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Clinical - Winter > 23 - Psychiatry > Flashcards

23 - Psychiatry Flashcards

1
Q

What are some psychiatric disorders?

A
  • Major depression
  • Psychosis
  • Schizophrenia
  • Bipolar affective
  • Generalized anxiety
  • Panic disorder
  • OCD
  • ADHD
  • Post-traumatic stress
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2
Q

What are some medications used for psychiatric disorders?

A
  • Antidepressants
  • Antipsychotics
  • Mood stabilizers
  • Anxiolytics
  • Sedative/hypnotics
  • Psychostimulants
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3
Q

Which psychiatric disorder is commonly misdiagnosed?

A

Bipolar disorder

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4
Q

What is the relative schizophrenia 10 year mortality rate compared to those w/o schizophrenia?

A
  • 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
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5
Q

What are the contributors to morbidity and mortality in the mentally ill?

A
  • 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
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6
Q

What are some neurological differences that are present in psychiatric disorders?

A
  • Modification of neurobiology
  • Loss of neuronal plasticity
  • Excitotoxicity
  • Absence or excess of neurotransmission
  • Imbalance in NTs
  • Wrong rate of neurotransmission
  • Wrong neuronal wiring
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7
Q

Which NTs are targeted by psychiatric medications?

A
  • Norepinephrine
  • Serotonin (5-HT)
  • Dopamine
  • Acetylcholine
  • Gamma-aminobutyric acid (GABA)
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8
Q

Which NTs are affected in depression? Are they increased or decreased?

A

Increased serotonin, NE, and dopamine

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9
Q

Which NTs are affected in psychosis/schizophrenia? Are they increased or decreased?

A

Decreased dopamine and serotonin b/c they are blocked

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10
Q

Which NTs are affected in bipolar affective disorder? Are they increased or decreased?

A

Increase GABA and its effects

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11
Q

Which NTs are affected in anxiety? Are they increased or decreased?

A

Enhanced effect of GABA

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12
Q

How does dopamine affect other NTs?

A
  • 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)
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13
Q

What are the challenges w/ treating psychiatric disorders?

A
  • Time to response
  • Effective regimen
  • Management of adverse effects
  • Drug interactions
  • Adherence
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14
Q

What is involved in creating an effective regimen for a psychiatric disorder?

A
  • Choice of agent, dose, and duration
  • Efficacy in disease state
  • Effectiveness vs. efficacy
  • Acute vs. chronic tx
  • Resistance to tx
  • Combination therapy
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15
Q

What are some factors that affect adherence to psychiatric disorder tx?

A
  • 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
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16
Q

What can be done by pharmacists to enhance adherence to psychiatric disorder tx?

A
  • Enhance education and communication
  • Collaborate between clinicians and clients
  • Medication reviews
  • Assess for potential drug related problems
17
Q

What should px know about their psychiatric medications?

A
  • What medication is for
  • When it should start to work
  • When, how, and how long to take it
  • Side effects
18
Q

What should be re-evaluated when a px is thought to have a resistant psychiatric disorder?

A
  • Correct dosage
  • Adequate duration
  • Compliance (beliefs, regimen, side effects, direction)
  • Other medical problems
  • Review diagnosis
19
Q

What are the goals of tx for psychiatric disorders?

A
    • Non-curative
  • Sx control only; for acute, reduce or resolve sx; for chronic, prevent recurrence of sx
  • Endpoint = improved functioning of individual
20
Q

What is the effect of nutrition, sleep, and exercise in psychiatric disorders?

A
  • 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
21
Q

What can deprivation of REM sleep cause?

A
  • 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
22
Q

What is the DSM?

A
  • Diagnostic and statistical manual of mental disorders
  • Describes diagnostic categories
  • Sx and diagnostic criteria
  • Standardizes diagnosis for mental disorders
23
Q

What are the axis’ that should be assessed?

A
  • 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)
24
Q

What is included in a mental status exam?

A
  • 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
25
Q

What are delusions? What are some examples?

A
  • Fixed, false beliefs out of keeping w/ px cultural background
  • Ex: persecutory, jealousy, sin or guilt, somatic, thought broadcasting
26
Q

What is the function of the mini-mental state examination (MMSE)?

A
  • 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
27
Q

What should be included in a psychiatric history?

A
  • Chief complaint
  • History of present illness
  • Previous illness
  • Personal history
  • Psychosexual history
  • Family history
  • Dreams, fantasies, values
28
Q

What should be included in a psychiatric report?

A
  • 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
29
Q

What are some schizophrenia rating scales?

A
  • Brief psychiatric rating scale (BPRS) – 4 clusters of sx: thinking disturbance, anxious depression, withdrawal-retardation, hostility-suspiciousness
  • Positive and negative syndrome scale
30
Q

What are some depression rating scales?

A
  • 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)

Clinical - Winter (24 decks)

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