Psych/Behavioral Med (6%) Flashcards
What is the principle therapy for mild-moderate depression?
Psychotherapy
Patients diagnosed with conduct d/o have a poor prognosis as 40% of them will go on to develop ________ d/o
Most commonly in (boys/girls)
Antisocial personality
boys
What social factor is considered a protective factor against attempting suicide?
Marriage
There are 4 main characteristics observed in a pt with conduct d/o, what are they?
Serious violations of laws
Aggressive/cruel to animals
Deceitfulness
Destruction of property
There are two types of anorexia nervosa, what are they?
Restrictive type: reduced calorie intake, dieting, fasting excessive exercise, diet pills
Purging type: primarily engages in self-induced vomiting, diuretic/laxative/enema abuse
What is the diagnostic criteria for panic disorder?
Recurrent, unexpected panic attacks (at least 2)
Panic attacks often followed by concern about future attacks
Worry about the implication of the attacks
Significant change in behavior related to the attacks
What age group/ethnicity has the highest suicide rate in the US?
Elderly white males
What is recommended for management of oppositional defiant d/o?
Psychotherapy
What are some examples of inattentiveness sx seen in patients with ADD/ADHD?
Easily distracted
Has difficulty maintaining focus on one task
Misses details
Forgets/loses things
Difficulty in completing assignments
Becomes bored with a task after a few minutes
What is the recommended management for an acute panic attack?
Benzodiazepines
T/F: In a pt with a specific phobia, the fear is in proportion to any real danger
FALSE, it is out of proportion!
What are some risk factors for developing major depressive disorder?
More common in males or females?
What is the age range that this dx is most commonly seen in?
FHx
female (2:1)
20-40 y/o with highest incidence
What is the recommended management for a pt with anorexia nervosa?
Medical stabilization: hospitalization for <75% expected body weight or pts who have medical complications; electrolyte imbalances may lead to cardiac abnormalities
Psychotherapy
Pharmacotherapy
What is savantism?
unusually talented
T/F: Physical abuse, sexual abuse, and child neglect are all three examples of child abuse and neglect
TRUE
What are options for the management of a pt’s phobia?
Exposure/desensitization therapy (tx of choice)
Short term BZDs and BBs can be used in some pts
What are some examples of hyperactivity/impulsivity sx seen in patients with ADD/ADHD?
Fidgets and squirms in their seat
Constantly in motion
Talks nonstop or excessively
Impatience
Dashes around, touching, or playing with everything
Has trouble sitting for long periods
Difficulty doing quiet tasks
Restlessness
Blurts out comments
Interrupts conversations/activities of others
Is there any association to psychosis if a pt has oppositional defiant d/o?
No
What is agoraphobia?
anxiety about being in places or situations from which escape may be difficult
Generalized anxiety d/o is associated with how many of the following sx?
fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, HA
greater than or equal to 3
Obesity associated with increased risk for ______ dz, _______, and what two cancers?
coronary dz
DM
breast & colon
What are some lab findings that may be observed in a pt with bulimia nervosa?
± hypokalemia, hypomagnesemia; electrolyte imbalance may lead to cardiac arrhythmias
Persistent depressive d/o, or dysthymia, is defined as a chronic depressed mood for how long in children/adolescents?
>1 year
For dx of anorexia nervosa, one must have a BMI that is less than or equal to _______ or a body weight that is less than _____% of ideal weight
less than or qual to 17.5 kg/m2
< 85%
To make the dx of major depressive d/o, which two sx must be ABSENT?
Mania and hypomania
What are three examples of clinical manifestations of a patient with autism spectrum disorder?
Social interaction difficulties: avoiding eye contact
Impaired communication
Restricted, repetitive, stereotyped behaviors and patterns of activities
What condition is described below?
REFUSAL TO MAINTAIN A MINIMALLY NORMAL BODY WEIGHT fueling a relentless desire for thinness with a morbid fear of fatness or gaining weight (even though they are underweight)
Anorexia nervosa
Normal grief resolves within _____ year (s)
Abnormal gried resolves in > ______ year (s)
within 1 yr
> 1 year
In cases of sexual abuse, the abuser is often (male/female) and (is not/is) known to the victim
Male
Is known
Patients with bulimia nervosa will ______ ______. They then partake in a compensatory behavior, which either includes ____ or not.
Binge eating
purging
Among highly skilled workers, ______ are at an increased risk of suicide
Physicians
What are options for the management of a patient with ADD/ADHD?
Behavior modification
Sympathomimetic medications (Stimulants): Pharmacologic tx of choice –> Methylphenidate, Amphetamine/dextroamphetamine, Dexmethylphenidate
Nonstimulants: Atomoxetine (Strattera)
What is the major difference between a pt with anorexia nervosa and bulimia nervosa?
Their weight!
Bulimia pts have a normal weight or are overweight
What d/o may oppositional defiant d/o progress to?
