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Sam: Psychiatry > Specialty Disciplines Part 1 > Flashcards

Specialty Disciplines Part 1 Flashcards

1
Q

What populations have a higher prevalence of mental illness?

A

American Indians, Veterans, prisoners, homeless

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2
Q

What are the “Big 3” mental health issues seen in primary care?

A
  1. Depression
  2. Anxiety
  3. Substance Abuse
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3
Q

37,000 people die by _______ each year

A

Suicide

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4
Q

Greater than ________ percent who committed suicide had contact with PCP within 1 year of their death

A

75 percent

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5
Q

For what diagnosis should you refer?

A

Psychosis, bipolar disorder, and multiple diagnoses (depression and substance use)

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6
Q

What is the term for involuntary hospitalization – justified if serious illness, risk to self or others.

A

Civil comittment

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7
Q

What is “Duty to Warn?”

A

Requires health care providers to disclose a patient’s intent to do harm by warning victim

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8
Q

What is the difference between confidentiality and privilege?

A

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

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9
Q

Up to _______ percent of healthcare providers are victims of violence sometime during their careers

A

50

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10
Q

There is a greater occurrence of this disorder among identical and fraternal twins

A

Eating disorders

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11
Q

There is increased re-uptake of this neurotransmitter in anorexics and bulimics

A

Serotonin

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12
Q

There is increased release of _______ during binging

A

Serotonin

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13
Q

This increases in gut in anorexics and bulimics which results in decreased appetite

A

Peptide Tyrosine Tyrosine (PTT)

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14
Q

What are some common comorbidities associated with eating disorders?

A

Depression, anxiety, bipolar, borderline personality disorders, impulse disorder, obsessive-compulsive

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15
Q

Prevalence of eating disorders are the highest in what population?

A

Adolescents and young adult women 18-21

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16
Q

What percentage of eating disorders are seen in women?

A

90-95%

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17
Q

In what populations is the prevalence of eating disorders increasing?

A

Males, older women, ethnic minorities, and female athletes

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18
Q

Out of the three types of eating disorders, which is most common? least common?

A

Most common – binge eating disorder

Least common – anorexia nervosa

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19
Q

What is the SCOFF self test?

A

Screening test for eating disorders

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20
Q

What is defined as persistent restriction of energy intake leading to significantly low body weight?

A

Anorexia Nervosa

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21
Q

What are the two types of anorexia nervosa?

A

Binge eating/purging type

Restricting type

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22
Q

A BMI of 16.5 is classified as what level of anorexia?

A

Moderate

Mild: BMI greater than 17
Moderate: 16-16.99
Severe: 15-15.99
Extreme: less than 15

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23
Q

This disorder is characterized by the following:

  1. 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
  2. A sense of lack of control over eating during the episode.
A

Bulimia Nervosa

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24
Q

What are some of the inappropriate, compensatory behaviors that bulimics perform in order to prevent weight gain

A
  1. Purging

2. Laxative abuse, diuretics, fasting, excessive exercise

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25
Q

How often do the binge eating and inappropriate compensatory behaviors occur?

A

at least once a week for 3 months

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26
Q

How do we classify how severe the bulimia is?

A

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

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27
Q

What is Russell’s sign?

A

Erosions on the hand from inducing vomiting

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28
Q

What metabolic disorder can excessive use of laxatives cause?

A

Metabolic acidosis

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29
Q

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?

A

Binge Eating Disorder

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30
Q

How is binge eating disorder different than bulimia?

A

There is no compensatory behavior so they gain weight

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31
Q

What is the cornerstone of treatment for binge eating disorder?

A

Cognitive behavior therapy

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32
Q

True or False:

Sole therapy for anorexia nervosa is SSRIs?

A

False.

There may be some benefit, but therapy is recommend as first line.

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33
Q

True or False

Bulimia has a better prognosis than anorexia

A

True

60% of bulimics reach long term remission
30% of anorexics reach remission

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34
Q

What type of therapy is known as “client or person centered therapy” and focuses on the needs of the individual?

A

Humanistic Psychotherapy

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35
Q

Therapist must demonstrate openness, empathy, and “unconditional positive regard”

A

Humanistic Psychotherapy

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36
Q

A growing openness to experience

Freedom of choice

Living a rich, full life

A

Client Centered Therapy

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37
Q

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

A

Insight Oriented

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38
Q

Learning through association. Stimulus elicits behavior.

A

Classical conditioning

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39
Q

Behavior is maintained by consequences of the behavior

A

Skinner and Thorndike

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40
Q

Behavior is observed in others, including punishment or reward

A

Bandura’s social learning

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41
Q

What type of therapy is classical conditioning, skinner and thorndike, and bandura’s social learning associated with?

