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Human Behavior > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

How many Americans experience a mental illness?

A

1 in 5

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2
Q

How many Americans LIVE WITH a SERIOUS mental illness?

A

1 in 25 (10 million)

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3
Q

How do mental illness stats change in LGBTQ community?

A

Doubles (the risk of having a mental illness is double that of someone not in the community)

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4
Q

How many incarcerated adults have mental health conditions?

A

1 in 5

the same number of adolescents that have a mental health condition

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5
Q

How many adults in homeless shelters have serious mental illnesses?

A

1 in 4

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6
Q

Of those who die of suicide, how many had a mental illness?

A

90%

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7
Q

What is the most prevalent mental illness in America among adults?

A

Anxiety

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8
Q

What is the most prevalent cause of disability worldwide?

A

Depression

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9
Q

How much greater is the risk of suicide among schizophrenia population that the general population?

A

50X greater

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10
Q

Suicide is the ___ leading cause of death overall in the US

A

10th

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11
Q

Suicide is the ___ leading cause of death among ppl between 15 and 34

A

2nd

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12
Q

Which race in the US has the highest prevalence of adult mental illness?

A

American Indian/ Alaska Native

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13
Q

Which race used mental health services more?

A

Whites

AA and hispanic Americans used it about half as much and Asian Americans about 1/3 as much

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14
Q

Which state has the highest prevalence of mental illness and lower rates of access to care?

A

Nevada

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15
Q

Which stat has the lowest prevalence of mental illness and higher rates of access to care?

A

Connecticut

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16
Q

What is the biopsychosocial model?

A

Biology + Psychology + Social Context = health
assumes illness is to a large extent based on lifestyle factors that can be modified
holistic
does not focus exclusively on the illness like the biomedical model did

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17
Q

What are the 4 Ps of the biopsychosocial model?

A

Predisposing factors - Why me?
Precipitating factors - Why now?
Perpetuating factors - Why is it still happening?
Protective factors - What or who can I count on?

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18
Q

Normalization

A

an interview technique
helps to reduce sham/stigma, being judged
ex. “sometimes when people are depressed they consider hurting themselves, has this happened to you?”

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19
Q

Continuation

A

interview technique

acknowledges the pt, engages, nonverbal cues

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20
Q

Redirection

A

helps to guide and focus the interview

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21
Q

For a pscyh interview, what is the equivalent of the ‘physical exam’?

A

Mental Status Exam (MSE)

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22
Q

SIGECAPS

A 
Psych ROS for asking questions in regard to mood of depression 
Sleep
Interest 
Guilt
Energy
Concentration
Apetite
Psychomotor agitation or slowing 
Suicidality
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23
Q

Mental Illness

A

a condition that affects a person’s thinking, feeling, or mood

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24
Q

Mental Disease

A

an interruption, cessation, or disorder of bodily functions, systems or organs with a recognizable etiologic agent, identifiable set of signs/sxs, and/or consistent anatomical alterations

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25
Q

Mental Disorder

A

a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning

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26
Q

Psychoanalytic Theory

A

One of the proposed etiological theories of mental disorders
Freud
personality development and unconscious motivations

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27
Q

What are the old Axis of the DSM

A

Axis 1 - clinical/affective disorders
Axis 2 - disorders from early in life
Axis 3 - general medical disorders
Axis 4 - psychosocial/environmental problems
Axis 5 - GAF scale (global assessment of functioning)

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28
Q

When was the first DSM published?

A

1952
it had about 200 pages
now there are about 1000 pages

it uses the dimensional approach (mild, moderate, severe, very severe)

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29
Q

What are the advantages of the DSM?

A

addresses cultural issues
considers gender differences
improves dx process
categorizes dimensions of disease (mild, moderate, severe)

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30
Q

What are the disadvantages of the DSM?

A

may pathologize normal cognitive age - related changes, behavioral changes, or other issues
its not a textbook, no theory, management, or treatment

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31
Q

MAPPSS-CO

A 
Diagnostic classes based on symptoms 
Mood 
Anxiety 
Psychosis 
Personality 
Substance/Addiction 
Somatic 
Cognitive 
Obsessions
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32
Q

Compare and contrast the psych interview from the traditional medical interview

A

relates to emphasis on biopsychosocial model
more on psych his, family hx, development
more pt centered (let them lead, especially in the beginning)
Longer (make take full hour for initial eval)

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33
Q

What are the components of the psych interview that get documented in the medical chart?

A 
Pt ID
CC
HPI - include impact of sxs (degree of impairment) 
Past psych hx 
Family hx 
General medical hx 
Mental Status Exam 
General PE
Dx impression (using DSM -5 criteria 
Treatment and management plan
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34
Q

What is the purpose of the MSE?

A

evaluate, quantitatively and qualitatively, a range of mental functions and behaviors at a specific point in time
provide important information for dx and for assessment of the disorders course and response to tx

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35
Q

What are the components for the MSE?

A

General Appearance & Attitude (Observed)
Motor Activity/Behavior (Observed)
Orientation/LOC (Inquired)
Mood and Affect (Inquired/observed respectfully)
Speech (Observed)
Thought form and content (Inquired/Observed)
Perception
Memory and Cognition (Inquired/Observed)
Judgment and Insight

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36
Q

Attitude

A

Describes the pt’s attitude TOWARDS examiner; how does pt relate to examiner?
Observed

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37
Q

What are the components of motor activity/behavior of the MSE?

