PSYCH MDTs Flashcards
1
Q
The complex somatic, cognitive, affective, and behavioral effects of psychological trauma
A
Post traumatic Stress Disorder
2
Q
What are some of the varying types of trauma that an lead to PTSD
A
Sexual trauma
Trauma to someone close in interpersonal network
Interpersonal violence
Participation in organized violence
Natural disasters
3
Q
What is seen to have a correlation with symptoms of PTSD
A
Presence of and extent of injuries
Strong correlation with TBI
4
Q
What timeframe shows a prevalence of symptoms of PTSD following a traumatic event
A
- 2% at ONE MONTH
- 2% at FOUR MONTHS
5
Q
Fear center of the brain
A
Left amygdala
6
Q
Memory center of the brain
A
Hippocampus
7
Q
Part of the visual portion of the brain
A
Anterior cingulate cortex
8
Q
What are some clinical manifestations of PTSD? These symptoms go beyond the realm of normal with multiple impairments
A
- Affective dysregulation (Anger common)
- Cognitive impairment
- Behavior responses caused by regular stimuli
9
Q
What should be the main focus of the IDC completing the screening for PTSD
A
Recognizing symptoms have been present for at least four weeks following trauma for psychiatry to make a diagnosis
10
Q
Available psychotherapy for the treatment of PTSD
A
- Exposure therapy
- CBT (Cognitive Behavior Therapy)
- EMDR (Eye Movement Desensitization and Reprocessing)
11
Q
What are types of behaviors are commonly seen with patients with PTSD that should prompt consideration for counseling
A
Marital problems and substance abuse
12
Q
Which medications are the first line therapy of choice for treating PTSD
A
Antidepressant medications SSRI
Sertaline
13
Q
That are adjunct mediation that may be used based on symptoms of PTSD
A
Prazosin - Nightmares
Beta blockers - Tremors and sympathetic responses
Antipsychotics - Comorbid psychosis
14
Q
What medication should be avoided for the treatment of PTSD and why should it be avoided
A
Benzodiazepines due to safety and dependency issues
15
Q
Persistent disturbance of eating that impairs both health and psychological functioning
A
Eating Disorder
16
Q
.S.C.O.F.F.
1) Do you make yourself Sick because you Feel uncomfortably full?
2) Do you worry you have lost Control over how much you eat?
3) Have you recently lost more than 14 pounds in a three month period? ONE stone
4) Do you believe yourself to be fat when others say you are thin?
5) Would you say food dominates your life?
A
Screening questions for psychiatric causes, used to differentiate between an eating disorder and other causes of weight loss.
SCOFF
17
Q
Restriction of caloric intake. Net negative caloric intake. Decrease in food intake.
A
Anorexia Nervosa
18
Q
What populations are most affected by anorexia nervosa
A
More common in women (10-20:1)
Median age of onset is 18
19
Q
What deficits are shown in patient’s with PTSD
A
Deficits in dopaminergic function and serotonergic function
20
Q
Eating behavior, motivation, and reward
A
Dopamine
21
Q
Mood, impulse control, and obsessive behavior
A
Serotonin
22
Q
Diagnostic criteria for anorexia nervosa based on the Diagnostic and Statistical Manual of Mental Disorders V
A
1) Restriction of energy intake that leads to low body weight.
2) Intense fear of gaining weight or becoming fat or persistent behavior that prevents weight gain, despite being underweight.
3) Distorted perception of body weight shape, undue influence of weight and body shape on self-worth, or denial of the medical seriousness of one’s own low body weight.
23
Q
Common physical exam finding associated with Anorexia Nervosa
A
1) Low BMI
2) Emaciation
3) Hypothermia
4) Bradycardia
5) Hypotension (Not enough energy to pump blood through the body)
6) Hypoactive bowel sounds
7) Xerosis (Dry and scaly skin)
8) Lanugo body hair
9) Abdominal distension
24
Q
Episodic uncontrolled ingestion of large quantities of food followed by recurrent inappropriate compensatory behavior to prevent weight gain. Self induced vomiting, laxatives, diuretics, fasting, or excessive exercise.
