Intro to Psychiatry Flashcards
negative psychosocial outcomes of bipolar disorder
suicidality
substance abuse
employment and family problems
what are bipolar patients often incorrectly diagnosed with
unipolar depression
anxiety
schizophrenia
common physical care problems seen in people with serious psychiatric disorders
poverty unemplyment homelessness violence incarceration stigma lifestyle suicide physical health rising death rate
what happens to the life expectancy to people with schizophrenia
decreases
what contributes to the increased mortality in the mentally ill
vulnerability genes smoking obesity diet sedentary diabetes stress polysubstance abuse poverty isolation access to medical care antipsychotic meds
people with schizophrenia are at an increased risk of what
CHD
smoking
diabetes
hypertension
how does disease alter neurotransmission
loss of neuronal plasticity
excitotoxicity
absence/excess/imbalance of neurotransmitters
wrong neuronal wiring
neurotransmitter sites of drug action
NE serotonin dopamine Ach GABA
which NT do you want to increase in depression
NE , 5HT, DA
which NT do you want to block in psychosis /schizophrenis
DA, 5HT
what do you wanna increase in bipolar affective disorder and anxiety
GABA
why is dopamine considered non selective
influences function of other NT pathways
inhibited by other neurotransmitters
what are some challenges of psychopharmacotherapy
time for meds to start working effective regimen for patient management of adverse effects drug interactions adherance
what are some factors affecting adherence to treatment
insight into disease and need for medication personal belief about meds therapeutic effects management of adverse effects complicated regimens quality of therapeutic regimen
what to enhance adherence to treatment
enhance education communication collaboration reminder systems med reviews
why might communicating with these patients be difficult
emotionally not responsive may be slow to respond decreased concentration agitated not interested negativ outlook
3 things that contribute to treatment effectiveness
adherence
efficacy
tolerability
goals of treatment
non curative
acute: reduce and resolve symptoms
chronic: prevent recurrence
want to improve functioning
what happens if youre deprived of REM sleep
less serotonin and NE synthesis
increased appetite, sexual activity, aggression, anxiety, depression
increase cortisol and stress hormones
what is the result of poor nutrition
decreased NT synthesis, storage and release
result of not exercising
decreased NT release
result of high chronic stress
increase stres hormones and deplete NTs
where can you go for diagnosis of mental disorders
DSM 4
what is axis 1 in the multi axial assessment
all psychiatric diagnosis
what is axis 2
personality disorders and mental retardation
what is axis 3
general medication conditions
what is axis 4
environmental and psychosocial stressors
positive and negative
what is axis 5
global assessment of function - psychological, social, occupational scale of 1-100
what are the 8 components of the mental status exam *
1 appearance
- speech
- mood, affect (emotional response)
- thinking
- perceptions (hallucinations)
- sensorium - MMSE
- insight
- judgement
what are delusions
fixed false beliefs out of keeping with patients cultural background
what is the mini-mental state examination (MMSE)
assess cognitive performance in a clinical setting
30 point scale
orientation, attention, memory, language
what are the values for the severity of alzeihmers using the MMSE
mild = 21-26 moderate = 10-2- severe = <10
whats in the psychiatric report
history mental status exam diagnostic studies to be ordered positive and negative findings diagnosis prognosis recommendations
what do rating scales show
objective description of the condition
snapshot - how theyre doing at that time
whats the clinical global impression scale
observational
severity of illness and global improvement both on a 7 point scale
what are the 2 schizophrenia rating scales
brief psychiatric rating scale (18 items)
positive and negative syndrome scale (PANSS) 30 items
what are the depression rating scales
hamilton psychiatric rating scale for depression
beck depressive inventory
describe the beck depressive inventory
patient rated
measure change due to treatment
describe the hamilton psychiatric rating scale for depression
gold standard
clinician rated
