ALU 201: Intermediate Medical Life Insurance Writing PDF

UNDERWRITING MENTAL ILLNESS AND PSYCHIATRIC DISORDERS Introduction with noted increases in stress, anxiety, depression, domestic violence, and the like. Accidental requires more scrutiny and diligence. th 1. Axis I lists major psychiatric illnesses (e.g., depression, bipolar disorder, schizophrenia)...

UNDERWRITING MENTAL ILLNESS AND PSYCHIATRIC DISORDERS Introduction with noted increases in stress, anxiety, depression, domestic violence, and the like. Accidental requires more scrutiny and diligence. th 1. Axis I lists major psychiatric illnesses (e.g., depression, bipolar disorder, schizophrenia). 2. 3. 4. 5. The multiaxial system was documented in Axes IV and V. Page 193 ALU 201: Intermediate Medical Life Insurance Writing When looking at medical records, it is usually not known whether the doctor or care provider diagnosis given is indeed the correct diagnosis. 1. 2. psychiatric disorders. 3. 4. using biological markers. 5. in vivo 6. 7. or with eating disorders, depression occurring with schizophrenia, and anxiety occurring with and the impairments themselves are termed comorbidities. Comorbidity can also occur when a psychiatric disorders. Mood Disorders 1. 2. 3. 4. depression dysthymia bipolar disorders I and II cyclothymia. the connection between melancholia and mania (i.e., bipolar disorder) was made by Aretaeus seventeenth century. Page 194 disorders, schizophrenia, alcohol abuse, and substance abuse, are common with all mood disorders. Depression diseases, endocrine diseases, and connective tissue diseases. Almost all medications have been the symptoms to arrive at the correct diagnosis. 1. 2. 3. 1. 2. nearly every day 3. nearly every day 4. 5. Page 195 ALU 201: Intermediate Medical Life Insurance Writing 6. 7. diminished ability to think or concentrate, or indecisiveness, nearly every day 8. and not recur. Dysthymia 1. psychotherapy 2. electroconvulsive therapy (ECT) 3. medications. Psychotherapy deal with depression and other psychiatric disorders. Psychotherapy is usually used in combination behavior therapy (CBT). 1. Page 196 episode. 2. more positive and constructive tools to assess their capabilities and circumstances. Electroconvulsive Therapy Electroconvulsive therapy (ECT) uses a small electric current to produce a generalized cerebral include cardiopulmonary events, aspiration pneumonia, dental and tongue injuries, and headache. cardiopulmonary events. There is currently no way to predict who will respond to treatment, which medication will be the individuals. 1. chemical structure 2. 3. neurotransmitters (i.e., norepinephrine, dopamine, and serotonin) levels, though exactly how Page 197 ALU 201: Intermediate Medical Life Insurance Writing Wellbutrin® medication is used. treatment is usually recommended. Depression and all mood disorders are associated with an increased mortality risk, primarily chronic and severe the depression, the greater the increase in mortality risk is. Bipolar Disorder currently bipolar I and bipolar II are the only accepted bipolar diagnoses. 1. 2. Bipolar II will have at least two major depression episodes and hypomanic episodes. It is and hypomanic episodes.) Page 198 3. episode or manic episode. Treatment and Comorbidities was the most used medication in the past and many bipolar patients are still treated with lithium. bipolar disorder include oxcarbazepine (Trileptal®), and carbamazepine (Tegretol®). The duration adjunctive therapies. Anxiety Disorders 1. panic disorder 2. phobias 3. typically in adolescence or early adulthood. Anxiety disorders are not curable. Mood disorders that could possibly cause the exhibited symptoms. Page 199 ALU 201: Intermediate Medical Life Insurance Writing Panic Disorder In addition to the attacks themselves, persistent concern or worry about their recurrence can lead to behavior changes. psychoeducation aimed at symptom control. It sometimes includes education in breathing have some improvement, and 20% have a static or worse course. is recommended that benzodiazepines not be used as to treat depression associated with anxiety. panic disorder. Phobias ® Page 200 ), are medications used to treat social phobias and anxiety. ® antidepressants, and bupropion. trichotillomania, and (skin) excoriation disorder. 