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Behavioral Medicine > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Emil Kraepelin

A
  • Studied disease classification for mental disorders

- Origins of current biological psychiatry

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2
Q

Sigmund Freud

A
  • Developed ego model

- Used psychoanalysis as treatment

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3
Q

Aaron Beck

A

Developed cognitive behavioral therapy.

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4
Q

Mental disorders characterized by

A
  • alterations in thinking, mood, or behavior

- an association with distress and/or impaired functioning

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5
Q

Surgeon general recommendations

A
  • efficacy of mental health treatment is well documented
  • range of treatment exists for most disorders
  • seek help if you have mental health problem or symptoms of a disorder
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6
Q

mental health prevalence

A
  • 1 in 5 US adults experience mental illness

- of the 50% who seek treatment, 25% will quit treatment within a year

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7
Q

suicide statistics

A
  • 1 suicide every 11 minutes
  • 10th leading cause of death for all ages
  • 2nd leading cause of death ages 10-34
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8
Q

serotonin

A
  • Helps control mood, appetite, and sleep.
  • Low levels associated with depression.
  • Most receptors are in GI system.
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9
Q

norepinephrine

A
  • Controls alertness
  • Implicated in the regulation of emotion and cognition.
  • fight or flight stress response
  • Low level associated with depression
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10
Q

Dopamine

A
  • involved in controlling movement
  • linked to reward systems in the brain and areas influencing emotion
  • low levels can result in movement disorders (parkinsons)
  • problems utilizing dopamine linked to schizophrenia
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11
Q

GABA

A
  • major inhibitory neurotransmitter

- abnormal levels linked to anxiety and depression

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12
Q

acetylcholine

A
  • enables muscle action, learning, and memory
  • Ach producing neurons deteriorate as alzheimer’s progresses
  • most abundant neurotransmitter in the brain
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13
Q

glutamate

A
  • increases the chance that a neuron will fire
  • important role in early brain development
  • may assist in learning and memory
  • high levels may produce seizures or migraine
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14
Q

DSM-V classification

A

main diagnosis with multiple specifiers

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15
Q

remission

A
  • partial 3-12 months

- full greater than 12 months

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16
Q

laboratory tests in psychiatry

A
  • rule out underlying medical causes
  • rule out substance abuse
  • aid in selection of treatment
  • monitor side effects
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17
Q

screening lab tests

A

CBC, CMP, thyroid panel, urine toxicology, brain imaging (if needed)

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18
Q

lab tests to establish baseline before treatment

A

pregnancy, A1C (or FBS), lipid panel, ECG

along with screening labs

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19
Q

special case lab tests

A

HIV/hepatitis, neurosyphilis, OD, GGT, folate, B12, magnesium, endocrine

GGT is like A1C for EtOH

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20
Q

Lithium monitoring

A
  • narrow therapeutic index
  • level every 3 days until stable and then every 3 months
  • desirable range 0.5-1.5 but in practice 0.8-1.2 mEq/L
  • 1st line drug for bipolar
  • toxic to kidneys at high dose
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21
Q

clozapine monitoring

A
  • risk of agranulocytosis (decreased WBC)

- CBC with differential weekly for first 6 months and then every 2 weeks

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22
Q

obstacles to mental health care

A
  • stigma
  • fear
  • cost
  • access
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23
Q

depression screening

A 
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal Ideation
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24
Q

diagnose MDD

A
  • constant symptoms for at least 2 weeks

- 5 of the SIGECAPS and one must be lost of interest

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25
Q

past psych history 3 questions

A
  • previous psych hospital admissions
  • outpatient treatment
  • prior medications
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26
Q

CAGE questionnaire

A

Cut down on drinking
Annoyed when asked about drinking
Guilty about drinking
Eye opener in the morning

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27
Q

level one screening

A
  • general symptom measures

- new patient or long time between psych evaluations

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28
Q

level two screening

A
  • specific disorders

- symptomatic

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29
Q

cognitive assessment

A
  • help in early diagnosis of cognitive function
  • helpful for documenting progression of dementia
  • do not distinguish between dementia and delirium
  • consider age and education when interpreting
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30
Q

cognitive assessment tools

A
  • mini mental state exam
  • montreal cognitive assessment
  • mini-cog
  • addenbrooke’s cognitive exam
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31
Q

appearance

A

describe general appearance and anything unusual or specific

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32
Q

mood

A

patient’s description of their mood

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33
Q

affect

A

outward manifestation of mood

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34
Q

thought form

A

how is the patient thinking

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35
Q

tangential

A

going on a tangent to 1 other subject

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36
Q

circumstantial

A

going on multiple tangents

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37
Q

flight of ideas

A

manic state

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38
Q

thought content

A

what is the patient thinking

obsessions, delusions, SI, HI

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39
Q

hallucination

A

something not real that is experienced through one of the 5 senses

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40
Q

illusions

A

misrepresentation of a real object

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41
Q

misperceptions

A

an incorrect interpretation

42
Q

fund of knowledge

A

-estimate of intelligence and ability of concrete/abstract reasoning

43
Q

proverb interpretation

A
  • abstract reasoning
  • concrete reasoning
  • bizarre reasoning
44
Q

insight

A
  • how aware a person is of their own mental state

- self awareness of a problem

45
Q

pathological anxiety

A
  • due to its intensity and/or duration it is deemed an inappropriate response to a given situation
  • when the anxiety significantly interferes with a person’s academic, occupational, or social functioning
46
Q