A 
Observed mannerisms, movements, patterns 
Gait 
Coordination of movements 
Rate of movements 
-psychomotor retardation 
-psychomotor agitation
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38
Q

Psychomotor retardation

A

a general slowing of physical and emotional reactions; may signify depression or negative symptoms of schizophrenia

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39
Q

Psychomotor agitation

A

excessive motor (handwringing, pacing) and cognitive activity may occur with anxiety or mania

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40
Q

Tics

A

sudden, repetitive, jerky movements of eyes, vocal organs, face, extremities, or trunk

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41
Q

Compulsion

A

Repetitive and ritualized behavior which the person feels compelled to perform

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42
Q

Echopraxia

A

the involuntary repetition or imitation of another person’s actions typically seen in pts with Tourette’s syndrome or autism

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43
Q

Akathisia

A

a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion; common side effects of neuroleptic antipsychotic or other medications; can cause restlessness, pacing, repeated sitting and standing

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44
Q

Catalepsy

A

(waxy flexibility) -condition of a person who can be molded into position that is then maintained for a prolonged period of time; seen in catatonic schizophrenia

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45
Q

Catatonia

A

a severe disturbance of motor function, usually manifested by markedly decreased activity, but may involve hyperactivity, with alternation between these states in the hypoactive state, the person is immobile and maintains peculiar postures for lengthy periods

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46
Q

Dystonia

A

involuntary muscle contractions that cause slow repetitive movements or abnormal postures; can be painful; can be drug induced

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47
Q

Dyskinesia

A

Difficulty or distortion in performing voluntary movements

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48
Q

What questions are asked to assess orientation?

A

Time
Place
Person
Situation

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49
Q

Stuporous

A

only awakening in response to pain

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50
Q

Obtunded

A

slowed response to stimulation

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51
Q

Letahrgic

A

drowsiness

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52
Q

Mood

A

inquired
sustained emotion that the pt is experiencing; usually reported by the pt
mood can be labile

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53
Q

Affect

A

observed expression of emotion

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54
Q

What are you looking for with speech in the MSE?

A 
Observed 
describe the physical characteristic of speech:
-volume (tone) 
-rate
-quantity
-intelligibility/fluency 
-spontaneity
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55
Q

Circumstantiality

A

a formal thought disorder

over-inclusion of trivial or irrelevant details that impede the sense of getting to the point

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56
Q

Clanging

A

a formal thought disorder

thoughts that are associated by the sound of words rather than their meaning (ex. through rhyming)

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57
Q

Derailment

A

a formal thought disorder
(loose association)
a breakdown in both the logical connection between ideas and the overall sense of goal-directedness
words make sentences, but the sentences do not make sense

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58
Q

Flight of idea

A

a formal thought disorder
a succession of multiple associations so that thoughts seem to move abruptly from idea to idea; often expressed through rapid, pressured speech

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59
Q

Neologism

A

the invention of new words or phrases or the use of conventional words in idiosyncratic ways

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60
Q

Perseveration

A

persistent repetition of specific words or concepts despite the absence or cessation of a stimulus; seen in cognitive d/o and schizophrenia

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61
Q

Tangentiality

A

in response to a question, the pt gives a reply that is appropriate to the general topic without actually answering the question

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62
Q

Thought blocking

A

a sudden disruption of thoughts or a breakdown in the flow of ideas

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63
Q

Word salad/incoherence

A

speech makes no sense at all

words joined, but do not convey a message

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64
Q

Pressured speech

A

fast and difficult to interrupt/understand; seen in bipolar-mania

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65
Q

Distractible speech

A

during the course of a discussion, pt changes subject in response to something unrelated in the environment (squirrel!)

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66
Q

Which type of a formal thought disorder or patterns of speech might you see in schizophrenia?

A

perseveration

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67
Q

Which type of a formal thought disorder or patterns of speech might you see in bipolar - mania?

A

Pressured Speech

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68
Q

Preoccupations

A

Both obsessions and phobias as well as suicidal or homicidal ideation

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69
Q

Obsessions

A

intrusive and unwanted ideas which intrude into consciousness despite efforts to suppress them

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70
Q

Phobias

A

persistent, irrational, exaggerated, and invariably pathological dread of a specific stimulus or situation, which typically results in a compelling desire to avoid the feared stimulus

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71
Q

Delusions

A

False, fixed personal beliefs that are not shared by others (seen in psychotic d/o)
Grandiose
Religious
Persecution
Erotomanic
Jealousy
Nihilistic (belief that self or part of self, other, or the world does not exist)

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72
Q

Types of delusional thoughts

A

Thought broadcasting
Thought insertion
Thought withdrawal
Ideas of reference -beliefs that everything refers to pts; person believes that the behavior or events refer specifically to him/her
Ideas of influence -beliefs about another person or force controlling some aspect of one’s behavior

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73
Q

Alogia

A

poverty of thought; no depth, minimal responses, very concrete
manifested as either:
-poverty of SPEECH: non-fluent empty speech, few spontaneous words, very concrete
-poverty of THOUGHT: fluent empty speech; conveys little information, overly abstract or concrete

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74
Q

Perception

A

perceptual disturbances may be experienced in reference to the self or the environment
illusions
hallucination
dissociation

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75
Q

Illusions

A

misperception or misinterpretation of REAL external sensory stimuli

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76
Q

Dissociation

A

lack of connection in a person’s thoughts, memory, or sense of identity

  • depersonalization
  • derealization: environment is unreal
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77
Q

Hallucinations

A

abnormal perceptions in which pt hears, see, tastes, smells, or feels something others cannot

  • auditory
  • visual
  • gustatory (taste)
  • tactile
  • olfactory
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78
Q

Auditory hallucinations are most commonly seen in ______

A

Schizophrenia

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79
Q

Visual hallucinations are most commonly seen in ______

A

Organic conditions

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80
Q

Tactile hallucinations are most commonly seen in ______

A

EtOH or benzo withdrawal

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81
Q

What are the components of the cognition section of the MSE?

