Exam 1 Flashcards
1
Q
acetylcholine decrease- diseases
A
alzheimers
impaired memory
2
Q
acetylcholine increase- disease
A
parkinsonian symptoms
3
Q
dopamine decrease- dis
A
substance abuse
anhedonia (An inability to experience pleasure from activities usually found enjoyable) (depression)
parkinson’s disease
4
Q
dopamine inc- dis
A
schizophrenia
psychosis
5
Q
norepinephrine (fight or flight)
decrease- dis
A
depression
6
Q
norepinephrine (fight or flight)
increase- dis
A
anxiety
7
Q
GABA (aminobutyric acid) decrease- dis
A
anxiety disorders
8
Q
glutamate inc- dis
A
bipolar
psychosis
9
Q
glutamate dec- dis
A
memory and learning difficulty
negative symptoms of schizophrenia (apathy, lethargy, withdrawal)
10
Q
serotonin inc- dis
A
inc aggression/ psychosis w/ schizo
11
Q
serotonin dec- dis
A
depressions
12
Q
schizo- population characteristics
A
earlier peak onset in men
diagnosis before age 10 or after age 60 very rare
13
Q
schizo- genetic cause
A
inc apoptosis and dec neurogenesis
14
Q
schizo- environmental risk factors
A
childhood trauma
preg complications
winter births (low vitamin d)
urban city
inc paternal age
inc NMDA (N methyl d aspartate) antibodies - lead to psychosis
15
Q
schizo- sociocul risk factors
A
poverty
stressful life events
cannabis
16
Q
schizo- complications (general systems)
A
cognitive processes
perception**
affect, emotions and beh
social-occupational
17
Q
schizo- social tendencies
A
pt look to isolate and withdrawal
if no support- patterns go unnoticed- become depression- inc risk self harm/suicide
18
Q
schizo- frontal region s/s
A
function- critical thinking
difficulty planning actions and organizing thoughts
19
Q
schizo- basal ganglia s/s
A
function- mvmnt/ sensory information
paranoia hallucinations
20
Q
schizo- auditory system s/s
A
function- hear and understand speech
auditory halluc
21
Q
schizo- limbic system s/s
A
function- emotion
agitation
22
Q
schizo- occipital lobe s/s
A
function- visual information
visual hallucinations, trouble interpreting complex images or recognizing motion
23
Q
schizo- hippocampus s/s
A
function- learning and memory
dec learning and memory
24
Q
schizo- neurotransmitters affected
A
dopamine- inc lvls= positive symptoms
serotonin- inc lvls= positive and neg. symp
25
schizo- phases
1- premorbid
2- prodromal
3- schizophrenia
4- residual
26
schizo- premorbid phase
1
first noticed in school and w/ family (identify first)
poor peer relationships and poor academic performance
* can be misdiag for ADHD
27
schizo- prodromal phase
2
depressive s/s
social withdrawal
cognitive impairment!!!
OCD
28
schizo- schizophrenia phase
3
dev of psychotic s/s
delusions, hallucinations
disorganized speech
29
schizo- residual phase
4
active psychotic phase s/s no longer present
flat affect
30
relationship btw schizo and psychosis
not all psychotic episodes are caused by schizo
= cant automatically diagnose w/ schizo
ex. other causes of mania/psychosis
drug induced
liver failure (ascites, inc ammonia, cognitive changes)
31
schizo- positive s/s- delusions
persecution, grandiose, referential and somatic
persecution- belief one will be harmed by others
grandiose- belief that person has exceptional greatness
referential- belief that everything is r/t them and a sign
somatic- belief that centers on one's own body
ex. i feel sick, take me to the ER
32
schizo- positive s/s- religiosity, paranoia, magical thinking
religiosity, paranoia, magical thinking
33
schizo- positive s/s- associative looseness
shift ideas from one unrelated topic to another
ex. "I love your hair, did you get it done at Blue Beach Salon?"
