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Psych Exam (Total) Flashcards

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1
Q

What is NREM and the stages?

A

Non-Rapid eye movements (SLOW). There are four stages.

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2
Q

What is REM? This contains:

A

Sleep associated with fast erratic movements. Contains dreaming.

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3
Q

Muscles are paralyzed in:

A

REM

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4
Q

What NREM cycles are most prominent in the first half of the night?

A

NREM stages 3/4.

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5
Q

REM pattern throughout the night (2):

A
  • Longer throughout the night

- Most prominent in the second half of the night

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6
Q

Normal sleep patterns for infants:

A

Sleep >66% of the day

50% is REM

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7
Q

Normal sleep pattern for adults:

A

<33% of the day

20% is in REM

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8
Q

Normal sleep for elderly:

A

Fragmented sleep

*Rarely get to the fourth stage

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9
Q

Insomnia disorder diagnostic criteria:

A

Dissatisfaction with sleep quantity or quality with 1 or more of the following:

  • Can’t initiate
  • Can’t stay asleep
  • Early morning awakening and can’t return
  • Must cause distress
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10
Q

Narcolepsy time span:

A

3 nights per week for at least 3 months

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11
Q

Most prevalent sleep disorder - Common among:

A

Insomnia (more common among females)

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12
Q

Insomnia is often observed with:

A

Another co-morbid mental disorder

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13
Q

The 5 Parasomnia disorders:

A
  • Wake-sleep transition
  • Light sleep stage disorder
  • NREM sleep disorders
  • REM sleep disorders
  • Diffuse sleep disorders
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14
Q

The two Wake-sleep transition disorders (parasomnias):

A
  • Sleep start (hypotonic jerks as the patient enters sleep - benign)
  • Rhythmic movement disorder: (Head banging at sleep onset in children)
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15
Q

The two Light Sleep Stage disorders:

A

Sleep - talking: Vocalizations while asleep, 1 word - convos.
Bruxism: Repeated teeth grinding (tx. mouthguard)

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16
Q

NREM Sleep disorders: When do they occur? How long?

A

1st third of the night, episodes last 1-10 minutes

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17
Q

What differentiates NREM sleep disorders from others?

A

The patient experiences amnesia in the morning or when awakened.

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18
Q

Night terrors are a:

A

Non-Rem disorder (autonomic arousal)

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19
Q

Two REM sleep disorders:

A
  • Nightmare disorder (NO autonomic arousal)

- REM sleep behavior disorder: Patients act out dream content (M > F)

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20
Q

REM sleep behavior disorder has a loss of:

A

Muscle atonia

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21
Q

Treatment for REM sleep behavior disorder:

A
  • Melatonin

- Clonazepam

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22
Q

Diffuse sleep disorders:

A

Nocturnal enuresis (C >A)

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23
Q

Treatment of nocturnal enuresis:

A

Desmopressin

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24
Q

Other treatments for nocturnal enuresis that are not medical:

A

Bladder training (with alarms)

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25
Q

Treatment for insomnia (2):

A
  • CBT - I (insomnia)

- Non-Benzo sleepers (GABA adrenergic)

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26
Q

Diagnosis for Somatic Symptom disorder (time):

A

One or more somatic symptoms for more than 6 months

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27
Q

Treatment for Somatic symptom disorder (2):

A
  • CBT

- ADs as an adjuvant treatment

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28
Q

What is Illness Anxiety disorder?

A

Preoccupation with having or acquiring a serious illness for more than 6 months (illness can change)

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29
Q

Are somatic symptoms present will Illness anxiety disorder?

A

Not present; if they are it is mild

*note: If they already have an illness and are preoccupied with developing another, this is disproportionate

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30
Q

Two types of Illness Anxiety Disorder:

A
  • Care-seeking

- Care-avoidant

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31
Q

Occurrence of Illness anxiety order (stats):

A

Equal among men and women; 3-8% of the population

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32
Q

Treatment of Illness anxiety disorder (3):

A
  • CBT
  • Supportive therapy (build trust)
  • Serotonergic meds
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33
Q

What is conversion disorder?

