Exam 1 Flashcards
1
Q
How many Americans experience a mental illness?
A
1 in 5
2
Q
How many Americans LIVE WITH a SERIOUS mental illness?
A
1 in 25 (10 million)
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)
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
5
Q
How many adults in homeless shelters have serious mental illnesses?
A
1 in 4
6
Q
Of those who die of suicide, how many had a mental illness?
A
90%
7
Q
What is the most prevalent mental illness in America among adults?
A
Anxiety
8
Q
What is the most prevalent cause of disability worldwide?
A
Depression
9
Q
How much greater is the risk of suicide among schizophrenia population that the general population?
A
50X greater
10
Q
Suicide is the ___ leading cause of death overall in the US
A
10th
11
Q
Suicide is the ___ leading cause of death among ppl between 15 and 34
A
2nd
12
Q
Which race in the US has the highest prevalence of adult mental illness?
A
American Indian/ Alaska Native
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
14
Q
Which state has the highest prevalence of mental illness and lower rates of access to care?
A
Nevada
15
Q
Which stat has the lowest prevalence of mental illness and higher rates of access to care?
A
Connecticut
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
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?
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?”
19
Q
Continuation
A
interview technique
acknowledges the pt, engages, nonverbal cues
20
Q
Redirection
A
helps to guide and focus the interview
21
Q
For a pscyh interview, what is the equivalent of the ‘physical exam’?
A
Mental Status Exam (MSE)
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
23
Q
Mental Illness
A
a condition that affects a person’s thinking, feeling, or mood
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
25
Mental Disorder
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
26
Psychoanalytic Theory
One of the proposed etiological theories of mental disorders
Freud
personality development and unconscious motivations
27
What are the old Axis of the DSM
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)
28
When was the first DSM published?
1952
it had about 200 pages
now there are about 1000 pages
it uses the dimensional approach (mild, moderate, severe, very severe)
29
What are the advantages of the DSM?
addresses cultural issues
considers gender differences
improves dx process
categorizes dimensions of disease (mild, moderate, severe)
30
What are the disadvantages of the DSM?
may pathologize normal cognitive age - related changes, behavioral changes, or other issues
its not a textbook, no theory, management, or treatment
31
MAPPSS-CO
```
Diagnostic classes based on symptoms
Mood
Anxiety
Psychosis
Personality
Substance/Addiction
Somatic
Cognitive
Obsessions
```
32
Compare and contrast the psych interview from the traditional medical interview
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)
33
What are the components of the psych interview that get documented in the medical chart?
```
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
```
34
What is the purpose of the MSE?
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
35
What are the components for the MSE?
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
36
Attitude
Describes the pt's attitude TOWARDS examiner; how does pt relate to examiner?
Observed
37
What are the components of motor activity/behavior of the MSE?
```
Observed mannerisms, movements, patterns
Gait
Coordination of movements
Rate of movements
-psychomotor retardation
-psychomotor agitation
```
38
Psychomotor retardation
a general slowing of physical and emotional reactions; may signify depression or negative symptoms of schizophrenia
39
Psychomotor agitation
excessive motor (handwringing, pacing) and cognitive activity may occur with anxiety or mania
40
Tics
sudden, repetitive, jerky movements of eyes, vocal organs, face, extremities, or trunk
41
Compulsion
Repetitive and ritualized behavior which the person feels compelled to perform
42
Echopraxia
the involuntary repetition or imitation of another person's actions typically seen in pts with Tourette's syndrome or autism
43
Akathisia
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
44
Catalepsy
(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
45
Catatonia
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
46
Dystonia
involuntary muscle contractions that cause slow repetitive movements or abnormal postures; can be painful; can be drug induced
47
Dyskinesia
Difficulty or distortion in performing voluntary movements
48
What questions are asked to assess orientation?
Time
Place
Person
Situation
49
Stuporous
only awakening in response to pain
50
Obtunded
slowed response to stimulation
51
Letahrgic
drowsiness
52
Mood
inquired
sustained emotion that the pt is experiencing; usually reported by the pt
mood can be labile
53
Affect
observed expression of emotion
54
What are you looking for with speech in the MSE?