biological basis of anxiety

A
  • serotonin (require higher SSRI dose), NE, GABA, CRH
  • amygdala increased response
  • prefrontal cortex inhibited response
47
Q

genetic basis of anxiety

A

-50% with panic disorder have at least 1 affected relative

48
Q

generalized anxiety disorder epidemiology

A
  • 1 yr prevalence 3-8%
  • more than 50% of those diagnosed have another mental disorder
  • female : male = 2 : 1
  • patients normally start treatment in their 20s
49
Q

GAD clinical features

A
  • anxiety, motor tension, fatigue, impaired concentration, and cognitive vigilance
  • chronic condition that can worsen with life stressors
  • worries about multiple aspects of life
  • may seek medical attention for somatic symptoms
50
Q

GAD course and prognosis

A
  • tends to be chronic and may be lifelong
  • up to 25% will eventually develop panic disorder
  • significant percentage likely to have comorbid depression
51
Q

GAD treatment

A
  • best results combine psychotherapy and pharmacotherapy
  • CBT focuses on identifying/changing dysfunctional though patterns; ways of coping with stressors
  • SSRIs are 1st line
  • other options SNRIs, TCA, buspirone
  • benzos short term
52
Q

SSRIs

A 
fluoxetine (prozac)
paroxetine (paxil)
citalopram (celexa)
fluvoxamine (luvox)
sertraline (zoloft)
escitalopram (lexapro)

AE: feeling “on edge”/nausea (early), sexual dysfunction (late)

53
Q

panic attack

A
  • discrete period of intense fear or discomfort accompanied by at least 4 somatic or cognitive symptoms
  • reaching a peak within 10 minutes
  • palpitations / chest pain
  • sweating, trembling, paresthesia
  • SOB, choking
  • nausea, dizziness
  • derealization (fear of losing control / of dying)
54
Q

panic disorder

A
  • recurrent, unexpected panic attacks (2 or more)
  • concern about additional attacks
  • worry about the implications of the attack or significant change in behavior related to the attacks
55
Q

panic disorder epidemiology

A
  • female to male = 2-3 : 1

- mean age of onset 25

56
Q

panic disorder etiology

A
  • theories include ANS dysregulation
  • genetic association
  • psychosocial factors
57
Q

panic disorder treatment

A
  1. SSRIs are first choice
  2. benzodiazepine (simultaneous with SSRI then taper)
  3. TCAs (alternative but more AE and lower safety profile)

treat 8-12 months after symptoms controlled

58
Q

phobia

A

irrational fear that produces a conscious avoidance of the feared subject, activity, or situation

Most commons are animals, heights, social/space

59
Q

specific phobia

A

strong, persisting fear of an object or situation

60
Q

phobia clinical feature

A
  • arousal of severe anxiety when the patient is exposed or the anticipation of exposure
  • patients recognize fear is excessive and go to great lengths to avoid the stimulus
61
Q

phobia treatment

A

exposure therapy with gradual exposure and desensitization

62
Q

Obsessions

A
  • something you think about

- recurrent and intrusive thoughts, feelings, ideas, or sensations

63
Q

compulsions

A
  • something you do
  • conscious, distressing, and recurring pattern of behaviors such as counting, checking, ordering, and cleaning
  • safety oriented behaviors
64
Q

OCD etiology

A
  • serotonin dysregulation
  • strong genetic component
  • may have comorbid depression
65
Q

OCD course and prognosis

A
  • more than half have sudden onset of symptoms
  • for 50-70% onset occurs after a stressful event
  • many delay seeking treatment due to embarrassment
66
Q

OCD treatment

A

-SSRIs are first choice but higher dosages are commonly required

67
Q

obsessive compulsive disorder personality

A

commonly confused with OCD, but not life altering

68
Q

specific obsessive disorders

A
  • hoarding
  • trichotillomania (hair pulling)
  • excoriation disorder (skin picking)
69
Q

separation anxiety

A
  • developing inappropriate and excessive fear and anxiety concerning separation from those whom the individual is attached
  • persistent for >4 weeks in children & >6 months in adults
  • more likely to develop in adults after loss of a close loved one
70
Q

selective mutism

A
  • consistent failure to speak in situations where there is an expectation of speaking
  • occurs for >1 month
  • child is able to speak but is silent/inaudible
  • often due to fear of the situation
71
Q

social anxiety disorder

A
  • strong, persistent fear of social situations in which embarrassment can occur along with fear of not being able to leave the situation
  • equally common in both sexes with peak age of onset in the teens
72
Q

social anxiety treatment

A

combination of SSRIs (long term), benzodiazepine (short term), beta blockers (PRN), and psychotherapy