A
Bulimia Nervosa
25
Is bulimia nervosa more common in men or women
Women
Women 1.5% vs men 0.5%
26
Diagnostic criteria for bulimia nervosa includes recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain. What is included in these behaviors?
1) Self induced vomiting
2) Misuse of laxitives
3) Diuretic use
4) Enemas
5) Fasting
6) Excessive exercise
27
Associated features that may be seen in patient's with bulimia nervosa
1) Mild psychological impairment
2) Body weight usually within or above normal range
3) Neurocognitive functioning (decision making) impaired
4) Emotional dysregulation
5) Self-harm
6) Additional psychiatric disorders
28
What additional psychiatric disorders may be seen in patients with bulimia nervosa
PTSD, ADHD, substance abuse, personality disorders, anxiety, and conduct disorders
29
Common clinical findings seen in patients with bulimia nervosa
1) Dehydration
2) Menstrual irregularities
3) Mallory-Weis syndrome
4) Pharyngitis
5) Erosion of dental enamel
6) ECG changes - electrolyte imbalances
30
What is required in the treatment for bulimia nervosa
Supportive care and psychotherapy.
Behavioral therapy.
Antidepressant Medications. fluoxetine and SSRIs
31
What eating disorder is associated with iron deficiency anemia
PICA
Eating nonfood substances - Hair, chalk, metal, dirt
32
Repeated regurgitation of food. Not associated with GERD, pyloric stenosis, or other medical conditions
Rumination Disorder
33
What labs should be considered during the work up of a patient with an eating disorder
CBC
Thyroid studies
metabolic panal
34
What is a late stage of alcohol withdrawal that can be fatal
Delirium Tremors
35
What does the acronym "DIGFAST" stand for and how is it used to remember the symptoms of mania
D - Distractibility
I - Indiscretions
G - Grandiosity
F - Flight of ideas
A - Activity increase
S - Sleeplessness
T - Talkativeness
36
Cage questioning for alcohol abuse
Have you ever felt that you should CUT down on your drinking?
Have people ANNOYED you by criticizing your drinking?
Have you ever felt bad or GUILTY about your drinking?
Have you ever taken a drink in the morning, EYE opener?
37
What syndrome is a major complication of Alcohol use disorder
Wernicke Korsakoff syndrome
38
What is the triad of Wernicke encephalopathy
1) Encephalopathy - disorientation
2) Oculomotor Dysfunction - Nystagmus
3) Gait Ataxia -
39
What is usually a consequence of Wernicke Encepholopathy, and causes anterograde / retrograde amnesia
Korsakoff syndrome
40
Is alcohol withdrawl potentially life threatening
Yes
41
Mild alcohol withdrawal symptoms that begin within 6 to 24 hours of last drink
Anxiety / agitation / tremor / restlessness / insomnia / diaphoresis / palpitations / alcohol cravings
42
Physical signs of mild alcohol withdrawal
Tachycardia
Hypertension
Tremor
43
When do mild alcohol withdrawals typically resolve
one to two days
44
What is included in more severe alcohol withdrawal
Hallucinations
Seizures
Delirium
45
leading preventable cause of mortality worldwide
Estimated cause of 6 million deaths world wide
Tobacco Use Disorder
46
Most important risk factor factor for COPD
Pulmonary Disease
47
Major causes of mortality associated with tobacco Use Disorder
Cardiovascular Disease
Pulmonary Disease
Cancer
48
Roles of the clinician in regards to tobacco cessation
- Ask about quitting
- Advise quitting
- Do not spend long time on this
- Assess readiness to quit
- Assist those who are ready to quit
- Follow up
49
What are a few of the stages that someone who is considering quitting may be in???
- Pre-contemplation: Not ready
- Contemplation: Considering a quit attempt
- Preparation: Actively planning a quit attempt
- Action: Actively involved in a quit attempt
- Maintenance: Achieved smoking cessation
50
When is the peak in nicotine withdrawal and when does it subside
first three days
Slowly subside over the course of about one month
51
What is a popular option for treatment of nicotine withdrawal?
Nicotine replacement therapy (short or long)
Long acting: nicotine patch
Short acting: Gum or lozenges
52
Used for both depression and smoking cessation
Atypical antidepressant.