```
Observed
describe the physical characteristic of speech:
-volume (tone)
-rate
-quantity
-intelligibility/fluency
-spontaneity
```
55
Circumstantiality
a formal thought disorder
| over-inclusion of trivial or irrelevant details that impede the sense of getting to the point
56
Clanging
a formal thought disorder
| thoughts that are associated by the sound of words rather than their meaning (ex. through rhyming)
57
Derailment
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
58
Flight of idea
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
59
Neologism
the invention of new words or phrases or the use of conventional words in idiosyncratic ways
60
Perseveration
persistent repetition of specific words or concepts despite the absence or cessation of a stimulus; seen in cognitive d/o and schizophrenia
61
Tangentiality
in response to a question, the pt gives a reply that is appropriate to the general topic without actually answering the question
62
Thought blocking
a sudden disruption of thoughts or a breakdown in the flow of ideas
63
Word salad/incoherence
speech makes no sense at all
| words joined, but do not convey a message
64
Pressured speech
fast and difficult to interrupt/understand; seen in bipolar-mania
65
Distractible speech
during the course of a discussion, pt changes subject in response to something unrelated in the environment (squirrel!)
66
Which type of a formal thought disorder or patterns of speech might you see in schizophrenia?
perseveration
67
Which type of a formal thought disorder or patterns of speech might you see in bipolar - mania?
Pressured Speech
68
Preoccupations
Both obsessions and phobias as well as suicidal or homicidal ideation
69
Obsessions
intrusive and unwanted ideas which intrude into consciousness despite efforts to suppress them
70
Phobias
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
71
Delusions
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)
72
Types of delusional thoughts
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
73
Alogia
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
74
Perception
perceptual disturbances may be experienced in reference to the self or the environment
illusions
hallucination
dissociation
75
Illusions
misperception or misinterpretation of REAL external sensory stimuli
76
Dissociation
lack of connection in a person's thoughts, memory, or sense of identity
- depersonalization
- derealization: environment is unreal
77
Hallucinations
abnormal perceptions in which pt hears, see, tastes, smells, or feels something others cannot
- auditory
- visual
- gustatory (taste)
- tactile
- olfactory
78
Auditory hallucinations are most commonly seen in ______
Schizophrenia
79
Visual hallucinations are most commonly seen in ______
Organic conditions
80
Tactile hallucinations are most commonly seen in ______
EtOH or benzo withdrawal
81
What are the components of the cognition section of the MSE?
```
General information
Attention and concentration
Calculations
Reading and writing
Visuospatial ability
Abstract thought
```
82
Attention vs concentration
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)
83
How do we assess visuospatial ability of a pt?
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
84
Insight
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?
85
Judgement
assessment of real life problem solving skills
| the greater degree of insight, greater the potential for sound judgement
86
Social Judgement
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
87
Test Judgment
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?
88
Off all the components are the MSE, which sections are assessing the emotional side of the pt?
Attitude, Mood and Affect
89
ASEPTIC
```
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)
```
90
What is the MMSE?
mini mental state exam
5 sections: orientation, immediate recall, attention/calculation, recall, language
out of 30 pts
91
What does an MMSE score of 19 mean?
<19 = cognitive impaired
92
What score on the MMSE means borderline?
19-22 (per the MMSE sheet she posted a score below 20 usually indicated cognitive impairment)
93
What are considered normal scores on the MMSE?
23-30
94
What are the positive sxs of psychosis?
Delusions
Hallucinations
Dissociation
Illusions
95
What are the negative sxs of psychosis?
```
primarily in schizophrenia
Alogia
Affective flattening or blunting
Avolition-apathy
Anhedonia-Asociality
Attention
```
96
What are the DSM criteria for MDD?
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
97
What are the DSM specifiers for MDD with anxious distress?
@ least 2:
- feeling keyed up or tense
- feeling unusually restless
- difficulty concentrating due to worry
- feeling something awful may happen
- feeling loss of control
98
What are the DSM specifiers for MDD with mixed features?
@ 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
99
What are the DSM specifiers for MDD with melancholic features?
```
Loss of pleasure or lack of reactivity
Worse in the morning
Early morning awakening
Weight loss
Marked psychomotor abnormalities
Guilt
```
100
What are the possible differential diagnosis for MDD?
- Secondary depression
- Bipolar disorder
- Anxiety disorder
- Grief, bereavement, or loss
- personality disorders
- dysthymia
- adjustment disorder
101
More than ____% of pts with MDD suffer comorbid psychiatric disorders. The most common are: ____ (there are 3)
50%
- anxiety disorders
- substance use disorders
- personality disorders
102
What neurotransmitters are suspected to be involved in the pathophysiology of depression?
