3rd Flashcards
Which neurotransmitter is implicated in the development of Tourette Disorder
Excess dopamine in the cortico-striatal-thalma-cortal circuit (CSTC)
Schizophreniform
shares features with schizophrenia but has shorter duration - usually less than 6 months.
What type of therapy can be good for someone with schizophrenia
Group therapy for addressing social withdrawal and enhancing social skills.
Which medication has been extensively studied to reduce risk of suicide in schizophrenia
clozapine (clozaril)
Which antipsychotic medication has been shown to have the least amount of weight gain
aripiprazole (Abilify)
Which mood stabilizer has the least amount of weight gain
lamotrigine (Lamictal)
Which antipsychotic medication is the least sedating
aripiprazole (Abilify)
Which antidepressant is least sedating
Lexapro (escitalopram)
Which mood stablizer is considered the safest during pregnancy
lamotrigine (lamictal)
Which SGA is known to have greatest potential for prolonging QT
ziprasidone (Geodon)
which SGA has the shortest half-life
ziprasidone (Geodon)
Concern of Kava for anxiety
has been associated with potential liver toxicity
Generic name for Latuda
larasidone - “give lara latitude”
ziprasidone Trade name
Geodon (Geod Don’s zipper)
Which medication is used as an ajunct medication to normalize prolactin levels with risperidone.
Apiprazole - Abilify
Which antipsychotic requires at least 350 calories of food for absorption
Latuda - Lurasidone
Geodon (500 calories)
which SGA is the most metabollicaly favorable
lurasidone (Latuda)
Mood neurotransmitters
- Serotonin body’s “feel good” transmitter
- low serotonin levels are associated with depression, anxiety and other mood disorders
- Dopamine - feelings of reward and motivation, decreased in depression and increased in mania
neurotransmitters involved in OCD
- Glutamate primary neurotransmitter in the cotico-striatal-thalmic circuit involved in OCD
- People with OCD have higher levels of glutamate in the brain, especially in the frontal regions particularly in the ACC (anterior cingulate cortex)
- Gaba - lower levels in frontal region particularly in the ACC
- Dopamine - dopaminergic overactivity is involved the frontostriatal pathways
- Serotonin - diminished in the frontolimbic systems
neurotransmitters involved in Parkinson’s
Increase acetylcholine
Decrease dopamine
Neurotransmitters involved in psychosis
Increased glutamate
Increase dopamine
Medications that can cause stomach pain
ranitidine, famotidine, omeprazole
Relationship between antipsychotics and antacids
Antacids decrease absorption of psychotropic medication
Primary Prevention
Prevent/promotion, safety initiatives, education, classes, modifying enviroment
Secondary
screen-early detection, crisis hotline, disaster
Tertiary
treat to prevent further deterioration, rehab, restoration, day treatment, social skills
IADLs
Instrumental activities of daily
* managing finances
* managing medication
* preparing meals
* cleaning (laundry, dishes, etc.)
* getting around (traveling, car, taxi, bus)
* commumicating - using phones, computers and other devices to communicate wit others
* Managing health - communicating with healthcare providers and scheduling appointmenst
ADLs - feeding, dressing, bathing, and walking
Cortical dementia examples
Alzheimers, creutzfield jacon disease
* Severe memory impairment with aphasia
subcortical dementia example and characterisitics
Huntington’s disease, parkinson’s disease and aids dementia
* Changes in personality and attention span, depression, clumsiness, irritability or apathy.
On a genetic profile screening what is considered normal
Extensive metabolizer
Lamictal side effects
(treats mood disorders and bipolar affective disorder)
Severe - Steven Johnson
Common - drowsiness, dizzy, ataxia, diplopia, nausea, headache, hepatotoxity
What medication when given with lamictal can double lamictal levels
Depakote
What medication when given with lamictal can decrease lamictal levels
carbamazepine
name the inhibitors and specific binding sites
- Buproprion (2D6)
- Clomipramine
- Cimetidine (1A2)
- Clarithromycin (3A4)
- Fluoroquinolones (1A2)
- Omeprazole (1A2)
- Grapefruit Juice
- Ketoconazole
- Nefazodone
- Alcohol (acute)
- Valporate
- SSRI (2D6)
Be Careful Cause COVID Feels Overwhelmingly Gross, Keep Nana always very Safe
Neuropeptides
- Substance P/endorphins
- serve to trigger and control the body’s response to injury and stress and is involved in pain perception
- Low levels are seen in substance abuse
what does excess of glutamate do?
