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Spring 2022 > Mental Health > Flashcards

Mental Health Flashcards

1
Q

What is a dangerous side effect to consider when prescribing trazodone monotherapy?

A

Priapism

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2
Q

Trazodone mechanism of action

A

Prevents serotonin reuptake

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3
Q

Which SSRI is most sedating?

A

Paroxetine (Paxil)

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4
Q

Lithium drug interactions

A

Diuretics

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5
Q

Side effects of lithium toxicity

A

Diarrhea, decreased LOC, weakness,

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6
Q

What labs need to be monitored when treating bipolar with lithium?

A

Lithium levels, kidney function, chemistry, thyroid

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7
Q

Side effects of SSRI

A

QTc prolongation, serotonin syndrome, angle-closure glaucoma, hyponatremia, sexual dysfunction, GI upset, diarrhea, headaches, blurred vision

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8
Q

Side effects of Tricyclic Antidepressants

A

Anticholinergic side effects: dry mouth, constipation, blurry vision, urinary retention

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9
Q

Side effects of SNRIs

A

Hypertension, QTc prolongation, serotonin syndrome, sexual dysfunction, GI upset

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10
Q

Which serotonin receptor do most antidepressants affect?

A

5-1T1A

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11
Q

Length of time for buspirone to reach peak efficacy?

A

4-6 weeks

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12
Q

Which drug class are the first therapy choices for depression, GAD, PTSD, and OCD?

A

SSRIs

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13
Q

A patient displays mania symptoms after initiating an SSRI for depression. What is the new diagnosis?

A

Bipolar Disorder

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14
Q

Lithium side effects

A

Polydipsia, polyuria

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15
Q

What are bupropion (Wellbutrin) indications, drug class, and side effects?

A

MDD, Seasonal depression, smoking cessation, ADHD*

Norepinephrine-dopamine reuptake inhibitor (NDRI)

Xerostomia, nausea, constipation, insomnia

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16
Q

What is the diagnosis?

Individual experiences stress out of proportion to stressor.
Stressors: employment, family, financial, life-transitions, death, relationships

May display mood or behavioral symptoms

Occurs within 3 months of identifiable stressor and resolves within 6 months

A

Adjustment Disorder

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17
Q

Treatment for Adjustment Disorder

A

-Supportive psychotherapy to strengthen existing coping mechanism and strengthen resiliency

  • Trazodone 12.5-25mg tid prn (anxiety)
  • Hydroxyzine 50mg prn (anxiety)
  • Lorazepam 0.5mg bid prn for short time (anxiety)
  • SSRI (short term use)
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18
Q

What is the diagnosis?

Exposure to a traumatic or life-threatening event

Experiencing flashbacks, nightmares, intrusive images, increased vigilance and avoidance symptoms

Symptoms present for at least 1 month and impair functioning

A

Post-Traumatic Stress Disorder

If symptoms present for only 3 days to 1 month following trauma, the diagnosis is Acute Stress Disorder

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19
Q

PTSD Psychotherapy Treatment Options

A

Cognitive processing therapy

Prolonged exposure therapy

Eye-movement Desensitization Reprocessing(*EMDR); 8-12 sessions ASAP

Psychological debriefing (single session)

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20
Q

PTSD Pharmacotherapy Options

A

Sertraline, paroxetine (FDA) (depression, panic attacks, sleep disruption, startle responses)

Beta-blockers Propranolol 80-160mg daily (tremors, palpitations)

Clonidine 0.1mg hs-0.2mg tid (hyperarrousal)

Prazosin 2-10mg hs (nightmares and sleep)

Trazodone 25-100mg hs (hypnotic)

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21
Q

Essentials of Anxiety Disorder Diagnoses

A

Persistent and excessive worry, anxiety, or fear with associated behavioral disturbances

Difficulty concentration, apprehension, tension, fear

Somatic symptoms: Autonomic NS symptoms; dyspnea, palpitations, paresthesia, tachycardia, hyperventilation, SOB

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22
Q

What is the diagnosis?

Cardiac, GI, neuro, and anxiety present for 6 months or longer?

