Introduction to Behavioral Health

Introduction to Behavioral Health

Updated: 04/22/2016

The Multiaxial System - used previously in DSM 4 (now DSM 5 is used, but we should still understand and recognize the importance of these axes).

1. Axis I – serious mental illnesses (mood, anxiety, eating, sleep, impulse-control, adjustment)
2. Axis II – personality disorders +/- mental retardation
3. Axis II – general medical conditions (neoplasms, injury, poisoning)
4. Axis IV – psychosocial and environmental problems (educational problems, economic, housing, access to healthcare)
5. Axis V – GAF (1-100) = global assessment of functioning

Terminology

AFFECT - The patient’s present emotional responsiveness, inferred from patient’s facial expression, including amount and range of expressive behavior [objective: what you observe about pt]

Appropriate	Inappropriate	Congruent	Incongruent
Appropriate amount of eye contact, facial expression, responsiveness, etc.	Incongruent with content or social norms	Psychotic content consistent with patient's mood	Psychotic content inappropriate to patient's mood

Restricted	Constricted	Blunted
Reduced intensity of affect – lesser degree than blunted	Restricted affect	Severe reduction in intensity of affect

Flat	Exaggerated	Labile
Virtually no signs of affective expression, no facial expression, monotonous voice	Dramatic, overly expressive	Fluctuating, rapid changes in emotion unrelated to external stimuli

Seizures, Headaches, and Migraines

Seizures, Headaches, and Migraines

Updated: 04/18/2016

Seizures, headaches and migraines are some of the most commonly occurring questions on the PACKRAT, rotation exams, PANCE, and PANRE. Since they also occur commonly in practice, you’ll definitely want to cover these topics thoroughly. Knowing the subtleties between each and the questions to ask is important not only for your understanding, but so you can treat the patient accordingly with the most appropriate therapy.

While Neurology only makes up 6% of the PANCE, knowing topics like this well can mean the difference between passing and not passing. As I have stated before, one of the best ways to prepare for your exams is through quality question banks and study guides. TrueLearn has introduced an incredible opportunity to work with the PA-student and PA community to help us excel in our didactic education and clinicals, and on our boards. See below for our second post discussing Seizure Disorders and Headaches and Migraines.

Remember from last month that TrueLearn’s SmartBanks include specialized medical content crafted to mirror rotation exams, the PACKRAT, the PANCE and the PANRE. This means that the best test writers have come together to write questions that not only get your juices flowing, but challenge you to think critically - the most important characteristic of great PAs.

Visit TrueLearn.com/Physician-Assistant/ today to learn more about their physician assistant products.  

Disclosure: I am not an employee of TrueLearn.

Seizure Disorders - sudden abnormal discharge of electrical activity

• Epilepsy - syndrome of recurrent, idiopathic seizures

• In seizures, duration of unconsciousness tends to be longer than in syncope (momentary)
• In syncope, bladder control is retained, but lost in seizures
• Causes: four Ms and four Is
• Metabolic and electrolyte disturbances - hyponatremia, water intoxication, hypoglycemia and hyperglycemia, hypocalcemia, uremia, thyroid storm, hyperthermia
• Mass lesions - brain mets, primary brain tumors, hemorrhage
• Missing drugs
• Non-compliance with anticonvulsants (most common reason)
• Acute withdrawal from alcohol, benzos, barbituates
• Miscellaneous
• Pseudoseizures - psychiatric in origin
• Eclampsia
• Hypertensive encephalopathy
• Intoxication - cocaine, lithium
• Infection - septic shock, bacterial or viral meningitis, brain abscess
• Ischemia - stroke, TIA (common in elderly)
• Increased ICP due to trauma
• Diagnosis
• If known epileptic → check anticonvulsant levels
• If first seizure
• CBC, CMP (LFTs), blood glucose, renal function tests, serum calcium, urinalysis
• EEG: most helpful diagnostic test, abnormal pattern is not diagnostic alone
• CT scan of head: r/o structural lesions
• MRI of brain with and without gadolinium: more sensitive than CT for structural changes
• LP/blood cultures if febrile
• Pregnancy test - before initiating anticonvulsants!!!
• Treatment
• ABCs first, secure airway and roll patient to side
• Known epileptics
• Check for non-compliance of anticonvulsant, check levels
• If persistent with monotherapy, increase dose of first anticonvulsant until signs of toxicity appear → add second drug if seizures uncontrolled
• If controlled → continue regimen x 2 years, then taper
• First seizure
• EEG with neurology consult
• Anticonvulsant therapy
• If normal EEG, recurrence low (15%) compared to abnormal EEG (41%)
• Do not treat patients with single seizure - start antiepileptics if EEG abnormal, MRI abnormal or status epilepticus