Psychiatric/Behavioral Medicine Flashcards
1
Q
bipolar disorder
A
- mood disorder characterized by episodes of mania, hypomania, and major depression, pathogenesis unkown
- sxs: mood disorder at onset (major depression, mania, mixed)
- dx: clinical dx, psychiatric and med hx, mental status, PE, labs (TSH, CBC< CMP, utox), mood . disorder questionnaire, PHQ9 (screens for major depression
2
Q
bipolar I, bipolar II
A
- Bipolar I: mean onset 18y, M=F
- at least one manic ep (3+ sxs for 7d), major depression (not required), hypomanic eps
- dx: clinical dx
- Bipolar II: mean onset 20y, M=F, more prevalent than bipolar I
- at least one hypomanic ep (3+ sxs for 4d), at least one major depressive ep (5+ sxs for 2wk), absence of manic eps
- dx: clinical dx
3
Q
mania vs hypomania
A
- mania: DIGFAST (distractibility, impulsivity, grandiosity, flight of ideas/racing thoughts, activity (increased), sleep (dec need), talkativeness)
- >/= 7d (or requiring hosp) and including >/= 3 of the DIGFAST sxs
- sxs not result of substance or general med condition
- tx: lithium OR valproic acid PLUS antispychotics (haloperidol, olanzapine, risperidone, etc.), benzos, ECT, Clozapine
- hypomania: >/=4d (not requiring hosp) and including >/=3 of DIGFAST
- impairs psychosocial fn only mildly and does not require hosp
- tx: monotx risperidone OR olanzapine PLUS antipsychotics (ariprprazole, quetiapine, ziprasidone), anticonvulsants (valproic acid, carbamazepine), lithium
- acute agitation tx: antipsychotics (haloperidol = 1st line, aripiprazole, olanzapine)
4
Q
suicide
A
- men over age 50 are more likely to complete a suicide because of their tendency to attempt suicide with more violent means (guns)
- women make more attempts but are less likely to complete a suicide
- suicide is 10x more prevalent in pts with schizophrenia than the gen pop with jumping from bridges the most common means of attempted suicide
- inc suicide rate among age 15-35 and pts w/ CA, resp illness, AIDS, and hemodialysis pts
- having a gun in the home inc the likelihood of suicide 5-fold
5
Q
generalized anxiety disorder
A
- onset before 20yo
- hx childhood fears, social inhib, F 2x > M
- all anxiogenic agents work on GABA-A receptor/chloride ion channel complex
- sxs: chronic, excessive anxiety, worry about job performance, health, marital relatinships, social life (duration >/=6 mo, usually lifetime)
- 3 out of 6 sxs: restlessness, irritability, muscle tension, easily fatigued, dec concentration, disturbed sleep (insomn, restless sleep)
- not attributable to physiologic effects of a substance
- dx: clinical dx, CBC< CMP, TSH, UA, EKG, urine or serum tox
- tx: SSRI/SNRI (1st line), CBT, buspirone (second line adjunct or monotherapy, TID dosing), pregabalin (Off-label), short acting benzos (adjunct or monotx), mirtazapine, antipsychotics (quetiapine), long acting benzos
- Time to onset = 4-6 weeks
- if no response to first SSRI/SNRI, taper and start different one
- if robust response, continue for at least 12 mos
- screening: GAD7
6
Q
panic disorder
A
- genetic predisp, altered autonomic responsivity, social learning
- onset: usually late adolescence or early adulthood, F 2x > M
- sxs: intense fear/discomfort
- requires at least 1 month of concern about attacks or their consequences, change in behavior related to attacks (avoidance of exercise or unfamiliar situation), recurrent (at least 2) unexpected panic attacks
- signs: palps, CP, SOB, N, abd pain, sweating, shaking, trembling, chills, dizziness, fear of dying, losing control or going crazy, paresthesias, GI distress, depersonalization, derealization, feelings of unreality
- dx: clinical, CBC, TSH, CMP, EKG (ro other causes), echo, cogonary angiogram = normal, PFTs
- tx: antidepressants (SSRI, SNRI, MAOIs), CBT
- complications: anticipatory anxiety (pt tries to predict attacks coming on) nezos useful in early course
- prognosis: higher likelihood of suicide attmenpts
- health maintenance: panic disorder severity scale (GOLD STANDARD for monitoring)
- comorbidities: major depression, OCD, agoraphobia, GAD, social anxiety disorder, PTSD
7
Q
Post traumatic stress disorder
A
- RF: past psychiatric hx and personality characteristics of high neuroticism and extroversion, excessive release of NE in response to stress and inc noradrenergic activity
- sxs: exposure to actual or threatened death, serious injury, or sexual violence
- the following occur for more than 1 month: (PAIN) 1+ Persistent avoidance of associated stim, 2+ Alterations in arousal and reactivity and feelings of isolation from close friends and fam, 1+ Intrusion/re-experiencing sxs, 2+ Negative alterations in cognitions/mood
- dx: clinical dx
- tx: SSRI (sertraline and paroxetine), trauma focused CBT, exposure tx, eye mvmt desens and reprocessing
8
Q
Major depressive disorder
A
- one or more major depressive eps, MC psychiatric disorder in gen pop, MDD is more frequent in families of bipolar indivs, but the reverse is not true, increases risk of developing CAD, 66% present with somatic complaints (HA, back probs, chronic pain)