Conduct d/o
(males/females) attempt suicide more often, but (males/females) complete suicide more often
females
males
What medications are often first line in patients with mild-moderate depression?
How long should antidepressants be continued for to determine if they are efficacious?
SSRIs
Should be continued for a minimum of 3- 6 weeks to determine efficacy
How to make the dx of MDD?
Depressed mood or anhedonia (loss of pleasure) or loss of interest in activities with >=5 associated sx almost every day for most of the days for at least 2 weeks:
Fatigue almost all day, insomnia or hypersomnia, feelings of guilt or worthlessness, recurring thoughts of death or suicide, psychomotor agitation, significant weight change (gain or loss), decreased or increased appetite, decreased concentration/indecisiveness
The sx are <strong>not</strong> due to substance use, bereavement or medical conditions
Somatic: constipation, HA, skin changes, CP, abd pain, cough, dyspnea
What d/o is described below?
Persistent pattern of behaviors that DEVIATE SHARPLY FROM THE AGE-APPROPRIATE NORMS & VIOLATE THE RIGHTS OF OTHERS
Conduct disorder
What medications and otherwise can be used in the management of social anxiety d/o?
Antidepressants (SSRIs)
Beta Blockers (for performance anxiety)
BZDs (short term)
Psychotherapy (CBT)
What condition is described below?
Neurodevelopmental d/o characterized by problems paying attention, difficulty controlling behaviors, and hyperactivity that is not age-appropriate
ADD/ADHD
T/F: Substance abuse is associated with an increased risk of suicide
TRUE
What is 1st line tx for dysthymia (persistent depressive disorder)?
SSRIs
Panic d/o is more common in men or women?
Women (2-3x)
Major depressive d/o may be due to an alteration in _______ or a _______ dysregulation
neurotransmitters
neuroendocrine
What are some examples of panic attack sx?
Dizziness, trembling, choking feeling, parasthesias, sweating, SOB, CP, chills, hot flashes, fear of losing control, fear of dying, palpitations, nausea, abd pain, depersonalization
There is a 60% of also being dx’d with _______ if a pt has anorexia nervosa
depression
Are males or females more afftected by autism spectrum disorder?
Males (4:1)
What comorbid d/o is seen in ~50% of pts with obesity?
binge eating
recurrent episodes characterized by eating w/in a discrete time (ex. 2 hours) more than people normally would w/ lack of control during an eating episode
Binge eating occurs at least weekly for 3 months
Obesity is defined as having a Body Mass Index (BMI) >_____ or body weight >/= ____ % over their ideal weight
> 30 kg/m2
>/= 20%
Patients with conduct disorder have both _____ and _____ difficutly
social and academic
What is seasonal affective d/o?
Atypical depression?
Melancholia?
Catatonic depression?
- Seasonal affective d/o: the presence of depressive sx at the same time each year (MC in winter due to reduction of sunlight & cold weather)
Management: SSRls, light therapy, Bupropion
- Atypical depression: shares many of the typical sx of major depression but pts experience mood reactivity (improved mood in response to positive events)
Management: MAO inhibitors
- Melancholia: characterized by anhedonia, lack of mood reactivity, depression, severe weight loss/loss of appetite, excessive guilt, psychomotor agitation or retardation & sleep disturbance (increased REM time & reduced sleep)
- Catatonic depression: motor immobility, stupor & extreme withdrawal
What medications are used in the management of generalized anxiety d/o?
Antidepressants (SSRIs)
Buspirone (does not cause drowsiness)
BZDs for short term use only, BBs, TCAs
Psychotherapy (CBT)
What age is the most common age of onset for anorexia nervosa?
Mid teens
What classic PE finding will be observed in a pt with bulimia nervosa?
Teeth pitting or enamel erosion
What is recommended management for a pt with autism spectrum disorder?
Referral to neuropsychologic testing
Behavioral modification strategies
Medications
In cases of physical abuse, the abuser is often (male/female) and (is not/is) usually the primary caregiver of the child
female
is primary caregiver
What is 1st line medical treatment for long term management of panic disorder?
SSRIs 1st line
Cognitive behavioral therapy
A majority of people who attempt suicide have what kind of underlying d/o?
Psychiatric
Which d/o is described below?
Persistent (> 6 months), INTENSE FEAR OF SOCIAL OR PERFORMANCE SITUATIONS in which the person is exposed to the scrutiny of others for fear of embarrassment
Social anxiety d/o
What are some options for management of a pt with bulimia nervosa?
Psychotherapy (CBT)
Pharmacotherapy: Fluoxetine has been shown to reduce the binge purge cycle, but may have CV side effects especially if the patient has electrolyte abnormalities
What are components of normal grief vs abnormal grief?
Normal grief: sadness, irritability, intense yearning for a loved one, poor concentration, sleep disturbances, illusions/hallucinations (hearing or seeing the dead) but pt perceives the illusions/hallucinations as not being real
Normal responses include denial, shock, confusion, sadness, numbness or guilt, may develop depressive sx
Abnormal grief: SI, psychosis, psychomotor deficits, illusions/hallucinations (hearing or seeing the dead) but the pt perceives the illusions/hallucinations as being real
What is mania?
