FINAL Flashcards

Question

ADHD

Answer 1

-Inattention -6+ < 16yo -5+ >17yo -6 months: -no close attention to details -> careless mistakes -cant hold attention on tasks -doesnt listen when spoken to -doesnt follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). -organizing tasks and activities. -avoids tasks that require mental effort over a long time -loses things -easily distracted -forgetful in daily activities. -Hyperactivity and Impulsivity: -6+ < 16 years -5+ >17 yo -6 months -fidgets; taps hands or feet, or squirms -leaves seat -runs about or climbs -unable to play quietly. -“on the go” - motor” -talks excessively. -blurts out -trouble waiting their turn. -interrupts or intrudes on others -Cause: Decreased dopamine in frontal lobe -> decreased arousal!

Answer 2

-poor social-emotional reciprocity, ex. abnormal back-and-forth -> reduced sharing of interest -> failure to initiate social interactions. -poor nonverbal communication -poor development, maintaining, and understanding relationships, ex. appropriate behavior per situation -> to difficulties in imagination -> absence of interest in peers -at least 2: -Stereotyped or repetitive motor movements, use of objects, or speech (motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases) -adherence to routines, ritualize patterns -Highly restricted, fixated interests that are abnormal in intensity or focus -Hyper- or hyporeactivity to sensory input (indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement) -based on social communication problems and repetitive patterns of behavior

Answer 3

-4+: -Aggressive toward people/animals -physical altercations with others -Use of a weapon -physically cruel to people -cruel to animals -forcible sex act on another -Property destruction by arson -Property destruction -economic crime; ex. breaking and entering -confrontational economic crime- ex. mugging -theft; ex. shoplifting -broke curfew before 13yo -run away at least 2 times -Truant before 13yo! -impairment in functioning - < 18 yo

Answer 4

-6 months -4 + -loses temper -touchy or easily annoyed -angry and resentful. Argumentative/Defiant Behavior -argues with authority figures -> for children, with adults -refuses to comply with authority figures or rules -deliberately annoys others -blames others -spiteful or vindictive > 2x within 6 months -<18yo

Answer 5

-Excessive thoughts/behaviors of somatic symptoms -1+, 6 months: -thoughts about seriousness of symptoms. -anxiety about health or symptoms. -time and energy to symptoms or health concerns. -1 somatic symptom may not be present, but being symptomatic is persistent (typically more than 6 months) -physical symptoms with no pathology -1. conversion- extreme stressor -> neurological loss -la belle indifference- pt appears less concerned with disability than expected -2. hypochondriasis -3. body dysmorphic disorder -4. factitious disorder -5. malingering

Answer 6

-heritability estimated between .60 and .90 -Emil Kraepelin- dementia -Eugene Bleuler- 1911- schizophrenia -Kurt Schneider- delusions, hallucination -> first rank symptoms -Tx in1950s- thorazine (chlorpromazine) -increase dopamine in limbic and decrease in frontal cortex -10 year period- 15% recover, 30% live independently, 30% require extensive help, 15% dont improve at all, and 10% suicide -each recurrence -> increase impairment -1. delusions -2. hallucinations -3. disorganized speech -disorganized or catatonic behavior -negative symptoms -impairment in work, interpersonal, or self relationships -6 months with at least 1 month with active symptoms -r/o schizoaffective disorder

Answer 7

-delusions- grandiose, paranoid, somatic (bodily abnormality, illness, special attribute) -bizarre or non-bizarre -hallucinations- derogatory, command -disorganized speech/thought -disorganized/bizarre behavior- inappropriate out of context -ex. pt covering self in feces, undressing in class -negative symptoms- anhedonia, asociality, affect -avolition- no interest in routine activity -alogia- no speech

Answer 8

-Clanging: Rhyming of words -I heard the bell. Well, hell, then I fell. -Flight of Ideas: Sequence of loose associations -> speaker jumps to unrelated topic -I own five cigars. I’ve been to Havana. She rose out of the water, in a bikini. -Neologisms: Made up words -I got so angry I picked up a dish and threw it at the geshinker.“ -Word Salad: Nonsensical use of words -Because it makes a twirl in life, my box is broken help me blue elephant. Isn’t lettuce brave? I like electrons, hello please! -Loose Associations: Connections between thoughts are very weak -He went to the ballpark and bought Frank’s beer belly home in a bag of grass seed. -Incoherence: no connections between thoughts -Blue afraid you no carpet cat got fear bricks of orderly mess.

