DSE Unit 4 Review Flashcards
(143 cards)
1
Q
Presence of physical symptoms in the absence of physical “signs”
Pain is the predominant symptom
Health Concerns play a central role in this patient’s life, to a degree that is not explainable by their physical condition
A
Somatic Symptom Disorder
2
Q
Somatic
A
Relating to the body as distinct from the mind
Somatic Symptoms should have basis in the physical body, not the mind
In somatic symptom disorder, the basis is not found in the body and is therefore assumed to be in the mind.
3
Q
DSM V criteria for Somatic Symptom Disorder
A
1+ symptom that significantly disrupts daily life
Symptoms may change but the state of “being symptomatic” lasts for at least 6 months
At least 1 of the following:
Disproportionate worry about severity not
supported by the actual severity
Persistant High Level of Health Anxiety Excessive Time & Energy devoted to Sxs Specify if PAIN is main complaint Specify if PERSISTANCE best describes Mild= 1 symptom Moderate = 2 Symptoms Severe = 3+ Symptoms
4
Q
Coexists mainly with Depression, Anxiety
and the non-aggressive Personality Disorders
A
Somatic Symptiom Disorder
5
Q
Cluster A Personality Disorders
A
Schitzophrenia-Delusional, Paranoid, Hallucinate
Schizoid - Asperger-ish Flat Affect, Detatched
Schitxotypal- Really Really Odd
6
Q
Overvalued Ideas
A
Schitzotypal Personality Disorder of Cluster A
7
Q
Flat Affect, Detached, Not interested in YOU
A
Schizoid Asperger’s - ish
8
Q
Hears voices, talks back to them
Unduly suspicious
Fixed False Beliefs (aliens are coming…)
A
Schitzophrenia
9
Q
Cluster B Personality Disorders
A
Antisocial
Histrionic
Narcissistic
Borderline
10
Q
The criminal who violates rights of others
Without Empathy
A
Antisocial Personality Disorder
Must begin before Age 15 (as conduct disorder)
Watch out, these folks can be Magnetic, Compelling and charming if reeling in a victim
11
Q
The Drama Queen; Everyone is her BFF
A
Histrionic Personality Disorder
12
Q
This girl makes the wrong choice every time
She is impulsive, unstable and very fearful of abandonment (guess why)
People love her or “see through her” and find her manipulative
She is often misdiagnosed as bipolar
A
Borderline Personality Disorder
THERAPY (evidence based) can really help these girls (2:1 female) learn coping skills enough to turn their lives around ENOUGH.
Totally worth a try
13
Q
Cluster B Personality Disorders
A
THE DISINHIBITED... Antisocial Histrionic Narcissistic Borderline
14
Q
Lamotragine (anti seizure that Rxs anger in mood disorders) & Antipsychotics are ok to treat this cluster but NOT BENZOS - too disinhibiting for a group that is already disinhibited
A
Cluster B:
Borderline
Narcisistic
Antisocial
Histrionic
15
Q
Lamotragine (anti seizure that Rxs anger in mood disorders) & Antipsychotics are ok to treat this cluster but NOT BENZOS - too disinhibiting for a group that is already disinhibited
A
Cluster B:
Borderline
Narcisistic
Antisocial
Histrionic
16
Q
Grandiose, Entitled, this Pt is most obnoxious and self involved but really she craves attention because she has very low self esteem.
A
Narcisistic Personality Disorder
(Juliana & Draco Malfoy)
DON’T LAUGH AT THESE PTS - self esteem is too low to sustain that without resorting to extreme responses
Reality Checks may not be the best idea either - Their deflection of responsibility is borne of shame, not hubris.
17
Q
Rx for Cluster Bs
A
Lamotragine, Abilify (antipsychotics) and Therapy but
NO BENZOS for Bs!!! Too disinhibiting !