Inhibits reuptake of norepinephrine and dopamine
Buproprion (Wellbutrin)
53
This tobacco cessation medication is a partial nicotine agonist, stimulate dopamine activity, and reduces cravings / withdrawal symptoms
Varenicline (Chantix)
54
How long is THC detected in urine tests
4-6 days
55
What effect will high doses of THC cause
psychotomimetic effects
56
Will marijuana aggravate existing mental illness
YES
57
What are negative affects of marijuana on men
decrease plasma testosterone and reduce sperm counts
58
What are some long term respiratory problems caused by smoking marijuana
pulmonary tree abnormalities, laryngitis, rhinitis, and COPD
59
What does the recent increase in opioid abuse directly correlate with
Increase in prescribed opioids
60
Physical findings associated with acute opioid toxicity
- Decreased respirations
- Decreased blood pressure
- Decreased bowel sounds
- Sedation
- Miosis
61
What is easily confused with acute opioid intoxification
Hypoglycemia
62
Treatment of choice for acute opioid intoxification
Naloxone
Short half-life, repeat doses may be required
63
What should be considered when prescribing or dispensing opioids
The opioids may cause a downward spiral
Opioids may not be necessitated
64
With a patient who is found down, what should you consider in regards to their immediate work up?
Consider rhabdomyolysis
65
What is included in the clinical picture of acute stimulant intoxication
- Sweating
- Tachycardia
- Elevated blood pressure
- Mydriasis
- Hyperactivity
- Acute brain syndrome
- Confusion and disorientation
66
What would alert clinicians to a patient using cocaine
Unexplained nasal bleeding, headaches, fatigue, insomnia, anxiety, depression, and chronic hoarseness
67
A distinct period of abnormally or persistently elevated, expansive, or irritable mood and persistently increased activity or energy, lasting at least one week and present mods of the day, nearly every day
Mania
68
Three or more of the following symptoms must be present to diagnose a manic episode
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressured speech
- Flight of thoughts / racing thoughts
- Distractibility
- Increased goal directed activity
- Involvement in activities that carry negative potential
69
Similar characteristics to mania.
No delusional grandiosity.
Thought form is more organized.
Easier to engage conversation.
Less risky behavior.
No psychotic symptoms.
No hallucinations or delusions
Hypomania
70
What is given to patients with bipolar disorder prior to being MEDEVAC'd
Haloperidol - Antipsychotic
71
S
I
G
E
C
A
P
S
Suicidal
Interest loss
Guilty feeling for no reason
Energy loss, very sluggish
Concentration difficulty
Appetite changes
Psychomotor retardation
Sleep disturbances
72
What is the timeframe for major depression
2 weeks
73
Most common psychiatric disorder in the general population
- Lifetime prevalence estimates around 16%
Depression
74
Ranked 2nd among all injuries and illnesses as cause of disability
Depression
75
Risk factors for depression
Family History. Female gender.
Childbirth. Childhood trauma.
Stressful life event. Poor social support.
Medical illness. Substance abuse.
76
What are some of the variable presentations of a patient with depression
- Changes in mood (Sadness, distress, numbness, anxiety)
- Cognitive problems (Change in work performance)
- Neuro-vegetative symptoms (Loss of energy, lack of sleep, appetite)
- Somatic symptoms (Headache, abdominal pain, pelvic pain, physical)
77
What is the PHQ-9 used for
Depression Questionnaire
GOLD STANDARD
78
What is the most feared and most important complication of depression
Suicide
79
What are key indicators that should prompt you to inquire about suicide ideation and behavior
- ) Specific nature of the ideation
- ) Intent, plan, ability to carry out plan
- ) Personal history of suicide attempts
- ) Family history of suicide attempts
80
How long does a patient need to be on SSRI's to have trialed SSRI's
4 weeks
81
What are common side effects of SSRI's
Sexual dysfunction. Drowsiness. Weight gain. Insomnia. Weight gain. Anxiety. Dizziness. Headache. Dry mouth. Nausea. Blurred vision. rash. tremor.
