Psych Quiz 2

if you suspect someone is suicidal what should you ask them?

ask them directly if they are suicidal

After someone admits suicidal ideation what do you do?

ask: Will you go with me to get help? Will you let me help you get help? Will you promise not to kill yourself until we find some help?

B12/folate deficiency dementia

assoc w/ anemia, peripheral neuropathy; improved w/ vitamin replacement

when does genital touching become goal oriented?

at puberty

what are some triggers of suicidal ideation?

crisis in relationship, loss of freedom, fired/expelled, illness, major loss

numerous instances (for at least 2 years) with hypomanic symptoms that don't meet criteria for a hypomanic episode and numerous instances w/ depressive symptoms that don't meet criteria for a major depressive episode

cyclothymic disorder

which antidepressant increases suicidal ideation in youth? which causes seizures?

SSRIs DNRI and tricyclics

which antidepressants have withdrawal syndrome?

SSRIs and SNRIs

what is the expected time line of "baby blues"?

"baby blues": 2-3 days postpartum, resolves ~15 days (50-85% incidence rate)

why should you avoid antidepressant monotherapy in bipolar I?

"uncovered" antidepressant treatment causes switches to mania in bipolar I and probably in bipolar II disorder

what is the incidence rate of postpartum depression?

10%

______% of adolescents do not use contraceptives during their first sexual experience & that ______% of all pregnancies occur during the first _______ months of sexual activity.

35% of adolescents do not use contraceptives during their first sexual experience & that 20% of all pregnancies occur during the first two months of sexual activity.

81-93%of those with completed suicide have a diagnosable __________________ at the time of death

81-93%of those with completed suicide have a diagnosable psychiatric illness at the time of death, usually depression, alcohol abuse, or both

81-93%of those with completed suicide have a diagnosable psychiatric illness at the time of death, usually ____________, ____________ or both

81-93%of those with completed suicide have a diagnosable psychiatric illness at the time of death, usually depression, alcohol abuse, or both

Non-Hispanic white men age ______ or older have the highest rate of suicide. in state of TN, the __________ are the highest risk group for death by suicide.

85 babyboomers

After _____ discrete episodes of MDD, research suggests patients should be on "antidepressants for life" to reduce morbidity and mortality.

After 3 discrete episodes of MDD (recurrence rate of 90% at that point), research suggests patients should be on "antidepressants for life" to reduce morbidity and mortality.

Pt presents w/ short term memory loss, apraxia, confusion, decreased ability to recognize people. EEG shows beta amyloid tau proteins and neurofibrillary tangles in the hippocampus, parietal, & occipital lobes. Genetic testing reveals ApoE4 gene defects on ch 19. Diagnosis?

Alzheimer's

Second Generation Antipsychotics (SGA's); "Atypical antipsychotics"

Anti-mania treatment; Use ACUTELY; can cause tardive dyskinesia, neuroleptic malignant syndrome, and EPS; more likely than the "typicals" to cause weight gain with basal metabolic syndrome

Antidepressants can precipitate a switch to ________ in some patients

Antidepressants can precipitate a switch to mania in some patients

Clozapine

Atypical antipsychotic w/ minimum D2 blockage: minimal risk for Tardive Dyskinesia but highest risk for metabolic syndrome a. ↑ positive symptoms b. ↑ negative symptoms c. ↑ cognitive symptoms d. Fewer extrapyramidal side effects e. Sedation and more weight gain f. Metabolic side effects: Hyperglycemia, insulin resistance, & dyslipidemia

Atypical MDD

Atypical: Increased weight or appetite, hypersomnia (excessive daytime sleepiness), leaden paralysis, rejection sensitivity, retain reaction to reward

what is the best referral for a suicidal patient? 2nd best?

