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Post TAV II > Psych > Flashcards

Psych Flashcards

1
Q

What is the complex somatic, cognitive, affective, and behavioral effects of psychological trauma

A

Post-traumatic stress disorder (PTSD)

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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

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3
Q

What are examples of sexual trauma

A

Rape
Childhood sexual abuse
Intimate partner violence

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4
Q

What are examples of trauma to someone in close interpersonal network

A

Death of a loved one
Critically ill child

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5
Q

What are examples of interpersonal violence

A

Assault
Childhood physical abuse
A serious threat of violence

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6
Q

What are examples of participation in organized violence

A

War
Witnessing death
Witnessing dead bodies

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7
Q

What are other types of violent events

A

Motor vehicle accident
Natural disasters

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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

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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

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10
Q

Sx must be present for how long following psychiatry to make dx

A

4 weeks

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11
Q

What is the treatment for PTSD

A

Therapy and medication are both useful and can be used either alone or in combination

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12
Q

What are examples of psychotherapy

A

Exposure therapy
CBT (cognitive behavioral therapy)
EMDR (eye movement desensitization and reprocessing)

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13
Q

What medications are used in PTSD

A

Antidepressant medications (SSRIs)

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14
Q

What are the first line therapy choice of medications

A

SSRIs - Sertraline

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15
Q

What medication can be given to a patient with PTSD that suffers from nightmares

A

Prazosin

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16
Q

What medication can be given to a patient with PTSD that suffer from tremors and sympathetic responses

A

Beta blockers

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17
Q

What medications can be given to a patient with PTSD that suffer from comorbid psychosis

A

Antipsychotics

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18
Q

Why do we NOT give a patient with PTSD benzodiazepines

A

Due to safety and dependency issues

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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

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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

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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

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22
Q

What does the “S” in SCOFF stand for

A

Do you make yourself SICK because you feel uncomfortably full

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23
Q

What does the “C” in SCOFF stand for

A

Do you worry you have lost CONTROL over how much you eat

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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

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25
Q

What do the “F”s in SCOFF stand for

A

Do you believe yourself to be FAT when others say you are thin

Would you say that FOOD dominates your life

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26
Q

Who is anorexia nervosa more common in

A

Women

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27
Q

What is the median age of onset of anorexia nervosa

A

18 years old

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28
Q

What are the specific deficits in dopaminergic function and serotonergic function

A

Dopamine: eating behavior, motivation and reward
Serotonin: mood, impulse control, obsessive behavior

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29
Q

What screening tool is used for anorexia nervosa

A

DSM V

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30
Q

What are common physical exam findings

A

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

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31
Q

Who is bulimia nervosa more common in

A

3X more common in women than men

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32
Q

What is the median age of onset of bulimia nervosa

A

18 years old

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33
Q

What are some diagnostic criteria for bulimia nervosa

A

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

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34
Q

How long does this behavior have to last to meet diagnostic criteria

A

Occurring on average at least once per week for 3 months

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35
Q

What are some clinical findings of bulimia nervosa

A

Dehydration
Menstrual irregularities
Mallory-Weiss syndrome
Pharyngitis
Erosion of dental enamel
ECG changes may occur

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36
Q

What are some other eating disorders

A

Binge eating disorder
PICA
Rumination disorder - repeated regurgitation of food

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37
Q

What is the management of eating disorders

A

Once recognized, eating disorders require referral - NEVER force feed

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38
Q

What labs are indicated for patients with eating disorders

A

CBC
Thyroid studies
Metabolic panel

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39
Q

Who do patients with eating disorders get referred to

A

Psychiatry
Nutrition consult

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40
Q

What is the triad for substance abuse

A

Psychological dependence or craving
Physiologic dependence
Tolerance

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41
Q

What is the 3rd leading preventable cause of death in the United States

A

Alcohol use disorder

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42
Q

What is the consumption amount of alcohol according to the NIAAA for men to consider alcohol abuse

