Psycho-Social-Spiritual Flashcards
What are risk factors for PERINATAL complicated grief? (8)
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
What are the strongest risk factors for opioid abuse? (5)
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
What therapies have best evidence for helping with chronic pain and fatigue?
1) CBT
2) Mindfulness Based Stress Reduction (for chronic pain and fatigue)
What integrative modality has best evidence for CANCER pain?
Acupuncture
What are risk factors for complicated grief? (8) (2)
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
What treatment has BEST evidence for chronic insomnia?
CBT!!!
Better than exercise, relaxation, benzos (only good for SHORT term use)
What are the 4 R’s of capacity assessment?
4 R’s
1) Relevant information
2) Reason Rationally
3) pROs and cons
4) Relay a choice ·
What are 5 risk factors for suicide ?
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!
Time frame for complicated grief?
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
Preferred SSRI fort agitation/depression/mood issues with Alzheimer’s? Preferred antipsychotic?
Citalopram
Risperdal/Abilify/Olanzapine»_space;> Seroquel (too sedating)
MDD diagnostic criteria?
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
Treatment for PTSD?
SSRI/SNRI
Prazosin and Topirimate (Topamax) for nightmares
3 personality disorders more likely to request PAD?
1) Borderline
2) Narcissistic
3) OCD
What are the 4 C’s of addiction?
1) Craving
2) Compulsion
3) Continued use despite Consequences
4) loss of Control
Treatment approach of pseudo addiction?
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
What behavioral therapy may be of benefit for patients with dementia and behavioral disorders?
Music therapy!
What 8 factors are PROTECTIVE against complicated grief?
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
What 3 factors predict poorer grief outcomes among children?
1) Pre-existing psychosocial RF
2) Lower SES
3) Depressed surviving parent
Dignity Therapy
- 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
In what 3 settings does acupuncture have data for efficacy?
1) Evidence in chronic pain
2) Evidence in CANCER pain
3) Evidence in SURGERY induced pain
Single factor that BEST differentiates anticipatory grief from depression?
HOPELESSNESS (not SI)
What are 7 complications of having complicated grief?
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
