Gilks Deck 5: Grief + Psychotherapies + SUD buzz words + Forensics etc Flashcards
(135 cards)
1
Q
how is normal bereavement distinguished from MDD
A
predominant affect is feeling of EMPTINESS and LOSS, comes in WAVES associated w thoughts of the deceased
self esteem preserved
suicidal thoughts limited to “joining” the deceased
sx resolev in less than 12 mo
2
Q
what are the TIPP skills for distress tolerance in DBT
A
Temperature (use cold water)
Intense exercise
Paced breathing
Paired muscle relaxation
3
Q
what is the goal of DBT
A
to “build a live worth living”
4
Q
what are the 5 components of DBT therapy
A
- skills group
- individual sessions, can feature chain analysis
- telephone coaching
- case management
- DBT consultation team to support staff
5
Q
how long does DBT last
A
1 year
6
Q
who developed IPT
A
Weissman and Klerman
7
Q
list the CBT interventions
A
- identifying cognitive distortions
- automatic thought records
- problem solving
- cost benefit analysis (pros, cons)
- generating rational alternatives
- activity scheduling and graded tasks assignments
- behavioural experiments
- role play
- relapse prevention
8
Q
what is gold standard treatment for insomnia disorder
A
CBT-insomnia
*more effective than medications
9
Q
how long does CBT for insomnia run
A
weekly for 6-8 sessions
10
Q
what are the 5 components of CBT-I (details are in the therapy section)
A
sleep hygiene
stimulus control
sleep restriction
relaxation training
cognitive therapy
11
Q
what are the focuses of Maudsley family therapy
A
parents highly involved in re-feeding patient
externalize the eating disorder, blame is placed on the illness
once weight restored, focus on establishing healthy adolescent identity
12
Q
which family therapy focuses on the most psychologically available person and combats enmeshment by shifting of the “hot triangle”
A
Bowen (family systems therapy)
13
Q
which family therapy focuses on hierarchies, alliances, splits and subsystems
A
Minuchin (structural family therapy)
14
Q
Which family therapy emphasizes individual maturation within the family and explores unconscious patterns in family relationships
A
psychodynamic experiential
15
Q
list indications for expressive therapies
A
- strong MOTIVATION to UNDERSTAND
- significant SUFFERING
- ability to regress in the service of ego
- tolerance for FRUSTRATION
- capacity for INSIGHT
- INTACT REALITY TESTING
- meaningful RELATIONSHIPS
- good IMPULSE control
- ability to MAINTAIN A JOB
- capacity for analog and METAPHOR
- reflective responses to trial interpretations
16
Q
indications for supportive therapies
A
- significant EGO DEFECTS of a CHRONIC NATURE
- severe LIFE CRISIS
- LOW anxiety tolerance
- POOR frustration tolerance
- LACK of psychological mindedness
- POOR REALITY TESTING
- severely IMPAIRED RELATIONSHIPS
- POOR IMPULSE control
- LOW intelligence
- little capacity for self observation
- tenuous ability to form a therapeutic alliance
17
Q
what are some of the techniques used in Motivational Interviewing
A
express empathy through REFLECTIVE LISTENING
develop DISCREPANCY between clients goals or values and their current behaviour
AVOID ARGUMENT and direct confrontation
adjust to client resistance rather than opposing it directly
support SELF EFFICACY and OPTIMISM
18
Q
what is a mnemonic to remember the spirit of Motivational Interviewing
A
Partnership
Acceptance
Compassion
Evocation
19
Q
what is a mnemonic to remember the skills of motivational interviewing
A
OARS
Open ended questions
Affirmations
Reflections
Summaries
20
Q
SUD buzz words
what treatment is preferable in a pregnant woman who is opioid dependent
A
methadone
21
Q
SUD buzz words
what drug do you think is on board in a dancing girl with hyperthermia
A
MDMA
22
Q
SUD buzz words
what medication might you offer to a patient with AUD who has a supportive wife/relative to aid them
A
disulfram
23
Q
SUD buzz words
what medication might you avoid in a person who has BPD/is unstable and also has AUD
A
AVOID disulfram in unstable/BPD
24
Q
SUD buzz words
what medication do you avoid in someone with kidney stones
A
AVOID topiramate in kidney stones
25
*SUD buzz words*
what medication do you avoid in a person who has both AUD and an opioid use disorder
avoid naltrexone
26
*SUD buzz words*
in an (intoxicated) patient presenting in ER with nystagmus and slurred speech, what drug do you think is on board
inhalants
27
*SUD buzz words*
in an (intoxicated) patient presenting with vertical nystagmus and is belligerent, what drug do you think is on board
PCP
28
*SUD buzz words*
in an intoxicated patient presenting with optical neuritis/blindness, what drug do you think is on board
