23 - Psychiatry Flashcards
What are some psychiatric disorders?
- Major depression
- Psychosis
- Schizophrenia
- Bipolar affective
- Generalized anxiety
- Panic disorder
- OCD
- ADHD
- Post-traumatic stress
What are some medications used for psychiatric disorders?
- Antidepressants
- Antipsychotics
- Mood stabilizers
- Anxiolytics
- Sedative/hypnotics
- Psychostimulants
Which psychiatric disorder is commonly misdiagnosed?
Bipolar disorder
What is the relative schizophrenia 10 year mortality rate compared to those w/o schizophrenia?
- Double the normal rate
- More likely to die from CV complications
- Much more likely to die from unnatural causes (ex: suicide, violence, accident)
- Ratio of unnatural:CV = 3:1 for schizophrenics
What are the contributors to morbidity and mortality in the mentally ill?
- Vulnerability genes
- Smoking
- Obesity
- Diet
- Sedentary
- Diabetes
- Stress
- Polysubstance abuse
- Poverty, poor living conditions
- Isolation
- Access to medical care, quality of medical care
- Antipsychotic medications
What are some neurological differences that are present in psychiatric disorders?
- Modification of neurobiology
- Loss of neuronal plasticity
- Excitotoxicity
- Absence or excess of neurotransmission
- Imbalance in NTs
- Wrong rate of neurotransmission
- Wrong neuronal wiring
Which NTs are targeted by psychiatric medications?
- Norepinephrine
- Serotonin (5-HT)
- Dopamine
- Acetylcholine
- Gamma-aminobutyric acid (GABA)
Which NTs are affected in depression? Are they increased or decreased?
Increased serotonin, NE, and dopamine
Which NTs are affected in psychosis/schizophrenia? Are they increased or decreased?
Decreased dopamine and serotonin b/c they are blocked
Which NTs are affected in bipolar affective disorder? Are they increased or decreased?
Increase GABA and its effects
Which NTs are affected in anxiety? Are they increased or decreased?
Enhanced effect of GABA
How does dopamine affect other NTs?
- Influences the function of other NT pathways (ex: if dopamine is blocked, ACh becomes overly active in nigrostriatal pathway)
- Inhibited by other NTs (ex: GABA and serotonin)
What are the challenges w/ treating psychiatric disorders?
- Time to response
- Effective regimen
- Management of adverse effects
- Drug interactions
- Adherence
What is involved in creating an effective regimen for a psychiatric disorder?
- Choice of agent, dose, and duration
- Efficacy in disease state
- Effectiveness vs. efficacy
- Acute vs. chronic tx
- Resistance to tx
- Combination therapy
What are some factors that affect adherence to psychiatric disorder tx?
- Insight into disease and need for medication
- Personal belief system about taking drugs
- Therapeutic effects (acute vs. chronic)
- Management of adverse effects
- Complicated regimens
- Quality of therapeutic relationship
What can be done by pharmacists to enhance adherence to psychiatric disorder tx?
- Enhance education and communication
- Collaborate between clinicians and clients
- Medication reviews
- Assess for potential drug related problems
What should px know about their psychiatric medications?
- What medication is for
- When it should start to work
- When, how, and how long to take it
- Side effects
What should be re-evaluated when a px is thought to have a resistant psychiatric disorder?
- Correct dosage
- Adequate duration
- Compliance (beliefs, regimen, side effects, direction)
- Other medical problems
- Review diagnosis
What are the goals of tx for psychiatric disorders?
- Non-curative
- Sx control only; for acute, reduce or resolve sx; for chronic, prevent recurrence of sx
- Endpoint = improved functioning of individual
What is the effect of nutrition, sleep, and exercise in psychiatric disorders?
- Many psychiatric disorders may be caused or made worse by poor nutrition, sleep deprivation, and inadequate exercise
- Skipping meals and poor nutrition = decreased NT synthesis, storage, and release
- Not sleeping = decreased serotonin or NE synthesis and storage
- Not exercising = decreased NT release
What can deprivation of REM sleep cause?
- Less serotonin and NE synthesis if less than 8 hours/day
- Increased appetite, sexual, and motor activity
- Increased aggression and fighting
- Increased anxiety and depression
- Increased cortisol and stress hormones
What is the DSM?
- Diagnostic and statistical manual of mental disorders
- Describes diagnostic categories
- Sx and diagnostic criteria
- Standardizes diagnosis for mental disorders
What are the axis’ that should be assessed?
- Axis 1 = all psychiatric diagnosis (except axis 2)
- Axis 2 = personality disorders and mental retardation
- Axis 3 = general medical conditions
- Axis 4 = environmental and psychosocial stressors (positive and negative; number, desirability, and degree of control)
- Axis 5 = global assessment of functioning (psychological, social, and occupational; scale of 1-100)
What is included in a mental status exam?
- Appearance
- Speech (quantity, rate, and quality)
- Mood, affect (subjective and objective)
- Thinking (form, content)
- Perceptions (hallucinations)
- Sensorium (alertness, orientation, concentration, memory, calculations, fund of knowledge)
- Insight
- Judgment
What are delusions? What are some examples?
- Fixed, false beliefs out of keeping w/ px cultural background
- Ex: persecutory, jealousy, sin or guilt, somatic, thought broadcasting
What is the function of the mini-mental state examination (MMSE)?
- Assesses cognitive performance in a clinical setting
- Assesses orientation, attention, memory, and language
- Severe Alzheimer’s = less than 10; mild = 21-26 on a 30 point scale
What should be included in a psychiatric history?
- Chief complaint
- History of present illness
- Previous illness
- Personal history
- Psychosexual history
- Family history
- Dreams, fantasies, values
What should be included in a psychiatric report?
- Psychiatric history
- Mental status examination
- Diagnostic studies to be ordered
- Summary of pos and neg findings
- Diagnosis through multi-axial assessment
- Prognosis
- Recommendations for tx plan
What are some schizophrenia rating scales?
- Brief psychiatric rating scale (BPRS) – 4 clusters of sx: thinking disturbance, anxious depression, withdrawal-retardation, hostility-suspiciousness
- Positive and negative syndrome scale
What are some depression rating scales?
- Hamilton psychiatric rating scale for depression (less than 6 = normal mood; over 25 = severe depression) **gold standard
- Beck depressive inventory (measures change due to tx; 0-9 = normal; 30-63 = severe depression)
