HOSA Behavioral Health
Antagonist molecules
A molecule from the outside of the body that blocks a neurotransmitter's function (I.e. Botulin which blocks ACh)
Agonist molecules
A molecule from the outside of the body that is similar enough to a neurotransmitter to Mimic is affects, like in certain opiate drugs
Bipolar Disorder
A mood disorder characterized by alternating periods of depression and mania.
Major Depressive Disorder
A mood disorder characterized by intense feelings of depression over an extended time, without the manic high phase of bipolar depression.
Mania
A mood that is elevated, expansive or irritable. Associated symptoms are hyperactivity, pressured speech, flight of ideas, diminished need for sleep, grandiosity, distractibility, short attention span, and extremely poor judgement in interpersonal and social areas.
Reticular formation
A nerve network in the brainstem that plays an important role in controlling arousal
Acetylcholine
A neurotransmitter that enables muscle action, learning, and memory
Reuptake
A neurotransmitter's reabsorption of the sending neuron
Adrenal glands
A pair of endocrine glands above the kidneys that secrete epinephrine and norepinephrine that help arouse the body in stressful situations
Phobia
A persistent and irrational fear of a specific object, activity, or situation that is excessive and unreasonable, given the reality of the threat.
Social Phobia
A persistent, irrational fear that arises in anticipation of a public situation in which an individual can be observed by others.
CBT cognitive behavioral therapy
A popular psychotherapy that focuses on exploring relationships among a person's thoughts, therapists will work with a person to uncover unhealthy patterns of thought and how they cause self-destructive beliefs and behaviors. produces healthier behavior, and beliefs. Identifies negative or false beliefs and tests or restructures things. treats depression, anxiety disorders, bipolar disorder, eating disorder and schizophrenia Therapists tells the patient to replace negative thoughts with positive realistic thoughts.
Maturational crisis
A process of maturation occurs over the life cycle. New development stage is reaches, old coping skills no longer effective, new coping mechanisms have yet to be developed, leads to increases tension and anxiety
Electroencephalogram (EEG)
An amplified recording of the sound waves of electrical activity that sweep across the brains surface. Electrodes on the scalp measure these waves
Functionalism
An approach that saw behavior as purposeful and contributing to survival.
Motor cortex
An area at the rear of the frontal lobes that controls voluntary movement, this area of the brain is involved in the idea of neural prosthetics
Wernicke's area
An area in the left hemisphere of the brain that controls language understanding
Broca's area
An area in the left hemisphere that controls language formation
Broca's area
An area in the left hemisphere that controls language information
Wernicke's area
An area in the left hemisphere that controls language understanding
Reward center
An area of the hypothalamus that, when stimulated, provides pleasure to the organism
Reward center
An area of the hypothalamus that, when stimulated, provides pleasure to the organism.
Dopamine
An excess amount of this neurotransmitter schizophrenia
Glutamate
An excess of this neurotransmitter can cause migraines and seizures
Agoraphobia
An extreme fear of being in public places or open spaces from which escape may be difficult or embarrassing.
Mental Disorder
An illness with psychological or behavioral manifestations associated with significant distress and impaired functioning caused by a biological, social, psychological, genetic, physical, or chemical disturbance. It is measured in terms of deviation from some normative concept.
Aphasia
An impairment of language, usually caused by damage to the left hemisphere of the brain
Gender Identity
An individual's perception of himself or herself as male or female.
Gamma-butyric acid
An inhibitory neurotransmitter, a lack is linked to seizures, tremors, and insomnia
Theory
An organized set of concepts that explains a phenomenon or set of phenomena.
Reflex
An unlearned response elicited by specific stimuli that have biological relevance for an organism.
temporal lobe
Anterior to occipital lobes, responsible for Auditory, Visual, personality, musical abilities, languages, and organization, speech.
B
Antisocial personality disorder belongs to which cluster?
Duloxetine (Cymbalta) S/E
Anxiety Hepatotoxicity with alcohol Hyperglycemia Orthostatic hypotension Serotonin Syndrome SIADH & hyponatremia
Rules
Behavioral guidelines for acting in certain ways in certain situations.
risk factors for substance abuse
Being male, loneliness, depression, low self-esteem, family history of addiction, peer pressure, presence of mental illness, lack of family involvement, using highly addictive drugs.
Self efficacy
Belief in one's ability to take action
Dualism
Belief that our mind is different from our physical being.
white matter
Brain tissue and it conducts information between grey matter areas.
Grey Matter
Brain tissue that is involved in analyzing information. The amount of grey to white matter changes over life.
Biological psychology
Branch of psychology that links biology and behavior
Dendrite
Branches that extend from the nerve cell body. Which receive messages and conduct impulses toward the body
Biofeedback
Brings autonomic nervous system under voluntary control. Patient learns relaxation techniques. EMG often used.
Disease
Broad social influence can affect an individual's response to ____________
Mental Retardation
Condition in which individuals have IQ scores 70 to 75 or below and also demonstrate limitations in the ability to bring adaptive skills to bear on life tasks.
Social Determinants of Health
Conditions in which people are born, grow up, live, learn, work, play, worship and age as well as systems put in place to deal with illnesses that affect health and quality of life Shaped by economics, social policies, and politics
Word salad
Confused or unintelligible mixture of seemingly random words and phrases", most often used to describe a symptom of a neurological or mental disorder. The words may or may not be grammatically correct, but are semantically confused to the point that the listener cannot extract any meaning from them.
Disorientation
Confusion; impairment of awareness of time, place, and person (the position of the self in relation to other persons). Characteristic of cognitive disorders.
environmental wellness
Good health by occupying pleasant, stimulating environments that support well-being
memory impairment
Gradual deterioration from recent to remote memory
Dementia
Gradual onset with a progressive deterioration of cognitive functioning & global impairment of intellect; normal consciousness; difficulty with memory, problem solving and complex attention.
narcissistic personality disorder
Grandiose and the need for constant admiration of others Exaggerated sense of self-worth, Extremely self-centered. Believe they are entitled to special privileges that others don't have
Focus in on the interaction with others in a controlled setting
Group therapy
PERCEPTION
HOW YOU SEE THINGS
how depression is diagnosed
Having 5 of the symptoms in 2 weeks, using scale's such as Hamilton depression Rating, Zung self ratin depression, raskin depression, beck depression inventory and geriatric depression scale. Thyroid test, Dexamethasone suppression test; positive is no problem
Wellness Strategies
Having a Healthy lifestyle, seeing a Primary Care Doctor, and Ask Questions
Mood stabilizers for Bipolar and cyclothymia
Lithium Anticonvulsants esp Valproic acid Takes 9-10 days for effect
Case Management
Living well, with a complicated health condition (physical or mental) can require working with a number of medical providers and support resources. Case management can help individuals get these services. A manager has knowledge of local medical facilities, housing opportunities, employment and social support programs. they are also familiar with many payment options, including local, state and federal assistance programs. This person can serve an important role in helping you or your family member get the best treatment possible.
Aphasia
Loss of language ability
Apraxia
Loss of purposeful movement in the absence of motor or sensory impairment
Psychotic
Loss of reality testing with delusions and hallucinations
Apraxia
Loss of the ability to execute or carry out learned (familiar) movements, despite having the desire and the physical ability to perform the movements.
Agnosia
Loss of the ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss.
TCAs - C/I
Low blood pressure Prostate hypertrophy Narrow angle glaucoma
neurobiology considerations for depression
Low glucose metabolism , decrease blood flow in the anterior cingulate cortex. hypothesis concern the level of serotonin, dopamine, norepinephrine and acetylcholine and monoamine oxidase (MAO)
10.7% of adolescents had a major depressive episode this year. Is this number higher or lower in males?
Lower than that of females by 3x
LP
Lumbar puncture
common medical conditions and medications that can cause depression
Lung and Pancreatic cancer, Heart failure, myocardial infarction, stroke, hypothyroidism, hyperthyroidism, Addison's, cushing's, AIDS, Influenza, hepatitis, infectious mononucleosis, Lyme disease, Parkinson's, MS, Alzheimer's, Iron deficiency, Thiamine deficiency, Vitamin B12 def.
Drug interactions of SSRIs
MAOI, lithium or other antidepressants increase the risk of serotonin syndrome Inhibit the cytochrome P-450 (CYP 450) system
Indications of TCAs
Major Depressive disorder Generalized Anxiety disorder (GAD)
Glutamate
Major excitatory neurotransmitter involved in memory
Illicit drug use is more common among what gender?
Males
Manipulation
Maneuvering by patients to get their own way; characteristic of antisocial personalities.
Illicit drugs
Marajuana, cocaine, inhalants, hallucinogens, heroin, prescription drugs
What are the most common drug problem?
Marajuana, misuse of prescriptions
Social Anxiety Disorder (Social Phobia) Diagnostic Criteria
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others (e.g. having a conversation, meeting unfamiliar people) being observed (e.g. eating or drinking) and/or performing in front of others (e.g. giving a speech). The individual fears that he/she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e. will be humiliating or embarrassing; will lead to rejection or offend others). The social situations almost always provoke fear or anxiety. NOTE: in children the anxiety must occur in peer settings and not just during interactions with adults. The social situation is avoided or endured with intense fear or anxiety. The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more. The fear, anxiety, or avoidance causes clinically significant distress or impairment of social,occupational, or other important areas of functioning. The fear, anxiety or avoidance is not better explained by another medical or mental disorder.
Disparities in Health
Non-communicable - Air pollution - Coronary heart disease - Colorectal cancer screening Communicable - Motor vehicle crashes - HIV - Influenza vaccination All are examples of what
What gender has the highest illicit drug use?
Men at 4% to women at 2%
Men
Men or women: of all races / ethnicities are 2 to 3x more likely to die in crashes than women
Judgment
Mental acts of comparing or evaluating choices within the framework of a given set of values for the purpose of electing a course of action. If the course of action is consonant with reality or with mature adult standards of behavior, judgment is said to be intact or normal; judgment is said to be impaired if the chosen course of action is frankly maladaptive, results from impulsive decisions based on the need for immediate gratification, or is otherwise not consistent with reality as measured by mature adult standards. (i.e. burning oneself purposely AND when asked what she would do if she found a stamped addressed envelope in the street, the patient replied, "well I would open it of course and read what it said. Maybe there would be money in it.")
Federal agencies
Substance Abuse & Mental Health Services Admin (SAMHSA) National Institutes of Mental Health (NIMH)
What percent of adolescents used cigarettes within the last month? What ethnic group used the most?
6%, whites
Proceed (Implementation & Evaluation Phase)
6. Implementation 7. Process evaluation 8. Impact Evaluation 9. Outcome level
Depression
A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life
Agnosia
loss of sensory ability to recognize objects
MRI
magnetic resonance imaging
cerebellum
maintaining balance and motor coordination
Glutamate
major excitatory neurotransmitter involved in memory. An excess can cause migraines or seizures
Bipolar disorder
major psychological disorder typified by a disturbance in mood. manifested by manic and depressive episodes that may alternate or elements of both may occur simultaneously
phobia
marked and persistent fear that is excessive or unreasonable cued by the presence or anticipation of a specific situation or object
pituitary gland
master gland; stimulates activity of other glands
risk factors and prevention strategies for Autism
maternal age of 40 and up, paternal age of 50 and up, misoprostol during pregnancy. children with genetic abnormality, boys higher rate than girls, premature or low birth weight. Hispanics are diagnosed less frequently than non-Hispanics
Duloxetine (Cymbalta) max dose
maximum 120 mg/day
Bupropion (Wellbutrin) Max dose
maximum 150 PO TID
ginkgo biloba ADE
mild GI upset, constipation, HA, dizziness, palpitations, increase bleeding LARGE DOSES: N/V/D, dec. muscle tone/weakness
kava used for
mild to mod GAD
illusions
misinterpretations of real external stimuli, such as mistaking rusting leaves for the sound of voices; any false perception NOT caused by an ALTERED MENTAL STATUS
marijuana
most used drug
Positive Symptoms
The active symptoms of psychotic disorders, including delusions and hallucinations as well as disorganized speech and behavior.
Perseveration
The avoidance of answering questions by using repetitions of phrases or behavior.
Denial
The avoidance of reality that threatens an individual's self-concept
Medulla
The base of the Brainstem that controls heartbeat and breathing
The three major types of neurotransmitters in the brain are:
The biogenic amines (DA, NE/epi, 5HT) The amino acids The peptides
dopamine
motivated movement too much can cause schizophrenia and lack of can cause parkinsons
Endocrine system
The body's chemical communication system that is made up of a set of glands that secrete hormones into the bloodstream
Nervous system
The body's electrochemical communication network that consists of all the nerve cells of the peripheral she central nervous systems
Plasticity
The brains ability to change, especially during childhood, by reorganizing after damage or by building new pathways based on experience
Basal Ganglia
motor learning, executive functions and behaviors, and emotions.
acetylcholine
motor movement and alertness lack of parkinsons too much schizophrenia
MS
multiple sclerosis
enteric nervous system
nerve cells embedded in lining of gastrointestinal system; communicates with endocrine system; source of 95% of boys serotonin
Peripheral Nervous System
nerves and ganglia outside the CNS; contains somatic and autonomic nervous systems
Sensory neurons
neurons that carry incoming information from the sensory receptors to the brain or spinal cord
Motor neurons
neurons that carry outgoing information from the brain and spinal cord to the muscles and glands
Interneurons
neurons within the brain and spinal cord that communicate with each other and regulate sensory and motor inputs
Social & Behavioral Health
The influence of the social environment and an individual's behavior on his or her health
blunted/constricted/flat
no emotional attachment in affect
Synapse
The junction between the axon of the relaying neuron and the dendrite of the receiving neuron. This is also known as the synaptic gap or synaptic cleft
Corpus callosum
The large band of neural fibers connecting the two brain hemispheres, carrying messages between them
Lateral fissure
The lateral sulcus divides both the frontal lobe and parietal lobe above from the temporal lobe below. It is in both hemispheres of the brain but is longer in the left hemisphere in most people
Myelin sheath
The layer of fatty tissue that encases the fibers of neurons in segments and increases the transmission speed of impulses
Threshold
The level of stimulation required to trigger a neural impulse
Threshold
The level of stimulation required to trigger a neural impulse. Comes from the level of excitatory signals minus inhibitory signals
Socialization
The lifelong process whereby an individual's behavioral patterns, values, standards, skills, attitudes, and motives are shaped to conform to those regarded as desirable in a particular society.
Behavioral Health
The mental well being of a person
Physiological component / addictive
The most difficult behaviors to change are those that have what?
Pituitary gland
The most influential glans that controls growth and other endocrine glands, and is controlled by the hypothalamus
Limbic system
The neural system located below the cerebral hemispheres and is associated with emotions and drives
Brainstem
The oldest part and central core of the brain, beginning where the spinal cord swells as it enters the skull; the brainstem is responsible for automatic survival functions.
Brainstem
The oldest part, and the central core of the brain. Starts where the spinal cord swells at the beginning of the skull and is responsible for automatic survival functions
Autonomic nervous system
The part of the PNS that controls the glands and muscles of the internal organs
Stress
The pattern of specific and nonspecific responses an organism makes to stimulus events that disturb its equilibrium and tax or exceed its ability to cope.
Limbic system
The portion of the brain that deals with three key functions, such as emotions, arousal, and memories. primary structures include the amygdala, hippocampus, thalamus, hypothalamus, basal ganglia. olfactory, pineal,
Primate or Neocortex Brain
The portion of the brain that is responsible for the higher order functions, like sensory, perception, cognition, generation of motor commands, spatial reasoning and language.
young adulthood
The prefrontal cortex in myelinated in
Branding
The theory of social marketing relies on what?
-$$ (biggest) -Children's Behavior/ Discipline/Sibling Rivalry -Lack of couple time -Lack of shared responsibility -Communication -Lack of personal time -Guilt -Relationship -Lack of family time -Over scheduling
The top 10 stressors in families: 1 2 3 4 5 6 7 8 9 10
Self-Awareness
The top level of consciousness; cognizance of the autobiographical character of personally experienced events.
Each year, 5000 youth under 21 die from what?
Underage drinking
Adventitious Crisis
Unplanned or unexpected Natural disasters, national disasters or crimes of violence.
Mania
Unrealistic mood
Treatment for mood swings in bipolar
Untreated mood swings can accelerate and become rapid cycling (kindling) prevents suicide
SES, Culture & Religion
What are the 3 key components of the social system that have a strong relationship with health?
Restricting Binge eating/purging
What are the two sub-types of anorexia nervosa?
Thinking, Mood, and Behavior
What changes when a person has a mental disorder?
Antagonist
What does a drug act like by blocking the effect of neurotransmitters?
Education
What is the strongest association with health behaviors and health outcomes?
Antisocial
What personality disorder does this drawing describe?
Avoidant
What personality disorder does this drawing describe?
Borderline
What personality disorder does this drawing describe?
Dependent
What personality disorder does this drawing describe?
Histrionic
What personality disorder does this drawing describe?
Narcissistic
What personality disorder does this drawing describe?
Obsessive Compulsive
What personality disorder does this drawing describe?
Paranoid
What personality disorder does this drawing describe?
Schizoid
What personality disorder does this drawing describe?
Schizotypal
What personality disorder does this drawing describe?
People With Schizophrenia Or People Who Are Bipolar
What types of mental diseases have a higher risk of death when they use tobacco?
Formal Concept
When a person forms a concept by learning the rule or feature that defines the particular concept.
Systematic Desensitization
When relaxation is replaced of fear and anxiety.
Seeing a primary health care doctor
When you see a primary health care doctor they know your past experiences and have a deeper connection with you
Black men & women
Which people are more likely to die from heart disease and stroke?
Which ethnic group of adolescents were most likely to initiate alcohol use, cigarettes, and prescription drugs?
Whites
What ethnic groups for adolescents binge drank the most?
Whites, Hispanics
All Age Groups - Any Person
Who do mental health issues affect?
no
Will a patient with psychosis usually have insight into their mental disorder?
Thyroid gland
a gland that surrounds the trachea and controls metabolism, among other things
Norepinephrine
a hormone that is released by the adrenal medulla and by the sympathetic nerves and functions as a neurotransmitter. It is also used as a drug to raise blood pressure
Synapse
a junction between two nerve cells, consisting of a minute gap across which impulses pass by diffusion of a neurotransmitter
Thyroid gland
a large, ductless gland in the neck that produces hormones which regulate metabolism, body heat, and bone growth
Acetylcholine
a neurotransmitter that enables learning and memory and also triggers muscle contraction
Acetylcholine
a neurotransmitter that enables muscle action, learning, and memory. Lack of this causes Alzheimer's
Dopamine
a neurotransmitter that influences movement, learning, attention and emotion. An excess causes schizophrenia and a lack causes tremors and Parkinson's
Seratonin
a neurotransmitter that regulates mood, appetite, sleep, muscle contraction, and some cognitive functions including memory and learning. Lack of this can cause depression.
Reuptake
a neurotransmitter's re-absorption of the sending neuron
Reuptake
a neurotransmitter's reabsorption of the sending neuron
Adrenal glands
a pair of endocrine glands above the kidneys that secrete epinephrine and norepinephrine that help arouse the body in stressful situations
Adrenal glands
a pair of endocrine glands that sit just above the kidneys and secrete hormones (epinephrine and norepinephrine) that help arouse the body in times of stress.
antisocial personality disorder
a pattern of disregard for, and violation of, the rights of others. Irresponsible & guiltless; exhibits no anxiety; anger and aggression. Rely on projection to control emotions. Socially irresponsible - in their mind they are a higher level of authority. Very manipulating for their own personal gain, very critical, no remorse, easy to anger and aggression
Functionalism
a school of psychology that focused on how mental and behavioral processes function - how they enable the organism to adapt, survive, and flourish
Somatic Nervous System
a subdivision of the PNS that controls the body's skeletal muscles.
Assertive community treatment
a team-based treatment model that provides multidisciplinary, flexible treatment and support to people with mental illness 24/7. based around the idea that people receive better care when their mental health care providers work together. team members help the person address every aspect of their life, whether it be medication, therapy, social support, employment or housing.
Function MRI (fMRI)
a technique for revealing the blood flow and brain activity by comparing successive MRI scans.
Function MRI (fMRI)
a technique for revealing the blood flow and brain activity by comparing successive MRI scans. Shows brain function
Magnetic Resonance Imaging (MRI)
a technique that uses magnetic fields and radio waves to produce computer-generated images of soft tissue.
Magnetic resonance imaging (MRI)
a technique that uses magnetic fields and radio waves to produce computer-generated images of soft tissue. Show brain anatomy
Evolutionary pyschology
a theoretical approach to psychology that attempts to explain useful mental and psychological traits—such as memory, perception, or language—as adaptations, i.e., as the functional products of natural selection.
Behavioralism
a theory that psychology is essentially a study of external human behavior rather than internal consciousness and desires
Behavior therapy
a therapy that is based on the application of learning principles to human behavior and that focuses on changing overt behaviors rather than on understanding subjective feelings, unconscious processes, or motivations; also known as behavior modification
Electroencephalogram (EEG)
an amplified recording of the waves of electrical activity that sweep across the brain's surface. Electrodes on the scalp measure these waves
ginkgo biloba CI
anticoag/platelets
Psychosurgery
brain surgery on human patients intended to relieve severe and otherwise intractable mental or behavioral problems
endorphorins pain control
involved in addictions
Glial cells
cells in the nervous system that support, nourish, and protect neurons
Glial cells
cells in the nervous system that support, nourish, and protect neurons.
glial cells
cells that form scar tissue in the brain and spinal cord
CNS
central nervous system
CP
cerebral palsy
what are the calming herbs
chamomile, lavender, passionflower, kava, valerian
lifespan consideration for adolescents associated with depression
change in typical activities, self-neglect, decrease in social contact, difficulty in personal relationships with teachers and parents, interest in violence. school performance issues
attention deficit hyperactivity disorder (ADHD)
characterized by either unusual inattentiveness, hyperactivity with impulsivity, or both
schizophrenia
characterized by hallucinations, delusions, disorganized thought and speech, disorders of movement, restricted affect, and avolition or asociality
major depressive disorder (MDD)
characterized by lengthy periods of depressed mood, loss of pleasure in normal activities, disturbances in sleep and appetite, difficulty concentrating, feelings of hopelessness, and possible thoughts of suicide
Borderline Personality Disorder
characterized by severe, unstable mood swings, impulsivity and instability, bad self-image and relationships.
hypothalamus
involved w/ motivation and homeostasis; regulates temperature, hunger thirst; directs ANS and endocrine system
ADHD supplements
iron, magnesium zinc
neurotransmitter
chemical messenger that communicates across a synapse
Hormones
chemical messengers that are made in the endocrine system, travel through the bloodstream, and affect other tissues
cognitive behavioral therapy
combination of cognitive restructuring with behavioral treatments that has been shown to be effective in reducing symptoms of many psychological therapy
most effective treatment for people w/ behavioral health problems
combination of counseling and medication
unspecific
combination or delusions really
evidence based practice
combines research evidence, clinical expertise, and individual values to provide the best outcome for a patient
biopsychosocial approach
combines treatments addressing biological, personal, and social underpinnings of psychological disorders
valerian efficacy
combo with: -St johns: greater reduction -passionflower: reduce anxiety similar to chlorpromazine
Edward Kitchener
established the theory of structuralism
kava efficacy
evaluated GAD -superior to placebo for symp. treatment
treatments and services take place where?
everywhere! (health centers, rehabilitation programs Independent providers, hospitals, support groups and peer-run organizations, schools, jails, at home through telebehavioral or home-based services, inpatient service providers, primary care programs with integrated behavioral health services, etc.)
amygdala
fear and aggression
active components of St. Johns
hyperforin and hypericin
clinical manifestations of ADHD
inability to concentrate, difficult listening to adults carrying out multistep instructions, rush to complete a task, start many activities without completing them, not have patience to wait their turn.
Anhedonia
inability to feel pleasure
anxiety diet
inc. omega 3 inc B vitamins: 6, 12, folic
Central Nervous system (CNS)
includes the brain and spinal cord
Drug interactions of fluoxetine (Prozac)
increase bleeding (anticoagulants, NSAIDs, Omega-3s, Salicylates, Vitamin E, Warfarin) Also- St. John's Wort- serotonin syndrome, Thiazide diuretic - hyponatremia
SAMe MOA
increase monoamines in the brain and enhance NT binding
Drug interactions of SNRIs
increased bleeding (anticoags, aspirin, NASIDs, Omgea-3s, Salycylates, vit E, warfarin)
St johns DDI
induces 1A2, 3A4, 2C9, 2C19 induces P-gp -avoid antiretrovirals, warfarin, cyclosporine, and oral BC
neologisms
invented or distorted words or words with new meaning; schizophrenia, psychotic disorders, or aphasia
ADHD
treatment for __________ includes: ritalin and other stimulants and behavioral therapies
Amygdala
two lima bean sized neural clusters in the limbic system linked to emotion
genetic considerations for depression
unipolar depression in the rate of 8% children of depressed parents. If parents have depression the risk raise to 75%. Bipolar depression have the greatest inherited, about 85%.
social anxiety disorder
unrealistic fear of being scrutinized and criticized by others
body dysmorphic disorder
unrealistic perception of physical flaws
Autism Spectrum disorder age
usually evident by age 3
functionalism
viewed behavior as purposeful because it led to survival
Somatic
voluntary movement of the muscles and organs and reflex movements. In the process of voluntary movement, sensory neurons carry impulses to the brain and the spinal cord. ... The second function of the somatic nervous system is the process of the reflex arc.
basal ganglia
voluntary movement; degeneration in Parkinson's, also involved in OCD and ADHD
female
what gender that is most affected by bipolar disorder?
thought content
what the patient thinks about, including level of insight and judgement
thought content
what the person is actually thinking about; follow patient's leads and cues rather than asking direct qts.
Eating Disorders
when a person is so preoccupied with food and weight issues that you find it hard to focus on other aspects of your life, it may be a sign of an eating disorder.
receptor
where neurotransmitter binds
discoitive identity
where you think you have multpile personalities
Sympathetic nervous system
part of the autonomic nervous system that arouses the body and mobilizing its energy in stressful situations
Parasympathetic nervous system
part of the autonomic nervous system that calms the body, conserving its energy
somatosensory cortex
part of the neocortex. Limited sensation such as touch, pain, and pressure.
