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STEP > Behavioral Health > Flashcards

Behavioral Health Flashcards

1
Q

Acting Out

A

Expressing unacceptable feelings through actions

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2
Q

Denial

A

Behaving as if an aspect of reality does not exist

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3
Q

Displacement

A

Transferring feelings to a more acceptable object
- Ex. If a mother hates her stepson, but instead of yelling and showing it towards him, she yells and displaces her anger at their dog

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4
Q

Passive Aggression

A

Avoiding conflict by expressing hostility covertly

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5
Q

Projection

A

Attributing ones own feelings to others
Ex. If a mother hates her stepson but instead of releasing her hate and anger on him, she accuses her husband of hating him

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6
Q

Rationalization

A

Justifying behavior to avoid difficult truths

Ex. Making excuses for unacceptable feelings or behavior

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7
Q

Reaction Formation

A

Responding in a manner opposite to ones own feelings
Ex. Mother that feels resentment and anger towards her stepson but masks her unacceptable emotions with declarations of love and care for him.

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8
Q

Regression

A

Reverting to an early developmental state

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9
Q

Splitting

A
  • Seeing others as all bad or all good
  • All or nothing
  • Patient is unable to integrate positive and negative qualities of the self or others into a cohesive and realistic whole.
  • Seen in borderline personality disorder
    Ex. One day you see your parents as all mean and the next day you see your parents as all nice
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10
Q

Sublimation

A

Channeling impulses into socially acceptable behavior

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11
Q

Suppression

A

Putting unwanted feelings aside to cope with reality

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12
Q

Define Delusional Disorder?

A
  • > 1 delusions x > 1 month
  • Persistent, false, fixed beliefs
  • Other psychotic symptoms are absent or not prominent
  • Still able to function properly, behavior is not obviously bizarre or odd
  • Types:
    1. Eromatic
    2. Grandiose
    3. Jealous
    4. Persecutory
    5. Somatica
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13
Q

Erotomatic delusional disorder

A

Believing that someone is in love with them

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14
Q

Grandiose delusional disorder

A

Believing that they have great talent, insights or achievements

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15
Q

Jealous delusional disorder

A

Believing that their partner is unfaithful

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16
Q

Persecutory delusional disorder

A

Believing they are being cheated, spied on, poisoned or harassed

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17
Q

Somatic delusional disorder

A

Believing bodily functions and sensations are abnormal

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18
Q

Brief psychotic disorder?

A
  • > 1 positive psychotic symptoms x < 1 month

- Sudden onset with full return to premorbid level of functioning

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19
Q

Paranoid personality disorder?

A
  • Suspiciousness, distrustful, hypervigilant
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20
Q

Schizotypal personality disorder

A
  • Eccentric behavior, odd thoughts and perceptions
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21
Q

What symptoms would you find with serotonin syndrome?

A
  1. Neuromuscular excitation
    - Hyperreflexia, clonus, myoclonus, rigidity or tremor
  2. Autonomic stimulation
    - Hyperthermia, tachycardia, diaphoresis and vomiting/diarrhea
  3. Altered mental status
    - Agitation or confusion
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22
Q

What causes serotonin syndrome and what is the precursor for serotonin?

A
  1. SSRIs taken in combination with MAOIs
  2. Excess dose of SSRIs
  3. Tryptophan is the precursor
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23
Q

What is the treatment for Serotonin syndrome?

A

Cyproheptadine

- An antihistamine with antiserotonergic properties, has 5-HT1 and 5-HT2 receptor antagonistic properties.

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24
Q

Lithium

  • Indications
  • Side effects
A 
Indications: 
- Manic and depressive episodes maintenance
Side effects: 
- Diabetes Insipidus
- Hypothyroidism
- Tremor
- Ebstein Anomoly of tricuspid valve
25
Q

Valproate

  • Indications
  • Side effects
A 
Indications: 
- Manic episodes maintenance 
- Absence seizures
- Generalized tonic-clonic seizures
- Myoclonic seizures
Side effects
- Hepatotoxic
- Neural tube defects in pregnancy
26
Q

Carbamazepine

  • Indications
  • Side effects
A 
Indications:
- Manic episodes maintenance
- Partial seizures
- Generalized seizures
- Trigeminal Neuralgia
Side effects:
- Agranulocytosis
- SIADH (Hyponatremia)
- Neural tube defects
27
Q

Lamotrigine

  • Indications
  • Side effects
A 
Indications
-Depressive episodes maintenance
- Focal seizures
Side effects
- Benign rash
- Stevens-johnson syndrome
28
Q

What are lithiums effects on the thyroid and how is it managed?

