Psych Block 2 Flashcards
1
Q
Define Dissociation
A
Mental process of disconnecting from thoughts, feeling memories of sense of identity
2
Q
Define Dissociative Symptom
A
Depersonalization- feeling detached from and as an outside observer of one’s mental processes or body
Derealization- experiences of unreality of surroundings
3
Q
What can cause Acute Stress Disorder
A
Exposure to actual or threatened death/injury/sexual violence
4
Q
How many Sxs are needed to Dx Acute Stress Disorder
A
9 Sxs that last between 3 days and 1month
5
Q
What are the five categories and 14 Sxs that can be used to Dx Acute Stress Disorder?
A
Intrusive- memory, dream, flashback
Negative Mood- negative mood or emotions
Dissociative- altered sense of reality
Avoidance- avoiding memories or reminders
Arousal- disturbed sleep, irritable, hypervigilant, decreased concentration, exaggerated startle response
6
Q
The clinical presentation of Acute Stress Disorder is variable but typically includes ?
A
Anxiety response
Form of re-experiencing/reactivity to traumatic event
7
Q
What are the non-pharm and pharmaceutical methods for treating Acute Stress Disorder?
A
Non: CBT, exposure and debriefing
Rx- SSRI, Benzo, Propanolol, Morphine
8
Q
How do people get PTSD?
A
Exposure or threat of death, injury, or sexual violence
9
Q
What are the criteria for Dx PTSD?
A
Sxs lasting more than 1mon
One or more intrusive Sx
Avoidance of BOTH memories and external reminders
Two or more alterations in cognition/mood
Two or more alterations in arousal/reactivity
10
Q
How is PTSD characterized?
A
Heightened sensitivity to potential threats
Very reactive to unexpected stimuli
11
Q
What are the DDxs for PTSD?
What are the DDxs for Acute Stress Disorder?
A
M GOAT- MDD, GAD, OCD, Acute Stress DO, TBI
PAP TOP- PTSD, Adjustment D/o, Panic D/o, TBI, OCD, Psych D/o
12
Q
What are the non-pharmaceutical treatments for PTSD?
A
Psychtherapy ASAP after event and brief 8-12 sessions
Cognitive processing
Prolonged exposure therapy
Eye movement desensitization
13
Q
What are the pharmaceutical treatments for PTSD?
A
SSRIs- Sertraline or Paroxetine Propanolol- peripheral anxiety Sxs Clonidine- hyperarousal Prazosin- nightmares Carbamazepine- impulse or anger Benzos- anxiety and panic Trazadone- insomnia
14
Q
How does Adjustment Disorder develop?
A
Emotional/behavior problems that develop withing 3mon of an identifiable stressor
15
Q
What are the Sxs for Dx Adjustment Disorder?
How long does it take for the Sxs to resolve?
A
Distress OOPT stressors intensity
Impaired social/occupation function
Within 6mon of removal of stressors/consequences
16
Q
For a Dx of Adjustment Disorder the Sxs must not be normal for what other Dx?
A
Bereavement
17
Q
What are the 3 DDXs for Adjustment Disorder?
A
MDD
PTSD
Personality D/o
18
Q
What are the non/pharmaceutical methods for treating Adjustment d/o?
A
Immediate Sx redution- bag breathing
Recognition and removal of stress source
Logging
Exercise and relaxation
Short term use of Benzo, Anti-histamine or SSRIs
19
Q
In summary, what are the timelines for ASR, PTSD and AD Sxs?
A
ASR- traumatic event causing Sxs for 3days-1mon
PTSD- traumatic event causing Sxs for 1mon or more
AD/o- stressful event presenting 3mon from start and resolves in 6mon
20
Q
Define Bereavement
Define Grief
A
Situation where someone who’s close dies
Natural response to bereavement
21
Q
What are the two phases of Grief?
Complicated grief is AKA ?
A
Acute and Integration
Persistent Complex Bereavement D/o
22
Q
What events occur during acute first phase of grief?