5-HT
NorEpi
Dopamine
103
Which part of the brain is responsible for sleep and appetite?
Hypothalamus
104
How long can an untreated episode of depression last?
months or even years
| failure to obtain treatment may lead to a worsening of the disease course
105
What are the risk factors for recurrence with MDD?
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
106
When risk of recurrent is high, how is depression managed?
as a chronic illness with long-term use of antidepressants
107
Suicide not limited to depression, but ___% suffered ____ or ___
70%
| depression or EtOH
108
What is the lifetime prevalence of MDD and which gender is more likely to get it?
17% (1 in 6)
| twice as common in W than M
109
What is the treatment for mild to moderate depression?
Antidepressants and expertly administered, evidence-based psychotherapy work EQUALLY WELL in mild to moderate depression
110
What is the treatment for severe depression?
antidepressant or the combo of antidepressant/psychotherapy
111
Improvement of which symptoms of depression comes first?
normalization of the somatic systems typically comes first, then psychological sxs
112
How do MAOIs work?
work inside the neuron terminal to prevent the breakdown of dopamine, norepi, and 5-HT
113
How do TCAs work?
work in the synapse to block the reuptake of 5-HT and norepi
114
How do SSRIs work?
specifically block the reuptake of serotonin (SERT)
115
What is NeuroStar TMS?
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
What is ECT?
Electroconvulsive therapy used for severely depressed pts who don't respond to drugs
117
What is the essential feature of Persistent Depressive Disorder (dysthymia)
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
What are the DSM criteria for Persistent Depressive Disorder (Dysthymia)?
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
What mnemonic is used to remember the major depression DSM criteria?
Depression Is Worth Studiously Memorizing Extremely Grueling Criteria. Sorry. (DIWSMEGCS)
120
What does DIWSMEGCS stand for?
```
Depressed mood
Interest
Weight
Sleep
Motor activity
Energy
Guild
Concentration
Suicide
```
121
Approximately ___-___% of all pts hospitalized for major depression will eventually take their own lives.
10-15%
122
What are the essential features of Disruptive Mood Dysregulation Disorder (DMDD)?
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
What are the differential dx for DMDD?
```
Bipolar disorder
intermittent explosive disorder
depressive disorder
ADHD
autism spectrum disorder
separation anxiety disorder
ODD (can't be ODD + DMDD)
```
124
What gender is DMDD more common in?
Male kids
125
What is the treatment for DMDD?
no empirically supported treatments yet
| consider CBT treatments
126
How is bereavement/grief different from MDD?
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
What is premenstrual dysphoric disorder?
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
What are the 'Core Sxs' of premenstrual dysphoric disorder?
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
DSM criteria for Mania/Hypomania
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
Before sulfa drugs, what was the number 1 cause of psychosis?
tertiary syphilis
131
What are positive symptoms?
hallucinations
delusions (bizarre vs. non-bizarre)
disorganized speech, behavior, affect (disorders of thought)
agitaiton and aggression
132
What are negative symptoms?
```
affective flattening
diminished emotional expressiveness
alogia
avolition
apathy
anergia
asociality
attentional impairment
```
133
What are cognitive symptoms?
working memory
executive function
attention
learning
134
What are mood symptoms?
depression
anxiety
suicide
135
Dopamine is ____active in the mesocortical pathway of a schizophrenic pt.
hypo
136
Dopamine is ____active in the mesolimbic pathway of a schizophrenic pt.
hyper
137
Where in the brain is responsible for positive symptoms in a schizophrenic pt?
mesolimbic pathway
138
Where in the brain is responsible for negative symptoms in a schizophrenic pt?
mesocortical pathway
139
What side effect occurs if you block dopamine in the tuberoinfundibular?
HPL -hyperprolactinemia
140
What side effect occurs if you block dopamine in the nigrostriatal?
EPS
141
How does phencyclidine (PCP) and ketamine induce schizophrenia-like effects?
by blocking NMDA receptors in the brain
142
What is the DSM criteria for Schizophrenia?
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
Which types of family members have the highest risk of getting schizophrenia?
identical twins ~48%
| first degree 10%>general population 1%
144
What chromosome has been identified with SCZ?
chromosome 22, 6
145
What can we see on a cellular level with SCZ pts?
synaptic 'pruning' - loss of synapses typically in adolescence and early adulthood
146
____% of SCZ pts commit suicide
10%
147
What are risk factors for SCZ?