A

Generalized Anxiety Disorder

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23
Q

What is the diagnosis?

Recurrent, unpredictable episodes of intense surges in anxiety with marked physiologic response (Impending doom, chest pain sweating, tachycardia, etc)

A

Panic Disorder

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24
Q

What is the diagnosis?

Social phobias and simple phobias

A

Phobic Disorder

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25
Q

What does the GAD-2 and GAD-7 screen for?

A

Anxiety

GAD-2
Over the last 2 weeks how often have you been bothered by (0-3)
1-Feeling nervous, anxious, or on edge
2-Not being able to stop or control worrying

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26
Q

Treatments for GAD

A

SSRI, SNRI, (benzo for brief acute management only), Buspar, Gabapentin, BB (avoid alcohol as self treatment), clonidine

CBT, relaxation, emotive imagery

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27
Q

Treatments for Panic Disorder

A

SSRI, SNRI (may use benzo for bridge until SSRI/SNRI becomes effective), trazodone

CBT, relaxation, emotive imagery

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28
Q

Treatments for Phobic Disorder

A

SSRI, SNRI, gabapentin

Propranolol 20-40mg 1 hr. prior to exposure

Relaxation techniques, Desensitization, Emotive imagery, CBT

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29
Q

What is the diagnosis?

Preoccupations or rituals that are distressing to individual.

Symptoms are excessive or persistent beyond developmentally normal periods

Anxiety relieved by ritualistic performance

A

Obsessive-Compulsive Disorder

Screening: Yale Brown Obsessive Compulsive Screening (YBOCS)

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30
Q

Treatments for OCD

A

SSRI (may take 12 weeks for response)
Topamax
Antipsychotics

Gradual exposure
CBT
Transmagnetic Stimulation (FDA approved)

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31
Q

What are the essentials for diagnosing Anorexia Nervosa?

A

Symptoms present for at least 3 months

Disturbance of body image or fear of becoming fat

Weight loss; Severity classified by BMI
Extremely severe: body weight 15% below expected

Absence of 3 consecutive menstrual cycles

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32
Q

What are the essentials for diagnosing Bulimia Nervosa?

A

Symptoms present for at least 3 months

Overly concerned with weight and food

Binge-eating and purging type: Engaged in recurrent episodes of binge-eating or purging behavior at least 2x/wk

Recurrent inappropriate weight gain compensations: self-induced vomiting or the misuse of laxatives, diuretics, or enemas

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33
Q

Potential lab findings in anorexia nervosa?

A

Anemia, leukopenia, electrolyte imbalances, elevated BUN and creatinine, increased cholesterol, depressed LH and FSH

Differentials: TB, Crohn disease, gluten enteropathy, Addison disease, DM, pan-hypopituitarism

34
Q

Potential complications of bulimia nervosa?

A

Gastric dilation, pancreatitis, poor dentition, pharyngitis, esophagitis, aspiration, dehydration, electrolyte imbalances

35
Q

What is the SCOFF questionnaire?

A

Screens for eating disorders

In the past 3 months have you:

Sick because uncomfortably full?
Controlling eating: Loss of control 
One Stone/14 lb weight loss?
Fat self-image?
Food dominates life?
36
Q

Anorexia Nervosa Management

A

Co-managed by PMHNP or Psychiatrist

Include family, supportive care = most important

CBT, intensive psychotherapy, family therapy
TCA, SSRI, lithium
Parenteral nutrition?
Hospital admit if signs of hypovolemia, major electrolyte imbalances, and severe protein-energy malnutrition

37
Q

Bulimia Nervosa Management

A

Co-managed by PMHNP or Psychiatrist

Psychotherapy, CBT, individual, group, SSRI

38
Q

What is the diagnosis?

Persistent patterns of inability to sustain attention, excessive motor activity/restlessness/impulsivity or both

Symptoms interfere with daily functioning

Symptoms began prior to age 12 or in at least two settings (school, work, home, with friends/family)

A

Attention Deficit Hyperactivity Disorder

39
Q

What does the Vanderbilt Assessment Scale screen for?