A
Immediate feeling of numb, shock and denial
Comprehension occurs months later
Intense sadness, longing and emptiness may peak after recognition sets in
23
Q
Sometimes grief can present with what Sx that actually provides some benefits?
A
Denial
Pain relief and allows time for funeral/post-death affairs
24
Q
What can cause the Acute Phase of grief to be substantially extended?
A
Suicides
25
What are the hallmarks of healing from death?
Recognition they have grieved
Returning to work/daily plans
Re-experiencing pleasures/companionship
26
How is grief treated?
Resources as requested
No formal interventions are indicated
Reserved therapy/pharmacotherapy
27
What complicating factors can decrease the prognosis for grief?
Nature of the loss
Poor support network
Comorbid psychiatric conditions
28
What causes Persistent Complex Bereavement Disorder and what Sxs are needed for Dx?
Death of someone close
One of: SY DC
Yearning, Intense sorrow, Preoccupation w/ deceased, Preoccupied w/ circumstances of death
Six of: DAAM ARMPIT AD
Accepting, Disbelief, Positivity, Anger, Maladaptive, Die, Trusting, Alone, Meaningless, Role, Interests
29
What is the time frame for diagnosing Persistent Complex Bereavement Disorder
Typically what is seen here from the PT?
Why is this time frame needed?
Sxs x 12mon (6mon if child) since death of person of close relationship
Persistent yearning/longing for deceased
Differentiates normal from persistent grief
30
What are the risk factors that can lead to Persistent Complex Bereavement Disorder?
Hx of Anx/Depression
Emotionally misunderstood/insecure
Several previous deaths near them
Death of child or young adult
Violent death- homicide, suicide, accident
Traumatic notification
Hostile/insensitive behavior of others before/after death
31
What comorbidites are associated with Persistent Complex Bereavement Disorder?
What needs to be screened/monitored for in these PTs?
Depression, PTSD, Substance abuse
SIs
32
What are the DDxs for Persistent Complex Bereavement Disorder?
Normal Grief
PTSD
GAD
MDD
33
What are the treatment methods for Persistent Complex Bereavement Disorder?
Resolve grief Sxs and foster adaptation for loss
Education
Monitor every 1-4wks
1st line= behavior therapy to focus on loss acceptance and resuming daily life
2nd line= Rx for comorbid psych conditions (depression, PTSD)
Serotonin active anti-depressants may augment therapy
34
What are the long term risks of untreated Persistent Complex Bereavement Disorder?
13mon= smoking, depression, eating and HTN
25mon= CVD or neoplastic Dz
SI/SAs
Chronic and unremitting
35
Suicide won't always be caught on screenings but what can be screened for?
High risk situations
| Suicidiality in depressed PTs
36
What is the strongest risk factor for suicide?
Hx of previous attempts/threats
| Previous attempt= 5-6x higher risk of repeat attempt
37
>90% of PTs who attempt suicide have ?
95% of are successful have ?
Psych d/o
Psych dz
38
What are two strong predictors for suicide?
Sx of hopelessness
| Impulsivity
39
What psych conditions have a higher risk factor for suicide?
BED PODS P
Bipolar, Eating, Depressive, Panic, OCD/PTSD, Dissociative, Substance abuse
Personality
40
What type of living statuses have a higher risk for suicide?
Regardless of martial status, what is the universal risk?
Never married- highest
Widowed, Separated, Divorced, Married w/o kids
Living alone
41
What age groups are at increased risk for suicide?
What other factors can increase the risks of a suicide?
Completed suicides increase w/ age, >85 males are at elevated risks
Military service
Poor health
FamHx of Suicide
42
What are the protective factors against a suicide?
Support
Pregnancy
Parenthood
Religion/participation in activities
43
What questions are asked to fill in the Objective part of the note for a suicidal PT?