A

Behavioral Psychotherapy

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42
Q

Behavioral psychotherapy is very helpful in the treatment of?

A

Phobias, chronic pain, addictions, anxiety, and obesity

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43
Q

Why did cognitive behavioral therapy arise?

A

From the dissatisfaction with behavioral therapy’s inability to achieve significant success with depressive disorders

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44
Q

The most commonly used “talk therapy” in the US?

A

Cognitive Behavioral Therapy

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45
Q

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

A

Cognitive Behavioral Therapy

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46
Q

What was the drive behind the development of dialectical behavior therapy?

A

To find an effective treatment for individuals with borderline personalty disorder and chronic suicidality

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47
Q

Effective CBT is dependent on?

A

The therapeutic relationship between the therapist and the patient

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48
Q

What type of therapy typically has homework?

A

Cognitive Behavioral Therapy

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49
Q

This type of therapy has been shown to reduce rates of suicidal gestures, hospitalizations, and treatment drop-out rates

A

Dialectical Behavior Therapy

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50
Q

This type of therapy focuses on facilitating and engaging the client’s intrinsic motivation to change their behavior

A

Motivational Therapy

51
Q

This type of therapy is the therapy of “nons”. Non-judgemental, non-confrontatoinal, non-adversarial

A

Motivational Therapy

52
Q

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

A

Acceptance and Commitment Therapy

53
Q

Is Acceptance and Commitment Therapy better than the placebo effect?

A

Yes, but not better than CBT

54
Q

The DSM-5 has replaced “abuse” and “dependence” with?

A

Substance Use Disorder

55
Q

Withdrawal symptoms in the absence of the drug

A

Physical dependence

56
Q

A neurobiological disease with genetic and psychological contributions leading to compulsive use and cravings despite harmful consequences

A

Addiction

57
Q

Studies suggest approximately _____ percent of the US population carry the diagnosis of a substance use disorder within a given year

A

8 percent

58
Q

What is the third leading preventable cause of death in the US?

A

Excessive alcohol consumption

59
Q

More than half of alcohol-related deaths are due to?

A

Binge drinking

60
Q

For general addiction treatment, why are the first few weeks so important?

A

Because if patients are able to stop during the first few weeks, they are likely to do well with less intensive continuing care

61
Q

What is one of the biggest reasons people relapse?

A

Low motivation for recovery

Also co-morbid psychiatric issues, sleep difficulties, poor social support, high levels of personal stress, history of relapse

62
Q

When withdrawing from alcohol, when do hallucinations typically occur?

A

12-48 hours

63
Q

How many hours into withdrawal to delirium tremens occur?

A

48-96 hours

64
Q

What is associated with disorientation, inattentiveness, oculomotor dysfunction, and gait ataxia?

A

Wernicke Encephalopathy

65
Q

What is a Korsakoff syndrome?

A

Chronic neurologic consequences of Wernicke’s encephalopathy

66
Q

What electrolyte disturbances do we have to be concerned about when patients are withdrawing from alcohol?

A

Hypokalemia, hypomagnesemia, hypophosphatemia

67
Q

How is GABA linked to alcohol tolerance?

A

GABA is a major inhibitory neurotransmitter.

  1. EtOH binds to GABA receptors and supplants ordinary inhibitory signals.
  2. Tolerance develops.

**sudden EtOH cessation leads to decreased inhibitory tone

68
Q

How is glutamate affected by EtOH?

A

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

69
Q

Seizures may occur in alcohol withdrawal patients how long after their first drink?

A

6 to 48 hours

70
Q

What metabolic issue is often associated with alcohol withdrawal?

A

Metabolic acidosis

71
Q

What class of drugs do we use for Seizure/DT prophylaxis?

A

Benzodizepines

72
Q

What Benzo is preferred in liver failure d/t less drug accumulation?

A

Lorazepam

73
Q

How do we counteract Benzo’s?

A

Narcan

74
Q

What drug can we absolutely not give to alcohol withdrawal patients due its potential to lower seizure threshold?

A

Bupropion

75
Q

How long does a typical inpatient alcohol withdrawal treatment last?

A

1-5 days

76
Q

What symptoms do you see after 8-24 hours of opiate withdrawal?

A

insomnia, restlessness, anxiety, yawning, stomach cramps, lacrimation, rhinorrhea, diaphoresis, and mydriasis

77
Q

What drug we give pregnant who are withdrawing from opiates?

A

Subutex

78
Q

What drug do we give to non-pregant people for opiate replacement?

A

Suboxone

79
Q

How long does it take opiate receptor pathways to reset after being affected by heavy opiate use?

