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Behavioral Medicine > Test 2 > Flashcards

Test 2 Flashcards

1
Q

evaluation of psychotic patient

A
  • history (talk to family)
  • mental state to establish baseline
  • physical exam
  • labs
  • imaging (at least one head CT)
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2
Q

positive schizophrenia symptoms

A
  • have to have at least 2*
  • respond to antipsychotic Rx*
  • disorganized speech
  • bizarre behavior
  • delusions
  • hallucinations
  • thought disorders
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3
Q

negative schizophrenia symptoms

A
  • alogia (sparse speech)
  • affective flattening
  • anhedonia
  • asociability
  • apathy
  • attention impairement
  • less responsive to Rx*
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4
Q

delusion

A

a fixed false belief with evidence that the belief is false

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5
Q

hallucination

A
  • vivid perceptual experience that occurs in absence of valid sensory stimulus
  • visual, olfactory, and tactile need medical causes ruled out
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6
Q

catatonia

A
  • abnormal motor behavior and periods of extreme hyperactivity and hypoactivity
  • waxy flexibility
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7
Q

schizophrenia diagnostic criteria

A
  • 2 characteristic symptoms of psychosis (hallucinations, delusions, disorganized speech, disorganized behavior, negative symptoms)
  • lasts at least 6 months with 1 month of characteristic symptoms
  • social and/or occupational dysfunction
  • exclude other disorders
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8
Q

schizophreniform disorder

A
  • one to six months of symptoms

- social/occupational impairment not required

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9
Q

schizoaffective disorder

A
  • psychotic symptoms plus prominent mood symptoms

- two week period of psychotic symptoms without mood symptoms

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10
Q

delusional disorder

A
  • delusions for at least 1 month

- no other criteria met

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11
Q

brief psychotic disorder

A
  • one of the characteristic symptoms

- time range one day to one month

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12
Q

substance induced psychotic disorder

A

-hallucinations or delusions during or within one month of substance abuse

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13
Q

acute psychosis treatment

A
  • one of haldol, geodon, zyprexa (or other 2nd generation antipsychotic)
  • plus ativan
  • sometimes benadryl or vistaril

“B-52”

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14
Q

long term schizophrenia treatment

A
  • haldol first line for typical

- clozapine most effect for atypical but not used first line due to agranulocytosis

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15
Q

depressive type schizoaffective treatment

A
  • 2nd generation antipsychotic

- antidepressant as adjunct

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16
Q

bipolar type schizoaffective long term treatment

A
  • 2nd generation antipsychotic

- mood stabilizer as adjunct

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17
Q

treatment of dystonia

A
  • cogentin

- benadryl

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18
Q

akathisia treatment

A

propranolol
benzodiazepine
benzotropine (cogentin)

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19
Q

tardive dyskinesia treatment

A

ingrezza (valbenazine)

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20
Q

insight oriented psychoanalysis

A
  • increase patient’s understanding of neurosis
  • uncover repressed memories
  • long term
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21
Q

supportive psychotherapy

A
  • therapeutic relationship for emotional support
  • acute crisis
  • patients with low ego strength
  • vulnerable patients
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22
Q

cognitive behavioral therapy

A
  • indicated for anxiety and mood disorders
  • focus on patient’s maladaptive thinking
  • learn new thought patterns and behaviors
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23
Q

dialectical behavioral therapy

A
  • indicated for borderline personality disorder
  • increase interpersonal skill and emotional regulation
  • decrease self destruction
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24
Q

group therapy

A
  • family
  • couples
  • self help
  • group patients with similar diagnosis
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25
Q

denial

A
  • primitive defense

- refusal to accept reality or fact

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26
Q

regression

A
  • primitive defense

- reversion to earlier stage of development

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27
Q

acting out

A
  • primitive defense

- extreme behavior to express thoughts or feeling

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28
Q

dissociation

A
  • primitive defense
  • person loses track of time and/or person and instead finds another representation of their self to continue in the moment
  • common with child abuse history
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29
Q

compartmentalization

A
  • primitive defense

- lesser form of dissociation where aspects of a person’s life are separated

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30
Q

projection

A
  • primitive defense

- misattribution of a person’s thoughts, feelings, or impulses onto another person

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31
Q

repression

A
  • intermediate defense

- unconscious blocking of unacceptable thoughts, feelings, or impulses

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32
Q

displacement

A
  • intermediate defense

- redirecting of thoughts, feelings, or impulses directed at one person/object but taken out on another person/object

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33
Q

intellectualization

A
  • intermediate defense
  • overemphasis on thinking when confronted with an unacceptable impulse, situation, or behavior without employing any emotions
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34
Q

rationalization

A
  • intermediate defense

- offering a different explanation for one’s perceptions or behaviors in the face of a changing reality