A

One or more symptoms with voluntary motor or sensory function that suggests a medical condition

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34
Q

Are people with conversion disorder causing their symptoms?

A

No - they are not intentionally produced

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35
Q

What is the main underlying cause of Conversion Syndrome?

A

There is a symbolic unconscious conflict - the physical symptoms block this memory/event from consciousness

*EVENT –> Onset of disorder (FAST)

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36
Q

What is la belle indifference?

A

Patients are calm about their somatic loss of function in their leg

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37
Q

What are three risk factors for Conversion disorder?

A
  • Maldaptive personality traits
  • Childhood abuse and stress in life
  • Presence of neurological disease that causes similar symptoms
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38
Q

On functional neuroimaging in the brain for someone with conversion disorder, you will see:

A

Decreased activity in the limbic region and the area of concern (Ex. Visual blindness - Decreased occipital lobe functioning)

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39
Q

Treatment for Conversion disorder:

A

Reassurance and physical/occupational therapies

Hypnoses and amytal ETOH can be used as well

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40
Q

Four features of a poor prognosis for conversion disorder:

A
  • Delayed treatment
  • Symptoms of seizure or tremor
  • Maladaptive personality traits
  • Co-morbid physical disease
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41
Q

What is Factitious Disorder?

A

Patient intentional induces or exaggerates signs and symptoms to be the patient (they are not trying to get drugs)

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42
Q

Many people that suffer from factitious disorder have had:

A

Abuse as a child with frequent hospitalizations - They believe the hospital is very safe

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43
Q

10% of those with Factitious disorder have:

A

Maunchausen Syndrome - Severe and chronic factitious disorder

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44
Q

What is Pseudologia fantasica?

A

Pathological lying

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45
Q

Ganser’s syndrome is:

A

A type of factitious disorder (they use approximate answers)

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46
Q

What are the three disposing factors for factitious disorder?

A
  • Childhood illness - attached to it
  • Medical professional
  • Personality: borderline or narcissistic
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47
Q

Most common co-morbid disorder with factitious?

A

Borderline personality disorder

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48
Q

Admission/Discharge pattern for someone with factitious disorder?

A
  • Admit late at night (less staffing)

- Discharge AMA - readmit at another hospital

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49
Q

Management for factitious?

A

Not specific - Dress psychiatric diagnosis

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50
Q

What is malingering?

A

Patient is intentionally feigning the illness - do not want to be discovered

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51
Q

What is someone motivated by with malingering?

A

External incentives - Drugs, financial compensation, avoiding the military, evade criminal prosecution

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52
Q

PTSD onset after traumatic event ____

A

Occurs a month after the event - duration for more than one month

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53
Q

What are the four symptoms of PTSD?

A
  • Intrusive (memories and nightmares)
  • Avoidance
  • Negative - Can’t remember the event
  • Arousal and reactivity - HYPER
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54
Q

1/3 to 1/2 of those with PTSD have suffered from:

A
  • Rape
  • Military (captivity)
  • Genocide
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55
Q

Therapies for PTSD (2):

A
  • Exposure based PTSD

- SSRI’s (1st-line)

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56
Q

What is Acute Stress Disorder?

A
  • Exposure to actual or threatened death, serious injury or sexual violation (can also be witnessed)
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57
Q

To diagnose Acute stress disorder:

A

Presence of 9 or more of the following symptoms from any category:

  • Intrusion
  • Negative mood
  • Dissociative
  • Avoidance
  • Arousal
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58
Q

Acute stress timing for diagnosis:

A

Disturbance is 3 days - 1 month after trauma

*Shorter and faster than PTSD

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59
Q

Definition of Panic Attacks:

A

An abrupt surge of intense fear that reaches a peak within minutes

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60
Q

Need at least 4 symptoms to diagnose a panic attack - can contain any of the 6 systems:

A
  • Cardiac
  • Pulm
  • GI
  • Neuro
  • Psych
  • Autonomic arousal
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61
Q

You can enter a panic attack from either:

A

A calm or an anxious state

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62
Q

What is panic disorder?