- Ecitatory neurotransmitter so increased levels will increase anxiety
*
What does decreased levels of glutamate look like
- Memory and learning difficulty
- negative symptoms of schizophrenia
Examples of the neuropeptides involved in addiction
- Orexin AKA hypocretins regulate energy metabolism, sleep, feeding, and stress response. Drug abuse can alter orexin system which may contribute to uncontrolled drug intake and relapse
- Substance p related to pain perception, stress, immune response, and inflammation
- Endorphins
- Galanin - feeding and drug seeking behaviors
Tuberoinfundibular neural pathway
*originates from hypothalmus (specifically arcuate nucleus) to pituitary gland (anterior pituitary)
* Regulates release of dopamine
* .Primarily inhibits prolactin secretion
* When dopamine decreases, there is an increase in prolactin causing galactorrhea
* Rationale for antipsychotics prolactin side effect
Function of acetylcholine
cholinergic -
* Learning, short term memory, arousal, reward (delerium), motivation, ACH are higher during wake and REM sleep and lower during NREM sleep
Low levels of acetylcholine are associated with
Alzheimers disease / impaired memory
Increased levels of acetylcholine are associated with
parkinsonian symptoms (acetylcholine stimulates muscles to conract. Overstimulation causes tremors and jerking movements)
increased levels contribute to motor symptoms. Imbalance of reduced dopamine levels causing muscles to become over excited leading to tremors and other involuntary movements. Dopamine normally acts to inhibit acetlcholine release. when dopamine is low acetylcholine is high.
Decreasing GABA levels would have what effect?
Increase anxiety
Decreased levels of GABA are noted in this mood disorder
Depression
GABA is the site of action for what
- benzodiazepines, ETOH, barbituates, and other CNS depressants
- Benzodiazepines are used to bind with GABA receptors to potentiate calming effects of GABA
which conditions are associated with low levels of serotonin (5-HT)
depression, OCD, anxiety disorders, violence, schizoaffective and personality disorders
Norepinephrine function
- fight or flight
- arousal, reward, attention (depression, ADHD)
- major transmitter implicated in mood, anxiety, and concentration disorders
Low levels of norepinephrine are found in which disorders
- mood and concentration disorders
- Depression, schizophrenia, and parkinsons, ADHD
Increased levels of norepinephrine are noted in which disorders
anxiety
family systems theory
based on the idea that on cant understand a member/part without understanding how all family members operate together (system)
Overt rules
- part of family systems therapy
- openly stated and clearly communicated
**Example **- a set curfew, chore responsibilites, expectations regading respectful communication
covert rules
Family systems therapy concept that families are governed by unspoken rules, may not be explicity stated, but still guide their actions (family members may not be conciously aware of them).
Example: “dont show weakness”, “dont talk about problems”, “the father is the decision maker.”
Boundaries
Family systems therapy
* barriers that protect and enhance functional integrity of families, individuals and subsystems.
clearly defined boundary
family systems therapy
* maintain individual separateness; emphasizing belongingness
Example-a rule where parents maintain privacy regarding personal finances of parents and only allowed to discuss children’s allowances
Rigid/inflexible boundary
Family systems therapy
* leads to distant relationship and disengagement
Exmple -always having dinner at 6 PM without exception, Always expected to get straight A’s without flexibility or adaptation
Diffuse boundaries
Family systems therapy
* blurred, indistinct, lead to enmeshment (an unhealthy level of emotional closeness and interdependence, where individuals struggles to maintain a separate sense of self., excessively involved in eachother’s lives, often with one person taking on the emotional role of another.