```
family hx
northern hemisphere
born in the winter
pregnancy complications
loss of parent during childhood
lower socioeconomic status
```
148
At what age are males typically dx with SCZ?
18-25
149
At what age are females typically dx with SCZ?
25-30
150
What sxs are typically seen in the prodromal phase of SCZ?
negative sxs
151
What sxs are typically seen in the acute phase of SCZ?
positive sxs
152
What is the treatment for SCZ?
Typical (1st gen) Antipsychotics
```
High:
-Haloperidol
-Thiothixine
-Trifluoperazine
-Fluphenazine
Low:
-Chlorpromazine
-Thioridazine
```
153
What are the extrapyramidal side effects? (EPS)
SE from antipsych meds
Acute dystonia
Akathisia
Drug-induced Parkinsonism
Tardive Dyskinesia
154
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"
Parkinsonism
155
Name the EPS: "Pacing, restless, fidgety. Increase in Haldol dose makes it worse."
Akathisia
156
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)"
Parkinsonism
157
Name the EPS: "treatment includes anticholinergic medicines such as Benadryl or cogentin"
actue dystonia
158
What drug might be helpful for Akathisia?
Propranolol
159
What is Neuroleptic Malignant syndrome?
a syndrome that can occur typically 4-14 days after start of neuroleptic medications
```
fever
HTN
rigidity
delirium, confusion
CPK elevation
```
160
What is the difference between typical and atypical antipsychotics?
Typical: D2 --help with positive symptoms
Atypical: 5HT + D2 -- can help with negative symptoms too
161
What are SE of antipsychotics?
Weight gain
QT prolongation
Sedation
increase blood glucose
162
Depot drugs are good for which types of drugs?
Typical antipsychotics for pts who have trouble complying
163
What is brief psychotic disorder?
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
Delusional Disorder
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
Types of Delusional Disorder Specifiers
```
Erotomanic
Grandiose
Jealous
Persecutory (pt believes they're being conspired against, or spied on)
Somatic
Mixed
Unspecified
```
166
Schizoaffective Disorder
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
What are the risk factors for suicide?
```
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
Cognitive elements of Panic Disorder
anticipatory anxiety (fear of fear), misinterpretation of bodily sensations, belief that avoidance is protective
169
Cognitive elements of Social Phobia
negative social expectations, distorted interpretations of others' responses, belief that avoidance is protective
170
Cognitive elements of PTSD
contents of memory, believing self unable to withstand, overestimation of risk of repetition of traumatic experiences - nightmares, forced recollection
171
What NTs are involved in the fight or flight response sxs?
NE (in the locus ceruleus)
| 5-HT (in the medial raphe)
172
What is the DSM criteria for Separation Anxiety?
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
The majority of adults with separation anxiety disorder had a first onset in _____
adulthood
*disorder that start in childhood generally do not persist into adulthood
174
What is the tx for separation anxiety?
Combo of meds (for anxiety and fear) + psychotherapy
| SSRIs and benzos
175
Define phobia
irrational fear of specific objects, places, or situations, or activities. The fear in phobias is irrational, excessive, and disproportionate to any actual danger
176
Define Social Anxiety Disorder
social phobia
| fear of humiliation or embarrassment in social settings
177
Define Specific Phobia
is a category that includes isolated phobias such as the irrational and intense fear of snakes
178
How might a person with social phobia appear in the initial interview?
ill at ease
anxious, fearful
verbal responses may be restricted
179
What is the DSM criteria for specific phobia?
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
What is the DSM criteria for social phobia?
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
What are some specifiers for specific phobia?
Animal
Natural Environment
Blood-injection-injury
Situational (airplanes, elevators, enclosed spaces)
Other (situations that might lead to choking)
182
Define panic disorder
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
DSM criteria for Panic Disorder
@ 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
When do panic disorders typically start?
| How long do they last?
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
Define agoraphobia
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
What are the DSM criteria for Agoraphobia?
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
What are the DSM criteria for GAD?
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
What is the most frequent complication of GAD?
MDD and substance use disorder
189
Who is more likely to get GAD?
Women
African Americans
people under the age of 30
190
What are the DSM criteria for PTSD?
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
Define Adjustment Disorder
when a person is unable to cope with a specific life stressor and become overwhelmed and develops sxs of emotional distress
192
What are the DSM criteria for adjustment disorder?