Best referral: take directly to someone who can help (psych referral; "warm hand-off") 2nd best: get commitment from them to accept help; arrange to get help 3rd best: give referral information; get good faith commitment for no attempt Any willingness to accept help = good outcome

Catatonic MDD

Bizarre posturing, motoric immobility, extreme negativism or mutism, or sometimes excessive motor activity, detachment, refusal to eat or drink

what do preschoolers need to know about sex? 5 things

Boys and girls are different Accurate names for body parts of boys and girls Babies come from mommies Rules about personal boundaries (for example, keeping genitals covered, not touching other children's genitals) Simple answers to questions about the body and bodily functions

what do 4-6 yr olds need to know about sex? 5

Boys' and girls' bodies change when they get older Simple explanations of how babies grow in their mothers' wombs and about the birth process Rules about personal boundaries (such as, keeping genitals covered, not touching other children's genitals) Simple answers to all questions about the body and bodily functions Touching your own genitals can feel nice, but is something done in private

how does postpartum depression damage the mother? the marriage? the baby?

Can cause damage to mother (injury to self-esteem, loss of expectations), marriage (↑ conflict, irritability, withdrawal; ↓ libido), and baby (insecure attachment, poor cognitive development, behavioral problems)

Chronic MDD

Chronic: Duration of more than 2 years diagnosed as Persistent Depressive

depression is common after MI (40 - 65% of patients), Depression may decrease/increase platelet aggregation

Common after MI (40 - 65% of patients), increases mortality rate Depression may increase platelet aggregation

Lamotrigine

DEPRESSIVE bipolar illness; estrogen contraceptives may decrease lamotrigine levels; lamotrigine can lower progestin oral contraceptive levels ("mini-pills"). Prophylaxes but not acute Tx of depression. Not effective against the manic phase

which antidepressants do not cause weight gain? sedation?

DNRI (Buproprion), SARIs DNRI causes agitation not sedation

Death by suicide occurs more frequently in Caucasian/non-caucasian males except in ages ______ - ______. what race is most at risk in this age group

Death by suicide occurs more frequently in Caucasian males than in non-Caucasians except in ages 15-24. Native American males at highest risk in this age group.

It is important to treat underlying cause of depression in these 3 depressive conditions:

Depressive Disorder due to Another Medical Condition Substance/Medication Induced Mood Disorder Premenstrual Dysphoric Disorder

Typical antipsychotic tx

Dopamine D2 blockers -Produce extrapyramidal symptoms -↑ Prolactin levels -Equally effective but differ in potency/side-effects - Largely effective for positive symptoms (e.g. delusions, hallucinations, disorganization of thought and behavior

an excess of what NT is thought to cause psychotic symptoms? what triggers a psychotic break?

Dopamine; Big life stressor

what is the most effective treatment of depression? what are the risks?

Electroconvulsive Therapy (ECT) transient confusion & short-term memory loss; headache

what are 5 other disorders that can cause depression?

Endocrine disorders: Cushing's disease, Addison's disease, diabetes mellitus, hypothyroidism, hyperthyroidism Collagen diseases: rheumatoid arthritis, temporal arthritis, polymyalgia rheumatic Chronic infections: infectious mononucleosis, hepatitis, herpes zoster, tuberculosis Neoplasms: cancer of lung, brain, head of pancreas Neurological diseases: Parkinsonism, CVA, MS, Alzheimer's

Genital touching: Boys at ___-___ months Girls at ___-___ months

Genital touching: Boys at 7-8 months Girls at 9-10 months Generally not purposeful or directed toward orgasm Parents' reactions are important

Which one of these tips is not helpful to a suicidal person? Be calm; show caring by listening closely; don't change topic or minimalize Communicate that you are there to help the person Offer reflections and empathy; enhance hopefulness "I want you to live." "I'm on your side. We'll get through this." Discuss suicide openly; assess risk and motives Provide psychoeducation on disorders and their treatments Have them sign a contract saying they will not hurt themselves Encourage and promote social support Get others involved - family, friends, etc. Point our realistic strengths; identify attainable goals Join a team - work with clergy, therapists, psychiatrists, family, etc. Take action - do not leave alone if immediate life threatening situation Follow up - visit, call, send card, etc. to let them know you care about what happens to them

Have them sign a contract saying they will not hurt themselves- not a very effective intervention without other help

Nicholas CAGe presents w/ paranoia (surprise, surprise), increased impulsiveness, memory loss, and "dance like" movements of his arms. Neuroimaging shows butterfly pattern. Diag?