* Example - like a child acting like a parent to their parent leading child to feel they are responsible for parents happiness or constantly trying to fix their problems.
Existential Therapy
- emphasizes free will and responsibility, accepting freedom and making responsible choices
- Goal to live authentically and focus on present and personal responsibilities
- understand the patient’s subjective experience
- Reflection on life and self-confrontation are encouraged
- Focus on meaning - especially in the face of existential anxieties like death and absurdity of existence
Humanistic thearapy - Carl Rogers
- person-centered therapy
- Concepts include Self-directed growth and self actualization
- Each person has the potential to actualize and find meaning
- Therapis provides unconditional positive regard and empathy to foster a supportive environment.
main differences between existential and humanistic therapy
* existential therapy puts stronger emphasis on exploring the fundamental questions of existence, like death and the meaning of life
*** Whereas humanistic therapy **focuses more on an individual’s potential for self actualization (reaching full potential) and becoming the best version of themselves, often assuming a more positive view of human nature.
Interpersonal therapy
- focus on interpersonal issues that are creating distress
- TIme-limited, active, focused on the present and interpersonal distress
- Goal is to identify and modify interpersonal problems, to understand and to manage relationsip problems
Strategic family therapy
- treatment goal is to help family members behave in ways that will not perpetuate problem behavior.
- Interventions are** problem-focused**. It is more symptom focused than structural therapy.
- Techniques used are **straightforward directives, paradoxical directives and reframing belief systems **(e.g., jealousy reframed to caring)
solution-focused therapy
- Goal is to resolve problems through cognitive problem-solving and use of personal resources and strengths
- Techniques include: miracle question, exception finding question, scaling question
Behavioral therapy
Focuses o changing maladaptinve behaviors by participating in active behavioral techniques
Exposure, relaxation, modeling, skills training, problem-solving, and role playing
Dialectical Behavioral Therapy (marsha linehan)
- borderline personality disorder
- Focuses on - emotional regulation, tolerance for distress, self-management skills, interpersonal effectiveness, mindfulness with an emphasis on treating therapy interfering behaviors
- longer that CBT as it is usually longer than six months to one year
Goals of DBT (several)
- Decrease suicidal behaviors
- Decrease therapy interfering behaviors
- decrease emotional reactivity
- decrease self-invalidation
- decrease crisis-gneraring behaviors
- decrease passivity
- increase realistic decision-making
- Increase accurate communication of emotions and competencies
Family systems therapy
- AKA systemic family therapy
- Focus is on chronic anxiety within families
- goals are to increase the families awareness of each member’s function within the family and to increase levels of **self differentiation **(the level at which one’s self-woth is not dependent on external relationships, circumstances, or occurences)
* Triangles: dyads that form triads to decrease stress; the lower the level of adaptatio, the more likely a triangle will develop
*** Triangles/triangulation, genograms - Triangles (triads only)**
Structural family therapy
- goal is to produce structual change in the family organization to more effectively manage problems
- Changing transactional patterns and family structure
- structural mapping (genogram); mapping relationships using symbols to represent overinvolvement, conflict, coalitions, and so forth
*** Hierarchies **- distribution of power
Family structure
an invisible set of functional demands that organize the way the members interact with each other, made up of subsystems (marital, parental, sibling), coalitions (two members joining forces against a third) and boundaries.
Experiential therapy
- Behavior is determined by personal experience and not by external reality
- Dive deep into one’s past experiences
- Best for issues that are hard for clients to discuss openly
- involves activities like role-play, props, music or art to process negative emotions
- examples - drama therapy, art therapy, music therapy, play therapy, outdoor therapy, animal-assisted therapy
Function of thyroid gland
- to take iodine from the blood, combine it with the amino acid tyrosine and convert it into the thyroid hormones T3 and T4.