```
AMSIT
Appearance
Mood/Affect
Sensorium/Intellect
Thoughts
```
44
What is the difference between Mood and Affect of a SI history note?
Mood- subjective
Affect- objective
45
What are the four parts of managing an SI PT?
Keep self and staff safe
Reduce immediate risk
Manage underlying conditions
Monitor and f/u
46
What meds can be prescribed to PTs presenting w/ SIs?
When are SI PTs at the highest risk for suicide?
SSRIs- best initial choice due to low chance of OD
First week after d/c
30% withing first year after release due to perceived loss of therapeutic support
47
What is the criteria for child abuse?
Any injury under 6mon
If older than 6mon:
Bruises, lacerations, scald burns, fractured bone presentation, drugged/intoxication, self report or shows fear of care taker
48
What types of PT presentation can suggest concerns of child neglect?
Unsupervised in dangerous environments
Malnourished/starved
Disregard of basic child needs- including drugs/ETOH use by caretaker
49
What type of info can an abusive parent provide regarding the presentation of their child?
Denial/lack of knowledge
Vague
Conflicting
Partial/complete admission
50
What type of info can a non-abusive parent provide about the presentation of their child?
Denial
Defends the abuser
Evasive answers
Witnesses
51
What type of info can a child who is a victim of abuse provide to a provider?
What can their sibling offer?
Denial
Protection of abuser
Truth
Denial/lack of knowledge
Truth
52
What act mandates professional reporting of cases of suspected/identified child abuse or neglect?
Child abuse Protection and Treatment Act of 1974 Public Law 93-247
53
What are the two most common types of elder abuse?
Physical
| Emotional
54
# Define Physical elder abuse?
Define Emotional elder abuse?
Non-accidental use of force including drugs, restraints or confinement
Speaking/treating elders in ways that cause pain
55
# Define Verbal elder abuse?
Define Non-Verbal abuse?
Intimidation w/ yelling or threats
Ignoring, terrorizing or menacing including isolation from friends/activities
56
Who is generally the first responder to report elder abuse, neglect or exploitation?
Adult Protective Services
57
When does domestic violence usually begin or escalate?
Pregnancy
58
Domestic violence PTs are at increased risks for ? and can have what non-specific somatic complaints?
Depression, suicide, substance abuse
Insomnia, HA, GI, pelvic, chest or back pain
59
Domestic violence can cause what health risks for families?
Older kids witnessing violence- issues at school, domestic complaints, participants of violence
Teens- more likely to be homeless, substance abusers, sex Dzx, early pregnancy, inc risk of suicide or self mutilation
60
How does possible domestic abuse victim present/info is offered?
```
Unexplained/multiple injuries
"Accident" prone
Partner is present or speaks for PT
Low self esteem
Somatic complaints
Hx of anxiety, depression, SIs of substance abuse
```
61
How are questions presented to PTs to screen for domestic violence and why are they asked in this way?
Present in matter of fact way
| Implies willingness to help
62
Define the criteria for Anorexia Nervosa
Energy intake restrictions resulting in body weight lower than normal due to intense fear of gaining weight or becoming fat or a behavior that prevent weight gain despite being low weight
Disturbance of self image in relation to body weight or lack of recognition of seriously low weight
63
What are the 3 essential features of anorexia nervosa
Persistent energy intake restriction
Intense fear of gaining weight/becoming fat
Disturbance in self perceived weight/shape
64
When does anorexia nervosa begin and what type of social life can the PT have?
Rarely begins before puberty
Some can remain socially active, others isolate and become reclusive
65
What are the 3 primary goals to anorexia nervosa treatment?
All PTs Dx need to be co-managed w/ ?
Restore normal body weight
Establish normal eating behavior
Resolve psychological difficulties
Psychiatrist
66
When do PTs w/ anorexia nervosa need to be admitted?
Hypovolemia
E+ d/o
Severe protein/energy nutrition
Failure to improve w/ out patient methods
67
What are the criteria for bulimia nervosa?
