116: exam 4

Question 1

what are the risk factors for suicide?

Answer 1

divorced, elderly, poor/uneducated, severe insomnia,

Question 2

what is the schizophrenia diagnosis criteria?

Answer 2

2 or more of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (decrased expression) FOR AT LEAST 6 MONTHS

Question 3

how long does delusional disorder last?

Answer 3

1 month, function still intact

Question 4

describe brief psychotic disorder

Answer 4

sudden onset, 1 day to 1 month then full return to functioning

Question 4

describe schizophreniform

Answer 4

less than 6 months of symptoms

Question 5

describe schizoaffective disorder

Answer 5

concurrent mood symptoms with depression or mania

Question 5

what is psychosis?

Answer 5

altered cognition, perception, or reality testing

Question 6

how long do symptoms last for schizophrenia?

Answer 6

more than 6 months

Question 7

what is the onset for schizophrenia?

Answer 7

gradual

Question 7

does schizophrenia meet the criteria for a mood disorder?

Answer 7

no

Question 8

what happens to function with schizophrenia?

Answer 8

marked functional impairment

Question 9

when you have schizophrenia with psychosis it is….

Answer 9

more severe

Question 10

what are the positive symptoms of schizophrenia?

Answer 10

hallucinations, delusions, disorganized thinking, alterations in behavior

Question 11

what are the negative schizphrenia symtpoms?

Answer 11

affective deficits, relational deficits, communicative deficits, apathy

Question 12

what is an example of a first generation antipsychotic given to schizphrenia pts?

Answer 12

haloperidol

Question 13

what are side effects of first generation antipsychotics?

Answer 13

extrapyramidal symptoms (EPS)

Question 14

what are some second generation antipsychotics?

Answer 14

risperidone, clozipine, quetiapine

Question 15

what are the extrapyramidal symtpoms?

Answer 15

pseudoparkinsonism, acute dystonia, akathisia, tardive dykinesia

Question 16

second generation antipsychotics are at an increased risk of developing

Answer 16

metabolic syndrome

Question 17

clozapine can cause

Answer 17

agranulocytosis

Question 18

what must you monitor if your pt is on clozpine?

Answer 18

neutrophils

Question 19

what are some dangerous side effect for all antipsychotics?

Answer 19

anticholinergic toxicity, neuroleptic maligant syndrome, agranulocytosis, QT interval prolongation, liver impairment

Question 20

symptoms of anticholinergic toxicity

Answer 20

(can’t see, can’t pee, can’t spit, can’t shit) flushed skin, altered LOC

Question 21

symptom of neuroleptic malignant syndrome

Answer 21

“FALTER” fever, ams, leukocytosis, tremor, elevated cpk, rigidity

Question 22

major depressive disorder is diagnosed when

Answer 22

5 or more symptoms during the same 2-week period at least one of the symptoms is depressed mood or loss of interest (depressed mood, decreased interest, weight change, sleep disturbance, fatigue, psychomotor changes, feelings of worthlessness or guilt, recurrent thoughts of death, diminished concentration)

Question 23

what is the normal WBC?

Answer 23

4-10 thousand microliter

Question 24

what are the symptoms of serotonin syndrome?

Answer 24

abdominal pain, fever, increased hr, sweating, delirium, htm, muscle spasms, irritability

Question 25

what should you do if you are experiencing symptoms of serotonin syndrome?

Answer 25

go to er; this is life threatening

Question 26

to ensure a seizure over the entire brain during electroconvulsive therapy,... what may be done?

Answer 26

a bp cuff may be inflated over the lower arm or leg before paralytic is given

Question 27

in bipolar I disorder, diagnosis must inlcude?

Answer 27

at least one manic episode

Question 28

bipolar I is different than bipolar II because...

Answer 28

a major depressive episode does not have to occur in bipolar I

Question 29

what is pressured speech?

Answer 29

fast, loud, won't let others talk

Question 30

what is circumstantial speech?

Answer 30

unneccesary details, but gets to the point

Question 31

what is tangenital speech?

Answer 31

same as circumstantial except the point is never reached

Question 32

what is the therapeutic range of lithium?

Answer 32

0.6-1.2

Question 33

lithium should not exceed?

Answer 33

1.5

Question 34

what are the expected side effects of lithium?

Answer 34

nausea, vomiting, diarrhea, thirst, polyuria, lethargy, fine hand tremor, goiter/hypothyroidism

Question 35

lithium use may result in what long term

Answer 35

renal toxicity

Question 36

what are the early signs of toxicity? what mEQ is it at?

Answer 36

1.5-2.0; gi upset, coarse hand tremor, confusion, hyperirritability of muscles, ecg changes, sedation

Question 37

what is the mneumonic to remember side effects of lithium?

Answer 37

"LITHIUM" lethargy, insipidus, tremor, hypothyroidism, increased weight, upset stomach, more severe

Question 38

what are the advanced signs of lithium toxicity?

Answer 38

ataxia, giddiness, serious ECG changes, blurry vision, clonic movements, large output of dilute urine, seizures, stupor, severe hypotension, coma

Question 39

why does death usually occur in advanced lithium toxicity?

