Behavioral Medicine
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| Axis I: | clinical disorders and conditions that may be a focus of clinical attention
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| Axis II: | personality disorders and mental retardation
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| Axis III: | any physical dz / general medical condition present in addition to the mental disorder
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| Axis IV: | psychosocial / environmental problems that contribute to the development or exacerbation of the current disorder
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| Axis V: | global assessment of functioning (GAF) scale, used for prognosis, that considers social, occupational and psychological function
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| BATHE | background, affect, trouble, handling, empathy
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| Four characteristics of supportive interventions | Encouragement; Reassurance; Acknowledging Emotion; Nonverbal Communication
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| Components of mental status exam | Appearance; Speech; Emotional Expression; Thinking and Perception; Sensorium
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| Violent patient mgmt strategies | Verbal ; Approach ; Space ; Don’t Touch; Hands ; Eyes ; Door
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| The most prevalent psychiatric disorders in the US = | anxiety disorders
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| Patients with anxiety disorder are more likely to develop: | medical disorders
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| Type of patients who have highest all-cause mortality: | anxiety disorders
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| Highest prevalence of all anxiety disorders | GAD (lifetime: 4.1 – 6.6%)
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| Dx of schizophrenia (classifications) | <6 mo = schizophreniform; >6 mo = schizophrenia
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| What is hypochondriasis? | Preoccupation with fears or having serious dz, based on misinterpretation of sxs;despite medical reassurance; > 6 mos; not delusional
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| What is factitious disorder? | Feign sx of dz to assume pt role (not for money or gain); unconscious motivation; counter-transference; comorbid with borderline
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| 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
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| Most common somatoform disorder: | Conversion disorder
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| What is somatization? | A way of responding to stress; psych / interpersonal problems expressed in somatic form, such as medically unexplained sx
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| What is malingering? | Feigning illness for gain
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| Palpitations, tremors, hyperventilation or respiratory alkalosis, numb or tingling mouth or extremities = | Anxiety
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| Feelings of worthlessness, hopelessness, apathy, weight loss, insomnia, daytime sleepiness. Thoughts of suicide = | Depression (SSRI = drug of choice)
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| Binge eating, laxative use, starvation | Bulimia nervosa (Tx w/ SSRI – Fluoxetine)
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| Electrolyte disorders in bulimia | Hypokalemia, metabolic alkalosis
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| Antipsychotic meds (phenothiazines), facial tics, lip smacking, tongue disorders, blinking, ataxia | Tardive dyskinesia
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| Pt on antipsychotic meds develops altered consciousness, lead-pipe rigidity, diaphoresis, catatonia. Hyperthermia, tachypnea, blood pressure changes. | Neuroleptic malignant syndrome. Tx supportive care & antipyretics
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| 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
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| Infrequent blinking, tremor, rigidity, bradykinesia, shuffling gait, masked facies | Parkinson
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| Periods of excessive drinking, buying, spending = | Manic phase of bipolar disorder
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| 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.
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| Hyponatremia, increased DTRs, lethargy, ataxia, tremor, bizarre behavior = sxs of: | Lithium toxicity
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| Antidepressant use w/ anticholinergic side effects, dry mouth, dysrhythmias, sedation, orthostatic hypotension = | TCA overdose
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| ADHD Dx criteria | Sxs before 7 y.o. and present for >6 months; occur in >1 setting (home, school); need >5 hyperactivity sxs
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| Anorexia nervosa Dx criteria: | Self induced starvation; morbid fear of fatness; medical sxs of starvation
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| Anorexia nervosa comorbidities | Depression (65%), social phobia (34%), OCD (26%)
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| Anorexia nervosa screening tool = | SCOFF questionnaire
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| Anorexia nervosa mgmt: | Hospitalize if <75% expected body weight (to medically stabilize); CBT & family therapy; tx depression with SSRIs; cyproheptadine to increase appetite
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| Bulimia medical tx | Fluoxetine 60-80mg; TCAs (but AEs)
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| Autistic spectrum disorder (ASD) prevalence | 1 in 110 (among those <8 y.o.); about 14 in 10,000. 4:1 M:F
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| Autistic spectrum disorder clinical features manifest when: | 12-24 months; onset usually observed at <36 months
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| Somatization disorder dx criteria | Sx onset <30 yo; 4 pain sxs (different systems); 2 other GI sxs; one sexual sx; one pseudoneurologic sx
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Created by:
Abarnard
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