Psych Flashcards
(170 cards)
1
Q
What is the complex somatic, cognitive, affective, and behavioral effects of psychological trauma
A
Post-traumatic stress disorder (PTSD)
2
Q
What are the types of trauma that may vary with PTSD
A
Sexual trauma
Trauma to someone in close interpersonal network
Interpersonal violence
Participation in organized violence
Other types of violent events
3
Q
What are examples of sexual trauma
A
Rape
Childhood sexual abuse
Intimate partner violence
4
Q
What are examples of trauma to someone in close interpersonal network
A
Death of a loved one
Critically ill child
5
Q
What are examples of interpersonal violence
A
Assault
Childhood physical abuse
A serious threat of violence
6
Q
What are examples of participation in organized violence
A
War
Witnessing death
Witnessing dead bodies
7
Q
What are other types of violent events
A
Motor vehicle accident
Natural disasters
8
Q
Studies using MRI have shown decreased volume in several areas of the brain such as where
A
Left amygdala - fear center
Hippocampus - memories
Anterior cingulate cortex
9
Q
What are some sx of PTSD
A
Affective dysregulation (anger common)
Cognitive impairment
Several behavior responses in response to regular stimuli: flashbacks, severe anxiety sx, fleeing, combative behaviors
10
Q
Sx must be present for how long following psychiatry to make dx
A
4 weeks
11
Q
What is the treatment for PTSD
A
Therapy and medication are both useful and can be used either alone or in combination
12
Q
What are examples of psychotherapy
A
Exposure therapy
CBT (cognitive behavioral therapy)
EMDR (eye movement desensitization and reprocessing)
13
Q
What medications are used in PTSD
A
Antidepressant medications (SSRIs)
14
Q
What are the first line therapy choice of medications
A
SSRIs - Sertraline
15
Q
What medication can be given to a patient with PTSD that suffers from nightmares
A
Prazosin
16
Q
What medication can be given to a patient with PTSD that suffer from tremors and sympathetic responses
A
Beta blockers
17
Q
What medications can be given to a patient with PTSD that suffer from comorbid psychosis
A
Antipsychotics
18
Q
Why do we NOT give a patient with PTSD benzodiazepines
A
Due to safety and dependency issues
19
Q
What is the prognosis for patients with PTSD
A
Sooner therapy leads to better prognosis
Do NOT wait to refer if PTSD is suspected
20
Q
What are the primary dx of patients that experience persistent disturbance of eating that impairs both health and psychological functioning
A
Anorexia nervosa
Bulimia nervosa
21
Q
What acronym can be used as a screening tool for psychiatric causes that can help differentiate between an eating disorder and other causes of weight loss
A
SCOFF
22
Q
What does the “S” in SCOFF stand for
A
Do you make yourself SICK because you feel uncomfortably full
23
Q
What does the “C” in SCOFF stand for
A
Do you worry you have lost CONTROL over how much you eat
24
Q
What does the “O” in SCOFF stand for
A
Have you recently lost more than ONE stone (14 pounds) in a three month period
25
What do the “F”s in SCOFF stand for
Do you believe yourself to be FAT when others say you are thin
Would you say that FOOD dominates your life
26
Who is anorexia nervosa more common in
Women
27
What is the median age of onset of anorexia nervosa
18 years old
28
What are the specific deficits in dopaminergic function and serotonergic function
Dopamine: eating behavior, motivation and reward
Serotonin: mood, impulse control, obsessive behavior
29
What screening tool is used for anorexia nervosa
DSM V
30
What are common physical exam findings
BMI less than 17.5
Emaciation
Hypothermia
Bradycardia
Hypotension
Hypoactive bowel sounds
Xerosis (dry and scaly skin)
Brittle hair and nails
Lanugo body hair
Abdominal distention
31
Who is bulimia nervosa more common in
3X more common in women than men
32
What is the median age of onset of bulimia nervosa
18 years old
33
What are some diagnostic criteria for bulimia nervosa
Recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain such as: self induced vomiting
Misuse of laxatives
Diuretic use
Enemas
Fasting
Excessive exercise
34
How long does this behavior have to last to meet diagnostic criteria
Occurring on average at least once per week for 3 months
35
What are some clinical findings of bulimia nervosa
Dehydration
Menstrual irregularities
Mallory-Weiss syndrome
Pharyngitis
Erosion of dental enamel
ECG changes may occur
36
What are some other eating disorders
Binge eating disorder
PICA
Rumination disorder - repeated regurgitation of food
37
What is the management of eating disorders
Once recognized, eating disorders require referral - NEVER force feed
38
What labs are indicated for patients with eating disorders
CBC
Thyroid studies
Metabolic panel
39
Who do patients with eating disorders get referred to
Psychiatry
Nutrition consult
40