A 
General information 
Attention and concentration 
Calculations 
Reading and writing 
Visuospatial ability 
Abstract thought
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82
Q

Attention vs concentration

A

Attention: ability to focus and direct cognitive processes (spell WORLD backwards)
Concentration: ability to focus and sustain attention over a period of time (serial 7s)

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83
Q

How do we assess visuospatial ability of a pt?

A

have the pt draw interlocking pentagons in order determine constructional apraxia
copy a figure of a 3D square
draw a clock indicating a certain time

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84
Q

Insight

A

ability of pt to understand and acknowledge factors that influence a situation; such as his/her illness
are they aware they are ill, in denial, both?

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85
Q

Judgement

A

assessment of real life problem solving skills

the greater degree of insight, greater the potential for sound judgement

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86
Q

Social Judgement

A

subtle manifestations of behavior that are harmful to the pt and contrary to acceptable behavior and is pt influence by that understanding
-ask pt to propose a solution tot their current problems

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87
Q

Test Judgment

A

pt’s prediction of what he/she would do in imaginary situations
-what would you do with a stamped, addressed letter found on the street?

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88
Q

Off all the components are the MSE, which sections are assessing the emotional side of the pt?

A

Attitude, Mood and Affect

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89
Q

ASEPTIC

A 
mnemonic to help remember MSE content 
A (appearance, attitude, and behavior) 
S (speech) 
E (emotion: mood and affect) 
P (perceptions) 
T (thought content and process) 
I (insight and judgment) 
C (cognition)
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90
Q

What is the MMSE?

A

mini mental state exam
5 sections: orientation, immediate recall, attention/calculation, recall, language
out of 30 pts

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91
Q

What does an MMSE score of 19 mean?

A

<19 = cognitive impaired

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92
Q

What score on the MMSE means borderline?

A

19-22 (per the MMSE sheet she posted a score below 20 usually indicated cognitive impairment)

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93
Q

What are considered normal scores on the MMSE?

A

23-30

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94
Q

What are the positive sxs of psychosis?

A

Delusions
Hallucinations
Dissociation
Illusions

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95
Q

What are the negative sxs of psychosis?

A 
primarily in schizophrenia 
Alogia 
Affective flattening or blunting 
Avolition-apathy 
Anhedonia-Asociality 
Attention
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96
Q

What are the DSM criteria for MDD?

A

5+ sxs for @ least 2 weeks (clear change from previous functioning)

  • depressed mood
  • loss of interest or pleasure in activities
  • weight gain or loss
  • insomnia or hypersomnia
  • psychomotor agitation or retardation
  • loss of energy
  • inappropriate guilt or worthlessness
  • decreased concentration
  • recurrent thoughts of death or suicide
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97
Q

What are the DSM specifiers for MDD with anxious distress?

A

@ least 2:

  • feeling keyed up or tense
  • feeling unusually restless
  • difficulty concentrating due to worry
  • feeling something awful may happen
  • feeling loss of control
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98
Q

What are the DSM specifiers for MDD with mixed features?

A

@ least 2:

  • elevated/expansive mood
  • grandiosity
  • more talkative pressured
  • flight of ideas
  • increased energy goal directed activity
  • decreased need for sleep but doesn’t meet criteria for bipolar disorder
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99
Q

What are the DSM specifiers for MDD with melancholic features?

A 
Loss of pleasure or lack of reactivity 
Worse in the morning 
Early morning awakening 
Weight loss 
Marked psychomotor abnormalities 
Guilt
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100
Q

What are the possible differential diagnosis for MDD?

A
  • Secondary depression
  • Bipolar disorder
  • Anxiety disorder
  • Grief, bereavement, or loss
  • personality disorders
  • dysthymia
  • adjustment disorder
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101
Q

More than ____% of pts with MDD suffer comorbid psychiatric disorders. The most common are: ____ (there are 3)

A

50%

  • anxiety disorders
  • substance use disorders
  • personality disorders
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102
Q

What neurotransmitters are suspected to be involved in the pathophysiology of depression?

A

5-HT
NorEpi
Dopamine

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103
Q

Which part of the brain is responsible for sleep and appetite?

A

Hypothalamus

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104
Q

How long can an untreated episode of depression last?

A

months or even years

failure to obtain treatment may lead to a worsening of the disease course

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105
Q

What are the risk factors for recurrence with MDD?

A

Multiple lifetime episodes
incomplete response to treatment
absence of acute stress when the episode begins
severity of the episode including suicide attempt, hospitalization, or psychosis

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106
Q

When risk of recurrent is high, how is depression managed?

A

as a chronic illness with long-term use of antidepressants

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107
Q

Suicide not limited to depression, but ___% suffered ____ or ___

A

70%

depression or EtOH

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108
Q

What is the lifetime prevalence of MDD and which gender is more likely to get it?

A

17% (1 in 6)

twice as common in W than M

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109
Q

What is the treatment for mild to moderate depression?

A

Antidepressants and expertly administered, evidence-based psychotherapy work EQUALLY WELL in mild to moderate depression

110
Q

What is the treatment for severe depression?

A

antidepressant or the combo of antidepressant/psychotherapy

111
Q

Improvement of which symptoms of depression comes first?

A

normalization of the somatic systems typically comes first, then psychological sxs

112
Q

How do MAOIs work?

A

work inside the neuron terminal to prevent the breakdown of dopamine, norepi, and 5-HT

113
Q

How do TCAs work?

