Exam 1 Flashcards
What is the most prevalent mental illness?
anxiety disorders
What is the 10th leading cause of death overall in the US?
suicide
What race has the highest prevalence of living with a mental health condition?
AI/AN followed by asian
What are the components of the psych interview?
establish relationship with patient assess risk formulate ddx and management plan negotiate and initiate tx plan produce standard record
What is the biopsychosocial model?
holistic approach that examines disease/illness beyond the pathophysiological construct
What facilitates working alliance?
attentive listening, empathy, respect and communication
What is content and process?
what is being said and how its being said
What are 3 psych interview techniques?
normalization
continuation
redirection
Normalization
helps reduce shame/stigma, being judges
Continuation
acknowledges patient, engages, nonverbal cues
Redirection
helps guide and focus interview
How long should you allow the pt to talk freely without interruption?
at least 3-4 minutes
What is SIGECAPS?
sleep interest guilt energy concentration appetite psychomotor agitation slowing or suicidality
What is the goal of past psych hx?
obtain information about psych illnesses and their course over pts lifetime including sx and tx
What is the goal of social development hx?
establish pts development and social hx across various stages of pts life
How far apart should clinician and patient be seated?
4-6 feet
What is WHODAS?
world health organization disability assessment schedule
What are the 6 domains of WHODAS?
cognition mobility self-care getting along life activities participation
What are the 4 Ps?
predisposing factors
precipitating factors
perpetuation factors
protective factors
What is MAPPS-CO?
mood anxiety psychosis personality substance/addiction somatic cognitive obsessions/compulsions
What is the purpose of the MSE?
evaluate, qualitatively and qualitatively a range of mental functions and behaviors at a specific point in and provide impt info for diagnosis
What are the components of MSE?
general appearance and attitude motor activity/behavior orientation/level of consciousness mood and affect speech thought form and content perception memory and cognition judgement and insight
What is psychomotor retardation and what does it signify?
slowing of physical and emotional rxns
may signify depression or negative sx of schizophrenia
What is psychomotor agitation and when may it occur?
excessive motor and cognitive activity may occur with anxiety or mania
Tics
sudden repetitive, jerky movements of eyes, vocal organs, face, extremities or trunk
Compulsion
repetitive and ritualized behavior which the person feels compeleld to perform
Echopraxia
involuntary repetition or imitation of another persons actions typically seen with Tourette’s or autism
Akathisia
movement disorder characterized by feeling of inner restlessness and compelling need to be in constant
SE of APS
Catalepsy
person can be molded into position that is then maintained for prolonged period of time
seen in catatonic schizophrenia
Catatonia
severe disturbance of motor fn usually manifested by markedly decreased activity but may involve hyperactivity with alteration btwn these states
Dystonia
involuntary muscle contractions that cause slow repetitive potentially painful movements or abnormal postures
Drug induced
Dyskinesia
difficulty or distortion in performing voluntary mvts
How do you check orientation?
time
place
person
situation
obtunded
slowed response to stimulation
stuporous
awakening in response to pain
comatose
unresponsive
Affect
patients observed expression of emotion
Circumstantiality
over inclusion of trivial or irrelevant details that impede sense of getting to the point
clanging
thought associated with sound of word rather than by their meaning
derailment
breakdown in both logical connection between ideas and overall sense of goal directness
flight of ideas
succession of multiple associations so that thought seem to abruptly move from idea to idea often expressed though rapid pressured speech
neologism
invention of new words or phrases
preservation
persistent repetition of specific words or concepts despite absence or cessation of stimulus
tangentiality
pt gives reply thats appropriate to general topic without actually answering the question
thought blocking
sudden disruption of thought or break in flow of ideas
word salad/incoherence
speech makes no sense at all
pressured speech
fast and difficult to interrupt
distractible speech
patient changes subject in response to something unrelated in environment
obsessions
intrusive and unwanted ideas which intrude into consciousness despite efforts to suppress them
grandiose
delusions of grandeur
persecution
belief that someone wants to cause them harm
erotomanic
belief that someone famous is in love with them
nihilistic
belief that self or part of self, others or the world does not exist
ideas of reference
belief that everything refers to pt
ideas of influence
beliefs about another person or force controlling some aspect of ones behavior
illusions
misperception or misinterpretation of REAL external sensory stimuli
dissociation
lack of connection in a persons thoughts, memory or sense of ID
depersonalization
sense that one is outside his/herself
derealization
subjective sense that the environment is strange of unreal
hallucinations
abnormal perceptions in which pt hears, sees, tastes, smells or feels something others cannot
When do illusions typically occur?
delirium and psychosis
When do hallucinations typically occur?
psychosis
When do auditory hallucinations typically occur?
schizophrenia
When do visual hallucinations typically occur?
organic conditions
when do tactile hallucinations typically occur?
alcohol or benzo withdrawal
How do you test attention?
spell world backwards
How do you test concentration?
serial 7s
What is patients insight?
patients ability to understand and acknowledge factors that influence a situation such as his/her illness
What is ASEPTIC?
appearance speech emotion perceptions thought content and process insight and judgement cognition
What is ddx for MDD?
