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Psychosocial Disorders > Psychosocial Disorders > Flashcards

Psychosocial Disorders Flashcards

1
Q

What are the two symptoms that must be present (in addition to three others) nearly every day for a two weeks period, to make a diagnosis of depression?

A
  1. depressed mood most of the day, nearly every day
  2. markedly diminished interest or pleasure in almost all activities (anhedonia)

Others include: weight gain/loss, insomnia/hypersomnia, psychomotor agitation, fatigue/loss of energy, lack of concentration, excessive guilt, suicidal thoughts

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2
Q

What are the 5 categories of feelings?

A

sad, mad, glad, afraid, and ashamed

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3
Q

What are the stages of grief?

A

DABDA. Denial, Anger, Bargaining, Depression, Acceptance

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4
Q

What is the most commonly describe anti-depressant for depression and what are some examples?

A

SSRIs. Fluoxetine (Prozac), Paroxetine (Paxil), Escitalopram (Lexapro), Sertraline (Zoloft).

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5
Q

What are the most common side effects of tricyclic antidepressants?

A

Dry mouth and constipation (anticholinergic effects).

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6
Q

What should you advise caution with use of MAOIs?

A

hypertensive crisis with the ingestion of wine and cheese

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7
Q

What are examples of depression scales?

A

PHQ-9 and Beck Depression Inventory (BDI)

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8
Q

Why are SSRIs often the drug of choice?

A

due to their low side effect profile/minimal anticholinergic effects. Plus they have low toxicity in overdose.
*They are the drug of choice in children and adolescents

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9
Q

What is a warning specifically related to citalopram?

A

QT-prolongation

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10
Q

Are SSRIs safe in pregnancy?

A

Unsure… the FDA has yet to conclude whether they cause pulmonary hypertension in the newborn.

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11
Q

What is the underlying cause in anxiety?

A

an unexpected threat to one’s feeling of self-esteem or well-being

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12
Q

What are the diagnostics performed if anxiety is a differential diagnosis?

A

TSH (r/o hyperthyroidism), serum drug analyses, glucose, EKG

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13
Q

For whom are antihistamines used as an anxiolytic?

A

those with COPD and are potential abusers

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14
Q

What specific anxiety disorder are TCAs or MAOIs used to treat?

A

panic attacks

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15
Q

All of the following are true of buspirone except:

a. it is not a tranquilizer
b. it takes 3-4 weeks to take effect
c. it has highly addictive properties
d. common side effects include nausea and sweating

A

c. it does not have highly addictive properties

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16
Q

True or False.

Suicide is the second leading cause of death in adolescents behind accidents.

A

TRUE.

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17
Q

What three categories of ppl have the higher incidence of suicide?

A
  1. adolescents
  2. white men > 45 yrs
  3. elderly men > 75yrs
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18
Q

Causes of suicide

A

overdose, firearms, hanging (the second most common method)

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19
Q

What are suicide risk factors?

A

SUICIDAL. Sex. Unsuccessful attempts. Identified family members with attempted suicide. Chronic Illness. Depression/Drug abuse/Drinking. Age. Lethal method available.

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20
Q

What three drugs have a low therapeutic index? Meaning a little will do a lot, and a little more will kill you…

A
  1. Lithium.
  2. Dilantin
  3. Coumadin
  4. Digoxin
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21
Q

What are suicide risk factors most specific to the elderly?

A

Loneliness and medical disability.

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22
Q

What are screening questions named by CAGE?

A
  1. Have you ever felt the need to cut down on your drinking?
  2. Have people ever annoyed you by criticizing your drinking?
  3. Have you ever felt guilty about your drinking?
  4. Have you ever had a drink first thing in the morning to take the EDGE off/steady your nerves/or get rid of a hang-over?
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23
Q

What are the 4 categories of the mini mental status exam?

A
  1. Appearance
  2. Behavior
  3. Cognition
  4. Thought processes
24
Q

What is the scoring breakdown of the MMSE?

A

Total of 30. 24-30= no cognitive impairment. 18-23= mild cognitive impairment. 0-7= severe impairment.

25
Q

What are the 11 components of the MMSE?

A

ORARL 23 RDW.
Orientation to place AND time. Recognition of 3 objects. Attention (serial 7s). Recall. Language. Identify names of 2 objects. Follow a 3-step command. Reading comprehension. Writing. Drawing.

