Exam 4: Psych/SUD/Repro Flashcards
Stress-Diathesis Theory
Trauma because of a variety of reasons underlies a wide range of psychiatric disorders
Schizophrenia
Patho: affects thoughts feelings, perceptions and overall behavior while interfering with filtering of stimuli from the environment
Epi: onset between 16-30, increased in men but it does equalize later in life
Clinical manifestations: incomprehensible speech, hallucinations, delusions, grossly disorganized or catatonic behavior
Major Depressive Disorder
Patho: loss of interesting in previously enjoyed activities
Etiology: early life stressor, trauma, vitamin D issues
Epi: women are twice as likely, numbers are increasing in all age groups
Bipolar disorder
Patho: a mood disorder with depressive components plus mania
Etiology: the book outlines 4 types of bipolar disorder. occur from genetic, neuroendocrine, autonomic and immune dysregulation.
Substance Use Disorder (SUD)
epidemiology: men more likely than women, but closing gap
etiology:
D2 dopamine receptor (DRD2) gene located at 11q23 is associated with addictive behaviors
Mu-opioid receptor, Delta-opioid receptor, brain-derived neurotrophic factor, Pre-existing psychological disease like anxiety, PTSD, depression, Exposure to substance use, Childhood abuse or trauma
Mesolimbic dopamine pathway
Goes to the Nucleus accumbens and is associated with the reward system
Normal reinforcement of adaptive behaviors get a natural high/release of dopamine
Drugs lead to abnormal message being sent through the network
Hypofunctioning reward system
Makes it harder to get a high
Drug tolerance
occurs when a subject’s reaction to a specific drug and concentration of the drug is progressively reduced, requiring an increase in concentration to achieve the desired physiological and psychological effects.
Withdrawal symptoms
, specific noxious physiological effects, occur if the individual does not maintain regular use of the drug.
Alcohol (ETOH)
mainly a CNS depressant
↓GABA receptors
↑NMDA receptors
Clinical manifestations
In low doses, alcohol disinhibits the individual, which may lead to out-of-character activities.
At higher doses, individuals show irrational thinking, lack of judgment, and absence of motor coordination.
AWS
alcohol withdrawal symptoms
Sympathetic stimulation initially
Hallucinations
Withdrawal seizures - gen. tonic/clonic, short
Delirium tremens - change in LOC
Opioids
heroine, oxycodone, morphine, codeine
Opioid clinical manifestations:
Respiratory depression, analgesia, euphoria, and miosis
Slurred speech or sedated
Opioid use and specific risk factors chronic use
Risk for infection related to inadequate sterile technique and contaminated drugs
Opioid withdrawal
Dysphoria and restlessness
Rhinorrhea and lacrimation, mydriasis, diaphoresis
Myalgias and arthralgias
Nausea, vomiting, abdominal cramping, and diarrhea
Abnormal uterine bleeding
“PALM-COEIN”
polyp, adenomyosis, leiomyoma, malignancy & hyperplasia, coagulopathy, ovulatory dusfunction, endometrial, iatrogenic, not otherwise classified
Polycystic ovary syndrome
vaginitis,
Inflammation or infection of vagina
Most common cause is bacterial vaginosis in childbearing years
Atrophic most common for post menopausal: lack of regenerative growth of vaginal epithelium
Clinical manifestations Burning, itching, redness, swelling vaginal tissues
cervicitis
Acute or chronic inflammation of the cervix
Reddened and edematous
Direct infection
C trachomatis: mucopurulent cervicitis
Secondary
Vaginal or uterine infection
Asymptomatic or mucopurulent drainage
Untreated can extend to pelvic cellulitis, cervical stenosis, infection into uterus or fallopian tubes
Disorders of Pelvic Support
- cele = prolapse
Pelvic inflammatory disease (PID)
An acute inflammatory process caused by infection of upper reproductive tract (uterus, fallopian tubes, ovaries)
Pathophysiology
Infection (STI or UTI)→enters uterus and surrounding structures→ inflammatory response → necrosis→ repeated infections
Asymptomatic
Lower abdominal pain
Fever
Symptoms occur during or end of menstruation
Increased pain with exercise
Cervical motion tenderness
Polycystic ovarian syndrome
Epidemiology
Affects 6-15% of women
50% are obese
Hyperinsulinemia and insulin resistant play a part
Leading cause of infertility in US, affecting young women
Diagnosis: need at least 2 out of 3
Few or anovulatory menstrual cycles