person will talk about sand on the beach in florida
34
schizo- positive s/s- neologisms
made up words that only have meaning to the person
35
schizo- positive s/s- concrete thinking
literal interpretations of the environment
often not accurate
ex. paranoia about someone whispering bc they think the people are talking about them
36
schizo- positive s/s- clang associtaions
choice of words governed by sound
rhyming
37
schizo- positive s/s- circumstantiality
delay in reaching point of communication bc of unnecessary details
38
schizo- positive s/s- tangentially
introduce many topics, can't get to the point
39
schizo- positive s/s- mutism
refusal/ inabil to speak
40
schizo- positive s/s- echolalia
repeating words that are heard
41
schizo- positive s/s- perseveration
repetition of same word or idea to, despite change in question topics
42
schizo- positive s/s- perception/ hallucinations
auditory- most common, voice commanding person to do something
visual
tactile
gustatory (foul taste)
olfactory (smell)
43
schizo- positive s/s- sense of self
person lacks feeling of uniqueness or individuality
-causes ppl to isolate bc uncomfortable
44
schizo- positive s/s- echopraxia
repeating movements observed
45
schizo- positive s/s- identification and imitation
taking on the form of behavior observed in other people
46
schizo- positive s/s-
47
schizo- positive s/s- depersonalization
feelings of unreality
see self from a distance
48
schizo- positive s/s- motor behavior
hyperactivity
agitation
catatonia (fast and strange mvmnts)
unusual posturing
49
schizo- negative s/s- inappropriate affect
emotions do not match situation
usually deny condition and downplay s/s
50
schizo- negative s/s- bland/ flat
weak emotional tone
51
schizo- negative s/s- apathy
disinterest in the environment
52
schizo- negative s/s-volition
impairment in ability to initiate goal directed activity
53
schizo- negative s/s- emotional ambivalence
contradicting emotions at same time towards object, person or situation
54
schizo- negative s/s- anergia
dec energy
55
schizo- negative s/s- waxy flexibility
even degree of resistance to passive movement
56
anosognosia
impairs ability to understand and perceive ones own illness
57
schizo- general trtmnt
multidisciplinary
meds, and therapy
58
schizo- prognosis (factors that inc good prognosis)
high lvl functioning before diag (premorbid)
female
later age at onset
no structural brain abnormalities
compliancy
no family hx of schizo
associated mood disorder
59
delusional disorder- definition
existence of prominent, non-bizarre delusions
* can be s/s of dev of schizo
60
delusional disorder- erotomanic
person believes someone of higher status is in love with them
61
delusional disorder- grandiose type
person thinks they have some amazing power or special relationship with God/ someone famous
62
delusional disorder- jealous type
thinks partner cheated
63
delusional disorder- persecutory type
thinks they have been done wrong (cheated on, stolen from etc)
64
delusional disorder- somatic type
person feeling imaginary physical sensations (bug crawling on skin)
65
delusional disorder- mixed type
combo of multiple types
66
brief psychotic disorder
sudden onset
duration < 1 month
return to premorbid functioning
can be drug induced psychosis
67
substance-induced psychotic disorder- causes
stimulants (meth)
psychoactive sub (bath salts, LSD)
substance withdrawal (DT's form etoh)
68
hallucinations/ delusions- non schizo causes
brain tumor
parkinsons
AIDS
alzheimers dementia
hepatic disease
69
schizophreniform disorder
same as schizo but lasts btw 1-6 months
if > 6 months = full blown schizo
70
schizoaffective disorder
schizo s/s w/ mood disorders (mania or depression)
71
catatonic features
muscle rigidity/ waxy flexibility (even degree of resistance to movement)
negativism- resists all requests to move
purposeless movement
echolalia and echopraxia (mimicking mvmnts)
stupor
72
schizo- downside of behavior therapy
can't generalize community setting after pt discharged from trtmnt
73
schizo- milieu therapy
use w/ med therapy
pt can be mobile, not restrained to room
74
antipsychotics- function
dec agitation and psychotic symp
75
1st gen typical antipsychotic agents- list
haldol, loxapine (loxitane), pimozide
76
1st gen typical antipsychotic agents- ae
EPS, tardie dyskin, NMS (fever, tachy, muscle rigidity), weight gain, GI upset, agranulocytosis, dec seizure threshold
77
1st gen typical antipsychotic agents- contraindications
prolonged QT
CNS depressant
liver, renal or cardiac disease
78
1st gen typical antipsychotic agents-action
suppress dopamine, histamine and acetylcholine
79
2nd gen atypical antipsychotic- Zyprexa
purpose
schioz maintenance
acute agitation assoc. w/ schizo (dec agitation 30 min)
80
2nd gen atypical antipsychotic- Zyprexa
ae
weight gain, tardive dyskin, NMS, hypotension, periph edema
81
2nd gen atypical antipsychotic- Zyprexa
contraindications
unstable cardiovasc. status
82
2nd gen atypical antipsychotic- Zyprexa
action
affects b/ positive (delusions, hallucinations) and negative symptoms (anhedonia, apathy)
weak dopamine antagonist
serotonin 5HT2A antagonist
83
2nd gen atypical antipsychotic- Clozaril
purpose/considerations
one week of medication at a time
for acute trtmnt only
only use after tried at least 3 o/ antipsych.