A

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

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43
Q

What is the consumption amount of alcohol according to the NIAAA for women considered alcohol abuse

A

Women and adults 65 years and older - more than 7 drinks per week on average, more than 3 drinks on any given day

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44
Q

What are some medical complications of alcohol use

A

HTN
Cardiovascular disease
Liver disease
Pancreatitis
Gastritis
Esophagitis
Neuropathy

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45
Q

What screening acronym is used for patients that abuse alcohol

A

CAGE

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46
Q

What does the “C” in the CAGE acronym stand for

A

Have you ever felt you should CUT down on your drinking

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47
Q

What does the “A” in the CAGE acronym stand for

A

Have people ANNOYED you by criticizing your drinking

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48
Q

What does the “G” in the CAGE acronym stand for

A

Have you ever felt bad or GUILTY about your drinking

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49
Q

What does the “E” in the CAGE acronym stand for

A

Have you every take a. Drink first thing in the morning (EYE OPENER) to steady your nerves or get rid of a hangover

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50
Q

What is a complication of alcohol use disorder

A

Wernicke Korsakoff syndrome

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51
Q

Why is wernicke Korsakoff syndrome a complication of alcohol use disorder

A

Due to a deficiency of Thiamine (Vitamin B1)

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52
Q

What is the difference between Wernicke encephalopathy (WE) and Korsakoff syndrome

A

Wernicke is an acute syndrome and Korsakoff is a chronic neuro condition

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53
Q

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

A

Wernicke encephalopathy (WE)

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54
Q

What causes anterograde and retrograde amnesia

A

Korsakoff syndrome

Usually a consequence of WE and it is a late neurophysciatric manifestation of Wernicke

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55
Q

What substance abuse disorder is a potentially life threatening problem

A

Alcohol withdrawal

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56
Q

What percentage of patients experience severe sx of alcohol withdrawal

A

20%

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57
Q

What are some mild alcohol withdrawal symptoms

A

Anxiety
Minor agitation
Restlessness
Insomnia
Tremor
Diaphoresis
Palpitations
Headache
Alcohol craving

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58
Q

How soon do sx generally begin and end for mild withdrawal to alcohol

A

Start within 6-24 hours of last drink
Resolves in one to two days

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59
Q

What sx present for severe withdrawal of alcohol

A

Hallucinations
Seizures
Delirium

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60
Q

How soon do hallucinations begin and end for severe alcohol withdrawal

A

Start within 12-24 hours
Resolves in 1-2 days

Hallucinations are common

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61
Q

How soon do seizures begin for severe alcohol withdrawal and what percentage of patients experience this

A

Usually tonic-clonic

Start 6-48 hours of last drink and 10-30% of patients will develop the sx

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62
Q

What is the kindling effect and what is it relationship to

A

Risk of seizures increases with repeated withdrawals for those that suffer from severe sx with alcohol withdrawal

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63
Q

How soon does delirium begin for severe alcohol withdrawal and what percentage of patients experience this

A

Begins within 72-96 hours after last drink

Occurs in 1-4% of patients hospitalized with withdrawal

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64
Q

What is delirium tremens

A

Fluctuating disturbance in attention and cognition that may include hallucinations

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65
Q

What is the mortality rate for severe alcohol withdrawal without treatment

A

20%

With treatment: 1-4%

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66
Q

What is the leading preventable cause of mortality worldwide

A

Tobacco use disorder

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67
Q

Smoking cessation has mortality benefit for who

A

Both men and women of all ages

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68
Q

What are the major causes of mortality for tobacco use disorder

A

Cardiovascular disease
Pulmonary disease
Cancer - cancer types associated with smoking are numerous

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69
Q

What is responsible for an estimated 33% of all cardiovascular related deaths in the US

A

Cardiovascular disease

70
Q

What has the most important risk factor for COPD

A

Pulmonary disease

71
Q

What are the stages that someone who is considering quitting tobacco use may be in

