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PANCE 2.0 > Psych/Behavioral Health #5 > Flashcards

Psych/Behavioral Health #5 Flashcards

1
Q

What is functional neurological symptom disorder (conversion disorder)?

A

At least 1 symptom of neurologic dysfunction that cannot be explained clinically

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2
Q

What are some examples of symptoms with conversion disorder?

A
  • Motor dysfunction: paralysis, mutism, seizures, tics, weakness, gait problems, globus sensation (lump in throat)
  • Sensory dysfunction: blindness, paresthesias, deafness
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3
Q

What is the first-line treatment for functional neurological symptom disorder (conversion disorder)?

A

Patient education about the illness

-CBT if not successful

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4
Q

What is factitious disorder?

A

-Intentional falsification of signs and symptoms for “primary gain” (inner need to be seen as ill or injured) but NOT for external rewards

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5
Q

What are some symptoms/clinical manifestations of factitious disorder?

A
  • 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
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6
Q

If the factitious disorder is imposed on another (child) what should the treatment be?

A

Child protective services

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7
Q

What is somatic symptom disorder?

A

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
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8
Q

Somatic symptom disorder is MC in which gender?

A

Female

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9
Q

What are some examples of symptoms in somatic symptom disorder?

A
  • SOB
  • Dysmenorrhea
  • Burning in sexual organ
  • Lump in throat (dysphagia)
  • Amnesia
  • Vomiting
  • Painful Extremities
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10
Q

Management of somatic symptom disorder

A
  • Regularly scheduled visits to provider

- Psychotherapy

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11
Q

What is the most important modifiable risk factor in the US for preventable pulmonary, cardiac, and cancer deaths?

A

Smoking

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12
Q

Symptoms of nicotine withdrawal

A
  • Restlessness
  • Anxiety
  • Sleep problems
  • Headaches
  • Depression
  • Weight gain
  • Increased appetite
  • Nicotine Craving
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13
Q

Management of nicotine dependence

A
  • Nicotine tapering therapy: gum, nasal sprays, patches, inhalers, lozenges
  • Bupropion
  • Varenicline
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14
Q

MOA of Bupropion

A

-Dopamine and norepinephrine reuptake inhibitor that reduces nicotine cravings and withdrawal symptoms

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15
Q

When should therapy with Bupropion begin and end?

A

Begin 1-2 weeks prior to quit date and continued for 4-6 months after quit date

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16
Q

Adverse effects of Bupropion

A
  • Seizures (lowers threshold)
  • Dry mouth
  • Insomnia
  • Avoid abrupt withdrawal
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17
Q

When should Bupropion NOT be used?

A
  • Epilepsy or increased seizure risk (Bulimia, Anorexia)

- Recent MAO use due to risk of serotonin syndrome

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18
Q

What are some examples of opioids

A 
Heroin
Oxycodone
Hydrocodone
Codeine
Morphine
Methadone
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19
Q

Opioid Intoxication Symptoms

A
  • Euphoria and Sedation: drowsiness, impaired memory, slow or slurred speech
  • Pupillary constriction
  • AMS
  • Respiratory depression
  • Bradycardia
  • Hypotension
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20
Q

Opioid Withdrawal Symptoms

A
  • Lacrimation
  • Hypertension
  • Pupillary Dilation (Mydriasis)
  • Flu-like symptoms
  • Rhinorrhea
  • Joint pains
  • Myalgias
21
Q

For opioid intoxication, what is the treatment of choice

A

Naloxone

  • Onset of action: 2 minutes
  • 30-60 minutes duration of action
22
Q

For opioid withdrawal, what medications are given for which symptoms?

A
  • Clonidine: decreases sympathetic symptoms
  • Loperamide: for diarrhea
  • NSAIDs for joint pains and muscle cramps
23
Q

For long-term management of opioid dependence, what is the treatment?

A

Methadone maintenance program

-Suboxone (Buprenorphine + Naloxone) or Naltrexone

24
Q

Methadone, although it can cause long QT syndrome, can or can not be used in pregnant women?

A

Can

25
Q

Withdrawal seizures from alcohol usually occur how long after the last drink?