What is the triad for substance abuse
Psychological dependence or craving
Physiologic dependence
Tolerance
41
What is the 3rd leading preventable cause of death in the United States
Alcohol use disorder
42
What is the consumption amount of alcohol according to the NIAAA for men to consider alcohol abuse
Men under age of 65 - more than 14 standard drinks per week on average or more than 4 drinks on any given day
Standard: 5 oz of wine, 12 oz beer
43
What is the consumption amount of alcohol according to the NIAAA for women considered alcohol abuse
Women and adults 65 years and older - more than 7 drinks per week on average, more than 3 drinks on any given day
44
What are some medical complications of alcohol use
HTN
Cardiovascular disease
Liver disease
Pancreatitis
Gastritis
Esophagitis
Neuropathy
45
What screening acronym is used for patients that abuse alcohol
CAGE
46
What does the “C” in the CAGE acronym stand for
Have you ever felt you should CUT down on your drinking
47
What does the “A” in the CAGE acronym stand for
Have people ANNOYED you by criticizing your drinking
48
What does the “G” in the CAGE acronym stand for
Have you ever felt bad or GUILTY about your drinking
49
What does the “E” in the CAGE acronym stand for
Have you every take a. Drink first thing in the morning (EYE OPENER) to steady your nerves or get rid of a hangover
50
What is a complication of alcohol use disorder
Wernicke Korsakoff syndrome
51
Why is wernicke Korsakoff syndrome a complication of alcohol use disorder
Due to a deficiency of Thiamine (Vitamin B1)
52
What is the difference between Wernicke encephalopathy (WE) and Korsakoff syndrome
Wernicke is an acute syndrome and Korsakoff is a chronic neuro condition
53
What presents with direct damage to the brain caused by thiamine deficiency, gait ataxia, wide based gait, slow and short spaced steps, with the most common sx of confusion
Wernicke encephalopathy (WE)
54
What causes anterograde and retrograde amnesia
Korsakoff syndrome
Usually a consequence of WE and it is a late neurophysciatric manifestation of Wernicke
55
What substance abuse disorder is a potentially life threatening problem
Alcohol withdrawal
56
What percentage of patients experience severe sx of alcohol withdrawal
20%
57
What are some mild alcohol withdrawal symptoms
Anxiety
Minor agitation
Restlessness
Insomnia
Tremor
Diaphoresis
Palpitations
Headache
Alcohol craving
58
How soon do sx generally begin and end for mild withdrawal to alcohol
Start within 6-24 hours of last drink
Resolves in one to two days
59
What sx present for severe withdrawal of alcohol
Hallucinations
Seizures
Delirium
60
How soon do hallucinations begin and end for severe alcohol withdrawal
Start within 12-24 hours
Resolves in 1-2 days
Hallucinations are common
61
How soon do seizures begin for severe alcohol withdrawal and what percentage of patients experience this
Usually tonic-clonic
Start 6-48 hours of last drink and 10-30% of patients will develop the sx
62
What is the kindling effect and what is it relationship to
Risk of seizures increases with repeated withdrawals for those that suffer from severe sx with alcohol withdrawal
63
How soon does delirium begin for severe alcohol withdrawal and what percentage of patients experience this
Begins within 72-96 hours after last drink
Occurs in 1-4% of patients hospitalized with withdrawal
64
What is delirium tremens
Fluctuating disturbance in attention and cognition that may include hallucinations
65
What is the mortality rate for severe alcohol withdrawal without treatment
20%
With treatment: 1-4%
66
What is the leading preventable cause of mortality worldwide
Tobacco use disorder
67
Smoking cessation has mortality benefit for who
Both men and women of all ages
68
What are the major causes of mortality for tobacco use disorder
Cardiovascular disease
Pulmonary disease
Cancer - cancer types associated with smoking are numerous
69
What is responsible for an estimated 33% of all cardiovascular related deaths in the US
Cardiovascular disease
70
What has the most important risk factor for COPD
Pulmonary disease
71
What are the stages that someone who is considering quitting tobacco use may be in
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
72
What is perhaps the greatest barrier to quitting tobacco use
Nicotine withdrawal - peaks in the first 3 days and slowly subsides over the course of about one month
73
What are some treatment options for those with nicotine withdrawal
Nicotine replacement therapy
Bupropion (Wellbutrin)
Varenicline (Chantix)
74
What is the popular option for nicotine withdrawal that includes long and short acting nicotine replacement
Nicotine replacement therapy
Long acting: nicotine patch
Short acting: gum or lozenges available
75
What is used for both depression and smoking cessation, considered atypical antidepressant, reduces nicotine cravings and withdrawal sx
