psych exam 2 Flashcards
suicidal plan
with means, has access to materials
higher rates of suicide
Native american Alaskan Non hispanic whites Veterans Sexual minority youth Survivor mass casualty
Highest risk for change in tx relating to suicide
in 3 days
then within 30 dys
SAFE-T
Suicide Assessment Five step Eval Triage
Columbia suicide severity rating scale
minimum 6 questions
Risk and Protective factor checklist
What chemical mainly associated with Anxiety
Seretonin
What is very effective for Anxiety
CBT
Gen Anxiety DSM5
at least 6 mo
THREE of following: restless, easty fatigue, poor conc, irritable, poor concentration, sleep disturbance
Tx for Mild Gen Anxiety
CBT
10-15 sessions
Tx for Mod/Severe Gen Anxiety
SSRI/SNRI
If conc about substance abuse: Buspirone or Hydroxyzine
Social anxiety disorder onset
late childhood/
early teen
6 mo or more
Tx for Social Anxiety
1st line: CBT
Tx ofr Performance Anxiety
Beta blockers
short term: Benzo
Strong Genetic component
Panic disorder
Higher in Native American
Panic disorder
Panic disorder
Onset early 20s
Period of intense fear/discomfort with FOUR of following, reach peak within 10 minutes
Panic disorder episode is followed by
at least 1 MONTH or more of: concern about future attack, implication of attack, maladaptive behavior
Tx for Panic disorder
CBT, SSRI, SNRI, or
Benzo (Clonazepam)
Onset for Phobia
7-10 YO (younger)
Tx for Phobias
CBT
Sig improvement in 1-5 sessions!
does not take as long, therapy can be super specific
OCD onset
early in life 11-20 YO
prog gets worse as age increases
Hoarding disorder (a subtype of OCD)
Male = Female
50% hereditary
50% have SI
Tx for OCD
TCA: Anafranil (Clomipramine)
+ SSRI, SNRI,
Adjustment disorder
Sx w/in 3 mo of stressor, Resolve w/in 6 mo
Tx for Adjustment disorder
Group therapy
Length of inpatient tx for Eating disorder
30-60 days
Length of Intensive outpatient tx for Eating disorder
1-3 months
Tx for Bulimia disorder (puke)
P for Puke
Prozac
Tx for Binge eating disorder
Vyvanse
SE of meds that can be concerning when treating Eating Disorders
Atypical Antipsychotic: Weight gain
Benzo: Habit forming
ADHD: decreased app, weight loss, heart problems
Anticonvulsant: underweight, purging
Time length when it goes from Acute stress to PTSD
1 month
Common areas disrupted by trauma
Safety Trust Power/control Esteem Intimacy
Hippocampus
Learns fear environment/ context
LC
NE release
Insula/Anterior Cingulate Cortex
Visceral/autonomic
“gut feeling” assoc w/fear
Pre-frontal cortex
Emotional regulation
Controls amygdala
(young ppl @ higher risk bc not developed)
DREAMS acronym relating to PTSD
Detachment Re-experiencing Emotional effects Avoidance Month long Systemic hyperactive
Common clinical comorbidities assoc w PTSD
Heart dz Auto-immune Hyperlipid Cystitis Dementia Fibromyalgia Chronic pain
Meds for PTSD
Sertraline
Paroxetine
Do NOT use these two meds for PTSD
Benzos
Antipsychotics
DO NOT do active Trauma therapy if:
Primary active substance abuse
Cognitive impairment
Psychosis not under control
CARE-MD approach to SSD
Consult Assessment Regular visit Empathy Medical-psychiatric interface Do no harm
Tx for SSD
CBT and Mindfulness
Tx usually only last days-weeks and remit spontaneously
Conversion disorder
neural complaints
Illness Anxiety disorder tx
Assurance
Regular visits
Indiv or Group therapy
1 comorbid associated with Body Dysmorphic Disorder
Depression
Components of CBT for treating Somatic disorders
12 sessions
Symptom focused
Incorporate journaling
Factitious disorder
On SELF or OTHERS
Internal reward
attention seeking
poor sense of identity
hard to treat
Malingering
external benefit
Secondary gain
no DSM5 criteria
Tx: Remove the incentive
