Exam 1 Flashcards
(201 cards)
1
Q
What is the most prevalent mental illness?
A
anxiety disorders
2
Q
What is the 10th leading cause of death overall in the US?
A
suicide
3
Q
What race has the highest prevalence of living with a mental health condition?
A
AI/AN followed by asian
4
Q
What are the components of the psych interview?
A
establish relationship with patient assess risk formulate ddx and management plan negotiate and initiate tx plan produce standard record
5
Q
What is the biopsychosocial model?
A
holistic approach that examines disease/illness beyond the pathophysiological construct
6
Q
What facilitates working alliance?
A
attentive listening, empathy, respect and communication
7
Q
What is content and process?
A
what is being said and how its being said
8
Q
What are 3 psych interview techniques?
A
normalization
continuation
redirection
9
Q
Normalization
A
helps reduce shame/stigma, being judges
10
Q
Continuation
A
acknowledges patient, engages, nonverbal cues
11
Q
Redirection
A
helps guide and focus interview
12
Q
How long should you allow the pt to talk freely without interruption?
A
at least 3-4 minutes
13
Q
What is SIGECAPS?
A
sleep interest guilt energy concentration appetite psychomotor agitation slowing or suicidality
14
Q
What is the goal of past psych hx?
A
obtain information about psych illnesses and their course over pts lifetime including sx and tx
15
Q
What is the goal of social development hx?
A
establish pts development and social hx across various stages of pts life
16
Q
How far apart should clinician and patient be seated?
A
4-6 feet
17
Q
What is WHODAS?
A
world health organization disability assessment schedule
18
Q
What are the 6 domains of WHODAS?
A
cognition mobility self-care getting along life activities participation
19
Q
What are the 4 Ps?
A
predisposing factors
precipitating factors
perpetuation factors
protective factors
20
Q
What is MAPPS-CO?
A
mood anxiety psychosis personality substance/addiction somatic cognitive obsessions/compulsions
21
Q
What is the purpose of the MSE?
A
evaluate, qualitatively and qualitatively a range of mental functions and behaviors at a specific point in and provide impt info for diagnosis
22
Q
What are the components of MSE?
A
general appearance and attitude motor activity/behavior orientation/level of consciousness mood and affect speech thought form and content perception memory and cognition judgement and insight
23
Q
What is psychomotor retardation and what does it signify?
A
slowing of physical and emotional rxns
may signify depression or negative sx of schizophrenia
24
Q
What is psychomotor agitation and when may it occur?
A
excessive motor and cognitive activity may occur with anxiety or mania
25
Tics
sudden repetitive, jerky movements of eyes, vocal organs, face, extremities or trunk
26
Compulsion
repetitive and ritualized behavior which the person feels compeleld to perform
27
Echopraxia
involuntary repetition or imitation of another persons actions typically seen with Tourette's or autism
28
Akathisia
movement disorder characterized by feeling of inner restlessness and compelling need to be in constant
SE of APS
29
Catalepsy
person can be molded into position that is then maintained for prolonged period of time
seen in catatonic schizophrenia
30
Catatonia
severe disturbance of motor fn usually manifested by markedly decreased activity but may involve hyperactivity with alteration btwn these states
31
Dystonia
involuntary muscle contractions that cause slow repetitive potentially painful movements or abnormal postures
Drug induced
32
Dyskinesia
difficulty or distortion in performing voluntary mvts
33
How do you check orientation?