A

6-8 weeks

80
Q

What would be the most comfortable opiate cessation?

A

Slowly stepping down the opiate dose over the course of weeks to months

81
Q

Increased anxiety, palpitations, tachycardia, restlessness, and peripheral sensory disturbances are symptoms of?

A

Benzo withdrawal

82
Q

What drug can we use for benzodiazepine detox?

A

Phenobarbital

83
Q

Is Cocaine withdrawal life threatening?

A

No.

84
Q

What is the leading preventable cause of mortality?

A

Tobacco

85
Q

What are withdrawal symptoms of tobacco use

A

weight gain, irritability, depression, insomnia

86
Q

What is the only exception to “Duty to Report”?

A

If the healthcare professional is your patient

87
Q

An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself

A

Personality trait

88
Q

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

A

Personality disorder

89
Q

What makes personality disorders different than most psychiatric disorders?

A

they are ego-syntonic

90
Q

What does ego-syntonic mean?

A

There is no conflict between the person and the way they view the world

they are unaware

91
Q

Why are personality disorders so hard to treat?

A

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.

92
Q

What three personalities make up Cluster A?

A

Paranoid, Schizoid, Schizotypal

93
Q

What four personalities make up Cluster B?

A

Antisocial, Borderline, Histrionic, Narcissitic

94
Q

What three personalities make up Cluster C?

A

Dependent, Obsessive-Compulsive, Avoidant

95
Q

Words such as “distrust”, “malicious”, “character assassination”, and “extreme suspicion” should make you think of what personality disorder?

A

Paranoid

96
Q

“Blunted affect”

“Detachment”

“Solitary”

“The night watchmen”

A

Schizoid

97
Q

“Cognitive distortions”

“Old speaking patterns”

“Experience strange perceptual occurrences”

A

Schizotypal

98
Q

“Disregard for and violation of the rights of others”

“Unlawful activities”

The ass holes…

A

Anti-social

99
Q

What is often diagnosed along with anti-social personality disorder?

A

Conduct disorder, ODD

100
Q

“Instability”

“Polarized (black and white”

“Impulsivity”

“Promiscuous sex”

A

Borderline

101
Q

“Emotionally and attention seeking behavior”

“Center of attention”

“Theatrical and overly dramatic”

A

Histrionic

102
Q

“Grandiose fantasies”

“Entitlement”

“Superiority”

A

Narcissistic

103
Q

“Want friends but don’t know how to obtain them”

“Interact with others as little as they possibly can”

A

Avoidant

104
Q

What is two personality disorders are often linked to domestic abuse?

A

Avoidant and Dependent

105
Q

“Clingy”

“Separation anxiety”

“Trouble making decisions on their own”

A

Dependent

106
Q

“Inflexible”

“Type A personality or Anal-Retentive”

“Preoccupation with details, rules, lists, and organizations”

A

Obsessive-compulsive

107
Q

We know there isn’t FDA approved treatment for personality disorders, but what can we try?

A

CBT – especially dialectical behavioral therapy for borderline personality disorder

108
Q

What is transference?

A

How the patient views you

109
Q

What is counter-transference?

A

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.

110
Q

Mental disorders characterized by physical symptoms but without a physical cause of the symptoms?

A

Somatoform disorders

111
Q

With somatoform disorders are symptoms and the illness intentionally produced?

A

No!

112
Q

Variety of complains in one or more organ systems lasting for months to years.

A

Somatic symptom disorder

113
Q

Preoccupation with and fear of having serious medical illness despite medical evidence and reassurance to the contrary.

A

Illness anxiety disorder “hypochondriasis”

114
Q

“Checkerboard abdomen” should make you think of?

A

Hypochondriasis

115
Q

Sudden loss of sensory or motor function often following an acute stressor.

For example, mom goes blind after losing son in car crash

A

Conversion disorder

116
Q

What are some diagnostic clues to somatoform disorders?

A

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

117
Q

The intentional/conscious production of false or grossly exaggerated physical or psychological symptoms and is motivated by external incentives

A

Malingering

118
Q

Is malingering for a primary or secondary gain?

A

Secondary

119
Q

These people will have poor compliance with treatment or follow-up of diagnostic tests except when its mandated to get something

A

Malingering disorder

120
Q

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

A

Factitious disorder

121
Q

Factitious – primary or secondary gain?

A

Primary

122
Q

We talked about two types of factitious disorders, what are they? and how are they different?

A

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

123
Q

What are some diagnostic clues to malingering or factitious disorder?

A

Presenting complaints are often dramatic, peculiar, and changing!

Sam: Psychiatry (3 decks)

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