Specialty Disciplines Part 1 Flashcards
What populations have a higher prevalence of mental illness?
American Indians, Veterans, prisoners, homeless
What are the “Big 3” mental health issues seen in primary care?
- Depression
- Anxiety
- Substance Abuse
37,000 people die by _______ each year
Suicide
Greater than ________ percent who committed suicide had contact with PCP within 1 year of their death
75 percent
For what diagnosis should you refer?
Psychosis, bipolar disorder, and multiple diagnoses (depression and substance use)
What is the term for involuntary hospitalization – justified if serious illness, risk to self or others.
Civil comittment
What is “Duty to Warn?”
Requires health care providers to disclose a patient’s intent to do harm by warning victim
What is the difference between confidentiality and privilege?
Confidentiality is a broad concept that prohibits professionals from revealing information about a client to anyone (some exceptions)
Privilege is a narrower concept that describes specific types of information may not be disclosed in a legal setting
Up to _______ percent of healthcare providers are victims of violence sometime during their careers
50
There is a greater occurrence of this disorder among identical and fraternal twins
Eating disorders
There is increased re-uptake of this neurotransmitter in anorexics and bulimics
Serotonin
There is increased release of _______ during binging
Serotonin
This increases in gut in anorexics and bulimics which results in decreased appetite
Peptide Tyrosine Tyrosine (PTT)
What are some common comorbidities associated with eating disorders?
Depression, anxiety, bipolar, borderline personality disorders, impulse disorder, obsessive-compulsive
Prevalence of eating disorders are the highest in what population?
Adolescents and young adult women 18-21
What percentage of eating disorders are seen in women?
90-95%
In what populations is the prevalence of eating disorders increasing?
Males, older women, ethnic minorities, and female athletes
Out of the three types of eating disorders, which is most common? least common?
Most common – binge eating disorder
Least common – anorexia nervosa
What is the SCOFF self test?
Screening test for eating disorders
What is defined as persistent restriction of energy intake leading to significantly low body weight?
Anorexia Nervosa
What are the two types of anorexia nervosa?
Binge eating/purging type
Restricting type
A BMI of 16.5 is classified as what level of anorexia?
Moderate
Mild: BMI greater than 17
Moderate: 16-16.99
Severe: 15-15.99
Extreme: less than 15
This disorder is characterized by the following:
- eating, in a discreet period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode.
Bulimia Nervosa
What are some of the inappropriate, compensatory behaviors that bulimics perform in order to prevent weight gain
- Purging
2. Laxative abuse, diuretics, fasting, excessive exercise
How often do the binge eating and inappropriate compensatory behaviors occur?
at least once a week for 3 months
How do we classify how severe the bulimia is?
Based on frequency of inappropriate compensatory behaviors.
Mild: 1-3 episodes/week
Moderate: 4-7 episodes/week
Severe: 8-13 episodes/week
Extreme: 14 or more episodes/week
What is Russell’s sign?
Erosions on the hand from inducing vomiting
What metabolic disorder can excessive use of laxatives cause?
Metabolic acidosis
What disorder is defined by eating in a discrete period of time an amount of food larger than what most would eat, and a sense of lack of control over eating during the episode?
Binge Eating Disorder
How is binge eating disorder different than bulimia?
There is no compensatory behavior so they gain weight
What is the cornerstone of treatment for binge eating disorder?
Cognitive behavior therapy
True or False:
Sole therapy for anorexia nervosa is SSRIs?
False.
There may be some benefit, but therapy is recommend as first line.
True or False
Bulimia has a better prognosis than anorexia
True
60% of bulimics reach long term remission
30% of anorexics reach remission
What type of therapy is known as “client or person centered therapy” and focuses on the needs of the individual?
Humanistic Psychotherapy
Therapist must demonstrate openness, empathy, and “unconditional positive regard”
Humanistic Psychotherapy
A growing openness to experience
Freedom of choice
Living a rich, full life
Client Centered Therapy
May be referred to as Depth of Psychodynamic psychotherapy
Objective is to encourage all of the patients thoughts
Techniques used to include free association, fantasies, and dream interpretation
Insight Oriented
Learning through association. Stimulus elicits behavior.
Classical conditioning
Behavior is maintained by consequences of the behavior
Skinner and Thorndike
Behavior is observed in others, including punishment or reward
Bandura’s social learning
What type of therapy is classical conditioning, skinner and thorndike, and bandura’s social learning associated with?