secondary depression bipolar disorder anxiety disorder greif/loss personality disorder dysthymia adjustment disorder
Dysthymia
persistent long term depression
What are the most common comorbid psych disorders associated with MDD?
anxiety
substance use
personality disorders
MDD etiology
early environment shapes neuronal connectivity and current environment unmasks vulnerabilities to trigger depression via release of cortisol
What is the stress diathesis model?
predisposed due to genetics and brain structure/abnormalities and neurotransmitters but triggered by stressors to develop psych disorders
What neurotransmitters are involved in pathophysiology of depression?
serotonin, NE, dopamine
Neocortex
concentration
Striatum
sluggish movement
Central striatum
anxiety
Hypothalamus
sleep and appetite
Hippocampus
memory
Risk factors for recurrence
multiple lifetime episodes
incomplete response to treatment
absence of acute stress when episode beings
severity of episode
Danger signs of suicide
talking about it hopelessness/helpless/worthlessness preoccupation with death making arrangements giving things away anxiety
MDD epidemiology
2x MC women
MDD general tx
tricyclics, SSRI, SNRI, MAOI
NeuroStar TMS
transcranial magnetic stimulation for MDD with no improvement from meds
ECT
100 volt shock for MDD pt who don’t respond to drugs
Epidemiology of DMDD
MC males
Positive symptoms
delusions, hallucinations, disorders of thought, agitation/aggression
Negative symptoms
affect flattening, apathy, anergia, asociality, alogia, diminished emotional expression, attentional impairment
cognitive sx
working memory
executive fn
attention
learning
mood sx
depression
anxiety
suicide
Brain pathways affected by schizophrenia
hyperactive mesolimbic pathway causing positive sx
hypoactive mesocortical pathway causing negative, cognitive and mood sx
What is the effect of blocking nigrostriatal D2?
EPS
How does glutamate regulate dopamine?
directly-fibers progect to brainstem neurons
indirectly-fibers direct to GABA to brake
How does PCP induce schizophrenia like effects?
Blocking brain NMDA receptors
Pathyphys od schizophrenia
synaptic pruning
lateral and third ventricles are enlarged
reduction of blood flow to left globus pallidus
thinner temporal love
smaller anterior hypothalamus
Precipitating factors of schizophrenia
brain damage, birth trauma, viral infections, nutritional dissues
risk factors for schizophrenia
FH urban areas northern hemi winter month birth pregnancy complications loss of parent during childhood lower socioeconomic status
What percentage of schizophrenia patients commit suicide?
10%
Poor prognostic factors of schizophrenia
early age of onset male more neg sx more brain abnormalities lower level of fn prior to onset substance abuse disorganized subtype
Fluphenazine
high potency APS for schizophrenia
Trifuoperazine
High potency APS for schizophrenia
thiothixine
High potency APS for schizophrenia
haloperidol
High potency APS for schizophrenia
thioridazine
low potency APS for schizo
chlorpromazine
low potency APS for schizo
Effect of anti-H1
sedation and weight gain
effect of anti alpha 1
orthostasis and reflex tachycardia
anti-M1
blurry vision, dry mouth, constipation, urinary retention, tachy, memory problems, delerium
effects of high potency APS
more EPS but less anti H1, anti alpha 1 and anti M1
What are EPS?
acute dystonia, akathisia, drug induced parkonsonism and tardive dyskinesia
Drug induced parkonsonism
bradykinesia, rigidity, tremors
Acute dystonia
sudden sustained forceful muscle contractions
akathisia
motor restless or discomfort relieved by movement
tx for dystonia
benztropine
tx for parkonsonism
reduce APS or benztropine
tx for akathisia
reduce APS, use propanolol or benzodiazepine (valium)
tx for tardive dyskinesia
cease APS if possible
clozapine
atypical APS
risperidone
atypical APS
olanzapine
atypical APS
quetiapine
atypical APS
ziprasidone
atypical APS
aripiperazole
atypical APS
paliperidone
atypical APS
iloperidone
atypical APS
SE of atypical APS
weight gain, inc blood glucose, increased triglycerides, possible sedation, QT prolongation
panic disorder
anticipatory anxiety, misinterpretation of bodily sensations, belief that avoidance is protective
social phobia
negative social expectations, fear of humiliation or judgement,
PTSD
overestimation of risk of repetition of traumatic experiences
Physiological response to stres
cortisol, monoamines (5-HT and NE), central NY (gaba and glutamate)
sympathetic
fight or flight
parasympathetic
rest and digest
agoraphobia
fear of places and situations that cause panic
How does avoidance sustain dysfunction?
rewarded by reduction in unplesant arousal
Anxiety treatments
benzos, SSRI, SNRI, tricyclic antidepressants, Buspar, anticonvulsants, cognitive behavior therapy
How are addictive behaviors reinforced?
dopamine is released in nucleus accumbens and DA will increase with anticipation of reward
sensitization
repeated administration of stimulus results in amplification of response
tolerance
need more to get desired effect
What is CAGE
2 yeses indicated possible substance use disorder
cut back
annoyed
guilty
eye opener
What is the most commonly abused drug?
