Psychosocial Flashcards
Define Advance care planning
A process that enables individuals with decisional capacity to identify their values, consider various serious illness scenarios, to define goals and preferences for future care. Includes identifying a decision maker and discussing preferences with family and healthcare providers
Stages of change relevant to ACP
Precontemplative
Contemplative
Preparing / planning
Action
Maintenance
Define goals of care
Overaching aim of medical intervention, informed by the patient’s values and priorities, established within the current context and used to guide decisions around use of specific interventions
2 key sources of information that go into medical decision making
values and goals
experience and information
5 steps to creating an Advance Care Plan
Think
Learn
Choose
Talk
Record
psychiatric illness is correlated with what factors in palliative patients
disability
symptom distress
proximity to end of life
DSM V criteria for depression (MDE)
2 weeks of
1 core symptom - low mood, anhedonia
+
5 or more of:
SIGECAPS
Symptoms not due to medical diagnosis
Causes impairment in functioning
No mania / hypomania
Not part of another psychiatric d/o
DDX for depression in Pall care
Adjustment d/o (sx. within 3 mo. of stressor)
Substance induced mood d/o
Depressive d/o due to medical condition
Persistent depressive d/o (chronic low grade >2yrs)
Depression management
- which anti-depressants have fewest drug interactions
- which are activating
- which are sedating
- citalopram, escitalopram, sertraline
- bupropion
- mirtazapine
S/S Panic attack
DSM criteria:
Period of intense anxiety peaks within 10min
4 or more of following symptoms
- chills
- fear of dying
- depersonalization / derealization
- loss of control
- shaking
- dyspnea
- chest tightness
- choking
- nausea
- palpitations
- lightheadedness
Panic d/o definition
recurrent panic attacks with 1mo of worry about having these attacks (incl. changed behavior etc.)
GAD criteria DSM
excessive, uncontrollable worry on most days for at least 6mo.
3 or more of:
- restlessness
- irritability
- muscle tension
- sleep disturbance
- difficulty concentrating
- easy fatigue
“worrier by nature”
Does life threatening illness qualify as trauma
Only if catastrophic
PTSD vs. ASD - difference?
Symptoms?
ASD - within 1mo. of stressor
PTSD - > 1mo.
criteria
1) exposure to trauma
2) intrusive memories (re-experiencing)
3) avoidance of reminders
4) hyper-arousal
5) negative mood alteration
specification (with or without dissociative symptoms):
- depersonalization
- derealization
impairment in functioning
not attributable to other medical condition / substance
anti-depressant dosing for those with panic attacks - what is the basic approach?
half dose
most common psych diagnosis in patients with illness
adjustment disorder
approach to management of adjustment d/o
psychological interventions are first line
- reduce severity of stressor
- enhance coping skills / strategies
- strengthen supports
Outline Kubler Ross’ stages of grief
Denial
Anger
Bargaining
Depression
Acceptance
Outline the Bowlby and Parkes model of grief
Shock - numbness
Yearning - searching
Disorganization - despair
Reorganization
Outline the Bowlby and Parkes model of grief
Shock - numbness
Yearning - searching
Disorganization - despair
Reorganization
2 steps in the dual process model of grief
Loss orientation (focusing on the loss)
Reorientation (refocusing on living life)
what are the risk factors for complicated grief
relationship - dependence (men die, women get depressed)
psychosocial - psych illness, low SES, old age, lack of support
circumstance - traumatic / sudden death, inability to prepare,
stigmatized death, long term caregiving (>6mo)
post-death - unable to complete ritual, loss of role, financial consequences
2 ways to differentiate depression from grief
Grief - thoughts focus on deceased, comes in waves
Depression - thoughts focus on self, pervasive
DSM V
Features of complex grief (persistent complex bereavement d/o)
1 of:
persistent yearning / longing for deceased
preoccupation with death circumstances
preoccupation with the deceased
intense sorrow or distress not improving with time
2 of:
difficulty accepting death
disbelief or emotional numbness
bitterness or anger
self blame / negative thoughts toward self
avoidance of reminders of loss
desire to die and reunite with deceased
alone, detached from others
loss of meaning in life
difficulty pursuing interests / planning for future
2 Suicide assessment scales
SAFE-T
SADPERSONS
What are the components of the SADPERSONS scale
S - sex (male)
A - age <19 or >45
D - depression
P - previous attempt
E - excess substance use
R - rationale lost
S - social support lacking
O - organized plan
N - no partner
S - sickness