18
Q
Cluster “C” Personality Disorders
A
The ANXIOUS Cluster
Avoidant
Obsessive-Compulsive PD (NOT OCD)
Dependent
19
Q
Perfectionistic to the point it interferes with task completion
Hoarders, Micromanagers & Work-a-holics
A
Obsessive Compulsive PD
20
Q
Rx for Cluster Bs
A
Lamotragine, Abilify (antipsychotics) and Therapy
21
Q
Can’t manage eating out alone, public restrooms or parties, feels INADEQUATE
A
Avoidant Personality Disorder
22
Q
Perfectionistic to the point it interferes with task completion
Hoarders, Micromanagers & Work-a-holics
A
Obsessive Compulsive PD
23
Q
You Can’t Shake This Friend Off
Submissive with very low self esteem
“Debbie”
A
Dependent PD
24
Q
Rx for Anxiety & Depression
A
Benzos until SSRIs kick in
25
Can't manage eating out alone, public restrooms or parties, feels INADEQUATE
Avoidant Personality Disorder
Use Benzos with these folks and SSRIs
26
An enduring pattern of inner experience & behavior that leads to distress & impairment OVER & OVER AGAIN
PERSONALITY DISORDER
27
REPETITION COMPULSION
divorce one abuser and marry another, compelled to keep making the same mistake. This is a "Disordered" person with a Personality Disorder. Figure out which one and refer to psychologist for testing and have him refer to an appropriate therapist.
28
Rx for Anxiety & Depression
Benzos until SSRIs kick in
29
Somatic Symptom Disorder
vs
Illness Anxiety Disorder
Somatic HAS physical symptoms + worry
Illness Anxiety HAS worry but no physical Sxs
30
Pt presents with unusual concern about howel movements or other vague complaint "tired heart"
No particular symptom but a great deal of concern about it
Illness Anxiety Disorder
Usually presents 20-50 yrs
Hypochondriacs
Often Obsessive-Compulsive Pers Disorder and/or Schitzophrenia
31
Rx for Illness Anxiety Disorder
SSRI + CBT Therapy
32
Somatic Symptom Disorder
Vs
Conversion Disorder
Somatic has physical Sxs but no SIGNS
Conversion has physical SIGNS that CAN BE LETHAL The mind disables the body. Prognosis is very poor. First Line Rx is education about the nature of the diagnosis, then CBT Therapy and attempt to relieve the sxs.
33
```
Chronic Stress/ HTN
Anxiety/ Asthma
Depression/ CAD
Smoking/ COPD
Obesity / Diabetes
```
Psychological Factors Affecting Other Medical Conditions
A DSM V Diagnosis
34
```
Chronic Stress/ HTN
Anxiety/ Asthma
Depression/ CAD
Smoking/ COPD
Obesity / Diabetes
```
Psychological Factors Affecting Other Medical Conditions
A DSM V Diagnosis
Mild-Won't take HTN meds
Mod-Smokes even though SOB
Severe- Results in ER or Hospitalizatin
Extreme (too depressed to go to ER for MI)
35
This Pt "fakes" a physical disorder, Tampers with equipment to support the lie, Implies head trauma when they have a genetically constricted pupil etc...
FACETIOUS DISORDER
Specify if first incident (that YOU know of)
or if this is a recurring behavior.
36
Munchausen
Facetious Disorder IMPOSED ON SELF
37
Munchausen by Proxy
Facetious Disorder IMPOSED ON ANOTHER
38
Substance ABUSE
vs
Substance DEPENDENCE
ABUSE: Tolerance, Withdrawal, Continued Use Even w/the understanding of cost
DEPENDENCE: loss of control over use
39
Well Being BAC
Up to 0.05%
40
Getting Risky BAC
| Reduced Inhibition
0.05 - 0.08%
41
Nausea/Vomit
| Dangerous BAC
.008 - 0.15%
42
BAC
| Stupor, Incontinence, Unable to walk unaided
0.15-0.4%
43
Death BAC
0.4% +
44
Well Being BAC
Up to 0.05%
3.75 Hrs to 0%
45
Nausea/Vomit
| Dangerous BAC
.008 - 0.15%
Legal Limit is 0.08% 5 hrs to 0%
46
Coma, Shock, Death BAC
0.4% +
47
MUST acronym for
Alcohol Poisoning:
M (Mental Confusion)
U (Unresponsive)
S (Snoring/Gasping for Air)
T (Throwing Up)
48
HELP Acronym for
Alcohol Poisoning
H (Hypothermia)
E (Erratic Breathing)
L (Loss of Consciousness)
P (Pale/Bluish Skin)
49
ETOH Poisoning Rx:
Thiamine IV/ Banana Bag
Pump Stomach
Respirator?