82
How common are side effects reported by patients taking SSRI's
Very common
55% of people treated
83
What is the mainstay treatment for depression
Psychotherapy, pharmacotherapy, or both
84
Two classes of drugs that are typically used to treat depression
Selective Serotonin Reuptake Inhibitors
- Fluoxetine, paroxetine, sertraline, escitalopram
Serotonin Norepinephrine Reuptake Inhibitors
- Venlafaxine, duloxetine
85
What about suicide and SSRI's
No clear evidence that SSRI's have an impact on suicidality
86
anxiety or depression in relation to an identifiable stress, though out of proportion to the severity of the stressor
May look similar to depression
Adjustment Disorder
87
What types of stressors can lead to adjustment disordor
Deployment, marital problems, recruit training, financial concerns, increasing responsibilities
88
Can adjustment disorder be diagnosed in the context of bereavement
NO
89
How long will adjustment disorder resolve when the stressor is removed
SIX MONTHS
90
How soon after delivery do women experience Post-Partum depression
12 months
91
What may the pathogenesis of Post-Partum depression be related to?
Genetic susceptibility and hormonal changes
92
Similar symptoms to Post-Partum depression but does not meet the minimum number of symptoms; milder and self-limited; typically develop within 2-3 days of deliver and resolve within 2 weeks
Post-partum blues
93
What are appropriate differential diagnosis for post partum depression
* Normal post-partum changes
* Post-partum blues
* Bipolar depression
94
What is used for the workup of a patient experiencing post-partum depression
Edinburgh Postnatal Depression Scale
95
Treatment for mild to moderate post-partum depression
Cognitive behavior therapy - Initial treatment
| (Especially for breastfeeding moms)
96
For the treatment of post-partum depression, what is useful if cognitive behavior therapy is unsuccessful
SSRI's
Paroxetine or sertraline appear to have the lowest adverse efffects
97
Are patients who have episodes of post-partum depression at risk for recurrences
YES
30-50% of patients
98
How does post-partum depression negatively affect the child?
Abnormal development, cognitive impairment, and psychopathology
99
Characterized by excessive and persistent worrying that is hard to control, causes significant distress, and occurs more days than not for at _least six months_
Generalized anxiety disorder
100
symptoms of anxiety occur for at least ____ months
6 months
101
Anxiety tends to go "hand in hand" with other psychiatric conditions
Yes
Depression
Phobias
Medically unexplained pain
102
Clinical manifestations of anxiety
- Excessive worry (not too common) May be worried about a bunch of minor matters
- Poor sleep
- Fatigue
- Difficulty relaxing
- Headaches
- Pain in the neck, shoulder, and back
103
General Anxiety Disorder 7 questionnaire usually focuses on seven questions based on a two week history
1) Feeling nervous, anxious, or on edge
2) Not being able t stop or control worrying
3) Worrying too much about different things
4) Trouble relaxing
5) Being so restless that it is hard to sit still
6) Becoming easily annoyed or irritable
7) Feeling afraid as if something awful might happen
104
Treatment for generalized anxiety disorder
```
Cognitive behavior therapy
SSRI's and SNRI's are the typical medication class used as first line
```
105
Recurrent, unpredictable episodes of intense surges of anxiety marked by physiologic manifestations
Panic attack
106
Diagnosed when panic attacks are accompanied by chronic fear of the recurrence of an attack or a maladaptive change in behavior to try to avoid potential triggers of the panic attack
Panic Disorder
107
How often are panic attacks thought to occur?
What is the median age?
⅓ of people are thought to experience a panic attack in their life. Median age is 24.
108
DSM-5 Diagnostic criteria for panic disorder
An abrupt surge of intense discomfort that reaches a peak within minutes, and during which time four or more accompanied symptoms occur
109
Palpitations. Sweating. SOB. Feeling of choking. Trembling / shaking. chest pain. Nausea / abdominal distress. Dizziness / light-headed. Paresthesia. Derealization. Fear of losing control / "Going crazy". Fear of dying.
Four or more of these symptoms associated with a panic attack
110
Why is the development of agoraphobia common in panic disorder?
Fear and anxiety lead to avoidance of situation that may lead to panic. Not wanting to panic.
111
Broadly defined as a loss of contact with reality.