1-6 wks for effectiveness
84
2nd gen atypical antipsychotic- Clozaril
ae
inc salivation, tachycard, dizziness, sedation, ha
seizurs, NMS,
PE
agranulocytosis
85
2nd gen atypical antipsychotic- Clozaril
monitoring
CBC every =week for 6 months
and then monthly forever
monitor WBC, EKG, LFT
86
general antipsychotic ae- life threatening
tardive dyskin
agranulocytosis (dec in neutrophils)
EPS
NMS
prolonged QT
87
agranulocytosis- s/s and trtmnt
concerning w/ 2nd gen
clozaril
trtmnt- antib or antifungal
s/s- sore throat, fever, malaise, mouth ulcers
88
tardive dyskinesia- assessment
report immedi
can be reversed
assess w/ AIMS- abnormal involuntary movement scale
89
dystonia
akathisia
akinesia
dystonia- involv musc mvmnt
akathisia- restless/ fidgeting
akinesia- muscle weakness
90
medications to trt EPS
Cogentin (benztropine)(antimuscarinic) , Artane (antimuscarinic) and Benadryl (antihistamine)
91
antipsychotic med pt ed
sunscreen
risk for ae
montior glucose, lipids- can cause dm 2
92
schizo- LEAP acronym
listen
empathize
agree
partner
93
neurotransmitter- cholingergic function
sleep and arousal
pain
memory retention
coordination mvmnt
94
neurotrans- norepinephrine function
fight or flight
cognition/perception
regulation mood
95
neurotrans- dopamine
regulation mvmnt
regulation emotions
decision making (pleasure v reward seeking beh)
attention/learning
96
neurotransmi- serotonin
sleep/arousal
libido
appetite
aggression
body temp
97
amino acid- gaba function
interrupts progression of impulse at synpase
inhibtory neurotransmitter
calms, inhibits act. of nerve cells
98
neuropeptide- substance p
found in gut
regulation pain, inflamm, memory and mood
99
neuropep- somatostatin
growth inhib hormone
involved in rapid reproduction of normal and tumor cells
100
amino acid- glutamate function
excitatory neurotrans
GAS
cognition, learning and memory
101
pituitary gland- posterior lobe function
vasopressin- regulates hr
oxytocin
102
pituitary gland- anterior lobe
GSH
TSH
prolactin
103
positron emission tomography (PET) v single photon emission computed tomography (SPECT)
PET- detects changes in bodys metab and chemical activities- color coded
SPECT- uses gamma-emitting radioactive sub.
creates 3D pictures
104
Timeline of dev of psych meds
lithium (mania), neuroleptics (seizures/ mood stabilizer), antidepressant, injectable antipsychotics
105
neuronal synapse action- antipsychotics
block dopamine
106
neurotransmitter action- antidep
block reputake serotonin and norepinephrin
107
benzodiazepine
facilitate transmission of gaba (block neurotrans)
depressants
trt anxiety, insomnia and seizures
108
neuronal synapse action- psychostimulants
inc release norepinephrine, serotonin and dopamine
109
2nd gen atypical antipsych assessment considerations- before admin
height, wt, waist girth (measure BMI)
has inc risk dev DM2 if taken long term
*effects metabolism
110
list SSRI
setraline (zoloft)
fluoxetine (prozac)
escitalopram (lexapro)
111
SSRI ae
inc effects beta blockers, haldol, clozapine and warfarin
dec effects digoxin
serotonin syndrome, NMS, sexual dysfunction
112
SSRI action
blocks serotonin reputake
113
SNRI list
trintellix , cymbalta, pristiq
114
SNRI interactions
NMS w/ concurrent use MAOI
SS w/ concurrent use other serotonin blocking medications
115
SNRI contraindications- alcohol, Wellbutrin, trazodone
inc risk liver injury w/ alcohol
inc risk toxicity w/ duloxetine or wellbutrin (inc risk of seizures w/ etoh)
altered effect of warfarin w/ wellbutrin
inc risk seziures (wellbutrin) w/ concurrent use other antidepres
priapism ( erection > 4hrs) w/ trazodone
116
heterocyclics (antidepressants) list + action
wellbutrin, trazodone
block norepinep. and dopamine receptors
117
tricyclic interactions
inc effect w/ PPI (cimetidine), haldol, SSRIs
hyperpyretic crisis w/ MAOI
hypertensive crisis w/ clonidine
118
antidep- tricyclic def and list
not first line bc lots ae
can also be used as sleep aids
norpraamin, tofranil
119
tricyclic OD
lethal!