Huntington's disease (CAG repeat on Ch. 4; AD)

If untreated, MDD duration is ____-_____ mo. versus if treated, lasts approx. ______ mo. About ____% of patients respond to antidepressants

If untreated, duration 6-13 mo. versus if treated, lasts approx. 3 mo. About 67% of patients respond to antidepressants

Pt presents w/ sever motor impairment and visual hallucinations. Wife states he's been increasingly agitated/aggressive lately. Neuroimagine shows presence of Lewy bodies in the frontal/parietal/occipital lobes. Diag?

Lewy body dementia

MDD 2X as common in women/men as women/men is most common in _____-____ year olds.

MDD 2X as common in women as men, and has a 20% women and 10% men lifetime prevalence (so very common) and is most common in 20-50 year olds.

what is double depression?

MDD on top of persistent depressive disorder

Patients with depression may develop psychotic symptoms, such as auditory hallucinations & delusions Content of hallucinations and delusions is usually congruent with mood (e.g. self-condemning)

MDD w/ psychotic features

how might elderly depression differ from normal presentation? what about children?

May present as somatic complaints or mimic dementia children may act out or also have somatic complaints

Melancholic MDD

Melancholic: Lack of pleasure in virtually all activities (anhedonia), lack of reactivity, distinct quality of depressed mood, diurnal variation, early morning awakening, severe vegetative symptoms

DA pathway for fine motor fxn; normal in schizophrenia; tx causes Parkinsonism sxs

Nigrostriatal pathway (sub nigra=striatum)

What does a diagnosis of major depressive disorder require?

One of these is required (patient-reported): Dysphoria (sad or irritable mood) Loss of interest/capacity for pleasure And four of these are required: Change in sleep Change in appetite Trouble concentrating Suicidal thoughts Guild, self-blame, worthlessness Decreased energy Psychomotor agitation or retardation

Onset of puberty is between ages of _____ and ____. It occurs (earlier/later) in females than males

Onset between ages of 8 and 16 earlier

Pt presents w/ tremor for the past 3 months. He has trouble standing up from a seated position and shows cogwheel rigidity/flat affect. EEG shows radiations of dopamine neurons in the basal ganglia and presence of Lewy bodies. Diag?

Parkinson disease

Pt presents w/ recurrent episodes of impulsive behavior. Family states he's been overtly sexual at family functions lately, which spurred them to make the appointment. Pt shows poor hygiene, poor social interaction w/ doc. Mental status exam shows no memory deficits or aphasia. Diag?

Pick disease (primary frontotemporal dementia)

Schizophrenia Positive sxs? Negative sxs? Cognitive sxs?

Pos: hallucinations, delusions, disorganized thought process, disorganized behavior Neg: loss of fxn/emotion; Flat affect, alogia, avolition, asociality Cognitive: impairment in executive functioning, reduced attention span, concrete thinking

what is the main concern in postpartum psychosis?

Postpartum psychosis: concern for homicidal ideation against baby, often requires hospitalization

what are some things that correlate with areas of the country that have the heaviest rates of suicide

Poverty, social and income inequality, low education, physical health problems have a direct correlation in the areas of the country with heaviest rates of suicide.

Preschool (Less than 4 years old) sexual development: 7 common activities related to sexual development

Preschool (Less than 4 years old): Touching genitals, in public and in private Showing genitals to others Trying to touch mother's or other women's breasts Removing clothes and wanting to be naked Attempting to see other people when they are naked or undressing (such as in the bathroom) Asking questions about their own, and others', bodies and bodily functions Talking to children their own age about bodily functions such as "poop" and "pee"

what is the most lethal combination for suicide?

Psychological distress + alcohol/drugs + firearm (especially rural males)

What are some normal sexually related activities of young children 4-6? what motivates them?

Purposefully touching genitals (masturbation), occasionally in the presence of others Attempting to see other people when they are naked or undressing Mimicking dating behavior (such as kissing, or holding hands) Talking about genitals and using "naughty" words, even when they don't understand the meaning Exploring genitals with children their own age (such as "playing doctor", "I'll show you mine if you show me yours," etc.) Sexual activity with others - pre-pubertal Motivated by curiosity, not erotic desire As likely with same sex as opposite sex Children are "students," not "voyeurs"

Normal sexual development of school aged children (7-12)?

