OnlineMedEd+ -- Psychosocial Disorders Flashcards
Alcohol Abuse
four areas used to Identify the problem?
Dx:
Tx:
What is important to know about relapse?
How long are symptoms of alcohol withdrawal?
Withdrawal symptoms?
Risk of sudden withdrawal? Name of serious type
What medications are used for Autonomic Hyperactivity?
Medications for tremors and tachycardia?
Medications for craving?
Medications to induce unpleasant effects with drinking?
Medications that modify the intoxicating effects of EtOH
Whats given for nutritional issues?
Expected Labs with EToH abuse?
What is CAGE:
States of change with 1 word description
Frames bonus
F – feedback on positive and negative
R – responsibility with you
A – advice
M—Menu of options to help
E—empathy
S – Self-efficacy
CRAFFT bonus for adolescents:
Car-Used while driving
R -relax
A -alone
F -friends
F-forget
Substance Abuse
four areas used to Identify the problem?
Control:
having too much, inability to cut down, spending too much time thinking about it or wanting it; craving it physically.
Social impairment:
inability to meet obligations, relationship impairment; activities are below the substance.
Risk Taking behavior:
hazardous behavior, health/legal trouble,
Physical:
Tolerance of high amounts, physical symptoms if they withdraw
Dx:
- 2-3 mild;
- 4-5 moderate;
- 6+ severe
Tx:
- +/- pharm
- Group therapy
- Psychotherapy
50-90% will relapse – just get back up
How long are symptoms of alcohol withdrawal?
24-48 hrs
Withdrawal symptoms?
Depression, anxiety, nervousness, fatigue, irritability, jumpiness, mood swings nightmares. Clammy skin, dilated pupils HA, insomnia loss
Risk of sudden withdrawal? Name of serious
Autonomic hyperactivity – agitation, hallucinations, disorientations, and seizures. Most serious is delirium tremens.
What medications are used for autonomic hyperacitivy?
BZDs. Librium. Lorazepam or oxazepam for individuals with liver impairment.
Medications for tremors and tachycardia?
BB (propranolol) and clonidine
Medications for craving?
Acamprosate
Medications to induce unpleasant effects with drinking?
Disulfram
Medications that modify the intoxicating effects of EtOH
naltrexone
Whats given for nutritional issues?
B supplements, C and mag
Expected Labs with EToH abuse?
Slight elevated AST. Slight Macrocytosis; AST:ALT ratio >1
What is CAGE:
Cut down, YOu should cut down
Anger, are you annoyed by being asked to cut down
Guilty, Do you feel guilty about your drinking?
“eye opener”. Do you need it to get going?
States of change with 1 word description
Pre-contemplation -
denial
Contemplative –
accept there is a problem
Preparation –
first steps
Action
– actual behavior changes
Maintenance –
sustain behavior changed
Frames bonus
F – feedback on positive and negative
R – responsibility with you
A – advice
M—Menu of options to help
E—empathy
S – Self-efficacy
CRAFFT bonus for adolescents:
Car-Used while driving
R -relax
A -alone
F -friends
F-forget
Liver enzymes
AST?
Increases rapidly with liver damage and clears quickly after damage ceases
ALT?
Increase slowly with hepatic damage and decreases slowly. Greatest elevation in acute hepatitis and drug reaction
ALP?
Levels increase in response to biliary obstruction and sensitive indicator of intra and extrahepatic cholestasis
GGT? Marked elevation in obstructive jaundice, hepatic metastasis; intrahepatic cholestasis.
Elevation mirrors ALP elevation
Fatty Liver: ALT:AST ratio > 1
Substance abuse
What is the epidemiology (age) of prescription drug abuse?
Age 19-25 highest with W > M
What must provider consider with substance abuse?
Usually more than one substance. They also often have comorbid emotional or psychological issues.
Considerations for females?
often have anxiety, depression and have prescriptions for BZD
Tips for reducing BZD abuse
- prescribe slow-onset long-acting BZD example is clonazepam.
- If PRN prescribe the number of tablets per week not by day
- Avoid using a benzo as PRN
Managing WD to avoid symptoms: best taper schedule
Taper by 25% per week
Rapid withdrawal symptoms
anxiety, hallucinations, seizure, DT like symptoms, tremors
Symptoms of opioid withdrawal
similar to EtOH WD. HTN, tachycardia, diarrhea, nausea, temperature dysregulation, fever, papillary dilation, restlessness, myalgia, lacrimation, rhinorrhea.
Medication for opioid WD symptoms?
Clonidine (Alpha-adrenergic agonist)
Managing addiction?
- long-term rehab;
- comprehensive counseling
- high level of patient desire,
- methadone (with monitoring)
- Buprenorphine (opioid agonist) with naloxone (antagonist) better profile, ease of use etc than methadone.
Effects of chronic inhaled Marijuana?
COPD
Compare edible marijuana with smoked mj
takes longer for effect but lasts longer. Eating on empty stomach hastens its effect.