This is a thought disorder.
Psychosis
112
What are some of the signs and symptoms of psychosis
- Delusions
- Hallucinations
- Thought disorganization
- Agitation and aggression
113
Strongly held false beliefs. Beliefs are broadly classified as bizarre vs non-bizarre
Delusions
114
Specific types of delusions associated with psychosis
- Persecutory Delusion: ex. Belief that one is being followed or harassed
- Grandiose Delusions: ex. Belief that one is a billionaire
- Erotomanic Delusion: ex. Believing a famous person is in love with them
- Somatic Delusions: ex. Worms in the sinuses
- Delusions of Reference: ex. Someone / something is talking to / directing them
- Delusions of Control: ex. believing you are controlled by an outside entitiy
115
Wakeful sensory experiences of content that is not actually present
Hallucinations
116
Which of the five sensory modalities are affected by hallucinations
All of them
Auditory
Visual
Tactile
Olfactory
Gustatory
117
Very little information conveyed by speech. Often very sparse reply or lack of spontaneous speech.
Alogia
Poverty of content
118
Sudden losing train of thought. Characterized by abrupt interruption in speech.
Thought blocking
119
Speech content that has ideas presented in a sequence that is not closely related or does not make sense
Loosening of association
120
Answers to interview questions diverge from being asked about. Is the interview question even asnwered?
Targentiality
121
Using words in a sentence that are linked by rhyming or sounding similar.
"I fell down the well sell bell"
Clanging or clang association
122
Real words are linked together in coherently.
Real words are basically nonsense
Word Salad
123
Repeating words or ideas persistently
Perseveration
124
What medical conditions may psychosis be associated with?
- Delirium
- Endocrine disorders
- Hepatic and renal disorders
- Infections
- Demyelinating conditions
- Neurological
- Vitamin deficiency
125
Extrapyramidal side effects of antipsychotics
- Akathisia
- Parkinsonian syndrome
- Dystonia
- Tardive Dyskinesia
126
Motor restlessness with compelling urge to move and inability to sit still
Akathisia
127
Mask like facies, resting tremor, cogwheel rigidity, shuffling gait, psychomotor retardation
Parkinsonian Syndrome
128
Involuntary contraction of muscles
Dystonia
129
- Involuntary movements of the face
- Sucking or smacking of the lips
- Movement of the tongue
- Facial grimacing
- Odd movements of extremities
- Usually occur after greater than six months of treatment on antipsychotic
- IRRIVERSABLE
Tardive Dyskinesia
130
An enduring pattern of perceiving, relating to, and thinking about the environment and oneself.
Personality Disorder
131
Characteristics of adjustment disorders
* Inflexible and maladaptive personality traits across a wide range of situations
* Cause significant distress and impairment in functioning in all areas of life
132
Instability of interpersonal relationships, self-image, and emotions.
* Very impulsive behavior
* Most widely studied personality disorder
Borderline Personality Disorder
133
Lifelong disorder that includes a pattern of socially irresponsible, exploitative, and guiltless behavior.
Antisocial Personality Disorder
134
Marked pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level and clearly interferes with functioning in at least 2 settings (School, home, work)
Attention-Deficit / Hyperactivity-Disorder
135
By what age should marked symptoms be present for a diagnosis of ADHD
Age 7
136
Adults must have childhood onset, persistent and current symptoms to be diagnosed
Age 12
137
What are factors that have been proposed contributors to ADHD
NO REAL CONSENSUS
Food additive/diet, lead contamination, cigarette/alcohol exposure, low birth weight
138
Clinical findings found in correlation with ADHD
* Marked inattention
* Distractibility
* Organization difficulties
* Poor efficiency
* Low frustration tolerance
* Shifting activities
* Difficulty organizing
*
139
Disorder that is characterized by a pattern of negativistic, hostile, and defiant behavior
Oppositional Defiant Disorder
140
habitual rule breaking defined by a pattern of aggression, destruction, lying, stealing, or truancy
Conduct disorder
141
What are the most common treatments for ADHD
Methylphenidate
* Ritalin, Concerta, Metadate
Amphetamines
* Adderall, Dexedrine, Vyvanse
142
Can patients taking ADHD medications be put at risk for substance abuse.
