bs Flashcards
insomnia
- dyssomnia is problem with timing, quality, or amount of sleep
- parasomnia is behavior of sleep, so restless legs, snoring etc
- diagnosis:
- difficulty intiating or maintaining sleep, early morning waking without able to go back
- impairs your life
- at least 3 NIGHTS A WEEK FOR A MONTH
insomnia etiology
- endogenous: excess excitatory NT at night (NE, serotonin, dopamine, histamine)
- deficiency of inhibitory GABA, melatonin, adenosine
- exogenous: use of stimulants of CNS like caffeine, withdrawl of sedatives like alcohol, barbituates, and benzodiazapenes, or medical condition like chronicpain
- psychiatric: mental disorder, depression, bipolar like manics cant fall asleep, anxiety and PTSD
- anxiety leads to insomnia
insomnia management
- diagnose, and educate
- behaviorla conseling, sleep hysgeine and stimulus control
- therapy: sleep restriction, cognitive (talking through sleep and imagery), and ehavioral (sleep log)
- pharmacotherapy: OTC melatonin, antihistamines -> Rx antihistamines melatonin 1+2 -> mild habit forming benz receptor agonists or orexin antagonist -> benzodiazapenes or off label drugs
- determine youre patient before giving habit forming drugs, and if they have something like apnea, dont give them a sedative
schizophrenia
- divergence bw behavior and thought content
- deterioration in mental status and behavior
- gene and environment interaction
- 1% disease
-psychosis is hallmark symptom
presents as 1. hallucination-alteration in sensory perception 2. delusions/abnormalities in thought content 3. abnormalities in thought organization and process- not linear thoughts, ex is my car rubber moon cheese
definitions for schizo
hallucination: sensory perception without an external stimuli
delusions: fixed false beliefs w/o basis- delusion of persecution is most common
thought blocking: abrupt halt in train of speech/thinking. can be bc of halluxinations
circumstantiality: when responding to a question, gives alot of info not necessary, but answers question
tangentiality: starting a logical response but then moving further and further away
loose associations: loss of meaning bw thoughts and words
characteristics of schizo
- one episode of psychosis (hallucination/delusion/abnormality of thought process
- persistent disturbance of thoughts/behavior/apperance/speech/emotionaffect
- impaired social occupational functioning
different from delirium or substance abuse bc there is no clouding of consciousness bc schizo is alert and oriented and attention and memory intact when not psychotic
DSM 5 for schizo
A. 2 characteristics for at least one month
- delusions
- halluciations
- disorganized catatonic behavior )neurological immobility)
- negative symptoms (flat affect, alogia, avoliton-no drive)
- disorganized speech
B. social/ occupation effect
C. duration: must persist for 6 months, so one month symptoms from A, with prodrome period
D. schizoaffective and mood disorder exclusion: cant be another illness
E. substance/medical exclusion- cant be other drugs
Key Symptoms
positive -additional to expeceted -delusions -hallucinations -agitation talkative -thought disorder ** responds well to most to traditional and atypical antipsychotics
negative
- missing expected behavior
- lack of motivation
- social withdrawl
- flat affect
- cognitive disturbance
- bad grooming and speech
- sometimes, responds with atypicals
atypical antipsychotics block D2 receptor of domapine, and 5HT2a of seratonin
the traditonals only blocked D2 dopamine receptors
Course has three phases
phase 1: prodrome before first psychotic break -avoiding social activities quiet, passive, irritable -interest in religion -physical complaints -anxiety and depression
phase 2: psychotic/active with loss of touch with reality
-poitive symptoms of delusions, hallucinations, agitation, talkative
phase 3: residual is the period between psychotic episodes. youre in touch with reality but not behaving normally
-negative symptoms, weird thinking, etc
etiology and other factors of schizo
- occurs earlier in men than women, avg age in men is 15-25 avg age in women is 25-35
- women respond better to antipsychotic mefs, but they have a greater risk for tardive dyskinesia
- —- cumulative days of D2 receptor dopamine blockade can lead to permanent movement disorders of choreic movements
- viral infections in preganancy can cause schizo
neurological abnormalities in schizo
- abnormal frontal lobe, decreased use of glucose in prefrontal cortex
- lateral ventricles and third ventricles enlarge
- loss of assymetry between cerebral hemispheres- normal is asymetrical. in schizo you become symmetrical
- density of brain changes, volume of hippocampus, amygdala, and parahippocampal gyrus go down
- EEG sleep study shows less alpha waves, increased theta and delta waves and epiletpiform activity of EEG
- weird eye movements
neurotransmitter abnormalities
- dopamine hypothesis
- excessive DA in mesolimbic tract. stimulant drugs, amphetamines, and cocaine can cause psychotic symptoms by amplifying this tract
- negative symptoms are causes by DECREASED activity in mesocortical tract
- elevated homovanillic acid is a metabolite of DA is increased and seen in pts with schizo
Neurotransmitter abnormalities
- seratonin hyperactivity
- hallucinogens like LSD increase seratonin and cause hallucinations and delusions, so possibly hyperactive seratonin is causing schizo
- can be treated with the newer second class atypical antipsychotics bc they have anti seratonin 5HT receptor activty
NT abnormalities
- glutamate hypothesis
- glutamate is the major excitatory NT in CNS
- expereimtnally seen that an antagonist of NMDA glutamante receptor will cause psychosis and an agonist will relieve symptoms
- theory is NMDA recepter hypoactivity theory
- mutated NMDA receptors are underactive
- they sit on GABA interneurons bw a cortical GLU pyramidal neuron and its secondary neuron. so, with NMDAR defect, you get a loss of inhibition and allow excessive firing and increased firing in the VTA which leads to dopamine release and extra DA into limbic system causing psychosis
normal is GLU-GABA-GLU-DA
other disorders causing psychosis
- psychotic disorder caused by general medical condition: B12, folate, temporal lobe epilepsy, cortico steroid induced
- manic phase of bipolar disorder
- substance induced: cocaine, crystal meth, ritalin slash any stimulants, ketamine, PCP, LSD, bath salts
other psychotic disorders
- brief psychotic disorder is 1-29 days of schizophrenia symptoms
- schizophrenifrm disorder is 1-6 months of symptoms
- schizoaffective is schizo+mania or depression
- delusional disorder is delusons but no other sympotms
- spared psychotic disorder is one person is delusional and another person shares the delusion