Somatosensory Association cortex
part of the neocortex. Understanding the sensations
CNS
part of the nervous system which in vertebrates consists of the brain and spinal cord.
orbitofrontal cortex
part of the prefrontal cortex in that is responsible for the personality, decisionmaking, and problem-solving. part of the neocortex brain
kava should be avoided in
patients with liver dysfunction, multiple liver metab. meds, drink alcohol on a daily basis
a study in 2006 said people w/ serious mental illnesses have a higher chance of dying early (8.2 years younger) than the general population. why?
preventable medical conditions (i.e. diabetes, heart disease, infectious disease like HIV or AIDS)
temporal lobe
primary auditory cortex
Sigmond Freud
psychodynamic theory; existence of unconscious mind, development of sexuality, dream analysis, psychoanalysis
Counseling is provided by trained clinicians such as...
psychologists, psychiatrists, social workers, and counselors
compulsions
repetitive behaviors that a person feels driven to perform in response to an obsession, aimed at preventing or reducing anxiety
poverty, social isolation, lack of access to quality healthcare
social factors related to early mortality are
Synapse
the junction between the axon of the relaying neuron and the dendrite of the receiving neuron. This is also known as the synaptic gap or synaptic cleft
Corpus Callosum
the large band of neural fibers connecting the two brain hemispheres and carrying messages between them
Corpus callosum
the large band of neural fibers connecting the two brain hemispheres and carrying messages between them
Myelin sheath
the layer of fatty tissue that encases the fibers of neurons in segments and increases the transmission speed of impulses
Threshold
the level of stimulation required to trigger a neural impulse. This comes from the level of excitatory signals minus inhibitory signals
thought process
the logic, coherence, and relevance of the patient's thought as it leads to selected goals
Axon (relay)
the long threadlike part of a nerve cell along which impulses are conducted from the cell body to other cells
Pituitary gland
the most influential gland that controls growth and other endocrine glands. Is controlled by the hypothalamus
Limbic system
the neural system located below the cerebral hemispheres and is associated with emotions and drives
Limbic system
the neural system located below the cerebral hemispheres and is associated with emotions and drives.
Brainstem
the oldest part and central core of brain that starts where the spinal cord swells at the beginning of the skull and is responsible for automatic survival functions
Autonomic nervous system
the part of the PNS that controls the glands and the muscles of the internal organs.
Automatic Nervous System
the part of the nervous system responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes
Posttraumatic Stress Disorder
the result of traumatic events, such as military combat, assault, an accident or a natural disaster.
Peripheral nervous system (PNS)
the sensory and motor neurons that connect the CNS to the rest of the body
Peripheral Nervous System (PNS)
the sensory and motor neurons that connect the central nervous system to the rest of the body
Gonads
the sex glands
What age group of Americans had the highest illicit drug dependence/use?
18-25
Psychology
The study of behavioral health
social psych
effects of social environment on behavior
How many medicaid enrollees have a mental health disorder
50%
Malingering
Feigning disease to achieve a specific goal, for example to avoid an unpleasant responsibility.
Prevalence of dysthymia
Female, age 30 to 44
Parathyroids
Glands right next to the thyroid that help regulate the calcium level in the blood
Endorphins
"Morphine within" a natural opiate like neurotransmitter that is linked to pain control and pleasure
Albert Ellis
"Rational emotive therapy- people are not disturbed by things but rather by their view of things."
amygdala learned helplessness.
"What I've found over the years is that as stress levels rise, chemicals are released into the brain which can impact two main areas: the prefrontal cortex, where decisions are made, and the ___________, which is the emotional system," explains Thompson. "So the ability to use logic and reason decrease as the stress level increases Study with mice found that when you are overwhelmed by stress you feel you have fewer choices-this is called ____________ Study was done in Mice who have very similar nervous systems to us as humans. If you provide mice with an escape route they will learn very quickly how to avoid a mild electric shock that occurs a few seconds after hearing a tone. If the escape route is blocked off whenever the sound occurs the mice eventually stop trying to run away. Later, even after the escape route is cleared the animal simply freezes at the sound of the tone-even though they once knew how to avoid it. Obviously, we have more intellectual resources than mice do but the underlying principle remains. When too many of the rules change, when what used to work doesn't anymore your ability to reason takes a hit.
Endorphins
"morphine within," a natural opiatelike neurotransmitter linked to pain control and pleasure
2.7
% of the population affected by panic disorder
2-3
% of the population is affected by OCD
autism spectrum disorder
(1 out of 50 children) have this disorder
Contraindications- prozac & zoloft
**BEERS criteria (DON'T GIVE)** Heart block Recent MI
Drug interactions of Sertraline (Zoloft)
**Grapefruit* increase bleeding (anticoagulants, NSAIDs, Omega-3s, Salicylates, Vitamin E, Warfarin) St. John's Wort- serotonin syndrome Thiazide diuretic - hyponatremia
Contraindication of Venlafaxine (Effexor), Duloxetine (Cymbalta)
*BEERS criteria (DON'T GIVE)*
c) The DSM V is now a nonaxial system
*How does the DSM V differ from the DSM IV?* a) The DSM V now has 5 axes b) The DSM V now codes the World Health Organization Disability Assessment Schedule (WHODAS) on Axis 5 c) The DSM V is now a nonaxial system d) The DSM V eliminated the cultural formulation interview
a) Enduring behaviors associated with significant distress or disability and deviate from social expectations.
*Personality disorders are best defined as which of the following?* a) Enduring behaviors associated with significant distress or disability and deviate from social expectations. b) The pattern of characteristic thoughts, feelings, and behaviors that distinguishes one person from another c) The patient has multiple personalities existing at the same time d) The patient has no defining personality of any type
c) The patient transfers issues from past relationships onto the current provider relationship.
*What is the best definition of transference in the patient provider relationship?* a) The patient transfers medical and psychiatric care to the provider b) The provider transfers issues from past relationships onto the current patient relationship. c) The patient transfers issues from past relationships onto the current provider relationship. d) The provider transfers medical records of the patient to a different psychiatrist.
b) The patient's understanding of what is going on with themselves
*Which of the following best describes insight?* a) The patient believes they can read minds b) The patient's understanding of what is going on with themselves c) The patient's ability to make a sensible decision d) The patient believes they can see the future
d) Legal history
*Which of the following is not routinely included in a standard history and physical but is included in a psychiatric interview?* a) History of Present Illness (HPI) b) Drug and alcohol intake c) Family history d) Legal history e) Sexual history
b) He feels people are putting thoughts into his brain
*Which of the following most closely resembles a symptom of psychosis?* a) A patient feels his heart just starts racing out of the blue b) A patient feels people are putting thoughts into his brain c) A patient feels like he cannot stop eating food
b) He doesn't need sleep especially over the last week
*Which sleep pattern may be most closely associated to a patient with mania?* a) He sleeps all the time b) He doesn't need sleep especially over the last week c) He falls asleep easily, but wakes up early in the morning and cannot get back to sleep d) He has trouble falling asleep and has trouble waking up in the morning
Drug interactions of TCAs
- OTC cold meds (CNS effects) - Cimetidine (Tagamet) (Incr plasma level of TCA) - birth control (Decr plasma level of TCA)
TCAs- interactions
- OTC cold meds (CNS effects) - Cimetidine (Tagamet) (Incr plasma level of TCA) - birth control (Decr plasma level of TCA)
st johns MOA
-inhib reuptake -inhib IL6, increase cortisol
ADHD diet
-omega 3 (EPA, DHA and linolenic acid 2x/wk) -reduce simple sugars -feingold diet (eliminates artificial) -organic foods ( no pesticides) -Caffeine
SAMe preg
-only benefits>risks -lactation: avoid
St Johns efficacy
-only mild-mod: was comparable to low dose TCA -severe: RR lower compared to sertraline
SAMe efficacy
-similar efficacy to imipramine and superior tolerability >6wks -non responding SSRI: adjunctive leads to remission
. Results from the 2014 NSDUH report (PDF | 3.4 MB) showed that of those adults with any mental illness, 18.2% had a substance use disorder, while those adults with no mental illness only had a 6.3% rate of substance use disorder in the past year.
. Results from the 2014 NSDUH report (PDF | 3.4 MB) showed that of those adults with any mental illness, 18.2% had a substance use disorder, while those adults with no mental illness only had a 6.3% rate of substance use disorder in the past year.
5 components of all crisis
1. A hazardous or traumatic event 2. A vulnerable state 3. A precipitating factor 4. An active crisis state 5. A resolution of crisis depends on: realistic perception of event, adequate situational supports, adequate coping mechanisms
8 Main Topics of the Mental Status Exam
1. Appearance and Behavior 2. Speech 3. Mood (anxiety/risk assessment) 4. Thoughts (both content and process) 5. Perception 6. Cognition 7. Insight 8. Judgment
Psychological stages after a disaser
1. Heroic - immediately after the event; friends/family/strangers help each other out 2. Honeymoon - 1 week to 3-6 months after event; community starts to share. High social attachment 3. Disillusionment - 2 months to 1-2 years; feelings of disappointment. Anger, resentment, bitterness, expectations of support were not met 4. Reconstruction - 2 moths to 1-2 years; physical/emotional reinvestment takes place
disaster management continuum
1. Preparedness 2. Mitigation 3. Response 4. Recovery 5. Evaluation
3 levels of care for crisis intervention
1. Primary Care: education, environmental manipulation, or new coping skills 2. Secondary Care: crisis intervention to prevent prolonged anxiety and to lessen the mental disability (occurs in hospital units, emergency departments, clinics or mental health centers). There are interventions taking place. 3. Tertiary care: provides support while recovering from a disabling mental state. (Rehabilitation center, day hospitals, and outpatient clinics)
Precede (Diagnostic Phase)
1. Social assessment 2. Epidemiological assessment 3. Behavior & environment assessment 4. Education & organizational assessment 5. Administrative & policy assessment
US adults
1.1% schizophrenia 2.6% bipolar 6.9% one major depressive disorder 18.1% anxiety disorder 0f 20.2 million with substance use disorder: 50% have co-occurring mental illness
2.7 million Americans ages ___ and older needed treatment for an illegal drug or alcohol use problem in 2013. However, less than ___ million people received the specialized treatment they needed.
12 ; 3
About what % of adults with drug dependence sought treatment last year?
15%
Every year how many people report having a major depressive episode (MDE)?
15.2 million
58% of people who tried alcohol for the first time were under what age?
18
Anxiety
18% of Americans have one OCD, PTSD, Social anxiety
Among adults with SMIs, males were less likely to receive treatment. What age group was also less likely to receive treatment?
18-25
Anxiety Disorder Symptoms
2 major components: 1. Awareness of psychological sensations (palpitations, sweating) 2. Awareness of being nervous or frightened. Fear: normal response to known threat Anxiety: alerting system of impending danger (unknown threat) secondary to serotonin and norepinephrine.
how long till St. johns works
2 months for full effects
Major depressive episode
2 weeks of depressed mood/ loss of interest in activities
What % of people 12 and older have drank in the last 12 months?
2/3
Zoloft max dose
200 mg/day
What age group of Americans has the highest percentage of heavy alcohol use?
21-25
max dose Venlafaxine (Effexor)
225 to 375 mg/day
Population and Community
3 Levels of Influence: Focusing factors with social structure Ex. Norms, rules, regulations, policies, laws
Interpersonal
3 Levels of Influence: Focusing on relationships between people Ex. Other people influence behavior by sharing their thoughts, advice, feelings, and emotional support
Intrapersonal
3 Levels of Influence: focusing on individual characteristics Ex. knowledge, attitudes, beliefs, motivations, self concept, past experiences, skills
Amitriptyline (Elavil) max dose
300 mg daily
how many people who experienced MDE did not seek professional help for their depression in 2013?
38.3%
Ginkgo biloba DDi
3a4 Efavirenz Inc HIV viral load
Produce Price Place Promotion
4 Ps that structure social marketing theory
What percent of adults have thought of suicide in the last year?
4%
Heavy alcohol use
5 or more drinks on 5 or more days
Binge alcohol use
5 or more drinks on one occassion
Major mental health diagnosis are corelated with death _________ years earlier
7-24
Genetic basis for Adult ADHD
70% heritability
In the US, what percent of adolescents reported use of illicit drugs in the month before study?
8.8% Went down for white and Hispanics, but not for blacks
Prozac maximum dose
80mg/d
Depression dx time frame
> 2 weeks
Persistent Depressive Disorder (Dysthymia) time frame
> 2 years with no symptom free intervals
Anxiety disorder
A mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities
Homeostasis
A Balance in the psychological well being
Neurotransmitter
A chemical messenger that crosses the synaptic gap between neurons binding to receptor sites on the dendrites of the receiving neuron.
Attention-deficit/hyperactivity disorder (ADHD)
A chronic condition including attention difficulty, hyperactivity, and impulsiveness
Personality Disorder
A chronic, inflexible, maladaptive pattern of perceiving, thinking, and behaving that seriously impairs an individual's ability to function in social or other settings.
Manic Episode
A component of bipolar disorder characterized by periods of extreme elation, unbounded euphoria without sufficient reason, and grandiose thoughts or feelings about personal abilities.
Split Brian
A condition resulting from surfer that Isolates the brains two hemispheres by cutting the fibers connecting them
Rumination
A constant preoccupation with thinking about a single idea or theme, as in OCD.
Bipolar disorder
A disorder associated with episodes of mood swings ranging from depressive lows to manic highs
Post traumatic stress disorder (PTSD)
A disorder characterized by failure to recover after experiencing or witnessing a terrifying event
Personality Disorder
A disorder characterized by impairments in identity, personality traits, and in establishment of empathy or intimacy.
Schizophrenia
A disorder that affects a person's ability to think, feel, and behave clearly
off label meds topic info
A doctor should be clear about the limits of the research around off-label medication and always check for alternate options. Be aware that generic medications and brand name medications are not exactly the same. The FDA requires only that generic medications contain the same active chemicals to those in brand name medications and that the route of administration—whether the medication is available as tablets, capsules, patches or injections—be identical.
Delusions
A false belief the mind creates.
Delusions
A false belief, based on incorrect inference about external reality, that is held firmly despite objective and obvious contradictory proof of evidence and despite the fact that other members of the culture do not share the belief. (i.e. "I believe that someone is following me and taking my picture.")
Fatigue
A feeling of weariness, sleepiness or irritability after a period of mental or bodily activity. Seen in depression anxiety, neurasthenia, and somatoform disorders.
Self-Esteem
A generalized evaluative attitude toward the self that influences both moods and behavior and that exerts a powerful effect on a range of personal and social behaviors.
Thyroid gland
A gland that surrounds the trachea, and controls metabolism, among other things
Dementia
A group of thinking and social symptoms that interferes with daily functioning
Ataxia
A lack of coordination while performing voluntary movements. It may appear as clumsiness, inaccuracy, or instability.
Serotonin
A lack of this neurotransmitter can lead to depression
Dopamine
A lack of this neurotransmitter causes tremors and Parkinson's disease
Concept
A mental category we have formed to group objects, events, or situations that share similar features or characteristics.
Obsessive Compulsive Disorder
A mental disorder characterized by obsessions-recurrent thoughts, images, or impulses that recur or persist despite efforts to suppress them-and compulsions-repetitive, purposeful acts performed according to certain rules or in a ritualized manner.
DBT Dialetical Behavioral Therapy
A psychotherapy that Originally developed to treat chronically suicidal individuals. Heavily based CBT. but accepts uncomfortable thoughts, emotions, behaviors. and having the person to accept it. This is used to treat BPD, longlasting improvement, they developed skills to accept and change. therapist help patient develop new methods and coping methods.
EMDR Eye Movement Desentization and reprocessing therapy
A psychotherapy, used to treat PTSD, proved by studies to reduce emotional stress from traumatic memories, replaces negative emotional reactions to difficult memories with less charged or positive reactions or beliefs. performs repetitive eye movements for 20 to 30 seconds can help people to change the emotional reactions. The eye movements makes the brain remember the traumatic experiences.
Rapid cycling
A quick change from mania to depression and back again
Autism
A serious developmental disorder that impairs the ability to communicate and interact
Reflex
A simple, automatic, inborn response to a sensory stimulus, such as the knee-jerk response.
Tolerance
A situation that occurs with continued use of a drug in which an individual requires greater dosages to achieve the same effect.
Narcolepsy
A sleep disorder characterized by an irresistible compulsion to sleep during the daytime.
Prevention, Healthcare & Social Service Setting
Behavioral Health Workforce
Learned Helplessness
A state in which experiencing random or uncontrolled consequences leads to feelings of helplessness and possibly depression.
All-or-none response
A strong stimulus can trigger more neurons to fire, and to fire more often, but it does not affect the action potentials strength or speed
All-or-none response
A strong stimulus can trigger more neurons to fire, and to fire more often, but it doesn't affect the action potentials strength or speed
Sample
A subset of a population selected as participants in an experiment.
Anxiety Disorders
A vague uneasy feeling of discomfort or dread accompanied by an autonomic response; the source is often non-specific or unknown to the individual. Affects cognition and often produces distortions of perception.
Positron emission tomography scan (PET Scan)
A visual display of the brain activity that detects where the radioactive form of glucose goes while the brain performs a given task
Mental disorder
A wide range of conditions that affect mood, thinking, and behavior
Which one of the following statements is an important feature of somatization disorder that helps differentiate it from conversion disorder, malingering, or hypochondriasis? -Abdominal pain that is recurring over many years after multiple negative workups -Physical symptoms disproportionate to a demonstrable organic disease -Sudden dramatic onset of a single symptom, typically simulating some non-painful neurologic disorder where there is no anatomical explanation -Symptoms that are intentionally produced in the absence of apparent external incentives
A-Abdominal pain that is recurring over many years after multiple negative workups Somatization refers to a tendency to experience and communicate psychological distress as physical symptoms in the absence of identifiable pathology. Question: What is the most common goal of malingering patients in the emergency department? Answer: Obtaining drugs.
A six-year-old boy is in clinic for a well-child evaluation. He has good grades and has a lot of friends in school. He plays baseball. He eats a healthy and balanced diet with meat, fruits, and vegetables. His father frequently goes hunting with his friends and has several guns at home. Which of the following is the best statement that you would give to the boy's parents regarding firearm safety? -Absence of guns from the home is the most effective means of prevention of firearm injuries in children -Firearm mortality among children has increased since the early 1990s -Gun safety programs alone appear to reduce the likelihood that children will handle firearms -Storing ammunition locked with an unloaded gun reduces the risk of unintentional firearm injury
A-Absence of guns from the home is the most effective means of prevention of firearm injuries in children Question: Which age group is greatest risk for burns, drowning, and falling? Answer: Toddlers.
Social or medical problems that result from substance use is defined by which of the following terms? Abuse Dependence Intoxication Tolerance
A-Abuse Question: Approximately what is the prevalence of substance use disorders in the general population of the United States? Answer: 8% of general adult populaiton.
A 21-year-old man runs a successful business as a methamphetamine cook. He frequently uses his own product. Recently, he has not been able to fill his typical orders due to being "high" all the time. Which of the following would best describe his substance use? Abuse Dependence Tolerance Withdrawal
A-Abuse Substance abuse is defined as a maladaptive pattern of recurrent substance use leading to clinically significant impairment or distress. This can manifest as failure to fulfill work Question: The National Survey on Drug Use and Health lists which three illicit drugs as the most commonly abused? Answer: Marijuana, cocaine and hallucinogens.
What disorder is characterized by emotional or behavioral responses to a stressful event that develops within 3 months after the onset of a stressor, and the patient's reaction must be in excess of what would be expected given the nature of the event (not the loss of a loved one)? Adjustment disorder Bereavement Grief reaction Personality disorder
A-Adjustment disorder Adjustment disorders comprise a category of emotional or behavioral responses to a stressful event that develop within 3 months after the onset of a stressor, and the patient's reaction must be in excess of what would be expected given the nature of the event. Question: What is the best treatment for adjustment disorders? Answer: Psychotherapy is the treatment that is most frequently recommended.
A 17-year-old boy is brought to the emergency department by his friends. They were at a house party and found their friend unconscious after he ingested an unknown substance. On physical exam, vital signs are temp 96°F, heart rate 50, respiratory rate of 4, and oxygen saturation 92% on room air. The boy's pupils are miotic. On lung auscultation, there are crackles bilaterally. You administer supplemental oxygen. Which of the following is the most appropriate clinical intervention? Administer intravenous naloxone Begin intravenous fluids with sodium bicarbonate Initiate therapy with benzodiazepines Perform gastric lavage
A-Administer intravenous naloxone Question: What are the clinical signs of subcutaneous heroin injection? Answer: Fat necrosis, lipodystrophy, atrophy over the extremities, and skin abscesses.
A 4-year-old girl presents to clinic for a well-child check and routine vaccination. History reveals that the patient and her mother have been residing in a homeless shelter for the past three months. Which of the following should be completed at this visit? Administration of all vaccines and placement of TST today Administration of all vaccines today, placement of the TST in 6 weeks Administration of inactivated vaccines and placement of the TST today Placement of the TST today, administration of all vaccines in 6 weeks
A-Administration of all vaccines and placement of TST today tuberculin skin test (TST) The above patient is due for her four-year immunizations, including MMR, Varicella, IPV, and DTaP. Both the MMR and Varicella vaccines contain live virus, while the IPV and DTaP vaccines do not
You finish taking a history of a patient at risk for suicide. Which of the following would suggest the highest likelihood of committing suicide? Age over 85 years Cohabitation with parents Married with children Tactile hallucinations
A-Age over 85 years The greatest suicide rate is in elderly white males over 85 years old
You examine a 2-year-old boy for a routine health visit. He eats a healthy diet. He can speak six words. He can also point to one body part. He is able to walk up the steps. You give him a crayon and he is able to scribble. His length is at the 45th percentile and weight is the 30th percentile. Physical examination is normal. The family recently acquired a puppy and has not yet been given vaccinations. You discuss rabies with the family. Which of the following is the best statement regarding rabies? All bites from animals that can be infected with rabies virus carry a risk of transmission Post-exposure prophylaxis should be given within a week if an exposing animal is suspected to be rabid Rabies cases among domestic animals have increased in the United States The risk of acquisition of rabies does not increase with multiple bites
A-All bites from animals that can be infected with rabies virus carry a risk of transmission The risk of acquisition increases with multiple bites, and with bites in closer proximity to the central nervous system (CNS). Children, presumably because of their size are more at risk as well. Question: What is the passive immunization to rabies? Answer: Rabies immunoglobulin.
A 29-year-old woman presents to your office with a complaint of worsening anxiety. Which additional finding would suggest a diagnosis of generalized anxiety disorder rather than panic disorder? Anxiety occurring more days than not for at least six months Changes in personality Excessive concern about medically unexplained symptoms Frequent periods of intense fear
A-Anxiety occurring more days than not for at least six months GAD is characterized by excessive and persistent worrying that occurs more days than not for six or more months. Other clinical manifestations include insomnia, headaches, difficulty relaxing, and fatigue Question: What disorder is characterized by anxiety occurring within three months of an identifiable stressor? Answer: Adjustment disorder.
A 14-year-old boy is in clinic for a well-child visit. He is a straight-A student and plays baseball in school. He eats a healthy and balanced diet. He has a lot of friends in school and enjoys hanging out with them. He likes to ride his bicycle on the weekends. Which of the following is the best advice you would give to the boy and his parents regarding bicycle injuries? Appropriate helmets are those with a firm polystyrene liner that fit properly on the head Helmets effectively reduce the risk of head injury by 55% Helmets reduce the risk of brain injury by 48% Parents should buy a larger helmet to give the child growing room
A-Appropriate helmets are those with a firm polystyrene liner that fit properly on the head Question: What can significantly decrease the risk and severity of head injuries among all-terrain vehicle (ATV) riders? Answer: Helmets.
A 3-year-old boy from South America presents to your office with his father for a well-child exam. While listening to his lungs you notice that his back is covered with circular lesions approximately 3-4 cm in diameter with central ecchymosis and petechiae. Which of the following is the next best step? Ask about traditional medicinal practices being used Begin workup for bleeding disorders Call child protective services Obtain a urinalysis
A-Ask about traditional medicinal practices being used
A 74-year-old woman is brought to her primary care provider by her adult son. The son says she has been very difficult at home and is "losing it." He seems very frustrated about her diminishing ability to take care of herself the way she used to and no longer thinks he can trust her watching his children. At her last visit you noted mild cognitive impairment. Today, she appears withdrawn and hesitates to make eye contact with you. She lets her son do most of the talking. Which of the following is the most appropriate next step? Ask the son to step out so you can speak with the patient alone Assess the patient's risk for depression Complete a mini-mental exam Discuss with the son the challenges of having a parent with dementia
A-Ask the son to step out so you can speak with the patient alone All patients, regardless of age, ought to be given a chance to speak with their physician alone Question: Which types of abuse require mandated reporting? Answer: Child abuse and elder abuse.
Which of the following statements is true regarding teenage suicide? Attempts are more common in girls than boys Boys complete suicide most commonly by ingesting a poisonous substance Girls complete suicide more often than boys Suicide rates are decreasing in teenagers
A-Attempts are more common in girls than boys Question: Based on the 2007 Youth Risk Behavior Survey, what percentage of students in grades 9 through 12 reported that they had seriously considered attempting suicide in the 12 months preceding the survey? Answer: 14.5%.
You suspect bipolar I disorder or major depression in a 17-year-old student. Which of the following tools is most appropriate in making one of these diagnoses? Beck Depression Inventory for Primary Care Mood Disorder Questionnaire My Mood Monitor Myers-Briggs Type Indicator
A-Beck Depression Inventory for Primary Care adapted from the Beck Depression Inventory, a 21-question multiple-choice self-report inventory and one of the most widely used instruments for measuring the severity of depression. Question: Which two common medical conditions need to be evaluated in a patient with a new diagnosis of depression? Answer: Diabetes and lipid disorders.
A patient with major depression spends $100,000 at a casino over the past week. He presents with his wife, who states they now are in severe debt and cannot make any more mortgage payments. She also reports that over the past week her husband talked all the time and never slept more than 3 hours at a time. Which of the following is the most likely diagnosis? Bipolar I Bipolar II Hypomanic episode Major depression, acute flare
A-Bipolar I Bipolar type I is defined as at least 1 manic episode with or without major depression. Bipolar type II is defined as at least 1 hypomanic episode with a major depressive episode. Question: How many patients with depression meet criteria for a bipolar disorder? Answer: Between 21 and 26%.