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35
Q

undoing

A
  • intermediate defense

- attempt to take back an unconscious behavior or thought that is unacceptable or hurtful

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36
Q

sublimation

A
  • mature defense

- channeling of unacceptable thoughts, impulses, and emotions in to favorable ones

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37
Q

compensation

A
  • mature defense

- psychologically counterbalancing perceived weaknesses by emphasizing strengths in other areas

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38
Q

assertiveness

A
  • mature defense

- strike a balance to speak up for themselves, express needs/opinions respectfully, and listen when spoken to

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39
Q

prescribing for pregnant population

A
  • 1st: avoid/minimize medications
  • 2nd: treat the mother
  • evaluate risk/benefit with patient and OB team
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40
Q

prescribing for geriatric population

A
  • start low and go slow
  • first think drugs as cause of symptoms when diagnosing
  • avoid polypharmacy
  • decreased volume of distribution
  • decreased metabolism
  • increased AE sensitivity
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41
Q

SSRIs drugs

A

“Effective For Sadness Panic Compulsions”

  • citalopram (celexa)
  • escitalopram (lexapro)
  • fluoxetine (prozac)
  • fluvoxamine (paxil)
  • sertraline (zoloft)
  • paroxetine (paxil)
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42
Q

SSRI+ drugs

A

vilazadone (viibryd)
vortioxetine (trintellix)

SSRI and partial serotonin agonist

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43
Q

SNRI drugs

A

desvenlafaxine (pristiq)
duloxetine (cymbalta)
venlafaxine (effexor)

also used for peripheral pain and neuropathy

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44
Q

SSRI side effects

A
  • GI upset
  • sexual dysfunction
  • activation/akathisia (will go away)
  • mania
  • SI in younger patients
  • serotonin syndrome
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45
Q

serotonin syndrome

A
  • potentially fatal
  • can be caused by combining an SSRI/SNRI with an MAOI (should separate by 5 weeks)
  • takes 24-48 hours to develop
  • variable mental status
  • increased muscle tone
  • HTN, tachycardia, tachypnea, fever
  • hyperreflexia
  • mydriasis
  • increased bowel sounds
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46
Q

serotonin syndrome treatment

A
  • stop all serotonergic drugs
  • supportive care to stabilize vitals
  • benzo for sedation, relaxation
  • serotonin antagonist for severe cases
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47
Q

bupropion (wellbutrin)

A
  • atypical antidepressant
  • do not use in patient with seizure history
  • often used as adjunct with SSRI
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48
Q

mirtazapine (remeron)

A
  • atypical antidepressant
  • also used as sleep aid
  • AE: weight gain
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49
Q

trazodone (desyrel)

A
  • atypical antidepressant
  • also used as sleep aid
  • AE: priaprism
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50
Q

esketamine (spravato)

A
  • used for treatment resistant depressant as an adjunct to other antidepressants
  • patients monitored for 2 hours after dose for hallucinations
  • not used in pregnancy
  • AE: dissociative and perceptual changes, derealization, depersonalization, HTN
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51
Q

tricyclics

A
  • 2nd/3rd line for Rx resistant depression
  • OD causes fatal cardiac arrhythmias
  • be aware of suicidal ideations when prescribing
  • amitriptyline, clomipramine
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52
Q

tricyclic side effects

A
  • cardiac toxicity (LBBB, V-tach)

- anticholinergic effects

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53
Q

MAOI

A
  • use is very uncommon

- avoid tyramine containing foods due to HTN crisis

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54
Q

SNRI side effects

A

same as SSRIs plus HTN

55
Q

benzodiazepine indications

A
  • EtOH withdrawal
  • anxiety disorder
  • muscle relaxant
  • seizure
56
Q

benzodiazepine onset of action

A

generally one hour

57
Q

benzodiazepine side effects

A
  • sedation
  • fatigue
  • disinhibition
  • depression
  • rebound anxiety
  • elderly: memory impairment, impaired performance, lowered attention span, muscle incoordination
58
Q

benzodiazepine treatment concerns

A
  • potentiate effects with alcohol
  • abuse and dependence
  • tolerance
59
Q

buspirone (buspar)

A
  • anxiolytic for anxiety only
  • don’t cross react with alcohol or benzos
  • little abuse potential
  • may take 1-2 weeks to show effect with max effect 3-4 weeks
  • mixed results on efficacy
60
Q

hydroxyzine (vistaril, atarax)

