Ipc 6 Including Ipc Drugs

Front 1

Case formulation (3 components)

Back 1

1) What is wrong

2) How it got that way

3) What can be done about it

Front 2

Case formulation vs diagnosis

Back 2

Case formulation includes the diagnosis and the integrated tx plan. May not always be a straightforward DSM diagnosis

Front 3

5 Categories for mental status exam

Back 3

1) General appearance, behavior, and attitude (GABA)

2) Mood & affect (M&A)

3) Thought process (TP) - how

4) Thought content (TC) - what

5) Sensorium and cognition (S&C)

Front 4

Indicators for psychiatric illness (5)

Back 4

1) Disheveled (schiz, depression)

2) Bizarre (mania, schiz)

3) Hygiene, makeup (looking at change, self esteem)

4) Flamboyant/seductive (mania, histrionic)

5) Appropriate for setting/weather

Front 5

Difference between mood and affect

Back 5

In theory, mood is subjective; affect, objective because it is what is observed by the clinician

Front 6

Thought process

Back 6

How the patient is thinking (speech patterns, goal directedness, organization)

Front 7

Affect descriptors (4)

Back 7

1) Range (full, constricted, flattened)

2) Intensity

3) Stability (vs. labile)

4) Appropriate and congruent with mood

Front 8

Examining suicidal/homicidal ideation (4 components)

Back 8

1) Passive deathwish vs. actively suicidal/homicidal

2) Do they have plans and means?

3) Have they written a note?

4) Appearance of imminent danger

Front 9

Types of hallucinations, typical associations (4)

Back 9

1) Auditory (psychiatric

2) Visual (medical/organic)

3) Olfactory/gustatory (usually organic)

4) Tactile ("bugs crawling," withdrawal)

Front 10

Examples of thought content (7)

Back 10

1) Suicidal/homicidal

2) Phobia

3) Preoccupation

4) Flashbacks

5) Illusions (misinterpretation of a stimulus that is actually there)

6) Hallucinations (no stimulus)

7) Delusions (fixed false belief)

Front 11

Sensorium and cognition is effectively the same as...

Back 11

... the Mini-Mental Status Exam

Front 12

Depressive disorders (DSM-V) (3)

Back 12

1) Dysthymic disorder

2) MDD

3) Depressive disorder NOS

Front 13

Bipolar disorders (DSM-V) (4)

Back 13

1) Cyclothymia

2) BD-I

3) BD-II

4) OSBRD (Other specified bipolar and related disorder)

Front 14

Bipolar I definition

Back 14

One or more manic or mixed episodes, usually accompanied by major depressive episodes (male = female)

Front 15

Bipolar II definition

Back 15

One or more major depressive episodes accompanied by at least one hypomanic episode (female > male)

Front 16

Cyclothymia definition

Back 16

At least 2 years of numerous periods or hypomanic and depressive symptoms

Front 17

Other specified bipolar and related disorder definition

Back 17

Bipolar features that do not meet criteria for any specific bipolar disorders

Front 18

Hypomanic episode definition (3)

Back 18

1) Period of persistent elevated, expansive, irritable mood (4 days)

2) Observable by others

3) Does not impair function, no psychotic features or hospitalization

Front 19

Manic episode mnemonic

Back 19

DIGFAST - need 3 (4 if only irritable)

Distractibility

Insomnia

Grandiosity

Flight of Ideas

Activity

Speech (pressured/subjective)

Thoughtlessness (spending/driving/sex)

Front 20

BD-I with psychotic features and additional treatment

Back 20

-- Delusions, hallucinations, grandiose &c.

-- Mood incongruency

Often needs antipsychotic medications

Front 21

Suicidality in BD vs. MDD

Back 21

Much more likely in BD (80% of patients exhibit significant suicidality)

Front 22

Untreated course of bipolar disorder

Back 22

Episodes occur more and more often. More common in BD-II because less likely to get treated initially (BD-I more severe).

Front 23

Usual sx in bipolar disorder (6)

Back 23

1) Depression

2) Mania/hyperactivity

3) Lack of sleep

4) Mood swings

5) Anger/irritability

6) Delusions/paranoia

Front 24

Predictors of suicide in bipolar disorder (5) and statistics fo suicide

Back 24

1) High impulsivity

2) Alcohol/substance abuse

3) Depression, mixed episodes

4) Hx of abuse in childhood

5) Exacerbation by incorrect tx

~50% attempt suicide, ~15% succeed

Front 25

Risk of using antidepressants in bipolar disorder

Back 25

Can cause the patient to go into a manic episode. Becomes a risk factor for suicide.