50
Methanol Poisoning Rx
Ethanol or Fomepizole
Fomepizole also for Ethylene Glycol Poisoning
51
NorEpi Dopamine Reuptake Inhibitors
Bath Salts & Meth
52
```
Extreme Insomnia
Jittery
Self Mutilation
Mutilation of others
Psychotic behavior
```
Hyperthermia
Bath Salts & Meth
53
CNS Depressants
Alcohol (s)
Aerosol Huffing
Benzos - hard to overdose on these just risk of addiction
54
Memory Loss, Unconsciousness, Urine/Fecal Incontinence/Liver Damage & Sudden Death by suffocation or MI
Aerosol Huffing Risks
55
Cocaine, Amphetamine, Caffeine, Nicotine
CNS Stimulants
56
Dilated pupils,
Elevated BP, Pulse & Temp
Nose Bleeds/Runny Nose
Seizures
Stimulants
Specifically Cocaine, Crack & Bath Salts
57
Euphoria
Rapid Speech
Increased Energy & Mental Alertness
Bleeds into Paranoia & Psychosis
Methamphetamine
& to a lesser degree
the other Amphetamines
58
NorEpi Dopamine Reuptake Inhibitors
Bath Salts & Meth
59
```
Extreme Insomnia
Jittery
Self Mutilation
Mutilation of others
Psychotic behavior
```
Hyperthermia
Bath Salts & Meth
60
```
Euphoria
Depressed Respirations
Constipation
Drowsiness
Tachycardia
Pin Prick Pupils (Myosis)
Sleepy to unresponsive
Apnea/Coma
```
Opiate High
61
```
Dyseuphoria
Tachypnea
HTN
Super Focus (on getting more)
Joint Aches
Mydriasis
Diaphoresis
Insomnia
Yawning (hyperrespiration)
```
Opiate Withdrawal
62
5 Ps
Drug/Alcohol Screen for pregnant women & women of childbearing age
63
Dopamine Releasor
Opiate
64
Heightened Senses
Loss of Identity
Illusions/Hallucinations
Altered Time/Distance Perception
Hallucinogens
Mushrooms
PCP
LSD
65
Illicit Drug relieves Asthma Sxs by relaxing bronchioles
Relieves Nausea, Migraines, Epileptic Seizure and Eye Pressure in Glaucoma, Joint Pain & Arthritis in ALS & MS
Marijuana
66
AUDIT screen for
Alcohol Abuse
67
CRAFFT
Alcohol & Drugs in Adolescents 6 questions
```
C Car
R Relax
A Alone
F Forget
F Family
T Trouble
```
68
TWEAK
Drinking During Pregnancy screen
69
DAST
10 quest Drug Abuse Screen
70
5 Ps
Drug/Alcohol Screen for pregnant women & women of childbearing age
71
Antidypsotropic
Rx that supports sobriety by effecting intolerable sxs when used with alcohol or drugs or by reversing affect of drug
```
Antabuse
Naltrexone
Campral for cravings & withdrawal
Methadone
Suboxone
```
72
Nicotine assistance
Chantix
Wellbutrin
nicotrol
73
Oxycodone
Immediate Relief
74
Oxycontin
Sustained Relief
| Street Value for 80mg Tablet is $1,000
75
Percocet
Oxycodone w/Tylenol
76
Seizure Protocol for ETOH Withdrawal
10 - 150mg Atavan IV to control agitation and prevent seizure
77
Seizures peak at ___ in ETOH withdrawal
24 hrs
But can begin 2 hrs after the last drink
78
SBRT Screen
Best Practice Primary Care Drug/ETOH Screen
Screen
Brief Intervention
Referral to
Treatment
79
SBRT Screen
Best Practice Primary Care Drug/ETOH Screen
Screen
Brief
Intervention
Referral to Treatment
80
Dilated Pupils & Tachy? Chest Pain?
