Psych Flashcards

Question

List 4 ED care goals for pts with Somatic Symptom and Related Disorders

Answer 1

1) establishment of rapport 2) building a therapeutic alliance 3) legitimizing the patient’s distress 4) enhancing the patient’s ability to function despite the symptoms

Answer 2

Patients’ maladaptive and inappropriate psychological response to somatic (bodily) symptoms

Answer 3

Women Low SES Age 20s-30s

Answer 4

Purposefully deceptive falsification of disease signs or symptoms for the sole purpose of causing others to see the person with the disorder as ill *can also occur 'by proxy'

Answer 5

- Anxiety-exacerbated asthma - Stress-induced Takotsubo cardiomyopathy

Answer 6

Psychiatric: - Depression - Anxiety - OCD - Schizophrenia - Personality d/os - SUDs - Malingering Medical: - TIA - MS - SLE - Thyroid d/o's - Parathyroid d/o's - Electrolyte d/o's - HIV - Anti-NMDA receptor encephalitis

Answer 7

Depressive disorders Bipolar disorders

Answer 8

- increase the availability and activity of serotonin and norepinephrine at the synapse to stimulate the postsynaptic neuron examples: - direct binding to presynaptic and postsynaptic receptors - blocking reuptake of neurotransmitter - inhibiting the enzymatic breakdown of neurotransmitter

Answer 9

A. 5+ of following symptoms have been present almost every day during the same 2-week period and represent a change from previous functioning - at least one of the symptoms is either (1) depressed mood or (2) anhedonia: 1. Depressed/irritable mood 2. Loss of interest or pleasure in activities 3. Significant weight loss or gain, OR decrease or increase in appetite 4. Insomnia or hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Feelings of worthlessness, excessive or inappropriate guilt 8. Diminished ability to think or concentrate, or indecisiveness 9. Recurrent thoughts of death, recurrent suicidal ideation, or a suicide plan/attempt B. Symptoms cause clinically significant distress or impairment in social, occupational, or other functioning. C. Symptoms are not caused by direct physiologic effects of a substance, medication or general medical condition D. Symptoms are not better explained by another mental health disorder. E. NEVER had manic or hypomanic episode.

Answer 10

- Severe, recurrent outbursts that are out of proportion for the situation AND - Inconsistent with developmental level - Outbursts must occur 3+/week - Mood between outbursts = angry/irritable - Duration 12mos, with no periods of 3+ mos WITHOUT symptoms - Symptoms must be dx before 10yrs old

Answer 11

- early morning awakening - diurnal variation in mood - low self-esteem - low mood reactivity

Answer 12

Occurs during pregnancy or w/in 4 weeks of delivery

Answer 13

- Hx postpartum episodes w/ psychosis - Hx depression or bipolar disorder - FamHx of bipolar disorder

Answer 14

= chronic MDD + dysthymic d/o --> Depressed mood most of the day, most days for at least 2 years --> 2+ of following: - poor appetite or overeating - insomnia or hypersomnia - low energy or fatigue - low self-esteem - poor concentration or difficulty making decisions - feelings of hopelessness --> Must cause significant distress or impairment in functioning * Never >2mos of the 2yrs WITHOUT symptoms * No hypomania, mania, psychosis allowed

Answer 15

Some Symptoms include: Breast tenderness Mood swings Irritability Appetite change Anxiety Anhedonia Sleep disturbances - 5+ symptoms present in final week BEFORE onset of menses - starts to improve few days into menses - absent-minimal in week after menses

Answer 16

- stress - history of interpersonal trauma - seasonal changes - sociocultural aspects of female sexual behaviour

Answer 17

Men = mid-teens & mid-20s Women = mid-teens & mid-30s

Answer 18

Bipolar I: - at least 1 manic episode - typically had 1+ MDEs (depressive episode is not necessary for diagnosis) Bipolar II: - hypomanic episode - at least 1 MDE

Answer 19

Features of manic episode WITHOUT psychosis, marked impairment of function, or the need for hospitalization

Answer 20

A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy lasting at least 1 week B. 3+ of following significant symptoms have persisted: 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing 5. Distractibility 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., buying sprees, sexual indiscretions, foolish investments) C. Mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or social activities or to necessitate hospitalization to prevent harm to self or others, or psychotic features are present. D. Symptoms are not caused by direct physiologic effects of a substance, medication or a general medical condition

Answer 21

- chronic mood swings that do not meet criteria for hypomanic or depressive episode - mood episodes must occur over at least 2 years, present for at least half the time - cannot be symptom-free for >2mos at a time

Answer 22

- Parkinsons - Pancreatic Ca - Brain Ca - Disseminated malignancy (Lymphoma) - CAD - MI - Stroke - ESRD - Connective tissue disease - Diabetes - Osteoporosis

Answer 23

- behavioural or emotional disorders that occur in response to identifiable stressor, with marked distress that is out of proportion to severity of stressor - Occurs within 3mos and does not last longer than 6mos