- sxs: syndrome with >/= 5 sxs lasting >/= 2 consecutive wk (depressed mood nearly qd, most of day), loss of interest/pleasure nearly qd, appetite disturbance (significant wt loss or gain), sleep disturbance (insomnia or hypersomnia), psychomotor disturbance (restlessness or feeling slowed down), fatigue, feelings of shame, guilt/worthlessness, hopelessness, impaired concentration, SI, abnl self-perception, not attributable to seasonal affective disorder, schizophrenia, schizophreniform disorder, delusional disorder, absence of manic or hypomanic ep (differs from bipolar)
- dx: clinical (CBC, CMP, UA, hCG, urine tox, TSH, vitB12, folate, EKG)
- screening: PHQ9, PHQ2, beck depression inventory for primary care
-
tx: SSRI (first line), bupropion (wellbutrin), TCA, MAOIs, psychotherapy
- tx for . 6-12 wks before deciding if . med effective
9
Q
opioid intox and withdrawal
A
- intox:
- sxs: pruritis, euphoria, drowsiness, slurred speech
- signs: miosis, resp depression, hyporeflex, hypotherm, flushing, bradycardia, hoTN, dec bowel sounds, dep mental status
- dx: serum gluc, APAP leve, serum CK, urine tox should NOT be routinely obtained, EKG, CXR
- tx: supportive (tracheopharyngeal suctioning, supplemental O2), IV naloxone (intranasal narcan)
- death often dt resp dep
- withdrawal: dysphoria, craving, anxiety, salivation, myalgias, N/V/D, restless
- signs: rhinorrhea, yawning, lacrimation, diaphoresis, mydriasis, piloerection, tremor, inc bowel sounds
- tx: methadone, buprenorphine, naltrexone, behavior mod program required, clonidine
10
Q
stimulant intox
A
- ex: cocaine, amphetamines, methylphenidate (ritalin), dextroamphetamine
- cocaine is an indirect sympathomimetic agent → inc availability of amines at receptors → euphoric properties derived from inhib of serotonin reuptake
- local anasthetic
- cocaine assoc. psychosis differs from acute schizophrenic by less thought disorder, bizarre delusions, and fewer neg symtoms such as alogia and inattention; more visual and tactile callucinations common
- sxs: hyperarousal, sweating, alertness, self-confidence, euphoria, dec fatigue and need for sleep; with inc dose → delusions or hallucinations, wt loss, anxiety or dep, restlessness
- signs: HTN, tachycardia, mydriasis, diaphoresis, xerostomia, bruxism
- complications: accel. atherosclerosis → MI, CVA; psychomotor agitation, pneumothora/mediastinum/pericardium; SOB, perf ulcers, rhabdo, acute angle closure glaucoma, nasal septal perf
- dx: gluc, APAP, ASA leves, EKG (prolonged QRS), preg test, benzoylecgonin (urinary metab of cocaine - only in urine a few hours), troponin, CXR, CT head, CK, CMP
- tx: supportive care (O2, intub WITHOUT succinylcholine), phentolamine prior to BB (for HTN), diazepam for agitation, BB should not be used alone
11
Q
stimulant withdrawal
A
- sxs: depression, anxiety, fatigue, difficulty concentrating, anhedonia, craving, musculoskeletal pain, initial “crash” → psychomotor retardation, severe depression, SI
- signs: tremors, chills, involuntary motor mvmts, bradycardia
12
Q
BZD intox
A
- potnetiate GABAs inhib actions, inappropriate sexual or aggressive behavior, mood lability, impaired judgment
- sxs: slurred speech, ataxia, AMS, stupor or coma
- signs: unremarkable, normal VS
- dx: 1+ of the following → slurred speech, incoordination, unsteady gait, nystagmus, impaired cognition, stupor/coma
- r/o phenobarb and ETOH by checking blood
- tx: O2, flumazenil
13
Q
tobacco use disorder
A
- leading preventable COD, 2/3 smokers say they want to quit
- dependence determined by: age of smoking initiation, number cigarettes smoked daily, how soon after waking pt has first cigarette
- dependence degree predicts difficulty patient will have in quitting and intensity of tx required
- dx: 5As (ask about smoking, advise quitting, assess readiness to quit, assist with smoking cessation, arrange follow up visits)
- tx: FIRST LINE = varencicline (chantix → avoid in pts w/ current unstable psych hx or recent SI), bupropion SR (wellbutrin → CI in pts w/ siezure disorder and in pts w/ hx of anorexia or bulemia), nicotine replacement therapy
- second line = nortryptyline, clonidine, CBT (for every pt)
- most relapses occur w/in first 3 mos of quitting
- best success w/ pharm tx and psychotx
14
Q
tobacco withdrawal
A
- development of cravings w/in first 3d of smoking cessation and subside over 3-4wks
- common triggers for relapse: being around smokers, drinking ETOH, smoking cues (drinking coffee), stressful situations
- sxs: inc appetite → wt gain, mood changes, insomnia, irritability, difficulty concentrating, anxiety, restlessness
- sxs peak 1-2w after quitting
15
Q
spouse or partner neglect/violence
A
- abusive behavior (physical, sexual, emotional) by person in intimate relationship
- F>M victims; goal of abuser is to gain control over victim
- RF: young, pregnant, single, divorced, separated, ETOH or drug abuse in victim or partner, smoking, low SES
- sxs: explanation . of injuries dont fit with exam, frequent ED visits, HA, abd pain, fatigue
- signs: vague during hx, minimal eye contact, abuser in room answers all question or doesnt leave room, injuries to central area of body, bruises in various stages of healing
- dx: HITS (hurt, insult, threaten, screamed at), WAST (women abuse screening tool), PVS (partner violence screen), AAS (abuse assessment screen), WEB (women’s experience with battering) scale
- tx: speak with pt alone, document all hx and findings carefully, screen women of childbearing age
- interventions: leave abusive situation ensuring a safe place to go, counseling to assess risk of danger, create plan for safety
