Disorders of Thought, Emotion, & Memory Flashcards
what is schizophrenia? prevalence? etiology? patho? CM?
-Characterized by altered perceptions of reality & disordered thinking.
-Disturbance & deterioration of cognitive, social & emotional functioning.
-Thought & behavior is disordered, disorganized & disconnected from reality
-Chronic, severe & disabling.
Prevalence
-Affects about 1% of world population.
-Men=women by the age of 50 or 60.
-Symptom onset is usually in late teens to early 20s; women show a second spike in diagnosis in their 40s to 50s.
-Estimated costs exceed that of all cancers combined in U.S.
Etiology: Unknown
1. Excessive dopamine production and activity
2. Genetic predisposition factors: ”runs in families”.
3. Gestational factors: Exposure to virus during gestation
4. Neurological factors: Abnormal structure.
5. Marijuana Use
Pathogenesis: Genetic predisposition & environmental factors thought to interact and produce biological changes in hippocampus, temporal lobes, & dopamine pathways that go the limbic system. Loss of brain volume shown on MRI.
CM:
-Positive symptoms—d/t excessive dopamine D2 receptor activation in brain—disorganized thinking, disorganized speech, hallucinations & delusions.
-Negative symptoms—mediated by dopamine D1 receptors in brain—loss of interest of everyday activities, social withdrawal, lack of motivation, flat affect & apathy.
-Cognitive symptoms—poor executive function (inability to make decisions based on information), memory problems, and inability to sustain attention.
what is bipolar disorder? prevalence? etiology? CM?
-Alternating mania & depression that can be severe enough to produce psychosis.
-Depression usually lasts 3X longer than mania.
-Psychosis with mania may be mistaken for schizophrenia
1. Bipolar I: at least 1 episode of mania, and major depression.
2. Bipolar II: 1 episode of hypomania, and major depression.
Prevalence:
Bipolar 1, men=women. Bipolar II, women>men
Onset 5 yrs to 50yrs, mean age of onset 30years.
Possible Etiologies: Theorized that external stressors or pressure act on a genetically or biochemically predisposed individual and precede an episode
Diagnosis/Clinical manifestations
Mania: Abnormal, persistently elevated, expansive or irritable mood & increased goal directed activity or energy, plus ≥ 3 symptoms below for at least 1 week
Hypomania: Persistently elevated, expansive or irritable mood & increased goal directed activity or energy, plus ≥ 3 symptoms below for at least 4 days
DIGFAST
Distractibility: Attention easily drawn to irrelevant outside stimuli
Indiscretion: Overindulging in pleasurable activities that can have bad outcomes
Grandiosity: Inflated self esteem
Flight of ideas: Subjective idea that thoughts are racing
Activities: Increase in goal directed activities at work, school; psychomotor agitation
Sleep deficit: Decreased need for sleep
Talkativeness: Increased talking or pressure to keep talking
what is unipolar disorder?
Depression without periods of mania.
Most common: 1 in 10 Americans suffers from episode of depression.
High suicide risk.
what is major depressive disorder? etiology? CM?
Depressive symptoms intense enough to cause distress & persistently impair psychosocial functioning. Can be severe enough to cause psychosis
Often occurs as a comorbid disorder with physical illness.
Females 2:1 males, mean age at onset is 40 & declines with age. 50% of cases have onset between ages 20 & 50. Prevalence in 18-29yr olds is 3x higher than those over 60yrs.
Possible Etiologies: Theorized to be a complex combination of several factors
-Genetically predisposed
-Early life adversity
-Ongoing stress
-Dysregulation of neurotransmitters
-MRI’s show changes in areas responsible for mood, thinking, sleep, appetite & behavior.
Diagnosis/Clinical Manifestations
≥5 symptoms over 2 wk period; must be a change in previous functioning
1 symptom must be either depressed mood or loss of interest or pleasure
SIGECAPS
Sleep: Insomnia or hypersomnia, staying asleep is problematic
Interest: Depressed mood, loss of interest or pleasure (anhedonia)
Guilt: Feelings of worthlessness
Energy: Fatigue
Concentration: Diminished ability to think clearly or make decisions
Appetite: Weight change (increase or decrease, loss of food enjoyment)
Psychomotor: Psychomotor retardation or agitation
Suicide: Recurrent thoughts of death, passive without plan most common
what is persistent depressive disorder?
Persistent Depressive Disorder (PDD): depression with ≥2 symptoms lasting 2 yrs or more.
-Uses same criteria as MDD but does not meet it
-Has never been without symptoms for more than 2 months at a time
-Previously known as dysthymic disorder
what is panic disorder? etiology? CM?
-Acute episodes of anxiety symptoms that are unexpected, sudden, recurrent & generate intense feelings of fear
-Anticipatory anxiety: Fearful expectation of panic anxiety onset
-Avoidance often used to increase feelings of control & lessen risk of episodes
-Women 2-3x more affected then men
-Mean age 25 yrs, though can be childhood through mid life
Possible Etiologies:
-Biological r/t excess of norepinephrine, family hx, substance abuse & major life stress. Caffeine may be panicogenic.
Manifestations: dyspnea, palpitations, sense of smothering, chest discomfort, light-headedness, fainting, sweating, tremors, expressed fear of dying.
-Attacks may last 5 to 30 minutes
what is generalized anxiety disorder? etiology? CM?
-Continuous moderate degree of anxiety, worry and tension without acute attacks.
-Worry is chronic & persistent, as well as physical anxiety symptoms.