Front 26

Basic pathophys for bipolar disorder

Back 26

Dysregulation between excitatory and inhibitory neurotransmitters (excessive vs. deficient NE, DA)

Front 27

Treatment of acute mania in bipolar disorder (2 steps)

Back 27

1) Initiate mood stabilizer (lithium, valproic acid, carbamazepine)

2) Adjunctive tx: benzodiazepine vs. antipsychotic (the latter if psychosis)

Front 28

Liver friendly benzos (LOT) (adjunctive tx for BD)

Back 28

Lorazepam, oxazepam, temazepam

Front 29

MOA of Lithium

Back 29

Enhances GABA, decreases serotonin reuptake, increases postsynaptic serotonin receptor sensitivity.

Front 30

Risks (5) and monitoring (3) of lithium

Back 30

Hypothyroidism, flattening of T waves, pregnancy category D, can cause leukocytosis, can cause inability to concentrate urine.

Want to monitor Na+, K+, SCr/BUN

Front 31

Valproic acid uses and limitations

Back 31

As effective as lithium for acute mania, more so for mixed episodes, more rapid onset, but more GI upset

Front 32

Major lithium drug interactions (3)

Back 32

1) Sodium-depleting drugs (thiazides)

2) NSAIDs (increases serum lithium)

3) Volume depletion and reduction in GFR (ACEi) - reduced Li+ clearance

Front 33

MOA of valproic acid

Back 33

Increases GABA, normalizes Na+/Ca2+

Front 34

Monitoring, SE of valproic acid (4)

Back 34

1) Category D for pregnancy

2) LFTs every 3-6 months (can cause hepatitis, pancreatitis)

3) Peripheral edema

4) Polycystic ovary

Front 35

Carbamazepine uses

Back 35

As effective as lithium for acute mania, better for mixed mania, rapid cyclers, organic mania

Front 36

MOA of carbamazepine

Back 36

Blocks voltage sensitive sodium channels, blocks calcium influx through NMDA glutamate receptor

Front 37

Monitoring of carbamazepine

Back 37

Electrolytes because of SIADH, LFTs

Lots of drug-drug interactions

Front 38

Adverse effects of carbamazepine (4)

Back 38

1) Diplopia, dizziness, and drowsiness

2) Cardiac conduction problems

3) Rarely, SJS/TEN

4) Teratogenic

Front 39

Lamotrigine use

Back 39

Maintenance tx of BD-I

Front 40

Major adverse effect of lamotrigine

Back 40

Rash (SJS), especially if titrated quickly

Front 41

MOA of lamotrigine

Back 41

Blocks voltage-sensitive Na+ channels, modulates glutamate

Front 42

Basis of cognitive behavioral therapy

Back 42

Based on idea that thoughts cause our feelings and behavior, not external factors

Front 43

Types of psychotherapy (3)

Back 43

1) Cognitive-behavioral therapy

2) Dialectical behavior therapy

3) Acceptance and commitment therapy

Front 44

Commonalities among psychotherapies (4)

Back 44

1) Strong therapeutic alliance

2) Opportunity for catharsis

3) Practicing new behaviors

4) Patient's positive expectation for help

Front 45

BATHE (how to interview patients with psychotherapeutic techniques)

Back 45

Background

Affect

Trouble (what troubles you most?)

Handling

Empathy

Front 46

Uses for ACT (Acceptance and commitment therapy)

Back 46

Uses mindfulness as a way to handle pain without avoiding it.

Front 47

Use for DBT (dialectical behavior therapy)

Back 47

Developed for borderline personality disorder, but generally good for emotion dysregulation

Front 48

Positive BATHE

Back 48

Best thing that happened today

Affect: How'd that make you feel?

Thankfulness

Happen (how to make good things happen more frequently)

Empathy/Empowerment

Front 49

Current model for depression risk

Back 49

"Diathesis-stress model" - genetic + psych (past & present) + social (current stressors)

Front 50

Approximate % of US with MDD, median age of onset

Back 50

6.7%

Age: 32

Front 51

Family Hx risk factors for depression (4)

Back 51

1) Depression

2) Bipolar disorder

3) Alcohol abuse

4) Other psychiatric illness

Front 52

Diagnostic criteria for major depressive disorder (9)

Back 52

5+ for 2+ weeks:

