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Behavioral Med Intro
Behavioral Medicine
| Question | Answer |
|---|---|
| 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:
Abarnard
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