Psych/Behavioral Health #5 Flashcards
What is functional neurological symptom disorder (conversion disorder)?
At least 1 symptom of neurologic dysfunction that cannot be explained clinically
What are some examples of symptoms with conversion disorder?
- Motor dysfunction: paralysis, mutism, seizures, tics, weakness, gait problems, globus sensation (lump in throat)
- Sensory dysfunction: blindness, paresthesias, deafness
What is the first-line treatment for functional neurological symptom disorder (conversion disorder)?
Patient education about the illness
-CBT if not successful
What is factitious disorder?
-Intentional falsification of signs and symptoms for “primary gain” (inner need to be seen as ill or injured) but NOT for external rewards
What are some symptoms/clinical manifestations of factitious disorder?
- Willing or eager to undergo surgery or testing repeatedly to obtain sympathy
- May inject themselves with substances to make themselves sick
- Often have extensive medical knowledge, terminology, hospitals
If the factitious disorder is imposed on another (child) what should the treatment be?
Child protective services
What is somatic symptom disorder?
Physical symptoms involving at least 1 body system but no physical cause found on workup
- Excessive thoughts and feelings related to the somatic symptoms
- May frequently seek medical treatment, lab work, procedures, or surgeries
Somatic symptom disorder is MC in which gender?
Female
What are some examples of symptoms in somatic symptom disorder?
- SOB
- Dysmenorrhea
- Burning in sexual organ
- Lump in throat (dysphagia)
- Amnesia
- Vomiting
- Painful Extremities
Management of somatic symptom disorder
- Regularly scheduled visits to provider
- Psychotherapy
What is the most important modifiable risk factor in the US for preventable pulmonary, cardiac, and cancer deaths?
Smoking
Symptoms of nicotine withdrawal
- Restlessness
- Anxiety
- Sleep problems
- Headaches
- Depression
- Weight gain
- Increased appetite
- Nicotine Craving
Management of nicotine dependence
- Nicotine tapering therapy: gum, nasal sprays, patches, inhalers, lozenges
- Bupropion
- Varenicline
MOA of Bupropion
-Dopamine and norepinephrine reuptake inhibitor that reduces nicotine cravings and withdrawal symptoms
When should therapy with Bupropion begin and end?
Begin 1-2 weeks prior to quit date and continued for 4-6 months after quit date
Adverse effects of Bupropion
- Seizures (lowers threshold)
- Dry mouth
- Insomnia
- Avoid abrupt withdrawal
When should Bupropion NOT be used?
- Epilepsy or increased seizure risk (Bulimia, Anorexia)
- Recent MAO use due to risk of serotonin syndrome
What are some examples of opioids
Heroin Oxycodone Hydrocodone Codeine Morphine Methadone
Opioid Intoxication Symptoms
- Euphoria and Sedation: drowsiness, impaired memory, slow or slurred speech
- Pupillary constriction
- AMS
- Respiratory depression
- Bradycardia
- Hypotension
Opioid Withdrawal Symptoms
- Lacrimation
- Hypertension
- Pupillary Dilation (Mydriasis)
- Flu-like symptoms
- Rhinorrhea
- Joint pains
- Myalgias
For opioid intoxication, what is the treatment of choice
Naloxone
- Onset of action: 2 minutes
- 30-60 minutes duration of action
For opioid withdrawal, what medications are given for which symptoms?
- Clonidine: decreases sympathetic symptoms
- Loperamide: for diarrhea
- NSAIDs for joint pains and muscle cramps
For long-term management of opioid dependence, what is the treatment?
Methadone maintenance program
-Suboxone (Buprenorphine + Naloxone) or Naltrexone
Methadone, although it can cause long QT syndrome, can or can not be used in pregnant women?
Can
Withdrawal seizures from alcohol usually occur how long after the last drink?
6-48 hours after last drink (tonic-clonic type)
Alcoholic hallucinosis occurs how often after last drink?
12-48 hours after last drink
Normal vital signs and clear sensorium with hallucinations
Delirium tremens, with abnormal vital signs and delirium, occurs how long after the last drink?
2-5 days
Because alcohol withdrawal can be fatal, what treatment should be given to the patient?