1) Depressed mood

2) Loss of interest/pleasure

3) Appetite/weight change

4) Sleep disturbance

5) Psychomotor disturbance

6) Fatigue/low energy

7) Feelings of worthlessness/inappropriate guilt

8) Impaired ability to think or concentrate

9) Recurrent thoughts of death or suicide

Front 53

3 most common primary care presenting symptoms for depression

Back 53

Fatigue

Pain

Sleep disturbance

Front 54

Common concomitant conditions with depression (5)

Back 54

1) Cancer

2) Diabetes

3) Postpartum

4) Post-stroke

5) Post-myocardial infarction

Front 55

High risk demographics for suicide (8)

Back 55

1) Male

2) White

3) Older

4) Living alone/unmarried/separated

5) Unemployed

6) Family hx

7) Recent loss

8) Poor health status or pain

Front 56

Patient Hx risk factors for depression (3)

Back 56

1) Gender

2) Periods of significant depression in the past

3) Previous episodes of other psychiatric disorder(s)

Front 57

Advantages of serotonin agents for depression (3)

Back 57

1) Safety

2) Less orthostatic hypotension, anticholinergic SE, adverse cardiac effects than TCA

3) Increased patient satisfaction

Front 58

Disadvantages of serotonin agents for depression (4)

Back 58

1) Other drug interactions

2) Lack of sedation

3) Development of serotonin syndrome

4) Some distressing side effects (~2%)

Front 59

MOA of tricyclic antidepressants

Back 59

Inhibition of 5-HT and NE reuptake by presynaptic neurons

Front 60

Side effects of tricyclic antidepressants (5)

Back 60

1) Block H, M, alpha receptors

2) Elevated liver enzymes

3) Sexual dysfunction (not common)

4) Withdrawal syndrome (not deadly, but uncomfortable - rebound of H, M, alpha)

5) Risk of death associated with overdose (seizures, coma, CV collapse)

Front 61

MOA of monamine oxidase inhibitors

Back 61

Increase concentrations of 5-HT, NE, DA through inhibition of MAO

Front 62

SE of MOAis (5)

Back 62

1) Diarrhea

2) Headache

3) Sexual dysfunction

4) Major drug interactions (high risk of serotonin syndrome), 2 week washout

5) Dietary restrictions (risk of HTN crisis so no tyramine)

Front 63

MOA of SSRIs

Back 63

Inhibition of 5-HT reuptake by presynaptic neurons

Front 64

Examples of SNRIs (3)

Back 64

1) Venlafaxine

2) Desvenlafaxine

3) Duloxetine (Cymbalta)

Front 65

Examples of SSRIs (5)

Back 65

1) Citalopram (Celexa)

2) Fluoxetine (Prozac)

3) Paroxetine (Paxil)

4) Fluvoxamine

5) Sertraline (Zoloft)

Front 66

SE of SSRIs (7)

Back 66

1) GI upset mostly

2) Headache

3) Anxiety (careful with MDD + anxiety disorder)

4) Insomnia

5) Sexual dysfunction (up to 25, 30%)

6) Withdrawal syndrome (flu-like sx)

7) Serotonin syndrome

Front 67

Advantages of SNRIs (3)

Back 67

1) Safety profile in overdose

2) Minimal risk for drug-drug interactions

3) Much better tolerated than TCAs

Front 68

MOA and use of trazodone

Back 68

MOA: inhibits 5-HT reuptake, acts on presynaptic receptors

Mostly used for insomnia with depression

Front 69

Disadvantages of SNRIs (4)

Back 69

1) Expensive

2) Potential for HTN

3) Sexual dysfunction

4) Withdrawal syndrome

Front 70

MOA of Bupropion (Wellbutrin)

Back 70

Inhibits NE and DA reuptake by presynaptic neurons

Front 71

SE of Bupropion (4)

Back 71

1) Nausea

2) Headache

3) Insomnia

4) Risk of seizures

No blockade of H, M, alpha receptors

Front 72

Advantages of Bupropion (5)

Back 72

1) No sexual dysfunction

2) Weight neutral

3) Few drug interactions

4) No withdrawal syndrome

5) Approved as aid in smoking cessation

Front 73

Mirtazapine advantages (4), disadvantages (2)

Back 73

A: Minimal sexual dysfunction, no withdrawal, few drug interactions, safety profile in overdose

D: Increased cost, weight gain

Front 74

Candidates for lifelong antidepressant treatment (6)

Back 74

1) 3+ prior major depressive episodes

2) Chronic MDD

3) High severity of prior episode(s)

4) Multiple medical/psychiatric disorders

5) Patient preference

6) Patients with risk factors for recurrence

Front 75

Clinical triad of sx for serotonin syndrome

Back 75

Mental status changes

Autonomic hyperactivity

Neuromuscular abnormalities

Front 76

Citalopram possible disadvantage and advantages (5)

