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Behavioral Med Intro

Behavioral Medicine

Axis I: clinical disorders and conditions that may be a focus of clinical attention
Axis II: personality disorders and mental retardation
Axis III: any physical dz / general medical condition present in addition to the mental disorder
Axis IV: psychosocial / environmental problems that contribute to the development or exacerbation of the current disorder
Axis V: global assessment of functioning (GAF) scale, used for prognosis, that considers social, occupational and psychological function
BATHE background, affect, trouble, handling, empathy
Four characteristics of supportive interventions Encouragement; Reassurance; Acknowledging Emotion; Nonverbal Communication
Components of mental status exam Appearance; Speech; Emotional Expression; Thinking and Perception; Sensorium
Violent patient mgmt strategies Verbal ; Approach ; Space ; Don’t Touch; Hands ; Eyes ; Door
The most prevalent psychiatric disorders in the US = anxiety disorders
Patients with anxiety disorder are more likely to develop: medical disorders
Type of patients who have highest all-cause mortality: anxiety disorders
Highest prevalence of all anxiety disorders GAD (lifetime: 4.1 – 6.6%)
Dx of schizophrenia (classifications) <6 mo = schizophreniform; >6 mo = schizophrenia
What is hypochondriasis? Preoccupation with fears or having serious dz, based on misinterpretation of sxs;despite medical reassurance; > 6 mos; not delusional
What is factitious disorder? Feign sx of dz to assume pt role (not for money or gain); unconscious motivation; counter-transference; comorbid with borderline
What is a conversion disorder? Sx suggests neuro dz, no med evidence; preceded by conflict/ stress; indifference; highly suggestible; F>M, vets; remits/recurs; rel to dissociative dz
Most common somatoform disorder: Conversion disorder
What is somatization? A way of responding to stress; psych / interpersonal problems expressed in somatic form, such as medically unexplained sx
What is malingering? Feigning illness for gain
Palpitations, tremors, hyperventilation or respiratory alkalosis, numb or tingling mouth or extremities = Anxiety
Feelings of worthlessness, hopelessness, apathy, weight loss, insomnia, daytime sleepiness. Thoughts of suicide = Depression (SSRI = drug of choice)
Binge eating, laxative use, starvation Bulimia nervosa (Tx w/ SSRI – Fluoxetine)
Electrolyte disorders in bulimia Hypokalemia, metabolic alkalosis
Antipsychotic meds (phenothiazines), facial tics, lip smacking, tongue disorders, blinking, ataxia Tardive dyskinesia
Pt on antipsychotic meds develops altered consciousness, lead-pipe rigidity, diaphoresis, catatonia. Hyperthermia, tachypnea, blood pressure changes. Neuroleptic malignant syndrome. Tx supportive care & antipyretics
Extrapyradimidal signs, BP changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, CV instability, fever, pulmonary congestion, diaphoresis. Pt on antipsychotic meds Neuroleptic malignant syndrome. Tx supportive care & antipyretics
Infrequent blinking, tremor, rigidity, bradykinesia, shuffling gait, masked facies Parkinson
Periods of excessive drinking, buying, spending = Manic phase of bipolar disorder
Male w/ gynecomastia, diminished or delayed secondary sex characteristics, small firm testicles, long arms & legs (eunechoid body habitus) Klinefelter Syndrome XXY. Low serum testosterone & infertility.
Hyponatremia, increased DTRs, lethargy, ataxia, tremor, bizarre behavior = sxs of: Lithium toxicity
Antidepressant use w/ anticholinergic side effects, dry mouth, dysrhythmias, sedation, orthostatic hypotension = TCA overdose
ADHD Dx criteria Sxs before 7 y.o. and present for >6 months; occur in >1 setting (home, school); need >5 hyperactivity sxs
Anorexia nervosa Dx criteria: Self induced starvation; morbid fear of fatness; medical sxs of starvation
Anorexia nervosa comorbidities Depression (65%), social phobia (34%), OCD (26%)
Anorexia nervosa screening tool = SCOFF questionnaire
Anorexia nervosa mgmt: Hospitalize if <75% expected body weight (to medically stabilize); CBT & family therapy; tx depression with SSRIs; cyproheptadine to increase appetite
Bulimia medical tx Fluoxetine 60-80mg; TCAs (but AEs)
Autistic spectrum disorder (ASD) prevalence 1 in 110 (among those <8 y.o.); about 14 in 10,000. 4:1 M:F
Autistic spectrum disorder clinical features manifest when: 12-24 months; onset usually observed at <36 months
Somatization disorder dx criteria Sx onset <30 yo; 4 pain sxs (different systems); 2 other GI sxs; one sexual sx; one pseudoneurologic sx
Created by: Adam Barnard Adam Barnard