Binge eating episodes of too much in one sitting w/ a sense of loss of control that occurs once per week x 3mon and outside of anorexia nervosa periods
68
What are the 3 essential features of bulimia nervosa?
Recurrent binge eating episodes
Inappropriate compensatory behaviors to prevent gain
Self evaluation that is influenced by body weight/shape
69
How do PTs w/ bulimia nervosa compensate for their actions?
What is an increased risk in these PTs?
Ashamed and conceal Sxs despite being within normal or overweight range
Suicide
70
What are the 4 DDx for bulimia nervosa?
Anorexia
Binge eating
Borderline personality d/o
71
What are the treatment methods for bulimia nervosa?
Support
Psychotherapy
SSRIs- fluoxetine hydrochloride
72
What are the criteria for binge eating disorders?
Recurrent episodes of binge eating (too much, loss of control)
3 or more: too fast, uncomfortably full, eating alone due to embarrassment, disgusted/depressed
Once a week x 3 mon with no compensatory/anorexia
73
What are the DDxs for binge eating d/o?
How is it treated?
Bulimia
Border line
Psychotherapy and CBT are best
74
Define ADHD
Persistent pattern of impaired functionality or development with inattention and/or hyperactivity or impulsivity
75
What are the inattention Sxs of ADHD?
```
6 of:
No attention to detail
Sustained attention
Not listening
Follow through w/ instructions
No organization
Avoids sustained mental effort
```
76
What are the hyperactive Sxs of ADHD?
```
Fidgets
Leaves seta
Runs/climbs
No leisure
"on the go"
Talks excessively
Blurts out/can't wait for turn
Interrupts/intrudes
```
77
What are the most notable/important S/Sxs of ADHD?
Peer rejection or accidental injury with hyperactivity or impulsivity
78
What are the most effective pharmaceuticals for ADHD?
Methylphenidate
Amphetamine
Desipramine- TCA for PTs w/ concomitant depression/neurological pain
Bupropion- contraindicated stimulant or PTs w/ major depression
Atomoxetine- NON-stimulant and second line drug approved by FDA for ADHD
Fuanfacine and clonidine- non-stimulants w/ efficacy for ADHD
79
Why do ADHD PTs need to have behavior and pharmaceutical therapies at the same time?
High concern for addiction w/ med monotherapy
80
What are the criteria for Autism?
Deficit in social/emotional reciprocity, non-verbal communication and relationships
Two of:
Motor movement, object or speech
Inflexible adherence to routines
Restricted/fixated interest that are abnormal in intensity
Unusual interest in sensory aspects of environment
81
Describe Levels 1 of Autism
1- Inflexibility of behavior causes significant interference w/ functioning.
Difficulty switching activities
Issues w/ organization and planning hamper independence
Person can speak full sentence and engage in communication but to/from conversations w/ others fail and attempts to make friends fail
82
Describe Levels 2 of Autism
Inflexible behavior
Difficult coping with change
Restricted/repetitive behavior noticeable to passerby
Person speaks w/ simple sentences, interaction is limited to narrow special interests and markedly odd nonverbal communication
83
Describe Levels 3 of Autism
Inflexibility of behavior
Extreme difficulty coping with change
Great distress/difficulty changing focus or action
Person w/ few words of speech and rarely initiates interaction or makes unusual approaches to meet needs and only responds to very direct social approaches
84
What are the first Sxs seen of Autism?
```
Delayed language development
Lack of social interest
Unusual social interactions
Odd play
Unusual communication patterns
```
85
What are the primary treatments for Autism?
Developmental and behavioral therapies
| Risperidone/Aripiprazole- only ones w/ FDA approval
86
Define Oppositional Defiant Disorder
```
Angry/irritable mood w/ argumentative/defiant behavior for 6mon with 4 of:
Loses temper
Easily annoyed
Angry
Argues w/ authority
Refusal to comply w/ authority/rules
Intentional annoys rules
Blames others for mistakes
Spiteful/vindictive- 2x in 6mon
```
87
When/where is Oppositional Defiant Disorder seen?