Answer 24

- Medical Disorders - Medications - Substance Abuse or Withdrawal - Grief + Bereavement - Adjustment disorders - Borderline personality disorder - Dementia

Answer 25

Response to given circumstance or threat becomes significantly disproportionate or uncontrollable Leading to deterioration of performance & inability to cope

Answer 26

GAD Panic disorder Agoraphobia Specific phobias

Answer 27

- Onset of anxiety >35 years - Lack of personal or family history of anxiety disorder - Lack of childhood history of significant anxiety, phobias, or separation anxiety - Lack of avoidance behaviour - Absence of significant life events generating or exacerbating the anxiety symptoms - Poor response to anti-anxiety agents

Answer 28

Abrupt surge of intense fear or discomfort that reaches a peak within minutes *in which 4+ of following occur: - Palpitations - Sweating - Trembling - Shortness of breath or feeling of being smothered - Feeling of choking - Chest pain or discomfort - Nausea or abdominal distress - Feeling dizzy or lightheaded - Chills or heat sensations - Paresthesias - Derealization or depersonalization - Fear of losing control or going “crazy” - Fear of dying

Answer 29

*Dx of exclusion Must experience recurrent, unexpected panic attacks, PLUS Persistent concern of future attacks OR Maladaptive behavioural change related to attacks

Answer 30

- excessive worry that occurs most days over 6-month period involving several events or activities - anxiety must cause significant distress or impairment in functioning

Answer 31

* Exposure to actual or threatened death, serious injury, or sexual violence. Presence of intrusion symptoms Persistent avoidance of stimuli associated w/ trauma Negative alterations in cognition & mood Marked alterations in arousal and reactivity Duration >1mo Disturbance causes clinically significant distress or impairment. Disturbance is not attributable to the physiological effects of a substance or another medical condition.

Answer 32

(1) anxiety or tension is often associated with obsessions and resistance to compulsions (2) anxiety or tension is often immediately relieved by yielding to compulsions

Answer 33

CARDIAC: MI Dysrhythmias ENDOCRINE: Hypoparathyroidism Hyperthyroidism Hypothyroidism Thyrotoxicosis Hypoglycemia Diabetes mellitus Pheochromocytoma Hyperadrenocorticism RESPIRATORY: COPD Asthma PE NEURO: Temporal lobe sz Tumours AVM CVA TBI Huntingtons Parkinsons Alzheimers DRUGS: Coke Amphetamines Caffeine THC LSD MDMA PCP Withdrawal of BZN Withdrawal of EtOH Withdrawal of anti-depressants

Answer 34

S/S that are intentionally produced or feigned by patient (or caregiver) in the absence of apparent external incentives, in order to fulfill illness role

Answer 35

simulation or production of a factitious mental or physical disease in an individual by a caregiver

Answer 36

simulation of disease by the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives ex) avoidance of military responsibility, avoidance of work, obtaining financial compensation, evading criminal prosecution, obtaining medication, hospital admission, or securing of better living conditions.

Answer 37

1. Falsification of psychological or physical signs or symptoms, or induction of disease or injury associated with identified deception. 2. The individual presents to others as injured, ill, or impaired. 3. The deceptive behaviour is apparent even in the absence of external incentives. 4. The behaviour is not better explained by another mental disorder. * Production of symptoms is compulsive, may be subconscious

Answer 38

1. Falsification of psychological or physical signs or symptoms, or induction of disease or injury in another, associated with identified deception. 2. The individual presents another individual (victim) to others as injured, ill, or impaired. 3. The deceptive behaviour is apparent even in the absence of external incentives. 4. The behaviour is not better explained by another mental disorder.

Answer 39

Bleeding Seizures CNS depression Apnea Diarrhea Vomiting Fever Rash

Answer 40

Bio moms All SES's Background in healthcare or SW Past psych tx Marital problems Suicide attempts Usually pleasant ppl

Answer 41

Antisocial personality disorder SUD

Answer 42

1. Medicolegal context of the presentation (e.g., the patient was referred by his or her attorney) 2. Marked discrepancy between the person’s claimed stress or disability and objective findings 3. Poor cooperation during the diagnostic evaluation or poor compliance with previously prescribed treatment regimens 4. The person exhibits or has a history of antisocial behaviour

Answer 43

- interpersonal relationship stressors - recent crises - problematic substance use - physical health problems - financial circumstances - criminal or legal issues - homelessness

Answer 44

Previous attempt

Answer 45

- age - ethnicity/race - geography - employment | Employment seems dynamic but oh well

Answer 46

- older white male - existing depression - cognitive dysfnc - decreased fnc'l ability - bereavement - stressful life events - social isolation - loneliness

Answer 47

Male gender Prior attempts Comorbid psychiatric disorders Recent psychiatric hospitalization More severe symptoms EtOH & Drug use FamHx of suicide

Answer 48

direct, deliberate destruction of one’s own body tissue in the absence of intent to die

Answer 49

1. Identify risk factors 2. Identify protective factors 3. Conduct suicide inquiry 4. Determine risk level and intervention 5. Document

Answer 50

A) Pts req'ing involuntary hospitalization --> WHY they are a danger to themselves or others B) Pts being discharged --> Decision-making of WHY they are low risk of imminent self-harm - reference access to potentially lethal methods, collateral hx, and f/u plans

Answer 51

(1) brief patient education (2) joint safety planning (3) lethal means restriction counseling (4) referral for outpatient care (5) provision of “caring contacts.”