Purposefully touching genitals (masturbation), usually in private Playing games with children their own age that involve sexual behavior (such as "truth or dare", "playing family," or "boyfriend/girlfriend") Attempting to see other people naked or undressing Looking at pictures of naked or partially naked people Viewing/listening to sexual content in media (television, movies, games, internet, music, etc.) Wanting more privacy (for example, not wanting to undress in front of other people) and being reluctant to talk to adults about sexual issues Beginnings of sexual attraction to/interest in peers

what are some drugs that can cause depression?

Result of treatment for another illness (e.g. steroids, beta-blockers, reserpine, alpha-methyldopa) Caused by drug or alcohol abuse (e.g. opiates, speed)

Risk factors for suicide attempts by youth include depression, ___________ or _____________ disorder, ___________ or ___________ abuse, and aggressive/disruptive behavior.

Risk factors for suicide attempts by youth include depression, alcohol or other drug-use disorder, physical or sexual abuse, and aggressive/disruptive behavior.

What does SIGECAPS stand for?

S: sleep disturbances I: interest in activities decreased G: guilt E: energy decreased C: concentration decreased A: appetite/weight changes P: psychomotor agitation or retardation S: suicidal ideations

which antidepressant causes priapism? cardiac problems?

SARIs trycyclics

Suicide is not the problem; it is the _______________ _________________ to a temporary problem

Suicide is not the problem; it is the perceived solution to a temporary problem

Suicide is the _______ leading cause of death in US and _______ leading cause death in 15-24 year olds

Suicide is the 10th leading cause of death in US and 3rd leading cause death in 15-24 year olds

- Abnormal, involuntary, irregular choreoathetoid movements of the muscles of the head, limbs and trunk - Common examples: darting, twisting or protruding movements of the tongue, chewing, lip puckering, facial grimacing. - Rarely before 6 months of treatment - Children and patients >50 years old are more likely to develop it Regular monitoring with AIMS score. - Rx: 1. Reduce dose or stop medication 2. Consider atypical antipsychotic medications with lower risk 3. Clozapine is the only antipsychotic with minimal risk

Tardive dyskinesia

what is the most likely antidepressant to work?

The most likely antidepressant to be effective for an individual is one that has worked for that person in the past (as long as the person was not on it so long that they became tolerant to the maximal recommended dosage) or one that worked well for a blood relative.

what do school aged children need to know about sex? 5 things

What to expect and how to cope with the changes of puberty (including menstruation and wet dreams) Basics of reproduction, pregnancy, and childbirth Risks of sexual activity (pregnancy, sexually transmitted diseases) Basics of contraception Masturbation is common and not associated with long term problems but should be done in private

what is persistent depressive disorder

a persistent depressed mood of 2 yrs plus 2 other MDD sxs instead of episodes of deep depressed state

what is a major feature of postpartum depression that is not an MDD feature?

anxiety. While anxiety is often comorbid in depression, marked anxiety is often a part of postpartum depression

A bipolar person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions The psychotic symptoms tend to reflect the person's extreme mood Ex: belief he/she is famous, lots of money, magical powers

bipolar disorder w/ psychotic features

Same diagnostic criteria as schizophrenia, but duration is < ONE MONTH. o Treat with antipsychotic

brief psychotic disorder

by age _____ most males and females have had PVI

by age 19 most males and females have had PVI

what are some of the things that make up the wall of resistance between contemplation of suicide and completion?

counselor, duty to others, good health, medication compliance, fear, job security, responsibility to children, support of spouse, sense of hope, best friend, positive self esteem, sobriety

what deficits most negatively affect a patient w/ schizophrenia?

cognitive deficits that happen gradually; mood/negative sxs second most damaging

Explain the impersonal theory of suicide

combination of percieved burdensomeness and thwarted belongingness combined with acquired capacity for suicide results in highest risk for suicide completion

normal pressure hydrocephalus dementia

compression of cortical tissue around the ventricles; bad gait problems and incontinence; better w/ early diag/shunting "wacky, wobbly, & wet!"

