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Psychiatry 2 Flashcards

1
Q

Clinical features of delusional disorder?

A

1+ delusions for 1+ months
Other psychotic symptoms are absent or not prominent
Behavior is not obviously odd/bizarre; ability to function apart from delusion’s impact

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2
Q

What are the subtypes of delusional disorder?

A

Erotomanic, grandiose, jealous, persecutory, somatic

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3
Q

DDx - delusional disorder

A
  1. Schizophrenia (other psychotic symptoms present, such as hallucinations, disorganization, negative symptoms + greater functional impairment)
  2. Personality disorders (paranoid - pervasive pattern of suspiciousness, narcissistic - grandiosity, schizotypal - odd beliefs, but no clear delusions)
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4
Q

Treatment of delusional disorder?

A
  1. Antipsychotics

2. CBT

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5
Q

Clinical features of brief psychotic disorder?

A

Sudden onset of 1+ psychotic symptoms lasting 1+ days, but less than 1 month; full return to function

Excluded if the symptoms are better explained by the effects of a medication or medical illness

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6
Q

Characteristics of personality disorders?

A

Long-standing patterns of interpersonal problems but no persistent delusions or other psychotic symptoms

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7
Q

Widespread distrust and suspiciousness are characteristic of ___ personality disorder.

A

Paranoid

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8
Q

Patients with ___ personality disorder exhibit eccentric behavior and odd beliefs or magical thinking; their beliefs are not held with delusional conviction.

A

Schizotypal

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9
Q

Patients with ___ personality disorder often display pervasive emotionality or the need to be the center of attention.

A

Histrionic

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10
Q

Medications commonly used to treat acute bipolar depression?

A

Second-generation antipsychotics (quetiapine and lurasidone) and the anticonvulsant lamotragine

[Lithium, valproate, and combined olanzapine/fluoxetine have also demonstrated efficacy]

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11
Q

Why should antidepressant monotherapy generally be avoided in patients with bipolar I disorder?

A

Risk of precipitating mania, development of rapid cycling, increased mood cycle frequency

(If necessary, antidepressants should be used in combination with mood stabilizers as these appear to decrease the risk of an anti-depressant-induced switch from depression to mania)

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12
Q

Define rapid cycling.

A

4+ mood episodes/year

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13
Q

True or false - haloperidol is a first-generation antipsychotic that has not shown efficacy in treating bipolar depression.

A

True

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14
Q

High-dose glucocorticoids, often given for allergic, inflammatory, or autoimmune conditions, may cause ___, typically during the first week of treatment, but can occur at any time. What other symptoms can it cause?

A

Glucocorticoid-induced psychosis; manic or depressive symptoms

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15
Q

Symptoms of cannabis use?

A

Euphoria, perceptual changes, increased appetite, red eyes, slowed reflexes, dizziness, and impaired coordination

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16
Q

What is the core feature of delirium?

A

Fluctuating cognitive impairment, such as poor attention and disorientation

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17
Q

What are the characteristic features of medication-induced psychotic disorder?

A

Acute onset of delusions and/or hallucinations that are temporally associated with the use of a new medication

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18
Q

Diagnosis of dementia with Lewy bodies (DLB)?

A 
Dementia plus 2+ of the following: 
Visual hallucinations
Parkinsonism
Fluctuating cognition
REM sleep behavior disorder
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19
Q

Treatments for dementia with Lewy bodies?

A 
Carbidopa-levodopa (Parkinsonism)
Cholineserase inhibitors (eg, rivastigmine; cognitive impairment)
Melatonin (REM sleep behavior disorder)
[Trial of antipsychotic medication may be indicated in patients with functionally impairing visual hallucinations or delusions]
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20
Q

Why must antipsychotics be prescribed with caution in DLB?

A

Extreme antipsychotic hypersensitivity of patients with DLB; may cause worsening confusion, parkinsonism, and autonomic dysfunction

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21
Q

Which antipsychotic is known for stronger dopamine receptor antagonism relative to other second-generation antipsychotics?

A

Risperidone

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22
Q

When antipsychotics are indicated in the treatment of DLB, evidence favors what? What should be avoided entirely?

A

Low-potency second-generation antipsychotics (eg, quetiapine); first-generation antipsychotics

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23
Q

Diagnosis of schizophreniform disorder?

A

1+ month, but <6 months, same symptoms as schizophrenia, functional decline not required

Symptoms of schizophrenia (2+): delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms

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24
Q

Diagnosis of schizophrenia?