A

work in the synapse to block the reuptake of 5-HT and norepi

114
Q

How do SSRIs work?

A

specifically block the reuptake of serotonin (SERT)

115
Q

What is NeuroStar TMS?

A

transcranial magnetic stimulation therapy that can be used for pts who have not achieved satisfactory improvement from prior antidepressant meds
using pulsing magnetic fields, transcranial magnetic stimulation therapy stimulates the part of the brain thought to be involved with mood regulation

116
Q

What is ECT?

A

Electroconvulsive therapy used for severely depressed pts who don’t respond to drugs

117
Q

What is the essential feature of Persistent Depressive Disorder (dysthymia)

A

depressed mood plus @ least two other depressive symptoms for @ least 2 years (1 year in children and adolescents)
may include periods of major depressive episodes (double depression)

118
Q

What are the DSM criteria for Persistent Depressive Disorder (Dysthymia)?

A

A) depressed mood for most of the day for @ least 2 years (1 year in children and adolescents)
B) 2+ sxs:
-poor appetite or overeating
-insomnia or hypersomnia
-low energy or fatigue
-low self-esteem
-poor concentration or difficult making decisions
-feeling of hopelessness
C) have not been without these sxs for more than 2 months at a time within the 2 year span
D) there has never been a manic episode or a hypomanic episode

Persistent Depressive Disorder can be specified with anxious distress, mixed features, and melancholic features

119
Q

What mnemonic is used to remember the major depression DSM criteria?

A

Depression Is Worth Studiously Memorizing Extremely Grueling Criteria. Sorry. (DIWSMEGCS)

120
Q

What does DIWSMEGCS stand for?

A 
Depressed mood 
Interest 
Weight 
Sleep 
Motor activity 
Energy 
Guild 
Concentration 
Suicide
121
Q

Approximately ___-___% of all pts hospitalized for major depression will eventually take their own lives.

A

10-15%

122
Q

What are the essential features of Disruptive Mood Dysregulation Disorder (DMDD)?

A

severe temper outbursts with underlying persistent angry or irritable mood
outburst 3 or more times/week for at least 12 months
occurs in 2 settings (typically home and school)
typically sxs are seen before the age of 10, dx can not occur before 6 or after 18

123
Q

What are the differential dx for DMDD?

A 
Bipolar disorder 
intermittent explosive disorder 
depressive disorder
ADHD
autism spectrum disorder 
separation anxiety disorder 
ODD (can't be ODD + DMDD)
124
Q

What gender is DMDD more common in?

A

Male kids

125
Q

What is the treatment for DMDD?

A

no empirically supported treatments yet

consider CBT treatments

126
Q

How is bereavement/grief different from MDD?

A

There is no bereavement exclusion in DSM5

  • feelings of emptiness and loss (vs. depressed mood)
  • dysphoria comes in waves (vs persistent)
  • capable of having positive emotional experiences
  • self-esteem preserved (vs. worthlessness clouding esteem)
  • can last 1-2 years –> can precipitate major depressive episode
127
Q

What is premenstrual dysphoric disorder?

A

depressive sxs that begin during the luteal phase of the menstrual cycle and terminate around the onset of menses
@ least 5 of the ‘core sxs’ including 1+ of the first 4 sxs
sxs confirmed in at least 2 cycles

128
Q

What are the ‘Core Sxs’ of premenstrual dysphoric disorder?

A

Must have @ least 5, including 1 of the first 4

Affective lability 
Irritability 
Depressed mood 
Anxiety/Tension
decreased interest
poor concentration
fatigue 
appetite change
hypersomnia/insomia 
overwhelmed 
breast tenderness/joint swelling/bloating/weight gain
129
Q

DSM criteria for Mania/Hypomania

A

persistently elevated, expansive, or irritable mood with increased activity or energy lasting @ least 1 week (4 days for hypomania)
3+ sxs:
-grandiosity
-decreased need for sleep
-talkative/pressured
-flight of ideas/racing thoughts
-distractibility
-increased activity, psychomotor agitation
-excessive involvement in consequential behavior

130
Q

Before sulfa drugs, what was the number 1 cause of psychosis?

A

tertiary syphilis

131
Q

What are positive symptoms?

A

hallucinations
delusions (bizarre vs. non-bizarre)
disorganized speech, behavior, affect (disorders of thought)
agitaiton and aggression

132
Q

What are negative symptoms?

A 
affective flattening 
diminished emotional expressiveness 
alogia
avolition 
apathy 
anergia 
asociality 
attentional impairment
133
Q

What are cognitive symptoms?

A

working memory
executive function
attention
learning

134
Q

What are mood symptoms?

A

depression
anxiety
suicide

135
Q

Dopamine is ____active in the mesocortical pathway of a schizophrenic pt.

A

hypo

136
Q

Dopamine is ____active in the mesolimbic pathway of a schizophrenic pt.

A

hyper

137
Q

Where in the brain is responsible for positive symptoms in a schizophrenic pt?

A

mesolimbic pathway

138
Q

Where in the brain is responsible for negative symptoms in a schizophrenic pt?

A

mesocortical pathway

139
Q

What side effect occurs if you block dopamine in the tuberoinfundibular?

A

HPL -hyperprolactinemia

140
Q

What side effect occurs if you block dopamine in the nigrostriatal?

A

EPS

141
Q

How does phencyclidine (PCP) and ketamine induce schizophrenia-like effects?

A

by blocking NMDA receptors in the brain

142
Q

What is the DSM criteria for Schizophrenia?

