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EOR Family Medicine > Psychiatry / Behavioral Medicine > Flashcards

Psychiatry / Behavioral Medicine Flashcards

1
Q

Risk factors for major depressive disorder

A

Family history

Female

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2
Q

Depressed mood or anhedonia (loss of pleasure) or loss of interest in activities with > 5 associated symptoms almost every day for at least ___ ______

A

2 weeks

Major Depressive Disorder

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3
Q

Somatic symptoms that can manifest from MDD

A 
Constipation
HA
Skin changes
Chest/abd pain
Cough
Dyspnea
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4
Q

Associated symptoms with MDD

A
  1. Fatigue
  2. Insomnia / hypersomnia
  3. Feelings of guilt or worthlessness
  4. Thoughts of suicide / death
  5. Weight changes
  6. Decreased / increased appetite
  7. Decreased concentration
  8. Indecisiveness
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5
Q

Presence of depressive symptoms at the same time each year - most common in the winter, due to reduction of sunlight and cold weather

A

Seasonal Affective Disorder

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6
Q

Management for Seasonal Affective Disorder

A

SSRIs
Bupropion
Light therapy

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7
Q

Shares many of the typical sx of MDD but pts experience mood reactivity (improved mood in response to positive events).

A

Atypical Depression

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8
Q

Treatment for atypical depression

A

MAO inhibitors

Isocarboxazid, Phenelzine, Selegiline

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9
Q

Characterized by anhedonia, lack of mood reactivity, depression, sleep disturbance.

A

Melancholia

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10
Q

Depression with motor immobility, stupor and extreme withdrawal

A

Catatonic Depression

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11
Q

____% of MDD pts commit suicide

A

15%

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12
Q

Screening for depression

A

PHQ-2 for initial screen

If positive, PHQ-9

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13
Q

Management of MDD

A
  1. Psychotherapy - principle therapy in mild-mod (CBT, psychoeducation)
  2. SSRIs often first line (SNRIs, Bupropion, Mirtazapine)
  3. ECT - for pts who fail medical therapy
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14
Q

Antidepressants should be continued for a minimum of ________ to determine efficacy

A

3-6 weeks

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15
Q

Generalized Anxiety Disorder is defined as excessive anxiety or worry for a majority of days > ________ period about various aspects of life

A

6 month period

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16
Q

Management of GAD

A
  1. SSRIs (paroxetine, escitalopram), SNRIs (venlafaxine)
  2. Buspirone
  3. Benzos (short term only), BB, TCAs
  4. Psychotherapy
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17
Q

S/E of buspirone

A

Does not cause sedation

Nausea, restless leg syndrome, extrapyramidal symptoms, dizziness

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18
Q

Social anxiety disorder is an intense fear of social or performance situations in which the person is exposed to the scrutiny of others for fear of embarrassment, for how long?

A

> 6 mo

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19
Q

Management of Social Anxiety Disorder

A
  1. SSRIs or SNRIs
  2. Beta blockers (may be used for performance anxiety)
  3. Benzos
  4. Psychotherapy
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20
Q

Panic disorder is 2-3 times more common in:

A

Women

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21
Q

Anxiety about being in places or situations from which escape may be difficult (open spaces, enclosed spaces, crowds)

A

Agoraphobia

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22
Q

Long term management of panic disorders

A
  1. SSRIs first line
  2. SNRIs
  3. CBT
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23
Q

Acute management of panic attacks

A

Benzodiazepines

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24
Q

Intense fear/anxiety of a specific situation, object, or place that is persistent for > 6 months. Fear is out of proportion to any real danger

A

Specific Phobia

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25
Q

Management of specific phobia

A
  1. Exposure/desensitization therapy

2. Short term benzos and BB’s in some pts

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26
Q

Criteria for PTSD

A
  1. Exposure to actual or threatened death, serious injury or sexual violence
  2. Presence of > 1 intrusion symptom
27
Q

Intrusion symptoms for PTSD

A
  1. Re-experiencing
  2. Avoidance of stimuli associated with event
  3. Negative alterations in cognition and mood
  4. Arousal and reactivity (angry outbursts, etc)
28
Q

Management of PTSD

A
  1. SSRIs first line
  2. MAO inhibitors
  3. Trazodone may be helpful for insomnia
  4. CBT
29
Q

Criteria of insomnia disorder

A
  1. Difficulty initiating sleep, maintaining sleep, or waking up too early
  2. Sleep difficulties occur despite adequate opportunity and circumstances for sleep
  3. Patient describes daytime impairment that is attributable to sleep difficulties
30
Q

Management of insomnia

A
  1. Advice regarding sleep hygiene and stimulus control
  2. CBT - suggested as initial management instead of medication
  3. Benzos, hypnotics, melatonin, doxepin, suvorexant
31
Q

Refusal to maintain a minimally normal body weight fueling a relentless desire for thinness with a morbid fear of gaining weight (even though they are underweight)