A

ADHD

40
Q

ADHD Treatments

A

Stimulants: Methylphenidate, amphetamine
Non-stimulants: Atomoxetine, burpropion, desipramine, clonidine

Start CBT after symptoms managed

41
Q

What is the diagnosis?

Persistent issues with social communication and interactions

Repetitive behaviors, interests or activities

Symptoms interfere with functioning

May or may not have accompanying language or intellectual impairment

A

Autism Spectrum Disorders

Needs comprehensive and multidisciplinary approach to assessment and management

No treatment for core symptoms, supportive

42
Q

What does the M-CHAT-R screen for?

A

Autism Spectrum Disorders

43
Q

What is the diagnosis?

Prominent physical symptoms involving one or more organ systems and associated with distress and/or impairment

Occasionally able to correlate symptom development with psychosocial stress

Combination of biogenetic and developmental patterns

A

Somatic Symptom Disorders

44
Q

What is the diagnosis?

Functional neurologic symptoms with no identifiable pathology

A

Conversion Disorder

45
Q

What is the diagnosis?

One or more somatic symptoms associated with significant distress or disability with no identifiable pathology

A

Somatic Symptom Disorder

46
Q

What is the diagnosis?

Displays intentional symptoms that can be self-induced or fabricated

A

Factitious Disorders (Munchausen Syndrome or by proxy)

47
Q

Management of Somatoform Disorders

A

Building a therapeutic clinician-patient relationship is mainstay of treatment
Regular, frequent, short appointments that are not symptom-contingent may be helpful
Medications should not replace appointments
Empathetic, realistic, optimistic approach

Hypnosis
Group Therapy
Psych referral
Biofeedback (Immediate feedback after learning to recognize symptoms)

48
Q

What is the diagnosis?

Chronic complaints of pain
Symptoms frequently exceed signs
Minimal relief with standard treatment
History of seeing many clinicians
Frequent use of several nonspecific medications
A

Chronic Pain Disorders

49
Q

What is the diagnosis?

Anatomic changes, chronic anxiety, depression, anger, and changed lifestyle

Possible secondary gains: sick role, financial compensation

May become more dependent on family/friends and less active

A

Chronic Pain Syndrome

50
Q

Management of Chronic Pain Disorders

A 
Intensive behavioral program
Decrease medication use
Positive reinforcement 
Partner with patient
Encourage only discussing pain with provider to stabilize home life
Biofeedback and hypnosis 
Self-rating chart
Sees only one provider for management
No referrals
No opioids
APAP or NSAIDs
SNRI, TCA, gabapentin, pregabalin, anticonvulsants 
Physical therapy
Acupuncture
51
Q

What are the three main types of psychosexual disorders?

A

Paraphilia, gender dysphoria, sexual dysfunction

52
Q

Management of Sexual Dysfunction

A

Social engineering - eliminate close proximity of others

Sildenafil, vardenafil - ED
SSRI - premature ejaculation

53
Q

What is the diagnosis?

Long history dating back to childhood
Recurrent maladaptive behavior
Difficulties with interpersonal relationships or society
Depression with anxiety when maladaptive behavior fails

A

Personality Disorders

54
Q

What is the cluster?

Paranoid, schizoid, schizotypal

A

Cluster A

55
Q

What is the cluster?

Avoidant, dependent, obsessive-compulsive

A

Cluster C

56
Q

What is the cluster?

Antisocial, borderline, histrionic, narcissistic

A

Cluster B

57
Q

Personality Disorder Mangement

A

Self-help
Peer pressure to modify self-destructive behaviors
CBT
Dialectal behavior therapy (DBT) for chronic suicidality and borderline
Maintain boundaries

Medications directed at symptom clusters (schizo, anxiety/depression, etc)

58
Q

What personality disorders have the most guarded prognosis?

A

Antisocial (Cluster B)

Borderline (Cluster B)

59
Q

What is the diagnosis?