- stores T3 and T4 until they are released int he blood stream under the influence of the thyroid stimulating hormone (TSH) released from the pituitary gland
What is the true determinant of thyroid disease
- the free portion of thyroid hormones
- Only a small portion of T3 and T4 are bound to protein
Free thyroxine (FT4)
*FT4- 0.8-2.8
* composes a small portion of total thyroxine
* measures the amount of active thyroxine (T4) in your blood
* The amount of T4 not attached to proteins and can enter tissues
Why would a FT4 test be done
- determine thyroid status
- rule out hypo and hyperthyroidism
- evaluate thyroid therapy
Diseases that have high thyroxine levels
- Graves disease
- thyrotoxicosis due to T4
- Hashimoto’s thyroiditis
- acute thyroiditis
Diseases that have low thyroxine levels
- primary hypothyroidism
- secondary hypothyroidism (secondary to pituitary insufficiency)
- Tertiary hypothyroidism (hypothalmic failure)
- Thyrotoxicosis due to T3
- renal failure
- Cushing’s syndrome
- cirrhosis
Which medications can cause high thyroxine levels
heparin, ASA, propranolol
Which medications can cause low thyroxine levels
lasix or methadone LITHIUM
TSH
stimulation of the thyroid gland causes release and distribution of stored hormone
TSH does what when T3 and T4 are high
decreases
TSH does what when T3 and T4 are low
TSH goes high
What happens to TSH if pituitary gland fails
Low levels of TSH
Diseases associated with increased TSH
primary hypothyroidism, thyroiditis
Diseases with low TSH include
hyperthyroidism, secondary and tertiary hypothyroidism
which drug can cause an increase in TSH
lithium can inhibit the release of thyroid hormone causing the pituitary to increase TSH. May cause enlarged thyroid.
Where are calcium levels in the body
- 99% in bone and the remainder is in the plasma and body cells
- 50% in plasma is protein bound
- 40% is the free or ionized form
- The remaining fraction circulates in the blood
Functions of calcium
- enzymatic cofactor for blood clotting
- required for hormone secretion
- required for function of cell receptors
- required for plasma membrane stability and permeability
- Required for transmission of nerve impulses and contraction of muscle
calcium balance is mediated by which 3 hormones
- parathyroid, vitamin D, calcitonin
- Together, they determine the amount of dietary Ca absorbed and the renal absorption and excretion of Ca by the kidney
Increased levels of Ca can be caused by
- acidosis
- hyperparathyroidism
- cancers
- thiazide diuretics, hormones, vitamin D, Ca
- Vitamin D intoxication
- Addison’s disease
- hyperthyroidism
Decreased levels of calcium can be caused by
- alkalosis
- hypoparathyroidism
- renal failure
- pancreatitis
- inadequate dietary intake of calcium and vitamin D
- barbituates, anticonvulsants, acetazolamide, adrenocorticosteroids
High levels of calcium in kids can be caused by, and what in adults?
