Mental Health Test #2

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-body wt < 85% of expected wt (BMI < 17.5) -intense fear of wt gain even though underwt -distorted perception of body size, wt, or shape -amenorrhea of 3 mos duration (women only): dx of anorexia nervosa
-malnutrition -muscle wasting -low HR, BP, dizzy, syncope -constipation, delayed gastric emptying -cold, blue hands and feet -secondary amenorrhea, small breast size: physical sxs of anorexia
-hypokalemia, increased HCO3 -euthyroid sick syndrome - abNL TFT -anemia -asx hypoglycemia -hyponatremia from excess water intake -low estrogen levels: lab findings for anorexia
-prolonged QT interval, reduced LV mass -bone loss - 2SD below NL in 50% -hypothalamic hypogonadism -cognitive sxs -cerebral atrophy on CT w/ reduced white and gray matter: findings associated with anorexia
% concordance in monozygotic twins for anorexia nervosa: 55%
% concordance in dizygotic twins for anorexia nervosa: 7%
-persistent denial of problem -frequent association w/ OCD and OCD personality -self-evaluation and self-esteem seen in terms of body shape -superficial perfect appearance -special, in control & somewhat superior: psychological etiology of anorexia
onset of anorexia: adolescence
anorexics have ___ & ___ about food or eating: obsessions & rituals
treatment of anorexia: -refeeding, wt gain, and nutrition counseling
-after stabilization: rework self-concept/self-esteem
-group and individual therapy
-alliance w/ pt and family
-educate pt and family
criteria for hospitalization of anorexic: -wt = 25-30% < BMI
-pulse < 40 BPM
-arrythmia or prolonged QT interval on ECG
-electrolyte abnormalities
what meds are given to anorexics in their tx?: -meds are NOT helpful
-antidepressents for associated depression
-low dose neuroleptics for severe obsessional or borderline psychotic thinking
-recurrent binge eating (>2x/wk, every wk for 3 mos) -recurrent purging, excess exercise or fasting (>2x/wk, every week for 3 mos) -excessive concern about body wt or size -absence of anorexia nervosa: dx of bulimia nervosa
-very secretive illness -ego dystonic -near NL wt range -wt and mood fluctuations -other impulse control problems -hx of unsucessful dieting: associated features of bulimia
physical sxs of bulimia: -oral:: dental caries, enamel erosion, parotid enlargement
-GI: esophageal reflux and tears, gastritis, gastric dilation, constipation, GI bleeding
-skin: marks on back of hand
-low K+, low Cl-, and high HCO3 -non-anion gap acidosis: labs for bulimia
what labs indicate vomiting in bulimia?: -low K+, low Cl-, and high HCO3
what labs indicate laxative abuse in bulimia?: non-anion gap acidosis
tx for bulimia: -multidisciplinary approach
-primary care, nutrition, and mental health
-tx associated psychiatric illness (PTSD, personality d/o, or depression)
-meds
-therapy (family and individual)
-change in attitude
-accepting self as not ideal
what meds are used to tx bulimia?: -they are helpful
-SSRIs: Zoloft, Paxil, Prozac, and Celexa
sleep problems are often associated w/?: mental illness
the first half of the night is when you ge the most ___ ____: restorative sleep
second half of the night is when you ___ the most: dream
what is the deepest and lightest sleep stage?: Stage 1 - lightest
Stage 4 - deepest
NREM is marked by ___ levels of physiological function: lower (pulse, respiration, BP, and blood flow)
EEG is also slower
in what stage(s) does NREM occur?: stages 1-4
what stage(s) are associated w/ parsomnias: night terrors, nightmares, sleep walking, enuresis?: Stages 3 and 4
the EEG pattern in REM sleep is...: similar to wakefulness
REM is marked by ___ levels of physiological function: increased (pulse, RR, BP, and muscle tone)
T/F: in REM a person's temp is higher (feel hot during the night): FALSE - feel cold
How are EEG waves & REM sleep affected by aging?: waves are slower and REM sleep is less efficient
Neurotransmitter involved in REM and wakefulness: NE
Neurotransmitter involved in sleep: 5HT (Serotonin)
Neurotransmitter involved in sleep regulation: Ach
Neurotransmitter involved in wakefulness (blockers cause sedation): DA (dopamine)
what is a NL amt of sleep hours?: 6-9hrs
T/F: the need for speed in increased w/ exercise, pregnancy, illness, and stress: true
what is needed in a sleep hx?: -typical night's sleep
-pattern on wkend
-napping
-acute vs. chronic
-awaken or difficulty falling asleep
-caffeine and tabacco
-illicit drugs and alcohol
-meds (stimulants)
-snoring, sleep apnea
-depression, anxiety, other psych illness
-interview the partner
insomnia, hypersomina, narcolepsy, breathing-related sleep disorder, and circadian rhythm sleep disorder: dyssomnias
