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Psych test 2

Is somatic symptom disorder more common in men or women? Women
In order to diagnose somatic symptom disorder, one must have at least ____ somatic symptom(s) that cause distress or impairment. 1
Best pharmacologic agent for somatic symptom disorder? SSRIs
Best psychotherapeutic intervention for somatic symptom disorder? Regularly scheduled visits
Is illness anxiety disorder more common in men or women? Equal
Preoccupation with having/acquiring a specific illness Illness anxiety disorder
Psychotherapeutic intervention for illness anxiety disorder? Close monitoring (don't treat if no treatment indicated!)
Is conversion disorder more common in men or women? Women
A 35 year old female presents 2 weeks after her husband passed away complaining of new onset of blindness and ataxia. What psychiatric disorder should be high on the differential? Conversion Disorder
What maneuver can be useful in determining conversion disorder vs. true paralysis? Hoover maneuver (put hand under paralyzed leg and ask pt to lift non-paralyzed leg, if conversion disorder, will feel "paralyzed" leg contract)
Treatment of conversion disorder Usually resolves in days to weeks
A diabetic patient purposefully takes too much insulin in order to develop hypoglycemia and assume the sick role. What is this called? Factitious Disorder
If a mother is found on video to be suffocating her child in order to get medical attention, what disorder does she have? Factitious Disorder by Proxy
If a patient takes purposefully takes too much insulin to develop hypoglycemia and avoid going back to jail, what is this called? Malingering
List the 5 stages of death and dying Denial, Anger, Bargaining, Depression, Acceptance
What are the phases of uncomplicated or normal grief? Yearning, Disbelief, Depressed mood, anger, acceptance
Which phase of normal grief predominates in the first few months following the loss? Yearning
What phase of normal grief predominates in the late months following the loss (i.e. 20 months +) Acceptance
Symptoms may continue for up to _____ months in uncomplicated grief and be considered normal. 12
The patient experiencing uncomplicated grief is at the greatest risk for complications at ____ months after the loss. 2
What is the hallmark symptom of bereavement related depression? Distubance of Self-Regard
What is the pharmacotherapy for managing complicated grief? SSRIs
All palliative care is hospice care. True or false. False (all hospice care is palliative care, but not all palliative care is hospice care)
In order to qualify for hospice care from medicare, at least ____ physicians must sign off on the certification or the expected prognosis musts be less than ___ months. 2, 6
If a physician gives a dying patient a lethal injection in order to end their suffering, what is it termed? Euthanasia
If a physician gives a dying patient a syringe with a lethal substance and the patient injects themselves in order to end their suffering, what is this termed? Physician assisted suicide
What is this: An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. Typically has an onset in adolescence or early adulthood and is stable over time. Personality Disorder
What are the 3 WEIRD (odd or eccentric) personality disorders? Paranoid, schizoid, schizotypical
What are the 4 WILD (dramatic, emotional, or erratic) personality disorders? Borderline, narcissistic, histrionic, antisocial
What are the 3 WORRIED (anxious or fearful) personality disorders? Avoidant, Dependent, Obsessive-Compulsive
You meet a patient that seems to have an attitude of distrust and suspiciousness towards you. What personality disorder may he have and what can you do to help? Paranoid Personality Disorder, give as much info as possible & involve them in decisions
You have a new pt that has very restricted range of emotions and seems withdrawn or detached from social relationships. He lives alone and seems to get anxious when several nurses walk into the room. What personality disorder may he have? What can help? Schizoid Personality Disorder, smaller treatment team, own room
You have a new patient that is having some unusual thoughts, magical thinking, and reports relative social isolation. What personality disorder might this patient have? What can you do to help? Schizotypal Personality Disorder, Rule out psychosis or drug use
A mom brings in 19yo daughter after finding her cutting her wrists. She reports daughters mood as unstable - she yells "I hate you", yet doesn't want her mom to leave. What personality disorder might she have? What can help? Borderline Personality Disorder, Psychotherapy very helpful, Mood stabilizers/antidepressants also helpful
What 2 personality disorders have evidence of modestly helpful treatment with pharmacotherapies? Schizotypal and Borderline