Non-bizarre delusions (involving situations that occur in real life, such as being followed, poisoned, infected, loved at distance or deceived by spouse) for 1 month Subtypes: Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed,

delusional disorder

what is the prognosis of early onset MDD? late onset?

early onset (in childhood) predicts long and difficult course whereas later onset is usually due to organic causes so is easier to treat

what other illnesses may predispose a pt to depression?

endocrine disorders, collagen diseases, chronic infections, neoplasms, neurological diseases, MI

which gender is more likely to attempt suicide? which is more likely to succeed?

female, male

HIV infection/AIDS-related infection dementias

frontal symptoms, remit w/ treatment of infxn

_____________ and a history of _________________ ______________ ____________ are strong prospective risk factors for death by suicide.

hopelessness and a history of previous suicide attempts are strong prospective risk factors for death by suicide.

What indicates a good prognosis for Schizophrenia?

late onset, acute onset, female, positive sxs, co-morbid mood disorder, married, good pre-morbid functioning, no aggressive behavior

what should be included in a medical screen for depression?

review of systems, physical exam, cbc, thyroid function tests, tests for autoimmune factors

DA pathway for cognition; LOW negative sxs in untreated schizophrenia; tx causes expressionless faces/mutism

mesocortical pathway: VTA-prefrontal cortex

DA pathway for: Reward, functions of limbic system; HIGH positive sxs in untreated schizophrenia; tx remits positive sxs

mesolimbic pathway: VTA-Limbic system

Abdominal obesity Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol) Elevated blood pressure Insulin resistance or glucose intolerance

metabolic syndrome

- Muscle stiffness (lead pipe rigidity), cogwheel rigidity, shuffling gait, stooped posture, coarse tremors, perioral-lips tremors (rabbit syndrome) - 5 to 90 days after initiation of treatment for Schizophrenia (anti-psychotic) - Elderly and female are at higher risk - Rx: Benztropine (Cogentin) or Diphenhydramine (Benadryl)

neuroleptic induced parkinsonism

- Life threatening complication that occur any time during the course of the treatment for Schizophrnia w/ anti-psychotic. Mortality rate: 10 to 20 % - Muscular rigidity, dystonia, akinesia, mutism, obtundation, agitation - Autonomic symptoms: high fever, sweating, increased pulse and BP - Increased CBC, CPK, liver enzymes, plasma myoglobin, myoglobinuria - Rx: 1. Supportive care 2. Dantrolene sodium- muscle relaxant 3. Bromocriptine and Amantadine- dopamine agonist

neuroleptic malignant syndrome

what are some behavioral cues for suicide?

preoccupation with death, acquiring means, putting affairs in order and giving away prized possessions, changes in personality/behavior

MS dementia

scattered white matter lesions, worsen w/ flares, sxs reversed by tx

Marked disturbances in motor function o Motor immobility, waxy flexibility, stupor o Extreme negativism ( resistance to instructions or attempts to be moved) o Bizarre posturing o Excessive motor activity ( Purposeless and not influenced by external stimuli)

schizophrenia w/ catatonic features

o Schizophrenia criteria are met, PLUS: o Loss of functions and emotions that healthy individuals have. o Flat affect, alogia, avolition, asociality.

schizophrenia w/ prominent negative features

Same diagnostic criteria as schizophrenia but duration is 1-6 months; Tx=antipsychotic

schizophreniform disorder

Resident started on an antidepressant and presents to the ER with: • agitation, confusion, rapid heart rate, elevated dilated pupils, loss of muscle coordination, heavy sweating, diarrhea, headache, shivering, overresponsive reflexes, fever, seizures, irregular heartbeat, unconsciousness

serotonin syndrome; can be fatal!

how does serotonin syndrome present? what causes it?

similar presentation to carcinoid tumor: agitation, confusion, rapid heart rate, elevated dilated pupils, loss of muscle coordination, heavy sweating, diarrhea, headache, shivering, overresponsive reflexes, fever, seizures, irregular heartbeat, unconsciousness caused by excess stimulation of serotonin

strongest risk factors for suicide attempts in adults are _________ disorders and ______________ ___________ ____________ disorders.

strongest risk factors for suicide attempts in adults are mood disorders and comorbid substance use disorders.

which antidepressant causes blurred vision? dry mouth? GI symptoms?

tricyclics tricyclics SSRIs and SNRIs

DA pathway for prolactin secretion; normal in schizophrenia; tx causes increased prolactin secretion

tuberoinfundicular pathway (hypothalamus-pituitary)

women with history of MDD are more/less at risk when perimenopausal

women with history of MDD are more at risk when perimenopausal