A

Recurrent unexpected panic attacks

**Chronic disease

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63
Q

After someone has a panic attack and they have panic disorder, what are they consumed with?

A

They are consumed with the thought of having another panic attack - THEY make behavior changes based on the fear of having another attacj

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64
Q

Who is more likely to have Panic Disorder? What ages?

A
  • Women 2-3x more likely

- Mean age 25 - Bimodal (teens and early 30’s)

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65
Q

Those with Panic Disorder - what percent have another psychiatric disorder?

A

50% (10-30% have MDD)

*Many drink to cope

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66
Q

What is Agoraphobia?

A

Anxious in open places

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67
Q

Someone with Agoraphobia has marked fear in 2 or more of the following 5 places:

A
  • Public transportation
  • Being in open or enclosed spaces
  • Standing in line/being in a crowd
  • Being outside of the home alone
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68
Q

Definition of Generalized Anxiety Disorder?

A

Excessive anxiety and worry more days than not for 6 months about a number of different events or activities

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69
Q

The anxiety and worry are associated with:

A

Three or more of the following:

  • Restlessness
  • Fatigue
  • Cant concentrate
  • Irritability
  • Muscle tension
  • Sleep disturbance
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70
Q

Epidemiology of GAD:

M/F affected, age and chronicity

A
  • 2:1 Females
  • Age of onset is childhood
  • Chronic but fluctuating
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71
Q

Treatment for GAD (2):

A
  • CBT
  • Antidepressants (SSRI)
  • Benzo +/- acute use only
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72
Q

What is Social Phobia?

A

Persistent fear of one or more social or performance situation in which the person is exposed to scrutiny by other.

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73
Q

Epidemiology of Social phobia: (M/F, age and comorbidity);

A
  • More females (but men seek help more)
  • Onset in adolescence
  • Comorbidity with depression and substance abuse
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74
Q

Treatment for Social Phobia (3):

A
  • Psychotherapy (1st line) - Restructuring
  • Antidepressants, SSRI and MAOI
  • High-Potency Benzos
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75
Q

What can be useful for public speaking or performance anxiety related to Social Phobia?

A

Low dose of beta-blockers - Propranolol

alleviates the autonomic symptom

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76
Q

What is Specific phobia?

A

Marked and persistent fear that is excessive; causes a panic attack when exposed - the person recognizes their irrational fear

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77
Q

Lifetime prevalence and onset of Specific phobia:

A
  • 10% of the population

- Varies with subtype

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78
Q

Treatment for Specific Phobia (3):

A
  • Exposure therapy

- Benzodiazpepines

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79
Q

What can be used acutely for Specific Phobia?

A

Beta Blockers

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80
Q

What is OCD?

A

Obsessions and compulsions take more than 1 hour a day and are recurrent thoughts, impulses or images that cause distress

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81
Q

What is Adjustment order and time span?

A
  • Development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor
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82
Q

Once the stressor is terminated with Adjustment disorder, does the patient still experience symptoms?

A

They should not experience symptoms for more than an additional 6 months

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83
Q

What are the two types of dissociative disorders?

A
  • Positive: Loss of continuity (depersonalization, derealization)
  • Negative: Inability to access information (amnesia)
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84
Q

When are Dissociative disorders common?

A

After a trauma (acute stress or trauma)

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85
Q

Treatment for OCD (2):

A
  • Large dose of SSRI

- Cognitive correction therapy to break the cycle

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86
Q

Onset of age and sex affected for OCD:

A
  • Men: 6-15
  • Females: 20-29
  • Overall the men and women affected are the same
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87
Q

Comorbidity with OCD:

A

67% MDD

Tourettes: 5-7%

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88
Q

Two examples of SSRI antidepressants (commonly used to treat anxiety):

A
  • Sertraline

- Venlafaxine

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89
Q

Diagnosis for depression:

A

5 or more symptoms present in the same 2-week period at least one of the symptoms is: depressed mood or loss of interest or pleasure

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90
Q

SIGECAPS (depression)

A 
Sleep disturbance
Interest Loss
Guilt or worthlessness
Energy depleted
Concentration depleted
Appetite change
Psychomotor agitiation
Suicidal ideation
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91
Q

Screening tool for depression:

A

PH-Q9

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92
Q

Depression severity interpretation:

A 
0-4 None
5-9 Mild
10-14 Moderate
15-19 Moderately severe
20-27 Severe
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93
Q

Less than what percent of patients are recognized as having depression in primary care?