A

2+ for 1 month

  • delusions
  • hallucinations
  • disorganized speech
  • grossly disorganized or catatonic behavior
  • negative sxs

+social/occupation dysfunction
continuous signs of the disturbance persistent for @ least 6 months with @ least 1 month of systems

143
Q

Which types of family members have the highest risk of getting schizophrenia?

A

identical twins ~48%

first degree 10%>general population 1%

144
Q

What chromosome has been identified with SCZ?

A

chromosome 22, 6

145
Q

What can we see on a cellular level with SCZ pts?

A

synaptic ‘pruning’ - loss of synapses typically in adolescence and early adulthood

146
Q

____% of SCZ pts commit suicide

A

10%

147
Q

What are risk factors for SCZ?

A 
family hx 
northern hemisphere 
born in the winter
pregnancy complications
loss of parent during childhood
lower socioeconomic status
148
Q

At what age are males typically dx with SCZ?

A

18-25

149
Q

At what age are females typically dx with SCZ?

A

25-30

150
Q

What sxs are typically seen in the prodromal phase of SCZ?

A

negative sxs

151
Q

What sxs are typically seen in the acute phase of SCZ?

A

positive sxs

152
Q

What is the treatment for SCZ?

A

Typical (1st gen) Antipsychotics

High: 
-Haloperidol
-Thiothixine
-Trifluoperazine 
-Fluphenazine 
Low: 
-Chlorpromazine 
-Thioridazine
153
Q

What are the extrapyramidal side effects? (EPS)

A

SE from antipsych meds

Acute dystonia
Akathisia
Drug-induced Parkinsonism
Tardive Dyskinesia

154
Q

Name the EPS: “masked facies and a slow oscillating bilateral hand tremor develop in a man 6 weeks after initiation of Haldol. Exam reveals diffuse hypertonia”

A

Parkinsonism

155
Q

Name the EPS: “Pacing, restless, fidgety. Increase in Haldol dose makes it worse.”

A

Akathisia

156
Q

Name the EPS: “Involuntary slow, writhing puckering movements of lips, with occasional tongue protrusion. H/O extensive past use of high potency typical neuroleptic (years)”

A

Parkinsonism

157
Q

Name the EPS: “treatment includes anticholinergic medicines such as Benadryl or cogentin”

A

actue dystonia

158
Q

What drug might be helpful for Akathisia?

A

Propranolol

159
Q

What is Neuroleptic Malignant syndrome?

A

a syndrome that can occur typically 4-14 days after start of neuroleptic medications

fever
HTN
rigidity 
delirium, confusion 
CPK elevation
160
Q

What is the difference between typical and atypical antipsychotics?

A

Typical: D2 –help with positive symptoms
Atypical: 5HT + D2 – can help with negative symptoms too

161
Q

What are SE of antipsychotics?

A

Weight gain
QT prolongation
Sedation
increase blood glucose

162
Q

Depot drugs are good for which types of drugs?

A

Typical antipsychotics for pts who have trouble complying

163
Q

What is brief psychotic disorder?

A

Same sxs as schizophrenia but is ONLY 1 day to 1 month

happens more in women
returns to normal level of functioning

risk factor: personality disorder

164
Q

Delusional Disorder

A

generally categorized in 4 groups: bizarre, non-bizarre, mood-congruent, and mood-neutral

mean age of onset: 40 (W>M)
typically functioning not affected except by delusion itself

less responsive to antipsychotic meds

165
Q

Types of Delusional Disorder Specifiers

A 
Erotomanic 
Grandiose 
Jealous 
Persecutory (pt believes they're being conspired against, or spied on)  
Somatic 
Mixed 
Unspecified
166
Q

Schizoaffective Disorder

A

features of both SCZ (hallucination, delusions, and distorted thinking) + mood component (such as depression or mania)
psych sxs for @ least 2 weeks in the absence of mood sxs

167
Q

What are the risk factors for suicide?

A 
SAD PERSONS
Sex (male > female) 
Age (older men, peaks in middle age for women) 
Depression
Previous attempt 
Ethanol abuse 
Rational thinking loss 
Social support lacking 
Organized plan 
No spouse 
Sickness
168
Q

Cognitive elements of Panic Disorder

A

anticipatory anxiety (fear of fear), misinterpretation of bodily sensations, belief that avoidance is protective

169
Q

Cognitive elements of Social Phobia

A

negative social expectations, distorted interpretations of others’ responses, belief that avoidance is protective

170
Q

Cognitive elements of PTSD

A

contents of memory, believing self unable to withstand, overestimation of risk of repetition of traumatic experiences - nightmares, forced recollection

171
Q

What NTs are involved in the fight or flight response sxs?

A

NE (in the locus ceruleus)

5-HT (in the medial raphe)

172
Q

What is the DSM criteria for Separation Anxiety?

A

A) developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached as evident with 3 of the following:
-recurrent excessive distress when anticipating or experiencing separation
-worry about losing major attachment figures
-worry about experiencing an untoward event
-refusal to go out, away from home
-reluctance about being alone
-refusal to sleep away from home
-nightmares involving theme of separation
-repeated complaints of physical sxs who separation
B) lasting @ least 4 weeks in children (6months in adults)
C) causes ‘clinically significant’ distress or impairment in important areas of functioning

173
Q

The majority of adults with separation anxiety disorder had a first onset in _____

A

adulthood

*disorder that start in childhood generally do not persist into adulthood

174
Q

What is the tx for separation anxiety?