Bupropion
76
What is a partial nicotine antagonist, reduces cravings and withdrawal sx
Varenicline
77
What is detected in most urine tests for 4-6 days in short-term users and 20-50 days in long-term users
Cannabis/marijuana
78
What are some findings associated with acute opioid toxicity
Vital signs changes: increased or decreased heart rate, decreased blood pressure, respiratory rate and temperature
GI: decreased bowel sounds
Neuro: sedation
Eyes: miosis
79
What is the treatment of choice for acute opioid intoxication
Naloxone
80
What are some clinical findings of stimulant use disorder
Sweating
Tachycardia
Elevated blood pressure
Mydriasis
Hyperactivity
Acute brain syndrome with confusion and disorientation
81
What is the 18th leading cause of disability in the US
Bipolar disorder
82
Bipolar disorder is a mood disorder that is characterized by what different mood states
Mania
Hypomania
Major depression
83
What is mania
A distinct period of abnormally or persistently elevated, expansive, or irritable mood and persistently increased activity or energy, lasting at least one week and present most of the day, nearly everyday
84
Three or more of what sx must be present to fall under mania
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressured speech
Flight of ideas/racing thoughts
Distractability (easily distracted by stimuli)
Increased goal directed activity
Involvement in activities that carry negative potential
85
What acronym can be used to remember sx of mania
DIGFAST
86
What are the contents of DIGFAST
Distractibility
Indiscretions
Grandiosity
Flight of ideas
Activity increase
Sleeplessness
Talkativeness
87
What has similar characteristics of mania only far less severe and presents with no grandiosity
Hypomania
88
What are some sx of major depression
Depressed mood
Diminished interest in pleasurable activities
Weight loss or weight gain
Insomnia or hypersomnia
Psychomotor agitation
Decreased energy
Guilt or feelings of worthlessness
Impaired concentration
Thoughts of death or thoughts of suicide
89
What classifications must be met to have major depression
Five or more sx during the same 2 week period
90
What is the management of bipolar disorder
Immediately refer and manage acute sx
91
If there is an agitated patient, what can the IDC do to manage
Try to talk them down or give an antipsychotic medication for assistance
92
What medication can be given to a MEDEVAC bipolar patient
Haloperidol if needed
93
What will usually be employed by psychiatrist with a mood stabilizer or antipsychotic
Maintenance therapy
94
What medications could a bipolar patient be prescribed
Lithium
Valproic acid
Lamotrigine (lamictal)
Quetiapine (Seroquel)
95
What is the 11th greatest cause of disability and mortality in the world
Depression
96
Major depression ranks as what among all injuries and illnesses as cause of disability
2nd
97
What are some of the risk factors for depressive disorder
Family history
Female gender
Childbirth
Childhood trauma
Stressful life events
Poor social support
Serious medical illness
Substance abuse
98
What screening tool is used for a patient that presents with depressive disorder
PHQ-9 Depression Questionnare
99
What pneumonic is us used by primary care clinicians to quickly screen for depression when a PHQ-9 is not utilized or available
SIG E CAPS
100
What does the first “S” in SIG E CAPS stand for
Sleep changes
101
What does the “I” in SIG E CAPS stand for
Interest (loss)
102
What does the “G” in SIG E CAPS stand for
Guilt (worthless)
103
What does the “E” in SIG E CAPS stand for
Energy (lack)
104
What does the “C” in SIG E CAPS stand for
Concentration
105
What does the “A” in SIG E CAPS stand for
Appetite
106
What does the “P” in SIG E CAPS stand for
Psychomotor agitation - anxious or lethargic feelings
107
What does the 2nd “S” in SIG E CAPS stand for
Suicide/death preoccupation
108
What os the most feared and most important complication of depression
Suicide
109
What are the mainstays of therapy for depression
Psychotherapy
Pharmacotherapy
Or both - evidence that doing both improves results the most
110
What are the 2 classes of medications that can be used to treat depressive disorder
SSRIs: Fluoxetine, paroxetine, setraline, escitalopram, citalopram
SNRIs: venlafaxine, duloxetine
111
Medications take weeks for full effect, what is the trial time frame
4-6 weeks before becoming effective
112
What is the role of the IDC when managing a patient with depressive disorder
Ensure adequate F/U with mental health, typically within 2 weeks of starting meds
Continue monitoring for concerning behavior
Consider medication side effects
113
What are some side effects of medications used for depressive disorder
Sexual dysfunction
Drowsiness
Weight gain
Insomnia
Anxiety
Dizziness
