Mental Health & Neurological Health Problems [Buttaro Ch 247-250, Ch 188-203] Exam 2

Mental Health & Neurological Health Problems [Buttaro Ch 247-250, Ch 188-203] Exam 2 A patient is diagnosed with panic disorder and begins taking a selective serotonin reuptake inhibitor medication. Six weeks later, the patient reports little relief from symptoms. What will the provider do next to manage this patient? a. Change the medication to buspirone b. Discontinue the medication c. Increase the medication dose d. Refer to a mental health provider - d. Refer to a mental health provider ANS: D Patients taking SSRIs for anxiety disorders should see effects within 2 to 4 weeks. If patients have not had good results in 4 to 6 weeks, the provider should change the medication or refer to a mental health provider. Discontinuing an SSRI abruptly can cause withdrawal symptoms. Increasing the medication dose will not improve the effects. Buspirone is somewhat useful only for GAD.REF: Management Which medication are useful in treating both obsessive-compulsive disorder and PTSD? Select all that apply. a. Benzodiazepines b. Buspirone c. Selective serotonin reuptake inhibitors d. Serotonin-norepinephrine reuptake inhibitors e. Tricyclic antidepressants - ANS: C, D, E SSRIs, SNRIs, and TCAs are useful in treating both OCD and PTSD. Benzodiazepines and buspirone are not indicated for either disorder.REF: Table 247-1: Pharmacologic Management of Anxiety Disorders: Indications and Considerations A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The provider determines that these symptoms occur in relation to many events and concerns. What other things will the provider question this patient about? a. Ability to manage social situations b. Body image and eating habits c. Headaches and bowel habits d. Occupational performance - c. Headaches and bowel habits ANS: C This patient has symptoms consistent with generalized anxiety disorder (GAD) in which feelings occur in relation to many events. Patients with GAD often have headaches and irritable bowel syndrome. Phobias are linked to particular events and often include social situations. Patients with OCD tend to have eating disorders and difficulty with occupational and academic performance.REF: Clinical Presentation A patient is seen in clinic 2 weeks after the death of a parent. The patient reports feelings of sadness and hopelessness and a feeling that the parent is still present, even to the point of hearing the parent's voice at times. What will the provider determine from these findings? a. There is a concern for hypermania. b. There is a possibility of manic episodes. c. These are concerning for depression. d. These are normal grief responses. - d. These are normal grief responses. ANS: D These are short-lived symptoms at this point, lasting less than 2 months. Auditory and sensory hallucinations only in relation to the deceased are normal during intense grief. Hypermania is an acute, short-lived manic episode. Mania involves abnormal elevation of a person's mood. Depression is present when symptoms of grief are more severe and more prolonged.REF: Introduction/Table 248-1: Assessing Symptoms of Grief and a Depressive Mood Episode A college student is brought to clinic by a parent who is concerned about increasingly bizarre behavior and poor school performance. The provider notes difficulty engaging the patient in an organized conversation. The patient denies any concerns about behavior. What will the provider do initially to manage this patient's symptoms? a. Admit the patient for inpatient treatment b. Begin treatment with lithium or lamotrigine c. Counsel the parent to report any symptoms of depression d. Schedule an appointment with a psychiatrist - b. Begin treatment with lithium or lamotrigine ANS: B Patients with symptoms of mania should begin treatment with a mood stabilizer and the primary care provider should initiate treatment for an acute episode. It is not necessary to admit as an inpatient unless there is indication of harm to the self or others. The primary provider should refer for psychiatric evaluation, but should begin medications as soon as possible.REF: Bipolar Disorder/Management A patient is seen frequently over a 9-month period with somatic complaints that are not related to physical disease. The primary provider notes that the patient has had a 15% weight loss in the previous 2 months and the patient reports difficulty sleeping. The spouse tells the provider that the patient seems tired all the time and is irritable with other family members. What will the provider do initially? a. Perform a suicide risk assessment b. Prescribe a selective serotonin reuptake inhibitor c. Refer the patient for psychotherapy d. Suggest cognitive-behavioral therapy - a. Perform a suicide risk assessment ANS: A For any patients with symptoms of depression, the initial action is to perform a thorough assessment and evaluate potential suicide risk. SSRIs can be prescribed once a diagnosis is determined according to diagnostic criteria. Psychotherapy and cognitive-behavioral therapy may also be