| Quick get ___
EKG
| Cocaine & Amphetamines cause MIs
81
Disulfiram
Antabuse
82
Dilated Pupils & Tachy? Chest Pain?
| Quick get ___
EKG
| Cocaine & Amphetamines cause MIs
83
Unfortunate side effect of Chantix
Depression
84
Non-Suicidal Self Directed Violence
Cutters/Burners
| Need "to feel"
85
Egoistic Suicidal Ideation
I don't belong...
86
Altruisitic Suicide
Die for a Cause
87
Anomic Suicide
No point in going on
| No point to anything
88
Fatalistic
No hope of change
| No Point in going on
89
Altitude is a risk for
Suicide
Over 2,000 ft above sea-level 70% increase in suicide risk?????
90
Clozapine Black Box Warnings
Agranulocytosis, CNS Depression, Seizure, Bone Marrow Suppression, Myocarditis, Hypotension & Dementia
Follow w/CBC when prescribing Clozapine
91
Too much dopamine in the mesolimbic and too little dopamine in the mesocortical
Schitzophrenia
92
LSD and other hallucinogens activate Serotonin receptors in normal brains and cause hallucinations. What do we use in Schitzophrenia to quell hallucinations?
Serotonin Receptor Antagonists like
Clozapine (a NEW atypical antipsychotic)
Does NOT induce tardive dyskinesia like Risperidone. DOES cause: Weight gain, Constipation, drooling, bed wetting and bears black box warnings for : AGRANULOCYTOSIS, CNS DEPRESSION, SEIZURES...
SO.. Check CBCs regularly when on Clozapine. For these reasons, its a third line drug for Schitzophrenia even though it works better than older atypical antipsychotics.
93
D2 Receptor Antagonists
Antipsychotics, pines & dones Block D2
1st Gen: Haloperidol, Fluphenidol, Thiothixine
2nd Gen: Pines, Dones & Rip
94
Clozapine Black Box Warnings
Agranulocytosis, CNS Depression, Seizure, Bone Marrow Suppression, Myocarditis, Hypotension & Dementia
Follow w/CBC when prescribing Clozapine
95
DDx for Schitzophrenia
Psychotic Disorder Caused by Med. Cond
ex: Folate/B12 Deficiency
Manic Phase of Bipolar Disorder
Stimulant/Amphetamine Overdose
96
Schitzophrenic Symptoms less than 1 month
Brief Psychotic Disorder
97
Schitzo Symptoms 1 - 6 months
Schitzoaffective Disorder
98
Psychotic Symptoms with Mood irregularities and Schitzo Symptoms over 6 months
Schitzoprhrenia
99
Schitzo Symptoms 1 - 6 months
Schitzophreniform Disorder
100
Has Depressive or other mental comorbidity but has at least 2 weeks of pure schizophrenic symptoms
Schitzoaffective Disorder
101
Synapse Depletors are VMAT blockers - they reduce the monoamines secreted into synapse by blocking transport. Drugs used in Schitzophrenia:
Reserpine treats the depression, psychosis & HTN at the same time
"Serpine" venom treats HTN permanently...
Tetrabenazine - a Huntington's drug for dyskinesia
102
D2 Receptor Antagonists
Antipsychotics, pines & dones Block D2
1st Gen:
2nd Gen
103
Use these to counteract the dyskinesia caused by blocking D2 in the Nigrostriatal Pathway when treating Schitzophrenia with 1st Gen Antipsycotics
Anticholinergics like:
Benztropine & Diphenhydramine
Side effects are Dry Mouth, Blurred Vision, Constipation
Remember, Cholinergics make you Sludgy, Anticholinergics make you dry as a bone, mad as a hatter...