Headache, dry mouth, blurred vision, nausea, rash, tremor, constipation, abdominal pain/upset stomach
114
What may look similar to a major depressive disorder but does not meet criteria
Adjustment disorder
115
What occurs in the context of a recent stressor and resolves within six months when the stressor is removed
Adjustment disorder
116
What usually occurs within 12 months after delivery
Post-partum depression
117
What diagnostic criteria must be met before making dx of post-partum depression
At least 5 sx for at least 2 weeks - same as those for major depressive disorder
118
What are some differentials for post-partum depression
Normal post-partum changes
Post-partum “blues”
Bipolar depression
119
What is recommended assessment used to dx post-partum depression
Edinburgh Postnatal Depression Scale (EPDS)
120
What is characterized by excessive and persistent worrying that is hard to control, causes significant distress, and occurs more days than not for at least 6 months
Anxiety disorder
121
Anxiety disorder is more common in who
Twice as common in women
122
Anxiety disorder goes “hand in hand” with what other psychiatric disorders
Depression
Specific phobias
“Medically unexplained” chronic pain
123
What is the treatment for generalized anxiety disorder
CBT, medications, or both
124
What are the typical first line choice of medication for treatment of generalized anxiety disorder
SSRIs
SNRIs
125
What is a panic attack
Spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour
126
What is the DSM-V diagnostic criteria for panic attack
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time FOUR OR MORE OF 13 SX OCCUR
127
What sx usually occur with panic attacks
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensation of shortness of breath
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed or faint
Chills or heat sensations
Parasthesia (numbness or tingling)
Derealization (feelings of unreality) or depersonalization
Fear of losing control
Fear of dying
128
What is agoraphobia
Fear and anxiety lead to avoidance of situations that may lead to panic
129
What conditions may mimic a panic attack
Angina
Arrhythmias
COPD
Epilepsy
Pulmonary embolus
Asthma
Hyperthyroidism
Substance abuse
Pheochromocytoma
130
What is the treatment for panic attacks
Require anxiolytics
Benzodiazepines - avoid chronic use due to addiction risk
Antihistamines - hydroxyzine
SSRIs
SNRI - venlafaxine
SSRIs/SNRIs are NOT anxiolytics, will not break an active panic attack and should be used for long term treatment
131
What is defined as the loss of contact with reality
Psychosis
132
What specific delusions accompany psychosis
Persecutors delusions
Grandiose delusions
Erotomaniac delusions
Somatic delusions
Delusions of reference
Delusions of control
133
What is defined as strongly held false beliefs
Delusions
134
What is defined as wakeful sensory experiences of content that is not actually present
Hallucinations
135
What are the sensory modalities that accompany hallucinations
Auditory (most common)
Visual
Tactile
Olfactory
Gustatory
136
What are the types of thought disorganization that are evident with psychosis
Alogia/poverty of content
Thought blocking
Loosening of association - think derailment
Tangentiality
Clanging or clang association - rhyming words
Word salad
Perseveration
137
What is the management of a patient with psychosis
Involves immediate referral
138
How do you treat acute agitation associated with psychosis, if present
Haloperidol (Haldol)
In retain scenarios may be able to simply “re-direct” the patient to help them with their agitation
139
What is an example of first generation antipsychotic which is older and also called “typical” antipsychotics
Haloperidol is a first generation
140
What are examples of second generation antipsychotics or atypical antipsychotics that are new and have improved side effect profiles
Aripiprazole
Risperidone
Quetiapine
Olanzapine
141
What are some side effect profiles of antipsychotics
Extrapyramidal side effects such as:
Akathisia - motor restlessness with compelling urge to move and inability to sit still
Parkinsonism syndrome - looks like Parkinson’s disease
Dystopia - involuntary contractions of muscles that is treated with Benadryl
142
What is Tardive Dyskinesia
Involuntary movements of the face: sucking or smacking of the lips
Movements of the tongue
Facial grimacing
Odd movements of extremities
Usually occur after greater than six months of treatment on antipsychotics
143
What are the two distinct phases of sleep
REM (rapid eye movement) - dream sleep
NREM - non-REM
144
What are some reasons that a patient may have sleep issues
Jet lag/travel and shift work can lead to temporary sleep disruptions
Circadian rhythm disorders (night owls)
Depression is a common cause of sleep disturbances
Poor sleep hygiene
145
What psychiatric disorders are often associated with sleep difficulties