A

6-48 hours after last drink (tonic-clonic type)

26
Q

Alcoholic hallucinosis occurs how often after last drink?

A

12-48 hours after last drink

Normal vital signs and clear sensorium with hallucinations

27
Q

Delirium tremens, with abnormal vital signs and delirium, occurs how long after the last drink?

A

2-5 days

28
Q

Because alcohol withdrawal can be fatal, what treatment should be given to the patient?

A

Hospitalization
IV Benzodiazepines (GABA mediated CNS inhibition)
-IV Fluids, IV thiamine (B1), magnesium, multivitamins (b12 and folate) and electrolyte repletion

29
Q

With alcohol dependence, the CAGE screening is used to determine dependence. What is considered a positive screen?

A

A score of 2 or more

  • Cutdown
  • Annoyed
  • Guilt
  • Eye Opener
30
Q

Management of alcohol dependence

A
  • Supportive: Psychotherapy, AA, Rehab programs
  • Disulfiram (Antabuse)
  • Naltrexone: reduces alcoholic cravings
31
Q

What is the MOA of Disulfiram (Antabuse)?

A

Inhibits aldehyde dehydrogenase leading to increase acetaldehyde when coupled with alcohol intake –> hypotension, palpitations, flushing, hyperventilation, dizziness, nausea, vomiting, and headache (uncomfortable symptoms)

32
Q

Symptoms of cocaine intoxication

A
  • Elevated or euphoric mood
  • Pressured speech
  • Tremor, flushing, hyperthermia, pupillary dilation
  • Seizures, repetitive behaviors, aggression, hallucinations, paranoia
33
Q

Management of cocaine intoxication

A

Benzodiazepines

DO NOT PLACE IN RESTRAINTS = rhabdomyolysis

Can use Haloperidol for psychosis

34
Q

Symptoms of cocaine withdrawal

A
  • Suicide ideation
  • Post-intoxication depression
  • Hypersomnia
  • Increased appetite
  • Constricted pupils
  • Headache
35
Q

Clinical manifestations of PCP intoxication

A
  • Hallucinations
  • Rage
  • Multidirectional nystagmus
  • Ataxia
  • Tachycardia
  • Dry Skin
  • Psychosis
  • Delirium
36
Q

Treatment for PCP Intoxication

A
  • Supportive care
  • Benzodiazepines if agitated, seizures, hyperthermic
  • Physical restraints may be needed
37
Q

Mechanism of marijuana intoxication

A

Binds to CB1 and CB2 cannabinoid receptors

38
Q

Symptoms of marijuana intoxication

A 
Dry (cotton) mouth
Increased appetite
Motor impairment
Anxiety
Giddiness
Euphoria
Fear/Depression
Conjunctivitis
Tachycardia
Hypotension
39
Q

Symptoms of marijuana withdrawal

A
  • Irritability
  • Insomnia
  • Diaphoresis
  • Diarrhea
  • Twitching
40
Q

Normal grief usually resolves in

A

6 months to 1 year

41
Q

Abnormal grief is characterized by

A

Severe symptoms, symptoms > 1 year, or positive suicidal ideation, hallucinations that the person perceives to be real

42
Q

Treatment for grief reaction

A
  • Psychotherapy

- Short course of Benzodiazepines may needed for insomnia in some

43
Q

What is neuroleptic malignant syndrome?

A

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
44
Q

What is the management of neuroleptic malignant syndrome?

A

Discontinuation of medication
Supportive care
Dopamine agonists (Bromocriptine or Amantadine)
Dantrolene for rigidity and fever

45
Q

What is Narcolepsy?

A

Long-term neurological disorder characterized by decreased ability to regulate sleep-wake cycles

46
Q

Symptoms of Narcolepsy

A
  • 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
47
Q

What does the workup for Narcolepsy look like?

A
  • 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)
48
Q

Prior to testing for narcolepsy, how long should patients discontinue antidepressants?

A

Discontinue 3 weeks prior (4 weeks for Fluoxetine)

49
Q

What is the first line management for Narcolepsy?

A

Modafinil

Or Solriamfetol

PANCE 2.0 (62 decks)

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