methanol poisoning
29
what psychotherapy is recommended in the acute phase for panic + agoraphobia
combo of CBT + meds = more effective than either alone for acute period BUT CBT was same as combo in long term follow up so CBT favored over combo or meds alone
30
what is the most effective part of CBT for panic + agoraphobia
exposure (interoceptive, virtual reality)
31
what two types of therapy do NOT have evidence for panic + agoraphobia
EMDR, psychodynamic
32
what is the most common anxiety disorder in patients 65+
specific phobia
33
what therapy is favored for specific phobia
exposure based therapy--> especially with prolonged exposure, real exposure, exposure in different settings adn with therapist involvement
34
what type of therapy should you use for blood-injection-injury type phobia
applied muscle tension + exposure
35
what is the most effective therapy for social anxiety disorder
CBT = most effective
exposure therapy also effective
CBT + exposure = FIRST LINE
CBT lasts longer than pharmacotherapy
36
what component of CBT is most helpful in treating social anxiety disorder
challenging maladaptive thoughts
37
what therapies are favored for GAD
CBT is AS EFFECTIVE as meds--> no evidence for *routine* combo tx
some evidence for:
psychodynamic
ACT
meta-cognitive therapy
MBCT
38
what neurostimulation therapy is effective in GAD
rTMS is effective as monotherapy or as adjunct
39
what therapy is favored in OCD
CBT + ERP is equivalent to meds --> best if exposure is therapist guided
strong evidence for "danger ideation reduction therapy" (DIRT)
some evidence for:
ACT
various cognitive therapies
internet CBT
*TARGET FAMILY ACCOMMODATION*
40
how long have benefits of psychotherapy been shown to last in OCD
up to 5 tears
41
what therapies have been shown to be effective in PTSD
TF-CBT
EMDR
stress management
cognitive processing therapy (CPT)
prolonged exposure
virtual reality exposure
internet CBT
*limited evidence for combo with meds*
ottawa lecture said could consider IPT if patient not willing to undergo exposures etc
42
what treatment can reduce self harm in PTSD patients undergoing psychothearpy
DBT pretreatment can reduce self harm
43
name two forms of psychotherapy that are NOT effective in PTSD
psychodynamic
supportive
44
define "interoceptive exposure"
bring on physical lsymptoms of anxiety on purpose to allow for habituation
used for panic disorder and social anxiety disorder
45
define "flooding"
in vivo exposure to main fear, paired with RELAXATION techniques
does NOT use hierarchical exposure
fear is decreased through EXTINCTION
46
define "gradual exposure"
uses a HIERARCHY to do exposure but does NOT use relaxation techniques --> relies on HABITUATION to the anxiety response and not on relaxation
47
define "systematic desensitization"
HIERARCHICAL exposure to phobic object WHILE participating in some form of RELAXATION technique
uses RECIPROCAL INHIBITION
more OUTDATED technique replaced by flooding and gradual exposure
48
define "reciprocal inhibition"
a technique in behavioural therapy that aims to replace an undesired response i.e anxiety with a desired one by counterconditioning
relies on the gradual substitution of a response that is incompatible with the original one
used in systematic desensitizaation
49
name the 3 therapies that are FIRST line in ACUTE phase of MDD
CBT
IPT
behavioural activation
50
name the TWO therapies that are FIRST line for MAINTENANCE phase of MDD
CBT
MBCT
51
name 6 therapies considered second line for acute phase of MDD
MBCT
cognitive-behavioural analysis system of psychotherapy (CBASP)
problem solving therapy
short term psychodynamic therapy
telephone/internet CBT/IPT
52
name 3 therapies that are second line for the maintenance phase of MDD treatment
IPT
behavioural activation
CBASP
53
what two therapies are third line for MDD treatment
long term psychodynamic
motivational interviewing
54
what therapy is first line for maintenance phase of bipolar disorder
psychoeducation
55
what therapy is first line for bipolar depression
there are NO first line psychological treatments for bipolar depression
56
what therapies are second line for bipolar maintenance
CBT
family focused therapy (FFT)
57
what therapies are second line for bipolar depression
CBT
FFT
58
which psychological interventions have level 1 evidence for borderline PD
DBT
psychodynamic therapy
schema focused therapy
59
which psychological interventions have level 2 evidence for borderline PD
ACT
CBT
IPT
psychoeducation
60
which psychological interventions have level 1 evidence for schiziphrenia
CBT
family intervention
psychoeducation
61