time
place
person
situation
34
obtunded
slowed response to stimulation
35
stuporous
awakening in response to pain
36
comatose
unresponsive
37
Affect
patients observed expression of emotion
38
Circumstantiality
over inclusion of trivial or irrelevant details that impede sense of getting to the point
39
clanging
thought associated with sound of word rather than by their meaning
40
derailment
breakdown in both logical connection between ideas and overall sense of goal directness
41
flight of ideas
succession of multiple associations so that thought seem to abruptly move from idea to idea often expressed though rapid pressured speech
42
neologism
invention of new words or phrases
43
preservation
persistent repetition of specific words or concepts despite absence or cessation of stimulus
44
tangentiality
pt gives reply thats appropriate to general topic without actually answering the question
45
thought blocking
sudden disruption of thought or break in flow of ideas
46
word salad/incoherence
speech makes no sense at all
47
pressured speech
fast and difficult to interrupt
48
distractible speech
patient changes subject in response to something unrelated in environment
49
obsessions
intrusive and unwanted ideas which intrude into consciousness despite efforts to suppress them
50
grandiose
delusions of grandeur
51
persecution
belief that someone wants to cause them harm
52
erotomanic
belief that someone famous is in love with them
53
nihilistic
belief that self or part of self, others or the world does not exist
54
ideas of reference
belief that everything refers to pt
55
ideas of influence
beliefs about another person or force controlling some aspect of ones behavior
56
illusions
misperception or misinterpretation of REAL external sensory stimuli
57
dissociation
lack of connection in a persons thoughts, memory or sense of ID
58
depersonalization
sense that one is outside his/herself
59
derealization
subjective sense that the environment is strange of unreal
60
hallucinations
abnormal perceptions in which pt hears, sees, tastes, smells or feels something others cannot
61
When do illusions typically occur?
delirium and psychosis
62
When do hallucinations typically occur?
psychosis
63
When do auditory hallucinations typically occur?
schizophrenia
64
When do visual hallucinations typically occur?
organic conditions
65
when do tactile hallucinations typically occur?
alcohol or benzo withdrawal
66
How do you test attention?
spell world backwards
67
How do you test concentration?
serial 7s
68
What is patients insight?
patients ability to understand and acknowledge factors that influence a situation such as his/her illness
69
What is ASEPTIC?
```
appearance
speech
emotion
perceptions
thought content and process
insight and judgement
cognition
```
70
What is ddx for MDD?
```
secondary depression
bipolar disorder
anxiety disorder
greif/loss
personality disorder
dysthymia
adjustment disorder
```
71
Dysthymia
persistent long term depression
72
What are the most common comorbid psych disorders associated with MDD?
anxiety
substance use
personality disorders
73
MDD etiology
early environment shapes neuronal connectivity and current environment unmasks vulnerabilities to trigger depression via release of cortisol
74
What is the stress diathesis model?
predisposed due to genetics and brain structure/abnormalities and neurotransmitters but triggered by stressors to develop psych disorders
75
What neurotransmitters are involved in pathophysiology of depression?
serotonin, NE, dopamine
76
Neocortex
concentration
77
Striatum
sluggish movement
78
Central striatum
anxiety
79
Hypothalamus
sleep and appetite
80
Hippocampus
memory
81
Risk factors for recurrence
multiple lifetime episodes
incomplete response to treatment
absence of acute stress when episode beings
severity of episode
82
Danger signs of suicide
```
talking about it
hopelessness/helpless/worthlessness
preoccupation with death
making arrangements
giving things away
anxiety
```
83
MDD epidemiology
2x MC women
84
MDD general tx
tricyclics, SSRI, SNRI, MAOI
85
NeuroStar TMS
transcranial magnetic stimulation for MDD with no improvement from meds
86
ECT
100 volt shock for MDD pt who don't respond to drugs
87
Epidemiology of DMDD
MC males
88
Positive symptoms
delusions, hallucinations, disorders of thought, agitation/aggression
89
Negative symptoms
affect flattening, apathy, anergia, asociality, alogia, diminished emotional expression, attentional impairment
90
cognitive sx
working memory
executive fn
attention
learning
91
mood sx
depression
anxiety
suicide
92
Brain pathways affected by schizophrenia
hyperactive mesolimbic pathway causing positive sx
| hypoactive mesocortical pathway causing negative, cognitive and mood sx
93
What is the effect of blocking nigrostriatal D2?
EPS
94
How does glutamate regulate dopamine?
directly-fibers progect to brainstem neurons
| indirectly-fibers direct to GABA to brake
95
How does PCP induce schizophrenia like effects?
Blocking brain NMDA receptors
96
Pathyphys od schizophrenia
synaptic pruning
lateral and third ventricles are enlarged
reduction of blood flow to left globus pallidus
thinner temporal love
smaller anterior hypothalamus
97
Precipitating factors of schizophrenia
brain damage, birth trauma, viral infections, nutritional dissues
98
risk factors for schizophrenia
```
FH
urban areas
northern hemi
winter month birth
pregnancy complications
loss of parent during childhood
lower socioeconomic status
```
99
What percentage of schizophrenia patients commit suicide?