Social withdrawal, slowly progressive with decrease in emotional expression and/or motivation

Deterioration in personal care with disorganized behaviors and/or decreased reactivity to the environment

Disorganized thinking, often inferred from speech that switches topics oddly or is incoherent

Hallucinations, delusions

A

Schizophrenia Spectrum Disorders

60
Q

What are delusions?

A

Fixed false beliefs despite conflicting evidence, frequently of a persecutory nature

61
Q

What are hallucinations in schizophrenia?

A

Usually auditory

Commands

62
Q

What are positive symptoms in schizophrenia?

A

Hallucinations and delusions

63
Q

What are negative symptoms in schizophrenia?

A

Disorganized speech, poor hygiene, lack of pleasure, withdrawal, anhedonia

64
Q

Schizoaffective disorder

A

Schizoaffective symptoms without psychotic symptoms lasting >6 months

65
Q

Brief psychotic disorder

A

Psychotic symptoms lasting <1m, causing psychological stress, may be precursor to schizophrenia

66
Q

What must you order with first episode of psychosis?

A

MRI or CT

67
Q

Schizophreniform disorder

A

Schizoaffective symptoms but lasting>1m but <6mo

68
Q

Management of schizophrenia

A

CBT, cognitive remediation, family therapy, positive reinforcement

Psych referral

Pharmacologic:
1st Gen antipsychotics
2nd Gen antipsychotics

Close monitoring of labs

69
Q

Side effects of first generation (typical) antipsychotics

A

EPS (dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia)

Less likely to have metabolic abnormalities

70
Q

Side effects of second generation (atypical) antipsychotics

A

Metabolic abnormalities: weight gain, elevated glucose, elevated lipid

Prolonged QTc

71
Q

What must you monitor monthly if a patient is taking clozaril?

A

Atypical antipsychotic

CBC monthly - r/f agranulocytosis

72
Q

What does the AIMS Scale screen for?

A

Movement disorders with antipsychotic treatments

73
Q

What is the diagnosis?

Chronic mood disturbance with episodes of subsyndromal depression and hypomania >2 yrs.

A

Cyclothymic Disorder

74
Q

What is the diagnosis?

Persistent depressed or low mood most days for 2 years

A

Dysthymic Disorder

75
Q

How does bipolar 1 differ from bipolar 2?

A

Bipolar 1: Experienced 1 episode of mania or mixed episode

Bipolar 2: Experienced at least 1 episode of hypomania and 1 episode of MDD; never manic

76
Q

What do these tools screen for?

PHQ-2, PHQ-9, SIGECAPS, MDQ

A

Mood Disorders

77
Q

SIGECAPS

A

Sleep, Interest, Guilt, Energy, Cognition/Concentration, Appetite, Psychomotor, Suicide

78
Q

Once depression stabilizes, how long should medications continue before considering discontinuation?

A

6-12 months

79
Q

After starting an SSRI, when is lethality risk greatest?

A

Beginning at 1-2 weeks for 28 days

80
Q

Management of Bipolar Disorders

A

Antipsychotics (Glucose, Lipids, Weight)
First or Second Generation

Mood stabilizers (blood levels)
Valproic acid
Tegretol
Lamotrigine
Lithium (monitor levels, TSH)

Caution with use of antidepressants and stimulants in patients with mood disorders

81
Q

Management of Sleep-Wake Disorders

A

Psychological
Insomnia-CBT, education re: sleep hygiene, avoid alcohol

Pharmacologic
Insomnia-may add medications if above are insufficient. If appropriate use for short course of 1-2 weeks.
-Benzodiazepines and Barbiturates: Caution—habit forming, cognitive slowing, increased risk for falls, increased somnolence
-Zolpidem caution in elderly,
-Antihistamines, Trazadone, Remeron-non-habit forming

Narcolepsy-Dextroamphetamine, modofinil

Medical Sleep study and treatment, if indicated

82
Q

Management of aggression

A

Violence Risk Screen

Seriously violent or psychotic-antipsychotics q 1-2 hours until sx relief

Acute agitation: atypical antipsychotics

Chronic aggressive states: risperidone, tegretol, Depakote
Lithium, SSRI, and Buspar helpful

Spring 2022 (14 decks)

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