Exam 1 Flashcards
What is the single biggest cause of morbidity, mortality, and years lost globally?
Major Depressive Disorder
What is the DSM V criteria for MDD (# of symptoms for how long)?
5 or more symptoms for at least 2 weeks
What are the DSM V symptoms for MDD?
Depressed mood, Loss of interest or pleasure in activities, weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, loss of energy, decreased concentration, inappropriate guilt or worthlessness, recurrent thoughts of death or suicide
What pathway do most antidepressants work on?
The monoamine systems
What is the Suprachiasmatic Nucleus?
Region of the brain in the hypothalamus that is responsible for controlling circadian rhythms
What are 6 danger signs of Suicide?
Talking about it; statements of hopelessness, helplessness, worthlessness; preoccupation with death; making arrangements; giving things away; anxiety
T/F–> MDD is more common in men
False
When is it appropriate to use ECT?
Severely depressed patients who do not repond to drugs
What is the essential feature of Persistent Depressive Disorder?
Depressed Mood + at least 2 depressive symptoms
How long must symptoms persist to be considered Persistent Depressive Disorders?
At least 2 years (1 for kids)
What is the essential feature of Disruptive Mood Dysregulation Disorder? and how often do outbursts occur?
Severe temper outbursts w/ underlying persistent angry or irritable mood; 3 or more times a week
What are 4 of the most common symptoms of Premenstrual Dysphoric Disorder?
Affective lability, irritability, depressed mood, anxiety/tension
What is the definition of mania?
Persistent, elevated, expansive, or irritable mood w/ increased activity or energy lasting for at least 1 week
To diagnose mania you need 3 or more of the following:
Grandiosity, decreased need for sleep, pressured talk, flight of ideas/racing thoughts, distractibility, increased activity/psychomotor agitation, excessive involvement in consequential behavior
T/F–> Bereavement can precipitate MDD
True
Grief or MDD –> Self-Esteem preserved
Grief
Grief or MDD –> Limited capacity to experience happening or pleasure
MDD
What are the 3 key tips to use in interviewing patients with behavioral disorders?
Normalization, Continuation, Redirection
What are the 4 Ps in a psychiatric interview?
Predisposing Factors, Precipitating Factors, Perpetuating Factors, Protective Factors
What are the 5 components of the Psychiatric interview in a medical chart?
Psych hx, Family hx, Social Developmental hx, PE, ROS
T/F–> you should always ask about suicide ideations even if patient makes no mention of it.
True
What aspect of the biopsychosocial model is described here: Learning/memory, emotions, coping skills, trauma, personality, behaviors, attitudes/beliefs
Psychology
Mental Health Illness or Disorder? –> A conditions that affects a person’s thinking, feeling or mood
Mental Illness
Mental Health Illness or Disorder? –> Syndrome characterized by clinically significant disturbance in cognition, emotion regulation or behavior
Mental Disorder
What is the Diathesis-Stress Model?
Etiological theory that examines the interaction of non-biological or genetic traits and environmental influences to produce disorders
T/F–> Autism, ADHD, Asperger’s Childhood disintegrative Disorder and Pervasive developmental disorder are all under one diagnosis of Autism spectrum disorder
FALSE (ADHD is not included here)
What pathways are involved in the dopamine hypothesis of schizophrenia?
Mesocortical, Nigrostriatal, Tuberoinfundibular, Mesolimbic
T/F–> To diagnose Schizophrenia there must be at least 3 positive symptoms
False–> only need 1 positive symptom
How many symptoms of Catatonia must be present and what are they?
3; Motor immobility, excessive motor activity, extreme negativism, peculiarities of voluntary movement, stereotyped movements
What makes for a worse prognosis for schizophrenia?
Early age of onset, male, more negative symptoms, brain abnormalities, lower level of function prior to onset, substance use, disorganized subtype
T/F–> The new generation antipsychotics have shown greater efficacy in treating schizophrenia
False; The only major difference is the SE profile
What is the require time course of symptom presentation in: Schizophrenia, Schizophreniform, and Brief Psychotic disorder?
Schizophrenia: signs of disturbance for at least 6 months
Schizophreniform: 1 month to 6 months
Brief Psychotic d/o: 1 day to 1 month with return to normal functioning
T/F–> Schizoaffective disorder is a thought disorder.
False; It is a Mood disorder with both schizophrenia ad mood components
What are the 6 types of delusions?
Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed
What is negative reinforcement in Substance Use Disorders?
the noxious experience that occurs when the reward is not obtained
Where do “uppers” hit in the brain vs. “downers”
“Uppers” hit the Nucleus Accumbens vs. “Downers” hit the VTA
What does CAGE stand for? How many does the patient have to say “yes” to determine the diagnosis?
C: Cut Down A: do people Annoy you by criticizing behavior? G: Guilt about drinking? E: Eye Opener 2 yes
How did the DSM 5 change the terminology around illnesses of addiction?
Substance abuse or dependence changed to Substance Use Disorders characterized as Mild, Moderate, Severe
What are the 3 criteria clusters in Substance Use Disorders?
Loss of Control, Adverse consequences, Physiological Dependence
What is considered “severe” substance abuse?
use exceeds daily or near daily limits with >6 sx
What is the most effective treatment of nicotine addiction?
Combination of Replacement and pharmacological treatments
What is the most commonly used treatment of alcohol and sedative withdrawal?
Diazepam (lorazepam, alprazolam, clonazapam also used)
T/F–> Drugs with shorter half lives are more likely to be addictive
True
What is the Wernicke Triad of Substance Use Disorders?