Almost all personality disorder have evidence of significantly helpful treatment with psychotherapies except for 3 - which are they? Schizotypal, Paranoid, Antisocial
A patient presents complaining of difficulty with holding onto new information and reports recent increased difficulty in working when when the TV/radio is on, which used to be the norm for him. What cognitive domain is he struggling with? Complex Attention
Patient reports have difficulty with memory - can't remember what bills have been paid or not, constantly has to make lists to not forget things (even if only picking up 3 items at the store). What cognitive domain is he struggling with? Learning & Memory
Etiology of Delirium (DELIRIUM) Drugs, Electrolytes or Environment change, Lack of drugs (withdrawal), Infection, Restraints or Reduced sensory input, Intracranial, Urinary retention, Metabolic
2 Very common drugs known to be culprits of causing delirium? (Both start with B's!) Benadryl, Benzos
Adding >____ new meds during a hospital stay is a risk factor for developing delirium and should be avoided. 3
What are the 3 types of delirium? Hyperactive (22-30%), Hypoactive (24-26%), Mixed (42-46%)
A patient on benzos recently missed several doses. He is brought in from his nursing facility for aggressive behavior and restlessness. What is he experiencing? Hyperactive Delirium
A patient with known liver disease is brought in from her nursing facility for increased confusion and flat affect. What is she experiencing? Hypoactive Delirium (secondary to hepatic encephalopathy)
How do you evaluate a patient you suspect has delirium? Confusion Assessment Method (CAM)
If you have to use a benzo in an elderly patient with risk factors for delirium, which one should you choose? Ativan (shorter half life)
What drug class is preferred to benzos in treating elderly patients? Antipsychotics
____% of people over age 85 have Alzheimer's Disease. 30
The development of Alzheimer's is thought to be due to extracellular deposition of __________-_______ protein, intracellular neurofibrillary tangles, and loss of neurons. amyloid-beta
Are visual spatial disturbances an early or late sign of Alzheimer's? Early
Are hallucinations and delusions an early or late sign of Alzheimer's? Late
Be sure to screen for ____________ in Alzheimer's patients, as up to 1/3 may be affected. Depression
What 3 diagnostic tests can be used to evaluate all types of dementia? Mini-cog, mini mental status exam, MOCA
List 2 drugs or drug classes that are commonly used to treat Alzheimer's Disease. Cholinesterase inhibitors, Memantine (Namenda)
What are 4 OTC medications often used to treat symptoms of Alzheimer's Disease (GAVE)? Gingko biloba, Anti-inflammatories, Vitamin E, Estrogen replacement
Dementia that starts earlier (age 45-65) and presents as progressive personality/social behavior changes or decline in language is likely due to what disease? Frontotemporal Lobar Degeneration
Is frontotemporal lobal degeneration more associated with impairment of executive function or with memory loss? Impairment of executive function
Parkinson's & Dementia occurring at the same time - this is called? Lewy Body Disease
In order to diagnose Lewy Body Disease, you must have 2 of 3 symptoms. What are these symptoms? Fluctuations, visual hallucinations, Parkinsonism
Lewy Body Disease may be diagnosed by looking for low ___________ transporter uptake in the basal ganglia via PET or SPECT scan. Dopamine
If a patient has a hx of a CVA or TIA and heart disease and are now experiencing symptoms of dementia, what type of dementia do they likely have? Vascular Disease
Up to _____% of Parkinson's patient may develop dementia. 30
Are learning and memory affected in Huntington's Disease or are they preserved? Preserved
Cognitive and associated behavioral changes often come ____________ the motor symptoms of Huntington's Disease (Chorea/Bradykinesia) Before
Your tone, volume, and cadence are all examples of what type of communication techniques? Paraverbal
List 7 communication techniques that can help de-escalate and volatile situation with an angry patient. Active listening, empathetic listening, simple listening, Acknowledgement, Agreeing, Apologizing, Allowing silence
List the 4 stages of sleep and how long we spend in each. N1 - 5% (light sleep), N2 - 50% (moederate sleep), N3 - 20% (deep sleep), REM - 25% (dream sleep)
What are the 7 components measured during a sleep study (polysomnogram)? (ROPEEE) Respiratory effort, Oronasal flow, Pulse ox, EEG, EMG, ECG, EOG
Most prevalent sleep disorder in general population? Insomnia
When might benzos be a better treatment option for insomnia than benzo receptor agonists (i.e. Ambien/Lunesta) If patient has co-existing anxiety
What class of medications used to treat insomnia is associated with a "hangover" effect? Benzos (Restoril or Halcion)