- children because of normal bone growth
- increased calcium (alkaline antacids) intake of vitamine D, thiazide diuretics, and lithium
systemic effects of hypocalcemia
- Increase in neuromuscular excitability, parasthesia around mouth and digits, muscle spasms hands & feet, contininuous severe muscle spasms, tetany, convulsions, intestinal cramping, hyperactive bowel sounds
- hyperreflexia confusions, ECG changes, prolonged QT interval
- Ca < 8.5
Systemic effects of hypercalcemia
- Ca>12.5
- fatigue, weakness, lethargy, anorexia, nausea, constipation, behavioral changes, impaired renal function, ECG changes - shortened QT intervals & depressed T-waves, bradycardia, heart block
What electrolyte accounts for 90% of extracellular fluid and is the most powerful cation in extracellular fluid
Na
Functions of Na in the body
- regulates osmolarity (interstitial and intravascular fluid volume)
- works with potassium and calcium to maintain neuromuscular irritability for conduction of nerve impulses
- regulates acid-base balance
- participates in cellular chemical reactions and membrane transport
- regulates renal retention and excretion of water
- Maintains systemic blood pressure
Increased Na levels can be caused by
- hypovolemia
What can cause hypernatremia
- dehydration
- diabetes insipidous
- excessive salt ingestion
- Lithium, vasopressin V2 receptor antagonist (desmopressin), mannitol, lactulose, ETOH, corticosteroids, loop diuretics
What causes hyponatremia
- dehydration (vomiting and diarrhea)
- NSAIDs, thiazide diuretics, SSRI, morphine and other opioids, tegretol, antipsychotics, methyldopa
- Increased water intake
- endocrine disorder (SIADH)
- organ failure
- recreational drugs (Ecstacy)
hyponatremia often indicates a hypovolemic state (CHF,Liver disease, nephrotic syndrome)
Systemic effects of hyponatremia, Na < 135
- lethargy, hypotension, decreased urine output, weight gain, edema, ascites, jugular vein distention
- headache
- confusion
- apprehension
- seizures, coma, rhabdomyolysis
- hypotension
- tachycardia
Systemic effects of hypernatremia
- convulsions
- pulmonary edema
- thirst
- fever
- dry mucous membranes
- hypotension
- tachycardia
- restlessness
Key points about magnesium
- major intracellular cation; 40-60% is stored in bone and muscle, 30% in cells
- regulation of Mg is primarily by the kidney
- low serum levels can cause coservation by the kidney
- cause of neuromuscular excitability
what drugs can cause high magnesium levels
antacids, laxatives containing magnesium, ASA, lithium
drugs can decrease Mg levels
thiazide diuretics, calcium gluconatem insulain, alcohol
systemic effects of hyperkalemia
- muscle weakness
- paralysis
- tingling of lips and fingers
- restlessness
- intestinal cramping
- diarrhea
- narrow and taller T-waves
- mild-shortened QT
- severe - depressed ST segment, prolonged PR interval, widened QRS complex leading to cardiac arrest
- > 5.5
Systemic effects of hypokalemia
- <3.5
- impaired carbohydrate metabolism
- impaired renal function
- polyuria
- polydipsia
- skeletal muscle weakness smooth muscle atony
- cardiac dysrhythmia
- paralysis and respiratory arrest
Drugs that give a false positive for amphetamine
- Aderall/methylphenidate
- Bupropionate
- fluoxetine
- trazodone
- ranitidine
- nefazodone
- nasal decongestants pseudophedrine
Drugs that give a false + for ETOH
valium
Drugs that give a false positive for benzodiazepines
sertraline
drugs that give a false + for cocaine
- amoxicillin
- most antibiotics
- NSAIDs
Drugs that can give a false + for heroin or morphine
- Quinolones
- rifampin
- codeine
- poppy seeds
Drugs that give a false + for methadone or PCP
- OTC cough meds (nyquil, dextromethorphan)
what is possible treatment for elevated prolactin levels
bromocriptine and cabergoline
symptoms of hyperprolactenemia
- milky discharge breast, decreased sex drive, irregular periods
Meds to quit smoking
- vareniciline (chantix)
- buproprion
Prader Willis disease
- excessive appetite, overeating leading to dangerous weight gain
- caused by missing genetic material in a group of genes on chromosome 15 leads to issues of the hypothalmus which produces hormones that regulate growth and appetite
- delayed growth (shorter than average)
- floppiness (hypotonia)
- Learning difficulties
- lack of sexual development
- behavioral challenges such as emotional outbursts and physcial aggression
Wilson’s disease
- Inherited excessive copper build due to lack of removal
- Kayer fleischer rings (golden-brown colored rings around irises
- jaundice
- edema in stomach and legs
- problems with speech, swallowing and physical coordination
- Depression, mood changes, personality changes, bipolar, psychosis, irritability
- having a hard time falling asleep and staying asleep
- uncontrolled movements or muscle stiffness
- diagnosis between ages of 5-35
Fragile X syndrome
- genetic disorder caused by changes in a gene called fragile X messenger ribonucleoprotein 1(FMR1) which usually makes a protein called FRMP that is needed for brain development. people with fragile x does not make this protein
- developmental delays
- learning disabilities (trouble learning new skills)
- social and behavioral issues (not making eye contact, anxiety, trouble paying attention, hand flappping, acting and speaking without thinking, very active)
- long narrow facem prominent forehead and jaw, large earsm hyperflexible fingers, boys large testicles, flat feet
Autonomic nervous system
Part of the peripheral nervous system that regulates cardiovascular, lungs, gut, sweat glands and salivary glands
Divisions of the autonomic nervous system - involuntary processses
- Sympathetic (fight or flight)
- Parasympathetic (rest and digest)
- enteric
Why is acetylcholine considered primary neurotransmitter of ANS
even though ANS utilizes both norepinephrine and acetylcholine, acetycholinie is considered the main because it is utilized in sympathetic and parasympathetic divisions
which neurotransmitteris primary in symptathetic nervous system
norepinephrine - fight or flight
acetylcholine in the ANS function
- regulates functions like HR, BP, gut motility
- neurones releasing acetylcholine are called cholingergic
norepinephrine in the sympathetic nervous system function
- fight or flight, increase HR, BP, blood sugar.