A

Less than 50%

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94
Q

SE of the anti-depression meds (SSRIS) onset:

A

Within the first 2 weeks and go away by 4-6 weeks

95
Q

Treatment for MDD (3):

A
  • CBT
  • SSRI/SNRI (second generation)
  • Exercise
    +/- Augmentation
96
Q

Options for treatment augmentation for MDD (3):

A
  • Omega-3 fatty Acids
  • SAM
  • Folates
97
Q

What is the definition of Persistent Depressive Disorder?

A

Depressed mood for most for the day for most of the week for at least 2 years.

98
Q

When someone with persistent depressive disorder is feeling depressed they must have at least two of the following:

A
  • Poor appetite or binging
  • Insomnia/hypersomnia
  • Low energy
  • Low self-esteem
  • Poor concentration
  • Feelings of hopelessness
99
Q

If someone has Persistent Depressive Disorder (Dysthmia) they have NEVER had:

A

A manic or hypomanic episode

100
Q

What is double depression?

A

Dysthmia –> Progress to meet depression –> Remission back to dysthymia

101
Q

DIGFAST - Cardinal symptoms of mania:

A 
Distractibility
Impulsivity
Grandiosity
Flight of ideas
Activities
Sleep - they do not want to
Talkative
102
Q

If the mood is euphoric, how many of the cardinal symptoms of DIGFAST do you have to meet for mania?

A

Three

103
Q

If the mood is irritable, how many of the cardinal symptoms of DIGFAST do you have to meet for mania?

A

Four

104
Q

Symptoms of mania must be present for ___ or the patient must be ___ for a diagnosis

A

1 week; hospitalized

*For a diagnosis of mania

105
Q

If the patient is experiencing symptoms of mania but no dysfunction, they have

A

Hypomania

106
Q

Diagnosis criteria for Hypomanic episode:

A

Symptoms last four consecutive days and are present most of the day (DIGFAST) but does not cause significant dysfunction

107
Q

If a patient is hypomanic and they have psychosis….

A

They are automatically bumped to the level of MANIA

108
Q

Four clues to suggest Bipolar disorder in a history of a patient:

A
  • Early onset of depression <25
  • FH of biopolar or schizoaffective disorder
  • Poor antidepressant response/no effect on depression
  • Worsening of illness
109
Q

Bipolar I disorder diagnostic criteria:

A
  • Has met criteria for at least 1 manic epsiode

- The occurrence of manic and depressive episodes cannot be explained by another disorder

110
Q

What are the duration of the depressive and manic phases if left untreated?

A

Depressive: 6-12 months
Manic: 3-6 months

111
Q

People with bipolar 1 have a ___ times risk for suicide

A

15X

112
Q

What sub-type of Bipolar 1 patients are at especially high risk for suicide?

A

Mixed (they have the energy to kill themselves)

113
Q

Bipolar II disorder diagnostic criteria:

A

No history of a manic episode.

- At last one hypomanic episode and one major depressive epsiode

114
Q

5-15% of those with Bipolar II disorder will…

A

go on to develop mania and then meet the criteria for Bipolar I disorder

115
Q

Cyclothymia diagnostic criteria

A
  • For at least 2 years, have had hypomanic symptoms (do not meet criteria however for hypomania) AND
  • Numerous periods with depressive symptoms (that do not meet criteria for a major depressive episode_
116
Q

Those with cyclothymia are at a higher risk to develop a mood disorder especially:

A

Bipolar disorder (15-50%)

117
Q

How do you manage Bipolar mania with drugs?