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
How do we get addicted?
operant conditioning (positive or negative reinforcement
194
How do we stay addicted?
classical conditioning (pavlovs dogs)
195
Anticipation
is a conditioned response and is itself reinforcing
196
What chemicals are involved in addiction?
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
Tolerance
need more and more to get the desired effect
198
Sensitization
repeated administration of a stimulus results in an amplification of response
199
What make a drug addictive?
```
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
CAGE
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
What are the 11 sxs of substance use disorder?
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
What is considered MILD substance use disorder?
"at risk"
exceeds daily limits
2-3 sxs (of the 11)
203
What is considered MODERATE substance use disorder?
'abuse'
exceeds daily limits
4-5 sxs (of the 11)
204
What is considered SEVERE substance use disorder?
'dependence'
exceeds daily limits
6+ sxs (of the 11)
205
What is the most commonly abused drug?
Marijuana; followed by prescription drugs
206
Who is at the highest risk for substance abuse disorders?
Native American + Pacific islanders
M > F
living in urban areas
207
What drugs are considered hallucinogens?
sympathomimetics
- PCP
- LSD
- Amphetamines (Ecstasy)
208
What drugs are considered stimulants?
dextroamphetamine
methylphenidate
methamphetamine
cocaine
209
What is nicotines MOA?
nicotinic receptor agonist throughout the body
| causes increase in NE, vasopressin, beta-endorphin, ACTH and cortisol resulting in overall CNS stimulation
210
What does nicotine intoxication look like?
relaxation, increased concentration, anorexia, increased BP
211
What does nicotine withdrawal look like?
beings 1 hour after last cigarette, peaks in 24h
| irritability, increased appetite, craving
212
How to treat nicotine use disorder?
```
Cognitive/Behavoiral strategies for cessation
-avoid cues
-stress managemnt
-healthy lifestyle
Pharm:
-replacement therapy
-Bupropion (Zyban)
-Varenicline (Chantix)
```
213
What is the most effective treatment for nicotine use disorder?
combo of nicotine replacement + pharm
214
What is alcohol + sedatives MOA?
GABA
215
What does alcohol + sedatives intoxication look like?
slurred speech, confusion, disinhibition, seizures, DTs
216
What does alcohol + sedative withdrawal look like?
elevated BP, HR
diaphoresis
confusion
seizures
217
What is Wernicke-Korsakoff Syndrome?
```
commonly seen in alcoholics due to thiamine deficiency
Wernicke's Encephalopathy Triad:
-confusion
-ataxia
-nystagmus
Korsakoff Syndrome/Psychosis:
-amnesia
-confabulation
-hallucinations
```
218
During what time frame do alcoholic hallucinosis begin?
12-24 h
| visual, auditory, or tactile hallucinations
219
When do you typically see alcoholic withdrawal seizures and what kind of seizures are they?
24-48 hours
| generalized tonic-clonic seizures
220
What is delirium tremens?
alcohol withdrawal delirium: (48-72 hours)
- hallucination (visual)
- disorientation
- tachycardia
- HTN
- fever
- agitation
221
How do you treat acute alcohol withdrawal?
```
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
How do you treat alcohol use disorder?
Acamprosate (Campral)
Naltrexone
Disulfiram
223
What is caffeines MOA?
dopamine
224
What does caffeine intoxication look like?
```
palpitations
anxiety
irritability
insomnia
can aggravate a variety of medical conditions
```
225
What does caffeine withdrawal look like?
headache
lethargy
irritability
depressed mood
226
What is the MOA for opiates?
Mu, Kappa, Delta
227
What are types of opiates?
heroin
morphine
oxycontin
228
What does intoxication on opiates look like?
```
euphoria
sedation
miosis (constricted pupils)
respiratory depression
constipation
```
229
What does withdrawal from opiates look like?
```
dysphoria
myalgias
rhinorrhea
diarrhea
lacrimation
dilated pupils
```
230
What are the adverse effects of opiates?
HIV, Hepatitis, endocarditis, self neglect, OD, death
231
What is the treatment for opiate OD?
NARCAN (naloxone)
232
What is the treatment for opiate substance disorder?
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
What is the MOA of stimulants?
cocaine, methamphentamine, amphetamines, methylphenidate
DOPAMINE
cocaine inhibits reuptake
amphetamines increased release
234
What are the routes of administration for stimulants?