A

6+ months, with 1+ months of active symptoms, can include prodromal and residual periods, requires functional decline

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25
Q

Diagnosis of schizoaffective disorder?

A

Major depressive or manic episode with concurrent active-phase symptoms of schizophrenia + lifetime history of 2+ weeks of delusions or hallucinations in the absence of prominent mood symptoms
Mood episodes are prominent and recur throughout illness
Not due to substances or another medical condition

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26
Q

DDx - psychotic disorders

A
  1. Brief psychotic disorder (1 day to <1 month, sudden onset, full return to function)
  2. Schizophreniform disorder (1 month to <6 months, schizophrenia symptoms, no functional decline required)
  3. Schizophrenia (6+ months with 1+ months active symptoms, requires functional decline)
  4. Schizoaffective disorder (mood episode with concurrent active-phase symptoms of schizophrenia + 2+ weeks of delusions or hallucinations in the absence of prominent mood symptoms)
  5. Delusional disorder (1+ delusions and 1+ month, no other psychotic symptoms, normal functioning except for direct impact of delusions)
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27
Q

Age of onset of the psychotic features of schizophrenia?

A

Between late teens and mid-30s

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28
Q

When the diagnosis of schizophreniform disorder is made without waiting for the patient to recover, it is specified as ___. If symptoms persist >6 months, the diagnosis is changed to ___.

A

Provisional; schizophrenia

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29
Q

Clinical features of PTSD?

A

Exposure to life-threatening trauma
Nightmares, flashbacks, intrusive memories
Avoidance of reminders, amnesia for event
Emotional detachment, negative mood, decreased interest in activities
Sleep disturbance, hypervigilance, irritability
Increased startle response
Duration 1+ months

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30
Q

Treatment of PTSD?

A

Trauma-focused CBT
Antidepressants
Prazosin for nightmares

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31
Q

What increases risk for PTSD in military veterans?

A

Repeated deployments
Longer duration
Higher severity of combat exposure

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32
Q

Clinical features of panic disorder?

A

Recurrent, spontaneous, unexpected panic attacks with 4+ of the following:

Chest pain, palpitations, SOB, choking
Trembling, sweating, nausea, chills
Dizziness, paresthesias
Derealization, depersonalization
Fear of losing control or of dying

1+ months of worry about additional attacks or avoidance behavior

Dx requires that at least some of the episodes are untriggered or unexpected

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33
Q

Treatment of panic disorder?

A

First-line/maintenance: SSRI/SNRI and/or CBT

Acute distress - benzodiazepines

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34
Q

When is anxiety disorder due to another medical condition diagnosed?

A

When the panic attacks are a direct physiological consequence of another medical condition (eg, hyperthyroidism, pheochromocytoma, arrhythmias, asthma)

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35
Q

Clinical features of GAD?

A

6+ months of persistent worry and anxiety about multiple issues
Difficult to control
3+ of the following symptoms: restlessness or feeling on edge, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
Significant distress or impairment
Not due to substances, another mental disorder, or a medical condition

Does not feature unexpected panic attacks

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36
Q

Following stabilization of acute symptoms, patients with bipolar disorder require maintenance treatment to delay or prevent recurrence of new mood episodes. Common first-line mood stabilizers?

A

Lithium
Valproate

Other options - quetiapine and lamotrigine

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37
Q

Why is lithium contraindicated in patients with renal dysfunction?

A

Lithium is excreted unchanged by the kidneys and may build up to toxic levels when used in patients with renal dysfunction

Long-term use has also been associated with nephrogenic DI and chronic tubulointerstitital nephropathy

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38
Q

True or false - topiramate has not demonstrated efficacy in acute or maintenance treatment of bipolar disorder.

A

True

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39
Q

What three things should be evaluated in a suicide risk assessment?

A

Ideation
Intent
Plan

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40
Q

What information should be included when evaluating suicidal ideation?

A

Passive (wish to die, not wake up) vs. active (thoughts of killing self)
Frequency, duration, intensity, controllability

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41
Q

What information should be included when evaluating suicidal intent?

A

Strength of intent to attempt suicide
Ability to control impulsivity
Determine how close patient has come to acting on a plan (rehearsal, aborted attempts)

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42
Q

What information should be included when evaluating suicide plan?

A

Specific details (method, time, place, access to means, preparations)
Lethality of method
Likelihood of rescue

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43
Q

What should be done for all patients presenting with depression?