A

Mood stabilizers and antipsychotics

118
Q

If you are in the hospital with a patient with mania, what drug do you use first?

A

Antipsychotics - faster onset

119
Q

If a patient has severe mania, what two drugs do you treat them with?

A

Antipsychotic + Mood stabilizer (Valproate)

120
Q

Milder cases of mania in bipolar can be treated with (2)

A

Lithium or Depakote

121
Q

What is something you could prescribe for the patient in mania to sleep better?

A

Benzo - short term only

122
Q

For someone with bipolar disorder, what are the first line options to treat their depressive episodes? (2)

A
  • Lithium or lamotrigine

- Atypical antipsychotics (Quetiapine)

123
Q

What do you NOT want to give a bipolar patient that is having a depressive episode?

A

Antidepressants - These can trigger cycling to mania

124
Q

Two non-pharmacological options for bipolar patients:

A
  • ECT

- Psychotherapy

125
Q

The only medication that has been proven to reduce the risk of suicide?

A

Lithium (50% in bipolar disorder)

126
Q

Baby blues last how long?

A

First two weeks only

127
Q

Criteria for postpartum depression:

A
  • Later onset (2-4 weeks)

- Severe symptoms (Anhedonia, suicidal thoughts, psychosis)

128
Q

Three Cluster A personality disorders:

A

Odd and Eccentric:

  • Paranoid - M
  • Schizoid
  • Schizotypal
129
Q

Four Cluster B personality disorders:

A

Dramatic:

  • Antisocial - M
  • Histrionic
  • Narcissistic
  • Bordeline - F
130
Q

Three Cluster C personality disorders:

A

Anxious:

  • Avoidant
  • Obsessive-Compulsive
  • Dependent
131
Q

Schizotypal - Cluster A Features:

Willy Wonka

A
  • Suspicious or paranoid
  • Behavior is odd and eccentric
  • Lack of close friends
  • Bodily illusions/odd thinking and speech
  • Excessive social anxiety that is associated with paranoid fears rather than neg. judgements
132
Q

Paranoid - Cluster A Features:

A
  • Long-standing mistrust
  • Holds grudges
  • Pathologically jealous in a relationship
  • Assign responsibility to others
  • Hostile, angry and irritable
133
Q

Schizoid - Cluster A Features:

Batman

A
  • Detachment from social relationships
  • Restricted range of expression of emotions
  • Neither desires nor enjoys relationships
  • Almost always chooses to be alone
  • Has little interest in sexual experiences
134
Q

Schizoid is not like schizophrenia because:

A

Schizoid lacks mania!

135
Q

Antisocial - Cluster B Features:

Grinch

A
  • Disregard and violation of the rights of others since age 15
  • Failure to conform to social norms - tries to get arrested
  • Deceitful
  • Impulsive and cannot plan ahead
136
Q

Histrionic - Cluster B Features:

Regina George/Zoolander

A
  • Excessive attention seeker
  • Uncomfy when NOT the center of attention
  • Uses body to get attention; sexual
  • Speech lacks detail
137
Q

Narcissist - Cluster B Features

Barney - HIMYM

A
  • Heightened sense of self-importance, grandiose
  • Preoccupied with fantasies of power
  • Arrogant and entitled
  • Requires excessive admiration
  • Takes advantage of others
138
Q

Borderline - Cluster B Features:

Stably unstable

A
  • Frantic efforts to avoid abandonment

Ex. Dozens of phonecalls to clinician before they go on vacation

139
Q

Avoidant - Cluster C Features:

Charlie Brown

A
  • Sensitivity to rejection –> Therefore are socially withdrawn
  • Shy but want relationships
  • Inferiority complex
140
Q

OCD - Cluster C Features:

Sheldon

A
  • Occupied with rules and details (lose track of the point)
  • Inflexible; overly conscious
  • Reluctant to delegate tasks
141
Q

How is OCD personality disorder different from OCD itself?

