T4 - MH

Question 1

When doing a MH eval, it’s good to ask about hallucinations.

Question 2

Always rule out ________ prior to prescribing SSRI/SNRI for depression.

Answer 2

Bipolar.

Question 3

SIGECAPS

Answer 3

changes in SLEEP
loss of INTEREST/pleasure
Thoughts of worthlessness/GUILT
Loss of ENERGY
Trouble CONCENTRATING
change in APPETITE or wt
Change in PSYCHOMOTOR activity
Thoughts about death or SUICIDE.

Question 4

Depressive disorder can present as
____ in the young
____ in adults
____ in the elderly

Answer 4

Irritability
Depressed mood/hopelessness
Somatic complaints.

Question 5

Acronym for bipolar assessment: DIGFAST

Answer 5

Distractibility
Indescresion or lack of inhibition
Grandiosity
Flight of ideas
Activity increase
Sleep deficit (not needing it)
Talkativeness

Question 6

If you have a score of _____ or higher on the PHQ-2, then move on to the PHQ9 AND do the _____

Answer 6

3
CSSR-S

Question 7

Adjustment disorder is anxiety and/or depression symptoms within ____ of an event. Resolves within ____ after stressor termination.

Answer 7

3mo
6mo

Question 8

Bipolar I vs II

Answer 8

I is classic bipolar with at least 1 documented manic episode for at least 7 days (hospitalized, arrested or psychotic episode)
II is bipolar with hypomania.

Question 9

Bipolar II is often misdiagnosed as _____

Answer 9

Depression.

Question 10

We tend to experience ______ in our heads and _____ in our bodies.

Answer 10

Worry
Anxiety.

Question 11

Worry vs anxiety

Answer 11

Worry: more specific, not much mental image, triggers problems solving, solutions
Anxiety: diffuse, general, mental images, physiological manifestations (HA, increased HR, palpitations, dry mouth, etc), frozen or cant think of a solution.

Question 12

Anxiety vs ADHD

Answer 12

Anxiety: worry, fear, restlessness, muscle tension, overthinking
ADHD: inattention, disorganization, carelessness, forgetfulness, avoidance of mental effort
Same: irritability, poor concentration, distractibility, poor sleep onset, excessive response to situations.

Question 13

DDx for psych conditions: THINCMED

Answer 13

Tumors
Hormones
Infx/immune dz
Nutrition
CNS
Miscellaneous (OSA, anemia, CHF)
Electrolyte and Tox
Drugs (nicotine, caffeine, prescribed and illicit drugs, ETOH, marijuana)

Question 14

Acute stress disorder (<1mo) -> acute PTSD (<3mo) ->chronic PTSD (>3mo)

Question 15

Generalized anxiety disorder - symptoms present for ______

Answer 15

> 6mo

Question 16

Don’t just treat to ______, treat all the way to ______

Answer 16

Response
Remission.

Question 17

If you treat ______ past remission, there is less chance of a relapse.

Answer 17

9-12mo

Question 18

Panic attacks vs panic disorder?

Answer 18

Panic attacks accompany anxiety - there is usually a specific trigger that the patient can pinpoint that started the attack.
Panic disorder is a panic attack out of no where - don’t know what triggered it.

Question 19

If you have depression with primary anxiety, what is a good med choice?

Answer 19

Zoloft

Question 20

Depression or anxiety with chronic pain - good med choice?

Answer 20

Cymbalta

Question 21

Med that is good to augment for low energy/poor concentration (NOT for anxiety)

Answer 21

Wellbutrin

Question 22

Med that is good augment for anxiety?

Answer 22

Buspirone.

Question 23

Med that is good augment for insomnia (difficulty FALLING asleep)

Answer 23

Trazodone.