Hospitalization
IV Benzodiazepines (GABA mediated CNS inhibition)
-IV Fluids, IV thiamine (B1), magnesium, multivitamins (b12 and folate) and electrolyte repletion
With alcohol dependence, the CAGE screening is used to determine dependence. What is considered a positive screen?
A score of 2 or more
- Cutdown
- Annoyed
- Guilt
- Eye Opener
Management of alcohol dependence
- Supportive: Psychotherapy, AA, Rehab programs
- Disulfiram (Antabuse)
- Naltrexone: reduces alcoholic cravings
What is the MOA of Disulfiram (Antabuse)?
Inhibits aldehyde dehydrogenase leading to increase acetaldehyde when coupled with alcohol intake –> hypotension, palpitations, flushing, hyperventilation, dizziness, nausea, vomiting, and headache (uncomfortable symptoms)
Symptoms of cocaine intoxication
- Elevated or euphoric mood
- Pressured speech
- Tremor, flushing, hyperthermia, pupillary dilation
- Seizures, repetitive behaviors, aggression, hallucinations, paranoia
Management of cocaine intoxication
Benzodiazepines
DO NOT PLACE IN RESTRAINTS = rhabdomyolysis
Can use Haloperidol for psychosis
Symptoms of cocaine withdrawal
- Suicide ideation
- Post-intoxication depression
- Hypersomnia
- Increased appetite
- Constricted pupils
- Headache
Clinical manifestations of PCP intoxication
- Hallucinations
- Rage
- Multidirectional nystagmus
- Ataxia
- Tachycardia
- Dry Skin
- Psychosis
- Delirium
Treatment for PCP Intoxication
- Supportive care
- Benzodiazepines if agitated, seizures, hyperthermic
- Physical restraints may be needed
Mechanism of marijuana intoxication
Binds to CB1 and CB2 cannabinoid receptors
Symptoms of marijuana intoxication
Dry (cotton) mouth Increased appetite Motor impairment Anxiety Giddiness Euphoria Fear/Depression Conjunctivitis Tachycardia Hypotension
Symptoms of marijuana withdrawal
- Irritability
- Insomnia
- Diaphoresis
- Diarrhea
- Twitching
Normal grief usually resolves in
6 months to 1 year
Abnormal grief is characterized by
Severe symptoms, symptoms > 1 year, or positive suicidal ideation, hallucinations that the person perceives to be real
Treatment for grief reaction
- Psychotherapy
- Short course of Benzodiazepines may needed for insomnia in some
What is neuroleptic malignant syndrome?
Rare complication of 1st generation (typical) antipsychotics
- Fever, AMS, Incontinence, tachycardia, tachypnea
- Lead pipe rigidity
- Tremor
- Elevated WBC and CPK (rhabdomyolysis)
- Regular sized pupils
- Excessive sweating
- Delirium
What is the management of neuroleptic malignant syndrome?
Discontinuation of medication
Supportive care
Dopamine agonists (Bromocriptine or Amantadine)
Dantrolene for rigidity and fever
What is Narcolepsy?
Long-term neurological disorder characterized by decreased ability to regulate sleep-wake cycles
Symptoms of Narcolepsy
- Chronic daytime sleepiness
- Cataplexy: emotionally triggered weakness in the muscles (laughter, anger)
- Hypnagogic Hallucinations: occur as the patient is falling asleep
- Sleep paralysis: complete inability to move 1-2 minutes after waking or falling asleep
- May also develop other sleep disorders: OSA, restless leg syndrome, sleepwalking
What does the workup for Narcolepsy look like?
- Polysomnography: REM sleep within 15 minutes after onset of sleep (healthy usually have this 80-100 minutes after onset)
- Multiple sleep latency test: Identifies sleep onsets rapid eye movement. Fall asleep < 8 minutes (healthy fall asleep in 10-15 minutes)
Prior to testing for narcolepsy, how long should patients discontinue antidepressants?
Discontinue 3 weeks prior (4 weeks for Fluoxetine)
What is the first line management for Narcolepsy?
Modafinil
Or Solriamfetol