When should you initiate pharmacotherapy for insomnia? If the patient has failed nonpharmacotherapy (stimulus control therapy, biofeedback, CBT, etc) or insomnia is affecting daily life
Narcolepsy is thought to be an auto-immune disease that causes decreased ________/____________ hormone that promotes wakefulness. Orexin/Hypocretin
Narcolepsy has a bimodal distribution, peaking in onset at age _____ and age ____. 15, 36
What is the best diagnostic marker for narcolepsy? Cataplexy! (sudden drop in muscle tone triggered by emotional factors)
What diagnostic study can be done to determine if a patient has narcolepsy? Multiple Sleep Latency Testing (give patient 5 nap opportunities and see if patient falls asleep)
What stimulant is used to treat narcolepsy? Modafinil (Provigil)
What medications are commonly used to treat cataplexy? TCAs or SSRIs
What is the most effective medication for treating both narcolepsy and cataplexy (and is only FDA approved med for cataplexy)? Sodium Oxybate (Xyrem)
Biggest risk factor for obstructive sleep apnea? Obesity
What is calculated during a sleep study to determine the severity of OSA? AHI levels (apnea vs. hyponeas)
What is a normal AHI level? <5
What is considered a severe AHI level? >30
What test is used to determine daytime sleepiness? Epworth Sleepiness Score
A score higher than ____ on the Epworth Sleepiness Score suggests daytime sleepiness. 10
A neck circumference >_____inches in men or >____ in women might cause concern for OSA. 17.5, 16
When should a patient be treated for OSA? If AHI>5 + complication (daytime sleepiness, mood disorder, insomnia, impaired cognition, CV disorder) or AHI >15.
Typical treatment for OSA? CPAP or BiPAP (may be more comfortable)
If your patient is diagnosed with OSA but doesn't tolerate the mask from CPAP or BiPAP, what might you suggest? (MUT POW) Maxillomandibular advancement, UPPP (uvulopalatopharyngoplasty), Tracheostomy, Positional therpay, Oral appliance, Weight loss
What sleep disorder can be associated with iron deficiency (ferritin <50 micrograms/L) Restless Leg Syndrome
What class of medications may make RLS worse? Antidepressants
A patient on dialysis presents complaining of difficulty sleeping due to urges to move legs due to unpleasant sensations. What is the diagnosis and what is the treatment? RLS, Dopaminergic Agents (Pramipexole, Ropinirole, Levodopa/Carbidopa) or Gabapentin
Last resort treatment for RLS if dopaminergic agents and gabapentin don't work? Opioids (Methadone) or Benzos
Non-REM sleep arousal disorder is defined as recurrent episodes of incomplete awakening from sleep usually occurring during the ____ 1/3 of major sleep episode and accompanied by __________ _________ disorder or _______________ disorder. 1st, sleep terror, sleepwalking
Low dose _________ may be prescribed to help with sleep walking. Benzos
Nightmares typically occur during the ______ half of major sleep episodes. 2nd
A patient presents complaining of recurrent nightmares. He can describe that in great detail. Is he experiencing nightmare disorder or sleep terror disorder? Nightmare disorder
What disorder is associated with REM sleep disorder? Parkinson's Disease
A patient presents reporting sleep disturbances. He reports that his wife complains that he frequently wakes up during the night and attacks the nightstand. What disorder does the patient have? REM Behavior Disorder
Female to male ratio for Anorexia Nervosa is ___:1 10
Bimodal peak of anorexia nervosa is at ages ____ and ____. 13, 18
If a young woman presents that is significantly under weight (BMI of 16), and reports fasting often and exercising at high intensity for 3 hours a day over the last 3 months, what eating disorder might she have? Restricting Type Anorexia Nervosa
pt BMI today is 15.50. The mom reports catching her daughter numerous times over the last 3 months making herself vomit after eating. Despite losing 30 lbs in this time, her daughter still believes she is overweight. What eating disorder might she have? Binge-Eating/Purging Type Anorexia Nervosa
Mild anorexia nervosa is considered as a BMI > ____. 17
Moderate anorexia nervosa is considered as a BMI of ____-_____ 16-16.99
Severe anorexia nervosa is considered as a BMI of ___-____. 15-15.99
Extreme anorexia nervosa is considered as a BMI <_____. 15
Primary goal of anorexia nervosa treatment? Weight restoration (can use CBT, interpersonal psychotherapy, +/- antipsychotics too)
In order to be diagnosed with bulimia nervosa one must eat a larger than normal amount of food in a discrete time period and experience a ____________ ___ _____________ while doing so. Lack of control
In order to be diagnosed with bulimia nervosa, the patient should, on average, be having compensatory behaviors at least ______ a week for ____ months. Once, 3
Mild bulimia nervosa is defined as an avg of __-___ episodes of compensatory behaviors per week. 1-3