Answer 39

secondary to pulmonary complications

Question 40

what are symptoms of severe toxicity >2.5?

Answer 40

convulsions, oliguria, death

Question 41

what mood stabilizers may be given to bipolar patients?

Answer 41

valproate (valproic acid and divaloproex sodium), carbamazepine, and lamotrigine

Question 42

if antidpressants such as SSRI are taken alone, it can cause a ____________ in a pt with bipolar disorder

Answer 42

manic episode

Question 43

benzos are used for

Answer 43

short term

Question 44

what is a non pharmalogical intervention for bipolar pts?

Answer 44

psychoeducation

Question 45

mild anxiety allows someone to...

Answer 45

solve problems more effectively

Question 46

what occurs in moderate anxiety?

Answer 46

ability to think is compromised but can still learn and solve problems

Question 47

what occurs in severe anxiety?

Answer 47

learning and problem solving are not possible; unable to be reoriented

Question 48

what happens in panic anxiety?

Answer 48

loss of touch with reality, unable to focus on one detail

Question 49

what is the main focus with panic anxiety?

Answer 49

safety

Question 50

what is the amygdala responsible for?

Answer 50

memories with emotional significance

Question 51

what is adaptive defenses against anxiety?

Answer 51

lowering the anxiety for the acceptable achievement of goals

Question 52

what is maladaptive defense against anxiety?

Answer 52

overuse of defense mechanisms; not helping being able to interact with others

Question 53

hypervigilance

Answer 53

knows where the exit doors is; always aware; on edge

Question 54

hyperarousal

Answer 54

anger issues, panic, agitation

Question 55

whats the most effective type of couseling for PTSD?

Answer 55

CBT cogntivie beahvioral therapy

Question 56

if symptoms of acute stress disorder last longer than one month what does this mean?

Answer 56

ptsd

Question 57

what is a reason someone may be experiencing adjustment disorder?

Answer 57

losing a loved one, prolonged grieving, divorce, failure,rejection)wh

Question 58

when does adjustment disorder typically prevail?

Answer 58

3 months after the event and continues up to 6 months

Question 59

somatic system disorder describe it.

Answer 59

distressing symptoms, usually more than 6 months, high levels of anxiety, and maladaptive response, without physical findings and medical diagnosis

Question 60

dissociatiave anemia is...

Answer 60

unable to recall their identity

Question 61

dissociative identity disorder is...

Answer 61

two or more personalities

Question 62

intentional act of killing oneself

Answer 62

suicide

Question 63

what is suicidal ideation?

Answer 63

thinking, wishing, considering, and/or planning death

Question 64

what is sucidal attempt

Answer 64

the intentional act of killing oneself

Question 65

acute dystonia

Answer 65

facial grimacing, involuntary upward eye movement, muscle spasms of the tongue, akathisia

Question 66

what medications are given for major depressive disorder?

Answer 66

SSRI, TCA, MAOI, bupropion

Question 67

what should you remember to ask about when reviewing meds?

Answer 67

do they take any herbal supplements

Question 68

what does st. johns wort work for?

Answer 68

depression; but dangerous when in combination with SSRI

Question 69

the combination of SSRI and st. johns wort=

Answer 69

serotonin syndrome

Question 69

you use electroconvulsive therapy as...

Answer 69

a last resort if meds dont work

Question 70

what is electroconvulsive therapy used for

Answer 70

only depression not schizophrenia

Question 71

what does ashwanghands work for?

Answer 71

anxiety

Question 72

what does kava work for?

Answer 72

anxiety but watch liver

Question 73

what should you watch for with ginko biloba?

Answer 73

bleeding with warfarin

Question 74

what should you monitor for with lamotrigine?

Answer 74

rash; can develop stevens johnsons syndrome

Question 75

agoraphobia

Answer 75

fear of being in open shops/markets but more specifically fear of being vulnerable and unable to get help

Question 76

what medicine can you give for OCD?

Answer 76

paroxetine

Question 77

pulling out of one's own hair that results in noticeable hair loss

Answer 77

trichotillomania

Question 78

what is the outcome criteria for ptsd?

Answer 78

acknowledging the event, expereince fewer flashbacks, demonstrate adaptive coping strategies, make realistic goals

Question 79

what is the first line treatment of ptsd?

Answer 79

SSRI: paroxetine and setraline

Question 80

what is the most effective treatment for ptsd?

Answer 80

cognitive behavior therapy

Question 81

what is important to remember aout somatic symptom disorder?

Answer 81

these symptoms are real to the pt so be careful of body language and tone

Question 82

what is illness anxiety disorde?

Answer 82

no somatic symptoms; overconcerned for health and preoccupied with symptoms for at least 6 months

Question 83

what therapies are available for dissociative disorders?

Answer 83

psychotherapy, hypnosis, CBT, individual/group therapy

Question 84

what precautions should you use with dissociative disorders?

Answer 84

suicide

Question 85

what should you remember to do with dissociative disorders

Answer 85

always assess safety and sucidie risk