nightmare d/o, sleep terror d/o, sleepwalking, and parasomnia not otherwise specified: parasomnias
-difficulty fallings asleep or staying asleep for at least a month -happens at least 3x/wk -causes sig distress or impairment in social or occupational function -not due to substance, medical condition, or other sleep disorder: primary insomnia
-excess sleepiness or prolonged daytime sleep episodes for at least 1 mo -causes sig distress or impairment in social or occupational functioning -not due to med condition, substance, or other d/o: primary hyperinsomnia
-irresistible attacks of refreshing sleep daily over at least 3 mos -not due to substance or med conditon or other sleep d/o -one or both: cataplexy and/or recurrent intrusions of REM manifested as hallucinations or sleep paralysis at beginning: Narcolepsy
cataplexy: loss of muscle tone associated w/ intense emotion
associated w/ leukocyte antigen HLA-DR2: narcolepsy
sleep apnea: breathing stops for > 10s, >5h or 30x/night
sxs of sleep apnea: -restless sleep
-loud snoring
-apnea periods
-h/a or fatigue upon wakening
nightmare d/o: -occurs during REM, late at night
-NO tx
sleep terror disorder: -arousal during the first 1/3 of night in NREM
-amnesia for the episode
sleep walking: -first 1/ of night in NREM
-unresponsive and have amnesia for the episode
-NO tx
sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction...experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships.: human sexuality defined by WHO
sex defined as a noun is...: male or female
sex defined as a verb is...: sexual acts; varies widely according to culture, class, etc
what is gender?: social construction of femininity and masculinity
what is sexual orientation?: refers to a person's erotic and romantic attractions to one or more sexes; who you are attracted to
what is sexual identity?: sense of ourselves in both individual and political ways, encompasses both our gender and our sexual orientation.
what is adrogengy?: intergendered; in the middle of masculinity/feminity
what is transgenered?: someone whose gender identity and gender roles encompass both
what is intersex?: people who are in the middle; have some of both biological features; used to be called hermaphrodites
what is sexual coercion?: any nonconsensual sexual behavior that occurs as a result of arguing, pleading and cajoling and includes, but is not limited to, force.
what is deconstruction?: see normal and deviant as deliberate social practices and cultural discourses.
interrogate the proscribed expectations, duties, and rights that define the relationship b/w a perosn in a particular position and the other people w/ whom she or he interacts
in the dying, tx delusions w/?: low dose antipsychotics (1mg Risperdal)
in the dying, tx fatigue/weakness w/?: stimulants
in the dying, tx dysphagia w/?: liquid diets
in the dying, tx dyspnea, cough w/?: bronchodilators, opioids
in the dying, tx n/v w/?: odansetron and compazine
in the dying, tx anxiety/depression w/?: antidepressents, benzos
Elisabeth Kubler-Ross Stages of Dying: -shock and denial
-anger
-bargaining
-depression
-acceptance
hospice care is for pts w/ ___ ___ to live: < 6mos
in the dying, tx pain w/?: aggressive opioids
in the dying, a very ___ threshold for tx is used: low
loss of a parent under the age of 14 is associated w/: higher rates of depression as an adult
existenstial crisis: -what is the purpose of living?
-i'm angry w/ God for letting this happen
-is this all there is to life?
mid-life crisis: -illusion of control and invulnerability taken away
-realization that life has limits
-new sports car, new career, changes in relationships
-attempt to reassert youth and vitality as a defense against againg and death
NL grief: -sadness, crying, sleep and appetite disturbance, weakness and fatigue
-rollercoaster course
-6mos-1yr for resolution is common
-complex psychological process of working through and making some sense of the loss and continuing w/ life
abNL grief: -suicidal ideaion or psychotic sxs
-intense and excessive guilt or self-reproach
-interference w/ daily functioning, work or school
among teens, every drug is decreased in use, except?: -cocaine/crack
-Rx drugs (vicodin & oxycotin)
-inhalants (easy access)
what are the gateway to drugs?: -POT
-ETOH
-tabacco (down due to education)
why do teens use drugs?: -peer pressure
-feel good/get high
-relax & relieve tension
-boredom
-to escape
addiction is a ___-____-____ disease: bio-psycho-social
dependence: person who has been on a certain prescription for 6mos and goes through a stage of minor w/d after the meds are abruptly stopped
addiction: person who is prescribed to take 3 percocet a day but takes 10 instead.