Families w/ child care is disrupted by succession of different caregivers or,
Families w/ harsh, inconsistent or neglectful practices
88
What are the two most common co-occurring conditions appear with oppositional defiant disorder?
ADHD
| Conduct d/o
89
How is Oppositional Defiant Disorder treated?
Psychotherapy
| Pharmacotherapy- to treat comorbidity
90
Criteria for conduct disorder?
Behavior that violates the basic right of others or social norms manifested as 3 of:
ALOT
91
What is the essential feature of conduct disorder?
Repetitive and persistent pattern of behavior where basic rights of others are violated
92
What other disorder is less severe than conduct disorder?
Oppositional defiant disorder
93
What are the treatment methods of Conduct Disorder?
```
Psychotherapy
Pharm:
Antipsychotics- Haloperidol, Risperidone, Olanzapine
Lithium
Stimulant if ADHD is present
```
94
What are the "CAPRI" of personality?
```
Cognition
Affect
Personal
Relations
Impulse control
```
95
What are the 3 clusters of personality disorders?
A- "weird": peculiar or withdrawn w/ FamHx of Psych Illness
B- "dramatic": emotional or dramatic w/ FamHx of mood disorders
C- "worried": anxious/fearful w/ FamHx of anxiety disorder
96
Cluster A Personality disorders includes what 3?
Paranoid Personality d/o
Schizoid Personality d/o
Schizotypal Personality d/o
97
Criteria for Dx of Paranoid Personality D/o
Pervasive distrust and suspiciousness of others w/ 4 Sxs:
98
Criteria for Cluster A Schizoid Personality Disorder
Detachment from social relationships and restricted range of emotion expression w/ 4 Sxs:
99
Criteria for Cluster A Schizotypal Personality Disorder
Acute discomfort w/ close relationships and cognitive/perceptual distortions w/ 5 Sxs:
Excessive social anxiety
100
What are the 4 Cluster B Disorders?
Antisocial
Borderline
Histrionic
Narcissistic
101
What are the criteria for Cluster B antisocial personality disorder?
Disregard and violation of rights of others starting at 15 and w/ 3 Sxs:
102
Antisocial personality disorder has also been AKA what 3 names?
Psychopathy
Sociopathy
Dyssocial personality disorder
103
What characteristics do antisocial personality disorder PTs have that allows them to blend in?
Exploits others for own need w/out empathy, compassion or remorse
Skilled at reading social clues and people so they appear charming
Hx of childhood sex/physical abuse
Hx of hurting animals or starting fires
104
What are the criteria for borderline personality disorder?
Instability of relationships, self image and impulsivity w/ 5 Sxs:
105
What are the criteria for Histrionic Personality D/o
Excessive emotion/attention seeking w/ 5 of:
106
What is the defense mechanism commonly used by PTs with Borderline Personality D/o
Splitting- view others or self as either all good or all bad
107
What type of meds can help PTs w/ Borderline Personality d/o?
Antidepressants have helped with anxiety, depression, and sensitivity to rejection
108
Who is more functional, borderline personality PTs or Histrionic PTs?
Histrionic
109
What are the criteria for Narcissistic Personality D/o?
Grandiosity, need for admiration and lack of empathy with 5 Sxs:
ehavior
110
What are the Cluster C Personality Disorders?
Avoidant personality
Dependent Personality
Obsessive Compulsive
111
What are the criteria for Avoidant Personality D/o?
Social inhibition, feeling inadequate and hypersensative to negative evaluation w/ 4 Sxs:
112
What meds can benefit Avoidant Personality D/o?
SSRIs
| Benzos
113
Criteria for Dependent Personality D/o
Pervasive and excessive need to be taken care of leading to submissive/clinging behavior or fear of separation w/ 5 Sxs:
114
What are the criteria for Obsessive Compulsive D/o?