26
Q

When considering a diagnosis of Dementia, what are your other differentials?

A

DEMENTIA. Drugs. Emotional disorders. Metabolic/endocrine disorders. Eye and Ear disorders. Nutritional problems. Tumors. Infection. Arteriosclerosis.

27
Q

Delirium vs Dementia

A

Delirium: rapid onset of clouded sensorium r/t toxins, alcohol/drugs, trauma, poor nutrition, electrolyte imbalances, anesthesia.
Dementia: gradual onset of memory loss r/t atherosclerosis, neurotransmitter deficits, cortical atrophy, Alzheimers disease, viral causes, loss of brain cells.

28
Q

Define aphasia.

A

Difficulty with speech.

29
Q

Define apraxia.

A

Inability to perform a previously learned task.

30
Q

Define agnosia.

A

Inability to recognize an object.

31
Q

What is Alzheimer’s Disease?

A

Impaired ability to learn new info and recall previously learned info + > or = 1: aphasia, agnosia, apraxia, or inability to plan, organize, sequence, and make abstract differences.

32
Q

What is the underlying problem in Alzheimer’s Disease?

A

Aceylcholine deficiency

…it is a diagnosis of exclusion

33
Q

What are the medications used to treat AD?

A

acetylcholinesterase inhibitors: donepezil (aracept), galantamine (razadyne), rivastigmine (exelon).
Sometimes these are combined with NMDA receptor antagonists such as memantine (namenda) to improve thinking and ADLs

34
Q

What is the primary function of the cerebellum?

A

Balance and coordination.

35
Q

How do you test cerebellar function?

A

Romberg test: eyes closed, feet together, arms at side.
Finger-to-Nose: nose to examiner’s finger
Heel-to-Shin: Runs heel of one foot along the shin of opposite leg

36
Q

What is the SSRI with the longest half life?

A

Fluoxetine

37
Q

What SSRI has the shortest half life?

A

Paroxetine

38
Q

Which SSRI is the most activating?

A

Fluoxetine

39
Q

Which SSRI is the most sedating?

A

Paroxetine

40
Q

Which type of SSRI should be prescribed to an elder?

A

One with a short half life

41
Q

Which type of SSRI should be prescribed to someone who occasionally misses doses?

A

One with a long half-life

42
Q

Which SSRI does not interact with any of the CYP 450 enzymes?

A

Escitalopram

43
Q

Which SSRI could interfere with warfarin causing a decrease in the dosage?

A

Sertraline

44
Q

In overdose, which class of antidepressants can cause cardiac abnormalities and seizures?

A

TCAs (“triptylines”)

45
Q

What are examples of SNRIs?

A

Venlafaxine, Duloxetine

46
Q

Which two benzos are most commonly used for the treatment of panic disorder?

A

alprazolam (Xanax) and clonazepam (Klonopin)

47
Q

In order, list the benzos in order of their most potent to least potent.

A

Alprazolam
Clonazepam
Lorazepam
Diazepam

48
Q

When would you expect to see postpartum depression, if it occurs?

A

2 weeks to 6 months postpartum

49
Q

You want to start your patient on a TCA. What test should you obtain prior to initiation?

A

An EKG.

50
Q

Which SSRI can and is used in childhood depression?

A

Fluoxetine…should be seen once a week or when changes dosages until stable.
(however, treatment and management is done by mental health specialist)

51
Q

Who are TCAs (Amitriptyline, Imipramine) contraindicated in?

A

Those with cardiac conduction disorders, narrow angle glaucoma, and prostatic hypertrophy.
*Can also cause weight gain so weight and BMI should be monitored.

52
Q

How are antidepressants most effective?

A

If taken for one year after symptoms remit.

*If patient has had > or= 2 episodes of depression, consider remaining on antidepressant.

53
Q

What is the treatment of choice in anorexia nervosa?

A

cognitive behavioral therapy

54
Q

What are common side effects of psychostimulants?

A

decreased appetite, insomnia, headache, stomachache, irritability

55
Q

What does follow-up look like in a child with ADHD?

A

office visit every month after starting therapy. BP, Ht, Wt at every visit. Frequent follow-up with medication adjustments then q3-6 months when stabilized.

56
Q

What are components of therapeutic communication?

A

Honesty, Empathy, Rapport, Trust, and Respect

Psychosocial Disorders (2 decks)

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