make it a great adjunct therapy to SSRI
- Does not cause sedation
- Almost negligible abuse or addiction potential
Most common type of phobia
Social anxiety disorder (Social Phobia)
Explain what social anxiety disorder is
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
Treatment for social anxiety disorder
- Psychotherapy (initial treatment of choice)
- Pharmacotherapy: SSRI
What can be used for performance anxiety and public speaking?
Beta-blockers (Propanolol, Atenolol) 30-60 minutes before the performance
What is the treatment of choice for specific phobias?
Exposure and desensitization therapy
However, what are the medication options for specific phobias?
-Short-term benzodiazepines or BB can be used in some patients
Name the SSRI’s (6)
Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
CEFFPS
Risk factors for major depressive disorder
- Female
- Family history
- Peak onset of age is 20’s
What form(s) are used for screening for major depressive disorder?
PHQ-2 and then if positive, use a PHQ-9
What is the pathophysiology of major depressive disorder?
Alteration in neurotransmitters: serotonin, epinephrine, norepinephrine, dopamine, acetylcholine, histamine
Neuroendocrine dysregulation
Diagnostic criteria for MDD
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
Treatment for MDD
- Psychotherapy, interpersonal therapy
- SSRI’s
- Second line: SNRI’s
When should you switch to another SSRI in treating MDD?
If no effect after 4 weeks, switch to other SSRI
When should you use electroconvulsive therapy for treating MDD?
Rapid response in patients unresponsive to medical therapy, unable to tolerate pharmacotherapy (pregnant), or rapid reduction in symptoms
What is seasonal affective disorder?
Presence of depressive symptoms at the same time each year (due to reduction of sunlight and cold weather)
Treatment for seasonal depressive disorder?
SSRI’s, light therapy, Bupropion
What is atypical depression?
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
Treatment for atypical depression
MAO inhibitors (Phenelzine, Tranylcypromine, Isocarboxazid)
What is the only antidepressant approved for treatment of Bulimia?
Fluoxetine
What is significant about Fluoxetine and the half-life?
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
On average, antidepressants take how long to reach maximum efficacy?
4-6 weeks
Adverse effects of SSRI’s
- GI (nausea and diarrhea)
- Sexual dysfunction
- Weight changes
- Increased suicidality in children and young adults (BBW)
Which SSRI should be avoided in patients with a long QT syndrome?
Citalopram
Name three SNRI’s
Desvenlafaxine
Venlafaxine
Duloxetine
What SNRI may be used as a first-line agent, particularly in patients with fatigue or neuropathy pain syndrome in association with depression?
Duloxetine
What are some adverse effects of SNRI’s?
- Hypertension
- Hyponatremia
- Avoid abrupt discontinuation
Mirtazapine, a tetracyclic, should be used in treatment for MDD when?
- In patients with insomnia or significant weight loss (has appetite stimulating and sedating properties)
- Fewer sexual side effects than SSRI’s
Indications for use of Bupropion for treatment of MDD?
If patient is fearful of sexual dysfunction or weight gain
-Also good for smoking cessation
What two neurotransmitters are inhibited with Bupropion?
Dopamine and norepinephrine
Contraindications for use of Bupropion?
- Epilepsy
- Eating disorders
- If undergoing discontinuation of alcohol, benzodiazepines
- MAO use in the past 2 weeks