MANIA: abnormal & persistently elevated, expansive, or irritable mood at least 1 week (or less if hospitalization is required) with marked impairment of social/occupational function, >=3:
- MOOD: euphoria, irritable, labile or dysphoric
- THINKING: racing, flight of ideas, disorganized, easily distracted, expansive or grandiose thoughts, judgment is impaired
- BEHAVIOR: physical hyperactivity, pressured speech, decreased need for sleep, increased impulsivity and excessive involvement in pleasurable activities including risk-taking and hypersexuality, disinhibition, increased goal directed activity –> Psychotic sx (paranoia, delusions, hallucinations) may be seen in these pts
What is child neglect?
The failure to provide the basic needs of a child
supervision, shelter, food, affection, education, etc
Signs of sexual abuse may include ____/____ trauma, _______ ______ dzs, and ______ ______ infections.
genital/anal trauma
Sexually transmitted dzs
Urinary tract infxns
For dx of oppositional defiant d/o, a pt must exhibit at least ___ months of the following 3 components:
Angry/irritable mood (often blames others for their misbehaviors, has negative attitudes and has anger/resentment)
Argumentative/defiant behavior
Vindictiveness
6
What is the difference between bipolar I and bipolar II disorder?
What is 1st line tx for each?
Bipolar I: >=1 manic or mixed episode, which often cycles w/ occasional depressive episodes, but major depressive episodes are not required for dx
Bipolar II: >=1 hypomanic episode + >=1 major depressive episode (mania or mixed episodes are absent)
Tx: LITHIUM
What lab results are associated with anorexia nervosa?
Leukocytosis, leukopenia, anemia; hypokalemia, increased BUN (dehydration), hypothyroidism
What are some examples of signs of physical abuse?
What kind of burn pattern is associated with physical abuse?
cigarette burns, burns in a stocking glove pattern (seen when feet or hands are held in the water), lacerations, healed fractures on radiographs, subdural hematoma, multiple bruises or retinal hemorrhages (seen in addition to hyphemia in shaken baby syndrome)
What are some signs of child neglect?
malnutrition, withdrawal, poor hygiene, and failure to thrive
What is the single greatest predictive factor for attempting suicide?
Previous attempt or threat of suicide
If you suspect a pt of attempting suicide, what should you ask them about?
If they have a plan
In order to be dx’d with ADD/ADHD, a pt’s sx of hyperactivity/impulsivity or inattentiveness leading to impairment must have an onset before ____ y/o and must be present for at least ____ months, and must occur in at least x____ settings.
12 y/o
6 months
x2 settings
(Teenagers/Older adults) attempt suicide more often than (teenagers/older adults)
teens attempt more than older adults
What d/o is described below?
Persistent pattern of negative, hostile & DEFIANT BEHAVIOR TOWARDS ADULTS
Oppositional defiant disorder
What d/o is described below?
Spectrum of developmental d/o probably linked to a combo of prenatal viral exposure, immune system abnormalities, and/or genetic factors
Autism spectrum disorder (ASD)
What is hypomania?
Sx similar to manic sx: period of elevated, expansive or irritably mood @ least 4 days that is clearly different from the usual nondepressed mood but does NOT cause MARKED impairment
No psychotic features and usually does not require hospitalization
Does not include racing thoughts or excessive psychomotor agitation
What should be attempted for tx in pts who fail to respond to medical therapy?
Electroconvulsive therapy (ECT)
Childhood phobias may ______ with age
lessen
What is lanugo? What condition is it associated with?
soft, downy hair on their arms and legs, it is the body’s strategy to protect itself against heat loss associated w/ extreme thinness
Anorexia nervosa
Cyclothymic disorder is similar to what other condition, but less severe?
Bipolar II d/o
Is generalized anxiety d/o more common in males or females?
When is the age range of anticipated onset of GAD?
Females
Early 20s
_____ _____ must be impaired by distress or avoidance of the situation or object, for a pt’s phobia to be diagnosed
Everyday activities
What is the diagnostic criteria for generalized anxiety?
Excessive anxiety or worry a majority of days >6 month period about various aspects of life
<em>not episodic, situational, or focal</em>
What condition is described below?
Persistent (> 6 months}, intense fear/anxiety of a specific situation (ex. heights, flying), object (ex. pigeons, snakes, blood) or place (ex. hospital)
Specific phobias
What are potential options for management of a patient who is obese?
B_ehavior modification_: exercise and dietary changes, therapy groups
Medical therapy: antidepressants
Anti-obese medications: Orlistat (decreases GI fat digestion), Lorcaserin (serotonin antagonist)
Surgical options: gastric bypass, gastric sleeve, gastric banding, bariatric surgery