73
Q

PTSD diagnosis

A
  • set of typical symptoms that develop after a person is exposed to a traumatic event
  • person reacts with fear and hopelessness, persistently relives the event, and tries to avoid reminders
  • symptoms >1 month
  • symptoms <1 month = acute stress disorder
74
Q

PTSD clinical feature

A 
ERASE
Experience a trauma
Relive the trauma 
Avoidance of reminders
Sympathetic nervous system
Excitement (hypervigilance, exaggerated startle response)
75
Q

SNRIs

A

Duloxetine (cymbalta)
Venlafaxine (effexor)
Desvenlafaxine (pristiq)

Monitor their BP

76
Q

bupropion (wellbutrin)

A
  • atypical antidepressant
  • anxiety, ADHD
  • wary of seizure Hx (lowers threshold)
77
Q

trazodone (desyrel)

A
  • low dose = sleep aid
  • higher dose = antidepressant
  • AE: priapism
78
Q

lithium

A
  • first line bipolar
  • NTI
  • AE: hand tremors, teratogenic (Ebstein’s anomaly), hypothyroidism, diabetes insipidus, renal function
79
Q

clozapine

A
  • schizophrenia (most effective, but not first line due to AE)
  • agranulocytosis
80
Q

PTSD treatment

A
  • SSRIs first line
  • TCAs alternative
  • prazosin for night terrors
  • psychotherapy (CBT, eye movement desensitization)
81
Q

adjustment disorder

A
  • external stressful event linked to development of new symptoms
  • occurs within 3 months of event
82
Q

mood disorder

A

syndrome consisting of a cluster of signs and symptoms sustained weeks-months which represent a marked departure from a person’s functioning and tend to recur often in a periodic or cyclical fashion

83
Q

mood disorders epidemiology

A
  • more women get MDD
  • men and women equal for bipolar I (more manic men and more depressed women)
  • higher risk if no close relationships
  • commonly comorbid with anxiety and substance abuse
84
Q

mood disorders psychosocial factors

A
  • life events: event most associated with developing depression is losing a parent before age 11
  • environmental stress: loss of spouse most likely to cause depression
  • personality types: OCPD, histrionic, and borderline more likely to develop depression
85
Q

cognitive triad of depression

A
  1. low self-perception, self-esteem
  2. tendency to experience the world as hostile and demanding
  3. expectation of suffering and failure

views lead to learned helplessness

86
Q

MDD diagnostic criteria

A
  • symptoms for same 2 week period that are a change from previous functioning
  • must have depressed mood and anhedonia
87
Q

persistent depressive disorder

A
  • chronic state of subclinical depression exhibited by a depressed mood for most of the days for at least 2 years
  • can’t go more than 2 months without symptoms
  • no previous manic episodes
  • don’t meet criteria for MDD
88
Q

pre-menstrual dysphoric disorder

A
  • 1st line treatment SSRIs
  • more severe form of PMS
  • higher risk for post partum depression
89
Q

post partum blues

A
  • mild depressive symptoms
  • 40-80% of women
  • symptoms usually peak on day 5 and resolve in 2 weeks
90
Q

post partum depression

A
  • 8-15% of women

- 0.9% get psychosis

91
Q

manic episode

A

distinct period of abnormal and persistently elevated, expansive, or irritable mood lasting at least 1 week (or any duration if hospitalization is needed)

92
Q

manic episode mnemonic

A 
DIG FAST
Distractibility 
Indiscretions
Grandiosity
Flight of ideas
Activity increase
Sleep deficits
Talkativeness
93
Q

hypomania episode

A
  • distinct period different from usual non-depressed mood lasting at least 4 days
  • does not impair functioning and no psychotic features
94
Q

Bipolar I criteria

A
  • at least one manic episode
  • symptoms not explained by another disorder
  • psychosis, marked impairment daily life, hospitalization
95
Q

Bipolar II criteria

A
  • one hypomania
  • one major depressive episode
  • symptoms not explained by another disorder
  • no psychosis or life altering impairement
96
Q

bipolar prognosis

A

50% of patients attempt suicide

97
Q

cyclothymic disorder

A
  • for at least 2 years (1 yr kids)
  • numerous periods of hypomanic symptoms that don’t meet hypomania criteria
  • numerous periods of depressive episodes that don’t meet MDD criteria
  • symptoms present at least half the time and not absent for more than 2 months
98
Q

MDD pharmacotherapy

A
  • SSRIs
  • SNRIs
  • atypical antidepressants as adjunct
  • TCAs
99
Q

MDD resistant to Rx

A
  • esketamine (special K)
  • adjunctive psychotherapy
  • ECT last resort
100
Q

treatment of acute mania

A
  • haldol, risperidone, and olanzapine are best
  • short term benzo if needed
  • continue or restart established med if bipolar diagnosed
101
Q

bipolar 1st line treatment

A
  • lithium 1st line monotherapy

- valproate alternative

102
Q

bipolar 2nd line treatment

A

-dual therapy first line drug with a 2nd generation antipsychotic

Behavioral Medicine (5 decks)

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