A

Pre-contemplation
Contemplation
Preparation
Action
Maintenance

72
Q

What is perhaps the greatest barrier to quitting tobacco use

A

Nicotine withdrawal - peaks in the first 3 days and slowly subsides over the course of about one month

73
Q

What are some treatment options for those with nicotine withdrawal

A

Nicotine replacement therapy
Bupropion (Wellbutrin)
Varenicline (Chantix)

74
Q

What is the popular option for nicotine withdrawal that includes long and short acting nicotine replacement

A

Nicotine replacement therapy

Long acting: nicotine patch
Short acting: gum or lozenges available

75
Q

What is used for both depression and smoking cessation, considered atypical antidepressant, reduces nicotine cravings and withdrawal sx

A

Bupropion

76
Q

What is a partial nicotine antagonist, reduces cravings and withdrawal sx

A

Varenicline

77
Q

What is detected in most urine tests for 4-6 days in short-term users and 20-50 days in long-term users

A

Cannabis/marijuana

78
Q

What are some findings associated with acute opioid toxicity

A

Vital signs changes: increased or decreased heart rate, decreased blood pressure, respiratory rate and temperature

GI: decreased bowel sounds
Neuro: sedation
Eyes: miosis

79
Q

What is the treatment of choice for acute opioid intoxication

A

Naloxone

80
Q

What are some clinical findings of stimulant use disorder

A

Sweating
Tachycardia
Elevated blood pressure
Mydriasis
Hyperactivity
Acute brain syndrome with confusion and disorientation

81
Q

What is the 18th leading cause of disability in the US

A

Bipolar disorder

82
Q

Bipolar disorder is a mood disorder that is characterized by what different mood states

A

Mania
Hypomania
Major depression

83
Q

What is mania

A

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
Q

Three or more of what sx must be present to fall under mania

A

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
Q

What acronym can be used to remember sx of mania

A

DIGFAST

86
Q

What are the contents of DIGFAST

A

Distractibility
Indiscretions
Grandiosity
Flight of ideas
Activity increase
Sleeplessness
Talkativeness

87
Q

What has similar characteristics of mania only far less severe and presents with no grandiosity

A

Hypomania

88
Q

What are some sx of major depression

A

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
Q

What classifications must be met to have major depression

A

Five or more sx during the same 2 week period

90
Q

What is the management of bipolar disorder

A

Immediately refer and manage acute sx

91
Q

If there is an agitated patient, what can the IDC do to manage

A

Try to talk them down or give an antipsychotic medication for assistance

92
Q

What medication can be given to a MEDEVAC bipolar patient

A

Haloperidol if needed

93
Q

What will usually be employed by psychiatrist with a mood stabilizer or antipsychotic

A

Maintenance therapy

94
Q

What medications could a bipolar patient be prescribed

A

Lithium
Valproic acid
Lamotrigine (lamictal)
Quetiapine (Seroquel)

95
Q

What is the 11th greatest cause of disability and mortality in the world

A

Depression

96
Q

Major depression ranks as what among all injuries and illnesses as cause of disability

A

2nd

97
Q

What are some of the risk factors for depressive disorder

A

Family history
Female gender
Childbirth
Childhood trauma
Stressful life events
Poor social support
Serious medical illness
Substance abuse

98
Q

What screening tool is used for a patient that presents with depressive disorder

A

PHQ-9 Depression Questionnare

99
Q

What pneumonic is us used by primary care clinicians to quickly screen for depression when a PHQ-9 is not utilized or available

A

SIG E CAPS

100
Q

What does the first “S” in SIG E CAPS stand for

A

Sleep changes

101
Q

What does the “I” in SIG E CAPS stand for

A

Interest (loss)

102
Q

What does the “G” in SIG E CAPS stand for

A

Guilt (worthless)

103
Q

What does the “E” in SIG E CAPS stand for

A

Energy (lack)