Which of the following diagnostic criteria differentiate Tourette syndrome from other neurological disorders? Childhood onset Comorbid symptoms of depression Developmental delay Observation of tics on physical exam
A-Childhood onset One diagnostic criterion for TS is onset before age 18 years. Other criteria for diagnosis include the presence of multiple motor and one or more vocal tics, persistence of tics for more than one year, and the symptoms not being related to a medical condition or physiologic effects of a substance. Question: How does coprolalia clinically manifest in patients with Tourette syndrome? Answer: Vocal tic with involuntary use of obscene words
Which one of the following screening practices is recommended for the adolescent/young adult population by the U.S. Preventive Services Task Force? Chlamydia screening in sexually active females Lipid screening Scoliosis screening Testicular examination
A-Chlamydia screening in sexually active females Screening for Chlamydia in all sexually active, non-pregnant women 18-25 years of age is recommended. Question: What is the treatment for Clamydia trachomatis? Answer: Azithromycin or Doxycycline.
A 52-year-old business executive presents to the ED with diaphoresis, tachycardia, visual hallucinations, and recent seizure. The patient states that he drinks alcohol daily but he is trying to quit. His last drink was one day ago. Which of the following is the most appropriate medication at this time? Chlordiazepoxide Haloperidol Phenytoin Quietiapine
A-Chlordiazepoxide Question: What is alcohol withdrawal delirium (delirium tremens)? Answer: Delirium and clouded consciousness that occurs as part of alcohol withdrawal.
A 18-year-old man presents to the ED in police custody after using an unknown drug. Vital signs are BP 170/85, HR 120, T 37.8°C, RR 18, and pulse ox 99% on room air. On exam, he is agitated and diaphoretic. His pupils are 7 mm and reactive. Which of the following substances did this patient most likely use? Cocaine Dextromethorphan Fluoxetine Phencyclidine
A-Cocaine Cocaine Intoxication: Sympathomimetic toxidrome Diaphoresis (unlike in anticholinergic overdose) Seizures Wide-complex dysrhythmias (rx: sodium bicarbonate) Rx: BZDs Avoid ßBs
Which of the following conditions, in which laws and social norms are repetitively violated, is the most common precursor to antisocial personality disorder? Conduct disorder Malicious compliance behavior disorder Oppositional defiant disorder Passive-aggressive personality disorder
A-Conduct disorder Conduct disorder is the best predictor of antisocial personality disorder, which cannot be diagnosed until the subject is 18 years old. Question: What is the treatment of conduct disorder? Answer: Multisystemic Treatment, an intensive integrative program that emphasizes correct behavior within the individual or the individual's family, instead of within society as a whole.
A 2-year-old boy presents with a burn to his right hand as seen above (multiple sharply demarcated round burns with a central eschar (cigarette burns)). The patient's mother states that he mistakenly got burned by hot water when she tipped a hot tea kettle over. What management is indicated? Consultation with child services for suspected abuse Consultation with plastic surgery for skin grafting Discharge home with silvadene and follow up Transfer to a burn center
A-Consultation with child services for suspected abuse. Question: What is the significance of the Tarasoff vs. Regents case? Answer: This case establishes the physicians duty to breach patient confidentiality if the patient poses a significant threat to a 3rd party.
Which of the following medical conditions excludes a child from participation in sports? Current fever History of HIV infection History of persistent asthma Known seizure disorder
A-Current fever Question: Why should children receiving chemotherapy with anthracyclines be restricted from competitive sports? Answer: Cardiotoxic effects of the medication that can lead to heart failure.
Which of the following is adequate for a new diagnosis of schizophrenia? Delusions and disorganized speech for 6 months Delusions and hallucinations for 2 weeks Flat affect and avolition Hallucinations and chronic alcohol use
A-Delusions and disorganized speech for 6 months Schizophrenia: ≥ 2 symptoms: Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms Brief psychotic disorder: < 1 month Schizophrenia: > 6 months Schizophreniform disorder: 1-6 months Schizoaffective disorder: psychosis + mania or depression Question: What are neologisms? Answer: Neologisms are nonsense words invented by the patient. This is a common symptom in schizophrenia.
Which one of the following has been shown to render some improvement in individuals with borderline personality disorder? Dialectic behavioral therapy Omega-3 fatty acids Second-generation antipsychotics Selective serotonin reuptake inhibitors
A-Dialectic behavioral therapy DBT is a multi-faceted program specifically designed to treat BPD. This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events Question: What is the reason for amenorrhea when using first generation anti-psychotics? Answer: Hyperprolactinemia.
A 46-year-old man with a history of depression presents with a self inflicted laceration to the left arm. The wound is superficial and the patient states that he didn't want to hurt himself. He reports that he is recently divorced, lives alone, and has increased stress at work. These stressors have worsened his depression. Which of the following treatments is most likely indicated for this patient? Emergency psychiatric evaluation Outpatient referral to psychiatry Prescribe antidepressant and discharge with follow up Prescribe anxiolytic and discharge
A-Emergency psychiatric evaluation This patient presents with a possible suicide attempt and a number of high risk factors for suicidality warranting an emergency evaluation from psychiatry. Patients often present to the emergency department after an attempt that may appear minor
Which of the following best defines delusions? Erroneous beliefs that usually involve a misinterpretation of perceptions or experiences Hallucinations occurring in the absence of insight into their pathological nature Marked disorientation, confusion, and fluctuating consciousness Sensory perceptions without external stimulation
A-Erroneous beliefs that usually involve a misinterpretation of perceptions or experiences Question: Which of the following is the most common type of delusion? Answer: Persecutory.
A 31-year-old woman presents to your office with a complaint of feeling depressed. In the past two months she has lost 10 pounds, is experiencing insomnia, has low energy, difficulty concentrating, and feels worthless. She denies thoughts of suicide. Which of the following is the most appropriate therapy? Escitalopram Imipramine Lithium Risperidone
A-Escitalopram First-line treatment for depression is pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) such as escitalopram, psychotherapy, or a combination of both. Question: True or false: Depression is more common among men than women? Answer: False.
Which of the following clinical scenarios in a patient with chronic ethanol use should prompt admission to the hospital? Fever, tachycardia, hypertension Intoxication with vomiting Mild tachycardia, tongue fasciculations Normal vital signs, one seizure six hours ago
A-Fever, tachycardia, hypertension major alcohol withdrawal which is a constellation of symptoms which may include anxiety, irritability, tremors, tachycardia, fever, hypertension, decreased seizure threshold and both auditory and visual hallucinations. Question: Before what day of abstinence is it rare for delirium tremens to develop? Answer: Day three.
A 14-year-old presents for a well child visit. She is healthy and has no complaints. A review of her past immunizations shows that she is up to date on all required immunizations at her 8-year-old well child visit. She also received the Human papillomavirus vaccine at age 11 and 12, and quadrivalent meningococcal vaccine and TdaP at age 12. Which one of the following vaccines should she receive at this visit? Human papillomavirus vaccine Inactivated poliovirus Measles Rubella
A-Human papillomavirus vaccine She is up to date on all immunizations at age 8, so it can be assumed that she has received her rubella (D), measles (C), and polio vaccinations (B).
Which of the following is the most common type of child abuse? Neglect Physical Psychological Sexual
A-Neglect Question: Shaken baby syndrome, a common form of infant abuse, typically leads to which pathological findings? Answer: Intracerebral hemorrhage, intracranial hypertension and permanent neurological damage.
A splinter went deep into the arm of a man while he was working in the yard. After thorough wound cleansing, you inquire about his tetanus status. He is certain that he received all of his childhood vaccines and a "tetanus booster" 4 years ago, but does not know which vaccine he received. Which one of the following is the best choice for this patient regarding tetanus immunization at this time? No immunization Tetanus immune globulin Tetanus toxoid Tetanus toxoid with reduced diphtheria
A-No immunization No additional vaccine is needed at this time since received his initial childhood vaccinations as well as a tetanus booster within the past 5 years. Question: When should the tDap vaccine be administered during pregnancy? Answer: Tdap should be administered to all pregnant women at 27-36 weeks of gestation.
On a Sunday afternoon, a surgical oncologist and his family attend a football game in the city where he practices. While at the game, he runs into a physician colleague that works at the same institution. After some casual small talk, his colleague inquires, "Are you taking care of Mr. Clarke, my personal trainer? I heard through the grapevine that he has melanoma, and I didn't know if you had started him on any chemotherapy or performed any surgical intervention yet. Hopefully you'll be able to take very good care of him." In this situation, the surgical oncologist may confirm which of the following? No information at all Only that Mr. Clarke is his patient The patient's diagnosis The patient's treatment plan
A-No information at all a PA must not discuss any information regarding a patient's care with anyone who is not actively involved in that patient's care. Question: At what age is a patient allowed to express his or her concerns to a physician without a family member or guardian present? Answer: At any age.
the role of ADHD and substance abuse
ADHD med are central nervous system stimulants they have a potential for abuse take them for appetite suppressant or to stay awake.
lifespan and cultural considerations associated with autism
ASD is a lifelong disorder. The earlier the intervention by parents, healthcare team members, and available support services, the greater chance children with ASD will have of reaching their potential.
Irritability
Abnormal or excessive excitability, with easily triggered anger, annoyance, or impatience.
Paresthesia
Abnormal spontaneous tactile sensation, such as a burning tingling, or pins-and-needles sensation
Aphasia
Absence or impairment of ability to communicate through writing speech or signs.
Negative Symptoms
Absent or decreased emotional and behavioral repertoire. Includes flat affect, alogia, avolition, anhedonia or hypohedonia.
ACh
Acetylcholine
a neurotransmitter that enables muscle action, learning, and memory. Lack of this causes Alzheimer's
Acetylcholine
Delirium
Acute onset; clouded state of confusion; decreases sensorium; disorientation to time and place; incoherent speech; aimless physical activity; SHORT-TERM AND REVERSIBLE D/t: head trauma, epilepsy, stroke, substance abuse
impaired control of some kind of substance on either the body or the mind
Addiction
Adjustment disorder with depressed mood:
Adjustment disorder with depressed mood: •Symptoms are similar to those of other depressive disorders and include sleep disturbances, feelings of hopelessness and sadness, loss of self-esteem, irritability, difficulty concentrating, and anhedonia. occurs after a stress full events
Serotonin
Affects mood, hunger, sleep, and arousal
Anxiety Disorders Epidemiology
Affects up to 15% of population, 40% of patients with primary anxiety disorders also have DSM-V diagnosis of depressive disorder. 50-70% of depressed patients have co-existing anxiety. Co-morbidity: Usually have one other disorder. Women>men 2:1 except in PTSD
fear of public spaces or crowds; usually stay home to avoid panic attacks in public
Agoraphobia
Drug interaction with Bupropion (Wellbutrin)
Alcohol - increase effects of Wellbutrin
Most people in substance abuse treatments were for what?
Alcohol, then drugs
schizotypal personality disorder
Aloof and isolated; behaves in a bland and apathetic manner; anxious. May be hearing voices. Say they have the 6th sense: believe they can read peoples minds or hear what they are thinking
AD
Alzheimer's Disease
ALS
Amyotrophic Lateral Sclerosis
Panic
An acute, intense attack anxiety associated with personality disorganization
Sensory cortex
Area at the front of the parietal lobes that registers and processes the body's touch and movement sensations. The larger the area of this region used for a particular body part, the more sensitive it is.
Association areas
Areas of the cerebral cortex that are not involved in primary motor or sensory functions but in higher mental functions such as learning, remembering, thinking, and speaking
Situational Crisis
Arises from events that are different, not the norm, unexpected, extraordinary, external. These events are often unanticipated, involve loss or change, and threatens a person's self-concept & self-esteem. Examples: loss or change in job, finances, divorce, abortion, death of a loved one. Successful resolution depends on resolution of the grief associated with the loss!
Melancholia
As an emotional symptom, it is detachment, alienation, sadness, apathy, and dejection. Formerly used as clinical term to describe the mental disorder of depression.
Process Evaluation
Assess extent to which intervention was implemented as planned
Social Assessment
Assess people's perceptions of their own needs and quality of life through data / interviews / focus groups etc.
Impact Evaluation
Assess the change in the factors identified by the behavior & environmental assessment & the educational and organization assessment
Cognitive Therapy
Assumes patient's problem is based on his perception of his environment. Used in patients with depression, panic disorder, OCD, personality disorders, somatoform disorders, usually individual therapy sessions. Cognitive triad of depression: Negative self-perception, view world in negative manner, expects world will not change. Therapy aimed at changing these perceptions.
Love
Attachment towards another person in a romantic sense.
ADHD
Attention Deficit Hyperactivity Disorder
the extension of the neuron that has fibers on the end that pass information to other neurons or to muscles
Axon
Nerves
Axons that have been bundled together into cables that connect the CNS with muscles, glands, and sense organs
A 53-year old previously healthy woman visits her primary care physician to review the results from the biopsy obtained from the solitary 8 mm polyp discovered in her colon by a routine colonoscopy. The report confirms that this is a hyperplastic polyp. Her family history is negative for colon cancer. Which one of the following is the most appropriate interval for follow-up colonoscopy in this patient? 1 year 10 years 3 years 5 years
B-10 years Small hyperplastic polyps, which are defined as less than 10 mm in size, are not neoplastic and are considered low risk. For patients at low risk the recommended interval between screening colonoscopies in 10 years. Question: What is the treatment for familial adenomatous polypsosis (FAP)? Answer: Prophylactic colectomy.
Screening for lung cancer with low-dose computed tomography of the chest is indicated for which one of the following patients with a 30-pack-year smoking history? A 50-year-old current smoker A 60-year-old who quit smoking 10 years ago A 75-year-old who quit smoking 20 years ago An 85-year-old current smoker
B-A 60-year-old who quit smoking 10 years ago 55 to 80 who have a 30 pack-year smoking history and currently smoke or who have quit within the past 15 years Question: What is the most effective way to decrease the mortality and morbidity associated with lung cancer? Answer: Smoking cessation.
Which of the following is consistent with a diagnosis of bulimia? Congestive heart failure Contraction alkalosis Hyperkalemia Hypothermia
B-Contraction alkalosis Question: What is Russell's sign? Answer: The presence of calluses on the knuckles that result from induced vomiting in bulimia.
A 32-year-old woman presents to your office for her annual exam. She reveals that one month ago her 6-year-old daughter was killed in a motor vehicle accident. Since the accident she has been crying uncontrollably, can't sleep through the night, and sometimes sees her daughter walking in the upstairs hall. Which of the following is a risk factor for the development of poor bereavement outcomes? Crying uncontrollably Death of a child Insomnia Occurrence of visual hallucinations
B-Death of a child Prolonged or complicated grief is characterized by persistent, disruptive emotional responses for at least six months after the death of a loved one Question: True or false: The majority of individuals seek professional intervention after the loss of a loved one? Answer: False.
A 6-month-old infant boy presents to his pediatricians office for a follow-up visit. His parents are concerned about his immunizations because an otherwise healthy and normal older brother died of varicella complications at a year of age. They are aware of the fact that varicella virus is highly infectious. They request your advice about their son's varicella immunization schedule. Which one of the following recommendations is most appropriate? -Administer the killed varicella vaccine at 12 months and 2 years of age -Administer the live varicella vaccine at 12 months and 4 years of age -Evaluate this infant for immune deficiency and administer a dose of varicella-zoster immune globulin (VZIG) prior to any further immunizations -Immunize this 6-month-old infant with his first dose of live varicella vaccine at this visit and the second dose at 9 months of age
B-Administer the live varicella vaccine at 12 months and 4 years of age This child should be immunized following the Advisory Committee on Immunization Practices (ACIP) recommendations. The specific recommendation is to administer the live varicella vaccine at 12 to 15 months and 4 to 6 years of age. The history of a fatal case of varicella in the older brother at a year of age does not imply any immune problem in the younger brother.
A 4-year-old boy is seen in your office for routine physical. His mother is concerned that he is not speaking like a normal 4 year-old. On further evaluation you notice that he has poor eye contact, rapid hand movements and he is preoccupied by repeatedly spinning the wheels on the toy cars he brought with him. What is the most likely diagnosis? Attention deficit hyperactive disorder Autism spectrum disorder Expressive speech delay Obsessive compulsive disorder
B-Autism spectrum disorder Autistic disorder is a clinical diagnosis. The core features include impaired social interactions, communication, and behavior. Early social skills deficits include poor eye contact, lack of interactive play, and lack of interest in other children Question: What tool is commonly used at 18 months of age to screen for an autism spectrum disorder? Answer: M-CHAT questionnaire.
A 29-year-old woman presents to the psychiatric clinic for a "lifetime" of intense anxiety not relieved by 12-weeks on fluoxetine. She reports low self-esteem, feeling "very uneasy" in social situations, and says she wishes she could make friends but worries that she'll say something "dumb" to people. Which of the following personality disorders does she most likely have? Antisocial personality disorder Avoidant personality disorder Dependent personality disorder Paranoid personality disorder
B-Avoidant personality disorder Avoidant personality disorder is characterized by this patient's symptoms of low self-esteem and desire for relationships which remains fruitless due to persistent fear of rejection. Other symptoms of avoidant personality disorder include a hypersensitivity to criticism and failure, often making patients unable to hold jobs and maintain relationships.
A 19-year-old man presents with his parents who state that their son has shown signs of impulsivity, pressured speech, racing thoughts, and a decreased need for sleep over the last 3-4 weeks that has caused him to miss school. What is the most likely diagnosis? Attention-Deficit/Hyperactivity Disorder Bipolar disorder Major depressive disorder Schizophrenia
B-Bipolar disorder Manic episodes are distinct periods of abnormally and persistent moods that can be euphoric, expansive, or irritable. Manic patients often have greatly inflated self-esteem, confidence, decreased need for sleep, pressured speech, racing or crowded thoughts, distractibility, increased involvement in goal-directed activities
A 23-year-old man presents with leg pain for 3 months and requests hydromorphone for pain. The nurse approaches you because she believes the patient is "drug seeking" as he became extremely upset when she told him that he would have to wait for the doctor to evaluate him before pain medications could be given. Upon entering the room, the patient speaks pleasantly with you and compliments you on your kindness. He tells you that he only comes to this hospital because "it's the best in the world," and "none of the other doctors understand me." Upon informing the patient that you will not be prescribing hydromorphone, he becomes extremely upset and starts yelling. What personality disorder traits is this patient exhibiting? Antisocial Borderline Histrionic Narcissistic
B-Borderline Borderline personality disorder is characterized by unstable relationships, self image and affect. This instability is often marked with impulsiveness. In the Emergency Department, these patients will often "split" providers Question: Which of the personality disorders are associated with an increased risk of suicide attempts? Answer: Borderline and histrionic personality disorders.
A patient with chronic spinal pain begins to obtain off-the-street opioids in an attempt to enhance his prescribed opioid analgesics. In addition to psychotherapy for substance dependence, you prescribe which of the following substitution adjuvant medications? Bromocriptine Buprenorphine and naloxone Disulfiram Modafinil
B-Buprenorphine and naloxone The goal of this is to provide a clinically supervised, stable dose of a partial opioid agonist (buprenorphine) and opioid-antagonist (naloxone) to provide pain and craving control, which allows the addict to function while reducing the negative aspects of addiction.
A 28-year-old previously healthy woman presents to your office with a complaint of feeling depressed. In the past 6 months she feels very tired despite sleeping 10-12 hours per night, has no desire to exercise like she did previously, has lost 10 pounds and complains of not having an appetite. She admits to having thoughts of wishing she weren't alive anymore, although denies being suicidal. Which of the following is considered first-line therapy for this patient? Amitriptyline Citalopram Olanzapine Phenelzine
B-Citalopram Diagnosis of depression is made when patients have at least one episode of major depression and no history of mania or hypomania. An episode of major depression lasts at least two weeks and includes having five or more symptoms of depression including anhedonia, depressed mood, change in appetite or weight, insomnia or hypersomnia, low energy, inability to concentrate, feeling guilty or worthless, and thoughts of death or suicide. Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, are considered first-line pharmacologic treatment
A 24-year-old woman presents to your office with a complaint of severe anxiety. Approximately three times per week she has episodes of sweating, chest pain, heart palpitations, shaking and fear of losing control or dying. The episodes seem to occur and resolve spontaneously. Which of the following is the most appropriate therapy? Carbamazepine Citalopram Imipramine Risperidone
B-Citalopram Panic attacks are periods of intense fear with specific symptoms that develop quickly and peak less than 10 minutes from the onset of the attack. First-line treatment is with a selective serotonin reuptake inhibitor (SSRI), such as citalopram. Question: True or false: Benzodiazepines should be avoided in the treatment of panic disorder for patients with a history of substance abuse? Answer: True.
Which of the following is most consistent with alcohol withdrawal? Agitation and increased appetite Delirium, hallucinations, tremor Depressed mood with diarrhea Dilated pupils, runny nose and watery eyes
B-Delirium, hallucinations, tremor
A 45-year-old man who lives alone and is a highly functional working individual, tells you that the police are coming into his home each night and stealing food from his refrigerator and unlocking all the doors. Which of the following is the most likely diagnosis? Delirium Delusional disorder Depression Schizophrenia
B-Delusional disorder The term delusional disorder refers to a condition whose core feature is persistent, nonbizarre delusions not explained by other psychotic disorders. It is a fixed false belief that has a certain level of plausibility Question: Should you directly challenge a delusional patient about his or her false beliefs? Answer: No, avoid directly challenging the patient but do not pretend to be in full acceptance.
A 26-year-old woman is brought in by her husband for evaluation. He states that over the last week, she has exhibited a number of concerning symptoms including tremors and seizures. On entering the room, the patient is noted to be resting comfortably. When asked about the tremor, the patient begins to exhibit coarse diffuse tremors. During the evaluation the patient has generalized shaking but is able to respond to questions. Further discussion with the patient's husband reveals that they are currently going through a separation and there has been a lot of stress at home. Which of the following disorders accounts for the patient's symptoms? Conversion disorder Factitious disorder Hypochondriasis Somatization
B-Factitious disorder Factitious disorder is characterized by falsified general medical or psychiatric symptoms. Patients deceptively misrepresent, simulate, or cause symptoms of an illness or injury in themselves, even in the absence of obvious external rewards such as financial gain, housing, or medications.
The leading type of death from an unintentional injury in adults aged 65 and older is due to which of the following? Automobile accidents Falls Fire-related injuries Gunshot wounds
B-Falls Falls are the leading type of injury for adults aged 65 and older. Between 30-40% of community-dwelling adults in this age group have at least 1 fall per year
You examine a 3-year-old girl for drowning. She was unsupervised for a few minutes and later her mother found her by the pool. The mother called 911 and CPR was performed for 5 minutes. Upon arrival in the emergency room she is unresponsive and is immediately intubated. Her blood pressure is 70/50 mm Hg, heart rate is 125 beats per minutes, and pulse oximetry reading is 95%. Which of the following is the correct statement regarding water safety? Adolescents who had swimming lessons are allowed to swim alone Fencing that surrounds a pool with a self-locking gate reduces the risk of drowning Less supervision is fine for toddlers who had swimming lessons Water wings and floaters can be relied upon as drowning prevention measures
B-Fencing that surrounds a pool with a self-locking gate reduces the risk of drowning Children and adolescents should never swim alone regardless of their swimming abilities. Even as they become more independent and participate in recreational activities without their parents, they should be encouraged to seek areas that are watched by lifeguards
A 27-year-old woman presents to your office with complaints of depression and thoughts of suicide. She is interested in starting both counseling and medication to address her symptoms. Which of the following is the safest medication to consider prescribing? Amitriptyline Fluoxetine Nortriptyline Venlafaxine
B-Fluoxetine Selective serotonin reuptake inhibitors (SSRIs) seem to be safer in the case of an overdose than other agents. SSRIs, such as fluoxetine, are therefore the agents of choice in the treatment of depression for patients who are potentially suicidal.
Which of the following medications is most likely to cause side effects such as tardive dyskinesia and have limited efficacy in treating the negative symptoms of schizophrenia? Aripiprazol Haloperidol Quetiapine Risperidone
B-Haloperidol Typical antipsychotics such as haloperidol have a relatively high risk of adverse effects such as tardive dyskinesia and parkinsonism, especially in older patients Question: Do individuals with schizophrenia have an increased risk of violence? Answer: Yes, especially those with uncontrolled paranoia and disorganized symptoms
A 45-year old man with diabetes mellitus sees you for the first time. If the patient has not previously received it, which one of the following vaccines is recommended for him? Hepatitis A Hepatitis B Meningococcal Varicella zoster
B-Hepatitis B hepatitis B vaccine should be administered to all previously unvaccinated adults aged 19-59 with diabetes mellitus Question: What are the 3 values used to diagnose diabetes mellitus type 2? Answer: Need 2: Fasting blood sugar > 125 mg/dL, HBA1c of 6.5%, glucose tolerance test results > 200 mg/dL or a random plasma glucose level > 200mg/dL + symptoms of hyperglycemia.
You examine a 12-month-old girl for a health supervision visit. She is asymptomatic and the mother has no complaints. The family lives in a house built in 1940s and so you perform a lead level in clinic which was read as elevated. You send the girl for a venous lead level at the hospital and the lead level obtained is 10. What is the next best step? Give more iron supplements Make changes in the home No intervention needed Treat with chelation
B-Make changes in the home For patients found to have mild elevations, (a level of 10-20) changes in the home should be made. Management usually requires the assistance of public health and housing agencies as well as education for the parents. The family should move out of a lead-contaminated apartment until repairs are completed.
You examine a 12-month old boy in clinic for possible measles exposure. He stayed at his grandmother's house two days ago where he played with his cousin. The mother is concerned because the boy's cousin developed measles that is confirmed by the laboratory. The mother denies any symptoms on the boy. The boy has not had his measles vaccination. Which of the following is the best therapy for the boy? Measles immune globulin Mumps, measles, rubella vaccination Ribavirin Vitamin A
B-Mumps, measles, rubella vaccination the administration of live measles vaccine within 72 hours of the exposure is preferable to immune serum globulin administration. Measles immune globulin (A) can prevent or diminish the severity of measles if administered to nonimmune individuals within six days of exposure. However,
Mainstream Factors
Behavior Change Factors: Result from the relationship of an individual with a larger group or population
Incentives or similar substitutes
Behavior change can be made easier with
What is the most common form of child abuse in the United States? Emotional Neglect Physical Sexual
B-Neglect Neglect is the most common type of child maltreatment in the United States (78.5%) and is caregiver failure to meet basic nutritional, medical, educational, and emotional needs of a child. Question: Which 3 populations of abuse require reporting to authorities? Answer: Elder abuse, animal abuse and child abuse. Note, reporting of domestic abuse is not mandated by law.