Behavioral Psychotherapy
Behavioral psychotherapy is very helpful in the treatment of?
Phobias, chronic pain, addictions, anxiety, and obesity
Why did cognitive behavioral therapy arise?
From the dissatisfaction with behavioral therapy’s inability to achieve significant success with depressive disorders
The most commonly used “talk therapy” in the US?
Cognitive Behavioral Therapy
This type of therapy has an emphasis on the development of a clear definition of the problem, measuring changes in cognition and behavior and the attainment of previously defined goals
Cognitive Behavioral Therapy
What was the drive behind the development of dialectical behavior therapy?
To find an effective treatment for individuals with borderline personalty disorder and chronic suicidality
Effective CBT is dependent on?
The therapeutic relationship between the therapist and the patient
What type of therapy typically has homework?
Cognitive Behavioral Therapy
This type of therapy has been shown to reduce rates of suicidal gestures, hospitalizations, and treatment drop-out rates
Dialectical Behavior Therapy
This type of therapy focuses on facilitating and engaging the client’s intrinsic motivation to change their behavior
Motivational Therapy
This type of therapy is the therapy of “nons”. Non-judgemental, non-confrontatoinal, non-adversarial
Motivational Therapy
The primary objective of this type of therapy is not the elimination of difficult feelings but instead to be present with what life brings us
Acceptance and Commitment Therapy
Is Acceptance and Commitment Therapy better than the placebo effect?
Yes, but not better than CBT
The DSM-5 has replaced “abuse” and “dependence” with?
Substance Use Disorder
Withdrawal symptoms in the absence of the drug
Physical dependence
A neurobiological disease with genetic and psychological contributions leading to compulsive use and cravings despite harmful consequences
Addiction
Studies suggest approximately _____ percent of the US population carry the diagnosis of a substance use disorder within a given year
8 percent
What is the third leading preventable cause of death in the US?
Excessive alcohol consumption
More than half of alcohol-related deaths are due to?
Binge drinking
For general addiction treatment, why are the first few weeks so important?
Because if patients are able to stop during the first few weeks, they are likely to do well with less intensive continuing care
What is one of the biggest reasons people relapse?
Low motivation for recovery
Also co-morbid psychiatric issues, sleep difficulties, poor social support, high levels of personal stress, history of relapse
When withdrawing from alcohol, when do hallucinations typically occur?
12-48 hours
How many hours into withdrawal to delirium tremens occur?
48-96 hours
What is associated with disorientation, inattentiveness, oculomotor dysfunction, and gait ataxia?
Wernicke Encephalopathy
What is a Korsakoff syndrome?
Chronic neurologic consequences of Wernicke’s encephalopathy
What electrolyte disturbances do we have to be concerned about when patients are withdrawing from alcohol?
Hypokalemia, hypomagnesemia, hypophosphatemia
How is GABA linked to alcohol tolerance?
GABA is a major inhibitory neurotransmitter.
- EtOH binds to GABA receptors and supplants ordinary inhibitory signals.
- Tolerance develops.
**sudden EtOH cessation leads to decreased inhibitory tone
How is glutamate affected by EtOH?
EtOH interferes with glutamate-triggered NMDA receptor activation.
With sustained and increasing EtOH use, accommodation occurs and more glutamate receptors are produced
Sudden EtOH cessation leads to increased excitatory activity
Seizures may occur in alcohol withdrawal patients how long after their first drink?
6 to 48 hours
What metabolic issue is often associated with alcohol withdrawal?
Metabolic acidosis
What class of drugs do we use for Seizure/DT prophylaxis?
Benzodizepines
What Benzo is preferred in liver failure d/t less drug accumulation?
Lorazepam
How do we counteract Benzo’s?
Narcan
What drug can we absolutely not give to alcohol withdrawal patients due its potential to lower seizure threshold?
Bupropion
How long does a typical inpatient alcohol withdrawal treatment last?
1-5 days
What symptoms do you see after 8-24 hours of opiate withdrawal?
insomnia, restlessness, anxiety, yawning, stomach cramps, lacrimation, rhinorrhea, diaphoresis, and mydriasis
What drug we give pregnant who are withdrawing from opiates?
Subutex
What drug do we give to non-pregant people for opiate replacement?
Suboxone
How long does it take opiate receptor pathways to reset after being affected by heavy opiate use?
6-8 weeks
What would be the most comfortable opiate cessation?