1. 2. 3. 4. ® ® ). Medications alone are disorders is another common comorbidity. Page 201 ALU 201: Intermediate Medical Life Insurance Writing The traumatic events are sexual relationship violence in about 33% (rape), interpersonal network 1. 2. avoiding stimuli associated with the trauma 3. individuals who have had similar experiences do not is unknown. disorders, such as mood disorders, anxiety disorders, and alcohol and substance abuse disorders. It is estimated that without treatment 30% recover completely, 40% have mild symptoms, 20% have moderate symptoms, and 10% will have severe symptoms benzodiazepines, carbamazepine, and valproate. Alcohol and substance abuse are common Personality Disorders They cause distress and lead to impaired work and social relationships. The behavior patterns are Page 202 1. 2. 3. this group. Psychotherapy is also used as a treatment modality. eating disorders, panic attacks, phobias, and tobacco addiction. Criminal and aggressive behaviors criteria to diagnose these disorders, which are characterized by many unexplained symptoms in socially. Common symptoms are pain, gastrointestinal, sexual, and neurological symptoms. 1. somatic symptom disorder 2. 3. person. Page 203 ALU 201: Intermediate Medical Life Insurance Writing Thought Disorders Delusional Disorders Schizophrenia hospital beds per year. 1. 2. Paranoid subtype has a prominent preoccupation with a delusional system. 3. 4. or decreased motor activity. Page 204 Schizophrenia is associated with an increased mortality rate, up to eight times normal in some and past suicidal attempts are poor prognostic indicators. Eating Disorders The eating disorders are anorexia nervosa, bulimia nervosa and binge eating, and obesity. genders. excessive exercise. (These same inappropriate compensatory mechanisms can also be seen with mechanisms and leading to an increased body mass index (BMI). Suicide Page 205 ALU 201: Intermediate Medical Life Insurance Writing 40/100,000 people. For males under age 30, depression, substance abuse, and antisocial personality spouse, and ill health are common comorbidities. diseases. ADHD/ADD 1. 2. is completed, interrupting, or intruding). In adults, the inattention symptoms are more common and tend to predominate. Page 206 include lead contamination, complications during pregnancy, low birth weight, traumatic brain injury, maternal smoking during pregnancy, and severe or extreme maltreatment during childhood. It is not known whether the disease plateaus in adulthood or progresses with age. transmitted diseases (STDs), unplanned pregnancies, and underachievement in school. Seventy comorbidities. Depression and bipolar mood disorders, alcohol and drug abuse, and anxiety are ® ) and amphetamines and treatment can be instituted. treatments, prognosis, and mortality risk. known genetic mutation. Those with autism spectrum disorders have elevated serotonin in their blood, almost exclusively in platelets and 90% have larger brain volumes than normal. Seizures Page 207 ALU 201: Intermediate Medical Life Insurance Writing Children with IQs >70, who develop language communication by age seven and have reasonable Psychiatric disorders are common illnesses worldwide in every race, ethnic group, and gender. the various psychiatric disorders. disorders. All those impairments are associated with increased mortality and suicide risks. Alcohol/ psychiatric disorders. 1. What is the exact psychiatric diagnosis? 2. or chronic? 3. 4. 5. 6. Is more than one psychiatric disorder present? The answers to these questions, along with the insurance company’s guidelines, will enable the underwriter to assess the risk in these situations. Page 208 Note to the student: Material in the Appendices will not be tested on the examination. Appendix 1. Beck Depression Inventory (BDI) Score Interpretation. 