104
Schitzophrenia is a time dependent diagnosis. Under 1 month of sxs is "Brief Psychotic Disorder" while 1-6 months is _______ and over 6 months is full on Schitzophrenia
Schitzophreniform Disorder
105
Schitzoaffective vs Schitzophreniform
- Affective = w/other dx but at least 2 weeks of pure full on schitzo symptoms
- Phreniform = Pure schitzo but for less than 6 months
106
All effective Antipsychotics block this, here
Block D2 Receptors in the mesolimbic but usually they also block in the mesocortical, bringing on parkinsonian dyskinesias
Clonzapine targets Serotonin receptors and does a great job controlling schitzo behaviors but has serious bone marrow & CNS consequences.
107
Blocking D2 in the MesoLimbic Pathway
Causes deceased firing and decreased Psychosis - YAY - this is the one we want, unfortunately First Generation Antipsychotics aren't really selective. Choos 2nd Gen, Atypical Antipsychotics and if they don't work try Abilfy or Clonzapine
108
All effective Antipsychotics block this, here
Block D2 Receptors in the mesolimbic but usually they also block all or several of the pathways bringing on parkinsonian dyskinesias, prolactinemia, and cognitive deficits.
Clonzapine targets Serotonin receptors and does a great job controlling schitzo behaviors but has serious bone marrow & CNS consequences.
109
Decrease Dopamine, decrease psychosis but you risk Increasing
Depression and dyskinesia
110
Too much Nor-Epi is also an issue in Schitzo
Block the monoamine transporter and you decrease both NorEpi and Dopamine
You decrease depression, decrease psychosis and decrease HTN all in one go
Reserpine
111
Synapse Depletors are VMAT blockers - they reduce the monoamines secreted into synapse by blocking transport. Drugs used in Schitzophrenia:
Reserpine treats the depression, psychosis & HTN at the same time
Tetrabenazine - a Huntington's drug for dyskinesia
112
D2 Receptor Antagonists
Antipsychotics, pines & dones Block D2
1st Gen:
2nd Gen
113
Tuberoinfundibular Pathway
Blocks Prolactin secretion.
Block the D2 receptor here and prolactin gets released leading to gynecomastia and low testosterone/ED/low sperm count symptoms
114
Blocking D2 in the NigroStriatal Pathway
Causes tardive dyskinesias
115
Blocking D2 in the Mesocortical Pathway
Causes Cognitive Deficits
116
Blocking D2 in the MesoLimbic Pathway
Causes deceased firing and decreased Psychosis - YAY - this is the one we want, unfortunately First and Second Generation Antipsychotics aren't really selective
117
All effective Antipsychotics block this, here
Block D2 Receptors in the mesolimbic but usually they also block all or several of the pathways bringing on parkinsonian dyskinesias, prolactinemia, and cognitive deficits.
Clonzapine targets Serotonin receptors and does a great job controlling schitzo behaviors but has serious bone marrow & CNS consequences.
118
Rare, but life-threatening, Rxn to NEUROLEPTIC MEDICATIONS LIKE ANTIPSYCHOTICS that is characterized by
fever
muscular rigidity
altered mental status, and autonomic dysfunction.
Usually occurs w/in 10 days of initiation of the neuroleptic, or after dose increases.
NEUROLEPTIC MALIGNANT SYNDROME
Too Much D2 Receptor Blocking
STOP the antipsychotic
Cool him to normal temp
Relax the muscles
Usually resolves w/in 2 weeks with supportive care, if dose was long term depot, will take a month
Can use Dantrolene to Rx muscle spasms and hyperthermia - its a D2 Agonist
119
D2 Agonist used to treat hyperthermia and muscle rigidity
Dantrolene
120
Rare, but life-threatening, Rxn to NEUROLEPTIC MEDICATIONS LIKE ANTIPSYCHOTICS that is characterized by
fever
muscular rigidity
altered mental status, and autonomic dysfunction.
Usually occurs w/in 10 days of initiation of the neuroleptic, or after dose increases.