- arrousal, attention, fcous, memory, sleep-wake cycle and plays a role in emotions
- Increases tear production and dilates pupils in response to light and emotion
- triggers kidneys to release renin (balance salt and water)
- Triggers pancreas to release glucagon which causes liver to produce more glucose
- Stimulates spleen, lymph nodes for immune response
- Decreases blood flow to intestines and slows digestion
Lab values that would be concerning for a patient on lithium
- lithium level
- thyroid panel
- leukocytosis
- creatinine (0.6-1.2)
- BUN (10-20)
- 4+ proteins
- 4+ketones
Side effects of lithium
- weight gain
- impaired thyroid functioning
- fine hand tremors
- fatigue, mental cloudiness
- thirst
- confusion and slurred speech, seizures/coma with toxicity
- Coarse hand tremors with toxicity
- GI upset - diarrhea, N&V, cramps
- T-wave inversion dysrhythmias
What lithium level warrants hemodialysis
> 4.0
How often do you check lithium lab values
- for chronic treatment - check level every 2 months, long-term every 6 months
key points regarding Lithium
- gold standard for treating manic episodes
- not as effective for rapid cyclers / mixed episodes
- Has anti-suicial effects and is 1st line neuroprotective for bipolar
- A level of 1.5 increases the risk for toxic side effects
- metabolized in renal, monitor kidneys
- Avoid in pregnancy, especially in first trimester
Which drugs increase lithium levels
- NSAIDS
- diuretics
- ACE inhibitors
- Carbamazepine
- Pheytoin (Dilantin)
Which drugs lower lithium levels
- sodium bicarbonate
- caffeine, ETOH
- pregnancy
- osmotic and loop diuretics
Which mood stabilizer (anti-eliptic) is weight neutral
carbamazepine
which lab values could be elevated with carbamazepine
ALT (normal is 5-35)
5 tanner stages
- hormones are hard at work behind the scenes: prepuberty
- when the first signs of puberty begin -breast buds start, areola expands, downy pubic hair begins growing. The testicles and scrotum grow larger.
- the** growth spurt**: breast buds continue to grow, no separation betwwn aereola and breast tissue, scant terminal hair, hair forms under the armpits, acne, fat accumulates on thighs and hips. Penis becomes longer and testes gets bigger.
- the continuation of development: aereola and papilla form a secondary mound above the breast. pubic hair covers entire triangle, breasts become ful
- the final stage, pubic hair extends into the groin - adult genitals
what is the null hypothesis
proposes that no significant difference exists in a set of given observations
Example: Do cats care about the color of their food?
null hypothesis: cats express no food preference based on color.
Type 1 error and Type 2 error examples
Type I error - Example -(false +) says you test + for COVID but you really dont have it. You reject the null hypothesis when it is actually true
Type II error - example (false -) says you test negative for covid when you really have it. Fail to reject the null hypothesis.
