Psycho-Social-Spiritual

Question 1

What are risk factors for PERINATAL complicated grief? (8)

Answer 1

1) Prior hx of mental illness
2) Low levels of perceived support
3) Pre-existing partner conflicts
4) No other kids at home
5) Anxious baseline personality
6) Unplanned pregnancy
7) Termination of pregnancy due to fetal abnormality
8) Poverty

Question 2

What are the strongest risk factors for opioid abuse? (5)

Answer 2

1) Personal hx of non-opioid substance abuse
2) Hx of psychiatric disease (MDD, anxiety)
3) Young age between 16-45
4) Family hx of substance abuse
5) Pre-adolescent sexual abuse (women)

Being MALE and WHITE

Question 3

What therapies have best evidence for helping with chronic pain and fatigue?

Answer 3

1) CBT
2) Mindfulness Based Stress Reduction (for chronic pain and fatigue)

Question 4

What integrative modality has best evidence for CANCER pain?

Answer 4

Acupuncture

Question 5

What are risk factors for complicated grief? (8) (2)

Answer 5

History of Psycho-Biological Dysfunction
1) Hx MDD, anxiety
2) Dependent relationship to decreased
3) Loss of CLOSE relationship (spouse/parent)
4) Hx of early parental loss, abuse, serious neglect
5) Poor parental bonding
6) Separation anxiety in childhood
7) Adverse to changes
8) Lack of preparation for the death

Type of Death
1) Loss of child
2) Loss by trauma/disaster

Question 6

What treatment has BEST evidence for chronic insomnia?

Answer 6

CBT!!!

Better than exercise, relaxation, benzos (only good for SHORT term use)

Question 7

What are the 4 R’s of capacity assessment?

Answer 7

4 R’s
1) Relevant information
2) Reason Rationally
3) pROs and cons
4) Relay a choice ·

Question 8

What are 5 risk factors for suicide ?

Answer 8

1) Elderly
2) White
3) Male
4) Socially isolated
5) Chronic terminal illness (cancer 2x rate of suicide as gen pop)

Also prior suicide attempt, concrete plan- also red flags!

Question 9

Time frame for complicated grief?

Answer 9

1) Symptoms must persist > 6 months after death
2) Maladaptive mourning with INTENSE pre-occupation with circumstances of loved one’s death, near total avoidance of reminders of person, acute grief
3) MUST interfere with person’s ability to function

Question 10

Preferred SSRI fort agitation/depression/mood issues with Alzheimer’s? Preferred antipsychotic?

Answer 10

Citalopram

Risperdal/Abilify/Olanzapine&raquo_space;> Seroquel (too sedating)

Question 11

MDD diagnostic criteria?

Answer 11

1) Depressed mood most of the day, nearly every day OR
2) Loss of interest/pleasure in things

PLUS 4 other of the following (SIGECAPS)
1) Sleep changes
2) Interest decreased
3) Guilt
4) Energy decrease
5) Concentration decreased
6) Appetite changes
7) Psychomotor retardation
8) Suicidal ideation

Question 12

Treatment for PTSD?

Answer 12

SSRI/SNRI

Prazosin and Topirimate (Topamax) for nightmares

Question 13

3 personality disorders more likely to request PAD?

Answer 13

1) Borderline
2) Narcissistic
3) OCD

Question 14

What are the 4 C’s of addiction?

Answer 14

1) Craving
2) Compulsion
3) Continued use despite Consequences
4) loss of Control

Question 15

Treatment approach of pseudo addiction?

Answer 15

Iatrogenic condition that we create by inadequately treating someone’s pain

INCREASE DOSING FREQUENCY
May need to increase opioid DOSE

If you change the dosing interval, increase dose, start PCA— they get better and behaviors go away!

1) Stimulus- at pain onset, patient gets inadequate pain medication/relief, requests more
2) Escalation- patient realizes to get more medicine, need to display more signs of pain, may ask for drugs by name
3) Crisis- patient appears to engage in drug seeking behavior, leading to “crisis of mistrust” with anger/frustration by patient and avoidance by health care team

Question 16

What behavioral therapy may be of benefit for patients with dementia and behavioral disorders?

Answer 16

Music therapy!

Question 17

What 8 factors are PROTECTIVE against complicated grief?

Answer 17

1) Male gender
2) Higher education level
3) Higher frequency of religious attendance
4) Robust social network
5) Death at HOME
6) Positive interactions with professional providers
7) Older age
8) Sense of preparedness for death

Question 18

What 3 factors predict poorer grief outcomes among children?

Answer 18

1) Pre-existing psychosocial RF
2) Lower SES
3) Depressed surviving parent

Question 19

Dignity Therapy

Answer 19

• Individual therapy done by SW or MH professional, or volunteer
  
  • Improves SADNESS (not depression) and grief
  • Key themes
    ○ Generativity
    ○ Continuity of self
    ○ Role preservation
    ○ Maintenance of pride
    ○ Hopefulness
    ○ Care tenor
    ○ Aftermath- what care do you want
    Ask patients set of questions–> then transcribe and give tpo patients

Question 20

In what 3 settings does acupuncture have data for efficacy?

Answer 20

1) Evidence in chronic pain
2) Evidence in CANCER pain
3) Evidence in SURGERY induced pain

Question 21

Single factor that BEST differentiates anticipatory grief from depression?

Answer 21

HOPELESSNESS (not SI)

Question 22

What are 7 complications of having complicated grief?

Answer 22

1) HIGHER risk of suicide (11.3 x higher risk)
2) Risk of MDD (21-52%)
3) Risk of GAD
4) PTSD in 30-50%
5) Increased poor health behaviors (tobacco, drug, EtOH use, unhealthy eating)
6) CANCER, CARDIAC ISSUES, FUNCTIONAL DECLINE
7) LESS likely to use healthcare services