only first option for OC anxiety
120
antidepressant- monoamine oxidase inhibitors- MAOIs
list, ae, contraindications and education
marplan, nardil
ae- tremor, sweating, hypertensive crisis, seizures, hypotension, hypoglycemia
contraindications CNS depress, OTC cold meds, antihistam, tricyclic antidepres, antihypertensive, and barbituates
education- avoid cheese, wine/beer, pickled foods, and processed meat (foods that are high in tyramine)
121
MAOI washout period
minimum 2 week period before start of MAOI or end
system has to be completely clear before starting new meds after ending maoi
122
antianxiety med list
benzodiapines
valium, clonazepam
act on GABA receptors
123
antianxiety
action, contraindicated, ae, interactions
action- depression of cns
contraindicated- coma, shock, pregnancy, o/ cns depressants
interactions- inc effect w/ etoh and antipsychotics, antidepress, antihistam,
dec effects w/ caffeine and smoking
ae- orthostatic hypoten, n/v, confusion, drowsiness, lethargy
124
mood stabilizer list
lithium, depakote, tegretol, topamax
125
topamax- considerations
mood stabilizer
action- dec compulsivity
alters metabolism of Ca in kidneys (kidney stones)
126
mood stabilizers
indications
action
interaction
contraindications
indication- prev/ trtmnt mania assoc. w/ bipolar
action- effects all neurotransmitters
interactions- caffeine inc effects
etoh inc dizziness and drowsiness while taking med
inc risk toxicity w/ dehydration- changes in fluid vol alter serum blood lvl of lithium rapidly
contraindic- kidney disease
127
lithium- ae
dry mouth, hypotension, fine hand tremors, dehydration, ha, weight gain, polyuria
128
lithium action
accum in reward center of brain
can also trt anxiety in low doses
129
lithium- therap range mania v maintenance
mania- 1-1.5 meq
maint- 0.6-1.2 meq
130
lithium toxicity symptoms
usually appear at 1 meq
blurred vision, tinnitus, persistent n/v, severe diarrhea
131
anticonvulsants- ae
severe rash w/ lamotrigine (starts around face/eyes)
n/v
prolonged bleeding time w/ valpronic acid
dec efficiancy w/ oral contraceptives
132
verapamil- ae
Ca ch blocker- used for anxiety, ha
bradycardia, hypotension, dizziness
133
anti-parkinson's agents list
carbidopa levodopa (dopamin antagonist)
cogentin- anticholinergic
MAOB inhib (prevent dopamine brkdwn)
134
anti-parkinsons indication, action, contraindications and interactions
indication- parkinsons and eps
action- alters acetylchol and dopamine (inc)
contraind- thyroid disturbance, gi obstructions
interactions- inc lvl of antichol and dec lvl of antipsych w/ use of haldol
increases cns depression
135
anti-parkinsons ae
n/ gi upset, exacerb of psychoses, orthostatic hypotension
136
list sedative hypnotics
phenobarbital (anticonv)
pentobarbital (pre op)
137
sedative hypnotic ae
confusion, lethargy, orthostatic hypoten, dry mouth, n/v
138
role of dopamine in adhd
meds activate dopamine d4 recep in basal ganglia/thalamus
which depresses motor activity
139
adhd- clonidine v atomoxetine action
clonodine- stim alpha adrenergic recep in brain (dec sympath stim from cns)
atomoxetine- inhibit reuptake norepinep, blocks uptake serotonin, norepin and dopamine
140
adhd med list
stimulants- adderall, ritalin, concerta, strattera
wellbutrin
clonidine
141
adhd contraindications
pts with advanced arterioscler, cardiovasc dis, htn, hyperthyroidism, hx drug use, less than 14 days since using maoi
bupropion (wellbutr)/ strattera (atomoxetine) - seizures, acute MI, bulimia/anorexia
renal/ hepatic insuff, Cardiovasc dis, SUICIDAL pts, urinary retention
142
adhd general ae
weight loss, insomnia, palpitations, liver damage (strattera) , seizures (wellbut)
rebound syndrome (alpha agonists (clonadine))