40 significantly above even severely depressed persons, possible exaggeration of depression; possible borderline or histrionic personality disorder Appendix 2. Functional Classes of Antidepressant Medications – Some Examples with Generic (Trade) Names. 1. Selective Serotonin Reuptake Inhibitors (SSRIs): citalopram (Celexa®), fluoxetine (Prozac®), escitalopram (Effexor®), paroxetine (Paxil®), sertraline (Zoloft®), 2. Serotonin (5-HT) Receptor Blocker/mixed action: Mirtazapine (Remeron®), Nefazodone (Serzone®), Trazodone (Desyrel®), Amoxapine (Asendin), Clomipramine (Anafranil) 3. Dopamine Reuptake Inhibitor: bupropion (Wellbutrin®) 4. Norepinephrine (NE) Reuptake Inhibitor: maprotiline (Ludiomil), desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactyl®) 5. NE and 5-HT Reuptake Inhibitors: amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil), venlafaxine (Effexor), duloxetine (Cymbalta) 6. Monoamine Oxidase Inhibitor: phenelzine (Nardil®), tranylcypromine (Parnate®) Appendix 3. Antidepressant Medications - Generic (Trade) Names, Usual Dosage, Functional Class Mechanism of Action. Medication amitryptiline (Elavil, Endep) amoxapine (Asendin) bupropion (Wellbutrin) citalopram (Celexa) clomipramine (Anafranil) desipramine (Norpramin) doxepin (Sinequan) duloxetine (Cymbalta) escitalopram (Lexapro) fluoxtine (Prozac) fluvoxamine (Luvox) Imipramine (Tofranil) maprotiline (Ludiomil) mirtazapine (Remeron) nefazadone (Serzone) nortriptyline (Aventyl, Pamelor) Dosage range 50-300 mg 150-450 mg 250-450 mg 20-40 mg 100-250 mg 150-300 mg 150-300 mg 40-60 mg 10-20 mg 20-60 mg 100-300 mg 150-300 mg 150-200 mg 15-45 mg 300-500 mg 50-150 mg Functional Class of Medication NE and 5-HT Reuptake Inhibitors Serotonin (5-HT) Receptor Blocker/mixed action Dopamine Reuptake Inhibitor Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin (5-HT) Receptor Blocker/mixed action Norepinephrine (NE) Reuptake Inhibitor NE and 5-HT Reuptake Inhibitors NE and 5-HT Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors (SSRIs) Selective Serotonin Reuptake Inhibitors (SSRIs) Selective Serotonin Reuptake Inhibitors (SSRIs) NE and 5-HT Reuptake Inhibitors Norepinephrine (NE) Reuptake Inhibitor Serotonin (5-HT) Receptor Blocker/mixed action Serotonin (5-HT) Receptor Blocker/mixed action Norepinephrine (NE) Reuptake Inhibitor Page 209 ALU 201: Intermediate Medical Life Insurance Writing paroxetine (Paxil) phenelzine (Nardil) protriptyline (Vivactyl) sertraline (Zoloft) trazodone (Desyrel) trimipramine (Surmontil) venlafaxine (Effexor) 20-60 mg 45-90 mg 15-60 mg 50-200 mg 150-300 mg 150-300 mg 125-375 mg Selective Serotonin Reuptake Inhibitors (SSRIs) Monoamine Oxidase Inhibitor Norepinephrine (NE) Reuptake Inhibitor Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin (5-HT) Receptor Blocker/mixed action NE and 5-HT Reuptake Inhibitors NE and 5-HT Reuptake Inhibitors Appendix 4. Bipolar Medications - Generic (Trade) Names. carbamazepine (Esquetro®, Tegretol®) divalproex (Depakote®) lamotrigine (Lamictal®) lithium (Eskalith®, Lithobid®) olanzapine + Fluoxetine (Symbyax®) olanzapine (Zyprexa®) used for schizophrenia and bipolar disorder quetiapine (Seroquel®) used for schizophrenia and bipolar disorder risperidone (Risperdal®) used for schizophrenia and bipolar disorder Appendix 5. Benzodiazepines - Generic (Trade) Names. alprazolam (Xanax®, Niravam®) chlordiazepoxide (Librium®) clonazepam (Klonopin®) clorazepate (Tranxene®) diazepam (Valium®) lorazepam (Ativan®) Appendix 6. Antipsychotic Medications - Generic (Trade) Names. aripiprazole (Abilify®) clozapine (Clozapine®, Clozaril®, FazaClo®) molindone (Moban®) olanzapine (Zyprexa®) used for schizophrenia and bipolar disorder pimozide (Orap®) used for Tourette’s syndrome quetiapine (Seroquel®) used for schizophrenia and bipolar disorder risperidone (Risperdal®) used for schizophrenia and bipolar disorder thioridazine thiothixene (Navane®) ziprasidone (Geodon®) Page 210