10%
100
Poor prognostic factors of schizophrenia
```
early age of onset
male
more neg sx
more brain abnormalities
lower level of fn prior to onset
substance abuse
disorganized subtype
```
101
Fluphenazine
high potency APS for schizophrenia
102
Trifuoperazine
High potency APS for schizophrenia
103
thiothixine
High potency APS for schizophrenia
104
haloperidol
High potency APS for schizophrenia
105
thioridazine
low potency APS for schizo
106
chlorpromazine
low potency APS for schizo
107
Effect of anti-H1
sedation and weight gain
108
effect of anti alpha 1
orthostasis and reflex tachycardia
109
anti-M1
blurry vision, dry mouth, constipation, urinary retention, tachy, memory problems, delerium
110
effects of high potency APS
more EPS but less anti H1, anti alpha 1 and anti M1
111
What are EPS?
acute dystonia, akathisia, drug induced parkonsonism and tardive dyskinesia
112
Drug induced parkonsonism
bradykinesia, rigidity, tremors
113
Acute dystonia
sudden sustained forceful muscle contractions
114
akathisia
motor restless or discomfort relieved by movement
115
tx for dystonia
benztropine
116
tx for parkonsonism
reduce APS or benztropine
117
tx for akathisia
reduce APS, use propanolol or benzodiazepine (valium)
118
tx for tardive dyskinesia
cease APS if possible
119
clozapine
atypical APS
120
risperidone
atypical APS
121
olanzapine
atypical APS
122
quetiapine
atypical APS
123
ziprasidone
atypical APS
124
aripiperazole
atypical APS
125
paliperidone
atypical APS
126
iloperidone
atypical APS
127
SE of atypical APS
weight gain, inc blood glucose, increased triglycerides, possible sedation, QT prolongation
128
panic disorder
anticipatory anxiety, misinterpretation of bodily sensations, belief that avoidance is protective
129
social phobia
negative social expectations, fear of humiliation or judgement,
130
PTSD
overestimation of risk of repetition of traumatic experiences
131
Physiological response to stres
cortisol, monoamines (5-HT and NE), central NY (gaba and glutamate)
132
sympathetic
fight or flight
133
parasympathetic
rest and digest
134
agoraphobia
fear of places and situations that cause panic
135
How does avoidance sustain dysfunction?
rewarded by reduction in unplesant arousal
136
Anxiety treatments
benzos, SSRI, SNRI, tricyclic antidepressants, Buspar, anticonvulsants, cognitive behavior therapy
137
How are addictive behaviors reinforced?
dopamine is released in nucleus accumbens and DA will increase with anticipation of reward
138
sensitization
repeated administration of stimulus results in amplification of response
139
tolerance
need more to get desired effect
140
What is CAGE
2 yeses indicated possible substance use disorder
cut back
annoyed
guilty
eye opener
141
What is the most commonly abused drug?
marijuana followed by prescription drugs
142
Nicotine MOA
agoist at nicotinic receptors causing inc NE
143
Nicotine route of administration
inhaled, oral
144
Nicotine intoxication
relaxation, increased concentration, anorexia, increased BP
145
Nicotine withdrawal
beings 1 hr after last cigarette, peaks in 24 rs, irritability, increased appetite, craving
146
Nicotine use d/o tx
bupropion, varenicline, replacement therapies, aovid cues, stress management, exercise
147
What is the most effective tx for nicotine use disorder
combo nicotine replacement and pharmacotherapty
148
alcohol use d/o MOA
GABA
149
alcohol use d/o intoxication
slurred speech, confusion, disinhibition, seizures
150
alcohol use d/o withdrawal
elevate BP, elevate puse, diaphoresis, confusion, seizures
151
alcohol use d/o adverse effects
cirrhosis, GI cancer, esophageal varices
152
alcohol use d/o minor withdrawal sx
insomnia, tremulousness, mild anxiety, GI upset, HA, palpitations, anorexia (6-12 hrs)
153
When are alcoholic hallucinations seen?
12-24 hours
154
When are alcoholic withdrawal seizures seen?