PO, IV, inhaled
235
What does intoxication on stimulants look like?
```
euphoria
increased vigilance
anorexia
mydriasis (dilated pupil)
tachycardia
HTN
arrhythmias
auditory + tactile hallucinations
psychosis
agistiaon
bruxism (teeth grinding/jaw locking)
```
236
What does withdrawal from stimulants look like?
```
can resemble sever MDD
can include suicidal ideation
dysphoria
hypersomina
increased appetite
irritability
craving
```
237
What are the adverse effects of stimulants?
necrosis of soft tissue
cyanosis
CV
stroke
238
What is the treatment for stimulants?
symptomatic + behavioral
239
What is the MOA for marijuana?
cannabinoid receptor (GPCR), inhibits adenylate cyclase in hippocampus, basal ganglia and cerebellum
240
What does intoxication on marijuana look like?
```
perceptual disturbances
anxiety
paranoia
conjunctival injection
tachycardia
dry mouth
increase appetite
```
241
What does withdrawal on marijuana look like?
```
irritability
depression
restlessness
anorexia
cravings
```
242
What are the adverse effects of marijuana?
amotivational syndrome
| psychosis
243
What is the treatment for marijuana?
none
244
What is the MOA for phenylcyclohexyl piperidine (PCP)?
NMDA antagonist
245
What are the routes of administration for PCP?
nasal, PO, inhaled, IV, transdermal
246
What does it look like when someone is intoxicated on PCP?
```
RED DANES
rage
erythema
dilated pupils
delusions
amnesia
nystagmus
excitation
skin dryness
```
247
What does withdrawal from PCP look like?
lack of energy and depression
248
What are the adverse effects of PCP?
memory loss
liver function problems
depression
psychosis
249
What is the treatment for PCP?
"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
What is the MOA for hallucinogens?
5-HT agonist
251
What is the route of administration for hallucinogens?
oral, transdermal, IV, inhaled
252
What are types of hallucinogens?
LSD, psilocybin, mescaline/peyot, PCP
253
What are the sxs of intoxication of hallucinogens?
```
mydriasis (pupil dilation)
wakefullness
synesthesia
LDS (hallucination)
Mescaline (visual disturbances, geometricization)
```
254
What are the adverse effects of hallucinogens?
unknown
| not considered addictive
255
What is the MOA of ecstasy (MDMA)?
release of monoamines
256
What does it look like to be intoxicated on MDMA?
euphoria
intimacy
diminished fear
improved self- confidence
257
What does it look like to withdrawal from MDMA?
```
depressed
paranoia
nervousness
tremors
feeling cold
```
258
What are the typical clinical presentations of a pt with delusional disorder?
Chronically suspicious, socially isolated, but their personality remains intact
middle to late adult aged people (M = F)
259
What is the most common type of delusion seen in delusion disorder?
Persecutory type (belief they're being conspired against)
260
How do you treat delusional disorder?
you can treat the anxiety and agitation with antipsychotics but the core delusions typically remains
Haloperidol
Risperidone
261
What is the time frame for brief psychotic disorder?
1 day to 1 month
with gradual recovery
signs and sxs similar to those seen in SCZ
W > M (2:1)
self limiting
262
What is the time frame for Schizophreniform Disorder?
SCZ sxs for @ least 1 month but no longer than 6 months
this is designed to guard against premature dx of SCZ
263
What are the 2 negative sxs most characteristic of SCZ?
diminished emotional expression (affective flattening or blunting) + avolition (lack of motivation)
264
Alogia
poverty of speech, is a general lack of additional, unprompted content seen in normal speech
265
Anhedonia
inability to experience pleasure
266
What are the typical phases/stages of schizophrenia?
Prodromal phase
Active phase
Residual phase (less prominent positive sxs but still some impairment) --can see "acute exacerbation"
267
What is the strongest predictor of outcome with SCZ?
IQ
age at onset, gender, severity, and typic of initial sxs play predictive value as well
268
What is the target of SCZ treatment?
block postsynaptic Dopamine receptors in the limbic forebrain
remember that all antipsych meds block dopamine receptors
269
What is the time frame for schizoaffective disorder?
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
Pts with this type of disorder are more likely to end up in the office of a lawyer rather than a doctor?
Delusional Disorder
271
Pts with this type of disorder are more likely to seek help at a primary care office than a psychiatrist?
Mood disorders