An 8-year-old boy presents for a well-child check. He wants to join his school's basketball team that involves weightlifting. His mother has concerns regarding whether this is appropriate for a child his age. Which of the following is the most accurate statement regarding resistance training? Most injuries related to resistance training are the result of weightlifting movements such as modified cleans, pulls, and presses Resistance training can begin as early as age 6 with appropriate supervision Resistance training is appropriate for children who are at least 10 years of age or are at least 4 feet 5 inches in stature The mechanical stress from heavy resistance training can negatively impact linear growth during childhood and early adolescence
B-Resistance training can begin as early as age 6 with appropriate supervision Which school team sport has the highest injury rate in the United States? Answer: Football, followed by wrestling.
A four-year-old boy is seen in clinic for a routine health visit. He was adopted from South Korea and arrived in the United States one week ago. He lived in an orphanage since birth. He already underwent evaluation in his birth country and findings were normal. He can copy a circle and can draw a person with two body parts. He can also walk up the stairs with alternating feet. He is shy but interacts well with his adoptive parents. On physical examination body mass index is at the 8th percentile. There is evidence of dental caries. Which of the following is the best statement regarding the infectious disease aspect of international adoption? -Children who are adopted from South Korea should be screened for Chagas disease -Routine screening for hepatitis B virus infection is recommended for internationally adopted children upon arrival -Routine screening for malaria is recommended for internationally adopted children -Routine screening of internationally adopted children for intestinal parasites is not needed upon arrival
B-Routine screening for hepatitis B virus infection is recommended for internationally adopted children upon arrival Centers for Disease Control and Prevention (CDC) recommend routine screening for hepatitis B virus (HBV) infection for internationally adopted children upon arrival, regardless of results provided in the country of origin Question: How soon upon arrival should internationally adopted children be evaluated by a healthcare professional? Answer: Two weeks.
Which one of the following cardiac rhythm abnormalities is most common in patients with anorexia nervosa? Atrial fibrillation Sinus bradycardia Sinus tachycardia Ventricular fibrillation
B-Sinus bradycardia Sinus bradycardia is almost universally present in patients with anorexia nervosa. It is hypothesized that this is due to vagal hyperactivity resulting from an attempt to decrease the amount of cardiac work by reducing cardiac output.
OCD compulsions
BEHAVIORS
cultural considerations associated with depression?
Because people from diverse cultures may express themselves in different ways, symptomatology may vary as a function of cultureThus, some have argued that although diagnosis can be helpful in treatment planning, it can lead to the misdiagnosis of culturally oppressed groups when clinicians do not fully take into account cultural, gender, and ethnic differences
Downstream Factors
Behavior Change Factors: Directly involve an individual and can potentially be altered by individual interventions
Upstream Factors
Behavior Change Factors: Grounded in social structures and policies
Lamotrigine (lamictal) in Bipolar
Bipolar depression May cause SJS
MOA of TCAs
Block the presynaptic reuptake of serotonin (5-HT) and norepinephrine (NE) - increases synaptic concentrations
TCAs - MOA
Block the presynaptic reuptake of serotonin (5-HT) and norepinephrine (NE) - increases synaptic concentrations
SSRIs- MOA
Block the reuptake of serotonin (5-HT)
SNRIs - MOA
Blocks reuptake of serotonin (5-HT) and norepinephrine (NE)
Nerves
Bundled axons that form neural "cables" connecting the central nervous system with muscles, glands, and sense organs.
Which of the following predicts a higher risk of suicide completion? Female gender Married relationship status Substance abuse Unemployment
C-Substance abuse Patients with active substance abuse, including alcohol, are among the highest risk for suicide completion
Screening for osteoporosis should be performed in which one of the following groups? 55-year old man with type 2 diabetes mellitus 55-year old woman with a BMI 30 kg/m2 65-year old previously healthy woman 75-year old previously healthy man
C-65-year old previously healthy woman all women 65 years or older and at-risk women aged 50-64 should undergo universal screening for osteoporosis (obesity is a protective factor d/t peripheral estrogen). Question: What is the diagnostic criteria used to diagnose osteoporosis? Answer: A T-score less than -2.5 on DEXA.
A 7-year-old boy presents to your office for a well-child check. His mother has concerns regarding his car booster seat. Which of the following is the most accurate statement regarding car safety seats? All children should be restrained in the rear seats of vehicles for optimal protection until they have outgrown the highest weight or height allowed by the manufacturer of their belt-positioning booster seat, typically after 12 years of age. All children should be transitioned to belt-positioning booster seats as early as possible for optimal protection. All children should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age. All infants and toddlers should ride in a rear-facing car safety seat until they are 1 year of age or older.
C-All children should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age.
Which of the following is true regarding anorexia nervosa? Affects men more than women Anti-depressants are an effective treatment Associated with a body image disturbance Menorrhagia is an early symptom
C-Associated with a body image disturbance An individual with anorexia nervosa refuses to maintain a minimally normal body weight, is fearful of gaining weight, and exhibits a distorted body self-image. The patient's body image is the predominant measure of self-worth, along with denial of the seriousness of the illness.
What is considered the first-line therapy for bulimia? Antidepressants Antipsychotics Cognitive behavioral therapy Weight management plan
C-Cognitive behavioral therapy Bulimia: Recurrent binge eating Overconcern with body shape/weight Weight: normal or above normal Submandibular gland enlargement Calluses over dorsal aspect of fingers Dental enamel erosion Rx: cognitive behavioral therapy (first-line), SSRIs (second-line) Question: What physical health problems are associated with bulimia? Answer: Electrolyte disturbances, loss of dental enamel, and esophageal tears.
A 14-year-old boy has been described by others as the "school bully." For the past 16 months he stole money from his parents, got into fights at school almost daily, failed to turn in most of his homework, and destroyed multiple items both at home and school. During parent-principal meetings the young boy denies having remorse for his actions and considers himself just a "normal" 14-year-old. Which of the following disorders is this individual suffering from? Antisocial personality disorder Attention deficit hyperactivity disorder Conduct disorder Obsessive compulsive personality disorder
C-Conduct disorder Conduct disorder criteria involves symptoms from 3 of 4 categories that include aggression to people and animals, destruction of property, deceitfulness or theft, serious violation of the rules. Symptoms must persist for over 12 months with at least 1 criterion for the past 6 months. They must also be under the age of 18. Question: A patient with conduct disorder diagnosed at 15 years of age may go on to develop which personality disorder as an adult? Answer: Antisocial personality disorder.
A mother presents to clinic with her 15-year-old son. She is concerned because over the past 2 years he has been having significant behavioral problems. At home he is bullying his younger siblings, staying out past curfew, and she recently caught him setting fires in the backyard. At school he is consistently truant and failing all of his classes. Last weekend police picked him up for spray-painting graffiti on a local church. When asked to explain his behavior, the patient says, "I don't have to explain anything, I can do what I want." This patient meets criteria for which of the following disorders? Antisocial personality disorder Attention deficit/hyperactivity disorder Conduct disorder Oppositional-defiant disorder
C-Conduct disorder conduct disorder is characterized by behavior which violates the basic rights of others, societal norms, or age-appropriate rules in a repetitive and persistent manner. At least 3 criteria need to be present for the past 12 months
A recently adopted 6-year-old from an Eastern Europe presents to your office with his parents for a first time visit. His past medical history and physical exam is unremarkable. His parents do not know his immunization history, so you order the appropriate vaccine and immunoglobulin titers in addition to standard testing. His titers are all negative and laboratory work-up is otherwise unremarkable. What immunizations should he receive? DTaP, HepA, HepB, HiB, IPV, MMR, PCV13, Varicella DTaP, HepA, HepB, IPV, MMR, PCV13, Varicella DTaP, HepA, HepB, IPV, MMR, Varicella Tdap, HepA, HepB, IPV, MMR, PCV13, Varicella
C-DTaP, HepA, HepB, IPV, MMR, Varicella No HiB >5yrs w/o risk factors PCV13 for ages 24-59mo Question: What is the maximum age to start Rotavirus vaccine? Answer: For rotavirus vaccine, the maximum age for the first dose is 14 weeks 6 days, and for the final dose, the maximum age is 8 months 0 days.
Which of the following represents the classic order of the stages of grief? -Anger, Denial, Bargaining, Depression, Acceptance -Bargaining, Anger, Denial, Depression, Acceptance -Denial, Anger, Bargaining, Depression, Acceptance -Depression, Denial, Anger, Bargaining, Acceptance
C-Denial, Anger, Bargaining, Depression, Acceptance Question: Which gender is more likely to experience all 5 stages of grief? Answer: Women are more likely than men to experience all 5 stages.
Which of the following is associated with an organic cause of psychosis? Auditory hallucinations Chronic onset of symptoms Disorientation Normal vital signs
C-Disorientation Psychosis can be caused by both organic (medical) and functional (psychiatric) etiologies Question: What are some common negative symptoms seen in schizophrenia? Answer: Flat affect, catatonic behavior, inexpressive facial expressions and monotone speech.
Which of the following is correct with regards to autism? Caused by thimerosal-containing vaccines Developmental screening tests have good sensitivity for autism Early intervention with a multidisciplinary approach improves outcomes Onset typically occurs after the age of 5
C-Early intervention with a multidisciplinary approach improves outcomes The term autism refers to a spectrum of pervasive developmental disorders characterized by various degrees of impaired social interaction and communication and repetitive, stereotyped patterns of behavior. These patients like aloneness, are hypersensitive to touch, desire sameness in every day activity, often have a lack of understanding, and can have good rote memory skills.
An 18-year-old woman with a history of frequent visits to the ED presents with multiple superficial lacerations to her left wrist. She is agitated and states she is suicidal. She is yelling at the nurses and demands to be seen only by the psychiatrist. Which of the following is the most appropriate next step in management? Administer 5 mg of intramuscular haloperidol Consult the psychiatry service Engage in conversation and discuss her symptoms and validate her distress Place her alone in a private room and wait for her to calm down
C-Engage in conversation and discuss her symptoms and validate her distress Borderline personality disorder (BPD) is a common emergency psychiatric presentation. BPD is characterized by unstable personal relationships, unstable self-image, and inappropriate behaviors. The disorder may include chronic feelings of emptiness, which may be misdiagnosed as depression, or lability of mood
A 21-year-old woman presents to your office for her annual exam. While taking the patient's history, she reveals that she has been eating excessive amounts of food and then vomiting almost daily for the past six months. She has started working with a nutritionist and is seeing a cognitive behavioral therapist but would like to know if there are any medications that might help her treatment. Which of the following is the most appropriate medication for this patient? Desipramine Diazepam Fluoxetine Lorazepam
C-Fluoxetine Treatment for bulimia nervosa includes psychotherapy, nutritional rehabilitation, pharmacotherapy and management of medical complications. The selective serotonin reuptake inhibitor (SSRI) fluoxetine is the only SSRI approved for use in treating bulimia nervosa and is considered first-line. Question: Which antidepressant is contraindicated in patients with eating disorders? Answer: Bupropion.
Which one of the following is recommended for routine prenatal care? Cystic fibrosis carrier testing Hepatitis C antibody testing HIV screening Parvovirus antibody testing
C-HIV screening All pregnant women should be offered screening for asymptomatic bacteriuria, syphilis, rubella, and hepatitis B and human immunodeficiency virus infection early in pregnancy. Question: At which gestational age should Rhogram be administered to an Rh neg woman? Answer: 28 weeks.
Routine vaccination against which of the following organisms has significantly reduced the risk of bacterial meningitis among children? Borrelia burgdorferi Escherichia coli Haemophilus influenzae Listeria monocytogenes
C-Haemophilus influenzae Question: What are the 3 most common causes of meningitis in neonates? Answer: Group B streptococcus, Escherichia coli and Listeria
What are the components of the "female athlete triad"? Anemia, iron deficiency, menorrhagia Delayed puberty, ligamentous injuries, weight loss Low bone density, menstrual dysfunction, low energy availability menstrual dysfunction, hirsutism, ovarian cysts
C-Low bone density, menstrual dysfunction, low energy availability
A 34-year-old woman has been seen multiple times in the past several months for various pain-related complaints. On each occasion, no physical or laboratory findings were found to explain the symptoms. The patient is involved in a worker's compensation case and could make a significant amount of money if it is demonstrated that her physical complaints are related to work conditions. Which one of the following diagnoses characterizes her unexplained physical symptoms? Conversion disorder Factitious disorder imposed on self Malingering Somatic symptom and related disorders
C-Malingering Question: What is the disorder called which patients deliberately impose harm on self for the principal purpose of assuming the sick role? Answer: Factitious disorder (previously referred to as Munchausen syndrome).
Carbamazepine monitoring
Causes blood dyscrasias-CBC
Glial cells
Cells in the nervous system support, nourish, and protect neurons
CSF
Cerebrospinal fluid
CVA
Cerebrovascular accident
A 15-year-old girl presents to clinic for a well child check. During her Home and Environment, Education and Employment, Activities, Drugs, Sexuality, Suicide and Depression (HEADSS) exam, she admits to using marijuana on a weekly basis for the past six months. She also drinks alcohol to excess once every few weeks. She denies smoking tobacco or using any other illicit substances. Which of the following is the most accurate information to give this patient? Chronic marijuana use improves focus and performance In human studies, marijuana has shown teratogenicity Marijuana can cause dependence and withdrawal Tetrahydrocannabinol concentrations are lower in today's marijuana compared to prior decades
C-Marijuana can cause dependence and withdrawal Question: Which behavioral interventions are effective in treating marijuana dependence? Answer: Cognitive-behavioral therapy and motivational incentives.
Which of the following is true regarding attention deficit hyperactivity disorder? Characterized by speech delay, poor eye contact, and lack of stranger anxiety More prevalent in girls than boys Most frequently diagnosed behavioral disorder in children Symptoms most commonly begin in adolescence
C-Most frequently diagnosed behavioral disorder in children present in 2 areas of social interaction (home and school); must have been present prior to age 12 years; must have persisted for longer than 6 months; and must be maladaptive or inappropriate for the child's developmental stage.
The DSM-5 groups personality disorders into 3 categories: odd/eccentric, dramatic/erratic and anxious/fearful. Which of the following is the correct personality disorder and cluster? Avoidant personality disorder - odd/eccentric (cluster A) Borderline personality disorder - odd/eccentric (cluster A) Narcissistic personality disorder - dramatic/erratic (cluster B) Schizoid personality disorder - anxious/fearful (cluster C)
C-Narcissistic personality disorder - dramatic/erratic (cluster B) Question: Can psychotropic drugs be the mainstay of treatment for personality disorders? Answer: No, a treatment plan that focuses largely or exclusively on medications probably will not meet the needs of a patient with a personality disorder.
A 35-year-old man with a history of alcohol abuse presents to your office with complaints of a 3-day history of abdominal pain and vomiting after a night of binge drinking. He has not eaten in days. Laboratory values show an elevated anion gap, ketonemia and normal glucose levels. In addition to thiamine, what other treatment should be provided for this patient? Bicarbonate and insulin Glucagon and hydrocortisone Normal saline and glucose Pyridoxine
C-Normal saline and glucose alcoholic ketoacidosis, which is defined by the clinical triad of ketones in the blood or urine, an elevated anion gap and a normal glucose level. Treatment of includes vigorous volume repletion with normal saline, along with administration of thiamine and glucose Question: What is the clinical diagnostic triad for Wernicke encephalopathy? Answer: Memory impairment, gait disorders and oculomotor dysfuction.
An 82-year-old woman presents for evaluation of pain on her sacrum. The patient is alert and oriented to person, place, and time. Physical examination is notable for a stage II decubitus ulcer. Multiple bruises are noted on her legs as well. She acknowledges that she remains in bed most of the day and sometimes her son who is her caretaker forgets to give her meals or change her diaper. He also squeezes her legs hard when she does not move quickly enough. You are concerned about elder neglect and abuse. She does not wish to report her son or speak with social work. Which is your most appropriate action? Call the son to discuss the case Discharge the patient home Notify adult protective services Psychiatry consultation for capacity determination
C-Notify adult protective services Question: What other population is protected under the laws of elder abuse? Answer: Persons with disabilities, often referred to as dependent adults.
A 67-year-old woman presents to your office accompanied by her adult daughter with a complaint of anxiety. She says that she's always been a "worrier," but since the birth of her grandchild last year her anxiety has gotten worse. Further discussion reveals that she sleeps only 2-3 hours per night, has daily headaches, and her daughter complains that she calls their house at least 15 times every day asking about her grandchild's safety. Which of the following is the most appropriate therapy? Imipramine Lorazepam Paroxetine Quetiapine
C-Paroxetine First-line medications for Generalized anxiety disorder (GAD) include SSRI's or SNRI's, including paroxetine. Psychotherapy is also recommended in the treatment of GAD. If one SSRI does not have the desired effect, then a trial of a different SSRI is used prior to initiating a second-line medication.
Which of the following is included in the criteria of substance abuse? Great deal of time spent in activities to obtain, use, or recover substances Persistent desire or unsuccessful efforts to cut down or control use Persistent or recurrent social or interpersonal problems caused or exacerbated by substance Substance taken in larger amount or for longer period than intended
C-Persistent or recurrent social or interpersonal problems caused or exacerbated by substance One or more of the following must be seen in a 12-month period: continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance, recurrent substance related legal problems, recurrent use in physically hazardous situations, recurrent use resulting in failure to fulfill major role obligation at work, home, or school. Substance Abuse Use → impairment or distress Not dependent
A 19-year-old woman refuses to go to any park or playground because of an excessive fear and anxiety that she may see a dog. She has never been bitten or had a previous bad experience with a dog. Which of the following conditions is she most likely suffering from? Generalized anxiety disorder Panic disorder Phobia Post-traumatic stress disorder
C-Phobia Phobic Disorder Excessive/unreasonable fear interfering with normal function Provocation: specific feared object/situation exposure Leads to avoidance behavior Rx: cognitive behavioral therapy Question: What is the most common type of phobia? Answer: Social phobia is now known to be one of the most common psychiatric disorders in the general population with a 13.3% lifetime prevalence.
A 14-year-old boy exhibits chronic conflict with his parents and siblings and has been suspended from school on a number of occasions. Which of the following additional findings would suggest a diagnosis of conduct disorder rather than oppositional defiant disorder? Being spiteful or vindictive Often losing temper Physical cruelty to animals Refusal to comply with requests from authority figures
C-Physical cruelty to animals Question: True or false: Preschoolers may be diagnosed with conduct disorder? Answer: True.
Early majority adopters
Classification of Adoption: Often option leaders who social status frequently influences others to adopt the behavior
You examine a five-year-old girl for a routine child check. She likes to sing and dance. She knows her name and address. She is also able to draw a person with six body parts. She also eats fruits, vegetables, fish and meat. Physical examination is normal. Her mother has no concerns. The girl is excited for the coming break because the family is going to the beach. Which of the following is the correct statement regarding sun exposure? Sunburn is primarily due to UV-A exposure Sunscreen should be applied generously 5 minutes before going outdoors Sunscreen should not be used on infants < 6 months of age Use a broad-spectrum, water-resistant sunscreen product with a minimum SPF of 15
C-Sunscreen should not be used on infants < 6 months of age Sunburn is primarily due to UV-A exposure (A) is wrong because it is due to UV-B. Sunscreen should be applied generously 5 minutes before going outdoors (B) is not correct because sunscreen should be applied 15 minutes prior to sun exposure. Using a broad-spectrum, water-resistant sunscreen product with a minimum SPF of 15 (D) is false because minimum SPF should be 30.
Which of the following is a valid statement regarding a well-documented adverse effect causally related to a vaccine administration? -Inactivated influenza vaccine can cause clinical influenza -Measles vaccine is associated with autism -The oral polio vaccine causes paralytic disease in immune deficient individuals -Thimerasol, a preservative contained in most vaccines, is associated with mental retardation in infants receiving thimerasol-based vaccines
C-The oral polio vaccine causes paralytic disease in immune deficient individuals Oral polio vaccine is a live attenuated viral vaccine Question: List some common live-attenuated vaccines? Answer: Herpes zoster, Influenza, Mumps/Measles/Rubella, Rotavirus, Typhoid, Vaccinia (Small pox), Yellow fever.
You provide care to a middle-aged man with hypertension and diabetes. He recently lost his job, and you are concerned that he may be exhibiting mild symptoms of depression. According to the US Preventive Services Task Force, screening for depression is recommended if which of the following exists? A local suicide prevention hotline routinely handles calls from your surrounding area The patient has a strong social support of friends, family and coworkers There is a cognitive-behavior therapist that works in your clinic You have developed a detailed depression screening form
C-There is a cognitive-behavior therapist that works in your clinic The US Preventive Services Task Force recommends that adults should only be screened for depression when there is staff-assisted care and support available to make an accurate diagnosis, offer effective treatment and provide follow-up care
During an intake history, a patient describes her husband as a violent, angry man. You suspect domestic violence of a physical nature. You counsel the woman that serious injury or death most commonly occurs during which of the following situations? After an argument about financial issues After an argument about sex-life issues When she tries to leave the husband When the husband tries to apologize for his actions
C-When she tries to leave the husband assaults occur more commonly near the end of relationships. Up to 75% of domestic assaults occur during an attempt to report abuse or leave an abusive relationship.
Before administration of TCA check:
CBC, CMP EKG in anyone over 30 years of age
Late Adopters
Classification of Adoption: Those who need support and encouragement to make adoption as easy as possible
Anti Anxiety meds
Certain medications work solely to reduce the emotional and physical symptoms of anxiety. Benzodiazepines such as alprazolam (Xanax) can treat social phobia, generalized anxiety disorder and panic disorder. These medicines work quickly and are very effective in the short-term. However, people prone to substance abuse may become dependent on them. Increasing the dosage over time might be necessary because the body can become used to these medications and require larger doses for the same therapeutic effect. People who stop taking benzodiazepines suddenly may experience unpleasant withdrawal symptoms. Other potential side effects include:
20-70
Changing your lifestyle: It takes __________ days to make a new behavior a habit -This won't happen overnight *Steps to take:* -Take a look at your lifestyle -Change or improve your environment -Take time for you -Take small steps-improving one thing at a time.
Detachment
Characterized by distant interpersonal relationships and lack of emotional involvement.
Neurotransmitter
Chemical messenger that crosses the synaptic gap between neurons, binding to receptor sites on the dendrites of the recording neuron
Hormones
Chemical messengers that are made in the endocrine system, which travel through the bloodstream and affect other tissues
Hormones
Chemical messengers that are manufactured by the endocrine glands, travel through the bloodstream, and affect other tissues
While alcohol dependence overall has decreased, it is highest in 18-25 year olds and those who live in the
City
Early adopters
Classification of Adoption: Those who seek to experiment with innovative ideas
Describe how Autism is diagnosed
Clinical practice guidelines, checklist for Autism in Toddlers or Modified Checklist for Autism in Toddlers, Autism diagnosic interview, communication ans Symbolic Behavior Scales Developmental Profile, Screening Tool for Autism in Two Year Olds, Autism Diagnostic Observation Schedule, screening Tool for Autism in Two Year olds, Childhood Autism Rating Scale, Dev. Checklist early screen.
Cultural ______ are increasingly used as a vehicle to foster improvements in community health
Coalition
Model
Combination of ideas and concepts taken from multiple theories and applied to specific problems in particular settings
Insight
Conscious recognition of one's own condition. In psychiatry, it refers to the conscious awareness and understanding of one's own psychodynamics and symptoms of maladaptive behavior; highly important in effecting changes in personality and behavior of a person (i.e. A 25 year old man was seen in the ED stating he was controlled by a computer on an Enterprise-like starship, similar to the one on Star Trek. He was convinced all of his thoughts, actions, and feelings were being programmed onboard the starship, which was located light-years away and, therefore, could never be detected by anyone else.)
emotional wellness
Coping effectively with life and creating satisfying relationships
Cigarette use is more common in the city or the country?
Country
Body Dysmorphic Disorder
Criteria: Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. At some point during the course of the disorder the individual has performed repetitive behaviors (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g. comparing his/her appearance with that of others) in response to the appearance concerns. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. BDD is a somatic expression of OCD. Co-exists with other depressive disorders. 90% MDD, 70% anxiety disorder, 30% psychotic episode, most common concerns are facial features. Men need to increase muscle mass. Patient may seek multiple plastic surgeries, fear of humiliation due to imagined defect may keep patient housebound (up to 33%), spends hours per day looking in mirror. Course and prognosis: long course, consists of frequent ups and downs, few times when patient is symptom free. Treatment: surgery to correct defect contraindicated. Meds: SSRI, effective in 50% of patients.
examples of serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
Cymbalta & Effexor
Augmentation of antidepressant
Cytomel T3 Lithium Bupropion Buspar 2nd gen antipsychotic
You are counseling a mother about the potential side effects of vaccines. Which of the following is a potential side effect of the diphtheria, tetanus and acellular pertussis (DTaP) vaccine? Immune thrombocytopenia purpura Intussusception Parotid swelling Whole limb swelling
D-Whole limb swelling The DTaP vaccine has a 1 in 30 risk of causing entire limb swelling, redness and pain. Question: Why is the MMR-Varicella combined vaccine given to 4-year-olds and not 1-year-olds? Answer: The risk of febrile seizures increases from 1 in 3,000 in 4-year-olds to 1 in 1,250 in 1-year-old children.
