Week 12: Adult Mental Health Flashcards

Question

obsessive compulsive disorder symptoms usually occur before what age?

Answer 1

15 year old Inflexible, no spontaneity

Answer 2

* false, fixed beliefs * Grandiose, jealousy, persecutory, somatic, mixed * “I AM GOD!” * a/s with acute illness or schizophrenia * r/o organic causes (delirium), looking at psychosis

Answer 3

false sensory experience with NO objects ie: hearing voices

Answer 4

misinterpretation of reality ie: sees tree branches as goblins

Answer 5

the patient feels thoughts or wishes can CONTROL OTHERS the belief that one's ideas, thoughts, actions, words, or use of symbols can influence the course of events in the material world

Answer 6

GENERAL complaints; normal PE/VS Restlessness, fatigue, difficulty concentrating **in relation to many events or activities**

Answer 7

* 3 or more x 6+ months: * restlessness or feeling on edge * easy fatiguability * difficulty concentrating * irritability * muscle tension * sleep disturbance

Answer 8

abrupt surge of intense fear or intense discomfort that reaches a peak within minutes

Answer 9

* **important to ask for psychosocial stressors or hx or evidence of trauma or abuse** (increase risk for anxiety disorders) * ask trauma history & refer if necessary * complete physical exam * ask about headaches and bowel habits → IBS

Answer 10

* must r/o other medical causes * urine toxicology * older adults: infection, anemia, e- imbalance, liver/kidney dysfunction, thyroid, hyperparathyroidism, glucose intolerance * caffeine * ECG for panic attacks * GAD -7 screening tool * med SE's

Answer 11

* psychotherapy/CBT first line mono therapy or w/ meds * exercise as adjunct

Answer 12

* #1: SSRI & SNRI first line * **paroxetine, venlafaxine** * continue 6-12 months after sx has resolved. **if pt doesn't respond, add med or switch med, AND refer** * educate: * takes 6 wks for effect * discontinuation syndrome if missed or stop med abruptly, * serotonin syndrome * Benzodiazepines - Lorazepam * increase GABA activity in a few minutes onset * risk of falls, confusion, memory problems * rebound insomnia if stop * NO in previous substance abuse * ***bus*****pirone*****“anxious to take the bus”*** * **non sedating** * **non addictive alt to benzos** * not 1st line..takes 1-3 wks for effect and short ½ life (2-3x/day) * no effect on depression * Quetiapine (antipsychotic) can be used WITH SSRI/SNRI

Answer 13

* if no previous dx, get drug urine test * CBC * TSH * liver * renal profile

Answer 14

asking about past dx of bipolar or hx of **mania** or hypomania, age of onset, features of illness, course of illness, hx of tx and family history bc if treat for depression, it can make their mania worse

Answer 15

* Mood Disorder Questionnaire (MDQ) * Composite International Diagnostic Interview (CIDI) * also ask: hx/current eps of mania and/or depression, SI?, impact of sx's on pt's daily life, family hx

Answer 16

* lithium (careful monitoring of thyroid, parathyroid, renal, and cardiac) * divalproex (Valproate) * carbamazepine (Tegretol) * SGA - asenapine (Saphris), apriprazole (Ambilify), olanzapine (Zyprexa), ziprasidone (Geodon) * ECT

Answer 17

* weekly/biweekly to titrate meds * assess SI * assess comorbidities (depression)

Answer 18

* Either witnessing a trauma or experiencing a trauma * paroxetine, sertraline * NO BENZOs

Answer 19

* Positive sx: * hallucinations, * disorganized behavior * mania * suspiciousness * Negative sx: * Deprssion sx * Apathy * Abstract thinking problems * Anhedonia * Attention deficits

Answer 20

* **Abnormal smooth pursuit eye movement** * Poor eye hand movement /clumsy * Soft signs: asterognosis, twitches, tics, rapid eye blinking * Impaired rapid alternating movements * Impairment in fine motor, left right confusion, see neurological hard signs like weakness, decreased reflexes