A

Careful screening for suicide risk

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44
Q

Signs and symptoms of neuroleptic malignant syndrome?

A 
Fever >40 C (104 F) common
Confusion/mental status changes/delirium
Muscle rigidity (generalized, lead pipe)
Autonomic instability (abnormal vital signs - HTN, tachycardia, sweating)

CK and WBC may be elevated

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45
Q

Treatment of neuroleptic malignant syndrome?

A 
Stop antipsychotics or restart dopamine agents
Supportive care (hydration, cooling); ICU
Dantrolene (direct-acting muscle relaxant) or bromocriptine/amantadine (reverse dopamine blockade) if refractory
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46
Q

What medications can cause NMS?

A

More commonly associated with high-potency first-generation antipsycsyndromeotics (eg, haloperidol), but can occur with every class, including second-generation

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47
Q

NMS should be differentiated from ___.

A

Serotonin syndrome

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48
Q

Signs and symptoms of serotonin syndrome?

A

Hyperthermia (usually not as high as NMS)
Autonomic instability
Mental status changes
Prominent GI symptoms
Neuromuscular irritability (hyperreflexia, myoclonus, tremor, NOT lead-pipe rigidity)

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49
Q

Cause of serotonin syndrome?

A

Typically due to a combination of serotonergic medications or the interaction of these medications and MAOIs (eg, phenelzine)

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50
Q

Compare NMS and SS.

A

NMS has a higher fever
SS has prominent GI symptoms and neuromuscular irritability (hyperreflexia and myclonus), NO lead-pipe rigidity

Both have autonomic instability and mental status changes

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51
Q

Characteristics of catatonia?

A

Syndrome of marked psychomotor disturbance with decreased motor activity, lack of responsiveness during interview, and posturing

Not associated with high fevers

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52
Q

What causes malignant hyperthermia?

A

Volatile anesthetics or succinylcholine

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53
Q

Dx - MDD?

A

2+ weeks
5+ of 9 symptoms - depressed mood and SIGECAPS
Significant functional impairment
No lifetime history of mania

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54
Q

Dx - adjustment disorder with depressed mood?

A

Onset within 3 months of identifiable stressor
Resolve 6 months after the stressor ends
Marked distress and/or functional impairment
Does not meet criteria for another DSM-5 disorder

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55
Q

DDx - depressed mood?

A
  1. MDD
  2. Dysthymia
  3. Adjustment disorder with depressed mood
  4. Normal stress response (not excessive or out of proportion to severity of stressor, no significant functional impairment)
56
Q

SIGECAPS?

A 
Sleep disturbance
Interest (loss of)
Guilt (excessive)
Energy (low)
Concentration (impaired)
Appetite disturbance
Psychomotor agitation/retardation
Suicidal ideation
57
Q

Rx of choice for adjustment disorder?

A

Psychotherapy (developing coping mechanisms and improving the individual’s response to and attitude about the stressful situation)

58
Q

Clinical features of MDD with psychotic features?

A

Depressive episode is accompanied by delusions and/or hallucinations, typically with depressive themes (eg, deserving punishment, worthlessness, nihilism)

Psychotic features occur ONLY during the major depressive episode

59
Q

First-line treatment of MDD with psychotic features?

A

Combination pharmacotherapy with an antidepressant and antipsychotic OR ECT

60
Q

Clinical features of illness anxiety disorder?

A

Excessive concern about having a serious, undiagnosed general medical condition

61
Q

Clinical features of somatic symptom disorder?

A

Excessive anxiety and thoughts about the seriousness of 1+ somatic symptoms lasting for 6+ months

62
Q

Clinical features of persistent complex bereavement disorder (aka complicated grief)/

A

Depressive symptoms with sadness centering on the loss of a loved one; characterized by intense yearning for the deceased

63
Q

What is tardive dyskinesia?

A

Involuntary movement disorder associated with dopamine-blocking agents

Characteristic movements include orofacial dyskinesias (rhythmic movements of the face, lips, and tongue) and choreoathetoid movements of the trunk and extremities

64
Q

Pathophysiology of tardive dyskinesia?

A

Dopamine D2 receptor upregulation and supersensitivity resulting from chronic blockade of dopamine receptors

(Other hypotheses include an imbalance between D1 and D2 receptor effects in the basal ganglia as well as excitotoxic destruction of GABA neurons in the striatum)

65
Q

Tardive dyskinesia is most commonly associated with…?