A
  • It interferes with normal thyroid functioning by decreasing thyroid hormone synthesis and release.
  • Leads to hypothyroidism and goiter.
  • Causes weight gain, dry skin, hair loss, constipation and bradycardia.
  • Periodically measure TSH
  • Treat with T4, do not have to discontinue Lithium
29
Q

What are lithiums effects on the kidney?

A
  • Nephrogenic diabetes insipidus
  • Chronic tubulointerstitial nephropathy
  • Requires regular monitoring of Lithium, BUN and creatinine
30
Q

What causes lithium toxicity?

A
  1. Overdose
  2. Volume depletion such as decreased GFR
  3. Drug interactions with:
    - Thiazide diuretics
    - NSAIDs besides aspirin
    - ACE inhibitors
    - Tetracyclines, metronidazole
31
Q

What are the clinical features of acute and chronic lithium toxicity?

A 
Acute
- Nausea, vomiting, diarrhea
- Late neurologic sequelae
Chronic
- Confusion
- Agitation
- Ataxia
- Tremors/Fasciculations
32
Q

How do you treat lithium toxicity?

A

Hemodialysis

33
Q

Major Depressive Disorder

  • Which criteria must be present and which are required?
  • What is the time frame?
A 
Five of the following
- Sleep disturbances
- Appetite change
- Low energy
- Psychomotor changes
- Low mood **
- Anhedonia (lack of feeling pleasure)**
- Guilt
- Focus/concentration difficulty
- Suicidal ideation
** Indicates must be present
Duration > 2 weeks
Social and occupational dysfunction
Suicidality related to hopelessness and worhtlessness
34
Q

Specific Phobia

A
  • Anxiety about a specific object or situation for more than 6 months
  • Ex. fear of flying, heights, animals, injections, blood
  • Patient usually tries to avoid the situation
  • Common (10% of the population)
  • Usually develops in childhood after a traumatic event
35
Q

What is the most effective treatment for a specific phobia?

A
  • Cognitive behavior therapy with systematic, repeated exposure
  • Usually performed in a gradual, stepwise manner
  • Decreases anxiety over time as habituation and extinction occur
  • Confrontation with stimulus in a safe, controlled manner can be accomplished through in vivo, imaginal and virtual reality
  • Short acting benzodiazepines may be used with a limited role in acute treatment if therapies are unavailable or there is insufficient time
36
Q

What medication can be used to treat performance anxiety?

A

Propanalol

37
Q

Escitalopram

  • MOA
  • Uses
A
  • Selective Serotonin Reuptake Inhibitor

- Used for panic disorder, generalized anxiety disorder and social anxiety disorder

38
Q

Benzodiazepines

  • MOA
  • Uses
A
  • Sedative hypnotic drugs with anxiolytic, muscle relaxant and anticonvulsant actions
  • Bind and modulate GABA receptor chloride channel in CNS neurons increasing its frequency of opening
  • Increase in chloride permeability hyperpolarizes and stabilizes the membrane making it less likely to depolarize
39
Q

What is the treatment for OCD?

A
  • Serotonin is the primary pharmacological target
  • First line treatment is Selective Seretonin Reuptake Inhibitors
    1. Fluvoxamine
    2. Citalopram
    3. Escitalopram
    4. Fluoxetine
    5. Paroxetine
    6. Sertraline
  • Second is cognitive behavioral therapy (exposure and response prevention)
40
Q

Tourrette Syndrome

A
  • Multiple motor and more than 1 vocal tic (doesn’t have to be concurrent or greater than 1 year)
  • Onset age must be before age 18
    1. Motor tics
  • Facial grimacing
  • Blinking
  • Head/neck jerking
  • Shoulder shrugging
  • Tongue protrusion
  • Sniffing
    2. Vocal tics
  • Grunts
  • Snorts
  • Throat clearing
  • Barking
  • Yelling
  • Coprolalia (involuntary obscene speech) 10-20% of pts
    Treatment
    1. Antipsychotics
  • Haloperidol
  • Fluphenazine
  • Pimozide
    2. Tetrabenzine
    3. Alpha-2-adrenergic receptor agonists
  • Guanfacine
  • Clonodine
    4. Behavioral therapy or psychoeducation
41
Q