104
Q

What does the “C” in SIG E CAPS stand for

A

Concentration

105
Q

What does the “A” in SIG E CAPS stand for

A

Appetite

106
Q

What does the “P” in SIG E CAPS stand for

A

Psychomotor agitation - anxious or lethargic feelings

107
Q

What does the 2nd “S” in SIG E CAPS stand for

A

Suicide/death preoccupation

108
Q

What os the most feared and most important complication of depression

A

Suicide

109
Q

What are the mainstays of therapy for depression

A

Psychotherapy
Pharmacotherapy
Or both - evidence that doing both improves results the most

110
Q

What are the 2 classes of medications that can be used to treat depressive disorder

A

SSRIs: Fluoxetine, paroxetine, setraline, escitalopram, citalopram

SNRIs: venlafaxine, duloxetine

111
Q

Medications take weeks for full effect, what is the trial time frame

A

4-6 weeks before becoming effective

112
Q

What is the role of the IDC when managing a patient with depressive disorder

A

Ensure adequate F/U with mental health, typically within 2 weeks of starting meds
Continue monitoring for concerning behavior
Consider medication side effects

113
Q

What are some side effects of medications used for depressive disorder

A

Sexual dysfunction
Drowsiness
Weight gain
Insomnia
Anxiety
Dizziness
Headache, dry mouth, blurred vision, nausea, rash, tremor, constipation, abdominal pain/upset stomach

114
Q

What may look similar to a major depressive disorder but does not meet criteria

A

Adjustment disorder

115
Q

What occurs in the context of a recent stressor and resolves within six months when the stressor is removed

A

Adjustment disorder

116
Q

What usually occurs within 12 months after delivery

A

Post-partum depression

117
Q

What diagnostic criteria must be met before making dx of post-partum depression

A

At least 5 sx for at least 2 weeks - same as those for major depressive disorder

118
Q

What are some differentials for post-partum depression

A

Normal post-partum changes
Post-partum “blues”
Bipolar depression

119
Q

What is recommended assessment used to dx post-partum depression

A

Edinburgh Postnatal Depression Scale (EPDS)

120
Q

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

A

Anxiety disorder

121
Q

Anxiety disorder is more common in who

A

Twice as common in women

122
Q

Anxiety disorder goes “hand in hand” with what other psychiatric disorders

A

Depression
Specific phobias
“Medically unexplained” chronic pain

123
Q

What is the treatment for generalized anxiety disorder

A

CBT, medications, or both

124
Q

What are the typical first line choice of medication for treatment of generalized anxiety disorder

A

SSRIs
SNRIs

125
Q

What is a panic attack

A

Spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour

126
Q

What is the DSM-V diagnostic criteria for panic attack

A

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
Q

What sx usually occur with panic attacks

A

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
Q

What is agoraphobia

A

Fear and anxiety lead to avoidance of situations that may lead to panic

129
Q

What conditions may mimic a panic attack

A

Angina
Arrhythmias
COPD
Epilepsy
Pulmonary embolus
Asthma
Hyperthyroidism
Substance abuse
Pheochromocytoma

130
Q

What is the treatment for panic attacks

A

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
Q

What is defined as the loss of contact with reality

A

Psychosis

132
Q

What specific delusions accompany psychosis

A

Persecutors delusions
Grandiose delusions
Erotomaniac delusions
Somatic delusions
Delusions of reference
Delusions of control

133
Q

What is defined as strongly held false beliefs

A

Delusions

134
Q

What is defined as wakeful sensory experiences of content that is not actually present

A

Hallucinations

135
Q

What are the sensory modalities that accompany hallucinations

A

Auditory (most common)
Visual
Tactile
Olfactory
Gustatory

136
Q

What are the types of thought disorganization that are evident with psychosis

A

Alogia/poverty of content
Thought blocking
Loosening of association - think derailment
Tangentiality
Clanging or clang association - rhyming words
Word salad
Perseveration