-Women 2x>men. Onset late adolescence or early adulthood.
Possible Etiologies: Biological and psychological factors work together to increase normal and adaptive anxiety to problematic and pathologic anxiety.
Dx/Clinical manifestations: Must have 1st two, plus ≥3 symptoms below for >6mos, most days of week
W: Worry: Difficulty controlling worry
A: Anxiety: Excessive anxiety
T: Tension in muscles
C: Concentration difficulty
H: Hyperarousal (or irritability)
E: Energy loss/fatigue
R: Restlessness, feeling keyed up/on edge
S : Sleep disturbance (typically difficulty initiating sleep)
what is obsessive compulsive disorder? etiology?
-Either obsessions or compulsions that are time-consuming (>1hr/day) or significantly interfere with the person’s normal functioning.
-Persistent involuntary thoughts that provoke anxiety & involuntary anxiety management rituals.
-Characterized by obsessive thoughts & compulsive behavior.
-Obsessions: Repeated, persistent, unwanted ideas, thoughts, images & have common themes.
-Compulsions: Repetitive, ritualistic behaviors prevent or reduce anxiety related to obsessions.
-Prevalence: Men=women, boys>girls. Mean age of onset 25 yrs.
Possible etiologies: Dysregulation of serotonin, possible link with strep infection, genetics; relatives of people with OCD have 3-5x´s higher probability of OCD.
what is post traumatic stress disorder? etiology? prevalence? CM?
Etiology:
Exposure to a stressor with intense fear and horror must have occurred
Stressor alone is not enough to cause PTSD, it’s subjective meaning is important
Important risk factors: Severity, duration and proximity of the persons exposure.
Prevalence:
8% general population, 13% Iraq/Afghanistan vets, 30% Vietnam vets
-Women 2x>men
If symptoms are experienced for <1 month, it is considered Acute stress response
Diagnosis/Clinical manifestations: Must occur for >1month
-Exposure to actual or threatened traumatic event that is direct or witnessed (required)
-Intrusive symptoms: Trauma is persistently re experienced; memories, dreams, flashbacks
-Persistent avoidance: Efforts to avoid trauma stimuli such as distressing memories, thoughts or feelings associated with event. External reminders (people, places, activities)
Persistent negative alterations in cognitions & mood that worsen after the trauma: Cannot recall aspects of event, exaggerated negative beliefs about oneself or others, ie; No one can be trusted, negative emotional state, feeling detached from others, unable to experience positive emotions, blaming self for event.
-Marked alterations in arousal and reactivity that began or worsened after the trauma: Irritability, bursts of anger, reckless self destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbances.
what is attention deficit hyperactivity disorder? CM?
Most common child psychiatric disorder.
-Difficulty with focus & behavior control & hyperactivity
-Affects 7-8% elementary school children
-2:1 boys to girls
-2-8x’s risk of ADHD between siblings of children with ADHD
-70% are also meet criteria for learning disability, anxiety disorder, mood disorder, conduct disorder and substance use disorder
Clinical Manifestations
-Inattention: unable to stay focused, easily distracted by external stimuli, difficulty organizing tasks & activities, loses things necessary for tasks, forgetful, does not seem to listen, dislikes activities that require sustained mental effort.
-Hyperactivity: consistent movement; always “on the go”, often fidgets or taps hands or feet or squirms, restless during activities when others are seated, tends to act without thinking, often impatient, blurts out answers, talks excessively, difficulty waiting turn.
what is personality disorder? criteria?
-Enduring pattern of perceiving, relating to, & thinking about oneself, others & the environment that is inflexible, maladaptive & causes major interpersonal distress and deviates from the cultural norm.
-10-20% of the population has a personality disorder
-Up to 50% of patients with a personality disorder have another psychiatric disorder
General diagnostic criteria for a personality disorder
Must have at least 2 of the following:
-Ineffective cognitive capacity (ie; immature and distorted ways of perceiving and interpreting self, other people and events)
-Affect abnormality (ie; intense, labile, extreme range, inappropriateness)
-Interpersonal functioning problems
-Difficulties with impulse control
what is borderline personality disorder? etiology? CM?
-intense emotional instability
Etiology: Unknown; but both environmental & genetic factors suggested.
Biochemical factors thought to be contributory.
Brain abnormalities, genetics, emotional deprivation & abuse may contribute.
Manifestations: Intense, unstable, dependent relationships, self destructive behaviors, panic when left alone.
what is antisocial disorder?
-Failure to internalize moral & ethical values consistent with societal norms.
-Pervasive disregard for the law & rights of others.
-Lack of anxiety & guilt, cold-bloodedness, careless indifferences.
-Occur before age of 15 & affects men 3X´s as often as women.
-More prevalent in prison population.
-Causes both environmental & possible genetic component.
-History of ADHD.
what is anorexia nervosa? CM?
Excessive dietary restriction, wt. loss > 15%, irrational fears of wt. gain, & disturbed body image.
Average age of onset 13-15 yrs.
Mortality rate: 5-18%
Manifestations: amenorrhea (absence of menstruation), hypothermia, edema, bone loss hypotension, anemia, heart problems, fluid & electrolyte imbalance.
what is bulimia nervosa? CM?
-binge eating and then purging through vomiting and laxative use, done secretly
-May fall in normal range for age and wt. but fear weight gain.
-Onset is about age 18-20 years.
Manifestations: electrolyte imbalances, GI problems, & oral/teeth problems.