A

OCD the disorder is ego dystonic (uncomfortable) the OCD personality disorder knows they are acting this way

142
Q

Dependent - Cluster C Features:

A
  • Subordinate their needs for others
  • Lack self-confidence
  • Cannot make decisions without a ton of advice and reassurance
143
Q

Treatment for personality disorders:

A
  • Psychodynamic psychotherapy, DBT
  • Serotonin for impulse control and rejection sensitivity
  • Mood stabilizer for lability
144
Q

What is a delusion?

A

Firmly believed false belief

145
Q

What is a thought disorder?

A

Disruption in the form or organization of thinking - Loosening of associations, concreteness and thought blocking

146
Q

To diagnose schizophrenia, the patient must have two or more of the following for a 1 month period:

A
  • Delusion
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Hallucinations
  • Negative symptoms
147
Q

To be diagnosed with schizophrenia, the patient must have had the disease (prodrome or residual) for at least

A

6 months

148
Q

Prodromal/residual symptoms of schizophrenia:

A
  • Social isolation
  • Impaired functioning, personal hygiene and speech
  • Odd beliefs
  • Weird behavior and inappropriate affect
149
Q

5 A’s and I of the negative symptoms of schizophrenia:

A
  • Anhedonia
  • Asocial
  • Alogia
  • Affective flat
  • Apathy
  • Inattentiveness
150
Q

Someone with schizophrenia can also have cognitive problems such as:

A
  • Deficits in attention/memory/decision making

- Cognitive problems are usually present at the time of diagnosis

151
Q

What are the four main hypothesis behind Schizophrenia?

A
  1. Dopamine hyperactivity Tx. DA antagonist
  2. Serotonin dysfunction
  3. Structural brain (enlarged ventricles and reduced neuron activity in the frontal lobe)
  4. Genetic
152
Q

Schizophrenia is not caused by (2):

A
  • Poor parenting

- Substance abuse in isolation

153
Q

What is schizophreniform?

A

Meets the schizophrenia criteria but is 1-6 months in duration

154
Q

Most people with schizophreniform will:

A

Progress to have schizophrenia

155
Q

What is schizoaffective disorder?

A

Presence of psychotic symptoms and there are additional episodes of depression or mania

156
Q

Secondary psychosis:

A

Is from a medication or a disease like an infection

157
Q

To be diagnosed with narcolepsy one of the three must be present:

A
  • Cataplexy (sudden loss of muscle tone)
  • Hypocretin deficiency (CSF measured)
  • Nocturnal polysomnography showing REM sleep latency is less than or equal to 15 minutes
158
Q

20-60% of those with narcolepsy experience vivid:

A

Hypnagoic (before falling asleep) or hypnopompic (right before waking up) hallucinations

159
Q

A patient’s reflex in cataplexy are:

A

Absent

160
Q

Narcolepsy in the population is:

A

Very rare but highly genetic

161
Q

Two newer sleep medications for insomnia:

A
  • Ramelteon

- Suvorexant

162
Q

What drug is safe to be used in OSA and COPD patients?

A

Ramelteon

163
Q

You can get the hangover effect from what new sleep drug?

A

Suvorexant

164
Q

Two over the counter drugs for sleep aid:

A
  • Melatonin

- Dyphenhydramine - do not use in old people

165
Q

Those with mild-moderate-severe substance abuse have brain changes on MRI that:

A

Persist even after detoxing

166
Q

What area of the brain is affected with substance abuse?

A

Limbic system - reward

167
Q

Percent of substance abusers that relapse:

A

50%

168
Q

What is substance use disorder?

A

Pattern of symptoms resulting from use of a substance which the individual continues to take despite experiencing problems

169
Q

What is substance-induced disorder?

A

The substance induces another disorder - Anxiety, depression, bipolar, psychosis etc.

170
Q

Two tolerance definitions:

A
  • A need for increased amount of opioids to achieve intoxication
  • Diminished effect with the continued use of the same amount of opioid
171
Q

Eventually with opioids:

A

cAMP is unregulated as G2 binds more than G1 = No relief from pain and you get increased pain

172
Q

Opioid antagonist treatment:

A

Naltrexone

173
Q

What is Naltrexone given with to avoid abuse potential?

