Psychosocial

Question 1

Define Advance care planning

Answer 1

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

Question 2

Stages of change relevant to ACP

Answer 2

Precontemplative
Contemplative
Preparing / planning
Action
Maintenance

Question 3

Define goals of care

Answer 3

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

Question 4

2 key sources of information that go into medical decision making

Answer 4

values and goals
experience and information

Question 5

5 steps to creating an Advance Care Plan

Answer 5

Think
Learn
Choose
Talk
Record

Question 6

psychiatric illness is correlated with what factors in palliative patients

Answer 6

disability
symptom distress
proximity to end of life

Question 7

DSM V criteria for depression (MDE)

Answer 7

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

Question 8

DDX for depression in Pall care

Answer 8

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)

Question 9

Depression management
- which anti-depressants have fewest drug interactions
- which are activating
- which are sedating

Answer 9

• citalopram, escitalopram, sertraline
• bupropion
• mirtazapine

Question 10

S/S Panic attack
DSM criteria:

Answer 10

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

Question 11

Panic d/o definition

Answer 11

recurrent panic attacks with 1mo of worry about having these attacks (incl. changed behavior etc.)

Question 12

GAD criteria DSM

Answer 12

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”

Question 13

Does life threatening illness qualify as trauma

Answer 13

Only if catastrophic

Question 14

PTSD vs. ASD - difference?
Symptoms?

Answer 14

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

Question 15

anti-depressant dosing for those with panic attacks - what is the basic approach?

Answer 15

half dose

Question 16

most common psych diagnosis in patients with illness

Answer 16

adjustment disorder

Question 17

approach to management of adjustment d/o

Answer 17

psychological interventions are first line

• reduce severity of stressor
• enhance coping skills / strategies
• strengthen supports

Question 18

Outline Kubler Ross’ stages of grief

Answer 18

Denial
Anger
Bargaining
Depression
Acceptance

Question 19

Outline the Bowlby and Parkes model of grief

Answer 19

Shock - numbness
Yearning - searching
Disorganization - despair
Reorganization

Question 20

Outline the Bowlby and Parkes model of grief

Answer 20

Shock - numbness
Yearning - searching
Disorganization - despair
Reorganization

Question 21

2 steps in the dual process model of grief

Answer 21

Loss orientation (focusing on the loss)
Reorientation (refocusing on living life)

Question 22

what are the risk factors for complicated grief

Answer 22

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

Question 23

2 ways to differentiate depression from grief

Answer 23

Grief - thoughts focus on deceased, comes in waves

Depression - thoughts focus on self, pervasive

Question 24

DSM V
Features of complex grief (persistent complex bereavement d/o)

Answer 24

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

Question 25

2 Suicide assessment scales

Answer 25

SAFE-T
SADPERSONS

Question 26

What are the components of the SADPERSONS scale

Answer 26

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