A wife is upset about how her husband has behaved after receiving a new diagnosis of terminal lung cancer. He has spent the last few days on the internet feverishly looking up his old girlfriends in an attempt to find phone numbers and call them. He has only slept a few hours in this time period, and has eaten only pretzels and soda. When the wife is finally able to get his attention, she asked him what he was doing, to which he responded "I feel great, so I thought I'd catch up with some old friends." He does not meet diagnostic criteria for a manic episode, and has no history of bipolar disorder. You suspect he may be in which stage of the Kubler-Ross grief reaction? Anger Bargaining Catastrophizing Denial
D-Denial Grief Reaction Stages: denial, anger, bargaining, depression, acceptance Nonpathologic symptoms: guilt, weight loss, simple hallucinations Pathologic symptoms: >12 months, severe functional impairment, suicidal ideation, psychotic symptoms
A 54-year-old man with chronic alcohol abuse presents with confusion and visual hallucinations. Vital signs are HR 113, BP 164/95, finger stick blood glucose 113, and T 100.5°F. Physical examination reveals a disheveled man with tremors, tongue fasciculations, and agitation. What management should be pursued? Admission to psychiatry for management Cyproheptadine Dantrolene Diazepam
D-Diazepam Ethanol Withdrawal: Autonomic hyperactivity (↑ HR, ↑ BP, diaphoresis) Visual, tactile hallucinations Seizures Delirium tremens: autonomic hyperactivity, psychosis, peaks 2-5 days after cessation Tremulousness → hallucinations → seizures → delirium tremens Rx: BZDs
A 29-year-old woman presents to her annual visit for routine screening and diagnostic tests. She is up to date on her Papanicolaou test and her vaccines. She has no significant medical or family history and has been married to her husband for 8 years. Which one of the following supplementations should be advised for this patient? Aspirin for coronary artery disease prevention Aspirin for stroke prevention Calcium Folic acid
D-Folic acid all women planning or capable of pregnancy should take a daily supplement containing 0.4-0.8 mg of folic acid.
A 45-year-old man presents after swallowing a pen. A review of his previous visits shows two prior evaluations for the same thing. He reports this is because of post-traumatic stress disorder. An X-ray confirms the presence of a pen in the esophagus. What is his most likely diagnosis? Borderline personality disorder Drug-seeking behavior Malingering Munchausen syndrome
D-Munchausen syndrome Munchausen syndrome is a form of factitious disorder in which patients feign illness for some sort of personal gain.
A 30-year-old woman presents to her family physician for her annual exam. Her last Papanicolaou test with HPV co-testing was 4 years ago. She has 2 children and underwent a bilateral tubal ligation with her last cesarean section. She does not smoke or have any significant past medical history. Her mother died of breast cancer at age 45. Her aunt was treated with chemotherapy and surgery for ovarian cancer. Which of the following prevention measures or diagnostic studies should this patient initially undergo? BRCA screening Genetic counseling National Cancer Institute Breast Cancer Risk Assessment Tool Ontario Family History Assessment Tool
D-Ontario Family History Assessment Tool Question: Which medications are considered risk-reducing medications for women who are at an increased risk of breast cancer? Answer: Tamoxifen & raloxifene. Inclusion criteria: Women who are asymptomatic, > 35 years old, and who are at increased risk of breast cancer, negative history for DVT and low risk for adverse medication side effects.
The parents of a 7-year-old boy ask you to evaluate him because of increasing concerns about his temper tantrums over the past 9 months. He becomes angry and hostile, argues constantly, and refuses to follow rules or directions. The boy often becomes aggressive and destructive, breaking his toys and sweeping his dinner plate and glass of milk onto the floor. The parents believe that their son is deliberately behaving this way to annoy them. This history is most consistent with which one of the following? Antisocial personality disorder Bipolar disorder Conduct disorder Oppositional defiant disorder
D-Oppositional defiant disorder a pattern of negative, hostile, and defiant behavior lasting at least 6 months Question: Antisocial personality disorder is part of which cluster group? Answer: Cluster B.
An 18-year-old woman complains of heart palpitations, diaphoresis, nausea, shaking of her whole body along with a choking sensation. These symptoms have occurred 3-4 times per week for the last 2 weeks. She states that the symptoms are most common shortly before going to bed and begin suddenly peaking in 10 minutes and eventually spontaneously resolving. These symptoms are accompanied with the intense fear that she is going to die. Which of the following is the most likely diagnosis? Angina Bipolar disorder Generalized anxiety disorder Panic attack
D-Panic attack Panic attacks are discrete periods of intense fear in the absence of real danger, accompanied by at least 4 of 13 cognitive and physical symptoms. The attacks have a sudden onset, build to a peak quickly, and are often accompanied by feelings of doom
A 23-year-old woman presents to her primary care physician for a routine annual visit. Her last Papanicolaou test was four years ago. She is a current smoker and is sexually active. Her mother was diagnosed with ovarian cancer at age 50. Which of the following should be offered to the patient? Mammography Meningococcal vaccine Ovarian ultrasound Papanicolaou test
D-Papanicolaou test Papanicolaou test is recommended for all women aged 21 years or older, at least every three years. Question: What is the recommended age for the administration of the Human Papillomavirus Virus (HPV) vaccine? Answer: The Human Papillomavirus vaccine is recommended to all males and females aged 9-26 years.
A 56-year-old widow comes to the physician at the request of her daughter. The patient's husband passed away unexpectedly 14 months ago from a heart attack. She tells you that she has been having a very difficult time since her husband's death. She hasn't been sleeping well because she can't get used to sleeping alone. She no longer enjoys going over to her daughter's house and finds interacting with her grandchildren too tiresome. She says she keeps thinking about the day her husband died and feels guilty about not being able to get him to the hospital sooner. She denies any plans to hurt herself, but does say she wonders if she'd be better off if she could join her husband. Which of the following diagnoses is most appropriate? Acute stress disorder Major depressive disorder Normal grief Persistent complex bereavement disorder
D-Persistent complex bereavement disorder Not only do symptoms persist beyond 12 months, but they are generally severe in nature and interfere with daily functioning. Also called complicated grief disorder
Which of the following distinguishes conduct disorder from oppositional defiant disorder? Angry and resentful Argues with adults Deliberately trying to annoy someone Physical aggression towards others
D-Physical aggression towards others Conduct disorder is characterized by a persistent pattern of serious rule-violating behavior, including behaviors that harm (or have the potential to harm) others. The patient with conduct disorder typically shows little concern for the rights or needs of others. Question: What is the primary evidence-based treatment for youths with conduct disorder? Answer: Social competence training, parent and family skills training, medications, academic engagement and skills building, and school interventions.
A previously healthy 10-year-old girl presents to your office with a complaint of repetitive, intermittent shoulder shrugging that began one year ago. She says that she can sense when the movement is going to occur, then feels relief after doing it. Her mother says that her daughter is becoming more socially withdrawn because she is embarrassed about these movements. She denies any other complaints. Which of the following is the most appropriate therapy? Clonidine Fluoxetine Methylphenidate Pimozide
D-Pimozide Tourette syndrome presents generally before age 11. Clinical manifestations of TS include motor or vocal tics. Tics may be treated with antidopaminergic medications such as pimozide Question: True or false: most tics in patients with Tourette syndrome resolve by age 18? Answer: True.
A 55-year-old man with COPD presents to his primary care physician. He has a 20 pack-year smoking history and requests a prescription for smoking cessation. His last colonoscopy was five years ago and he received the influenza vaccine earlier this year. Which of the following should also be offered to the patient? Abdominal aortic ultrasound Colonoscopy Influenza vaccine Pneumococcal vaccine
D-Pneumococcal vaccine Pneumococcal vaccine is recommended for all adults aged 65 or older. Patients aged 2 years or older who are immunocompromised or who have chronic diseases should also receive the pneumococcal vaccine
A 16-year-old girl presents to the ED via ambulance for general pain. She is a refugee from a conflict area who is known to have frequent nighttime visits to the ED over the past year for the same chief complaint. She's undergone multiple medical workups that have all been negative. In the ED she appears angry, irritable, and demonstrates hypervigilance. After a brief conversation with the patient her pain resolves and she feels much better. Which of the following is the most likely diagnosis? Adjustment disorder Borderline personality disorder Malingering Posttraumatic stress disorder
D-Posttraumatic stress disorder Posttraumatic stress disorder (PTSD) is a long-lasting anxiety response following a traumatic or catastrophic event. patients having difficulty falling or staying asleep, problems with concentration, hypervigilance, irritability, angry outbursts, and increased startle response.
Which of the following is considered a negative symptom of schizophrenia? Delusions Disorganized speech Hallucinations Poverty of speech
D-Poverty of speech Negative symptoms in schizophrenia include alogia or poverty of speech, avolition or lack of purposeful action and affective flattening or decreased emotional reactivity Positive symptoms may include: delusions (A), disorganized speech (B), hallucinations (C),
Which of the following risk factors is the strongest predictor of suicide? Access to firearms History of depression Male sex Prior history of suicide attempts
D-Prior history of suicide attempts
A 16-year-old boy is in clinic for a routine health check. He is doing well in school and has plans to join the military when he reaches 18 years of age. He practices and plays basketball about 60 minutes per day. He denies smoking and drug use. Physical examination is normal. At this visit you recommend meningococcal vaccine booster. Which of the following is the best statement regarding meningococcal infection? -Chemoprophylaxis can be administered 2 weeks after exposure to the index case -Droplet precaution is not necessary for patients infected with meningococcal meningitis -Nasopharyngeal cultures are needed in determining the need for chemoprophylaxis -Prophylaxis is indicated in close contacts of patients with meningococcal infection
D-Prophylaxis is indicated in close contacts of patients with meningococcal infection and should be given as early as possible following the exposure Question: Children who have been treated for bacterial meningitis should undergo which kind of evaluation? Answer: Hearing test.
A 30-year-old woman presents to your office requesting medication to help her quit smoking. Which of the following is a contraindication to prescribing bupropion? Cardiovascular disease Chronic obstructive pulmonary disease Depression Seizure disorder
D-Seizure disorder Bupropion decreases the seizure threshold and is therefore contraindicated in patients with seizure disorder Question: Which smoking cessation medication is recommended for patients who are concerned about post-cessation weight gain? Answer: Bupropion.
A 21-year old woman sees you because of a depressed mood since the birth of her son 2 months ago. She is breastfeeding, and her baby is doing well. She denies any suicidal or homicidal ideation and has never had thoughts about hurting the baby. She has a history of depression 2 years ago that was associated with starting college. She began taking sertraline, changed her schedule, and spent more time exercising. Within 6 months her depression resolved and she stopped the medication. She reports this current depression feels worse than her previous depression. Which one of the following would be the most appropriate medication for this patient? Amitriptyline Diazepam Phenytoin Sertraline
D-Sertraline Selective serotonin reuptake inhibitors such as sertraline are the most commonly used medications for postpartum depression. They have fewer side effects and are considered safer than tricyclic antidepressants, especially in depressed women. In one study, infant serum levels of sertraline and paroxetine were undetectable.
A two-month-old boy is in clinic for a well child exam. He has been exclusively breastfeeding and has been gaining weight appropriately. He has been staying asleep longer for four to five hours. His stools are soft. He is also less fussy. His length is at the 90th percentile and weight is at the 85th percentile. Physical examination is normal. He is due for his vaccinations and the mother gives her consent. Which of the following is the best statement regarding the rotavirus vaccine? Dietary restriction is needed before or after rotavirus vaccine is administered Rotavirus vaccines are administered intramuscularly Rotavirus vaccines cannot be given at the same visit as the other routine immunizations Vaccine doses that are regurgitated, spit out, or vomited do not need to be repeated
D-Vaccine doses that are regurgitated, spit out, or vomited do not need to be repeated Question: Is the rotavirus vaccine contraindicated for an infant with history of intussusception? Answer: Yes.
A mother brings her 12-month-old daughter for routine vaccinations. She is up to date with her vaccinations. The girl has a history of a simple febrile seizure at 10 months of age and has a history of respiratory distress after eating eggs. She lives with her parents and her paternal grandmother who is currently undergoing chemotherapy for breast cancer. Because of anxiety of her daughter getting a fever and a febrile seizure, the patient's mother would like to spread out her vaccines. Today she would like her daughter to get the varicella vaccine. She would like to bring the patient back to the office in 2 weeks to get her measles-mumps-rubella (MMR) vaccine but you explain this is contraindicated. Why can the patient not get the MMR vaccine then? Her risk of vaccine-induced seizure She has an anaphylactic egg allergy She is living with an immunosuppressed family member She must wait 4 weeks between live vaccines
D-She must wait 4 weeks between live vaccines Live vaccines include the varicella vaccine, the MMR vaccine, the intranasal influenza vaccine, the rotavirus vaccine, the yellow fever vaccine, the BCG vaccine, the typhoid vaccine, the rabies vaccine, and the oral polio vaccine. Live vaccines must replicate to cause an immune response. Antibodies developed after the first live vaccine can interfere with viral replication of the subsequent vaccine if live vaccines are given apart are given too close together. Question: What are contraindications to getting rotavirus? Answer: History of intussusception, weakened immune system, or life-threatening reactions to prior doses of the vaccine.
Which of the following conditions should prompt administration of the meningococcal vaccine prior to the standard 11 years of age? Cystic fibrosis Diabetes mellitus Hypoplastic left heart Sickle cell anemia
D-Sickle cell anemia Children with sickle cell anemia (D) who no longer have a functional spleen should receive the meningococcal vaccine. Patients with sickle cell anemia are at high risk of developing functional or anatomical asplenia due to splenic infarction from vascular occlusion by defective red blood cells. Autosplenectomy dramatically increases the risk of serious infections from encapsulated organisms including Neisseria meningitides, Streptococcus pneumoniae and Haemophilus influenzae.
A 27-year-old woman presents to your office with complaints of pain and discomfort. She tells you that she has seen numerous doctors and none of them have been able to help her. Her symptoms today include nausea, gluten sensitivity, irregular menses, weakness in her legs, headache, dysuria, dyspareunia, and back pain. She would like you to do a CT scan to determine the cause of her complaints. Which of the following is the most likely diagnosis? Chronic pain syndrome Factitious disorder Munchausen's syndrome Somatization disorder
D-Somatization disorder Somatoform Disorders Genuine sx with no identifiable cause F > M Conversion disorder: sudden loss of sensory or motor function Hypochondriasis: Preoccupation with having illness Pain disorder Somatization disorder: many complaints in ≥ 1 organ systems Rx: Reassurance, minimize providers
A 28-year-old man presents to the emergency department by ambulance. His family called for help after finding him unresponsive at home with a syringe on the floor beside him. His blood pressure is 120/78 mm Hg, pulse 95/min, and respirations are 6/min and shallow. On physical exam he is non-responsive to questions, his skin is cool with cyanosis, and his pupils are minimally reactive to light and constricted. Which of the following is the most appropriate next step in management? Administer naloxone Administer sodium bicarbonate Place a nasogastric tube and administer activated charcoal Support airway and breathing
D-Support airway and breathing ABC's Question: What medication is commonly used for maintenance therapy for opiate use disorder? Answer: Methadone.
A 23-year-old man with a history of opiate abuse presents with tachycardia, hypertension and mydriasis. Which of the following is true regarding management? Antiemetics should be witheld as they may cause serious side effects Consider ICU admission for the potential for symptoms to worsen Naloxone should be given Symptom control may be achieved with clonidine
D-Symptom control may be achieved with clonidine This patient presents with opiate withdrawal and management should focus on the relief of symptoms.Opiate withdrawal is not life-threatening. Supportive and symptomatic care can decrease the patient's discomfort. Clonidine has been used to mitigate symptoms as have antiemetics. Question: What is the duration of action for naloxone? Answer: Naloxone will reverse opiate effects for 1-2 hours.
Which of the following vaccines does the Centers for Disease Control and Prevention consider safe for administration during pregnancy? HPV (human papillomavirus) LAIV (live, attenuated influenza vaccine) MMR (measles, mumps, rubella) Tdap (tetanus, diphtheria, pertussis)
D-Tdap (tetanus, diphtheria, pertussis) and the vaccine is considered safe at any point in pregnancy. Question: True or False: Varicella vaccination is contraindicated in pregnancy? Answer: True.
A 58-year old postmenopausal woman presents with painless vaginal bleeding. Her last menses occurred 5 years ago. She reports that her Papanikolaou smears have always been normal; the last one was obtained a year ago. Which of the following is the next step in management? Colposcopy with endocervical curettage Hysteroscopy Repeat Papanikolaou smear Transvaginal ultrasound
D-Transvaginal ultrasound An endometrial thickness less than 3-4 mm excludes most endometrial pathology in women with postmenopausal vaginal bleeding. A transvaginal ultrasound can identify other causes of vaginal bleeding such as polyps and fibroids Question: What is the most common type of endometrial carcinoma? Answer: Adenocarcinoma.
A nine-month-old girl is seen in clinic for a routine child visit. She is able to pull to stand, plays peek-a-boo, copies sounds and gestures of others, and clingy with parents. She eats cereal and table food. You discuss car seat safety with her parents. Which of the following is the best advice would you give her parents? Front seat is much safer than the rear seat for children Frontal airbags appear to offer good protection to children in crashes Side airbags do not pose a risk for children who are in the front seat Use of child restraint devices can be expected to reduce fatalities by 71%
D-Use of child restraint devices can be expected to reduce fatalities by 71% Question: What type of injury is most commonly involved in bicycle accidents? Answer: Head trauma
A patient with schizophrenia is starting treatment with clozapine. Which of the following needs to be monitored weekly? Electrocardiogram Fasting plasma glucose Hemoglobin and hematocrit White blood cell and absolute neutrophil count
D-White blood cell and absolute neutrophil count clozapine involves a risk of life-threatening agranulocytosis, therefore regular monitoring of white blood cell and absolute neutrophil count (ANC) is required
Primary Visual Cortex
Responsible for seeing objects and or light. part of the neocortex
A 60-year-old man who has a 20-pack-year smoking history presents to his pulmonologist for an evaluation of his COPD. He recently quit smoking 5 years ago and underwent a colonoscopy 8 years ago. He received his pneumococcal vaccine four years ago and his influenza vaccine this year. Which of the following should be offered to this patient? A second dose of the pneumococcal vaccine Annual screening for lung cancer with low-dose computed tomography scan Tuberculin skin testing Zoster vaccine
D-Zoster vaccine A single dose of the zoster vaccine is recommended for adults aged 60 regardless of whether they report a previous episode of herpes zoster. What is the first-line treatment for an immunocompetent adult with Herpes zoster? Answer: Famciclovir or Valacyclovir.
A 65-year-old woman with Crohn's disease that is well controlled on infliximab presents to her primary care physician. As you are updating her immunization status, which one of the following should be noted? Hepatitis A vaccine is contraindicated Pneumococcal vaccine is contraindicated Tetanus toxoid is contraindicated Zoster vaccine is contraindicated
D-Zoster vaccine is contraindicated The varicella zoster vaccine is a live attenuated vaccine and therefore is contraindicated in this patient due to her immunocompromised state. Bonus Question: What is the antibody associated with Crohn's disease? Answer: ASCA is present in 60-70% of patients with Crohn's disease.
prevention
Data have shown that early intervention following the first episode of a serious mental illness can make an impact. Coordinated, specialized services offered during or shortly after the first episode of psychosis are effective for improving clinical and functional outcomes.
American Indians / Alaska Natives
Death rates are twice as high amount who in motor vehicle crashes
In the past year, has nonmedical use of pain relievers increased or decreased for males and females?
Decreased
The percent of binge drinking adolescents has increased or decreased to 6% from 2008-2013
Decreased
Did marajuana use increase between 2012 and 2013 in adolescents 12-17?
Decreased, but still above desired 6%
Personality
Deeply ingrained personal patterns of behavior, traits, and thoughts that evolve, both consciously and unconsciously, as a person's style and way of adapting to the enviornment
Denial
Defense mechanism in which the existence of unpleasant realities is disavowed; refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety
Persuasion
Deliberate efforts to change attitudes.
the branches that extend from the nerve cell body. These receive messages and conduct impulses towards the body
Dendrite
Defense mechanisms for neurocognitive disorders
Denial, confabulation, perservation, avoidance of questions
includes symptoms like feeling worthless or hopeless, having difficulty sleeping, lacking energy, or suicidal thoughts; most common mental illness
Depression
Indications for SSRIs:
Depression Panic disorder Generalized anxiety disorder
Main indications for SSRIs
Depression Panic disorder Generalized anxiety disorder
Indications for Buproprion (Wellbutrin)
Depression Smoking cessation
SNRIs indicated for
Depression Generalized anxiety disorder (GAD)
Epidemiological Assessment
Determine which health problems are most important for which groups in the community through analytics / stats
Aaron T Beck
Developed a negative cognitive bias - consistently distorting their experiences in a negative way.
social wellness
Developing a sense of connection, belonging, and a well-developed support system
Serious mental illness
Diagnosable disorder that is different from substance abuse and can impair function
Any mental illness
Diagnosable mental health, emotional, or behavioral disorder
Conversion Disorder
Diagnostic criteria: one or more symptoms of altered voluntary motor or sensory function, clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. The symptom or deficit is not better explained by another medical or mental disorder, the symptom or deficit causes clinically significant distress or impairment in social, occupational or other important areas of functioning or warrants medical evaluation. Most commonly found in: rural populations, lower IQ, less educated, lower socioeconomic groups, military with combat experience. Co-morbidity: major depressive disorder, anxiety disorder, schizophrenia. Etiology: may follow acute trauma (most common), repression of unconscious intra-psychic conflict, conversion of anxiety into physical symptom. Examples: symptom allows patient to consciously avoid confronting the problem, vaginismus-unable to have sexual intercourse; rape in personal history, blindness-patient observed traumatic experience. Mimics dysfunction in voluntary or sensory systems: blindness, deafness, mutism most common, paralysis and anesthesia (sensory are also common). Motor involvement- abnormal movements, gait abnormalities, weakness, paralysis. Exam doesn't correlate- deep tendon reflexes present in paralyzed patient. Primary gain: blindness prevents dealing with trauma. Secondary gain: patient benefits from illness. La belle indifference: lack of appropriate concern for severe symptoms. Identification: patient may take on characteristics of person important to them (patient may exhibit s/s of deceased parent). Differential Diagnosis: must r/o medical disorder, up to 25-50% of patients diagnosed with conversion disorders later have a medical dx of neurological disease, if s/s disappear with suggestion, hypnosis, amobarbital (Amytal) or lorazepam (Ativan) = conversion disorder. Conversion Disorder= 1 s/s which violates laws of H&P. Somatic Symptom Disorder=multiple s/s. Can recur 20-25% recur within 1 year of first episode, need to make sure true disease is not overlooked. Failure to consider conversion disorder as dx can lead to continued treatment=permanent invalid. Usually patient will have spontaneous resolution best with good rapport with therapist. Meds: benzodiazepines for anxiety and antidepressants. Psychological: insight therapy and behavior therapy.
lifespan consideration for children associated with depression
Difficult to determine prevalence reports vary b/n 5% to 11% because of reluctance of clinicians to diagnose children and lack of qualified providers in some community. whininess, and aberrant play themes
Dysarthria
Difficulty in articulation, the motor activity of shaping phonated sounds into speech, not in word finding or in grammar.
Impaired Judgement
Diminished ability to understand a situation correctly and to appropriately.
Racism
Discrimination against people based on their skin color or ethnic heritage.
Colorectal cancer screening
Disparities exist based on education and income level As education and income increase screening increases What type of screening is being mentioned?
Circumstantiality
Disturbance in the associative thought and speech process in which a patient digresses into unnecessary detail and inappropriate thoughts before communicating the central idea. Seen in schizophrenia, obsessional disturbances, and certain cases of dementia (i.e. when asked about a bruise on her arm, the patient recounts everything else that happened that some day before explaining how she was injured)
State agencies
Division of Behavioral health development disabilities (DBHDD) -24/7 call center
Apathy
Dulled emotional tone associated with detachment or indifference; observed in certain types of schizophrenia and depression.
S/E Venlafaxine (Effexor)
Dyslipidemia HTN anxiety Sexual dysfunction
Treatment of choice in psychotic depression
ECT
31 Pairs
How many spinal nerves exit the spinal curve?
examples of Tricyclic/Tetracyclic Antidepressants (TCAs)
Elavil & Pamelor
EEG
Electroencephalogram
eight dimensions of wellness
Emotional, environmental, financial, intellectual, occupational, physical, social, spiritual
personality disorder
Enduring pattern of experience and behavior that deviates significantly from the expectations of within the individual culture.
Traits
Enduring personal qualities or attributes that influence behavior across situations.
Factitious Disorder (Munchausen Syndrome)
Falsification of physical or psychological signs of symptoms or induction of injury or disease, associated with identified deception. The individual presents him/herself to others as ill, impaired, or injured. The deceptive behavior is evident even in the absence of obvious external rewards. The behavior is not better explained by another mental disorder. May be inflicted on self OR another (child is common). Clinical Findings: may present with nausea, vomiting, or pain. Patient may take poison in small amounts to give s/s. Put blood in feces or urine, artificially elevate temperature. Multiple hospital admissions, surgeries (look for multiple abdominal scars), Munchausen by proxy: mother induces illness or lies about symptoms, rare occurrence.
Most people who used pain-relievers for non-medical reasons got the from who?
Family or friends
Generalized Anxiety Disorder (GAD)
Epidemiology: 3-8% of population, women:men 2:1, seen in primary care>psychiatry. Diagnostic Criteria: persistent fear, worry, or tension in the absence of panic attacks for at least 6 months. Worry out of proportion to the impact of the feared event, typically revolve around routine life circumstances, occurs frequently with mood disorders (e.g. major depression). Person finds it difficult to control the worry. Need 3 or more of the following: restlessness OR feeling on edge, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbances (falling or staying asleep). Anxiety, worry cause significant distress/impairment in social, occupational, or other important areas. Disturbance not due to substance abuse or general medical condition. Disturbance is not explained better by another mental disorder. Treatment: variable response to therapy and medication. Psychotherapy is useful. Anxiolytic: benzodiazepines +SSRI, buspirone (BuSpar), venlafaxine (Effexor). Prognosis: chronic for most patients, usually treated in primary care setting.
clinical manifestations of Psychostimulantse, cocain and amphetamines abuse
Euphoria Lung damage Atrophy of the nasal mucosa Perforation of the nasal septum Necrosis of the nasal septum High risk of overdose,- agitation, tremor, blurred, vision; severe, convulsions, anxiety, hyperpyrexia)
clinical manifestations of Opiates, morphine, meperidine, codeine abuse
Euphoria Respiratory depression Nausea
Hypervigilance
Excessive attention to, and focus on, all internal and external stimuli: usually seen in delusional or paranoid states.
Aerophagia
Excessive swallowing of air. Seen in anxiety disorder.
Obsessive compulsive disorder (OCD)
Excessive thoughts (obsessions) that lead to repetitive behaviors (compulsions)
spiritual wellness
Expanding a sense of purpose and meaning in life
Panic Attack
Experience of intense fear.
Wisdom
Expertise in the fundamental pragmatics of life.
Social Anxiety
Fear of being judged by others and being around a large amount of people.