A

Combo of meds (for anxiety and fear) + psychotherapy

SSRIs and benzos

175
Q

Define phobia

A

irrational fear of specific objects, places, or situations, or activities. The fear in phobias is irrational, excessive, and disproportionate to any actual danger

176
Q

Define Social Anxiety Disorder

A

social phobia

fear of humiliation or embarrassment in social settings

177
Q

Define Specific Phobia

A

is a category that includes isolated phobias such as the irrational and intense fear of snakes

178
Q

How might a person with social phobia appear in the initial interview?

A

ill at ease
anxious, fearful
verbal responses may be restricted

179
Q

What is the DSM criteria for specific phobia?

A

Marked fear or anxiety about a specific object or situation.

  • the phobic object almost always provokes immediate fear or anxiety and is actively avoided or endured with intense fear or anxiety
  • fear or anxiety is out of proportion to the actual danger
  • causes ‘clinically significant’ distress or impairment
  • typically last for 6+ months
180
Q

What is the DSM criteria for social phobia?

A

Marked fear or anxiety about social situations in which the pt might be exposed to scrutiny by others

  • fears that he/she will act in a way or show anxiety sxs that will be negatively evaluated
  • the social situation almost always provoke fear or anxiety, are avoided or endured with intense fear
  • fear is out of proportion to the actual threat
  • causes ‘clinically significant’ distress or impairment
  • typically last 6+ months

only one specifier: ‘performance only’

181
Q

What are some specifiers for specific phobia?

A

Animal
Natural Environment
Blood-injection-injury
Situational (airplanes, elevators, enclosed spaces)
Other (situations that might lead to choking)

182
Q

Define panic disorder

A

recurrent, unexpected panic (or anxiety) attacks accompanied by at least 1 month of persistent concern about having another attack
@ least 4 of the 13 characteristic sxs must be met

183
Q

DSM criteria for Panic Disorder

A

@ least 4:
-palpitations, pounding heart, accelerated HR
-sweating
-trembling or shaking
-sensation of SOB or smothering
-feelings of choking
-chest pain or discomfort
-nausea or abdominal distress
-feeling dizzy, unsteady, light-headed, or faint
-chill or heat sensations
-paresthesias (numbness or tingling)
-derealization (feelings of unreality) or depersonalization
-fear of losing control or ‘going crazy’
-fear of dying
@ least 1 attack must be followed by:
-fear/worry about having another attack and worry about the consequences of attacks
-a maladaptive change in behavior related to attacks (avoid locations you have had attacks before)

184
Q

When do panic disorders typically start?

How long do they last?

A

onset: mid 20s
typically develop suddenly, peak within 10 minutes, and last between 5-20 minutes
panic disorders are considered CHRONIC, although sxs fluctuate in frequency and intensity

185
Q

Define agoraphobia

A

when an individual fears being unable to get out of a place or situation quickly in the event of a panic attack
SO the pt avoids places or situations where this might occur
this often occurs as a complication of panic disorders

186
Q

What are the DSM criteria for Agoraphobia?

A

Marked fear or anxiety about 2 of the 5 situations:
-using public transportations
-being in open spaces
-being in enclosed spaces
-standing in line or being in a crowd
-being outside of the home alone
Pt fears these things because in the event of a panic attack they might not be able to escape
fear, anxiety or avoidance lasting 6+ months

187
Q

What are the DSM criteria for GAD?

A

A) excessive anxiety or worry occurring more days than not over 6 months
B) individual finds it difficult to control the worry
C) 3+ of the follow 6 sxs for 6+ months: (only 1 sxs in children)
-restlessness or feeling keyed up or on edge
-being easily fatigued
-difficulty concentrating or mind going blank
-irritability
-muscle tension
-sleep disturbance
D) ‘clinically significant’ distress or impairment

188
Q

What is the most frequent complication of GAD?

A

MDD and substance use disorder

189
Q

Who is more likely to get GAD?

A

Women
African Americans
people under the age of 30

190
Q

What are the DSM criteria for PTSD?

A

this is for people 6y/o+
lasting for 1+ month
A) exposure to actual or threatened death, serious injury, or sexual violence (this can be direct, witnessed, finding out it happened to a family member, or even repeated exposure to details)
B) 1 or more of the following intrusion sxs:
-recurrent distressing memories
-recurrent distressing dreams
-dissociative reactions (ex. flashbacks)
-intense or prolonged psychological distress
-marked reaction to cues that resembles traumatic event
C) persistent avoidance (either memories/thoughts or external reminders)
D) negative alterations in cognitions and mood (2 or more):
-inability to remember aspects of event
-negative beliefs about oneself/world
-distorted cognitions about the cause of event
-persistent negative emotional state
-diminished interest
-inability to experience positive emotions
E) alterations in arousal (2 or more):
-irritable behavior
-reckless behavior
-hypervigilance
-exaggerated startle response
-problems with concentration
-sleep disturbance

191
Q

Define Adjustment Disorder

A

when a person is unable to cope with a specific life stressor and become overwhelmed and develops sxs of emotional distress

192
Q

What are the DSM criteria for adjustment disorder?

A

Within 3 months of onset of the stressor
1 or both:
-marked distress out of proportion to the severity of the stressor
-significant impairment in social, occupation, or other important areas of functioning

193
Q

How do we get addicted?

A

operant conditioning (positive or negative reinforcement

194
Q

How do we stay addicted?

A

classical conditioning (pavlovs dogs)

195
Q

Anticipation

A

is a conditioned response and is itself reinforcing

196
Q

What chemicals are involved in addiction?

A

Dopamine + endogenous opioids
a key circuit: ventral tegmental area (VTA) that release DA in the nucleus accumbens (NAc)

DA levels increase with anticipation of reward

197
Q

Tolerance

A

need more and more to get the desired effect

198
Q

Sensitization

A

repeated administration of a stimulus results in an amplification of response

199
Q

What make a drug addictive?