A

Prolonged use of antipsychotic medications

Typically seen in patients with chronic psychotic disorders

Also common for it to worsen or first appear following antipsychotic dose reduction or discontinuation

More common with first-generation, can also occur with second-generation such as risperidone

66
Q

Cauadate nucleus atrophy is associated with?

A

Huntington disease

67
Q

What is Huntington disease?

A

Inherited progressive neurodegenerative disorder characterized by choreiform movements, psychiatric symptoms, and dementia

68
Q

The ___ area is a region in the midbrain that contains a high density of dopamine-releasing neurons, which project to the ___ (nucleus) and modulate reward pathways.

A

Ventral tegmental area; nucleus accumbens

69
Q

Separation anxiety commonly develops at what age? Time course/prognosis?

A

9-18 months; Tends to improve with time, but can recur during times of transition that require separation

70
Q

When is parent-child relational problem diagnosed?

A

When conflict in the parent-child relationship is beyond that seen in normal development and causes significant distress requiring clinical intervention

71
Q

Clinical features of separation anxiety disorder?

A

Extreme and persistent anxiety with separation and excessive worry about losing major attachment figures

May have physical symptoms, repeated nightmares involving the theme of separation, difficulty sleeping alone, and school refusal

72
Q

What is stranger anxiety?

A

Fear of being around unknown people rather than fear of separation from parents and can occur with the parents in the room

73
Q

Stranger anxiety is developmentally appropriate beginning around age ___.

A

6-12 months

74
Q

True or false - although confidentiality should be maintained whenever possible to facilitate rapport and encourage trust, if an adolescent patient is at risk of harm to self others, safety becomes more important and confidentiality must be broken in order to facilitate treatment.

A

True

75
Q

True or false - parental consent is not required for emergency hospitalization of a minor.

A

True

76
Q

What types of medications are effective in alcohol use disorder treatment?

A

Medications that target the reinforcing effects of alcohol by modulating opioid and glutamate function

77
Q

First-line treatment medications for alcohol use disorder?

A

Naltrexone (mu-opioid receptor antagonist)

Acamprosate (glutamate modulator)

78
Q

Discuss the efficacy of naltrexone in treating alcohol use disorder.

A

Shown to decrease alcohol craving, reducing heaving drinking days, and increase days of abstinence

79
Q

True or false - naltrexone cannot be initiated until the patient stops drinking.

A

False - it can be initiated while the patient is still drinking

80
Q

When is naltrexone contraindicated?

A

Patients taking opioids (can precipitate withdrawal)

Those with acute hepatitis or liver failure

81
Q

When is acamprosate contraindicated?

A

Significant renal failure

82
Q

Mechanism of buprenorphine?

A

Opioid partial agonist

83
Q

Uses of buprenorphine?

A

Opioid use disorder

Pain management

84
Q

Uses of valproate?

A

Epilepsy

Bipolar affective disorder

85
Q

First-line treatments for smoking cessation?

A

Bupropion

Varenicline

86
Q

Rx of moderate to severe alcohol withdrawal?

A

Benzodiazepines (eg, chlordiazepoxide)

87
Q

Mechanism of disulfiram?

A

Aldehyde dehydrogenase inhibitor that causes an unpleasant physiologic reaction (tachycardia, flushed skin, headache, N/V) when alcohol is consumed

88
Q

What should disulfiram be used to treat alcohol use disorder?

A

Abstinent patients who are not actively drinking

Highly motivated or taking the medication in a supervised setting to avoid skipping a dose when alcohol is desired

89
Q

Clinical features of acute distress disorder?

A

Exposure to actual or threatened trauma
Intrusive memories, nightmares, flashbacks with intense psychological/physiological reactions
Amnesia for event, detachment, avoidance of reminders
Negative mood
Arousal with sleep disturbance, irritability, hypervigilance, exaggerated startle, impaired concentration
Lasting 3+ days and no longer than 1 month

90
Q

Management of acute stress disorder?

A

Trauma-focused, brief CBT (first-line)
Consider pharmacotherapy for insomnia, intense anxiety
Monitor for development of PTSD

91
Q

An adequate antidepressant trial is generally considered to be at least ___.

A

4-6 weeks (+adequate dose)

92
Q

Compare the prevalence of postpartum blues, depression, and psychosis.