24-48 hours
155
When are alcoholic delirium tremens seen?
48-72 hours
156
Wernicke's enphalopathy triad
confusion, ataxia, abnormal eye movements
157
Korsakoff syndrome/psychosis
amnesai, confabulation, hallucinations
158
What causes wernicke-korkoff syndrome?
thiamine deficiency
159
Tx for acute alcohol withdrawal
```
Lorazepam
Alprazolam
Clonazepam
Diazepam
Chlordiazepoxide
```
160
alcohol use disorder tx
acamprosate
naltrexone
disulfiram
161
Caffeine MOA
dopamine
162
caffeine intoxication
palpitations, anxiety, irritability, insomnia
163
caffeine withdrawal
HA, lethargy, irritability, depressed mood
164
Opiates MOA
mu, kappa, delta
165
Opiate types
heroin, morphine, oxycotin
166
Opiates intoxication
euphoria, sedation, miosis, respirtory depression, constipation
167
Opiates withdrawal
dysphoria, myalgias, rhinorrhea, diarrhea, lacrimation, dilated pupils
168
Opiates adverse effects
HIV, hepatitis, endocarditis, self neglect, OD, death
169
Opiate OD tx
Naloxone (Narcan)
170
Tx for opioid use d/o
methadone
buprenorphine
clonidine
naltrexone
171
Stimulants
coaine, methamphetamine, amphetamines, methylphenidate
172
stimulants MOA
cocaine inhibits DA reuptake (increased DA in synapse)
173
stimulants intoxication
euphoria, increasde vigilance, anorexia, mydriasis, tachycardia, hypertension, arrhythmias, auditory and tactile hallucinations, psychosis, agitation
174
stimulants withdrawal
resemble MDD and suicidal ideation and attempts, dysphoria, hypersomnia, increased appetite, irritability, craving
175
stimulants adverse effects
necorsis of soft tissues, cyanosis, cardiovascular, stroke
176
tx for stimulant use d/o
symptomatic and behavioral
177
marijuana MOA
cannabinoid receptor is GPCR and inhbits adenylate cyclase
178
marijuana intoxication
perceptual disturbances, anxiety, paranoia, conjunctival injection, tachycardia, dry mouth, increased appetite
179
marijuana withdrawal
irritability, depression, restlessness, anorexia, cravings
180
marijuana adverse effects
amotivations syndrome, psychosis
181
PCP MOA
NMDA antagonist
182
PCP intoxication
RED DANES
183
REDDANES
rage, erythema, dialted pupils, delusions, amnesia, nystagmus, excitation, skin dryness
184
PCP withdrawal
lack of energy and depression
185
PCP adverse effects
memory loss, liver fn problems, depression, psychosis
186
hallucinogens MOA
serotonin agonist
187
hallucinogens effects
pupil dilation, wakefulness, hallucinations, visual disturbances
188
MDMA MOA
release monoamines
189
MDMA effects
euphoria, intimacy, diminished fear, improved self-confidence
190
MDMA withdrawal sx
depressed, paranoid, feeling cold, confused, nauseated, dizzy
191
What is perceptual distortions a symptom of?
delerium termens
192
mental illness
condition that affects pesons thinking, feeling or mood
193
mental disease
interruption, cessation or disorder of bodily functions, systems or organs with recognizable etiologic agent, identifiable set of signs/sx and or consistent anatomic alterations
194
mental disorder
clinically significant disturbance in individuals cognition, emotion, regulation or behavior
195
psychoanalytic theory
personality development and unconscious motivations
196
attachment theory
role of early caregive and child relations
197
Jealosy
belief that everynoe wants what they have
198
alogia
impoverished thinking and cognition assessed by patients speech
199
Anhedonia-asociality
difficulties in experiencing interest or pleasure and lack of involvement in social relationship
200
What is "depression is worth studiously memorizing extremely grueling criteria. sorry."
```
Depressed mood
loss of Interest
Weight loss or gain
inSomina
psychoMotor agitation
loss of Energy
inappropriate Guilt
decreased Concentration
Suicidal ideations
```
201
Suicide risk factors
```
M>F
Older men
Depression
Previous Attempt
Ethanol Abuse
Rational thinking loss
Lack of social support
organized plan
no spouse
sickness
```