prescribed.REF: Depression/Clinical Presentation/Management A patient is brought to the emergency department who is experiencing disorientation, confusion, and fever. The patient describes visual and auditory hallucinations. The patient's spouse states that the patient had several drinks 12 hours prior to passing out. A blood alcohol level is 0.2%. What is the recommended treatment? a. Benzodiazepines b. Intravenous fluids and rest c. Naloxone d. Phenobarbital - a. Benzodiazepines ANS: A This patient is showing symptoms of major alcohol withdrawal and should be treated with a benzodiazepine, which is the safest, most effective drug to treat alcohol detoxification. Without medications, the patient may develop seizures and delirium tremens or may die. Naloxone is used for narcotics. Phenobarbital is used to treat seizures.REF: Alcohol Abuse/Management A college student is brought to the emergency department by a roommate who is concerned about symptoms of extreme restlessness, nausea, and vomiting. The provider notes elevations of the pulse and blood pressure and pupillary dilation, along with hyperactive bowel sounds. The provider suspects withdrawal from which substance? a. Alcohol b. Cocaine c. LSD d. Opioids - d. Opioids ANS: D This patient has symptoms consistent with opioid withdrawal, which causes restlessness, hyperactive bowel sounds, pupillary dilation, and changes in vital signs. Alcohol withdrawal involves tremors, confusion, and hallucinations. Cocaine withdrawal causes muscle tension, teeth clenching, and blurred vision. LSD symptoms cause hallucinations.REF: Opioids A 17-year-old male is brought to the clinic by a parent who is concerned that the patient has become more isolated and withdrawn and expresses suspicions that his teachers hate him and want him to fail. What will the provider tell this parent? a. The adolescent should be evaluated by a psychiatrist. b. The adolescent should be given a trial of antipsychotic medications. c. These are common adolescent behaviors and will eventually go away. d. These signs are diagnostic for schizophrenia. - a. The adolescent should be evaluated by a psychiatrist. ANS: A These signs, along with a family history of psychosis can be predictive of schizophrenia, so referral for psychiatric evaluation should be made. Unless symptoms are present longer than a month and the patient is diagnosed, antipsychotic medications are not indicated. Without evaluation, these behaviors should not be dismissed as normal. While these signs may raise concerns for schizophrenia, they are not diagnostic. REF: Clinical Presentation A young male patient is reported to be more withdrawn from his peers than usual and has dropped out of college and quit his job within the last 5 months. The parent is concerned that the patient may have schizophrenia because a maternal uncle has the disease. What will the provider do next? a. Ask about the patient's speech and thinking patterns b. Consider treatment with antipsychotic medications c. Reassure that classic symptoms of schizophrenia are not present d. Refer the patient for inpatient psychiatric treatment - a. Ask about the patient's speech and thinking patterns ANS: A In order to diagnose schizophrenia, one or more of the positive signs of delusions, hallucinations, or disorganized speech must be present. Unless there is a definitive diagnosis, hospitalization and treatment are not indicated. The patient has some signs of schizophrenia, so further evaluation is necessary before reassurance can be made. REF: Box 250-1: Diagnostic Criteria for Schizophrenia Which are considered "negative" symptoms of schizophrenia? Select all that apply. a. Auditory hallucinations b. Delusions of persecution c. Impaired self care d. Poor school performance e. Withdrawing from peers - ANS: C, D, E Negative symptoms are those related to decrease or loss of normal functions and may include social withdrawal, impaired self care, and poor school performance. Hallucinations and delusional beliefs are things added to normal behaviors and are considered positive symptoms of schizophrenia. REF: Clinical Presentation/Positive Symptoms/Negative Symptoms What are some common goals of neuropsychiatric evaluation? Select all that apply. a. To definitively diagnose neurobehavioral disorders b. To determine the need for neurosurgical procedures c. To evaluate cognition when neuro-diagnostic tests are normal d. To help identify rehabilitation goals in brain-injured patients e. To monitor changes in symptoms over time - ANS: C, D, E Neuropsychological testing is performed to evaluate cognition when other diagnostic tests may be normal, to help identify rehabilitation goals for brain-injured patients, and to monitor changes in patients over time. Because they are one piece of the diagnostic workup, they do not definitively diagnose disorders or determine the need for surgical procedures.REF: Box 188-2: Neuropsychological Assessment Goals What is an important purpose of conducting an interview prior to beginning neuropsychological testing on an older adult suspected of having dementia? CONTINUES...