Preoccupation w/ orderliness, perfectionism and interpersonal control w/ 4 Sxs
115
How is Social Personality D/o treated?
Social/therapeutic environments to peer pressure modification of self destructive behavior
If young, school and home can be foci of intensified social pressure
116
How is Behaviors personality d/o treated?
Operant conditioning
| Aversive conditioning
117
How is Pyschological personality d/o treated?
Group therapy w/ peer pressure
| Individual therapy
118
What pharmacologic treatments can help w/ personality d/o?
Antidepressants- Anx/Dep and sensitivity
SSRI- reduce aggression in impulse aggressive PTs
Antipsychotics- help w/ targeting hostility, agitation, and adjunct to anti-depressants
Anticonvulsant- decrease behavioral dyscontrol
119
Schizotypal personality PTs improve on what meds?
Anti psychotic
120
Avoidant personality PTs improve from ? strategies?
Anxiety reduction
SSRI
Benzos
121
Define Tolerance
Reduced effect when using the same amount of a substance and need for increased amounts to gain the same effect
122
Define Withdrawal
Reduction/lack of substance use causing PT to feel the "need" to use substance for Sx relief
123
What are the 11 criteria for alcohol abuse?
```
Increased use
Desire/attempts to reduce
Time using/obtaining
Craving
Decreased work/home/life
Continued use despite issues in life
Dangerous situation usage
Continued use despite psych/physical problems
Tolerance
Withdrawal
```
124
Define Alcohol use disorder
Behavior and psych problems w/ first episode during mid-teens and characterized by periods of remission/relapse
125
Define Alcohol withdrawal
```
Diaphoresis/+100bpm
Tremor
Insomnia
N/V
Hallucination/illusion
Psychomotor agitation
Anxiety
Seizure
```
126
How long do alcohol withdrawals last?
What other issues can it mimic?
4-5 days
Hypoglycemia
DKA
127
What meds are used for alcohol abuse and withdrawal?
Disulfiram- aversive med to discourage use
Naltrexone- opiate antagonist to lessen pleasure effects
Haloperidol- hallucinations
Benzo- depress CNS
All hospitalized PTs- hydration, E+, Mg, Ca, K, thiamine, folic acid and multi-vitamin
128
What meds are used for alcohol withdrawal if benzos efficacy is lacking?
Propofol
| Phenobarbital
129
# Define Caffeine Intoxication
How long is caffeine's half life?
Consumption +250mg and 5 Sxs
4-6hrs
130
What are the criteria for caffeine withdrawal?
```
Prolonged use
Cessation
3 of:
HA, fatigue, moody, difficult concentration, flu like Sxs
HA= hallmark
```
131
How long do caffeine withdrawal Sxs last?
How quickly do they subside w/ ingestion of caffeine?
2-9 days, up to 21
30-60min
132
How many Sxs are needed to meet criteria of substance abuse?
2 of the same 11 from alcohol
133
What type of brain function is altered in cannabis users?
Higher executive function
134
What are the criteria for cannabis intoxication?
```
2 Sxs within 2hrs of use
Conjunctival injection
Inc appetite
Dry mouth
Tachy
```
135
What are the Sxs of cannabis high?
```
Inappropriate laughter
Grandiosity
Sedation
Lethargy
Impaired short term memory
```
136
What are the criteria for cannabis withdrawal?
```
3 of:
Irritable
Anxiety
Sleep issues
Dec appetite
Restlessness
Depressed
```
One of :
ab pain, tremor, sweating, fever, chills, HA
137
Cannabis withdrawals can mimic what other two issues/
Depressive d/o
| Bipolar d/o
138
What are the effects of using PCP?
Separation from body/mind
Residual Sxs resemble schizophrenia
Nystagmus, analgesia and HTN distinguish PCP use from other hallucinogens
139
What are the S/Sxs of PCP use?