Answer 21

acute phase → hospitalize antidepressants, anxiolytics, anticonvulsants **mini mental status exam (**disorganized thinking, tangential loose speech, blunt affect, bland mood, hallucinations/delusions)

Answer 22

* typical antipsychotics (1st gen) * same effectiveness * mostly on positive sx's but DON'T impact negative sx's * haloperidol, fluphenazine, chlorpromazine * atypical antipsychotics (2nd gen) * clozapine * olanzapine * risperidone

Answer 23

* mostly from 1st gen antipsychotics * life-threatening * sx's: F.E.V.E.R. * fever/hyperthermia * encephalopathy * vitals unstable (hypotension) * elevated CPK levels * rigidity of muscles * hyperreflexia

Answer 24

CPK, WBC, LFTs

Answer 25

* STOP antipsychotics * same day ER * administer tantrum (dantrolene) or parlodel (bromocriptine) * antipyretic and cooling blanket * IV hydration * benzos for muscle rigidity (catatonic sx's)

Answer 26

TCA's or venlafaxine **d**iabetic neuropathy pain: **d**uloxetine (Cymbalta)

Answer 27

* sedating * anticholinergic effects * **contraindicated with pts with arrhythmias / cardiac dz**

Answer 28

* irritability * insomina * agitation * sexual dysfunction * GI distress * **warn all pts increased risk of suicidde when starting med.** * **if \< 25 yrs old or severely depressed pts, need weekly f/u x 1 month, then bi weekly x 1 month, then monthly**

Answer 29

* not sure about diagnostic * manic or psychotic sx present * tx failure or severe sx's * substance abuse * risk for suicide

Answer 30

CAGE * CUT down? * ANNOYED someone judging u? * GUILTY feelings about drinking? * EYE opener (another drink) to get rid of hangover next day? * yes to 2 or more is 77% / 80% specific but may be biased to gender, ehtnicity, age AUDIT and AUDIT-C test online * more sensitive, not gender/eth biased but time consuming

Answer 31

comorbidities (anxiety disorder, depression, PTSD, sleep disturbances) & to treat it bc higher rates of relapse.

Answer 32

methadone, naltrexone, buprenorphine

Answer 33

* Exposure to actual or threatened death, injury, or sexual violence * \> 50% have mood, anxiety, or SUD with PTSD * 1 or more of: * Recurrent, involuntary, or intrusive memories of the traumatic event * Recurrent distressing dreams related to the traumatic event * Dissociative reactions (flashbacks) where it feels as if the traumatic event is recurring (children may reenact traumatic events during play) * Intense distress to cues that remind patient of the event * Avoidance of stimuli associated with the traumatic event * Negative alterations in cognition associated with traumatic event (2 or more of the following): * Inability to remember important aspects * Persistent and exaggerated negative beliefs about oneself and/or the role one played in the traumatic event * Diminished interest/participation in significant events * Feelings of detachment from others * Persistent inability to experience positive emotions * Marked alterations in arousal and reactivity as evidenced by: * Irritable behavior * Reckless or self-destructive behavior * Hypervigilance * Exaggerated startle response * Sleep disturbance * Symptoms last \> 1 month and are not attributable to another medical or mental condition \*Note: Acute stress disorder meets criteria for PTSD, but symptoms are self-limited and last for a minimum of 2 days and a maximum of 4 weeks.

Answer 34

* PTSD checklist - 17 reported sx's of PTSD if bothered w/in the past month * PCL-M (military) * PCL -C (civilian) * PCL-S (specific stressful experience)

Answer 35

* if no psych comorbidities, SI, prior trauma, sx's of refractory top rio rtf, can treat primary care setting with referral to psychotherapist * CBT, exposure therapy * SSRI's for positive sx's (nightmares, flashbacks) /SNRI * 1st line: paroxetine, sertraline, fluvoxamine, fluoxetine, citalopram * slow dose titration up * counsel suicide risk of med * NO anxiolytics (abuse) or benzos

Answer 36

* chronic condition * 1 yr f/u ⅔ still have sx's * at 10 yr f/u, ⅓ continue have sx's * early tx can decrease chronicity of illness → consider tx of sx present \> 4 wks

Answer 37

focus on safety of patient and those around him if pt at risk of harming himself or others or unable to care for himself, ADMIT TO PSYCH!

