Psychosocial

Question 1

Depression

Answer 1

Mood state characterized by diminished interest in formal activity, fatigue, feelings of sadness, and impaired concentration nearly every day.

Question 2

Dysthymia

Answer 2

Chronic form of depression lasting at leas 2 and frequently many more years

Question 3

Stable causality

Answer 3

“it will always be this way”

Question 4

Global thinking

Answer 4

“Everything is ruined”

Question 5

Internal vs. external causes

Answer 5

“it’s my fault”

Question 6

Biochemical theories in depression

Answer 6

Neurotransmitter imbalance (dopamine/serotonin/epi/norepi)
Thyroid dysfunction
Med side effects

Question 7

DSM-5 Criteria

Answer 7

States that a person must have 5 or more of the following symptoms for the same 2-week period and represent a change in precious functioning:
*Depressed mood most of the day, nearly everyday
*Markedly diminished interest or pleasure in almost all activities (Anhedonia)
Weight change >5%
Insomnia/hyperinsomnia
Psychomotor agitation/retardation
Fatigue/loss of energy
Lack of concentration/indecisiveness nearly every day
Excessive guilt or feelings of worthlessness
Recurrent thoughts of death/suicide ideation w/o plan or attempt

Question 8

“In Sad Cages”

Answer 8

In terest: loss of pleasure
S leep disturbances
A ppetite changes 
D epressed mood
C oncentration difficulty
A ctivity: agitation/retardation
G uilt feelings
E nergy loss
S uicidal ideation

Question 9

Stages of grief

Answer 9

DABDA

Denial, anger, bargaining, depression, acceptance

Question 10

Selective Serotonin Reuptake Inhibitors (SSRI’s)

Answer 10

Paroxetine, fluoxetine, sertraline, citalopram, fluvoxamine
Low OD danger 
Fast symptom response
No postural hypotension
Sexual dysfunction

Question 11

Serotonin syndrome

Answer 11

Cognitive changes, neuromuscular changes and autonomic hyperactivity (high fevers)

Question 12

Tricyclics and MAOI;s

Answer 12

Increased SE and high OD potential
TCA’s-anticholinergic effects (dry mouth and constipation) –HIGH OD potential (cardiac)
MAOI’s= Wine + Cheese = Hypertensive crisis

Question 13

Generalized anxiety disorder

Answer 13

Excessive worry/anxiety about life circumstances

Question 14

Panic Disorder

Answer 14

Morbid dreads of seemingly harmless object/situation; may lead to agoraphobia

Question 15

Obsessive compulsive disorder

Answer 15

OCD
Repetitive thoughts (obsession) that a person is unable to control and/or urge to perform an act that cannot be resisted without great difficulty (compulsion), interferes with normal ADL's

Question 16

Post-traumatic stress disorder

Answer 16

PTSD
Having anxiety for at least 6 months after a severe trauma/event perceived as a threat to one’s integrity
Flashbacks, nightmares and intrusive thoughts

Question 17

Benzodiazepines

Answer 17

Most commonly used

high abuse potential

Question 18

Antihistamines

Answer 18

For those with COPD or potential for abuse

Question 19

Beta blockers

Answer 19

to reduce tachycardia, palpitations and breathlessness

Question 20

TCA’s and MAOI’s

Answer 20

May be beneficial for panic attacks but less efficacious for GAD

Question 21

Buspirone (Buspar)

Answer 21

Only antianxiety med not classified as a tranquilizer, takes 3-4 weeks to reach full therapeutic effects

Question 22

Incidence of suicide

Answer 22

80% of pts who state intent of suicide DO
Second leading cause of death among adolescents
Hopelessness is commonly a predicting variable!
Women attempt more often, but men are 3x more likely to succeed

Question 23

SUICIDAL mnemonic

Answer 23

S ex
U nsuccessful attempts
I dentified family members w/ attempt hx
CI Chronic illness hx
D epression, drug abuse, drinking
A ge of pt
L ethal method available

Question 24

Antipsychotics

Answer 24

Lithium- use caution when prescribing (LOW therapeutic index) can become lethal with just a little
Significant weight gain w/ atypical antipsychotics

Question 25

CAGE

Answer 25

C: Have you ever felt the need to cut down on your drinking? A: Have people annoyed you by criticizing your drinking? G: Have you ever felt guilty about your drinking? E: Have you ever had a drink first thing in the AM to steady your nerves or get rid of a hangover? (eye-opener)

Question 26

Korsakoff syndrome

Answer 26

chronic memory impairment d/t severe Vit B12 deficiency

Question 27

Delirium

Answer 27

Sudden, transient onset of clouded sensorium; may occur at any age associated with a physical stressor

Question 28

Causes of delirium

Answer 28

``` Toxins Alcohol/drug abuse Trauma Impactions in the elderly Poor nutrition Electrolyte imbalances Anesthesia ```

Question 29

Dementia

Answer 29

Neurocognitive d/o | Gradual memory loss with decreased intellectual functioning usually occurring over the age of 60

Question 30

Causes of dementia

Answer 30

``` Atherosclerosis Neurotransmitter deficits Corticol atrophy Ventricular dilation Loss of brain cells possible viral causes Alzheimer's disease ```

Question 31

DEMENTIA mnemonic

Answer 31

``` To rule out other diseases indicative of dementia D: drug reactions/interactions E: emotional disorders M: metabolic/endocrine disorders E: eye and ear problems N: nutritional problems T: tumors I: infection A: arteriosclerosis ```

Question 32

Alzheimer's Disease

Answer 32

Development of multiple cognitive defects characterized by both memory impairment and one or more of the following: 1. aphasia (speech difficulty) 2. apraxia (inability to perform a previously learned task) 3. agnosia (inability to recognize an object) 4. Inability to plan, organize, sequence and make abstract differences

Question 33

S/s of Alzheimer's

Answer 33

``` Limb rigidity Flexion posture Disorientation Recent memory impairment Impaired judgment Gait disturbances ```

Question 34

Cause/incidence of AD

Answer 34

Most common cause of dementia Earliest complaint= loss of short term memory Acetylcholine deficiency

Question 35

Management of AD

Answer 35

Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon) *Acetylcholinesterase inhibitors are often prescribed in conjunction with NMDA receptor antagonists sucj as Memantine to improve thinking and ADL's

Question 36

Cerebellar Function

Answer 36

Balance and coordination + Romberg Finger to nose test Heel-to-shin test