Confusion, Ataxia, Nystagmus
What are 3 parts of Korsakoff Psychosis?
Amnesia, Confabulation, Hallucinations
What is the treatment of opioid overdose vs. use disorder?
overdose: Naloxone (Narcan)
Use Disorder: Methadone, Buprenorphine, Clonidine, Naltrexone
What is the physiological mechanism of stimulants?
Cocaine inhibits DA reuptake at presynaptic neuron and amphetamines cause increased DA release
What is the MOA of PCP?
NMDA antagonist
T/F–> Hallucinogens are not considered addictive
True
What is the treatment of choice for Ecstasy?
Cognitive Behavioral Therapy for Use Disorder
What are the 3 underlying structures for anxiety disorders?
Cognitive, Physiological, Behavioral
What are the 3 chemical systems involved in the Physiological response in anxiety disorders and the associated substance
Stress Response–> Cortisol
Monoamines–> Norepi and Serotonin
Central NTs–> GABA. Glutamate
What are the 5 steps to the Anxiety Circle?
- Threats
- Anticipation, negative prediction, cognitive distortions
- Arousal
- Avoidance
- Risk Factors
What is the key to treating Anxiety Disorders?
Break the cycle
What are the types of Cognitive Behavioral Therapy used in treating Anxiety Disorders?
Exposure Therapy
Systematic Desensitization
Flooding
What pharmacological treatments are used for anxiety disorders?
benzodiazepines, SSRIs/SNRIs/TCAs, Buspirone, Anticonvulsants, Atypical Antipsychotics
What is the purpose of the Mental Status Exam?
Evaluate, quantitatively and qualitatively, a range of mental functions and behaviors
What is clanging?
Thoughts that are associated by the sound of words rather than by their meaning
What is pressured speech?
Fast and difficult to interrupt/understand; Seen in bipolar and mania
What is perseveration?
Persistent repetition of specific words or concepts despite the absence or cessation of a stimulus; seen in cognitive disorders and schizophrenia
Define Obsessions
Intrusive and unwanted ideas which intrude into consciousness despite efforts to suppress them
What are Delusions? What are types of delusions
Delusions: false fixed personal beliefs that are not shared by others
Grandiose, Religious, Persecution
Erotomatic, Jealousy, Nihilistic
Thought broadcasting, thought insertion, thought withdrawal
Ideas of reference, ideas of influence
Define Hallucinations
Abnormal perceptions in which patient hears, sees, tastes, smells, or feels something others cannot
How is visuospatial ability tested on the mental exam?
Draw a clock indicating a certain time
How do you test a patient’s insight and judgement?
Ask questions such as “How do you plan to follow up with your medical care?” and “What would you do with a stamped, addressed letter you found on the street?”
How do you test attention and concentration on the mental status exam?
Attention: spell World backwards
Concentration: calculations, test ability to read and write
How do you test registration/recall?
Can patient learn something new (give them 3 words) and repeat it back to you almost immediately
What are the 4 components to “Orientation”
Time, Place, Person, Situation
What is Echopraxia?
the involuntary repetition or imitation of another persons actions; especially seen in tourettes or autism
What is Catalepsy?
Condition in which a person can be molded into a position and they maintain position for prolonged period of time; seen in catatonic schizophrenia
What is the minimum # of symptoms and the time period in which they must present for a diagnosis of Major Depressive Episode?
5 symptoms that must be present during the same 2-week period and must represent a change from previous functioning; 1 of the symptoms must be either depressed mood or loss of interest or pleasure
What are the 9 characteristic symptoms of major depression?
“Depression Is Worth Studiously Memorizing Extremely Grueling Criteria. Sorry.”
Depressed mood, Interest, Weight, Sleep, Motor activity, Energy, Guilt, Concentration, Suicide
One ore more of the following symptoms must be present in Premenstrual Dysphoric Disorder:
- Marked Affect Lability (mood swings, sensitivity, sudden sadness or tearfulness)
- Marked Irritability or anger or increased interpersonal conflicts
- Marked Depressed Mood, feelings of hopelessness, self-deprecating thoughts
- Marked anxiety, tension, and/or feelings of being keyed up or on edge
Diagnostic Criteria for Delusional disorder: Presence of one (or more) delusions with a duration of _____________ or longer.
1 month
What are the 3 typical stages of Schizophrenia
- Prodromal Phase: insidious onset occurring over months or years; subtle behavioral changes
- Active Phase: Psychotic symptoms develop, including hallucinations, delusions, disorganized speech and behavior
- Residual Phase: Active-phase symptoms are absent or no longer prominent; often role impairment
What is Derailment (loos association) speech?
Breakdown in both the logical connection between ideas and the overall sense of goal-directedness; Words make sentences but the sentences don’t make sense
What are the 7 symptoms of Mania?
Euphoric mood, increase in activity, racing thoughts/flight of ideas, inflated self-esteem, decreased need for sleep, distractibility, poor judgement
What are Negative Symptoms–> 5 A’s (found primarily in schizophrenia)
Alogia, Affectie Flattening or Blunting, Avolition-Apathy, Anhedonia-Asociality, Attention
What are the Risk Factors associated with Suicide?
SAD PERSONS–> Sex (male>female), Age (older for men, middle aged women), Depression, Previous Attempt, Ethanol abuse, Rational thinking loss, Social support lacking, organized plan, No spouse, Sickness
What is the most prevalent mental illness in adults?
Anxiety Disorders
_________% of those who die by suicide have an underlying mental illness
90%
Suicide among those with _____________ is 50x greater than the general population.
Schizophrenia
What race has the highest prevalence of adult mental illness?
American Indians/Alaskan Natives