Answer 9

-1) Prodrome: Gradual onset of behavioral disturbances, social withdrawal, academic decline -irritable, suspicious, disorganized, obsessed with odd hobbies or the occult. -2) Acute: Clinically significant signs and symptoms, causing great distress -May be episodic with transient remissions or chronic. -3) Residual: Negative symptoms predominate. Appears withdrawn, preoccupied, flat or depressed. Impoverished speech and poor cognition.

Answer 10

-Dopamine antagonists -Haldol! (haloperidol!), Loxitane (loxapine), Mellaril (thioridazine) -MOA- strong affinity for dopamine receptors -decrease positive symptoms -negative symptoms - probably worsened -SE: -dystonia, EPS's, targive dyskinesia (contortions), prolactinemia -neuroleptic malignant syndrome- fever, muscle rigidity, AMS

Answer 11

-Dopamine/Serotonin antagonists -Olanzipine (Zyprexa), Quetiapine (Seroquel), Risperidone (Risperdal) -MOA- weak dopamine blocker, strong serotonin blocker -positive symptoms- decrease -negative symptoms- possible decrease -Side Effects: Decreased Dystonia, EPS’s, Tardive Dyskinesia, Prolactinemia -much less side effects

Answer 12

-Dopamine partial agonist (agonist/antagonist) -Abilify (Aripripazone), Geodon (Ziprasidone) -MOA- decrease dopamine where too high and increase dopamine where too low -positive symptoms- decrease -negative symptoms- possible decrease -Side Effects: Decreased dystonia, EPS’s, Tardive Dyskinesia, Prolactinemia -best side effect profiles

Answer 13

-Parkinsonism-rigidity, tremor, bradykinesia, masklike facies. -TX- lowering dose, changing meds, adding anticholinergic (cogentin, artane) -Akathisia- restlessness, pacing, fidgeting, jitteriness. -TX- lowering dose, changing meds, propanolol, benzodiazepines, cogentin -Acute dystonia- muscle spasm, torticollis, tongue protrusion -TX- IM benadryl or cogentin -Tardive dyskinesia- involuntary movements after long term antipsychotic therapy. -begins with tongue or digits and progresses to face, limbs -TX- switching meds, lowering dose -usually a symptom for life

Answer 14

-3+; 12 months: -tolerance -withdrawal -substance taken in larger amounts of longer period intended -persistent desire, craving -failure to quit -time spent trying to get it, use it, recover -can get work, home, or school work done -social, occupational, recreational activities given up because of abuse -continue addiction even though they know the problem

Answer 15

-supportive -hydration- may have 6L deficit with DT -electrolytes -Thiamine -> decrease risk of Wernickes dementia -nursing care -tx of symptoms -> -benzos -antipsychotics -clonidine

Answer 16

-SX: -insomnia -cramps -dilated pupils -goose bumps -muscle twitching- restless legs -vomiting -diarrhea -going from 3 to 2 wont make a difference BUT -going from .5 to .25 -> pt will feel this -TX: -methadone, suboxone -clonidine -ultra rapid detox- naltrexone (opiate antagonist) administered under 6hrs general anesthesia -supportive

Answer 17

-worse in morning -wt loss -guilt -memory failure -somatic sx -sx wrongly attributed to dementia, or other condition -> pseudodementia ->65yo is 20% of all suicides -increase risk in nursing homes -increases disability -36%- respond well -34%- response but relapse -30% poor response -most specific- irritability and anhedonia

Answer 18

-45% of dementia pts have depression -mimic dementia but is actually depression -psychomotor retardation -Selective mutism and poor appetite -Poor attention and concentration -Symptoms resolve as depression is treated -If cognitive impairment remains -> underlying dementia is suspected -Highest risk- > 65

Answer 19

-Geriatric Depression Scale (GDS): A self-rated scale that focuses on internal experience and is valid and reliable in mild dementia -Beck Depression Inventory (BDI): most widely used self rating scale with focus on emotional/somatic symptoms -Zung Self Rating Depression Scale (SDS): 20 question self rating scale; screening tool in general practice offices -Hamilton Depression Scale (HDRS): A interview that focuses on somatic and vegetative symptoms -Cornell Scale for Depression in Dementia: sensitive for superimposed depression -Median sensitivity (true positive rate) of the most common depression screening scales: 85%

Answer 20

-assess pain, insomnia, GI -assess thyroid, B12, meds -environmental changes -involuntary hospital admission- suicidal, homicidal, gravely disabled -antidepressents- more susceptible to SE -> low and slow -long half life -do not undertreat -tx for life is 3+ episodes -minimum 4-9 months beyond symptom resolution with first episode