which psychological interventions have level 2 evidence for shizophrenia
ACT
metacognitive therapy
62
what non pharmacological intervention is first line for seasonal affective disorder
light therapy
10000 lux for 30 min every morning for 6 weeks
63
what does it mean to be "unfit to stand trial"
this is defined by the Criminal Code
accused person is unable, because of a mental disorder, to defend against the charges they are facing or to tell their lawyer what they want to do with their case
requires at least 1/3 of:
1. accused is not able to understand that they are in a courtroom, who the people in the courtroom are (i.e judge, their lawyer) and why they are there
2. the accused is not able to understand what they are charged with, what kinds of pleas they can enter, what can happen to them if they plead guilty or what can happen if they dont tell the truth in court
3. the accused is not able to communicate with their lawyer and tell them, even in basic terms, what they want to do with their case
64
what was "Taylors test" with regards to being fit or unfit to stand trial
based on the Taylor case
a fit person does NOT need to have "analytical capacity" to make choices in his or her own best interest--> they only need capacity to TELL LAWYER THEIR VERSION OF EVENTS and GIVE INSTRUCTIONS--> i.e "reasonably participate"
65
what was the significance of the following trial with regard to forensic psychiatry:
Winko
canadian standard on duty to protect (pertains to review boards)
66
what was the significance of the following trial with regard to forensic psychiatry:
Tarasoff
duty to warn and protect (US)
67
what was the significance of the following trial with regard to forensic psychiatry:
Taylor
fitness to stand trial
68
what was the significance of the following trial with regard to forensic psychiatry:
Smith v Jones
significant risk to public safety (duty to warn)
69
what was the significance of the following trial with regard to forensic psychiatry:
Starson
treatment capacity (ontario)
70
what was the significance of the following trial with regard to forensic psychiatry:
McNaughten
precursor to NCRMD
71
list the exceptions to confidentiality
1. FLYING hazard --> federal aeronautics act--> mandatory, notify transport canada
2. RAILWAY hazard--> federal railway safety act--> mandatory
3. MARITIME hazard--> federal canada shipping act--> mandatory
4. CHILD ABUSE--> provincial legislation--> mandatory except Yukon
5. depending on province, the following are either mandatory or discretionary:
--driving hazards
--elder abuse
--professional sexual misconduct
--births/stillbirths
--communicable diseases
--gunshot wounds
6. civil litigation or court order
7. duty to warn
8. patient provides consent
72
apparently there is a blood alcohol test question--> answer is SEARCH WARRANT not subpoena
73
what 3 things does a person have to have/understand in order to have testamentary capacity to make a will
1. Bounty--> knowledge of nature and extent of property
2. BEQUEST--> knows that they are giving it away
3. BENEFICIARIES--> knows the identities of their beneficiaries
74
what type of study uses odds ratio
case control studies--> you are starting with the outcome and working backwards to look as exposures
75
what type of study uses relative risk
cohort studies--> you are starting with an exposure and then working forward to the outcome
76
what does it mean to have a low p value in stats
the lower the p value, the more "surprising" the evidence is and the more ridiculous the null hypothesis looks
77
what is the use of correlation coefficients
used to measure how strong a relationship is between two variables
most popular is Pearsons, which has values between -1 and 1 (with a value of 0 meaning there is no relationship between the variables)
78
what is the use of the t-test in stats
used to compared two continuous variables
79
what is the use of the ANOVA test in stats
used to compare more than 2 continuous variables
80
what is the use of the chi-squared test in stats
used to compare two or more categorical variables
81
what tools can be used to assess fitness to stand trial
McGarry's criteria
Fitness Interview Test-Revised (FIT-R)
the Nussbaum Fitness Questionnaire (NFQ)
Georgia Court Competency Screening test, Canadian Adaptation
82
what is the GOLD STANDARD depression scale (per Gilks notes)
Montgomery-Asberg Depression Rating SCale (MADRS)
83
what is the best test/scale for peripartum depression
Edinburgh Postnatal Depression Scale
--10 qs
--self reported
84
do the PHQ-9 and C-SSRS have any utility in identifying risk for suicide and suidical behaviour in the near and long term?