Moderate bulimia nervosa is defined as an avg of __-___ episodes of compensatory behaviors per week. 4-7
Severe bulimia nervosa is defined as an avg of __-___ episodes of compensatory behaviors per week. 8-13
Extreme bulimia nervosa is defined as >_____ episodes of compensatory behaviors per week. 14
What types of psychotherapy are often used to treat both anorexia and bulimia nervosa? CBT, interpersonal psychotherapy
What class of medications may help to reduce bulimic sx in the short term? Antidepressants
Baclofen (a muscle relaxant) may be used to treat what eating disorder? Bulimia Nervosa
In order to diagnose binge-eating disorder, the binge eating should occur, on avg, at least _______ a week for __ months. once, 3
Treatment for binge-eating disorder (esp if patient also obese) involves ___________ in caloric intake and _____________ in physical activity. reduction, increase
Dermatologic complications like lanugo hair and pruritis and CV complications like bradycardia, hypotension, and QT prolongation are related to what eating disorder? Anorexia Nervosa
Dental erosions, GERD, melanosis coli, aspiration pneumonitis, and cheilosis are complications associated with what eating disorder? Bulimia Nervosa
What syndrome make occur when trying to restore weight in severely underweight anorexia nervosa patients? Refeeding Syndrome
Is there a higher mortality associated with anorexia nervosa or bulimia nervosa? Anorexia Nervosa
What questionnaire can be used to diagnose anorexia or bulimia nervosa? SCOFF
If a parent expresses concern about their teenager, reporting that they have become increasingly irritable, their grades are declining, and they have lost interest in social relationships and activities, what might you be concerned about? Major Depressive Disorder
Parent reports that their teenager has always been a "worry wart" but has gotten worse lately, becoming irritable, having trouble sleeping and having subsequent fatigue and trouble concentrating in class. What might you be concerned about? Generalized Anxiety Disorder
A mother discusses concern over her son's tantrums - she reports that every day it's a battle to get him to go to class. He clings to her and throws a tantrum, begging her not to leave. What disorder might this child have? Separation Anxiety Disorder
Separation Anxiety Disorder may progress to what disorder in adolescence or adulthood? Panic Disorder
On his way home from school, an 11 year old boy was held up at gunpoint and asked to hand over his cell phone and wallet. Since this encounter, he has had disorganized behavior, nightmares, and is avoiding going to school. What is the diagnosis? PTSD
In addition to psychotherapy options like acute post traumatic interventions, CBT, family therapy, and dialectical behavioral therapy, what is the 1st line psychotropic agent used to treat PTSD in children/adolescents? SSRIs (others - alpha adrenergics, atypical antipsychotics, mood stabilizers)
What childhood disorder is considered a prerequisite for antisocial personality disorder? Conduct Disorder
In addition to psychotherapeutic treatments like parent management training, multisystemic therapy, functional family therapy, CBT, and marital therapy, what pharmacologic class of agents is often used to treat conduct disorder? Psychostimulants (others - anticonvulsants, atypical antipsychotics, antidepressants)
Mild intellectual disability is defined as an IQ from ____-____ 55-70
Moderate intellectual disability is defined as an IQ from ____-____ 40-55
Severe intellectual disability is defined as an IQ from ____-____ 25-40
Profound intellectual disability is defined as an IQ below _____. 25
Children with ADHD often outgrow the symptoms of ______________ by adolescence but may still have problems with ______________. Hyperactivity, inattention
Main pharmacologic treatment for ADHD includes what 2 classes of psychostimulants? Amphetamine derivates (i.e. Adderall, Vyvanse), Methylphenidate derivates (Ritalin, Focalin)
What medication class used to treat ADHD, especially the hyperactivity symptoms, is associated with no effects on growth or appetite and may aid in sleep? Alpha 2 agonists (clonidine, guanfacine)
If you suspect a child to have ADHD with depression, what may be the medication of choice? Antidepressants (Wellbutrin or Strattera)
Symptoms of autism spectrum disorder are often noticed before age _____. 3
What 2 medications may help with irritability associated with Autism Spectrum Disorder? Risperdal, Abilify
By what age should enuresis be treated? 6-7
What 3 medications may be used to treat Enuresis? Desmopressin, Imipramine, Nortriptyline (only up to 65% efficacy though)
A mother brings in her daughter for evaluation because she is still having trouble controlling her bowels at age 5. What are the treatment options? Educational and behavioral interventions (no evidence based medical treatments)
Created by: duanea00