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? CONTINUES...