hallmark of addiction: denial
chromosome identified as culprit to addiction?: chromosome 10
addiction =: drug + time + X (genetic or environment)
area of the brain that controls emotions/feeling; "pleasure center": limbic system
area of the brain responsible for the site of action of cocaine: focus cerellus
area of the brain where the neurotransmitters act: mid-forebrain
neurotransmitter involved w/ stimulant drugs: dopamine
neurotransmitter involved w/ multiple drugs of abuse: Ach
neurotransmitter involved w/ hallucinogens: Serotonin
neurotransmitter involved w/ cocaine primarily and opioids: NE
neurotransmitter involved w/ sedatives and ETOH: gaba(gamma)-aminobutyric acid
neurotransmitter involved w/ opiates: endorphine
neurotransmitter involved w/ ETOH: G-protein
is addiction a brain dysfunction?: yes
C-A-G-E: C-need to cut down
A-annoyed by criticism
G-guilty
E-need an eye opener

70% sensitive and 90% specific test
substance w/d or alcoholics will have a ___ pulse: rapid
sedative drugs will have a ____ BP: lower
alcohol _____ the RR: depresses
cocaine use or w/d will have a ____ RR: elevated
spider angiomas is a sn of: vascular cirrhosis of the liver; sn of alcohol abuse; usually appear in the chest
telangiectases is a sn of: cirrhosis of the liver due to alcohol abuse; seen in the abdomen and lower chest
enlarged spleen will cause a ____ in the platelet count: decrease
pupils are dilated w/ use of ____: stimulants
pupils are constriced w/ use of ____: opiates
nystagmus is found in pts on _____: sedatives
what can be a tip off for AIDS/HIV?: adenopathy
rhonchi heard w/ use of ____: crack or pot
wheeze heard w/ use of ___ & ___: crack and pot
what is a tip off of liver disease?: gynecomastia
murmurs can be caused by use of? pt may have?: consequence of IV drug use; may have subacute endocarditis
decreased bowel sounds indicate?: opioid use
increased bowel sounds indicate?: stimulant drug use
palmar erythema sn of?: cirrhosis of the liver; alcohol disease
testicular atrophy sn of?: liver disease
increased WBC seen in?: early alcoholics
decreased WBC seen in?: chronic alcoholics
H/H decreased in?: endocarditis and alcoholics
MCV increased in?: alcoholics
decreased BUN seen in?: Stage 3/4 of liver disease
increased BUN seen in?: GI bleeding
H-A-L-T: H-drink to get HIGH
A-drink ALONE
L-LOOK forward to drinking
T-TOLERANCE
B-U-M-P: B-BLACKOUTS
U-UNPLANNED drinking
M-drink MEDICINALLY
P-PROTECT your supply
F-A-T-A-L D-T's: F-FAMILY HX
A-AA
T-THOUGHTS of suicide
A-ALCOHOLISM
L-LEGAL problems

D-DEPRESSION
T-TRANQUILIZER use
a maladaptive pattern of behavior substance use leading to clinically significant impairment or distress, as manifested by certain traits, over a 12 mo period: substance abuse
a maladaptive pattern of substance use, leading to clinically significant impairment or distress manifested by 3 or more trains over a 12 mo period: substance dependence
legal limit neuro status in PA: 0.08%
3 phases of treatment for drug abuse: -detox
-rehab
-after care
w/d sedatives are dangerous b/c a person can do into ___ ___: status epilepticus
what are the stimulants?: -cocaine
-amphetamines (meth, ritalin)
-opioids (heroin, morphine, opium)
what are the sedatives/hypnotics?: -barbs
-ethchlorvinyl
-methaqualone
-meprobamate
-benzodiazepenes
-glutethimide
-PCP
what are the hallucinogens?: -phenylethylamines
-tryptamines
-ergotamines
-anticholinergics
what are the inhalants?: -solvents (glue, petroleum products, paint thinner/nail polish, butanediol-industrial solvent)
-amylnitrate & butyl nitrate
-anesthetics (ether, chloroform, NO)
-aerosols
what are the club drugs?: -MDMD
-ketamine
-GHG - #1 date rape drug
-rohypnol
-nexus
-Illis, WET
Grade I seizure: all minor s/s
Grade II seizure: minor + hallucinations
Grade III seizure: minor + hallucinations + seizure
Grade IV: DTs
three types of dual dx: -affective or mood d/o
-ADHD
-personality d/o
hallmark of sedative use: blackout
tx alcoholism: -antabuse (disulfiram)
also used in tx of cocaine: -antabuse (disulfiram)
antidote for opioid overdose: -naltrexone (Revia)
decreases cravings for alcohol: -campral (acamprostate)
lessens cravings for cocaine: -topamax (topiramate)
tx opioid addiction, blocks mu receptor: -suboxone (buprenorphine)
prevents severe w/d from heroine use: -methadone

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