Positive effects of MJ
- helpful for cancer, AIDS and chronic pain
- topical effect for joint disease, migraines, psoriasis, and restless leg symptoms.
Physiology of cocaine use
- potent sympathomimetic
- increase HR, contractility, constricts coronary and cerebral vessels
Risks of cocaine use
- cerebral ischemia
- cardiac ischemia
- stroke
- MI
So inquire about chest pain!
Amphetamine and methamphetamine info
most commonly abused illicit drug in US
Eating Disorders
Labs for all eating disorders?
CBC; CMP
Anorexia Nervosa What are the DSM-5? (4 bullets)
- inabiity or refusal to maintain weight at or above mininal normal weight
- intese fear of gaining weight or becoming fat despite low body weight
- body dysmorphia
- Ammenorhea will help establish/confirm the diagnosis
epidemology and comorbids?
- F>M
- onset in teens (14-18)
- Life threatening with with mortality of 5-20%
- high rate of comorbid depression
Physical signs
- very thin
- muscle wasting
- abdominal distention with hepatomegaly
- oral and gum disease
- coarse dry skin
- hypotension
- bradycardia
- hypothermia
- cheilosis (angular cheilitis)
Tx
- Cognitive and behavioral therapy
- Pharm therapy with SSRI setaraline; (zoloft) or fluoxetine (prozac)
- Cyproheptadine -enhance appetite and decrease anxiety (1st gen antihistamine-off label use)
- NO bupropion increased risk of seizures
Bulemia nervosa (BN) DSM-5 criteria
- binge eating with excessive food in a 2 hr period
- Lack of control amount and type of food
- recurent behavior such as laxative/diuretic use or fasting, or excessive exercise
- binge eating & recurrent behavior at least 1/week for 3 mo
- body weight and shape influence self worth
What are the PE findings?
- dental erosion on lingual of upper arch
- hypokalemia from laxatives and diuretics
- Weight is normal to slightly above normal
Tx of BN?
- CBT
- Pharm with SSRI
- lisdesxamphetamine or topiramate (reduced relapse)
- NO Wellbutrin (exacerbates bingeing and seizures)
Binge Eating Disorder
lack of control over amount and type of food eaten 2/W for 6 M
binging with distress, self-anger, shame and frustration
ALERT associated with suicide
Mood disorders
this is also missing the end!!!
MDD = major depressive disorder
Path: depressed mood with anhedonia
how is it Dx?: Duration of Depressed mood > 2 weeks PLUS 5 of SIGECAPS
What is SIGECAPS?
- S - awaken early in the am
- I- interest - in activities enjoyed in the past
- G guilt or feelings of worthlessness -
- E - Energy
- C- concentration
- A- appetite
- P- psychomotor inhibition or agitation
- S - suicidal ideation or thoughts of death
Pearls for MDD
- Must rule out Suicidal ideation
- cause significant impairment life function and no other health problems are untreated.
- 30% have hypochondriasis. Can’t understand they don’t have a problem. hear their existing problem as worse then it is.
- need to check for s/sx of mania
Tx for 3 MDD presentations:
- + SI and + plan and means =
hospitalization
- SI and - plan or means
= contract for safety and SSRI or SNRI plus psychotherapy
- SI SSRI or SNRI plus psychotherapy
- ECT is good for refractory MDD, catatonia, and psychosis
persistent depressive disorder pearls
- reduced mood for < 2 months several times in past 2 years.
- Check a TSH
- previously called dysthymia
General pearls for medication selection
What has worked in the past?
What has worked for relatives?
ADD FROM 5 min CONSULT
Anxiety
This has been done 4 times
What are the physical signs?
worry fear hypervigilance
What are the emotional signs?
palpitations, SOB, CP, perspiration, agitation
Associated conditions? epidemiology
- W> M
- +/- mood disorders
- +/- EtOH abuse
GAD path: chronic low level, insidious, all the time
Pt:s/sx:constant state of worry > 6 months. with 3 or more somatic symptoms: concentration, sleep, change in weight, irritability.
Dx: Clinical
Tx: Psychotherapy is the most effective; no specific trigger
Meds: SSRI; avoid BZD will become required
PTSD
Herbal products
St Johns Wort:
- MAOi; SSRI and TCA like avoid prescription meds because of serotonin syndrome possibility;
- photosensitivity and possible peripheral neuropathy in high doses.
- alters CYP450 enzymes. reduces antiretrovirals, cyclosporine and effectiveness of OCP.
KAVA:
- action of GABA like a BZD
- sedating can potentiate EtOH
- cross allergenic with pepper
- hepatoxicity
Valerian root:
Action similar to BZD; weaker, shorter duration of action, less drug hangover.
Abuse is the same in all socioeconomic classes
Men to women tend toward more harm than women to men
occurs in same-sex relationships
Should screen in pregnancy
Refer for counseling
access to a gun increases the risk of harm
child abuse is present in about 50% of all households
strangulation is correlated with homicide in men to women.