```
Within 1hr and 2 of:
Vert/Horizontal nystagmus
HTN/Tachy
Diminished pain response
Ataxia
Dysarthria
Muscle rigidity
Seizure/Coma
Hyperacusis
```
140
What are the most COMMON Sxs of PCP use?
Coinfusion w/out hallucination
Hallucination/delusion
Catonic syndrome
Coma
141
What are the criteria for hallucinogen intoxication but NOT from PCP?
```
2 of:
Dilated pupils
Tachy/diaphoresis
Sweating
Palpitations
Blurred vision
Tremor
```
142
What is the hallmark Sx of hallucinogen persisting perception disorder?
This is primarily seen after what drug use?
Re-experiencing perceptual disturbances but while PT is sober
LSD
143
What is the only dissociative hallucinogen?
PCP
| All other- psychedelic
144
How are hallucinogen drugs treated?
Primary= protection of PT
Severe- antipsychotics (haldol)
Bad trips- Olanzapine, Risperidone
Acute agitation- Lorazepam or Clonazepam
145
What evidence is used to support the diagnosis of inhalant use disorder?
Recurrent episodes of intoxication w/ negative results in standard drug screens
146
What class of vapors are inhaled to get high?
Volatile hydrocarbon
147
Why do PTs die from Sudden Sniffing Death?
Cardiac arrhythmias
148
How are PTs the present with inhalation intoxication treated?
```
Supportive care for Sxs:
Respiratory suppression
Ventricular arrhythmias
Hypokalemia
Coma
```
149
Of the drug abuse disorders, which one has a higher risk of suicide?
Opioid
150
What are the Sxs of opioid use and withdrawal?
Use- dry mucous secretions, constipation, pupils constricted
Withdrawal- anxiety, restless, rhinorrhea, lacrimation, dilated pupils
151
What are the most common medical condition associated with opioid use disorder?
Viral- HIV, Hep C
| Bacterial infection- especially if injecting
152
What criteria is used for opioid intoxication?
Pupil constriction plus one:
Drowsy/coma
Slurred speech
Impaired attention/memory
153
What are the criteria for opioid withdrawal?
```
3 Sxs after cessation or administration of opioid antagonist:
Dyphoric mood
N/V
Muscle aches
Lacrimation
Diarrhea
Yawning
Fever
Insomnia
```
154
What drug is used for immediate opioid reversal?
Which one is used for PTs opioid free for 7-10 days?
Naloxone
Naltrexone
155
What is the benzo reversal agent?
Why mus there be caution when using this drug?
Flumazenil- don't use in PTs w/ seizure disorder and benzos will be ineffective
156
What type of Sxs may be prominent in stimulant abusers?
Auditory hallucinations
| Paranoid ideations
157
What are the criteria for stimulant withdrawal?
```
Dysphoric mood and 2:
Fatigue
Vivid bad dreams
In/hypesomnia
Inc appetite
Psychomotor retardation
```
158
When are acute stimulant withdrawal Sxs usually seen?
Periods of repeated high douse use called runs or binges
159
What drug can be used for stimulant treatment?
Bromocriptine for cocaine withdrawal
160
How is tobacco tolerance identified?
Disappearance of nausea and dizziness
161
What are the most common presentations of tobacco use disorder?
Within 30min of waking
Daily
More and more
Waking at night to smoke
162
What is the criteria for tobacco withdrawal?
```
Cessation for 24hrs and 4 of:
Anger
Anxiety
Difficulty concentrating
Restless
Depressed
Insomnia
```
163
What odd Sx can present w/ tobacco withdrawal?
Sugar cravings
| Impaired performance on vigilant tasks
164
What type of smoking PTs have more severe tobacco withdrawal Sxs?
Depression/Anxiety
Bipolar
ADHD
Substance abuse
165
What meds are given for tobacco cessation?
Varenicline
| Buproprion
166
What are the defense mechanisms of Borderline and Histrionic disorders?
Border- Splitting
| Histrionic- Regression