Elevated levels of androgens (hyperandrogenism)
Polycystic ovaries via ultrasound
Complications
Cardiovascular disease, Diabetes, Sleep apnea, Fatty liver, Association between breast, & endometrial CA
*maybe ovarian CA it is controversial
Infertility
Endometriosis
Functional endometrial tissue is found in ectopic sites outside of the uterus
In reproductive years ovarian hormones stimulate endometrial to proliferate and breakdown→ bleed into surrounding structures → no exit for blood surrounding tissue irritated and develops fibrous tissues
clinical manifestations: Dysmenorrhea, Dyspareunia,
Infertility, Pain* 80% will present with pain, Strongest premenstrual, subsiding after cessation of menstruation, Pain with defection (bowel movement) or urination, Asymptomatic
Cervical cancer
Etiology: Human papillomavirus (HPV) is central to the development of cervical neoplasia and can be detected in 99.7% of cervical CAs
3rd most common cancer for people with uteruses
Patho: Oncogenic HPV infection of epithelium -> Persistence of the HPV infection -> Progression from persistent viral infection to pre-cancer -> Development of carcinoma and invasion through the basement membrane
Menopause
HRT
Varicoele
dilation of testicular veins, feeling of fullness,
scrotal abnormalities among infertile men
hydrocele
scrotal swelling due to excess fluid
Phimosis
Foreskin cannot be retracted over glands of the penis
Caused by chronic inflammation and infection from poor hygiene
Remove infection then circumcise
Predisposing factor for penile cancer
Paraphimosis
Foreskin has been retracted and cannot be moved forward over glans
Retracted can constrict penis and cause edema of glans
Reduce foreskin or surgery depending on severity
Priapism
Prolonged penile erection >4 hours
Painful not associated with sexual arousal
Considered urologic emergency
Aspirate blood from the corpus through glands
Peyronie disease
Fibrotic condition curvature of penis during erection
Middle aged men
Painful erection
Painful intercourse (for both partners)
Erectile dysfunction
Etiology: two types
psychogenic due to performance anxiety or psychological disorders
Organic: hormonal, vascular, drug, disorders, age
Epi: affects 30 million males age 40-70
Testicular cancer
young men, 15-35
Clinical Manifestations
Painless testicular enlargement
Ache in the abdomen or dragging or heaviness in the scrotum
Frank pain
Increase in growth of tumor
Metastatic
Swelling lower extremities, back pain, neck mass, dizziness, gynecomastia
Gonorrhea
N. Gonorrhoea
can become chronic and reinfections are common and the bacteria can adapt quickly and develop resistance to antibiotics which could ultimately lead to an untreatable infection.
men - Asymptomatic, Urethra pain, Creamy yellow bloody discharge, Rectal infections in homosexual men
women - Asymptomatic, Genital or urinary discharge
Dysuria, pelvic pain/tender, Symptoms may occur or increase during menses
Syphilis
Treponema pallidum
Primary manifestations
Chancre at site of exposure (penis, anus, mouth, vagina, cervix), Within 3 weeks exposure, Discrete raised borders, Chancre heals 3-6 weeks
Secondary
weeks- a few months, Rash palms, mucous membranes, stomach, lymph nodes, Fever/sore throat
Enters a latent phrase after secondary phase
Tertiary
Decades after infection, Cardiovascular lesions, Aorta aneurysm, aortic valve insufficiency, Development of central nervous system lesions, Blindness, dementia, mimic SCI, ataxia, sensory loss
Chlamydia
Etiology: most common bacterial STI intercourse, oral/anal sex, during birth
Clinical manifestations: asymptomatic, may or may not get discharge
Prognosis: leading cause infertility men and women, PID, ectopic pregnancy, pass disease to newborn
Herpes
Etiology: virus that spread through sexual activity
Epi: women have a great mucosal surface area exposed so therefore have a greater risk of acquiring the infection
Patho: virus spread through peripheral nerves and can become dormant or reactivated. It is unknown what reactivates the virus.
Clinical manifestations: local tenderness, burning and erythema, with eruptions of vesicles that develop into painful sores, crusting of lesions after several days. Can be asymptomatic
Prognosis: no cure antiviral medications treat infection to reduce symptoms and outbreak. It can be transmitted to baby during birth in which case we worry about the baby getting encephalitis or meningitis.
