Gero Exam 4 Review

81問 • 8ヶ月前

問題一覧

-5% of sleep time -Theta activity, T waves -Eye movements slow/rolling, skeletal muscle relaxes, feeling like they didn’t sleep

Stage N1 (NREM)

-50% of sleep time, jerks -Spindles, k complexes (EEG), awakenings not as easy

Stage N2 (NREM)

-25% % of sleep time -Slow wave & delta waves (EEG), awakening rare, deep sleep

Stage N3 (NREM)

-> 25% of sleep time decreased skeletal muscle paralyzed -Most dreams occur, awakenings occur easily

Stage R (REM)

-Predominant complaint of dissatisfaction with sleep quality or quantity. Associated with one or more: -Difficulty falling asleep -Difficulty maintaining sleep, frequent awakening -Early morning awakening with inability to return

Criteria A: Insomnia Disorder

Disturbance causes significant distress or impairment

Criteria B: Insomnia Disorder

The sleep occurs at least three nights per week

Criteria C: Insomnia Disorder

The sleep difficulty is present for at least 3 months

Criteria D: Insomnia Disorder

The sleep difficulty occurs despite adequate opportunity to sleep

Criteria E: Insomnia Disorder

Insomnia not better explained by and does not occur exclusively during the course of another sleep-wake disorder

Criteria F: Insomnia Disorder

The insomnia is not attributable to the physiological effects of a substance

Criteria G: Insomnia Disorder

Coexisting mental disorders and medical conditions do not explain insomnia

Criteria H: Insomnia Disorder

Last between 1-3 months

Episodic Insomnia

Symptoms last 3 months or longer

Persistent Insomnia

Two or more episodes within the space of 1 year

Recurrent Insomnia

Irrepressible need to sleep, lapsing into sleep occurring within the same day. Occur 3 times per week, over 3 months

Critieria A: Narcolepsy

The presence of at least one of following: -Cataplexy few X per mo. -Hypocretin deficiency – by CSF values -Nocturnal sleep polysomnography showing REM sleep latency less than or equal to 15 minutes

Critieria B: Narcolepsy

Cataplexy less than once weekly

Mild Narcolepsy

Cataplexy once daily or every few days

Moderate Narcolepsy

Drug-resistant cataplexy with multiple attacks daily

Severe Narcolepsy

Name a wake promoting medication for narcolepsy

Modafinil

What group(s) of medication can reduce cataplexy in narcolepsy?

TCAs and SSRIs

What is the criteria for diagnosing OSA?

Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep

<15 obstructive apneas and/or hypopneas per hour of sleep

Mild OSA

15-30 obstructive apneas and/or hypopneas per hour of sleep

Moderate OSA

>30 obstructive apneas and/or hypopneas per hour of sleep

Severe OSA

Test used to diagonse narcolepsy

Multiple Sleep Latency Test

Which of the following DSM criteria must be met for Insomnia Disorder, recurrent?

Two or more episodes within the space of 1 year

Define sleep continuity

Time asleep from lights out to lights on

In which stage of sleep do most dreams occur?

Stage R : REM

In narcolepsy, clients express irresistible sleep attacks, in addition to one of three criteria. Which of the following is NOT included in the DSM criteria?

Nocturnal breathing disturbances: snoring, gasping, pauses

Which of the following is obstructive sleep apnea with moderate severity?

Apnea hypopnea index 15-30

Which of the following medical conditions cause secondary RLS?

Iron and folic acid deficiency anemias

-Close, but troubled relationships with parents -Social interest may also factor- ballet, wrestling -Homosexual orientation -Altered concentrations of CRF, neuropeptides, gonadotropin-releasing hormone and TSH

Anorexia Nervosa

What area of the brain is associated with anorexia nervosa?

Dorsal striatum

Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is less than expected or less than minimally normal

Criteria A: Anorexia Nervosa

Intense fear of gaining weight or becoming fat; persistent behavior that interferes with weight gain even at significantly low weight

Criteria B: Anorexia Nervosa

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or lack of recognition of seriousness of low body weight

Criteria C: Anorexia Nervosa

During last 3 months, individual has not engaged in binge eating or purging behavior (self-induced vomiting, use of laxatives, diuretics, enemas.) Weight loss achieved through excessive dieting, fasting, and/or exercise

Restricting Type: Anorexia Nervosa

During the last 3 months, the individual has engaged in binge eating or purging behavior (self-induced vomiting, use of laxatives, diuretics, enemas)

Binge-Eating/Purging Type: Anorexia Nervosa

BMI> 17

Mild: Anorexia Nervosa

BMI 16- 16.99

Moderate: Anorexia Nervosa

BMI 15-15.99

Severe: Anorexia Nervosa

BMI < 15

Extreme: Anorexia Nervosa

This TCA increases appetite, assists with weight gain in anorexia nervosa

Mirtazepine

Usually occurs later in adolescents and serotonin and norepinephrine have been implicated due to the benefits of their meds.