Acute Stress Disorder
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: directly experiencing traumatic event (s), witnessing in person the event as it occurs to others, learning that the event(s) occurred to a close family member or friend, experiencing repeated or extreme exposure to aversive details of the traumatic event (first responders). Presence of 9 or more of the following symptoms form any of the five categories of intrusion, negative mood, disassociation, avoidance, or arousal, beginning or worsening after the traumatic event (s) occurred: Intrusion symptoms: 1. recurrent, involuntary, and intrusive distressing memories of the event. 2. recurrent distressing dreams in which the content and/or affect of the dream are related to the event 3. dissociative reaction (e.g. flashbacks) in which the individual feels or acts as if the event were recurring 4. intense or prolonged psychological distress or marked psychological reactions in response to internal or external cues that symbolize or resemble an aspect of the event(s). Negative Mood symptoms: 5. persistent inability to experience positive emotions (happiness, satisfaction, or loving feelings) Dissociative symptoms: 6. an altered sense of reality of one's surroundings or oneself 7. Inability to remember an important aspect of the event (s) (dissociative amnesia) Avoidance Symptoms: 8. efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the event 9. efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with event(s). Arousal Symptoms: 10. sleep disturbances (difficulty falling or staying asleep, restless sleep 11. irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects 12. hypervigilance 13. problems with concentration 14. exaggerated startle response Duration of symptoms (in criterion B) is 3 days to one month (note: symptoms typically begin immediately after the trauma, but the persistence for at least 3 days and up to a month is needed to meet the disorder criteria)
Axon
Extension of the neuron that has fibers on the end that passes information to other neurons or muscles
avoidant personality disorder
Extreme sensitivity to rejection and excessively anxious in social situations. They feel awkward/uncomfortable in social situations. Agree to do things and then back out at the last minute. Refuse to enter into personal relationships because of fear of humiliation and rejection
SENSATION
FEELING SEEING HEARING WITH CENTRAL
True or false: adults 18-25 have a higher treatment rate for alcohol dependence than 12-17 year olds
False
True or false: the % of adults who thought about suicide was higher in those with health insurance and were above the poverty line?
False
Bizarre Delusion
False belief that is patently absurd or fantastic (e.g. invaders from space have implanted electrodes in a persons' brain). Common in schizophrenia.
Hallucinations
False sensory perception occuring in the absence of any relevant external stimulation of the sensory modality involved. (i.e. the patient complains of an overwhelming chemical smell in and around his room; no one else smells it, although he insists it's still there and says he fells faint)
4F
Feeding, Fleeing, Fighting, and Fornication.
Among the adolescents who reported having a major depressive episode, a higher percentage of which gender were treated?
Females
clinical manifestations of Hallucinogens (psychedelics) abuse
Flashbacks Uninhibited sexual responses in women
SSRI's approved for PEDS
Fluoxetine Escitalopram
antidepressant med least likely to cause discontinuation syndrome (d/t long half-life)
Fluoxetine (Prozac)
Family Therapy
Focused on improving relationships within family structure. Therapist trained for family therapy. Uses interview technique. Sessions held weekly 1-2 hours/session
Interpersonal Therapy
Focuses on patients relationships with others with goals of improving the person's interpersonal skills often treats depression therapists teach patients statefies for understanding and interacting positivity with others
what supplements should be used in depression
Folic acid b12
Early signs and symptoms of neurocognitive disorders
Forgets an item, doesn't recognize people, loses ability to express self, doesn't know the day, is not aware of important events, seriously impaired memory of recent past, difficulty learning, and easily lost in familiar places.
risk factors and prevention strategies for ADHD
Genetic, environmental, poor child care during infancy, parental alcohol consumption by the mother, exposure to lead or other heavy metals.
risk factors for depression
Genetic, neurobiology
Suicide rate
From 1999 to 2010, the suicide rate among American ages 35 to 64 increased nearly 30 percent. The largest increases were among men in their fifties, with rates rising nearly 50 percent, to 30 per 100,000
Disorders that have no known brain injury
Functional
KAVA ade
GI upset, HA, dizziness, drowsiness, dry mouth, extrapyradmidal side effects
St. johns ADE
GI upset, constipation, fatigue, DRY MOUTH, restlessness, sex dysfunction
overcoming or managing ones disease, making healthy choices that support physical and emotional well-being
Health
Norepinephrine
Helps control alertness and arousal
physical basis
Hermann von Helmholtz studies of nerve signaling provided evidence that the mind had a
pathophysiology and etiology of Attention-Deficit/Hyperactivity Disorder (ADHD
Heterogeneous, nonprogressive, neurological condition. biological and environmental factors such as genetics 60 to 90, perinatal complications, neurological illness allergies, toxic are correlated. dysregulation of dopamine and norepinephrine, less blood flow and decreased electrical activity in children. perinatal complications.
NOT associated with the use of inappropriate compensatory behavior such as purging or excessive exercise.
How does binge eating disorder differ from anorexia nervosa and bulimia nervosa?
MAOI - Adverse Effects
Hypertensive crisis can develop when MAOI's are taken with tyramine-rich foods (cheeses, beer, mets, sourdough bread, dried fruits, tofu) & caffeine
Administrative & Policy Assessment
ID policies, resources, and circumstances that may help or hinder implementation of the intervention
Behavioral & Environmental Assessment
ID risk factors internal / external to individual that contributes to health issue of interest Literature searches & theory application provide guidance
Referential Thinking
Ideas of reference, or the feeling that casual incidents and events have an unusual or particular meaning specific to the person.
prevetnion
If communities and families can intervene early, behavioral health disorders might be prevented, or symptoms can be mitigated.
Organic
Illness caused by a specific agent producing structural changes in the brain; usually associated with cognitive impairment, delirium, or dementia (Not used in DSM-V)
major risk factor for undiagnosed or untreated depression
Impairment in daily function, dysfunction of he nervous system, affect ANS functioning, anemia, arthritis, asthma, back pain, diabetes, eczema, peptic ulcer, kidney and lung disease.
clinical manifestations of Autism
Impairments of social interaction, communication, ability to adapt to new situation, attention span and ability to organize responses to situations, obsessive behavior. speech pattern shows abnormalities; using you in place of I, engaging in echolalia, repeating questions, fascinated with rhythmic, repetitive songs and verses, difficulty dealing with new situations.
borderline personality disorder
Impulsive, unpredictable mood and self-image, resulting in unstable relationships. Pattern of intense and chaotic relationships. Self-destructive behavior - multiple suicide attempts and self-mutilation.
Variable
In an experimental setting, a factor that varies in amount and kind.
major depressive disorder (MDD)
In order to be diagnosed with ____________ at least 5 symptoms and one must be depressed mood or anhedonia (lack of interest in activities that previously provided pleasure)
Word Salad
Incoherent, essentially incomprehensible mixture of words and phrases commonly seen in far advanced cases of schizophrenia (i.e. it was shockingly not of the best quality I have known all such evildoers coming out of doors with the best of intentions!)
Did the amount of Americans enrolled in a substance abuse treatment increase or decrease?
Increase
clinical manifestations of Cannabis(source of marijuana)abuse
Increase in heart rate, Bronchodilator ,Airway constriction, Airway inflammation, Decrease in testosterone levels in males,Decrease in follicle stimulating and prolactin hormones in females, Dry mouth, Euphoria and relaxation Sedation Hallucinations, Apathy and dullness Poor grooming, Disinterest Memory impairment
clinical manifestations of caffeine abuse
Increased heart rate Acts as a diuretic Higher total cholesterol levels Insomnia
Prevalence of major depressive disorder
Individuals age 45 to 64, women blacks, Hispanics, non-Hispanic persons of other races o multiple races ind. with less than a high school diploma unemployed or unable to work ind. with out health insurance residents of southern state; Oklahoma, Louisiana, Mississippi, Alabama, Tennessee, west Virginia and Puerto Rico
Brain stem
Inferior of cerebrum, controls the flow of messages between the brain and the body. responsible for breathing.
65 years
Influenza vaccination Whites aged ______ and older have consistently higher rates of vaccination coverage
Mental health counseling
Inpatient or outpatient care for mental health problems
data has shown early __________ following the first episode of a serious mental illness can make an impact
Intervention
Implementation
Intervention is implemented (that's the stage)
autism spectrum disorder
Is characterized by deficits in social relatedness and communication skills that are often accompanied by repetitive, ritualistic behavior
Careers stress
Jobs and careers cause lots of stress in many different ways, such as
Lithium monitoring
Kidney Thyroid EKg
Ask Questions
Know the medicines you are taking, their side effects, concerns about them, and look at results of check ups
Secondary
Known to be a symptomatic manifestation of a systemic, medical, or cerebral disorder (like delirium from a fever)
Acetylcholine
Lack of this neurotransmitter causes Alzheimer's
schizoid personality disorder
Lacks personal and social relationships; RECLUSIVE Lifelong pattern of social withdrawal, want to spend time alone and don't really socialize
Counter-conditioning
Learning of a new conditional response that is incompatible with a previously learned response.
Agoraphobia
Marked fear or anxiety about two or more of the following five situations: 1. using public transportation (e.g. cars, buses, trains, ships, planes) 2. Being in open spaces (e.g. parking lots, marketplaces, bridges) 3. Being in enclosed spaces (e.g. shops, theaters, cinemas) 4. Being in line or being in a crowd 5. Being outside the home by themselves. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of an attack. The agoraphobic situations almost always provoke fear or anxiety. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. The fear or anxiety are out of proportion to the actual danger posed and to the sociocultural context. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of function. Treatment: the same as panic disorder. benzo +SSRI, cognitive and behavioral therapies.
examples of Monoamine Oxidase Inhibitors (MAOIs)
Marplan & Nardil
Types of Crisis
Maturational or Situational or adventitious
major depressive disorder (MDD): •
May be one episode or recurring episodes •Symptoms are present for ≥ 14 days •Symptoms coexist and represent change from the individual's previous functioning. ◦Depressed mood for much of day on most days
a substance used for medical treatment, especially a medicine or drug.
Medication
Anxiety Disorder
Mental disorders marked by physiological arousal, feelings of tension, and intense apprehension without apparent reason.
Echopraxia
Mimicking others movements
HIV
Minorities experience disproportionately high rates of ____ diagnosis Rates are increasing among black, American Indian / Alaska Native
Goal of Behavior Therapy
Modify specific problem behaviors - not change entire personality.
Bipolar Disorder
Mood disorder that alters periods of emotion and rationality.
Mood Stabilizers
Mood stabilizers commonly treat the mood swings associated with bipolar disorder. The oldest of them, lithium, has been in use for over 50 years and has proven very effective, particularly for bipolar disorder, type I. However, regular blood tests are required when taking lithium because of potential serious side effects to the kidneys and thyroid. Newer mood stabilizers, many of which were originally used to treat seizure disorders, may work better than lithium for some people. Mood stabilizers can prevent manic or hypomanic episodes and depressive episodes. but also have side effects to know about and monitor.
Olfactory bulb
Responsible for smell. Part of the limbic system. part of the reptilian brain?
Depressive Syx in Elderly
More somatic or vegetative syx
Phobias
Most common anxiety disorder. 8-10% of general population. Etiology: anxiety + specific environmental event. Onset in early childhood/early adult life. Specific> social. Marked fear or anxiety about a specific object or situation (e.g. flying, heights, animals, receiving and injection, seeing blood). NOTE: in children, the fear or anxiety may be expressed by crying, tantrums, freezing or clinging. The phobic object or situation almost always cause immediate fear or anxiety. The phobic object or situation is actively avoided or endured with intense fear or anxiety. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. The fear, anxiety, or avoidance is persistent, typically for 6 months or more. The fear, anxiety, or avoidance causes clinically significant distress or impairment of social, occupational, or other important areas of functioning. The disturbance is not better explained by the symptoms of another mental disorder.
SAMe ADE
N/V/D, gas, insomnia
ginkgo biloba preg
NO
epinephrine
NT involved in arousal
norepinephrine
NT involved in arousal and vigilance; released by SNS; disruptions in PTSD and bipolar disorder
serotonin
NT involved in mood, appetite, sleep; associated with depression
acetylcholine
NT involved in movement, memory, ANS function
dopamine
NT involved in movement, planning, and reward; receptors die in Parkinson's, overactive in Schizophrenia
reuptake
NT reabsorbed by neuron that released it
C/I of TCAs
Narrow angle glaucoma Low blood pressure Prostate hypertrophy
Non-Profit
National Alliance for the Mentally Ill (NAMI)
What ethnic groups have the highest illicit drug dependence?
Native Americans, Alaska Natives, African Americans. Asians have lowest
cognitive theory
Negative view of self, the present, and the future focus on negative messages; congnitive errors
Neuron
Nerve cell
Action potential
Neural impulse, brief electrical charge that travels down an axon
a nerve cell
Neuron
PERCEPTION BRAIN ACTIVITY RELATED TO THE EYES
Neuronal activity in the brain and conscious visual experience. Transcranial magnetic stimulation of the human occipital lobe disrupts the normal perception of objects in ways suggesting that important aspects of visual perception are based on activity in early visual cortical areas.
Motor neurons
Neurons that Carry outgoing information from the brain and spinal cord to the muscles and glands
Sensory neurons
Neurons that cary incoming information from the sensory receptors to the brain or spinal cord
Interneurons
Neurons within the brain and spinal cord that communicate with each other and regulate sensory and motor inputs
Dopamine
Neurotransmitter that influences movement, learning, attention, and emotion.
Lock & Key mechanism
Neurotransmitters bind to the receptors of the receiving neuron in this manner
Lock and key mechanism
Neurotransmitters bind to the receptors of the receiving neuron in this manner
For those adolescents who suffer from depression, are most treated?
No
prevention strategies for depression
No definitive way, teach and promote use of healthy coping strategies, building social support, proper diet, exercise and rest are important in maintaining physical and mental well being. Abstain from illegal drugs and using alcohol only in moderation. learn risk factors and s/s
valerian preg
No for both
Primary
No known cause; aka idiopathic
Neurotic
No loss of reality testing; based on mainly intrapsychic conflicts or life events that cause anxiety; symptoms include obsessions, phobia, and compulsion
Buproprion (Wellbutrin) MOA
Norepinephrine and dopamine reuptake inhibitor No action on serotonin
Healthy lifestyle
Not smoking, Eating right, stress regulation
Most common ADHD comorbidity
ODD
Tangentially
Oblique, digressive, or even irrelevant manner of speech in which the central idea is never communicated. (i.e. the patient is asked to explain how she was injured, but loses her train of thought and goes on to other subjects)
Obsessive-compulsive Disorder
Obsessive-compulsive disorder causes repetitive, unwanted, obssessive thoughts and irrational, excessive urges to do certain actions.
serious mental illness
Occurs at any time during the last year having a diagnosable, mental, behavioral, or emotional disorder that causes functional impairment that interferes with at least one major life event
serious mental disturbance (SED)
Occurs in children who have been diagnosed with a mental, behavioral, or emotional disorder
Females have more serious mental illnesses than men, but what age group has the fewest?
Older than 65
Somatic Symptom Disorder Diagnostic Criteria
One or more somatic symptoms that are distressing or result in significant disruption of daily life. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: Disproportionate and persistent thought about the seriousness of one's symptoms; Persistently high level of anxiety about health or symptoms; Excessive time and energy devoted to these symptoms or health concerns Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically for more than 6 months). Multiple system complaints, occurs over several years, results in either significant impairment, seeking treatment or both. Epidemiology: Women>men 5:1, not uncommon, could be 2% of women, 10% of patients in family practice. Often co-exists with other psychiatric disorders. Etiology: unknown. Unexplained physical symptoms: not intentional or under voluntary control, believed by family and patient to have a medical cause, patient resent implication of psychiatric diagnosis. Female patients may present as dramatic, may dress seductively, attention seeking. 3 Classic features: multiple system complaints, early onset and chronic course without physical signs. Diagnostic studies are normal. Clinical findings: long complex medical history, numerous invasive and diagnostic or treatment procedures, "fashionable diagnoses" Treatment: single healthcare provider, regularly scheduled appointments, long term strategy- never tell a patient it's all in their head, group therapy, meds not effective unless used for co-morbid psychiatric diagnosis, provider should think of patient's complaints as emotional expressions, not medical complaints. Prognosis: chronic lifetime disorder. Complications/adverse outcomes: failure to ID medical cause for s/s, use of unnecessary invasive and diagnostic or surgical treatment, adverse effects of multiple meds, Rx drug abuse, can lead to helpless and dependent lifestyle.
2-5 years
Only after how long do behaviors become so deeply ingrained in a person that a person cannot imagine abandoning it? Termination / Adoption phase of the Trans-theoretical Model
DBS Deep Brain stimulation
Originally developed to reduce tremors from Parkinson's disease, the FDA approved DBS for use in treating obsessive-compulsive disorder (OCD). DBS is currently being studied as treatment for Tourette's syndrome and major depression. The use of DBS for mental health, however, is largely experimental and its safety and effectiveness are unknown. In deep brain stimulation involves two electrodes put surgically directly in the brain and a pulse generator put in a person's chest.
Mood swings
Oscillation of a person's emotional feeling tone between periods of elation and periods of depression.
Outcome Evaluation
Outcome evaluation assesses the effect of the intervention of the health issue of interest
Nonmedical use of prescription psychotherapeutics
Pain relievers, stimulants, tranquilizers, sedatives, not over the counter drugs
PD
Parkinson Disease
SSRI that has high potential for sedation and weight gain
Paroxetine (Paxil)
Sympathetic nervous system
Part of the autonomic nervous system that arouses the body and mobilizing its energy in stressful situations
Parasympathetic nervous system
Part of the autonomic system that calms the body, conserving its energy
Primary Motor cortex
Part of the neocortex and is responsible for voluntary, and refined movement. In frontal lobe, responsible for movement
Gustatory cortex
Responsible for taste and is part of the neocortex
Malingering
Patient exaggerates symptoms for external gain. Malingering is deliberate behavior for a known external purpose. It is not considered a form of mental illness or psychopathology, although it can occur in the context of other mental illnesses. Strongly suspect malingering in the presence of any combination of the following: medicolegal presentation (e.g. an attorney refers patient, a patient is seeking compensation for injury), marked discrepancy between the claimed distress and objective findings, lack of cooperation during evaluation and in complying with prescribed treatment. Presence of antisocial personality disorder. Common goals of people who malinger: in ED: obtaining drugs and shelter. In the clinic or office: financial compensation.
paranoid personality disorder
Pattern of DISTRUST and SUSPICIOUSNESS; projects blame. Very guarded behavior, NO TRUST
________________ occurs when people provide knowledge, experience, emotional, social or practical help to each other.
Peer Support
Number of persons enrolled in a substance use treatment
People at alcohol or drug abuse facilities
Visual association cortex
Responsible for understanding vision, for what you are seeing. part of the neocortex
Phobia
Persistent, pathological, unrealistic, intense fear of an object or situation; the ________ person may realize that the fear is irrational but, nonetheless, cannot dispel it. A ________ is classified as a type of anxiety disorder, since anxiety is the chief symptom experienced by the sufferer. _________ are thought to be learned emotional responses.
occupational wellness
Personal satisfaction and enrichment from one's work
Treatment for Anxiety Disorders
Pharmacological: benzodiazepines, SSRIs, tricyclic antidepressants-not first line, monoamine oxidase inhibitors-not first line. Psychological: supportive psychotherapy, insight-oriented psychotherapy, behavior therapy, cognitive therapy, group therapy.
a popular theory that claimed bumps on the skull could reveal our mental abilities or character traits
Phrenology
Psychomotor agitation
Physical and mental overactivity that is usually nonproductive and is associated with a feeling of inner turmoil, as seen in agitated depression
Phrenology
Popular theory that claimed bumps on the skull could reveal our mental abilities or character traits
Everyone (High & low risk)
Population efforts for successful behavior change should be aimed at who?
"Stage of Change" Theory aka Transtheoretical Model
Population efforts should: take into account what theory?
Temporal lobes
Portion of the cerebral cortex above the ears that include the auditory areas that receive information from the opposite ear
Occipital lobes
Portion of the cerebral cortex at the back of the head that receives information from the visual fields
Parietal lobes
Portion of the cerebral cortex at the top rear of the head that receives sensory input for touch and body position
Frontal lobes
Portion of the cerebral cortex just behind the forehead that is involved in speaking, muscle movements, add in making plans and judgements
PTSD
Post Traumatic Stress Disorder
occipital lobe
Posterior to temporal, responsible for vision and visual info,
PTSD
Posttraumatic stress disorder
Education & Organizational Assessment
Preceding & reinforcing factors that start & sustain behavior change are identified
Illness Anxiety Disorder (Fka Hypochondriasis)
Preoccupation with having or acquiring a serious illness. Somatic symptoms are NOT present or if present are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g. strong family history present) the preoccupation is clearly excessive or disproportionate. There is a high level of anxiety about health and the individual is easily alarmed about personal health status. The individual performs excessive health-related behaviors (e.g. repeated checks his/her body for signs of illness) or exhibits maladaptive avoidance (e.g. avoids doctor appointments or hospitals). Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. Illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder-somatic type. Epidemiology: ranges from 3-8% of population, men and women are equally affected, men in their 30s and women in their 40s. Several theories of etiology: lower pain threshold and tolerance, social learning, may be variant of other mental disorder, defense against guilt, sense of innate "badness" low self-esteem reflected in pain and suffering as a means of "self-atonement." Clinical findings: no physical exam to correlate with complaints, patient focuses on fear and belief that disease is present more than on symptoms, continues in belief disease is present even when diagnostic studies are negative, can have depression and/or anxiety. Course and prognosis: usually episodic, 33-50% may eventually improve. Prognosis is better with higher socioeconomic level, response to treatment for accompanying depression/anxiety, sudden onset, no accompanying personality disorder. Treatment: Treat psychiatric symptoms (anxiety, depression, etc) with appropriate meds, behavior therapy, reassurance from clinician, problem: remaining objective and not missing real disease.
obsessive-compulsive personality disorder
Preoccupied with orderliness, perfectionism and details; inflexible They have their own set of rigid unbending rules that they believe everyone should follow. The rules can't bend for anyone
Physical Confinement
Restraint
wellness
Presence of purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, and happiness
Health insurance coverage
Private insurance, Medicare, Medicaid, military
S/E of TCAs
Prolonged QT on EKG Blurred vision; increased IOP Tachycardia delerium orthostatic hypotension
What is "P.H.I."?
Protected health information
the therapeutic treatment of mental illness provided by a trained mental health professional. Examples include: Cognitive Behavioral Therapy, Exposure Therapy, etc.
Psychotherapy
Flight of Ideas
Rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent. Seen in mania. (i.e. a man starts talking about his business, but quickly shifts to discussing the economy, the government, and other countries)
Illicit drug use treatment
Received in order to stop illicit drug or alcohol use: hospital, rehab, mental health center, ER, doctor office, self help group, prison
Cerebellum
Receives information from the sensory systems, regulates motor movement. Posture, balance coordination. Responsible for balance, coordination of muscles. part of the reptilian brain.
intellectual wellness
Recognizing creative abilities and finding ways to expand knowledge and skills
physical wellness
Recognizing the need for physical activity, healthy foods, and sleep
Panic Disorder
Recurrent unexplained panic attacks. Panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the follow symptoms occur: palpitations, pounding heart or tachycardia; sweating, trembling or shaking; sensation of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light-headed or faint; chills OR sudden heat sensation; paresthesias (numbness or tingling); derealization (feeling of unreality) OR depersonalization (being detached from one-self); fear of losing control or "going crazy;" fear of dying. At least one of the attacks has been followed by 1 month (or more) of one or both of the following: persistent concern or worry about additional panic attacks or their consequences (e.g. losing control, having a heart attack, "going crazy." A significant maladaptive change in behavior related to the attacks (e.g. behaviors designed to avoid having panic attacks, such as avoidance of things known to cause prior panic attacks.) Median onset is 24 y/o, left untreated it becomes chronic but "waxing and waning," prevalence is 2-3% of adults in US, high rate of suicide or suicidal ideation, frequency and severity vary widely, if specific situations only cause the attacks, then diagnosis is agoraphobia. Treatment: for new onset-start with double medication treatment-an SSRI, like sertraline (Zoloft) PLUS a short-acting benzodiazepine like alprazolam (Xanax). Start low with SSRI and up the dose every 2 weeks until effects are achieved. The benzo is for rapid relief and short term use only (typically no more than two to four weeks) until the SSRI begins to take effect. Taper the benzo slowly to prevent recurrence of panic attacks. Cognitive and behavioral therapies should be utilized from a qualified therapist. Refer for that.
Temporal Lobe
Region of brain found below the lateral fissure; contains auditory cortex.
Childhood Disintegrative Disorder (autism spectrum)
Regression in multiple areas onset by age 10 rare
Compulsion
Repeated behavior associated with anxiety.
clinical manifestations of CNS Depressantse abuse
Respiratory depression Sedation Possible coma Possible death
Hypothalamus
Responsible for "low" moods. Responsible for sleeping, waking, and is responsible for thirst and hunger. part of the limbic system
MEDULLA OBLONGOTA
Responsible for Homeostasis, breathing, heart rate, and Blood pressure. part of the Reptilian brain.
Wernickes area, left side only
Responsible for Understanding what you are hearing, if damaged, the person will understand gibberish only. part of the neocortex
pons
Responsible for breathing. Part of the reptilian brain.
primary auditory cortex
Responsible for hearing. part of the neocortex
Wernicke's area
Responsible for language unserstanding
Hippocampus
Responsible for longterm memory. part of the limbic system. responsible for learning and memory as well.
Prefrontal cortex
Responsible for planning complex cognitive behavior, personality expression, decision making, and moderating social behavior. motivation conciousness, happiness, regulates anxiety.
Amygdala
Responsible for raw intense, emotion. part of the limbic system, mo
What role does depression have with substance abuse and it's progression
Risk of death from overdose of depressant meds like Benzodiazepines.
what are the alternative agents for depression
SAMe St. Johns Wort Ginkgo biloba
considered first-line for depression
SSRIs
Post Traumatic Stress Disorder (PTSD)
Same criteria for acute stress disorder EXCEPT the symptoms last for MORE than one month! Treatment: first-line treatment should consist of "trauma-focused cognitive-behavioral therapy." If there is a delay expected in treatment with the psychotherapy, then start an SSRI or SNRI, typically sertraline (zoloft) or paroxetine (paxil). Animal therapy has been shown to help with many patients with PTSD.
financial wellness
Satisfaction with current and future financial situations
Describe how substance abuse is diagnosed?