Schizoid personality disorder

A

Prefers to be a loner, detached, unemotional

42
Q

Antisocial personality disorder

A

Disregard; violation of the rights of others

- Not to be confused with avoidant personality disorder

43
Q

Borderline personality disorder

A

Chaotic relationships, sensitivity to abandonment, labile mood, impulsivity, inner emptiness, self harm

44
Q

Histrionic personality disorder

A

Dramatic, superficial, attention seeking

45
Q

Narcissistic personality disorder

A

Grandiosity, entitlement, lack of empathy

46
Q

Avoidant personality disorder

A

Avoidance due to fears of criticism; rejection

47
Q

Dependent personality disorder

A

Submissive, clingy, needs to be taken care of

48
Q

Obsessive compulsive disorder

A

Rigid, controlling, perfectionist

49
Q

What are the 8 childhood and early onset behavioral disorders?

A
  1. Attention deficit hyperactive disorder
  2. Autism spectrum disorder
  3. Rett syndrome
  4. Conduct disorder
  5. Oppositional defiant disorder
  6. Separation anxiety disorder
  7. Tourette syndrome
    8 Disruptive mood dysregulation disorder
50
Q

ADHD

A
  • Onset before age 12
  • Limited attention span and poor impulse control
  • Hyperactivity, impulsivity and/or innatetntion in multiple settings (school, home, church, etc)
  • Normal intelligence but coexists with difficulties at school
  • Continues into adulthood in 50%
    Treatment:
    1. Stimulants
  • Methylphenidate
  • Adderal
    2. Cognitive behavioral therapy
    3. Alternatives
  • Atomoxetine (SNRI): Brand name straterra
  • Guanfacine
  • Clonidine
51
Q

Autism Spectrum Disorder

A
  • Poor social interaction, social communication deficits, repetitive visualized behaviors, restricted interests
  • Presents in early childhood
  • May be accompanied by intellectual disability
  • Rarely accompanied by unusual abilities (savants)
  • More common in boys
  • Associated with increased brain/head size
52
Q

Rett Syndrome

A
  • X-linked dominant disorder
  • Seen almost exclusively in girls
  • Males die in utero or shortly after birth
  • De novo mutation of MECP2
  • Symptoms present ages 1-4
  • Regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, stereotyped hand wringing
  • No longer solitary diagnosis within DSM-5
53
Q

Conduct disorder

A

Repetitive and pervasive behavior violating the basic rights of others or social norms

  • Such as aggression to people and animals, destruction of property, theft
  • After age 18 it is reclassified as antisocial personality disorder
  • Treatment is cognitive behavioral therapy
54
Q

Oppositional defiant disorder

A
  • Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
  • Treatment is cognitive behavioral therapy
55
Q

Separation anxiety disorder

A
  • Fear of separation from home or attachment figure
  • Can be normal behavior up to age 3-4
  • May lead to factitious physical complaints to avoid school
  • Treatment is cognitive behavioral therapy, play therapy or family therapy
56
Q

Disruptive mood dysregulation disorder

A
  • Before age 10
  • Severe recurrent temper outbursts out of proportion to situation
  • Child is constantly angry and irritable between outbursts
  • Treatment is with psychostimulants, antipsychotics or cognitive behavioral therapy
57
Q

Buspirone

  • MOA
  • Properties
  • Uses
A
  • Nonbenzodiazepine anxiolytic
  • Partial agonist of 5HT1A receptor
  • Has no muscle relaxant or anticonvulsant properties
  • Used for treatment of generalized anxiety disorder
  • Not useful in acute anxiety because of its slow onset of action (may take up to 2 weeks)
  • Not effective in panic disorder
  • No risk of tolerance, dependence or withdrawal
58
Q

What is Clozapine and what are the 2 indications for its use?

A
  • Second generation antipsychotic that has affinity for dopamine and serotonin receptors
  • Treatment resistant schizophrenia
  • Schizophrenia associated with suicidality
59
Q

What are the adverse effects of clozapine?

A

Agranulocytosis
Seizures
Myocarditis
Metabolic syndrome

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