marijuana followed by prescription drugs
Nicotine MOA
agoist at nicotinic receptors causing inc NE
Nicotine route of administration
inhaled, oral
Nicotine intoxication
relaxation, increased concentration, anorexia, increased BP
Nicotine withdrawal
beings 1 hr after last cigarette, peaks in 24 rs, irritability, increased appetite, craving
Nicotine use d/o tx
bupropion, varenicline, replacement therapies, aovid cues, stress management, exercise
What is the most effective tx for nicotine use disorder
combo nicotine replacement and pharmacotherapty
alcohol use d/o MOA
GABA
alcohol use d/o intoxication
slurred speech, confusion, disinhibition, seizures
alcohol use d/o withdrawal
elevate BP, elevate puse, diaphoresis, confusion, seizures
alcohol use d/o adverse effects
cirrhosis, GI cancer, esophageal varices
alcohol use d/o minor withdrawal sx
insomnia, tremulousness, mild anxiety, GI upset, HA, palpitations, anorexia (6-12 hrs)
When are alcoholic hallucinations seen?
12-24 hours
When are alcoholic withdrawal seizures seen?
24-48 hours
When are alcoholic delirium tremens seen?
48-72 hours
Wernicke’s enphalopathy triad
confusion, ataxia, abnormal eye movements
Korsakoff syndrome/psychosis
amnesai, confabulation, hallucinations
What causes wernicke-korkoff syndrome?
thiamine deficiency
Tx for acute alcohol withdrawal
Lorazepam Alprazolam Clonazepam Diazepam Chlordiazepoxide
alcohol use disorder tx
acamprosate
naltrexone
disulfiram
Caffeine MOA
dopamine
caffeine intoxication
palpitations, anxiety, irritability, insomnia
caffeine withdrawal
HA, lethargy, irritability, depressed mood
Opiates MOA
mu, kappa, delta
Opiate types
heroin, morphine, oxycotin
Opiates intoxication
euphoria, sedation, miosis, respirtory depression, constipation
Opiates withdrawal
dysphoria, myalgias, rhinorrhea, diarrhea, lacrimation, dilated pupils
Opiates adverse effects
HIV, hepatitis, endocarditis, self neglect, OD, death
Opiate OD tx
Naloxone (Narcan)
Tx for opioid use d/o
methadone
buprenorphine
clonidine
naltrexone
Stimulants
coaine, methamphetamine, amphetamines, methylphenidate
stimulants MOA
cocaine inhibits DA reuptake (increased DA in synapse)
stimulants intoxication
euphoria, increasde vigilance, anorexia, mydriasis, tachycardia, hypertension, arrhythmias, auditory and tactile hallucinations, psychosis, agitation
stimulants withdrawal
resemble MDD and suicidal ideation and attempts, dysphoria, hypersomnia, increased appetite, irritability, craving
stimulants adverse effects
necorsis of soft tissues, cyanosis, cardiovascular, stroke
tx for stimulant use d/o
symptomatic and behavioral
marijuana MOA
cannabinoid receptor is GPCR and inhbits adenylate cyclase
marijuana intoxication
perceptual disturbances, anxiety, paranoia, conjunctival injection, tachycardia, dry mouth, increased appetite
marijuana withdrawal
irritability, depression, restlessness, anorexia, cravings
marijuana adverse effects
amotivations syndrome, psychosis
PCP MOA
NMDA antagonist
PCP intoxication
RED DANES
REDDANES
rage, erythema, dialted pupils, delusions, amnesia, nystagmus, excitation, skin dryness
PCP withdrawal
lack of energy and depression
PCP adverse effects
memory loss, liver fn problems, depression, psychosis
hallucinogens MOA
serotonin agonist
hallucinogens effects
pupil dilation, wakefulness, hallucinations, visual disturbances
MDMA MOA
release monoamines
MDMA effects
euphoria, intimacy, diminished fear, improved self-confidence
MDMA withdrawal sx
depressed, paranoid, feeling cold, confused, nauseated, dizzy
What is perceptual distortions a symptom of?
delerium termens
mental illness
condition that affects pesons thinking, feeling or mood
mental disease
interruption, cessation or disorder of bodily functions, systems or organs with recognizable etiologic agent, identifiable set of signs/sx and or consistent anatomic alterations
mental disorder
clinically significant disturbance in individuals cognition, emotion, regulation or behavior
psychoanalytic theory
personality development and unconscious motivations
attachment theory
role of early caregive and child relations
Jealosy
belief that everynoe wants what they have
alogia
impoverished thinking and cognition assessed by patients speech
Anhedonia-asociality
difficulties in experiencing interest or pleasure and lack of involvement in social relationship
What is “depression is worth studiously memorizing extremely grueling criteria. sorry.”
Depressed mood loss of Interest Weight loss or gain inSomina psychoMotor agitation loss of Energy inappropriate Guilt decreased Concentration Suicidal ideations
Suicide risk factors
M>F Older men Depression Previous Attempt Ethanol Abuse Rational thinking loss Lack of social support organized plan no spouse sickness