Answer 52

1) ED setting - time constraints - lack of privacy 2) Individual clinician influences - personal bias - poor communication 3) Patient contributions - behavioral, social, or substance use issues

Answer 53

"FIND ME" FUNCTIONAL (Psychiatric ) - Schizophrenia - Paranoid ideation - Catatonic excitement - Mania - Personality disorders (BPD, Antisocial) - Delusional depression - PTSD - Decompensating OCD SITUATIONAL - Mutual hostility - Miscommunication - Fear of dependence or rejection - Fear of illness - Guilt about disease process INFECTIOUS - CNS infection - AIDS NEUROLOGIC - Delirium - Dementia - Trauma - Seizure - CVA - AVM - Huntingtons dz - Sleep d/o DRUGS - Unanticipated reaction to prescribed medication (especially sedatives in brain-injured or elderly patients) - Alcohol (intoxication and withdrawal) - Amphetamines - Cocaine - Sedative-hypnotics (intoxication or withdrawal) - PCP - LSD - Anticholinergics - Aromatic hydrocarbons (e.g., glue, paint, gasoline) - Steroids Synthetic cannabinoids - Synthetic cathinones METABOLIC - Neoplasm - Hypoglycemia - Hypoxia - Electrolyte abnormality - Hypothermia - Hyperthermia - Anemia - Vitamin deficiency or toxicity - Porphyria - Wilson dz ENDOCRINE - Endocrine disorder - Hyperparathyroidism

Answer 54

Physical and system factors to minimize ED violence risk: 1. Prominently displayed warning signs prohibiting weapons and alerting all entering that they may be screened for weapons 2. Nondiscriminatory inquiry about weapon carriage and searches of individuals for weapons with clear local policies for staff about searches and contraband disposal 3. A panic or alarm system to activate hospital security or local police response 4. ED placement of dedicated telephone(s) with a direct line to police or security to request additional personnel if needed 5. Control flow into the ED by limiting access to one or two entrances and consider buzzer access systems, and protective bulletproof glass or metal bar barriers at front desks 6. A secure examination room with solid ceiling, shatterproof ceiling lights, heavy indestructible chairs, well-secured restraint bed, two outward swinging doors that can be locked from the outside, an emergency distress button that can be activated unobtrusively, and consideration of a video monitoring system

Answer 55

1. Minimize waiting times to the extent feasible 2. Optimize waiting room environment 3. The presence of visible surveillance cameras 4. The presence of a trained visible security force reflecting both hospital needs and anticipated violence based on local community prevalence

Answer 56

1. Recognition of risk (pre-violent patients and their companions) 2. Implementation of de-escalation techniques 3. Minimize treatment delays of pre-violent individuals 4. Ongoing staff training in violent management techniques to increase caregiver confidence and comfort while decreasing the rate of aggressive incidents

Answer 57

1. Use of physical and chemical restraints 2. Appropriate security and police intervention 3. Apply familiar protocols for dealing with the violent individual

Answer 58

Provocative behaviour Angry demeanor Loud, aggressive speech Tense posturing (e.g., gripping arm rails tightly, clenching fists) Pacing or frequently changing body position Aggressive acts (e.g., pounding walls, throwing objects, hitting oneself)

Answer 59

1. Respect personal space 2. Purposefully avoid provocation with neutral body language 3. Establish verbal contact 4. Use concise, simple language 5. Identify feelings and desires 6. Listen closely to what the patient is saying 7. Agree, or agree to disagree: (a) Agree with clear specific truths; (b) agree in general (e.g., “Yes, everyone should be treated with respect.”); (c) agree with minority situations (e.g., “There are others who would feel like you.”). 8. Set clear limits 9. Offer choices and optimism 10. Debrief the patient and staff

Answer 60

Midazolam 2.5-5mg IM/IV Lorazepam 1-2mg PO or IV/IM Haldol 5mg IM/IV Olanzapine 5-10mg PO Risperidone 2mg PO Ketamine 1-2mg/kg IV or 4-5mg/kg IM *cut in half for elderly

Answer 61

diphenhydramine 25-50 mg IV/IM benztropine 1-2 mg IV/IM

Answer 62

Altered mental status Autonomic instability Hyperthermia “Lead-pipe” muscle rigidity

Answer 63

hypertension tachycardia drooling laryngospasm emesis emergence reactions

Answer 64

- Maintain Appropriate Emotional Distance - Understand Negative Behavior as a Symptom - Look for your own Cognitive Distortion - View Negative Reactions in Context

Psych Flashcards

(89 cards)