Self administered 0 item questionnaire, The objective Opite withdrawal scale (13 physically observable signs) and subjective opite withdrawal scale (asking to rate 16 symptoms)
Social Cognitive Theory Constructs
Self-efficacy - belief in one's ability to take action Observational learning - learn by watching others Expectations - likely outcome of particular behavior Expectancies - value placed on outcome Emotional arousal Behavioral capability - knowledge / skills necessary to engage in behavior change Reinforcement - rewards / punishments Locus of control - belief of one's personal power over events
S/E of Fluoxetine (Prozac)
Serotonin Syndrome QT prolongation SIADH
Theory
Set of interrelated concepts that presents a systematic view of relationships among variables in order to explain and predict events and situations
S/E Sertraline (Zoloft)
Sexual dysfunction (anorgasmia) anxiety
Side effects of SSRIs
Sexual dysfunction (anorgasmia) [>30%] anxiety Weight gain
Dyspnea
Shortness of breath
Reflex
Simple, automatic response to a sensory stimulus
SNRIs- S/E
Somnolence Anxiety Blurred vision Sexual dysfunction Dry Mouth
Personality traits
Specific features or behavioral patterns that make up an individual's overall personality.
Most prevalent psych disoder
Specific phobia
Norms
Standards based on measurements of a large group of people; used for comparing the scores of an individual with those of others within a well-defined group.
Orientation
State of awareness of oneself and one's surroundings in terms of Person, Place, Time and Situation (Ox4). (i.e. a 42 year old alcoholic man in delirium tremens was examined in a local hospital, 2010. When he was asked date and where he was he replied, "I am Jesus Christ standing on a street corner in Tennessee; it's 2008 and I'm minding my own business. Why don't you do the same?")
Nonstimulat drugs for ADHD
Strattera atomoxetine Bupropion alpha2agonists clonidine, guanfacine imipramine
300+ 150-299 <150
Stress scores: Score Interpretation _________= High susceptibility to stress-related illness ___________= Medium susceptibility to stress-related illness _________ = Low susceptibility to stress-related illness
Edward Titchener
Student of Wilhelm Wundt; a founder of Structuralist school of psychology.
Continued use of a psychoactive drug despite the knowledge that it is causing or contributing to persistent/recurrent social, occupational, psychological or physical problem
Substance abuse
substance abuse
Substance abuse disorder occurs when a person needs alcohol or drug to function normally; excessive use of illegal social drugs: alcohol, caffeine, tobacco.
Suicide
Suicide is the act of intentionally causing one's own death. Risk factors include mental disorders such as depression, bipolar disorder, schizophrenia, personality disorders, and substance abuse, including alcoholism and use of benzodiazepines
Parietal lobe
Superior to temporal, responsible for sensation, perception.
the junction between the axon of the relaying neuron and the dendrite of the receiving neuron. This is also known as the synaptic gap or synaptic cleft
Synapse
ginkgo biloba caution
T2DM because may alter insulin metabolism and lead to hyperglycemia
antidepressant that is lethal in overdose
TCAs
antidepressant with antihistaminic, anticholinergic, and antiadrenergic activity
TCAs
OPPONENT PROCESS THEORY
THEORY CONES ARRANGED IN GROUPS RED AND GREEN PAIRS BLUE AND YELLOW PAIRS SEEING ONE BLUE CANNOT SEE THE OTHER
TRICHLAMATIC THEORY
THEORY THREE TYPES OF CONES LIKE BLUE RED OR GREEN, THEY CAN WORK TO MAKE OTHER COLORS
OCD obsessions
THOUGHTS
Treatment for depression
Talking to a doctor or using prescription drugs for depression
Magnetic resonance imaging (MRI)
Technique that uses magnetic filers abs radio waves to produce computer generated images of soft tissue, this shows the brains anatomy
Function MRI (fMRI)
Technique used to reveal the blood flow and brain activity by comparing successive MRI scans, this shows the brains function
Lithium AE's
Teratogenic (Ebsteins Anomoly-heart) Tremor Thyroid Renal dz Slow heart rate-junctional escape
Cerebellum
The "little brain" at the rear Of the brainstem that processes sensory input and coordinates movement output and balance
Reptilian Brain
The Portion of the brain that controls vital functions like heart rate, breathing, body temperature and balance. (medulla, pons, cerebellum, midbrain, globus pallidus, and olfactory).
action
The _________ potential is initiated when the membrane is depolarized to threshold
Thalamus
The brains sensory switchboard which is located on top of the Brainstem. This switchboard directs messages to the sensory receiving areas in the cortex, and transmits relies to the cerebellum and medulla
Somatic nervous system
The division of the PNS that controls the skeletal muscles
Unconscious
The domain of the psyche that stores repressed urges and primitive impulses.
Pituitary gland
The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands.
Validity
The extent to which a test measures what it was intended to measure.
Cerebral cortex
The fabric of interconnected neural cells covering the cerebral hemispheres and the body's ultimate control and information processing center
Neurogenesis
The formation of new neurons
Perception
The processes that organize information in the sensory image and interpret it as having been produced by properties of objects or events in the external, three-dimensional world.
Peripheral nervous system (PNS)
The sensory and motor neurons that connect the CNS to the rest of the body
Gonads
The sex glands
Hypothalamus
The structure below the thalamus, that directs eating, drinking, body temp., as well as helping govern the endocrine system via the pituitary gland. Linked to emotion and reward
Social Cognitive Theory
Theories / Models Used to Address Health Behavior: Interpersonal model - interaction b/t individuals and their social systems Changing behavior requires understanding: individual, influences of environment, interactions of all of these factors Reciprocal determinism - dynamic interplay among personal factors, the environment & behavior (changing one factor changes them all)
Health Belief Model
Theories / Models Used to Address Health Behavior: Intra-personal model Focuses on individuals perceptions & thought process prior to taking health related action People are more likely to take action based on their beliefs Their perceptions!
Theory of Planned Behavior
Theories / Models Used to Address Health Behavior: Intrapersonal model Intention is the main predictor Behavior intention is influenced by: attitude, beliefs (subjective norms) & self efficacy
Diffusion of Innovation Theory
Theories / Models Used to Address Health Behavior: Population and community level model How a new thing is disseminated & adopted into a population 5 Stages: 1. Knowledge of Innovation 2. Persuasion of benefits 3. Decision to adopt 4. Implementation 5. Confirmation Classification of Adoption: - Early adopters - Early majority adopters - Late adopters
Trans-theoretical Model aka "Stages of Change"
Theories / Models Used to Address Health Behavior: Pre-contemplation contemplation Preparation Action Maintenance Termination / Adoption Model of progression or relapse prevention
Precede-Proceed
Theory into Practice: Provides a structure to design and evaluate health education and health promotion programs using a diagnostic planning process followed by an implantation and evaluation process 9 steps divided in these two phases: Diagnostic & Implementation / Evaluation Phase
Social Marketing
Theory into Practice: Use and extension of traditional product marking to approach behavioral change Truth Campaign National Youth Anti-Drug Campaign VERB Campaign 4 P's
Treatment of Social Phobia
Therapy is most important- Cognitive Behavioral Therapy is 1st choice, social skills training, relaxation training, group therapy, medication-SSRIs, benzodiazepines, Effexor, Buspar, Beta-blocking especially for performance anxiety.
Racial / ethnic minorities
These groups are more likely to live in most polluted urban areas and continue to experience a disproportionately larger impact
Antidepressants
These medications improve symptoms of depression by affecting the brain chemicals associated with emotion, such as serotonin, norepinephrine and dopamine. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are newer antidepressants that have fewer side effects than older drugs, but no medication is entirely free of side effects. Potential side effects of SSRIs and SNRIs include:
Lesion
Tissue destruction caused either naturally or experimentally
Reinforce change - encouragement, positive feedback, support
Transtheortical Model: Action phase - observable changes in behavior with potential for relapse Action you can take?
Motivate Change
Transtheortical Model: Contemplation stage - person is thinking about it Action you can take?
Maintain Change - reinforce & recognize long term nature of behavior change
Transtheortical Model: Maintenance Action you can take?
Predict - assess readiness - timing is key
Transtheortical Model: Precontemplation stage - individual not considering change Action you can take?
Plan Change - goals / deadlines, realize existing behavior & remove issues
Transtheortical Model: Preparation phase - starting the planning Action you can take?
ADHD treatments
Treatments for ADHD include: -Support group -Cognitive behavioral therapy -Anger management -Counseling psychology -Psychoeducation -Family therapy -Applied behavior analysis -Medications (Stimulant, Cognition-enhancing medication, and Antihypertensive drug)
Autism Spectrum Disorder treatment
Treatments for Autism include: -Anger management -Family therapy -Applied behavior analysis -Behavior therapy -Sensory processing -Animal-Assisted therapy -Online speech therapy -Medication (antipsychotic drugs)
OCD Treatments
Treatments for OCD: -Support group -Cognitive behavioral therapy -Aversion therapy -Psychoeducation -Rational emotive behavior therapy -Exposure and response prevention -Psychotherapy -Systematic desensitization -Group psychotherapy -Medication (Selective Serotonin Reuptake Inhibitor (SSRI), Anxiolytic, and Antidepressant)
PTSD Treatments
Treatments for PTSD include: -Cognitive behavioral therapy, -Eye Movement Desensitization and Reprocessing -Exposure & Response Prevention -Medication (Selective Serotonin Reuptake Inhibitor (SSRI))
Schizophrenia treatments
Treatments for schizophrenia include: -Support group -Rehabilitation -Cognitive therapy -Psychoeducation -Family therapy -Behavior therapy -Group psychotherapy -Medication (Antipsychotic and Anti-tremor)
True or false: a majority of US adolescents perceived no great risk from monthy/weekly marajuana use and having 5 or more drinks a week
True
True or false: methadone and buprenorphine has increased in opioid treatment programs?
True
True or false: most adults with SMIs receive treatment
True
True or false: those 26-44 had the highest rate of treatment for alcohol dependence
True
True or false: those who had serious mental illnesses were more likely to be in poverty, uninsured, and in the country
True
Amygdala
Two Lima bean sized neural clusters in the Limbic system that are linked to emotion
1 in 5
US adults experience a mental illness/disorder in a given year
1 in 25
US adults experiences serious mental illness (9.8 Million)
Depression: Screening
USPSTF (I)screening of children (7-11 years old) for depression USPSTF (B)(12-18 years old) and adults for depression First postpartum evaluation should include screening for depression
Psychoanalysis
Used by psychiatrist, goal is to bring suppressed memories into present personality, main emphasis is on "conflicts between unconscious drives and moral judgments" a patient makes regarding their behavior, based on Sigmund Freud, patient lies on couch, indicated for psychoneuroses-anxiety disorders, compulsive behavior, conversion disorder, sexual dysfunction, personality disorders. Patient indications: genuine desire to gain self-understanding of behavior, able to handle emotions that emerge with psychoanalysis, must be honest with analysis. Traditional setting: Couch, Fundamental Principle: free association. Second principle: analyst must remain neutral. Limitations: expense and time
Group Therapy
Usually 8-10 patients with variety of mental health disorders, usually meet weekly, therapist present. Goal is to change behavior. Few contraindications even social anxiety can benefit when properly prepared prior to group work. Can be inpatient or outpatient
Vocational Rehabilitation (VR)
VR provides career counseling and job search assistance for people with disabilities, including mental illness. VR program structures vary from state to state. To learn more about your specific state program, visit your state's VR agency.
Drug of choice for Rapid Cycling Bipolar
Valproic Acid Carbanazepine Lithium less effective
how ADHD is diagnosed
Vanderbilt parent and teacher scales, conners' parent and teacher rating scales, Swanson, Nolan, and Pelham Questionnaire teacher and parent Rating Scale, Disruptive Behavior Disorder scale, ADHD Rating Scale, Revise Behavior Problem checklist, child behavior Checklist. no lab, neurological assessment or attention assessment however, evaluate individual to rule out any complicating medical illnesses.
Overall state of well being or total health
Wellness
A BMI under 17.5 in an adult or child/adolescent lower than the 15th percentile of BMI for their age.
What are 2 clinical indications a patient may have anorexia nervosa?
SCOFF EDE-Q
What are 2 of the validated screening tools for eating disorders?
Has illicit drug use increased in the last decade? To what #?
Yes. 10%
examples of Selective Serotonin Reuptake Inhibitors (SSRIs)
Zoloft, Prozac, & Celexa
7
____ % of the population is affected by MDD
1.9
____ million people abuse opiods
63-87
____%-____% is the concordance rate for OCD
11
_____ % is the Percentage of children diagnosed with ADHD
30
_____ % of americans experience disorders
2.6
_____ % of the adult population is affected by bipolar disorder
females
_________ are the most affected gender affected by MDD
anxiety
_________ is a disorder that is not proportional to a person's circumstances
stress
__________ - Pressure from outside that can make you feel tense inside. It is an unavoidable fact of life. Everyone has stress - infant to elderly. We need stress - helps to keep us on our toes. It is a survival mechanism of animals Stress comes in many forms. It can be positive (playoff game, test), it can be tolerable (death of a loved one, divorce, natural disaster) or it can be toxic (abuse, neglect, ongoing tolerable stress)
Holmes and Rahe Stress Scale
__________ = Psychiatrists, Thomas Holmes and Richard Rahe, from the University of Washington School of Medicine in Seattle, have developed a "life-events scale" designed to measure the stress that can be caused by various changes in life events. The scale provides a modest correlation between life changing events experienced in the previous year with a person's health in the present year.
anxiety
__________ disorders are the most common mental disorders
social
___________ explanation for depression: feelings of sadness and loneliness
biological
___________ explanation for depression: heritability is 40%; certain genes affecting serotonin levels
learning
___________ explanation for depression: reduction in positive enforcement or increase in negative outcomes
cognitive
___________ explanation for depression: result of a combination of negative thoughts about the self, the world, and the future
biological and psychological
____________ and ___________ factors make people vulnerable to mental illness
Religion
_____________ is related to: May affect social practices (Sex, Food, Alcohol, Tobacco) May affect response to symptoms (Christian Scientists reject traditional medical care) Types of interventions that are acceptable (Prohibition, stem cell research attitudes, abortion, end life treatments) Response to disease & interventions (Prayer)
Culture
_______________ is related to: Behavior Diet Attitude towards healthcare (Respect for providers, fear of institution) Beliefs regarding etiology of disease (Physiological vs spiritual) Beliefs in effectiveness of modern medicine Response to symptoms (level of urgency to seek care) Types of interventions that are acceptable (Western medicine vs non-traditional healers) Response to disease & interventions (Follow ups, adherence to treatment, acceptance of adverse outcome)
behavioral health
___________________ definition: is the promotion of mental health, resilience, and well-being, prevention and treatment of mental and substance abuse disorders, support during recovery
Electroconvulsive therapy
a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an aenesthetized patient
Biological psychology
a branch of psychology concerned with the links between biology and behavior
Neurotransmitter
a chemical messenger that crosses the synaptic gap between neurons, binding to receptor sites on the dendrites of the receiving neuron.
Neurotransmitter
a chemical substance that is released at the end of a nerve fiber by the arrival of a nerve impulse and, by diffusing across the synapse or junction, causes the transfer of the impulse to another nerve fiber, a muscle fiber, or some other structure.
language
a complex symbolic system for expressing, receiving, and comprehending words
ADHD
a condition in which characterized by inattention, hyperactivity and impulsivity symptoms include Becoming easily distracted, and jumping from activity to activity.
Split brain
a condition resulting from surgery that isolates the brain's two hemispheres by cutting the fibers (mainly those of the corpus callosum) connecting them
Split brain
a condition resulting from surgery that isolates the brain's two hemispheres by cutting the fibers connecting them
Autonomic
a control system that acts unconsciously and regulates functions like heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal.
Reticular Formation
a diffuse network of nerve pathways in the brainstem connecting the spinal cord, cerebrum, and cerebellum, and mediating the overall level of consciousness
Schizophrenia
a disorder characterized by the profound disruption of basic psychological processes; a distorted perception of reality; altered or blunted emotion; and disturbances in thought, motivation, and behavior
Anxiety Disorders
a disorder that becomes overwhelming and repeatedly impacts a person's life, with stress
Sympathetic Nervous System
a division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations.
Parasympathetic Nervous System
a division of the autonomic nervous system that calms the body, conserving its energy
Myelin sheath
a fatty white substance that surrounds the axon of some nerve cells, forming an electrically insulating layer
Myelin
a fatty, protective coating around nerves that makes quicker transmission of information.
affect
a fluctuating pattern of observable behaviors that expresses subjective feelings or emotions through tone of voice, facial expression, and demeanor
counseling
a focus on personal strengths and development
Schizoaffective Disorder
a mental illness with symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as depressive or manic episodes.
Antagonist molecules
a molecule from outside the body that blocks a neurotransmitter's function
Antagonist molecules
a molecule from outside the body that blocks a neurotransmitter's function, like Botulin, which blocks ACh
Agonist molecules
a molecule from outside the body that is similar enough to a neurotransmitter to mimic its effects, like in certain opiate drugs
mood
a more pervasive and sustained emotion that colors the person's perception of the world; subjective
Endorphins
a natural, opiate-like neurotransmitters linked to pain control and to pleasure.
Neuron
a nerve cell
Motor neurons
a nerve cell forming part of a pathway along which impulses pass from the brain or spinal cord to a muscle or gland
Reticular formation
a nerve network in the brainstem that plays an important role in controlling arousal
Action potential
a neural impulse, or, a brief electrical charge that travels down an axon
Action potential
a neural impulse; a brief electrical charge that travels down an axon. The action potential is generated by the movement of positively charged atoms in and out of channels in the axon's membrane.
Hypothalamus
a neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward
Autism Spectrum Disorder
a neurodevelopmental disorder characterized by persistent deficits in social interaction and communication across different life settings (e.g., home, school) and by restricted and repetitive behavior, interests or activities, and in which symptoms begin during early childhood
Sensory neurons
a neuron conducting impulses inwards to the brain or spinal cord
Interneurons
a neuron that transmits impulses between other neurons, especially as part of a reflex arc
All-or-none Response
a neuron's reaction of either firing (with a full-strength response) or not firing.
Dopamine
a neurotransmitter associated with movement, attention and learning and the brain's pleasure and reward system
Stress
a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
Phrenology
a popular theory that claimed bumps on the skull could reveal our mental abilities or character traits
ECT Electroconvulsive Therapy
a procedure where controlled electric currents are passed through the brain while the person is under general anesthesia. This results in a brief, controlled seizure that affects neurons and chemicals in the brain. It is most often used to treat severe depression and depression with psychosis that has not responded to medications. In some cases of treatment resistant bipolar disorder, ECT may be considered as a treatment option.
Amygdala
a roughly almond-shaped cluster of neurons inside each cerebral hemisphere, involved with the experiencing of emotions.
feelings of depersonalization
a sense that one's self or identity is different, changed, unreal lost, or detached from one's mind or body
feelings of unreality
a sense that the environment is strange, unreal, or remote
Dendrite (receive)
a short branched extension of a nerve cell, along which impulses received from other cells at synapses are transmitted to the cell body.
Reflex
a simple, automatic response to a sensory stimulus
Neuron
a specialized cell transmitting nerve impulses; a nerve cell
Behavioral health
a state of mental/emotional being and/or choices and actions that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and mental and substance use disorders
psychotherapy
a type of talking therapy that the person speaks with a therapist to explore a and understand feelings, behavior and to gain coping skills. popular and versatile treatment.
Position Emission Tomography (PET)
a visual display of the brain activity that detects where the radioactive form of glucose goes while the brain performs a given task
Positron emission tomography scan (PET scan)
a visual display of the brain activity that detects where the radioactive form of glucose goes while the brain performs a given task
Serotonin
affects mood, hunger, sleep, and arousal. A lack leads to depression
attention
ability to focus or concentrate over time on a particular activity or stimulus
psychosis
abnormal condition of the mind, major mental disorder characterized by extreme derangement, often with delusions and hallucinations
enlarged ventricles
abnormalities in what brain area is associated with schizophrenia?
large ventricles
abnormalities in what brain area is associated with schizophrenia?
Dopamine
abnormalities in what neurotransmitter, are associated with schizophrenia?
Thought Blocking
abrupt interruption in train of thinking before a thought or idea is finished; after a brief pause, the patient indicates no recall of what was being said or was going to be said. Often indicates the presence of mental illness such as schizophrenia (i.e. in the middle of talking about his childhood, the patient abruptly pauses, after which he can't remember what he was saying)
Attention Deficit/Hyperactivity Disorder (ADHD)
achronic condition including attention difficulty, hyperactivity, and impulsiveness
Mental Health Parity and Addition Equality Act (MHPAEA)
act where deductibles, copays, out of pocket maximums, treatment limitations can be no more restrictive than requirements for other medical care
Patient Protection and Affordable Care Act
act where mental illness and substance abuse fall under the 10 essential health benefits that most plans must cover
level of consciousness
alertness or state of awareness of the environment
Mental Health Disorders
alterations in thinking, mood, or behavior associated with distress
clinical manifestations Persistent depressive disorder
altered appetite, weight loss or gain
Electroencephalogram (EEG)
an amplified recording of the waves of electrical activity that sweep across the brain's surface. These waves are measured by electrodes placed on the scalp
Post Traumatic Stress Disorder (PTSD)
an anxiety disorder associated with serious traumatic events and characterized by such symptoms as survivor guilt, reliving the trauma in dreams, numbness and lack of involvement with reality, or recurrent thoughts and images
Obsessive Compulsive Disorder (OCD)
an anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions)
Panic disorder
an anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations
Biopsychosocial Approach
an approach to psychological disorders that considers conditions and treatments to be dependent on biological, psychological, and social causes
Humanistic approach
an approach to psychology emphasizing a persons positive qualities, the capacity for positive growth, and the freedom to choose any destiny. Founded by Roger Maslow, it emphasizes the idea that all humans are naturally good natured, and are striving to attain a strong self-image and climb the pyramid of needs
Occipital lobe
an area at the back of each cerebral hemisphere that is the primary receiving area for visual information.
Motor cortex
an area at the rear of the frontal lobes that controls voluntary movements. This area of the brain is involved in the idea of neural prosthetics
Motor Cortex
an area of the brain, near the rear of the frontal lobes, that controls voluntary movement
Temporal lobe
an area on each hemisphere of the cerebral cortex near the temples that is the primary receiving area for auditory information
Structuralism
an early school of psychology that used introspection to explore the structural elements of the human mind
Paranoid ideation
an exaggerated, sometimes grandiose, belief or suspicion, usually not of a delusional nature, that one is being harassed, persecuted, or treated unfairly, that one is being harassed or persecuted, or beliefs involving general suspiciousness about others' motives or intent.
Gamma-butyric acid
an inhibitory neurotransmitter. A lack is linked to seizures, tremors, and insomnia
Trepanation
ancient medical procedure in which a hole was drilled into a patient's skull to "relieve pressure" or "release evil spirits"
trepanation
ancient practice of drilling holes in the skull
C/I for Bupropion (Wellbutrin)
anxiety or panic disorder Seizures PMHx - anorexia/bulimia Pt undergoing detox - ETOH or sedatives
psychopathy
any disease of the mind
Specific phobias
any of the disorders characterized by extreme and irrational fear of a particular object or situation
schizophrenia
any one of a large group of psychotic disorders characterized by gross distortions of reality, disturbance of language, and communication, withdraw from social interaction, and the disorganization and fragmentation of thought, perception, and emotional reaction
behavior therapy
applications of classical and operant conditioning principles to the treatment of symptoms of psychological disorder and adjustment problems
anxieties
apprehensive anticipation of future danger or misfortune accompanied by feelings of worry, distress, or somatic symptoms
4 major dimensions of recovery
are heath, home, purpose, and community
individual level protective factors
are positive self image, self control, social competence
positive self image, self control, social competence
are the individual level protective factors
amphetamines, methanphetamines, and cocaine
are the most commonly abused stimulants
Sensory Cortex
area at the front of the parietal lobes that registers and processes body touch and movement sensations
Sensory cortex
area at the front of the parietal lobes that registers and processes body touch and movement sensations. The larger the area of this region used for a particular body part, the more sensitive it is (i.e. lips being more sensitive than toes have a bigger used area of this region). This also includes the visual cortex
Association areas
area of the cerebral cortex that are not involved in primary motor or sensory functions but in higher mental functions such as learning, remembering, thinking, and speaking
Association areas
areas of the cerebral cortex that are not involved in primary motor or sensory functions; rather, they are involved in higher mental functions such as learning, remembering, thinking, and speaking
higher cognitive function
assessed by vocabulary, fund of information, abstract thinking, calculations, construction of objects that have two or three dimensions
obsessive compulsive disorder
associated with intrusive obsessions and compulsions
psychosurgery
attempt to improve symptoms of psychological disorders through the use of brain surgery
St johns preg
avoid both
kava preg
avoid in both -goes in breast milk
orientation
awareness of personal identity, place, and time
insight
awareness that symptoms or disturbed behaviors are normal or abnormal
Nerves
axons that have been bundled together into cables that connect the CNS with muscles, glands, and sense organs. For instance, the optic nerve
anxiety exercise
both work but aerobic has greater effect 12-40 minutes
negative symptoms
behaviors found in normal people but not in schizophrenics (ex: avolition, flat affect)
positive symptoms
behaviors found in patients with schizophrenia but not in normal people (ex: hallucinations, delusions)
ginkgo biloba efficacy
benefit in older adults unresponsive to standard treatment (51-78)
jealous
beyond normal; this drives them to do terrible things
MAOI - MOA
block the MAO complex, allowing increased levels of serotonin (5-HT) and norepinephrine (NE) (producing more serotonin/NE)
exercise for depression?
both aerobic and anaerobic are effective: high> low energy
PTSD
caused by the experience of trauma, which leads to flashbacks, dreams, hyper vigilance, and avoidance of stimuli associated with the traumatic event
what should you avoid in depression
caffeine, simple sugars, alcohol
Mentalization-based therapy (MBT)
can bring long-term improvement to people with BPD, according to randomized clinical trials. is a kind of psychotherapy that engages and exercises the important skill called mentalizing. Mentalizing refers to the intuitive process that gives us a sense of self. When people consciously perceive and understand their own inner feelings and thoughts, it's mentalizing.
main causes of death (95.4%) in people with serious mental illnesses
cardiovascular disease (33.9%), cancer (21%), and pulmonary disease (13.5%)
thought processes
coherence/connection between thoughts; does speech progress logically towards a goal
Clubhouses
community-based centers open to individuals with mental illness. members have the opportunity to gain skills, get a job, find housing, and pursue continuing education. Members work side-by-side with staff to make sure the program operates smoothly. Members also have the opportunity to take part in social events, classes and weekend activities.
pica
compulsive eating of nonintrusive substances such as clay or ice. This condition is often a result of iron deficiency is the cause of pica the condition will disappear in 1 or 2 weeks when treated with iron therapy.