A
  • antihistamine
  • anxiolytic
  • treat agitation in alcohol detox
  • adjunct for insomnia
61
Q

typical antipsychotics drugs

A

-haldol

  • prolixin
  • thorazine
62
Q

atypical antipsychotics

A
  • aripiprazole (abilify)
  • ziprasidone (geodon)
  • risperidone (risperdal)
  • quetiapine (seroquel)
  • onlanzapine (zyprexa)
  • clozapine (clozaril)
63
Q

antipsychotic indications

A
  • acute and chronic psychosis
  • bipolar with or without psychosis
  • depression with psychotic features
  • resistant anxiety disorders
  • impulse control disorder
  • agitation in medically compromised
64
Q

side effects of typical antipsychotics

A
  • extrapyramidal symptoms
  • tardive dyskinesia
  • sedation
  • neuroleptic malignant syndrome
  • weight gain
  • orthostatic hypotension
  • QT prolongation
65
Q

tardive dyskinesia

A
  • involuntary muscle movements of fact, tongue, trunk
  • long term side effect at 5-20 years of treatment
  • higher incidence with typical antipsychotic
  • treated with valbenazine
66
Q

neuroleptic malignant syndrome

A
  • result of too much dopamine and occurs over few weeks/months
  • variable mental status
  • increased muscle tone
  • HTN, tachycardia, tachypnea, fever
  • hyporeflexia
  • normal pupils
  • normal bowel sounds
67
Q

atypical antipsychotic side effects

A
  • weight gain
  • hyperlipidemia
  • DM
  • clozapine = agranulocytosis
68
Q

quetiapine (seroquel)

A
  • highly sedating
  • adjunct for severe depression or bipolar
  • AE: orthostatic hypotension
69
Q

aripiprazole (abilify)

A
  • partial D2 antagonist
  • uses: schizophrenia, bipolar, agitation, MDD
  • AE: akathisia, nausea, anxiety, headache, insomnia, sedation
70
Q

treatment of parkinsonian side effects

A
  • amantadine

- levodopa

71
Q

lithium

A
  • mood stabilizer
  • 1st line for bipolar mania
  • narrow therapeutic index
72
Q

lithium side effects

A
  • diabetes insipidus
  • renal toxicity
  • tremor
  • hypothyroidism
73
Q

valproic acid (depakote, depakene)

A
  • 2nd line mood stabilizer

- AE: ototoxicity, teratogenic, low platelet

74
Q

propranolol use

A

performance anxiety

75
Q

paranoid personality disorder

A
  • cluster A
  • pervasive distrust of others
  • principal ego defense is projection
  • Tx: CBT
76
Q

schizoid personality disorder

A
  • detached and solitary, but well functioning

- no desire for social interaction

77
Q

schizotypal personality disorder

A
  • odd beliefs, magical thinking
  • suspicious or fearful of others
  • avoids social interaction due to fear
78
Q

antisocial personality disorder

A
  • lack of concern or remorse
  • aggressive and reckless
  • mental disorder most associated with crime
79
Q

antisocial personality disorder diagnostic criteria

A
  • at least 18
  • evidence of conduct disorder before 15
  • occurrence of behavior is not exclusively during schizophrenia or manic episode
80
Q

borderline personality disorder

A
  • unstable relationships
  • unstable self image
  • anger outburst
  • frequent SI/harm threats
  • fear of abandonment
  • Tx: dialectical behavior therapy
81
Q

histrionic personality disorder

A
  • excessive emotions, attention seeking
  • seductive and provocative behavior
  • shallow expression of emotion
  • self dramatization
82
Q

narcissistic personality disorder

A
  • grandiose sense of self importance
  • requires excessive admiration
  • sense of entitlement
  • exploits others
  • lacks empathy
  • arrogant
83
Q

avoidant personality disorder

A
  • social inhibition
  • feeling inadequate
  • hypersensitive to negative evaluation
84
Q

dependent personality disorder

A
  • need to be taken care of
  • submissive and clinging behavior
  • fear of separation
85
Q

obsessive compulsive personality disorder

A
  • perfectionism that interferes with task completion

- over conscientious, scrupulous, and inflexible

86
Q

normal BMI

A

18.5 - 24.9

87
Q

anorexia nervosa

A
  • refusal to maintain body weight above 17.5 or 85% expected weight
  • intense fear of weight gain even though underweight
  • disturbance in body image
88
Q

anorexia restricting type

A
  • weight loss through dieting, fasting, excessive exercise

- no binging or purging for the last 3 months

89
Q

anorexia binge/purge type

A

in the last 3 months recurrent binge/purge episodes

90
Q

anorexia labs/results

A
  • leukopenia
  • hypokalemia
  • low albumin
  • amenorrhea
  • lanugo
  • EKG changes
91
Q

anorexia treatment

A
  • hospitalization if more than 20% below ideal body weight
  • family therapy and CBT
  • Rx if depressed
92
Q

bulimia nervosa

A
  • recurrent episodes of binge/purge
  • at least once a week for 3 months
  • maintains normal or above body weight
  • dental caries, esophageal tears, parotid or salivary gland enlargement
93
Q

binge eating disorder

A
  • recurrent episodes of binge eating

- occurs weekly for at least 3 months

94
Q

body dysmorphic disorder

A
  • type of OCD
  • obsession with perceived flaw in appearance
  • repetitive behavior centered around that flaw
95
Q