Back 76

Box warning for QTc prolongation (don't see for escitalopram)

Low side effects, drug interactions, well tolerated, cheap

Less sexual dysfunction than other SSRIs

Front 77

Fluoxetine clinical features (3)

Back 77

1) Long half-life (long SE but high tolerance for low compliance and no withdrawal)

2) More stimulating than other SSRIs

3) Major drug interactions (CYP2D6 inhibitor)

Front 78

Paroxetine (Paxil) disadvantages (4)

Back 78

1) Mild anticholinergic component (problem for elderly patients)

2) Major drug interactions

3) Sedating drug (make you tired/groggy, but can be calming in PTSD)

4) Pregnancy Category D, don't use with small children

Front 79

Sertraline (Zoloft) (3)

Back 79

1) Very few drug interactions

2) Safest in elderly, pregnancy, children

3) Dosing flexibility

Front 80

Brief intervention steps for substance abuse (5 steps)

Back 80

1) Raise the subject

2) Provide feedback

3) Offer advice

4) Enhance motivation

5) Negotiate a plan

Front 81

Nicotine replacement therapy success rate, dosing, adjunts

Back 81

NRT doubles the success rate in quitting smoking

Start with 21 mg/day for 1 ppd, can increase up to two 21 mg/day patches

Using patch + gum works better

Front 82

Tobacco prescription options

Back 82

Bupropion: doubles success rate

Varenicline (Chantix): increases quit rate 2-4 fold, but induces nausea

Front 83

Medications for alcohol use disorders, in order of efficacy (4)

Back 83

1 & 2) Naltrexone and acamprosate - both excellent evidence

3) Topiramate

4) Gabapentin

Front 84

Choosing between naltrexone and acamprosate for treating alcohol abuse

Back 84

Naltrexone might be better for reducing heavy drinking in non-abstinent alcoholics

Acamprosate may be better for maintaining abstinence.

Front 85

Use of disulfiram for alcohol abuse

Back 85

AKA Antabuse, causes bad side effects when combined with alcohol, but is best taken with supervision.

Front 86

Good drug for alcohol withdrawal

Back 86

Gabapentin on tapering dose.

Front 87

Most effective pharmacotherapies for substance use disorders:

Back 87

Methadone and buprenorphine for opioid use disorder.

Front 88

Downsides of buprenorphine (5)

Back 88

1) Constipation and other SE of opioids

2) Extensive first-pass hepatic metabolism so administered SL

3) Tastes bad

4) Therapy may be indefinite (getting off is hard), but opioid addiction is a chronic brain dz.

5) Physician has to be certified to prescribe

Front 89

Comorbid disorders of somatic symptom disorder

Back 89

MDD, panic disorder, delusional disorder. Adds complexity to these diagnoses

Front 90

Definition of Somatic symptoms disorder

Back 90

Distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms.

Have affective, cognitive, and behavioral components

Front 91

Diagnostic criteria for somatic symptom disorder (3)

Back 91

1) 1+ somatic sx that are distressing/disrupt daily life

2) Excessive thought, feelings, behaviors with at least one: disproportionate/persistent thoughts, anxiety, time/energy.

3) Persistent (6+ months)

Front 92

Risks and prognostic factors for somatic symptom disorder (4)

Back 92

1) Temperamental or neuroticism

2) Anxiety, depression

3) Low SES and few years of education

4) Stressful life event

Front 93

DDx of somatic sx disorder (3 with subtypes)

Back 93

1) Mental disorder such as MDD, panic disorder, OCD, body dysmorphic disorder (can co-occur)

2) Medical condition such as Irritable bowel syndrome, fibromyalgia

3) Conversion disorder

Front 94

Illness anxiety disorder criteria (6)

Back 94

1) Preoccupation with having serious illness

2) Somatic sx are not present or are mild

3) High level of anxiety

4) Excessive health-related behaviors or maladaptive avoidance

5) 6+ months, but specific feared illness can change

6) Not another mental disorder

Front 95

Conversion disorder diagnostic criteria

Back 95

1) Altered voluntary motor or sensory fxn (usually weakness or paralysis)

2) Incompatibility with neurological/medical conditions

3) Not another mental/medical disorder

4) Significant distress or impairment

Front 96

Factitious Disorder diagnostic criteria (4)

Back 96

1) Falsification of physical or psych signs or sx, induction of injury or disease, associated with identified deception

2) Presents as ill, impaired, injured

3) Absence of obvious external rewards

4) Not another mental disorder