70
concordance rates for bipolar disorder in twins is as high as ____%
Marital Therapy
conflict between 2 people, usually involves social, emotional, sexual or economic problems. Can be conducted through individual therapy, couples, groups, etc. Contraindications: psychosis of one person involved in conflict. Goal: alleviate emotional distress and disability. To promote the levels of well-being of both partners together and of each as an individual. Does NOT always result in couples remaining together; divorce therapy.
corpus callosum
connects hemispheres
PNS
connects the central nervous system to sensory organs.
brainstem
contains midbrain, medulla, and pons
cerebellum
contains more neurons than the rest of the brain
flight of ideas
continuous flow of accelerated speech with abrupt changes from one topic to the next. most frequent in manic episodes
pons
control the management of sleep, arousal, facial expression
autonomic nervous system
controls glands and organs; contains sympathetic and parasympathetic nervous system
reticular formation
controls mood, arousal, sleep; major source of serotonin and norepinephrine
thalamus
controls sensation, memory, states of consciousness; receives sensory input from most systems
midbrain
controls sensory reflexes, movement, pain
medulla
controls vital body functions ex: heart rate, breathing
corpus callosum
corpus callosum has the biggest collection of white matter within the brain, and it has a high myelin content.
Confabulation
creation of stories or answers in place of actual memories to maintain self-esteem
longitudinal fissure
deep groove that separates the two hemispheres of the vertebrate brain.
Abnormally low levels of norepinephrine have been linked to
depression
Major Depressive Disorder
depressive disorder characterized by loss of interest in almost all of life's usual activities; a sad, hopeless, or discourage mood, sleep disturbance; loss of appetite; loss of energy; and feelings of unworthiness and guilt
Antipsychotics
developed in the mid-20th century are often referred to as first-generation or typical antipsychotics, while antipsychotics developed more recently are referred to as second-generation or atypical antipsychotics. These medications reduce or eliminate symptoms of psychosis (delusions and hallucinations) by affecting the brain chemical called dopamine.
Sigmund Freud
developed the psychodynamic theory; existence of unconscious mind, development of sexuality, dream analysis, and psychoanalysis
Autism
developmental disorder that makes it difficult to socialize and communicate with others.
alcohol use disorder
diagnostic criteria: problems controlling intake, continued use despite problems, developed tolerance, risky behavior caused by drinking; 17 million alcohol users have alcohol use disorder
Psychosocial treatments
different types of psychotherapy and social and vocational training, and aim to provide support, education and guidance to people with mental illness and their families. Psychosocial treatments are an effective way to improve the quality of life for individuals with mental illness and their families. They can lead to fewer hospitalizations and less difficulties at home, at school and at work.
cingulate cortex
directs ANS; plays role in decision making, emotion, anticipation of reward, empathy
post-traumatic stress disorder
disorder characterized by a chronic debilitating emotional response to a traumatic event perceived as a life threatening or severe emotional stress
obsessive-compulsive disorder
disorder characterized by intrusive, unwanted thoughts that result in the tendency to perform repetitive acts or rituals, usually as a means of releasing tension or anxiety
attention deficit/hyperactivity disorder
disorder of learning and behavioral problems characterized by marked inattention, distractability impulsiveness, and hyperactivity
somatoform disorders
disorders characterized by physical symptoms for which no known physical cause exists
Dissociative Disorders
disorders that affect a person's memory and self-perception.
melatonin and calming herbs use
do not improve daytime sump -used to improve sleep
Therapy pets
domestic animals can reduce symptoms of anxiety, depression, fatigue and pain for many people. Hospitals, nursing homes and other medical facilities sometimes make use of this effect by offering therapy animals. Trained therapy pets accompanied by a handler can offer structured animal-assisted therapy or simply visit people to provide comfort.
prevention strategies for substance abuse
don't ignore poor performance, don't lighten or change the assignment, don't accept excuses, don't allow yourself to be manipulated or fear confronting
Schizophrenia is believed to be associated with abnormally high levels of what neurotransmitter?
dopamine
neurotransmitter associated with the 'pleasure-seeking system' of the brain
dopamine
pathophysiology and etiology of substance abuse
dopamine reward system in the brain is hypothesized as a reason for substance abuse an effort to compensate for deficiencies in the dopaminergic system. A1 allele of the D dopamine receptor gene located at 11&23 is associated with addictive behaviors.
anorexia nervosa
eating disorder characterized by a disturbed perception of body language resulting in failure to maintain body weight, intensive fear of gaining weight, pronounced desire for thinness, and in females, amenorrhea
Bulimia nervosa
eating disorder characterized by uncontrolled binge eating followed by purging
strategies for mental health
educate, talk about it, show compassion, equality with physical& mental illness, empowerment over shame
resting potential
electrical charge across membrane when neuron is not firing
action potential
electrical signal arising in a neurons axon
deep brain stimulation
electrical stimulation applied through surgically implanted electrodes that is used to treat some anxiety and mood disorders
Deep Brain Stimulation
electrical stimulation applied through surgically implanted electrodes; used to treat some anxiety and mood disorders
S/E of Dopamine
elevated prolactin levels- leads to gynecomastia and galactorrhea long term: tardive dyskinesia
risk factors for early death and health disparity in people with serious mental illnesses
elevated tobacco use, poverty, social isolation, trauma, obesity, side effects of medication, and lack of access to quality health care
orbitofrontal cortex
emotion, impulse control
anxiety disorder
emotional disorder characterized by feelings of apprehension, tension or uneasiness arising typically from the anticipation of unreal or imagined danger
Parathyroids
endocrine glands in neck; help maintain calcium ion level in blood necessary for normal functioning of neurons.
Panic attack
episode of sudden onset of acute anxiety, occurring unpredictability, with feelings of acute apprehension, dyspnea, dizziness, sweating, and/or chest pain, depersonalization, paresthesia, and fear of dying, loss of mind or control
EP studies
evoked potential studies
broad/labile
exaggerated affect
generalized anxiety disorder
excessive anxiety for 6 months that is not correlated with a specific object
histrionic personality disorder
excessive emotionality and attention seeking behaviors that are dramatic and egocentric. Extroverted behavior, seductive, manipulative, want to be the center of attention
glutamate
excitation of brain activity
glutamate
exiciatory neurotransmitter involved in memory
clinical psych
explain, define, treat abnormal behavior
confabulation
fabrication of facts or events in response to questions, to fill in the gaps from impaired memory. korsakoff syndrome from alcoholism
delusions
false, fixed personal beliefs that are not amendable to change in light of conflicting evidence
agoraphobia
fear of open spaces, being outside the home, being in a crowd
specific phobias
fears of specific objects or circumstances
Anxiety
feeling that often causes a sense of nervousness or a need to escape a situation.
Rett syndrome (autism spectrum)
females regression after age 18 months meaningless gestures/movements NO LANGUAGE
sympathetic nervous system
fight or flight; expenditure of energy
biological psych
focuses on relationship between the mind and behavior
Intrapersonal Factors , depression theory
focuses on the theme of loss of another person, an object, self esteem or security, either real or symbolic. anger is turned inward and aginst the self cause depressive episodes.
hippocampus
formation of long term memories
TCAs- unique S/E
galactorrhea
Distinguish the pathophysiology and etiology of Autism
genetic, immunologic, environment, such as drugs during pregnancy and abnormality of dopamine and serotonin.
Parathyroids
glands right next to the thyroid that help regulate the calcium level in the blood
Self-help and support groups
groups can help address feelings of isolation and help people gain insight into their mental health condition. Members of groups may share frustrations, successes, referrals for specialists, where to find the best community resources and tips on what works best when trying to recover.
4 Major Dimensions of Recovery
heath, home, purpose, and community
prevention approaches
help individuals develop knowledge, attitudes, and skills they need to make good choices or change harmful behaviors
Norepinephrine
helps control alertness and arousal. A lack can depress
Psychosocial rehabilitation
helps people develop the social, emotional and intellectual skills they need in order to live happily with the smallest amount of professional assistance they can manage. uses strategies for intervention: learning coping skills so that they are more successful handling a stressful environment and developing resources that reduce future stressors.
Treatment for OCD
high dose SSRI SEROTONIN basis
which two parts of the limbic system reacts together when memory is triggering a type of emotion
hippocampus and amygdala
Special impacts
homeless, prison populations, local jails, juvenile justice centers
1 and 5 adults have mental depression
how many aduts
(1 out of 50 children) have this disorder
how many children have autism spectrum
a behavioral disorder often manifest two to four years before a disorder is present.
how will you developed
kava had cases of what reported
idiopathic hepatotoxic hepatitis
personality disorder
impairments in identity, personality traits, and in establishment of empathy or intimacy
GABA
important inhibitory neurotransmitter assicocated with seixures sleep problems
ginkgo biloba MOA
improv blood flow, protect against free radicals, block platelet activating factor
cognitive psych
information processing, thinking, reasoning, problem solving
GABA
inhibition of brain activity
myelin
insulating material covering axons; increase conduction
Social Anxiety Disorder
intense fear of social situations, leading to avoidance of such (formerly called social phobia)
Gender bias theory
internalization of cultural norms of behavior, rigid gender role and age expectations
Adjustment disorder with depressed mood
is a change in mood and affect following a stressor, such as the end of a relationship.
central sulcus
is a prominent landmark of the brain, separating the parietal lobe from the frontal lobe and the primary motor cortex from the primary somatosensory cortex.
gyri
is a ridge on the cerebral cortex. It is generally surrounded by one or more sulci
Gamma-amino Butyric acid (GABA)
is an amino acid which acts as a neurotransmitter in the central nervous system. It inhibits nerve transmission in the brain, calming nervous activity
Individual Placement And Support (IPS) Supported Employment
is evidence-based programs that help people with mental illness locate jobs that match their individual strengths and interests. Once an individual locates a job, these programs provide continuous support to help the person succeed in the workplace.
ADHD
it's most commonly diagnosed in young people, according to the Center for Disease Control and Prevention CDC. About 9% of children between ages 3-17 have this. While it is usually diagnosed in childhood, it does not only affect children. An estimated 4% of adults have it.
what drug has reports of hepatotoxic hepatitis
kava
anxiety alt. agents
kava valerian
Learning theory
lack of control over experiences; learned helplessness difficult in adaptation. No longer have the will or energy to cope wih life, and a depressive state results
anhedonia
lack of interest in activities that previously provided pleasure
anhedonia
lack of interest in activities that previously provided pleasure 7
Broca's area
located on the left side of the brain only, is responsible for speech production, physical speech. part of the neocortex.
D2 receptors found in:
limbic system
lateralization
localization of function in one of the hemispheres (Ex: language lateralized in the left hemisphere)
most commonly used medical therapy?
medications
off label and generic meds
meds that haven't been approved by the FDA for a given condition.
ADHA alt. agents
melatonin and calming herbs
Bipolar Disorder
mental illness causes dramatic highs and lows in a person's mood, energy and ability to think clearly.
Schizophrenia
mental illness that causes people to lose touch with reality with hallucinations, delusions and extremely disordered thinking and behavior
Early Psychosis and Psychosis
mental illness that has disruptions to a person's thoughts and perceptions that make it difficult for them to recognize what is real and what isn't.
Applied Behavior Analysis
modern term for a form of functional analysis and behavior modification that uses a variety of behavioral techniques to mold a desired behavior or response
serotonin
mood control lack of is clinical depression
bipolar disorder
mood disorder characterized by alternating periods of mania and depression
includes depression, bipolar disorder, and seasonal affective disorder
mood disorders
major depression
mood disturbances characterized by feelings of sadness, despair, discouragement, hopelessness, lack of joy, altered sleep patterns, and difficulty with decision making and daily function
Depression
more than just feeling sad or going through a rough patch; it's a mental health condition that requires understanding and treatment.
valerian DDI
no sig. DDI caution with sedating meds
SAMe DDI
none -risk of serotonin synd. when adjunctive therapy to other antidepressants
developmental psych
normal changes in behavior over the lifespan
valerian results
not immediate: takes several wks for both anxiety and sleep
affect
objective; emotional responsiveness during the encounter inferred from conversations, expressions, and behavior; range/variation
OCD
obsessive-compulsive disorder
sociocultural factors
occurrence of stressful life events cause depression.
clinical manifestations of Seasonal affective depression disorder
occurs within 3months of onset of the stressor. lesser degree than other depressed mood although a higher level of anxiety may be present
75%
of mental health conditions begin before age 24
lifespan and cultural considerations associated with substance abuse
older adults substance abuse will increase by double in 2020. consequences in older adults may be more critical, older adult specially women use prescription or OC meds hard to reorganize sub. abuse, risk for more other prob.
ginkgo biloba is used in what population
older patients with depression associated with dementia
what diets help depression
omega 3 ( fish, veggies) Vit. D
Risk of cardiac death with stimulants
only if preexisting cardiac condition Check EKG if syx or cardiac risks
psychogenic
originating in the mind
endorphins
pain; opioid drugs mimic endorphins
chronic health conditions
people with mental illness are more likely to have
8 years
people with mental illness die on an average of how many years earlier?
hallucinations
perceptual disturbances that occur in the absence of a sensory stimulus caused by an altered mental status; person may or may not realize the experiences are false; multi-systematic- auditory, visual, olfactory, gustatory, tactile, or somatic
PNS
peripheral nervous system
phobias
persistent irrational fears accompanied by a compelling desire to avoid the provoking stimulus
perseveration
persistent repetition of words or ideas
psychosomatic
pertaining to the mind and body
2 major roots of psychology
philosophy and natural sciences
Major roots of psychology (two)
philosophy and natural sciences
medical models of psychological disorders
physical cause and medical treatment used _______..
somatic
physical or body sensation; you think that something is happening to you when it's happening to someone else
evolutionary psych
physical structure and behavior being shaped by contributions to survival and reproduction
psychiatrist
physician who studies & treats disorders of the mind
Pineal gland
pineal gland produces melatonin, a serotonin derived hormone which modulates sleep patterns in both circadian and seasonal cycles.
prefrontal cortex
planning behavior, attention, and judgement
synapse
point of communication between neurons
Temporal lobes
portion of the cerebral cortex above the ears that includes the auditory areas that receive info from the opposite ear
Occipital lobes
portion of the cerebral cortex at the back of the head that receives information from the visual fields
Parietal lobes
portion of the cerebral cortex at the top rear of the head that receives sensory input for touch and body position
Frontal lobes
portion of the cerebral cortex just behind the forehead that is involved in speaking, muscle movements, and in making plans and judgments
Parietal lobe
portion of the cerebral cortex lying at the top of the head and toward the rear; receives sensory input for touch and body position
Frontal lobe
portion of the cerebral cortex lying just behind the forehead; involved in speaking and muscle movements and in making plans and judgements
PET
positron emission tomography
Social factors that are related to early mortality
poverty, social isolation, and lack of quality healthcare
social factors related to early mortality
poverty, social isolation, lack of access to quality healthcare
frontal lobe
primary motor cortex and areas responsible for most complex cognitive processes
parietal lobe
primary somatosensory cortex (involved in neglect syndrome)
occipital lobe
primary visual cortex
TMS Transcranial Magnetic Stimulation
procedure that creates magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. it has a large electromagnetic coil is placed on a person's forehead and short pulses are directed into an area of the brain believed to control moods. The doctor performing the treatment will determine the amount of magnetic energy needed during the first treatment session. TMS treatments will last about 40 minutes. Unlike ECT, it does not require the use of anesthesia and person will remain awake during the treatment. Several sessions generally are required over a period of weeks.
judgement
process of comparing and evaluating alternatives when deciding on a course of action
memory
process of registering or recording information, tested by asking for immediate repetition of material, followed by storage or retention of info
Supported Employment
programs that are designed specifically to help people with conditions with work readiness, searching for jobs and providing support in the workplace.
Continuum of care
promotion, prevention, treatment, & recovery
continuum of care
promotion, prevention, treatment, recovery
glial cells
provide structural matrix, clean up debris, form blood-brain barrier
VNS Vagus Nerve Stimulation
pulse generator, about the size of a stopwatch, placed in the upper left side of the chest to stimulate the vagus nerve, which carries messages to parts of the brain that control mood and sleep, with electrical impulses. VNS can be used to treat depression, as well as other medical conditions including epilepsy.
grandiose
put themselves on a pedestal
psychodynamic therapy
recognizes negative patterns of behavior and feeling that are rooted in past experiences and resolve them. This type of therapy often uses open-ended questions and free association so that people have the opportunity to discuss whatever is on their minds. The therapist then works with the person to sift through these thoughts and identify unconscious patterns of negative behavior or feelings and how they have been caused or influenced by past experiences and unresolved feelings.
obsessions
recurrent persistent thoughts, images, or urges experienced as intrusive and unwanted that the person tries to ignore, suppress, or neutralize with other thoughts or actions
pineal gland
releases melatonin; maintenance of sleep-wake cycles
panic disorder
repeated panic attacks and fear of future attacks
echolalia
repetition of the words and phrases of others
thalamus
responsible for consciousness, sleep, and sensory interpreatation.
lateral hypothalamus
responsible for hunger
Frontal lobe
responsible for personality, motor functions, problem solving, behavior, and memory. movement, speech production.
endocrine system
responsible for release of hormones into bloodstream; responses to input from hypothalamus
parasympathetic nervous system
rest and digest; storage of energy
nucleus accumbens
reward and pleasure
Local agencies
river edge, oconee center
humanistic approach
saw people as inherently good and motivated to learn and improve
1
schizophrenia affects what percentage of the population?
valerian ADE
sedation, GI ipset, N/V, HA, excitability, uneasiness, ataxia
Cognitive Behavioral therapy
seeks to make people aware of irrational negative thoughts and replace them with new ways of thinking AND practice a more positive approach in everyday settings
ginkgo biloba response
seen 2-3 wks full affect 3 months
electroconvulsive therapy (ECT)
seizures are induced in an anesthetized patient; used to treat mood disorders that have not responded to medication
somatic sensory association cortex
sensations such as temperature touch, and pain.
perceptions
sensory awareness of objects in the environment and their interrelationships
Sensory receptors
sensory nerve ending that responds to a stimulus in the internal or external environment of an organism
Wilhelm Wundt
set up first psychological laboratory; a founder of structuralism
Gonads
sex glands
psychological model
show abnormalities resulting from life experiences
valerian MOA
similar to BZD treat sleep disturbances limited use for anxiety
kava MOA
similar to BZDs -alter limbic system
main parts of the neuron
soma (cell body), axons (transmit info), dendrites (receive info)
psychological problems that result in bodily symptoms or physical complaints
somatoform disorders
persecutory
someone or something is out to get them
psychologist
specialist of the mind
neurons
specialized nerve cell that receives, processes, and transmits information to other cells in the body. We have a fixed number of neurons, which means they do not regenerate.
psychiatry
specialty of the mind dealing with treatment of mental disorders
autism
spectrum of mental disorders, the features of which include onset during infancy, or childhood, preoccupation with subjective mental activity, inability to interact socially and impaired communication
Broca's area
speech production in left hemisphere
incoherence/word salad
speech that is incomprehensible and illogical, with a lack of meaningful connections. severe psychotic disturbances
clanging
speech with choice of words based on sound, rather than meaning, as in rhyming and punning. it occurs in manic episodes and schizophrenia
circumstantiality
speech with unnecessary detail, indirection, and delay in reaching the point. common in those without mental disorder
Depression
start early 30's more common in females mood disorders
substance/chemical dependence
state of periodic or chronic intoxication by repeated consumption of a drug (natural or synthetic).
In 2014, an estimated 9.8 million adults aged 18 and older in the United States had a serious mental illness, and 1.7 million of which were aged 18 to 25. Also 15.7 million adults (aged 18 or older) and 2.8 million youth (aged 12 to 17) had a major depressive episode during the past year. In 2014, an estimated 22.5 million Americans aged 12 and older self-reported needing treatment for alcohol or illicit drug use, and 11.8 million adults self-reported needing mental health treatment or counseling in the past year
statistics
Cues to action
strategies
sources of causality
strong genetic vulnerability (50% concordance rate in twins); environmental factors (birth month, stress)
behavioralism
study and careful measurement of observable behaviors
behavioral health
study of emotions, behaviors, biology relating to a person's mental well-being, ability to function "mental health" is preferred
psychology
study of the mind and mental processes in relation to human behavior
SAH
subarachnoid hemorrhage
mood
subjective; ask the patient to describe his or her mood
dependent personality disorder
submissive and clinging behavior with an excessive need to be cared for by others. Lack of self confidence, low self worth, allow others to make important decisions
blocking
sudden interruption of speech in midsentence or before the idea is completed. can occur in normal people or schizophrenia
Diathesis-stress Model
suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress
diathesis-stress model
suggests that biological vulnerabilities for a disorder interact with a person's experience of stress
sulci
sulci and fissures are both grooves in the cortex but they are differentiated by size. A sulcus is a shallower groove that surrounds a gyrus.
Cerebrum
superior to pons Medulla Oblongata. responsible for thoughts and action
what type of services play an important role in promoting health and recovery?
supportive services (case or care management)
Treatment for Geriatric depression Timeframe
takes longer up to 12 weeks to reach steady state If no response by 4 weeks-not coming If some response-maximize dose and wait
derailment
tangential speech with loosely connected or unrelated topics; schizophrenia or manic episodes
Psychoeducation
teaches people about their illness and how they'll receive treatment. includes education for family and friends where they learn things like coping strategies, problem-solving skills and how to recognize the signs of relapse. Family can often help ease tensions at home, which can help the person experiencing the mental illness to recover. Many of NAMI's education programs are examples of this.
Cerebellum
the "little brain" at the rear of the brainstem that processes sensory input and coordinates movement output and balance
philosophy and natural sciences
the 2 major roots of psychology
health, home, purpose, community
the 4 major dimensions of recovery are:
Medulla
the base of the brainstem that controls heartbeat and breathing
Endocrine System
the body's chemical communication system that is made up of a set of glands that secrete hormones into the bloodstream
Endocrine system
the body's chemical communication system that is made up of a set of glands that secrete hormones into the bloodstream
Nervous system
the body's electrochemical communication network that consists of all the nerve cells of the peripheral and central nervous systems
Central nervous system (CNS)
the brain and spinal cord
Plasticity
the brain's ability to change, especially during childhood, by reorganizing after damage or by building new pathways based on experience
Thalamus
the brain's sensory switchboard located on top of the brainstem that directs messages to the sensory receiving areas in the cortex and transmits relies to the cerebellum and medulla
Biological psychology
the branch of psychology that links biology and behavior
Dendrite (receive)
the branches that extend from the nerve cell body. These receive messages and conduct impulses towards the body
ADHD
the causes of _______ are genetic (heritability 70%), and environmental factors
Personality
the complex of characteristics that distinguishes an individual or a nation or group; especially : the totality of an individual's behavioral and emotional characteristics
Central Nervous System (CNS)
the complex of nerve tissues that controls the activities of the body. In vertebrates, it comprises the brain and spinal cord
promotion, prevention, treatment, recovery
the continuum of care are
Somatic nervous system
the division of the PNS that controls the skeletal muscles
Axon (relay)
the extension of the neuron that has fibers on the end that pass information to other neurons or to muscles
Cerebral cortex
the fabric of interconnected neural cells covering the cerebral hemispheres and the body's ultimate control and information-processing center
Wilhelm Wundt
the first psychologist who constructed the first experiment was
Neurogenesis
the formation of new neurons
hope
the foundation of recovery
Insula
the insula has combined sensory and autonomic information from the internal organs. It can affect certain language functions, as evidenced by the loss of ability in speaking or understanding in patients with some insular damage. The insula processes pain, temperature sensation and possibly taste.
Cerebral Cortex
the intricate fabric of interconnected neural cells that covers the cerebral hemispheres; the body's ultimate control and information-processing center
Gender
the state of being male or femal
parity
the state or condition of being equal, especially regarding status or pay.
Hypothalamus
the structure below the thalamus that directs eating, drinking, body temperature, as well as helping govern the endocrine system via the pituitary gland. Linked to emotion and reward
Cognitive therapy
therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions
88,000
there are ___________ deaths in a year caused by excessive alcohol
cerebral cortex
thin layer of gray matter covering cerebral hemispheres
Loosening of associations
thinking or speech disturbance involving a disorder in the logical progression of thoughts, manifested as a failure to communicate verbally adequately; unrelated and unconnected ideas shift from one subject to another (i.e. he went to the ballpark and brought Frank's beer belly home in a bag of grass seed)
PTSD
treatment for __________ includes: exposure therapy with or without SSRI's
bipolar disorder
treatment for __________ includes: medication (lithium); has serious negative side effects; poor compliance
schizophrenia
treatment for __________ includes: phenothiazines (medication) reduce psychotic symptoms; don't affect negative symptoms and don't work in 1/4 of schizophrenia patients
Lesion
tissue destruction caused either naturally or experimentally
Lesion
tissue destruction; a brain lesion is a naturally or experimentally caused destruction of brain tissue
TIA
transient ischemic attack
somatic nervous system
transmits commands for voluntary movement
Transverse fissure
transverse fissure is what separates the cerebrum from the cerebellum
psychotherapy
treatment designed to improve symptoms of psychological disorder through conversation between the therapist and client
autism spectrum disorder
treatment for __________ includes: ABA therapies to help with socially important behaviors
major depressive disorder
treatment for __________ includes: antidepressants (SSRI's); CBT therapy also used to increase activity levels and social skills
OCD
treatment for __________ includes: antidepressants; CBT therapy (highly effective)
anxiety disorder
treatment for __________ includes: benzodiazepines (enhance effects of GABA); CBT therapy
erotomanic
you think someone is in love with you
Persistent depressive disorder
•Chronic depression, most days for at least two years in adults one year for children and adolescents. •No more than two months symptom-free during that time •Often occurs in childhood, adolescence, or early adulthood and tends to be chronic •Symptoms similar to those of MDD but less severe
lifespan consideration for older adults associated with depression
•Depression is not a normal part of aging, but common in older adults. other conditions complicate treatment of depression. depression also make other treatment complicated.