NEUROLEPTIC MALIGNANT SYNDROME
Too Much D2 Receptor Blocking
STOP the antipsychotic
Cool him to normal temp
Relax the muscles
Usually resolves w/in 2 weeks with supportive care, if dose was long term depot, will take a month
Can use Dantrolene, to Rx muscle spasms - its a Ca+ blocker in the sarcoplasmic reticulum & prevents muscle contraction
121
Muscle Relaxant used to treat muscle rigidity
Dantrolene
122
D2/D3/D4 Agonist used to Rx hyperthermia and also Restless Leg, Parkinsons and Bipolar Disorder
Pramiprexole But...
Causes: Compulsive Gambling, eating & hypersexuality
It prefers D3 but does agonize D2 & D4
123
Use these to counteract the dyskinesia caused by blocking D2 in the Nigrostriatal Pathway when treating Schitzophrenia with 1st & 2nd Gen Antipsycotics
Anticholinergics like:
Benztropine & Diphenhydramine
Side effects are Dry Mouth, Blurred Vision, Constipation
Remember, Cholinergics make you Sludgy, Anticholinergics make you dry as a bone, mad as a hatter...
124
Choreic Movements in dyskinesia
Fast, Jerky
Blocking D2 too much causes this but so does too much Dopamine as with too much levodopa in parkinsons treatment
125
Athetotic Movements
Slow & Writhing
126
1st Gen High Potency Antipsychotics
(FGA-High Potency)
1st Gens are aka TYPICAL Antipsychotics
Haloperidol
Fluphenazine
Thiothixine
Dyskinesia, Dry Mouth, Hypotension & Sedation via H1 blockade
127
1st Gen Low Potency Antipsychotics
| FGA-Low Potency
Chlorpromazine
| Thioridazine
128
FGA High Pot Side effects
Dyskinesia, Dry Mouth, Hypotension & Sedation via H1 blockade
129
2nd Gen Antipsychotics aka
A-Typical Antipsychotics
130
Atypical Antipsychotic Drug MOA
Selectively Blocks Mesolimbic D2 receptors controling psychosis but leaving the others alone, reducing dyskinesia, cognitive impairment and Prolactin effects of 1st Gens
Also block Serotonin Receptors to further decrease hallucination (recall LSD antagonizes serotonin receptors and causes hallucinations)
131
2nd Gen Atypical Drugs for Schitzophrenia
Dones Pines Rips
Risperadone Olanzapine Ariprazole
Quetiapine
Clozapine
132
2nd Gen Atypical Drugs for Schitzophrenia
Dones Pines Rips
Risperadone Olanzapine Ariprazole
Quetiapine D2/D3
Clozapine Agonist
133
Dones make you
Twitchy
134
Pines make you
Fat
135
2nd Gen Atypical Drugs for Schitzophrenia
Dones Pines Rips
Risperadone Olanzapine Ariprazole
Quetiapine D2/D3
Clozapine Agonist
"Abilify"
136
Dones make you
Twitchy
Ziprasidone and Iloperidone have long QT
137
Pines make you
Fat & Lazy (due to sedation from H1 blockade)
138
aRIPrazole (Abilify) makes you
Fat, Stuffy Nose, Constipated & Twitchy
139
long term Brain Changes in Schitzophrenia
Grey matter/Cortical tissue atrophies
Ventricles enlarge and fill with CSF
140
IS PATH WARM??
Suicide Acronym
```
I Ideation
S Substance Abuse
P Purposeless-ness
A Anxiety
T Trapped
H Hopeless
W Withdrawal
A Anger
R Reckless
M Mood Change
```
141
Rapid Onset Drug Rxn: Increases in Heart Rate, Bp and Temp with Altered Mental Status, Rhabdo, Acidosis, Seizures
Twitching, Hyper-reflexia, Renal Failure, Death
Serotonin Syndrome
May occur within minutes of elevation of serotonin levels
142
Lead Pipe Rigidity, Hyporeflexia, Normal Bowel Sounds
vs
Clonus, Mydriasis and Hyperreflexia and Hyperactive Bowel Sounds
Neuroleptic Malignant Syndrome has rigidity whereas Serotonin Syndrome has the clonus and hyper-reflexia.
Both have increased HR, BP and Temp as well as altered mental status and Drooling
143
Overdose causes cardiac arrythmias within the hour that very well may be fatal
TCAs
The brugada type QRS