A

Blues - 40-80%
Depression - 8-15%
Psychosis - 0.1-0.2%

93
Q

Compare the onset of postpartum blues, depression, and psychosis.

A

Blues - 2-3 days (resolves within 14 days)
Depression - typically within 4-6 weeks, can be up to 1 year
Psychosis - variable (days to weeks)

94
Q

Compare the symptoms of postpartum blues, depression, and psychosis.

A

Blues - mild depression, tearfulness, irritability
Depression - 2+ weeks of moderate to severe depression, sleep or appetite disturbance, low energy, psychomotor changes, guilt, concentration difficulty, suicidal ideation
Psychosis - delusions, hallucinations, thought disorganization, bizarre behavior

95
Q

Compare the management of postpartum blues, depression, and psychosis.

A

Blues - reassurance and monitoring
Depression - antidepressants, psychotherapy
Psychosis - antipsychotics, antidepressants, mood stabilizers; hospitalization, do not leave mother alone with infant (risk of infanticide)

96
Q

Among antidepressants, ___ are commonly used as first-line therapy in treatment-naive patients as they have demonstrated efficacy and tolerability in postpartum depression.

A

SSRIs

97
Q

In breastfeeding patients, what antidepressant is preferred, as levels in infants are usually undetectable?

A

Sertraline

98
Q

List 9 risk factors for homicide.

A
  1. Young male
  2. Unemployed
  3. Impoverished
  4. Access to firearms
  5. Substance abuse
  6. Antisocial personality disorder
  7. History of violence or criminality
  8. History of childhood abuse
  9. Impulsivity
99
Q

What are the most commonly used weapon in youth homicide in the US?

A

Firearms

100
Q

True or false - all patients, including children, vulnerable adults, and the elderly, should be given the opportunity to speak with the physician alone and tell their story in their own words.

A

True

101
Q

Clinical features of sleep terrors (type of parasomnia that occurs during NREM sleep)?

A

Abrupt arousals from sleep (panicked scream, terror, autonomic arousal, unresponsive to comfort)
Little or no dream recall
Cannot be fully awakened
Amnesia for episodes

102
Q

Management of sleep terrors?

A

Reassurance that sleep terrors are not dangerous and usually resolve spontaneously within 1-2 years
Low-dose benzodiazepine at bedtime if episodes are frequent, persistent, and distressing

103
Q

Sleep terrors are most commonly seen in children age ___, with a peak incidence at age ___.

A

2-12; 5-7

104
Q

How do nightmares differ from sleep terrors?

A

In contrast to sleep terrors, nightmares usually occur in the latter half of sleep when REM occurs and are associated with complete awakening and dream recall

105
Q

Desmopressin and imipramine are used in the treatment of ___.

A

Nocturnal enuresis

106
Q

How are sleep terrors diangosed?

A

Clinically

107
Q

Diagnostic criteria of borderline personality disorder?

A

Pervasive pattern of unstable relationships, self-image and affects, and marked impulsivity with 5+ of the following:

  1. Frantic efforts to avoid abandonment
  2. Unstable and intense interpersonal relationships
  3. Markedly and persistently unstable self-image
  4. Impulsivity in 2+ areas that are potentially self-damaging
  5. Recurrent suicidal behaviors or threats of self-mutilation
  6. Mood instability (marked mood reactivity)
  7. Chronic feelings of emptiness
  8. Inappropriate and intense anger
  9. Transient stress-related paranoia or dissociation
108
Q

Rx - Borderline personality disorder?

A

Primary treatment - psychotherapy (several types effective, best evidence for DBT)
Adjunctive pharmacotherapy to target mood instability and transient psychosis (second-generation antipsychotics, mood stabilizers)
Antidepressants if comorbid mood or anxiety disorder

109
Q

A history of ___ is common in patients with borderline personality disorder.

A

Childhood trauma (physical and sexual abuse and neglect)

110
Q

___ to the primary caregiver may underlie the unstable relationships and fears of abandonment commonly seen in borderline personality disorder.

A

Insecure attachment

111
Q

If present, psychotic symptoms in borderline personality disorder are ___ and ___.

A

Transient; stress-related

112
Q

Describe the affect typically seen in borderline personality disorder.

A

Intense, labile, or angry

113
Q

Clinical features of narcolepsy?