Yes
143
What associated impairments are part of the prognosis for ADHD
Impairment in occupational, academic, social, and intrapersonal domains
144
Disturbances in sexual functioning which causes clinically significant distress
Sexual Dysfunction
145
Delayed or absent ejaculation/orgasm occurring in almost all occasions of partnered sexual activity and persists for a minimum of six months
Delayed Ejaculation
SIX Months
146
What should treatment for delayed ejaculation be tailored for?
Patient/coupe psycho education
147
What my cause delayed ejaculation in men?
Could be due to severe depression or anger at women in general or to sexual partner
148
failure to obtain erections in a situation in which they were anticipated, causing embarrassment, self-doubt, and loss of self confidence
Erectile Dysfunction
149
Typical causes for erectile dysfunction
Increased age, depression, smoking, diabetes, hypertension, nervous tissue disorders.
150
What effects to nitrates have on the vascular system
Vasodilator
151
Contraindication for avanafil, sildenafil, tadalafil, ad verdenafil
myocardial infarction within 6 months, hypotension, moderate-severe aortic stenosis, concurrent use of nitrates
152
Absence of desire for sexual activity and persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies for at least **_6 MONTHS_**
Male hypoactive sexual desire disorder
153
Typical causes for Male hypoactive sexual desire disorder
Hypogonadism. Transient stress or interpersonal conflict. Mood disorder. Schizophrenia. Substance Abuse. Medications. Age related decline in sexual desire.
154
Lack of or significantly reduced sexual interest/arousal for at least 6 months in women
Female Sexual interest / arousal for at least six months
155
Treatment options for Female Sexual Interest/Arousal Disorder
Sex therapy
Cognitive Behavioral Therapy
Bupropion
156
Possible causes for male hypoactive sexual disorder
* Hypogonadism
* Transient stress or interpersonal conflict
* Mood diorder
* Schizophrenia
* Substance abuse
* Medications
* Normal age related decline in sexual desire
157
Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it, present for at least six months, occurring all or almost all of the time and distressing
Premature ejaculation
158
significant disturbance in sexual function which develop during or soon after substance intoxication or withdrawal or after exposure to a medication. the involved substance / medication is capable of producing these symptoms
substance/medical-induced sexual dysfunction
159
are men or women more successful in suicide
men
160
do men or women make more suicide attempts, with lower mortality rates
women
161
what age group has has an increased rate of observed suicide
young
15 - 35
162
what is the immediate goal when treating a suicidal patient
psychiatric evaluation - to assess the current suicidal risk and the need for hospitalization versus outpatient management
163
What factors are positively correlated with suicide attempts
Alcohol, hopelessness, delusional thought, and complete or nearly complete loss of interest in life or ability to experience please
164
Can the successful treatment of a patient at risk of suicide be achieved if the patient abuses drugs
No!
165
What safety precautions should be taken for a patient who is at risk for suicide but when hospitalization is not indicated
* Medication should be dispensed in small amounts
* Guns and drugs should be removed from the household
* Driving should be interdicted until improvement
166
Thoughts about killing oneself
Suicidal idiation
167
Self-injurious behavior intended to kill oneself but not fatal
Suicide attempt
168
Thought of engaging in self-injurious behavior that are verbalized and intended to lead others to think that one wants to die, despite no intention of dying
Suiidal threat
169
self-injurious behaviors that is intended to lead others to think that one wants to die, despite no intention of dying
suicidal gesture
170
Deliberately hurting oneself without intent to die
Purposes not personal gain or attention
Non-suicidal self-injury
171
what aspects of the patient's childhood history are important when considering the relationship to borderline personality disorder.
* Sexual/physical abuse, verbal abuse, neglect
* early parental separation or loss. “Abandonment issues”
172
Clinical features associated with borderline personality disorder
* Affective instability (mood) triggered by stressors
* Impulsive behaviors. Self damaging behaviors.
* Tend to have poorer cognitive function
* Suicidal threats, gestures, and attempts more common
173
Lifelong disorder.
Pattern of socially irresponsible, exploitative, and guiltless behavior
Antisocial Personality Disorder