Answer 38

clozapine reduces suicide attempts in schizophrenia/schizoaffective disorder

Answer 39

**nicotine** smoking - induces cytochrome P450, which lowers clozapine serum concentrations = emergence of psychotic sx's get accurate smoking hx and stop smoking

Answer 40

clozapine gold standard * can add ECT if sx's come back. they have synergetic effects and can try if don't respond to clozapine alone

Answer 41

* at least 1 mania episode: * distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week * must have at least 3 concurrently: * inflated self esteem / grandiosity * decreased need for sleep * more talkative than usual * flight of ideas or racing thoughts * distractibility * increased goal directed activity or psychomotor agitation * excessive involvement in pleasurable activities with high risk for neg consequences (gambling, spending spree, risky sexual behavior) * must impair job / social * can't be substance induced

Answer 42

at least 1 episode of depression or 1 episode of hypOmania * persistently elevated, expansive, or irritable mood x at least 4 days which is diff from non depressed mood * during hypomanic episode, need at least 3 of manic sx's present, although episode is not sever enough to cause impairment tin job/social, hospitalize

Answer 43

* 20% will commit suicide * risk is highest in depressed state or mixed states (mania + depression) * onset can be any stage of life * *can be later in life* * ½ are misdx with depression * affects men and women equally

Answer 44

* **Lithium for mania + depression** * has anti-suicide effect 8-9x reduction * taken night time or twice daily * narrow TI * lots of drug-drug intxn * lamotrigine (Lamictal) NOT for acute mania but approved mood stabilizer for bipolar tx * carbamazepine (Tegretol) 2nd line * olanzapine (Zyprexa), risperidone (Risperdal) ziprasidone (Abilify), quetiapine (Seroquel) = acute mania * SE: EPS, sedation, weight gain

Answer 45

* **TSH monitoring**! (causes hypothyroidism) * affect *renal function* and electrolyte levels * monitor thyroid, parathyroid, renal, and cardiac changes * narrow TI, measured 12 hrs after last dose * goal: 0.6-1

Answer 46

since it's renally excreted, any change in renal function can affect lithium levels NSAIDs, diuretics ACE inhibitors, ARBs

Answer 47

* goal is safety and improved mood! * anticonvulsants, antidepressants, SGA, lithium * don't use antidepressants alone! use olanzapine and fluoxetine combo * lithium or valproate can be used in combo with SGA for bipolar depression

Answer 48

* **Aim—R/O organic cause** * **_complete neuro exam and psych assessment/mental status exam!_** * Blood chemistries * Hepatic and renal studies * Thyroid studies * CBC * Syphilis * HIV infection screen * Alcohol and drug testing * CT, MRI

Answer 49

drug use, alcohol use

Answer 50

SHIVERS * shivering * hyperreflexia * increasing temperatures * vital sign instability (HR/BP/RR) * encephalopathy (alter LOC) * restlessness * sweating

Answer 51

* severe alcohol withdrawal symptoms occurring 72-96 hrs after last consumption * severe tachycardia, tremor, confusion, hallucinations, agitation, diaphoresis, fever, seizures

Answer 52

* withdrawal seizures * delirium tremens * overdose of any substance that causes unstable VS --\> ED! * opioid OD: pinpoint pupils, respiratory depression = give naloxone * suicidal/homicidal/psychosis * ready for treatment for moderate - severe SUD should be referred to facility that can provide it

Week 12: Adult Mental Health Flashcards

(77 cards)