A

Recurrent lapses into sleep or naps (3+ times/week for 3 months)
1+ of the following:

Cataplexy (emotionally triggered loss of muscle tone)
Low CSF levels of hypocretin-1/orexin-A
Shortened REM sleep latnecy

Associated features:
Hypnagogic/hypnopompic hallucinations
Sleep paralysis

114
Q

Treatment of narcolepsy?

A

Sleep hygiene and scheduled naps
Avoidance of alcohol and drugs that cause drowsiness
Medication to promote wakefulness may be necessary when sleepiness impairs daily functioning; first-line is Modafinil (nonamphetamine medication that promotes wakefulness)

If significant cataplexy, may benefit from REM-sleep suppressing drugs (antidepressants and sodium oxybate)

115
Q

Uses of pramipexole?

A

Treat symptoms of Parkinson disease and restless legs syndrome

116
Q

Why can antipsychotic medications cause hyperprolactinemia?

A

Dopamine is a prolactin-inhibitng factor; medications cause dopamine blockade in the tuberoinfundibular pathway

117
Q

Symptoms of hyperprolactinemia?

A

Gynecomastia
Galactorrhea
Menstrual dysfunction
Decreased libido

118
Q

What second-generation antipsychotic is known to have a high frequency of prolactin elevation?

A

Risperidone

119
Q

Why is aripiprazole less likely to cause hyperprolactinemia?

A

It is both an antagonist and partial agonist of D2 receptors

120
Q

DDx - galactorrhea

A

Antipsychotic use
Galactocele (benign milk collection in lactating women due to blocked duct)
Hypothyroidism (also presents with lethargy, dry skin, cold intolerance)
PCOS (hyperandrogenism - acne, hirsutism, menstrual irregularities)
Prolactinomas (headaches, visual disturbances, very high prolactin levels)

121
Q

DDx - schizoaffective disorder?

A
  1. Major depressive disorder with psychotic features
  2. Bipolar disorder with psychotic features
    (#1 and #2 - psychotic symptoms occur exclusively during mood episodes)
  3. Schizophrenia (mood symptoms may be present for a relatively brief period)
122
Q

List the EPS of antipsychotics in order of onset.

A
  1. Acute dystonia
  2. Akathisia
  3. Parkinsonism
  4. Tardive dyskinesia (gradual onset after prolonged therapy; >6 months)
123
Q

Define acute dystonia.

A

Sudden, sustained contraction of the neck, mouth, tongue, and eye muscles

124
Q

Define akathisia.

A

Subjective inner restlessness, inability to sit still

In severe cases, patients may become extremely distress, resulting in increased agitation and overall global worsening

125
Q

Define parkinsonism.

A

Gradual-onset tremor, cogwheel rigidity, bradykinesia, shuffling gait, masklike facies

126
Q

Define tardive dyskinesia.

A

Dyskinesia of the mouth, face, trunk, and extremities

127
Q

Clinicians must differentiate akathisia from worsening psychotic agitation, as akathisia is ___.

A

Dose dependent (efforts to target restlessness and agitation by increasing the antipsychotic dose were ineffective)

128
Q

First steps in management of akathisia?

A

Cautiously reducing antipsychotic dosage and/or adding a beta blocker (eg, propranolol), an anticholinergic (eg, benztropine), or a benzo (eg, lorazepam)

129
Q

How does propranolol work in managing akathisia?

A

Likely blocks noradrenergic and serotonergic inputs on dopamine pathways

130
Q

Why are benzos not first-line treatment for akathisia in patients with schizophrenia?

A

Associated with increased mortality

131
Q

Rx acute dystonia?

A

Benztropine (anticholinergic)

Diphenhydramine

132
Q

Rx parkinsonism?

A

Benztropine (anticholinergic)

Amantadine

133
Q

Rx tardive dyskinesia?

A

Valbenazine

134
Q

List 11 risk factors for suicide.

A
  1. Psychiatric disorders and prior suicide attempts
  2. Hopelessness
  3. Never married, or divorced/separated
  4. Living alone
  5. Elderly white man
  6. Unemployed or unskilled
  7. Physical illness
  8. Family history of suicide, family discord
  9. Access to firearms
  10. Substance abuse
  11. Impulsivity
135
Q

List 4 protective factors against suicide.

A
  1. Social support/family connectedness
  2. Pregnancy
  3. Parenthood
  4. Religion/participation in religious activities
136
Q

Strongest single factor predictive of suicide?

A

Prior suicide attempt

137
Q

What is often the first symptom of NMS?

A

Delirium

Step 2 (27 decks)

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