Depression
Bipolar disorder
146
What is the first line of treatment for sleep disorder
Sleep hygiene
147
When seeking treatment, what should be avoided for patients with sleep disorders
No caffeine/nicotine in evening
Daily exercise regimen (avoid evening workouts)
Avoid alcohol
Limit fluids in evening
Relaxation techniques should be practiced
148
What can be given to patients with sleep disorder when sleep hygiene is ineffective: acute
Antihistamines - beneficial and produce no dependency
Hydroxyzine
Diphenhydramine
149
What can be given to patients with sleep disorder when sleep hygiene is ineffective: long term use
Trazadone
150
What are the personality types associated with Personality Disorder: Cluster B
Borderline Personality Disorder (BPD)
Antisocial Personality Disorder (ASBD)
151
What are distinct characteristics for BPD
Instability of interpersonal relationships, self-image, and emotions
Very impulsive behaviors
Common and most widely studied personality disorder
Interpersonal difficulties
Affective instability (unstable moods)
Impulsive behaviors
Tend to have poorer cognitive function
Suicidal threats, gestures and attempts more common
152
What are distinct characteristics for ASBD
Pattern of socially irresponsible, exploitative and guiltless behavior
Lifelong disorder
More prevalent in men
Wide range of sx with criminality being common
153
What is the definition of attention-deficit/hyperactivity-disorder
Marked pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level and clearly interferes with functioning in at least 2 settings (school, home, work)
154
Symptoms of ADHD must be present before what age
7 years old
155
Adults must have childhood onset of what age with persistent and current symptoms to be diagnosed with ADHD
By age 12
156
What are the clinical findings of ADHD
Marked inattention, distractability, organization difficulties, and poor efficiency
Can present with low frustration tolerance, shifting activities, difficulty organizing, daydreaming
Attenuate during late adolescence
More frequent in males
157
What is the mainstay of treatment and found to have similar effects when given alone than if psychotherapy was also done for ADHD
Medications:
Methylphenidate - Ritalin, concerta, metadate
Amphetamines - adderall, vyvanse
158
What is the definition of memory loss
Dementia due to Traumatic Brain Injury refers to a wide range of alterations in thinking, mood, and behavior resulting from neurological damage related to brain trauma
159
What is the pathophysiology of memory loss
Deceleration and acceleration forces act within the cranium to produce injury and the swirling movement of brain tissue causes diffuse injury to axons and contusions to cortical areas adjacent to jagged bone
160
What are some clinical findings of memory loss
Fatigue, headache, and/or dizziness occur shortly after trauma
Amnesia almost always involves loss of memory for the event and frequently includes loss of recall for events immediately before (retrograde amnesia) and after (anterograde amnesia) the head trauma
161
What is the treatment for memory loss
In mild trauma, treatment consists of determining the neuropsychological deficit and giving appropriate counseling as well as treating the sx of dizziness, headaches, and mood alteration
162
What is a complication/prognosis of memory loss
Symptoms attributed to post-concussion syndrome are greatest within the first 7-10 days for the majority of patients and at one month symptoms are usually improved and often resolved
163
What is the definition of gender dysphoria
Strong desire to be or the insistence that one is a gender other than the one assigned at birth
164
What is the treatment for a patient with gender dysphoria
Psychotherapy
Medical - hormonal therapy can be given to promote sexually dimorphic characteristics with the opposite sex and eventually sex reassignment surgery
165
What is a disturbance of processes in sexual functioning which causes clinically significant distress
Sexual dysfunction
166
What is a delayed or absent ejaculation/orgasm occurring on almost all occasions of partnered sexual activity and persists for a MINIMUM OF 6 MONTHS
Delayed ejaculation
167
What is failure to obtain erections in a situation in which they were anticipated, causing embarrassment, self-doubt, and loss of self-confidence
Erectile dysfunction
168
What is the essential criterion for gender dysphoria
The presence of clinically significant distress or impairment of functioning in one or more important areas (social relationships, work, etc.)
169
What are examples of treatment for psychological and organic impotence of erectile dysfunction
Avanafil (Stendra)
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
170
What is a complaint of normal libido and sexual excitement without the capacity to reach orgasm