Bulimia Nervosa

-Family is not close, but there is conflict -Parents usually neglectful and rejecting -Difficulties separating from caretakers -Not as secretive about symptoms compared to AN -Lack superego control -MRI -overeating results from exaggerated perception of hunger signals

Bulimia Nervosa

Recurrent episodes of binge eating. An episode is both: Eating in a discrete period of time an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances AND a sense of lack of control over-eating during the episode.

Criteria A: Bulimia Nervosa

Recurrent inappropriate compensatory behaviors to prevent weight gain (self-induced vomiting, laxative misuse)

Criteria B: Bulimia Nervosa

Binge eating and inappropriate behaviors occur on average at least once a week for 3 months

Criteria C: Bulimia Nervosa

Self-evaluation influenced by body shape and weight

Criteria D: Bulimia Nervosa

Does not occur exclusively in the context of anorexia nervosa

Criteria E: Bulimia Nervosa

1-3 episodes per week

Mild: Bulimia Nervosa or Binge Eating Disorder

4-7 episodes per week

Moderate: Bulimia Nervosa or Binge Eating Disorder

8-13 episodes per week

Severe: Bulimia Nervosa or Binge Eating Disorder

Average of 14 or or more episodes per week

Extreme: Bulimia Nervosa or Binge Eating Disorder

In skin/hair complications, compare and contrast bulimia vs anorexia

Bulimia associated with Russel's sign and Anorexia associated with Lanugo, hair loss or thinning carotenemia

-Recurrent episodes of binge eating. Both: -Eating an amount of food in a discrete period of time (2 hours) that is definitely larger than what most would eat in the same time under the same circumstances -A sense of lack of control overeating during the episode (feel cannot stop eating or control what/how much)

Criteria A: Binge Eating Disorder

Three of the following: -Eating more rapidly than normal -Eating until uncomfortably full -Eating large amounts when not physically hungry -Eating alone due to embarrassment -Feeling disgusted, depressed, or guilty afterwards

Criteria B: Binge Eating Disorder

Marked distress regarding binge

Criteria C: Binge Eating Disorder

Binge occurs at least once a week for 3 months

Criteria D: Binge Eating Disorder

Binge eating is not associated with recurrent use of inappropriate compensatory behavior as in BN and does not occur exclusively during the course of BN or AN

Criteria E: Binge Eating Disorder

Other than Lisdexamfetamine, what is another medication for binge eating disorder maintence that reduces binging and also decreases weight?

Topiramate

FDA approved for short term use in binge eating disorder

Vyvanse

Explain the main difference between unspecified vs other specified feeding or eating disorders.

In other, the clinician documents why the full criteria is not met, whereas in unspecified the clincian does not document why full criteria not met.

Cathy eats very little, and only when under some family pressure. She has lost over 16 kgs, and now has a BMI of 16. She most likely has:

anorexia with moderate severity

Which of the following is anorexia nervosa with mild severity?

BMI >17

To differentiate bulimia nervosa from anorexia nervosa, the DSM-5 highlights which of the following features?

Severe underweight in anorexia nervosa

According binge eating disorder in the DSM, binging occurs:

At least once a week for three months

Which of the following is binge eating disorder with moderate severity?

4-7 binges per week

Bulimia nervosa can be differentiated from binge eating disorder by which of the following criteria in DSM-5?

The presence of purging behavior in bulimia nervosa

What is a standard drink?

12 oz of beer, 8-9 oz of malt liquor, 5 oz of wine, and 1.5 oz of distilled spirits

What is the recommendation for drinking in moderation?

Men - 2 drinks daily Women - 1 drinks daily

Discuss the definition(s) of binge drinking

NIAAA: Men-5 or more drinks or women who drink 4 or more in 2-hours Substance Abuse and Mental Health Services (SAMHSA): Men who have 5 or > drinks or women who have 4 or > drinks in one setting in the last 30 days

Discuss the definition(s) of heavy drinking

NIAAA: Women who drink > 3 drinks on any day or more than 7 drinks per week; Men who drink > 4 drinks on any day or more than 14 drinks per week SAMHSA: binge drinking on at least 5 occasions in the last 30 days

What blood level is considered binge drinking?

> 0.08 g/dL

Alcohol Withdrawal

-Usually begins 8 hours after last use -Peaks on day 2 or 3 , declines day 4 -5 -Mild symptoms can persist for 3-6 months

Caffeine withdrawl typicall begins within?

12-24 hours after last use

What does the acroynm CAGE stand for?

C - Cut A - Annoyed G - Guilty E - Eye Opener

Measure of impairment due to alcohol/drugs the last 30 days/lifetime

Addiction Severity Index (ASI)

-Can detect risky use at early stage -Assesses alcohol consumption, behaviors and consequences -Score of 8 or more is considered hazardous

Alcohol Use Disorder Identification Test (AUDIT)

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