A

Anorexia Nervosa

32
Q

_____% incidence of depression associated with anorexia nervosa

A

60%

33
Q

_____% of people diagnosed with anorexia nervosa are women

A

90%

34
Q

Diagnosis of anorexia nervosa

A
  1. BMI < 17.5 or body weight < 85% of ideal weight

2. Labs: leukocytosis, leukopenia, anemia, hypokalemia, increased BUN (dehydration), hypothyroidism

35
Q

Physical exam with anorexia nervosa

A 
Emaciation
Hypotension
Bradycardia
Skin/hair changes (lanugo)
Dry skin
Salivary gland hypertrophy
Amenorrhea
Arrhythmias
Osteoporosis
36
Q

Management of anorexia nervosa

A
  1. Medical stabilization (may need hospitalization)
  2. Psychotherapy - CBT, supervised meals
  3. SSRIs if depressed
37
Q

Major difference between anorexia and bulimia nervosa

A

Pts with bulimia nervosa will have normal weight +/- overweight

38
Q

With bulimia nervosa, binge eating must occur:

A

At least weekly for 3 months

39
Q

Physical exam with bulimia nervosa

A

Teeth pitting or enamel erosion
Russell’s sign - calluses on dorsum of hand
Parotid gland hypertrophy

40
Q

Labs with bulimia nervosa

A

Metabolic alkalosis from vomiting

Hypokalemia, hypomagnesemia

41
Q

Management of bulimia nervosa

A
  1. CBT

2. Fluoxetine has shown to be helpful

42
Q

> 1 manic or mixed episode which often cycles with occasional depressive episodes

A

Bipolar I disorder

43
Q

Strongest risk factor for bipolar I disorder

A

Family history

44
Q

Abnormal and persistently elevated, expansive or irritable mood at least 1 week with marked impairment of social/occupational function

A

Manic episode

45
Q

Management of bipolar I disorder

A
  1. Lithium first line
  2. Valproic acid, carbamazepine
  3. Haloperidol, benzos if psychosis or agitation develops
  4. SSRIs, antidepressants
  5. Therapy, CBT, good sleep hygiene
46
Q

> 1 hypomanic episode + > 1 major depressive episode. Mania or mixed episodes are absent

A

Bipolar II disorder

47
Q

Symptoms similar to manic symptoms that is clearly different from usual nondepressed mood but does not cause marked impairment

A

Hypomania

48
Q

Management of bipolar II disorder

A

Similar to bipolar I

49
Q

Signs/symptoms of nicotine withdrawal

A 
Restlessness
Anxiety
Irritability
Sleep abnormalities
Depression
Nicotine craving
50
Q

Management of tobacco use/dependence

A
  1. Counseling and support therapy, CBT
  2. Nicotine tapering therapy: gum, nasal sprays, patches, inhaler
  3. Bupropion - often used in combo with nicotine tapering therapy
  4. Varenicline (Chantix)
51
Q

Symptoms of opioid intoxication

A 
Euphoria and sedation
Drowsiness
Impaired social functioning
Impaired memory
Slow or slurred speech
Nausea, vomiting, seizures, coma
52
Q

Physical exam findings for opioid intoxication

A
  1. Pupillary restriction
  2. Respiratory depression
  3. Biot’s breathing
  4. Bradycardia
  5. Hypotension
53
Q

Groups of quick, shallow inspirations followed by regular or irregular periods of apnea

A

Biot’s breathing

Seen with opioid intoxication

54
Q

Symptoms of opioid withdrawal

A

Piloerections (goose bumps)
Pupil dilation
Flu-like sx
Diarrhea, tachycardia, N/V

55
Q

Management of acute opioid intoxication

A

Naloxone (Narcan) - about 5 minutes IM

56
Q

Management of opioid withdrawal

A
  1. Clonidine (for sympathetic sx)
  2. Loperamide for diarrhea
  3. NSAIDs for joint pain
  4. Methadone tapering
  5. Benzos may be helpful
57
Q

Symptoms of alcohol withdrawal:

A

Tremors, anxiety, diaphoresis, palpitations, insomnia, GI sx

Seizures, hallucinations

58
Q

Management of alcohol withdrawal

A
  1. May require medical treatment and hospitalization - can be potentially fatal
  2. IV benzos
  3. IV fluids, IV thiamine and magnesium, glucose, multivitamins
59
Q

IV thiamine and magnesium should always be given _______ glucose administration

A

before

60
Q

Management of alcohol intoxication

A
  1. Observation
  2. If known to be alcohol dependent, IV thiamine, magnesium, and glucose
  3. May need haloperidol if aggressive
61
Q

CAGE Alcohol Screening

A

> /= 2 considered a positive screen

  1. Cutdown - have you felt the need to cutdown?
  2. Annoyed - have people told you they were annoyed at you when you drink?
  3. Guilt - have you ever felt guilty for drinking?
  4. Eye opener - have you needed a drink to start your day or reduce jitteriness
62
Q

Management of alcohol dependence

A
  1. Psychotherapy, support (AA)
  2. Disulfiram can be used as deterrent
  3. Naltrexone - reduces alcohol craving
63
Q

Strongest predictive factor of suicide

A

Previous attempt or threat

EOR Family Medicine (14 decks)

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