A

Buprinoprhine

174
Q

Buprenorphine drug information:

A
  • Partial agonist
  • Bell response curve
  • Sublingual administration
  • Schedule III drug
175
Q

Methdone drug information:

A
  • Full agonist
  • Linear response curve
  • Oral
  • Schedule II
176
Q

Catatonia is common with __ and uncommon with ___

A

Common with: Mood disorders

Uncommon with: schizophrenia

177
Q

What are 5 classic signs of catatonia?

A
  • Stupor
  • Mutism
  • Negatavism
  • Staring
  • Rigidity
178
Q

Treatment for catatonia:

A

Benzodiazepines - Adivan (high-dose)

179
Q

If benzodiazepines do not work to take someone out of catatonia, what else can you do?

A

ECT (bilateral)

180
Q

What are supportive cares for someone when they are catatonic?

A
  • DVT prophylaxis and fluids/feedings
181
Q

What is the pathogenesis of Neuroleptic Malignant Syndrome?

A

There is too little dopamine

182
Q

What are the four symptoms of Neuroleptic Malignant syndrome?

A
  • Hyperthermia but NOT febrile
  • Muscle rigidity (lead-pipe)
  • Mental status changes (delirium and catatonia)
  • Autonomic dysfunction (tacky, diaphoretic,)
183
Q

What are some lab findings of Neuroleptic Malignant Syndrome?

A
  • Rhabdo
  • Leukocytosis
  • Low serum iron
  • Metabolic acidosis
184
Q

Medications that block ___ can cause NMS:

A

D2 receptors

185
Q

General treatment for NMS: (4)

A
  • Hydration
  • Temp. reduction
  • Stop neuroleptic medications
  • Supportive care and monitoring
186
Q

Specific treatments for NMS:

A
  • Stop all medications that decrease DA (anti-nausea meds)
187
Q

What medications can you give a patient with NMS?

A
  • Benzos
  • Dantrolene
  • DA meds (3)
188
Q

What are the three DA enhancing drugs for NMS?

A
  • Amatadine
  • Bromocriptine
  • Levodopa
189
Q

What are three drugs that can cause serotonin syndrome?

A
  • SSRI
  • TCAs
  • MAOIs
190
Q

When does Serotonin syndrome occur?

A

When 2 or more serotonin modifying agents are used in combination - sometimes after just one drug

191
Q

What receptor is effected with serotonin syndrome?

A

5-H1TA

192
Q

Clinical triad of Serotonin Syndrome:

A
  1. Cognitive/behavioral problems - Delirium, agitated, lethargy
  2. Autonomic instability - Hyperthermia, tachycardia, dilated pupils, diaphoretic
  3. Neuromuscular abnormalities: Myoclonus, hyperreflexia, rigidity
193
Q

Blood levels of serotonin for diagnosis?

A

No they do not reflect the amount in the brain

194
Q

What three things could be elevated on labs in someone with serotonin syndrome?

A
  • WBC
  • CPK
  • Transaminases
195
Q

What will be decreased on the labs in someone with serotonin syndrome?

A

Serum bicarbonate

196
Q

Most common drug combo that causes serotonin syndrome:

A

MAOI and SSRI

197
Q

Treatment for serotonin syndrome:

A

None. Recognize early, stop the meds, supportive care

198
Q

Antidote for serotonin syndrome:

A

Cyproheptadine - Antihistamine

199
Q

Other drug that can be used for serotonin syndrome that helps with agitation:

A

Benzos

200
Q

Difference between NMS and SS:

A

NMS: Develops within 7 days of a neuroleptic agent (too little DA)
SS: Develops within 24 hours of a serotonergic agent (too much serotonin)

201
Q

What are the three current parts of standard of care for a gender identity patient?

A
  1. Reversible changes (name, pronoun)
  2. Partially reversible: HRT
  3. Permanent: Surgery
202
Q

What drugs can you give to a man to make him a female?

A
  • Estradiol
  • Spironolactone
  • Medroxyprogesterone
  • Finasteride
203
Q

What drugs can you give a woman to become a man?