A 
predisposing genetics, temperament 
route of administration/bioavailabity 
time to onset 
elimination (1/2 life) - the fast the drug is eliminated in your system the more addictive it can become 
schedule of administration
200
Q

CAGE

A

C- cut back
A - annoyed (Have people Annoyed you by criticizing your drinking?)
G - guilty
E - eye opening

if the pt has 2+ of these they have reached the criteria for alcoholic

201
Q

What are the 11 sxs of substance use disorder?

A

Broken down into Clusters
LOSS OF CONTROL (4)
1) substance often taken in large amounts or longer time
2) persistent desire or unsuccessful attempts to control
3) great deal of time spent on anticipation/use/recovering
7) important alternative activities reduced or given up
ADVERSE CONSEQUENCES (4)
9) persistent physical or psychological problem likely to have been caused or exacerbated by the substance
6) persistent social or interpersonal problems likely to have been caused or exacerbated by the substance
5) failure to fulfill major roles
8) recurrent use in physically hazardous situations
PHYSIOLOGICAL DEPENDENCE (3)
10) tolerance
11) withdrawal
4) cravings

202
Q

What is considered MILD substance use disorder?

A

“at risk”
exceeds daily limits
2-3 sxs (of the 11)

203
Q

What is considered MODERATE substance use disorder?

A

‘abuse’
exceeds daily limits
4-5 sxs (of the 11)

204
Q

What is considered SEVERE substance use disorder?

A

‘dependence’
exceeds daily limits
6+ sxs (of the 11)

205
Q

What is the most commonly abused drug?

A

Marijuana; followed by prescription drugs

206
Q

Who is at the highest risk for substance abuse disorders?

A

Native American + Pacific islanders
M > F
living in urban areas

207
Q

What drugs are considered hallucinogens?

A

sympathomimetics

  • PCP
  • LSD
  • Amphetamines (Ecstasy)
208
Q

What drugs are considered stimulants?

A

dextroamphetamine
methylphenidate
methamphetamine
cocaine

209
Q

What is nicotines MOA?

A

nicotinic receptor agonist throughout the body

causes increase in NE, vasopressin, beta-endorphin, ACTH and cortisol resulting in overall CNS stimulation

210
Q

What does nicotine intoxication look like?

A

relaxation, increased concentration, anorexia, increased BP

211
Q

What does nicotine withdrawal look like?

A

beings 1 hour after last cigarette, peaks in 24h

irritability, increased appetite, craving

212
Q

How to treat nicotine use disorder?

A 
Cognitive/Behavoiral strategies for cessation 
-avoid cues
-stress managemnt 
-healthy lifestyle 
Pharm:
-replacement therapy 
-Bupropion (Zyban)
-Varenicline (Chantix)
213
Q

What is the most effective treatment for nicotine use disorder?

A

combo of nicotine replacement + pharm

214
Q

What is alcohol + sedatives MOA?

A

GABA

215
Q

What does alcohol + sedatives intoxication look like?

A

slurred speech, confusion, disinhibition, seizures, DTs

216
Q

What does alcohol + sedative withdrawal look like?

A

elevated BP, HR
diaphoresis
confusion
seizures

217
Q

What is Wernicke-Korsakoff Syndrome?

A 
commonly seen in alcoholics due to thiamine deficiency 
Wernicke's Encephalopathy Triad:
-confusion
-ataxia
-nystagmus 
Korsakoff Syndrome/Psychosis:
-amnesia
-confabulation
-hallucinations
218
Q

During what time frame do alcoholic hallucinosis begin?

A

12-24 h

visual, auditory, or tactile hallucinations

219
Q

When do you typically see alcoholic withdrawal seizures and what kind of seizures are they?

A

24-48 hours

generalized tonic-clonic seizures

220
Q

What is delirium tremens?

A

alcohol withdrawal delirium: (48-72 hours)

  • hallucination (visual)
  • disorientation
  • tachycardia
  • HTN
  • fever
  • agitation
221
Q

How do you treat acute alcohol withdrawal?

A 
most commonly used is Diazepam (valium) 
can also use:
lorazepam (ativan)
alprazolam (xanax)
clonazepam (klonopin)
cholrdiazepoxide (librium)

things to keep in mind:

  • use shorter half life drugs on pts with liver problems
  • dont replace EtOH addiction with benzo addiction
222
Q

How do you treat alcohol use disorder?

A

Acamprosate (Campral)
Naltrexone
Disulfiram

223
Q

What is caffeines MOA?

A

dopamine

224
Q

What does caffeine intoxication look like?

A 
palpitations 
anxiety 
irritability 
insomnia 
can aggravate a variety of medical conditions
225
Q

What does caffeine withdrawal look like?

A

headache
lethargy
irritability
depressed mood

226
Q

What is the MOA for opiates?

A

Mu, Kappa, Delta

227
Q

What are types of opiates?

A

heroin
morphine
oxycontin

228
Q

What does intoxication on opiates look like?

A 
euphoria
sedation
miosis (constricted pupils)
respiratory depression 
constipation
229
Q

What does withdrawal from opiates look like?

A 
dysphoria
myalgias
rhinorrhea
diarrhea
lacrimation
dilated pupils
230
Q

What are the adverse effects of opiates?

A

HIV, Hepatitis, endocarditis, self neglect, OD, death

231
Q

What is the treatment for opiate OD?

A

NARCAN (naloxone)

232
Q

What is the treatment for opiate substance disorder?

