Psychosocial/Behavioral/Cognitive Health (3%)

Question 1

Generalized anxiety disorder

Answer 1

• Manifestations – restlessness, irritability, difficulty concentrating, muscle tension, sleep disturbances, fatigue, tachycardia, diarrhea, headache, etc.
• Screening tools – the GAD-7 (7 questions about their mental state over the past week) score of > 10 = moderate anxiety
• Diagnostic criteria – excessive anxiety and worry occurring more days than not for at least 6 months
• Management – most effective combination is cognitive behavioral therapy and pharmacologic tx
• Pharmacologic – SSRIs (first line) – Paroxetine [Paxil] 10 mg/day to start, sertraline [Zoloft] 25-50 mg/day to start, Lexapro 10-20 mg/day

Question 2

PTSD

Answer 2

• Common causes – sexual violence, interpersonal trauma, interpersonal violence (ex: assault), combat, natural disasters, etc.
• To diagnose – must have had some type of exposure that led them to this issue, there is the presence of intrusive thoughts or symptoms, and there has been a marked alteration in behavior or > 1 month
• Usually occurs within a few months of the event
• Management – SSRIs (first line – paroxetine [Paxil], sertraline [Zoloft], Lexapro); treatment is usually 6 months but can be up to 1 year to prevent relapse/reoccurrence

Question 3

Delirium

Answer 3

 An acute event characterized by global cognitive impairment, altered sleep-wake cycle, and altered behavior
 It’s acute and global nature distinguishes it from dementia
 Causation is typically outside of the CNS
 Management should include simple/firm communication, reality orientation, validity of feelings, visible clock, and presence of familiar person if possible
 Patient safety is primary concern
 Drug therapy PRN for safety – short-acting, low anticholinergic properties such as Haldol (QTc prolongation risk), Olanzapine (Zyprexa)

Question 4

Dementia

Answer 4

 A syndrome characterized by deterioration of or impairment of mental, behavioral, or emotional functions
 The persistent state/progressive nature distinguishes it from delirium
 Alzheimer’s dementia is most common
 Vascular dementia is second most common
 Others include Parkinson’s dementia, Lewy body dementia, Pick’s disease

Question 5

Alzheimer’s dementia

Answer 5

 Most common type of dementia
 Typically, patients are very animated (either happy or angry) and as the disease progresses, the more extreme in animation
 Confabulation is characteristic as well as paranoia (especially as disease progresses)

Question 6

Depression

Answer 6

• Manifestations – many – low energy, chronic fatigue, unexplained GI complaints, anxiety, weight gain, poor posture, slowed body systems
• Management goal – absence of depressive symptoms
• Psychotherapy + medication = best combination
• Always rule out suicidal ideation
• SSRIs – first line – paroxetine, fluoxetine, sertraline; may cause headaches but they usually fade after awhile
• Follow-up at 1 week (suicide risk increases here)