A

Testosterone

204
Q

For breast surgery, what number of referrals do you need?

A

1 mental health eval. and referral

205
Q

For genital reconstruction what number of referrals do you need?

A
  • 2 mental health evals/referrals

- 12 months living in the gender role

206
Q

For gonadectomy, what number of referrals do you need?

A
  • 2 mental health evals/referrals

- 12 months of CONTINUOUS HRT

207
Q

What are the two types of anorexia nervosa?

A
  • Restricting type - dieting, fasting, exercise

- Binge-eating - May have fasting but take in extra calories

208
Q

What are the BMIs and severity for weight loss?

A

Mild: Less than 17
Moderate: 16 - 16.99
Severe: 15-15.99
Extreme: <15

209
Q

What are some physical exam findings of anorexia nervosa?

A
  • LOW BP
  • SLOW HR
  • LOW temp
  • muscle wasting
  • Skin pale, dry
  • Hair is brittle and cracking
210
Q

What can you find on the skin of someone with anorexia nervosa?

A

Lanugo

211
Q

What are the two types of purging for bulimia?

A
  • Purging: Self induced vomiting or medication abuse

- Non-purging: Fasting or excessive exervise

212
Q

Timing of disease for Bulimia nervosa diagnosis:

A

Duration of 3 months with both binge eating and compensatory behavior occurring at least once a week *severity is based on how much compensatory behavior is happening a week

213
Q

What is Russell’s sign?

A

Abrasions on the hand (bite marks) from throwing up

214
Q

What can be seen in the eyes for someone with Bulimia?

A

Subconjunctival hemorrhages

215
Q

Two dental/oral findings in someone with Bulimia:

A
  • Dental erosion

- Salivary gland enlargement

216
Q

What is Binge- Eating disorder?

A

Binge eating without compensation - at least once a week for 3 months

217
Q

Substance abuse with eating disorders:

A
  • Alcohol + opiates = bulimia

- Stimulants + cocaine = Anorexia

218
Q

Three treatment locations for someone with an eating disorder:

A
  • Inpatient
  • Residential
  • PHP;ICP
219
Q

Top 6 complications of starvation:

A
  • Bradycardia
  • Hypotension
  • Hypothermia
  • Osteoporosis
  • Constipation
  • Amenorrhea
220
Q

Who is most likely to be victimized or killed by IPV?

A
  • Multi-racial
  • American Indian
  • Blacks
221
Q

Who else is at risk for IPV (2):

A
  • Single moms

- Transgenders

222
Q

USPTF grade for screening women of childbearing age for IPV

A

B

223
Q

Four high index of suspicion for someone to be suffering from IPV:

A
  • Young age
  • Social isolation
  • Substance abuse dependency
  • Pregnancy
224
Q

What are some physical cues for IPV? (5)

A
  • Bilateral injuries
  • sexual trauma
  • Bite marks
  • Dental trauma
  • Subconjunctival hemorrhage
225
Q

What are the two parts of CBT?

A
  • Cognitive: Focus on what people think instead of what they do
  • Behavioral: Focus on learning the role between normal and abnormal behavior (operant)
226
Q

What are the three core strategies for CBT?

A
  • Identify problem thoughts and beliefs
  • Schedule pleasant activities to increase environmental reinforcement
  • Extend exposure to unpleasant thoughts
227
Q

Timing of CBT:

A

one 60 - 90 minute session weekly for 8-12 weeks with weekly HW assignments

228
Q

What does SBIRT stand for?

A
  • Screening
  • Brief intervention
  • Referral to treatment
229
Q

Change talk has to include (5):

A
  • Desire to change
  • Ability to change
  • Reasons to change
  • Need to change
  • Commitment to change
230
Q

What is the tool used to screen for alcohol?

A

AUDIT - 10 items

231
Q

What is used to screen for drugs?

A

DAST - 10 items

232
Q

A score of 4 or above on the DAST is

A

Probably substance disorder

233
Q

A score of 20 or above on the AUDIT is

A

Probably substance disroder

Psych STATS (2 decks)

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