yes, across diagnoses
have positive predictive value
85
List some self reported scales for depression
PHQ-9
Beck depression inventory
(+Edinburgh for PPD)
86
name two clinician rated scales for depression
MADRS
HAM-D
87
what is a rating scale that can be used in social anxiety disorder
Leibowitz Social Anxiety Scale
88
what is a scale that can be used to differentiate between social anxiety and panic disorder
Fear Questionnaire
89
name a scale that can assess hypersomnolence
Epworth Sleepiness Scale
90
name a scale that can be used to assess narcolepsy
Multiple Sleep Latency Test
91
what is an exam for EPS
AIMS and ESRS
92
name two rating scales that can be used to assess pediatric ADHD
SNAP-IV and Conner's Symptom Rating Scale
93
name a rating scales that can be used to assess adult ADHD
Adult ADHD Self Rating Scale
94
name two scales that can be used in the assessment of IED, ODD and conduct disorder
Childrens Aggression Scale (parent/teacher)
Outburst Monitoring Scale
95
name a rating scale for OCD
YBOCS
40 items, clinician rated
96
which is more SENSITIVE for mild cognitive impairment, the MoCA or the MMSE
MoCa
97
list 4 symptom rating scales that can be used in dementia
Dementia Observation Scale (DOS)
Behavioural Pathology in Alzheimer's Disease (BEHAVE-AD)
Cohen Mansfield Agitation Inventory (CMAI)
Neuropsychiatric Inventory (NPI)
98
what two components are in the Mini-Cog
3 word recall
clock drawing
99
what is the most frequently used IQ test
Wechsler Adult Intelligence Scale (WAIS)
100
what is the average score on the WAIS
100
2/3 people score between 85-115
101
what four areas are tested on the WAIS
perceptual reasoning
processing speed
verbal comprehension
working memory
102
what is an IQ test for children
Weschler Intelligence Scale for Children (WISC)
103
what does the Weschler Individual Achievement Test (WIAT) assess
grade level/academic achievement
(vs the WISC which assesses IQ in kids)
104
what is the Bender-Gestalt test
test of visuo-motor functioning in children ages 3+
105
what is the best test for executive functioning
Wisconsin card sorting test
106
other than the Wisconsin card sorting test, which is the best test for executive functioning, name 3 tests which assess frontal/executive functioning
Luria 3 step motor test
Trails B
clock drawing
107
name a test for psychopathy
PCL-R
108
name a scale/assessment tool for violence risk
HCR-20V3
20 item structured clinical guide for assessment of violence risk--> assesses risk to others, both current and future
can be used in clinical and forensic populations
109
*dont forget to review whats on the MMSE vs MoCA*
110
list 4 characteristics of late onset SCZ
more common in WOMEN
onset between ages 40-60
responds well to treatment
more POSITIVE symptoms
111
rapid cycling bipolar is associated with what four factors
female sex
antidepressant use
hypothyroidism
substance use
112
in the cell, what causes the rising action potential
influx of sodium
113
what is the mechanism that causes the sialorrhea seen in clozapine
M4 agonism
114
what bill deals with high risk offenders
bill C-55
115
name a medication that causes/is highly associated with lithium toxicity
captopril (ACEi)
116
name a heart medication that is OKAY to Rx with lithium
amlodipine (calcium channel blocker)
117
what effect does the following have on lithium levels:
caffeine
decreases lithium levels
118
what effect does the following have on lithium levels:
low sodium diet
increases lithium levels
119
what effect does the following have on lithium levels:
ibuprofen
increases lithium levels
120
what effect does the following have on lithium levels:
thiazide diuretics
increases lithium levels
121
what should you do if someone trials a stimulant for ADHD with poor response?
trial the other class of stimulant first, before moving to a non stimulant
122
what is the risk of developing SCZ if both parents haev SCZ
50%
123
what is the risk of developing SCZ if your twin has SCZ
50%
124
what is the risk of developing SCZ if non twin sibling has SCZ
10%
125
list 3 risk factors for delusional disorder
social isolation
sensory impairment
old age
(MDD not a risk factor)
126
does epival interact with the OCP
no
but carmabazepine does
127
can you combine aripiprazole and venlafaxine
yes
128
what would an EEG show prior to sleep attacks/nightmares
since they occur during N3, prior to attack the EEG would show slow waves
129
what would you augment an SSRI with in the treatment of panic disorder
benzo (clonazepam)
130
what meds are used to treat bipolar depression
QLLL
quetiapine
lithium
lamotragine
lurasidone
131
list the anxiety disorders in order of age of onset, from youngest to oldest
separation anxiety
specific phobia
social anxiety (around age 12)
OCD (around age 20)
PTSD
GAD (around age 30)
panic disorder/agoraphobia (middle age)
132
list first line meds for GAD
escitalopram
paroxetine
sertraline
venlafaxine
duloxetine
agomelatine
pregabalin
133
*D-cycloserine is broadly recommended in anxiety guidelines*
134
what two elements would suggests someone is experiencing a pseudoseizure and NOT an epileptic seizure
eyes closed
out of phase shaking movements
135
list 5 medications recommended for BPSD
risperidone
abilify
olanzapine
*not quetiapine*
+SSRIs, trazodone
