Flashcards in PSYCHOSOCIAL DISORDERS Deck (45):
chronic form of depression lasting at least 2, and frequently more, years
example of stable causality
"it will always be this way"
cognitive cause of depression
example of global thinking
"everything is ruined"
cognitive cause of depression
What is the DSM5 criteria for depression
person must have 5 or more of the following symptoms for the same 2 weeks period and represent a change in previous functioning
What must be present in depression
depressed mood most of the day, nearly every day AND/OR
Markedly diminished interest or pleasure in almost all activities (anhedonia)
What is anhedonia
markedly diminished interest or pleasure in almost all activities
In sad cages of depression
activity: agitation/ retardation
Guilt feelings or low self esteem
Initial tests in depression
TSH, BMP, CBC, LFTs, U/A, VDRL, B12, ect.)
What are some SSRIs (selective serotonin reuptake inhibitors)
What are some reasons SSRIs are preferred
low overdose danger, fast symptom response, no postural hypotension
concerns of tricyclic antidepressants
anticholingergic effects such as dry mouth and constipation and QT prolongation
Concerns with MAOIs
wine and cheese= hypertensive crisis
Common RXd TCAs
common RXd MAOIs
Generalized anxiety disorder
excessive worry/ anxiety about life circumstances
morbid dread of seemingly harmless object/ situation; may lead to agoraphobia
Obsessive compulsive disorder
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) which interferes with normal ADLs
Having anxiety for at least 6 months after a severe trauma/ event perceived as a threat to ones integrity-characterized by flashbacks, nightmares and intrusive thoughts
benzodiazepines: ativan 1mg HS
Antihistamines: For those with COPD or potential for abuse
Bet blockers: To reduce tachycardia, palpitations, and breathlessness
tricyclics and MAOIs: May be beneficial for panic attacks but less efficacious for generalized anxiety
Buspirone (buspar) only anti anxiety medication not classified as a tranquilizer, takes 3 to 4 weeks to reach full therapeutic effects (SE nausea, sweating)
What do you RX for psychosis
atypical: risperidone, quetiapine (seroquel), olanzapine (zyprexa) aripiprazole (abilify)
what should you expect with atypical antipsychotics
significant weight gain
What might be the major reasons for suicide in the elderly that should be targeted in tx
loneliness and medical disability
What screening test for alcoholism?
CAGE screening. If 2 or more is a positive
What are the components of the cage screening?
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 morning to steady your nerves or her rid of a hangover?
Mini mental status exam components
orientation to time and place
recognition (repeat 3 objects)
attention (serial 7 counting backwards)
Recall (ask to recall 3 objects 5 minutes later)
Identify names of 2 objects
follow 3 step command
What does the mental status assessment test for (mini-mental status)?
What is the cerebral function?
senses and functioning
What is the scoring of the mental status exam (cerebral function)
no cognitive impairment: 24-30
Delirium/dementia: 18-23 (mild impairment), 0-7 (severe impairment)
What is impaired in delirium/ dementia?
SUDDEN, TRANSIENT onset of clouded sensorium, may occur at any age. Associated with a physical stressor
Neurocognitive disorder. GRADUAL memory loss with decreased intellectual functioning usually occurring over the age of 60
Causes of delirium
toxins, ETOH or drugs, trauma, impactions in the elderly, poor nutrition, electrolyte imbalances, anesthesia
causes of dementia
loss of brain cells
possible viral causes
DEMENTIA to rule out other diseases indicative of dementia
D: Drug reactions/ interactions
E: emotional disorders
M: metabolic/ endocrine disorders
E: eye and ear disorders
N: nutritional problems
define alzheimers disease
the development of multiple cognitive defects characterized by both memory impairment (impaired ability to learn new information and recall previously learned information) and one or more of the following:
Aphasia, apraxia, agnosia, inability to plan, organize, sequence, and make abstract differences
difficulty with speech
inability to perform a previously learned task
inability to recognize an object
What kind of deficiency in ALZ
Management of ALZ
medications to increase availability of acetylecholine
medications to increase the availability of acetylcholine
OFTEN RX with NMDA receptor antagonist such as memantine (named) to improve thinking and ADLs
What is the cerebellum responsible for?
balance and coordination
Assessment for cerebellar functioning
Romberg test, finger to nose test, heel-to-shin test
evaluates proprioception and cerebellar function
ask patient to stand FEET TOGETHER, EYES CLOSED, and ARMS AT THE SIDE
Positive romberg if the patient has a loss in balance