Slowly stepping down the opiate dose over the course of weeks to months
Increased anxiety, palpitations, tachycardia, restlessness, and peripheral sensory disturbances are symptoms of?
Benzo withdrawal
What drug can we use for benzodiazepine detox?
Phenobarbital
Is Cocaine withdrawal life threatening?
No.
What is the leading preventable cause of mortality?
Tobacco
What are withdrawal symptoms of tobacco use
weight gain, irritability, depression, insomnia
What is the only exception to “Duty to Report”?
If the healthcare professional is your patient
An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself
Personality trait
A pervasive, inflexible, maladaptive manner by which the world is viewed, which originates in adolescence or earlier, and alters how the patient views the world
Personality disorder
What makes personality disorders different than most psychiatric disorders?
they are ego-syntonic
What does ego-syntonic mean?
There is no conflict between the person and the way they view the world
they are unaware
Why are personality disorders so hard to treat?
Besides the fact that these people don’t believe they have a problem
There are NO medications FDA approved for their treatment. Nor psychotherapies. We can only attempt to treat symptoms.
What three personalities make up Cluster A?
Paranoid, Schizoid, Schizotypal
What four personalities make up Cluster B?
Antisocial, Borderline, Histrionic, Narcissitic
What three personalities make up Cluster C?
Dependent, Obsessive-Compulsive, Avoidant
Words such as “distrust”, “malicious”, “character assassination”, and “extreme suspicion” should make you think of what personality disorder?
Paranoid
“Blunted affect”
“Detachment”
“Solitary”
“The night watchmen”
Schizoid
“Cognitive distortions”
“Old speaking patterns”
“Experience strange perceptual occurrences”
Schizotypal
“Disregard for and violation of the rights of others”
“Unlawful activities”
The ass holes…
Anti-social
What is often diagnosed along with anti-social personality disorder?
Conduct disorder, ODD
“Instability”
“Polarized (black and white”
“Impulsivity”
“Promiscuous sex”
Borderline
“Emotionally and attention seeking behavior”
“Center of attention”
“Theatrical and overly dramatic”
Histrionic
“Grandiose fantasies”
“Entitlement”
“Superiority”
Narcissistic
“Want friends but don’t know how to obtain them”
“Interact with others as little as they possibly can”
Avoidant
What is two personality disorders are often linked to domestic abuse?
Avoidant and Dependent
“Clingy”
“Separation anxiety”
“Trouble making decisions on their own”
Dependent
“Inflexible”
“Type A personality or Anal-Retentive”
“Preoccupation with details, rules, lists, and organizations”
Obsessive-compulsive
We know there isn’t FDA approved treatment for personality disorders, but what can we try?
CBT – especially dialectical behavioral therapy for borderline personality disorder
What is transference?
How the patient views you
What is counter-transference?
How you view the patient – make sure you’re consciously aware of this. If you’re patient looks like you’re crazy ex, still treat with respect.
Mental disorders characterized by physical symptoms but without a physical cause of the symptoms?
Somatoform disorders
With somatoform disorders are symptoms and the illness intentionally produced?
No!
Variety of complains in one or more organ systems lasting for months to years.
Somatic symptom disorder
Preoccupation with and fear of having serious medical illness despite medical evidence and reassurance to the contrary.
Illness anxiety disorder “hypochondriasis”
“Checkerboard abdomen” should make you think of?
Hypochondriasis
Sudden loss of sensory or motor function often following an acute stressor.
For example, mom goes blind after losing son in car crash
Conversion disorder
What are some diagnostic clues to somatoform disorders?
Complaints will be dramatic, multiple, and peculiar.
Extreme anxiety or profound lack of anxiety (just went blind and don’t care)
Many medical work ups with inconclusive findings
The intentional/conscious production of false or grossly exaggerated physical or psychological symptoms and is motivated by external incentives
Malingering
Is malingering for a primary or secondary gain?
Secondary
These people will have poor compliance with treatment or follow-up of diagnostic tests except when its mandated to get something
Malingering disorder
Involves the intentional/conscious production or feigning of physical or psychological illness based primarily upon a desire to assume the sick role and get medical attention
Factitious disorder
Factitious – primary or secondary gain?
Primary
We talked about two types of factitious disorders, what are they? and how are they different?
Munchausen syndrome – hurting one’s self to get attention
Munchaunsen by proxy – when illness in a child or elderly patient is caused by the caregiver
What are some diagnostic clues to malingering or factitious disorder?
Presenting complaints are often dramatic, peculiar, and changing!