Answer 21

-intoxication, withdrawal, rapid changes in behavior -inpatient -> extended observation -> release with initial Rx -> f/u appt w/ psychiatrist/therapist/clinic -mini-MSE

Answer 22

-CBC with diff- infection -chemistry- electrolyte imbalance, hypoglycemia, hyperglycemia -TSH- hypo/hyper -B12 and folate -U-tox: substance abuse -UA- UTI -chest x ray- infection -EKG- acute MI, arrythmia, QTC -RPR- syphilis -Beta HCG- pregnancy -all systems are important for PE BUT -> -Pay attention to Vitals, HEENT, and Neurologic systems

Answer 23

-Major Depressive Disorder -Bipolar Disorder, Depressive Phase -Alcohol or Substance Abuse- 10% -Schizophrenia -Personality Disorders like Borderline Personality Disorder -male- 75% of suicide completers -women- 3x more attempts than males

Answer 24

-never leave pt -consider hospitalization if: -substance abuse -strong intent -access to weapons/harm -delirium -dementia -consider discharge if: -positive response to initial intervention -good social support -medically stable -impulse action while under influence -> stable after extended observation

Answer 25

-reduce likelihood of suicide -enhance resilience -counterbalance risk factors -care for mental, physical, and substance use disorders -Easy access to clinical interventions and support -Restricted access to lethal means of suicide -Strong connections to family and community -Support through ongoing medical and mental health care relationships -Skills in problem solving -Cultural and religious beliefs that discourage suicide and support self-preservation

Answer 26

-#1: history of violence -psychosis- schizophrenia, depressive, mania -substance abuse -personality disorder- paranoid, antisocial, boderline -neurological impairment- TBI, delirium, dementia -chaotic family event -physical/sexual abuse -poor coping skills -impulsive -close to weapons

Answer 27

-1976 CA rulings -Mental Health Providers have duty to protect 3rd parties from dangers of their clients -Tarasoff Precedent- Psychiatrists should contact 3rd parties or police if threat is made to identifiable victim, the pt has capability to carry out act and is likely to do so soon -Psychiatrists determine if threat is valid -if someone says they are going to beat someone up -> dont report -if someone is specific with a plan -> report

Answer 28

-Haldol 2.5-5.0 mg IM q 2-4 hours PRN acutely -Given with Cogentin 2.0 mg IM, Benadryl 50.0 mg IM, or Ativan (counteract EPS) -Long term- Mood stabilizer (Lithium vs Depakote) -Geodon 10.0-20.0 mg IM May give q 2hrs PRN (Cogentin or Benadryl not needed) -Neuroleptics also FDA approved -Haldol used as a mood stabilizer in pregnancy -consider long term antipsychotics -consider mood stabilizer -admit if indicated

Answer 29

-rare, life threatening -rxn to neuroleptic med -fever, rigidity, AMS, and autonomic dysfunction -tachy, hypo/hypertension -labs- leukocytosis, increased CPK, myoglobinuria -TX: -D/C med immediately -supportive- IV, cooling blankets, ventilation -muscle relaxant- dantrolene: 2-3 mg/kg per day by IV in TID or QID doses. -Dopamine Agonist: Bromocriptine: 5 mg QD-QID, Amantadine: 100 mg BID

Answer 30

-only temporary solution -staff must 1st attempt structure (redirecting pt to more appropriate behavior) and meds before restraint can be legally applied -If pt strikes another person -> legally considered a danger -> restraint may be applied -Every restraint attempt- explain to pt and family purpose of restraint and obtain consent -remove restraints at least every 2 hrs to reassess and allow for ADLs -Restraints are “prescription devices” -> require physician’s orders -Documentation: pt’s behavior, type of restraint, circulation status, vital signs, medical reason for applying restraints, time restraints used, and any alternatives that were tried -Circulation checks: At least every 2 hrs, fluids and foods given, and care for personal hygiene -Renewal of order every 2 hrs. -Often remains on 1:1 during this duration

Answer 31

-CPEP (comprehensive psychiatric emergency program) -voluntary/involuntary -CPEP: -Standard for Admissions: -immediate observation, care and tx is appropriate -illness must carry “likelihood of serious harm” -Duration of Stay: Up to 72 hrs involuntarily (with VALID DOCUMENTATION AND justification) -> after pt must be discharged or admitted involuntarily for further observation and tx -After 24 hours -> switched to extended observation beds -VOLUNTARY: -mental hospital is appropriate -needs a written request for admission and discharge from pt -duration- if hospital feel pt needs to stay involuntary -> must apply to judge within 72 hrs for authorization to keep pt