A

Methadone: long acting mu opioid agonist (once daily dosing, can be abused) [can be used in PREGGOS]
Buprenophrine - partial agonist (can’t be abused)
Clonidine - blocks autonomic hyperactivity (watch for hypotension)
Naltrexone -may desensitize opiate receptors thereby reducing craving

233
Q

What is the MOA of stimulants?

A

cocaine, methamphentamine, amphetamines, methylphenidate
DOPAMINE
cocaine inhibits reuptake
amphetamines increased release

234
Q

What are the routes of administration for stimulants?

A

PO, IV, inhaled

235
Q

What does intoxication on stimulants look like?

A 
euphoria
increased vigilance 
anorexia
mydriasis (dilated pupil)
tachycardia 
HTN
arrhythmias 
auditory + tactile hallucinations
psychosis
agistiaon
bruxism (teeth grinding/jaw locking)
236
Q

What does withdrawal from stimulants look like?

A 
can resemble sever MDD 
can include suicidal ideation 
dysphoria 
hypersomina 
increased appetite 
irritability 
craving
237
Q

What are the adverse effects of stimulants?

A

necrosis of soft tissue
cyanosis
CV
stroke

238
Q

What is the treatment for stimulants?

A

symptomatic + behavioral

239
Q

What is the MOA for marijuana?

A

cannabinoid receptor (GPCR), inhibits adenylate cyclase in hippocampus, basal ganglia and cerebellum

240
Q

What does intoxication on marijuana look like?

A 
perceptual disturbances 
anxiety 
paranoia
conjunctival injection 
tachycardia
dry mouth 
increase appetite
241
Q

What does withdrawal on marijuana look like?

A 
irritability 
depression
restlessness
anorexia
cravings
242
Q

What are the adverse effects of marijuana?

A

amotivational syndrome

psychosis

243
Q

What is the treatment for marijuana?

A

none

244
Q

What is the MOA for phenylcyclohexyl piperidine (PCP)?

A

NMDA antagonist

245
Q

What are the routes of administration for PCP?

A

nasal, PO, inhaled, IV, transdermal

246
Q

What does it look like when someone is intoxicated on PCP?

A 
RED DANES
rage
erythema
dilated pupils
delusions
amnesia
nystagmus
excitation
skin dryness
247
Q

What does withdrawal from PCP look like?

A

lack of energy and depression

248
Q

What are the adverse effects of PCP?

A

memory loss
liver function problems
depression
psychosis

249
Q

What is the treatment for PCP?

A

“acidification of the urine”
not really a treatment
just wait it out
the drug is stored in the fate cells, so the bigger the person the longer the drug is in their system

250
Q

What is the MOA for hallucinogens?

A

5-HT agonist

251
Q

What is the route of administration for hallucinogens?

A

oral, transdermal, IV, inhaled

252
Q

What are types of hallucinogens?

A

LSD, psilocybin, mescaline/peyot, PCP

253
Q

What are the sxs of intoxication of hallucinogens?

A 
mydriasis (pupil dilation)
wakefullness
synesthesia
LDS (hallucination) 
Mescaline (visual disturbances, geometricization)
254
Q

What are the adverse effects of hallucinogens?

A

unknown

not considered addictive

255
Q

What is the MOA of ecstasy (MDMA)?

A

release of monoamines

256
Q

What does it look like to be intoxicated on MDMA?

A

euphoria
intimacy
diminished fear
improved self- confidence

257
Q

What does it look like to withdrawal from MDMA?

A 
depressed
paranoia
nervousness
tremors
feeling cold
258
Q

What are the typical clinical presentations of a pt with delusional disorder?

A

Chronically suspicious, socially isolated, but their personality remains intact
middle to late adult aged people (M = F)

259
Q

What is the most common type of delusion seen in delusion disorder?

A

Persecutory type (belief they’re being conspired against)

260
Q

How do you treat delusional disorder?

A

you can treat the anxiety and agitation with antipsychotics but the core delusions typically remains
Haloperidol
Risperidone

261
Q

What is the time frame for brief psychotic disorder?

A

1 day to 1 month
with gradual recovery
signs and sxs similar to those seen in SCZ

W > M (2:1)
self limiting

262
Q

What is the time frame for Schizophreniform Disorder?

A

SCZ sxs for @ least 1 month but no longer than 6 months

this is designed to guard against premature dx of SCZ

263
Q

What are the 2 negative sxs most characteristic of SCZ?

A

diminished emotional expression (affective flattening or blunting) + avolition (lack of motivation)

264
Q

Alogia

A

poverty of speech, is a general lack of additional, unprompted content seen in normal speech

265
Q

Anhedonia

A

inability to experience pleasure

266
Q

What are the typical phases/stages of schizophrenia?

A

Prodromal phase
Active phase
Residual phase (less prominent positive sxs but still some impairment) –can see “acute exacerbation”

267
Q

What is the strongest predictor of outcome with SCZ?

A

IQ

age at onset, gender, severity, and typic of initial sxs play predictive value as well

268
Q

What is the target of SCZ treatment?

A

block postsynaptic Dopamine receptors in the limbic forebrain

remember that all antipsych meds block dopamine receptors

269
Q

What is the time frame for schizoaffective disorder?

A

mixture of psychotic and mood sxs

uninterrupted period of illness during which there is a major mood episode AND there is delusions or hallucinations for 2+ weeks without major mood episode

270
Q

Pts with this type of disorder are more likely to end up in the office of a lawyer rather than a doctor?

A

Delusional Disorder

271
Q

Pts with this type of disorder are more likely to seek help at a primary care office than a psychiatrist?

A

Mood disorders

Human Behavior (2 decks)

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