137
Q

What is the management of a patient with psychosis

A

Involves immediate referral

138
Q

How do you treat acute agitation associated with psychosis, if present

A

Haloperidol (Haldol)

In retain scenarios may be able to simply “re-direct” the patient to help them with their agitation

139
Q

What is an example of first generation antipsychotic which is older and also called “typical” antipsychotics

A

Haloperidol is a first generation

140
Q

What are examples of second generation antipsychotics or atypical antipsychotics that are new and have improved side effect profiles

A

Aripiprazole
Risperidone
Quetiapine
Olanzapine

141
Q

What are some side effect profiles of antipsychotics

A

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
Q

What is Tardive Dyskinesia

A

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
Q

What are the two distinct phases of sleep

A

REM (rapid eye movement) - dream sleep
NREM - non-REM

144
Q

What are some reasons that a patient may have sleep issues

A

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
Q

What psychiatric disorders are often associated with sleep difficulties

A

Depression
Bipolar disorder

146
Q

What is the first line of treatment for sleep disorder

A

Sleep hygiene

147
Q

When seeking treatment, what should be avoided for patients with sleep disorders

A

No caffeine/nicotine in evening
Daily exercise regimen (avoid evening workouts)
Avoid alcohol
Limit fluids in evening
Relaxation techniques should be practiced

148
Q

What can be given to patients with sleep disorder when sleep hygiene is ineffective: acute

A

Antihistamines - beneficial and produce no dependency

Hydroxyzine
Diphenhydramine

149
Q

What can be given to patients with sleep disorder when sleep hygiene is ineffective: long term use

A

Trazadone

150
Q

What are the personality types associated with Personality Disorder: Cluster B

A

Borderline Personality Disorder (BPD)
Antisocial Personality Disorder (ASBD)

151
Q

What are distinct characteristics for BPD

A

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
Q

What are distinct characteristics for ASBD

A

Pattern of socially irresponsible, exploitative and guiltless behavior
Lifelong disorder
More prevalent in men
Wide range of sx with criminality being common

153
Q

What is the definition of attention-deficit/hyperactivity-disorder

A

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
Q

Symptoms of ADHD must be present before what age

A

7 years old

155
Q

Adults must have childhood onset of what age with persistent and current symptoms to be diagnosed with ADHD

A

By age 12

156
Q

What are the clinical findings of ADHD

A

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
Q

What is the mainstay of treatment and found to have similar effects when given alone than if psychotherapy was also done for ADHD

A

Medications:
Methylphenidate - Ritalin, concerta, metadate
Amphetamines - adderall, vyvanse

158
Q

What is the definition of memory loss

A

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
Q

What is the pathophysiology of memory loss

A

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
Q

What are some clinical findings of memory loss

A

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
Q

What is the treatment for memory loss

A

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
Q

What is a complication/prognosis of memory loss

A

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
Q

What is the definition of gender dysphoria

A

Strong desire to be or the insistence that one is a gender other than the one assigned at birth

164
Q

What is the treatment for a patient with gender dysphoria

A

Psychotherapy
Medical - hormonal therapy can be given to promote sexually dimorphic characteristics with the opposite sex and eventually sex reassignment surgery

165
Q

What is a disturbance of processes in sexual functioning which causes clinically significant distress

A

Sexual dysfunction

166
Q

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

A

Delayed ejaculation

167
Q

What is failure to obtain erections in a situation in which they were anticipated, causing embarrassment, self-doubt, and loss of self-confidence

A

Erectile dysfunction

168
Q

What is the essential criterion for gender dysphoria

A

The presence of clinically significant distress or impairment of functioning in one or more important areas (social relationships, work, etc.)

169
Q

What are examples of treatment for psychological and organic impotence of erectile dysfunction

A

Avanafil (Stendra)
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)

170
Q

What is a complaint of normal libido and sexual excitement without the capacity to reach orgasm

A

Post TAV II (7 decks)

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