Mental Health
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49 questions
| 🇬🇧 | 🇬🇧 |
| Bipolar 1: Manic +/- major depression Bipolar 2 : Major depression with at least one episode of hypomania | What is the difference between Bipolar 1 and 2 |
| 2/3 have multiple relapses. Mose within 2 years. | What is the relapse rate for Bipolar? |
| Depression and anxiety ( 25% will be Bipolar) Social anxiety Substance abuse ( 70%) Suicide attempt ( 50%) Thyroid disease. | What comorbidities are associated with Bipolar? |
| 3 jobs, 3 marriages and 3 antidepressants | What is the Rule of 3 for Bipolar? |
| DIGFAST 3/7 Screen with MDQ Positive > 7/13 Distractability Irritability Grandiosity Flight of Ideas Agitation: Periods of mania confirms Dx Sleep Talkativeness | How do you diagnose Bipolar? |
| MDQ + > 7/13 PHQ9 Ask about suicide Ask about psychosis, hallucination and delusion: may need hospitalization. CBC, BMP, TSH, urine tox screen | How do you evaluate Bipolar |
| Trazodone, Steroid, SSRI, Albuterol and caffeine | Which drug can precipitate mania? |
| Depakote and Olanzapine ( Zyprexa) SE: Olanzapine: EPS, Somnolence, increase prolactin and metabolic syndrome. | What is second line treatment of mania? |
| Quetiapine ( Seroquel) Dose: 50 mg QHS x 4 days then 100 mg QHS Monitor levels, lipid, A1C and BP Least EPS, moderate metabolic syndrome. | What is the first line treatment of Bipolar depression? |
| Olanzapine ( Zyprexa) Works better in conjunction with Fluoxetine Monitor EPS, Somnolence, prolactin and metabolic syndrome. Lurasidone: Least metabolic SE, or wt gain. | What is the second line treatment of Bipolar depression? |
| Lamotrigine (Lamictal) Prevents recurrence Caution: Steven-Johnson syndrome. Need 6 wk titration to prevent. SE: Dyspepsia, insomnia. | Which drug is used for Bipolar maintanance? |
| Do you feel depressed. F/u with PHQ 9. Always screen for Bipolar with Question of elevated mood for > 2 wk. Screen for substance use. | How do you screen for depression? |
| DSM4: > 5 sx for > 2wk SIG EM CAPS; Sleep, Interest, Guilt, Energy, Mood, Concentration Appetite, Psychomotor, Suicide. | How do you Dx depression |
| Treat for at least 9 mo for first episode and monitor with goal to get PHQ9 to < 4. Recurrence is high: 50%, with 2 episodes 70% and with 3 episodes 100%. | How long to you treat depression. |
| Sertaline ( Zoloft), Citalopram ( Celexa)- good with anxiety, escitalopram ( Lexapro) If partial response can augment with Wellbutrin Can add Buspar, gabapentin or hydroxyzine for anxiety. | What is the first line treatment of depression? |
| SSRI Citalopram ( Celexa) 10 mg/d Sertaline ( Zoloft) 25 mg/d | What is the first line treatment for anxiety? |
| SNRI ( Venlafaxine) Buspar Hydroxyzine Gabapentin | What is second line treatment for anxiety? |
| Eval: GAD 7, PHQ 9, TSH, CBC, CMP, tox screen, EKG if CP Treat: Citalopram or Ecitalopram, Venlafaxine. | How do you evaluate and treat Panic disorder? |
| Untreated depression, substance abuse, trans gender, psychosis, PTSD, Age 20-24 or > 65, male, NA, white, recent illness, chronic disease, limited social support. | What are the RF for suicide? |
| Sexual assault, DV, substance abuse, mood disorder, hx of suicide | What are RF for PTSD |
| HITS Hurt, Insult, Threaten, Scream OR 3 Question: Have you been hurt, Do you feel safe, Partner making you feel unsafe? Screen during well adult exam. | How do you screen for Domestic Violence? |
| SOS-DoC Support/safety Options Strengths - validate, Document Continuity- follow up | How do you manage DV? |
| Emotionaly labile, Self injury, fear of abandonment, turbulent relationships, substance abuse, impulsive | What are main features of Borderline personality disorder? |
| Functional impairment at work, home and relationships. | How do you evaluate ADHD? |
| Substance abuse hx, HTN, Bipolar, arythmie, psychosis, anorexia and Tourette. | What are the contraindication to stimulant ? |
| 30% have comorbid psych disorder. Treat that first. | ADHD comorbidities |
| Citalopram. | How do you treat OCD? |
| Baseline and Q 3 mo: WT, BP, Fasting glucose, A1c, Lipids- annually, Baseline EKG for QT interval: > 500 abnormal | How do you monitor pt on Antipsychotics? |
| Psychotic sx for > 1 mo and Positive sx > 6 mo: hallucination, delusion, diorganized speech, and Negative sx 6 mo: catatonic, emotional flattening and lack motivation. | How do you dx Schizophrenia? |
| Advanced paternal age and dopamine and serotonin imbalance. | What is implicated in cause of schizophrenia? |
| Second generation antipsychotics Risperidone and olanzapine are best due to lower extrapyramidal SE. | How do you treat schizophrenia? |
| Loss contact with reality Delusions of persecution of somatic and thought disorganization. | What is the definition of psychosis? |
| Schizophrenia, trauma, Bipolar, Delusion disorder, substance use, Delerium, Meds: steroid, anticholinergic, CO poisoning, Bupropion | What is the differential of psychosis? |
| Asses risk of harm to self or others and if positive, hospitalize. Check MSE Chem 14, CBC, RPR UA drug screen, B12 and HIV, CT/MRI head, consider heavy metal screen. | How do you evaluate psychosis? |
| Psych: depression, anxiety and PTSD Sleep apnea 20% GERD Substance abuse. | Insomnia: comorbidities |
| Impaired sleep > 3x/wk causing impairment. | What is the definition of insomnia? |