Diseases Week 3 Flashcards
Substance Abuse Disorder and Mental Illness
High comorbidity and Very few get proper treatment.
Common Underlying Neurobio Factors:
- Imbalance of NT
- Same regions and pathways
- Genetic inherited factors
Drugs of abuse can cause symptoms similar to most forms of mental illness.
Often due to self-medication.
Longtime users often become particularaly susceptible to mental illness.
Can be diagnostic confusion between intoxication/withdrawal/chronic use and mental illness.
The relationship is complex and bidirectional w/ special problems with adolescent use.
Screen mental illness pts for SUD and vice versa
Ddx based on timing of illness and drugs.
Treat at same time and maximize non-pharmacologic options (CBT)
Panic Disorder
Panic attack is a brief episode of intense fear accompanied by multiple physical symptoms that occur repeatedly and unexpectedly in the absence of a threat.
Sx: Racing heart, chest pain, dizziness/nausea, tingling/numbness in hands, flushes or chills, dreamlike sensations, terror, fear or losing control or doing something embarassing, and a fear of dying.
Lifetime prevalence is 1.5%
4x higher in women
Agoraphobia
Marked anxiety or distress of leaving home, being in public places, or feared situations.
Usually co-occurs with panic.
Life prevalence 2.7-5.8%
4x higher in women
Social Phobia
An intense fear of becoming humiliated in social situations.
Lifetime prevaence 3-13%
Typical onset around 16y.o
Specific phobias
Marked and persistent fear that is excessive or unreasonable, that is caused by the presence or anticipation of a specific object or situation.
Exposure to feared stimulus provokes and immediate anxiety response.
Recognition by the patient of excessivenss of the fear.
More prevalent in women
Prevalence rate is 5-12%
Obsessive Compulsive Disorder
Obsessions are unwanted, recurrent, and disturbing thoughts, impulses, or images which the person can’t suppress which cause overwhelming anxiety.
Compulsions are repetitive, ritualized behaviors that the person feels driven to do to alleviate their anxiety caused by the obsession.
Diagnostic criteria - recurrent obsessions or compulsions that are severe enough to be time consuming. At some point the person has recognized that the obsession or compulsions are excessive or unreasonable.
Life prevalence is 2-3%.
Comorbidity with depression and panic disorders.
Cyclical in nature.
Cluster C Personality Disorder (Worried)
PTSD
May occur after exposure to a terrifying event or ordeal in which grave physical harm was threatened or occurred.
Traumatic events that can trigger PTSD include: violent personal assaults (i.e. rape or mugging), natural disasters, wars, car accidents, and witnessing trauma.
Sx: Re-experiencing the trauma, avoidance of things that remind one of the trauma, and hyper-vigilance.
DREAMS Detachment Rexperiencing the event Event had emotional effects Avoidance Month + in duration Sympathetic hyperactivity or hypervigilance.
Life prevalence - 4% and can occur at any age
Females > Males
Must persist > 1 month; acute >3 mo. ; chronic
Major Depressive Disorder
Sx: Five or more sx must persist for more than 2 weeks
At least one of these:
- Persistent sadness (in children or adolescents irritable mood)
- loss of interest in activities once enjoyed
Others:
- Significant change in appetite or body weight
- Difficulty sleeping or over sleeping
- Psychomotor agitation or retardation
- Loss of energy
- Feelings of worthlessness or inappropriate guilt
- Difficulty concentrating
- Recurrent thoughts of death or suicide
Etiology: Vulterabiltiy + Stressor (influenced by biopsychosocial) = depression.
Lifetime prevalence: 16.5%
12 month prevalence: 6.7%
Average age of onset = 32 years old
Women 70% more likely than men.
Genetic vulnerability- Serotonin transporter linked promoter region polymorphism –> long + long = resilient; short + long = average; short + short = low resilience & high depression
Sleep physiology changes: Increased REM density
Abnormal HPA-axis function –> decreased plasticity
Comorbidities - Anxiety, chronic pain, MI (worse outcomes), Metabolic disease (worse outcome), substance abuse, suicide
Treatment: Meds, CBT, psychotherapy, exercise, sleep hygeine, diet
Goal is to manipulate neurotransmission which increases the transcription of BDNF to enhance Neurogenesis
Persistent Depressive Disorder (Dysthymia)
Depressed mood for at least two years plus accompanying sx
Bipolar 1
Mania period that lasts around 7 days
Bipolar 2
Hypomania that lasts aroung 4 days
Disruptive Mood Dysregulation Disorder (DMDD)
New to DSM-V with goal to distinguish children with milder mood dysregulation from childhood-onset bipolar.
Currently less than 1% of childhood dx’s go onto having adult bipolar.
Most children treated for irritabilty and disruptive behavior develop anxiety or depression. (we don’t know how psychotropic meds affect young brains)
Goal is reduce amt of rx’s.
Onset before age 10
Sx: Severe recurrent temper outbursts, outbursts inconsistent with age, average 3+ times a week,
mood between outbursts irritable or angry
Present 12+ months and in 2 settings
ADHD
Key symptoms: Hyperactivity, Impulsivity, and Inattention
Disorder of executive function (under developed PFC = low DA and NE) and self-regulation
Several symptoms must be present before age 12 in multiple settings. The symptoms must not be due to psychosis, depression, or anxiety.
Two types:
Inattentive - often struggles to sustain focus/problems. Meds really help this
Hyper/Impulsive - Talks loud/excessive, interrupts, squirms/jumps around
Most common:
- Mixed (boys)
- Innattentive (girls)
- Hyper/Impulsive (least common)
Important Hx ?’s - Family history; In utero exposures; birth trauma (nuchal chord); other frontal lobe trauma/ heavy metal exposure
Most commonly treated childhood disorder. Prevalence approximately 5%.
Male:Female = 3:1
Rx: First line - Methylphenidate or Amphetamine
Second line - Atomoxetine.
Adjunctant treatment - individual education plan (i.e.p.), increased exercise, behavioral therapy, patient/parent education, etc.
Rape Trauma Syndrome
Medical term given to the response that survivors have to rape. RTS is a natural response and not a mental illness.
Symptoms:
Physical - Nausea/vomiting, headaches, sleep disturbance
Behavioral - Difficulty concentrating, fear of being alone, drop in work performance
Psychological - shame, numbness, flashbacks, loss of memory.
Support system is biggest factor influencing recovery.
Taijin kyofusho (TKS)
Japanese and Korean individuals who are concerned about being observed and consequently avoid a variety of social situations.
Difference from SAD is TKS is concerned about doing something, or presenting an appearance, that will offend the OTHER person, compared to oneself in SAD.
Cluster A Personality Disorder
“Weird” Includes: Paranoid pd, schizotypal pd, and schizoid pd
Largely genetic.
Paranoid Personality Disorder
Cluster A (Weird)
A pervasive distrust and suspiciousness of others. Their “threat detector is too high”
Schizoid Personality Disorder
Cluster A (Weird)
A pervasive pattern of detachment from social relationships. Not psychotic just don’t want to be around people. Solitary activities, little pleasure.
Not functional, but not distressed.
Think “basement boys”
Schizotypal Personality Disorder
Cluster A (Weird)
A pervasive pattern of social deficits marked by acute DISCOMFORT. Reduced capacity for relationships, eccentric, etc. Often odd beliefs or magical thinking.
Related to schizophrenia (spectrum)
Both Distressed and not functional.
Cluster B Personality Disorder
Wild. Patients are very tough to deal with.
Borderline personality disorder
Narcissistic personality disorder
Antisocial personality disorder
Histrionic personality disorder
