Intro to Psychiatry Flashcards
What is the incidence of depression? What is the incidence of suicide in depression?
- 5% incidence of depression
- 15% of the severely depressed commit suicide
What is the incidence of bipolar disorder?
1%
What is the incidence of schizophrenia? What % commit suicide?
- incidence is 1%
- 10% commit suicide
What is the incidence of general anxiety disorder?
- incidence is 5.1%
What is the primary goal in treating any major psychiatric disorder?
- working to minimize symptoms and prevent them from coming back
What is the statistical impact of psychiatric disorder?
one quarter of disability life years is attributable to mental health issues
What is the impact of bipolar disorder?
- its progressive and causes impairment of neuroplasticity and/or cellular resilience with systemic consequences
- higher incidence of substance abuse, suicidality, employment and family problems
If someone with bipolar disorder is left untreated, they have a ___ higher change of dying than the normal population?
2.5 (why there needs to be higher rates of diagnosing these patients)
35% of patients with bipolar disorder are symptomatic for more than _____ before the correct diagnosis
10 years
What are some of the other physical care issues that can be common in those that have psychiatric disorders?
- poverty
- unemployment
- homelessness
- violence
- incarceration
- stigma
- lifestyle
- suicide
- cardiovascular, metabolic, respiratory, endocrine, digestive health
- rising death rate
Contributors to morbidity and mortality of physical conditions in the mentally ill
- vulnerability genes
- smoking
- obesity
- diet
- sedentary
- diabetes
- stress
- polysubstance abuse
- poverty
- poor living conditions
- isolation
- access to medical care
- quality of medical care
- antipsychotic medications
What are the different ways that disease alters neurotransmission?
- modification of neurobiology
- loss of neuronal plasticity
- excitotoxicity
- absence of neurotransmission
- excess of neurotransmission
- imbalance in neurotransmitters
- wrong rate of neurotransmission
- wrong neuronal wiring
What is the mechanism of action for treating depression?
- increase neurotransmission: NE, 5HT, DA
What is the mechanism of action for treating psychosis?
- blocks neurotransmission: 5HT, DA
What is the mechanism of action of medications to treat bipolar disorder?
- increases GABA and its effects
- membrane stabilizers
What is the MOA of anxiety medications?
to enhance the effect of GABA
What NT becomes overly activated in the nigrostriatal pathway?
acetylcholine becomes blocked
Dopamine pathways can also be inhibited by other NTs such as what?
GABA and 5HT
What kind of medications lead to an increase in SE?
non-selective medications
What are the challenges associated with treating mental health issues?
- time to response
- effective regimen
- management of adverse effects
- drug interactions
- adherence
How long do antidepressants take to have full effect?
- take about 6-12 weeks to get to the full dose- need to also wait after the full dose is met for another 6-12 weeks after
What age group are more sensitive to the way the NTs are affected in the brain, causing you to need to start more slow at a low dose
elderly
What are some of the factors affecting adherence to treatment?
- insight into the disease and need for medication
- personal belief system about making meds
- therapeutic effects - acute vs chronic
- management of adverse effects
- complicated regimens
- quality of therapeutic relationship
What are some things that can be done to enhance adherence to treatment?
- enhance education
- enhane communication
- collaboration between clinicians and clients
- reminder systems
- medication reviews
- pharmacist assessment for potential drug related problems
What are some of the key things to watch for when communicating with patients that are suffering from mental health issues?
- emotionally not very responsive
- may be slow to speak, respond
- decreased concentration
- may be agitated
- may not seem interested
- negative outlook. feeling of guilt
- note any suicidal thought, lack of support system
What are the 10 components of the medication adherence rating scale? (MARS)
- Do you ever forget to take your medicine
- Are you careless at times about taking your medicine?
- When you feel better, do you sometimes stop taking your medicine?
- Sometimes when you feel worse when you take the medicine, do you stop taking it?
- I take my medicine only when I am sick
- It is unnatural for my bind and body to be controlled by medication
- My thoughts are clearer on medication
- By staying on medication, I can prevent getting sick
- I feel weird, like a zombie on medication
- Medication makes me feel tired and sluggish
How long should be waited until the patient gets bumped up on medication?
- 4 weeks
What are the goals of treatment of treating psychiatric condition?
- non-curative
- symptom control only
- acute (reduces symptoms, resolution of symptoms)
- chronic (prevents recurrence of symptoms)
- endpoint (improves functioning of the individual)
What is important for mood, sleep, energy and appetite regulation?
- regular intake of protein and complex carbs (needed every 3-4 hours for adults)
What hormones are important for mood regulation?
- thyroid, estradiol, testosterone, etc
There is less ________ synthesis if a person has under 8 hours of sleep a day
5HT and NE
What are the required precursors for the synthesis of 5HT and NE?
- 1-tryptophan and phenylalanine/tyrosine
What happens to the body when there is less synthesis of NE and 5HT?
- increased appetite, sexual and motor activity
- increased aggression and fighting
- increased anxiety and depression
- increased cortisol and stress hormones
What is axis 1 in the DSM 4?
- all psychiatric diagnosis
What is axis 2 in the DSM 4?
- personality disorders (PD) and mental retardation
What is axis 3 in the DSM 4?
- general medical conditions
What is axis 4 in the DSM 4?
- environmental and psychosocial stressors
- positive and negative
- number, desirability and degree of control
What is axis 5 in the DSM 4?
- global assessment of functioning
- psychological, social and occupational
What ar the different components of a mental status exam?
- appearance
- speech
- mood, affect (subjective and objective)
- thinking (form, content)
- perceptions
- sensorium
- insight
- judgement
What is considered to be a delusion?
- fixed false belief out of keeping with the patients cultural background
- persecutory, jealousy, sin or guilt, grandiose, somatic, ideas and delusions of reference, thought broadcasting, thought insertion, thought withdrawal
What is a mini-mental state examination?
- assesses cognitive performance in a clinical setting
- assesses orientation, attention, memory and language
- 30 point scale
- severity of alzheimer’s disease
- – mild 21-26
- – moderate 10-20
- – severe <10