enuresis

A
  • repeated bed wetting
  • either twice a week for 3 months or significant distress
  • 5 or older
  • involuntary or intentional
  • Tx desmopressin
96
Q

encopresis

A
  • repeated passage of feces inappropriately
  • at least once a month for 3 months
  • 4 or older
97
Q

pica

A

persistent eating of non-food and non-nutritional substances

98
Q

rumination

A
  • repeated regurgitation of food

- >1 month

99
Q

impaired control criteria

A
  • larger amounts of time
  • desire to reduce use
  • time obtaining, using, recovering
  • craving
100
Q

social impairment criteria

A
  • fail to fulfill duties
  • social/interpersonal problems
  • give up activities
101
Q

risky use criteria

A
  • hazardous use

- use despite physical/psychological problems

102
Q

tolerance/withdrawal criteria

A
  • tolerance

- withdrawal symptoms

103
Q

severity depends on number of eleven criteria

A
  • mild 2-3
  • moderate 4-5
  • severe 6 or more
104
Q

early remission

A

no criteria for 3-12 months except craving

105
Q

sustained remission

A

no criteria >12 months except craving

106
Q

in controlled environment

A

access to substance restricted

107
Q

alcohol use disorder

A
  • presence of at least 2 symptoms
  • mild 2-3
  • moderate 4-5
  • severe 6 or more
108
Q

alcohol tolerance

A

-neuroadaptation from continued use
-need to use increased amount to achieve effect
OR
-diminished effect with continued use of same amount

109
Q

alcohol intoxication

A
  • mood lability, impaired judgement, poor coordination
  • neurological impairment
  • can be fatal
110
Q

wernicke encephalopathy

A
  • reversible
  • acute thiamine deficiency
  • triad: delirium, ocular motor dysfunction, ataxia
111
Q

korsakoff syndrome

A
  • irreversible
  • chronic thiamine deficiency
  • anterograde amnesia and confabulation
112
Q

alcohol withdrawal

A

-early: anxiety, tachycardia, HTN, insomnia, headache, tremor
-grand mal seizures at 12-24 hours
-delirium tremens at 24-72 hours
altered mental status, hallucinations, autonomic instability
-life threatening

113
Q

alcohol withdrawal treatment

A
  • withdrawal assessment
  • benzodiazepine
  • carbamazepine
  • DT treated in ICU
114
Q

naltrexone

A
  • prevent EtOH relapse
  • first line
  • reduce craving
  • hepatoxicity at high dose
115
Q

acramprosate

A
  • prevent EtOH relapse
  • first line
  • renal clearance
116
Q

antabuse

A
  • prevent EtOH relapse

- blocks alcohol metabolism

117
Q

CDC opioid prescribing guidelines

A
  • nonopioid therapy preferred
  • lowest dose for shortest time when prescribed
  • monitor all patients closely
118
Q

opioid intoxication

A
  • pinpoint pupils
  • euphoria followed by apathy
  • drowsiness
  • slurred speech
  • memory impairment
119
Q

opioid use long term effects

A
  • constipation
  • hepatitis
  • HIV
  • heart infection
  • CNS injury
  • miscarriage/neonatal withdrawal
120
Q

methadone

A
  • mu agonist
  • titrated until no craving and no illicit use
  • can be continued or tapered
121
Q

buprenorphine (subutex)

A
  • partial opioid agonist
  • ceiling effect limits high
  • long duration
  • highly motivated patients who do not need high doses
122
Q

suboxone

A
  • subutex and naloxone

- discourage illicit use

123
Q

naltrexone

A
  • full opioid antagonist
  • alcohol and opioid use disorder
  • used under medical supervision
124
Q

PCP intoxication

A
  • unpredictability
  • hallucinations
  • nystagmus
125
Q

PCP treatment

A
  • benzodiazepine

- low stimulation environment

126
Q

PCP tolerance/withdrawal

A

-typically does not occur

127
Q

hallucinogen persisting perception disorder

A

reliving perceptual symptoms experienced while intoxicated with hallucinogen with significant distress

128
Q

sedative, hypnotics, anxiolytic intoxication

A

similar to alcohol but less motor deficit

129
Q

sedative, hypnotics, anxiolytic overdose

A
  • CNS and respiratory depression

- treated with flumazenil

130
Q

barbiturates withdrawal

A

potentially life threatening

131
Q

benzodiazepine withdrawal

A
  • similar to alcohol

- common detox mistake is fast taper

132
Q

stimulant intoxication

A
  • euphoria
  • pupillary dilation
  • cardiac arrhythmia
133
Q

cocaine withdrawal

A
  • exhaustion
  • dysphoria
  • lethargic

Behavioral Medicine (5 decks)

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