L54 Mental Illness Flashcards
what is the impairment of the cerebral function associated with thought, volition?
psychoses
schizophrenia
what is the impairment of the cerebral function associated with mood, affect?
Affective disorders (depression, mania, anxiety disorders)
what is the impairment of the cerebral function associated with language?
aphasia (dyslexia, alexia)
what is the impairment of the cerebral function associated with memory, learning?
mental retardation, dementia
what is the impairment of the cerebral function associated with social behavior?
personality disorders (will not cover – too complex)
_____ is one the 10 most frequent causes of disability worldwide!
schizophrenia (“the cancer of personality”)
what is the incidence rate for schizophrenia worldwide?
1% - very frequent disease
1/3 - get psychotic episode once and never again
1/3 - get psychotic episodes repeatedly, the are fine in between episodes
1/3 - develop chronic psychosis - their personality deteriorates
what percent of people with schizophrenia commit suicide?
10% - anxious, hearing voices etc. cause it
30% of ALL hospitalizations are because of what?
schizophrenia
what percent of homeless people in USA have schizophrenia?
30%
who developed the idea of neurosis?
Sigmund Freud
who developed the idea of psychosis?
Bleuler and Kraepelin
what does schizophrenia breakdown to?
split mind - Greek origin
concordance of schizophrenia in monozygotic twins is____ higher than concordance of schizophrenia in dizygotic twins
3x
how much more prevalent is schizophrenia when compared to Alzheimer’s, MS, diabetes, and muscular dystrophy?
AD - 2x
MS - 5x
DM - 6x
MD - 60x
is there a genetic predisposition to schizophrenia?
yes - the closer you are to a relative with schizophrenia, your risk of developing schizophrenia increases!
what are positive symptoms?
additional pathological symptoms (more than normal)
- delusions
- hallucinations
- disorganized thoughts etc.
what are negative symptoms?
loss of normal function
- social isolation
- lack of motivation
- poor attention
- flat affect etc
what are the stages of schizophrenia?
- prodromal signs of a psychotic episode
- psychotic episode
- non-psycotic period
describe the prodromal signs of a psychotic episode
- social isolation and withdrawal
- impairment in the normal fulfillment of expected roles
- odd behavior and ideas
- neglect of personal hygiene
- flat affect
*you would just think that the person is different
describe the psychotic episode
-mental state in which the pt thoughts do not represent reality correctly
Positive symptoms (1 or more must be present)
- delusions - feeling of being controlled by outside force
- hallucinations - usually auditory
- disordered thoughts, incoherence - loss of normal association between ideas, poverty of speech accompanies by loss of emotional expression
- unusual postures, mannerisms, rigidity
- there are a WIDE range of sx/sx… this isn’t all of them
- auditory hallucinations are used to distinguish between schizophrenia vs. organic psychosis (delirium etc.)
describe the non-psychotic period
Negative symptoms
- eccentric behavior
- social isolation
- flat affect
- reduced social drive
- poverty of speech
- poor attention span
- lack of motivation
what diseases MUST be excluded from differential dx in order to diagnose schizophrenia?
- encephalitis/Meningitis
- intoxicatoin (amphetamines, PCP, diphenhydramine = Benedryl)
- brain tumor
- manic - depressive illness
what is the prognosis of people who have schizophrenia?
generally poor
its with negative symptoms have the poorer prognosis
what makes up the pathogenesis of schizophrenia?
genetic aspect - polygenetic psychodynamic aspect (things can make people psychotic)
what are the anatomical abnormalities seen in patients with schizophrenia?
- reduced blood flow in Left globus pallidus (problem in the system connecting BG to frontal lobes)
- no blood flow increase in frontal lobe during test of working memory
- cortex of medial temporal love is thin + anterior hippocampus is smaller (memory defect)
- lateral and third ventricle are enlarged, wide sulci, reduced volume of temporal and frontal lobe
what system is impaired in schizophrenia?
cognitive - hippocampus, prefrontal cortex, globus pallidus
where are loss of functions such as planning and working memory (negative symptoms) structurally involved?
prefrontal association areas
what receptors do typical antipsychotic medications (like Haldol) block?
D2 receptors
*side effects: block D1 and D2 receptors in BG
schizophrenics have an increase in ___ int he frontal lobe and we don’t know why
DA
what is the link between Parkinson’s disease and schizophrenia?
if you give a pt with parkinson’s disease L-DOPA too much = psychosis
schizos can get drug-induced parkinson’s disease
DA is the link!
what are the short term effects of antipsychotic meds?
hand- tremor
rigidity of muscles
what are the long term effects of antipsychotic meds?
tardive dyskinesia (involuntary movements …of the mouth and tongue especially)
All anti-psychotic meds have significant ____ with a high interpersonal variation, and they are unfortunately only treating the symptoms of schizophrenia and not the cause of the disease
side effects
what drugs can avoid motor side effects?
D3/D4 receptor antagonist
describe the atypical antipsychotic drugs
high affinity to D3 and D4 receptors
almost NO side effects in the extrapyramidal system
but they gain lots of weight, so no one wants to take it.
what are the general symptoms of schizophrenia?
- Impairment of cognition, emotion, thought, affect, perception, language and sense of self
- Symptoms are acoustic, sometimes visual, olfactory, tactile or gustatory hallucination
what are the 3 types of symptoms of schizophrenia?
- positive
- negative
- disorganized
describe each type of symptom of schizophrenia
DISORGANIZED SPEECH
-Frequent derailment or incoherence; word salad
GROSSLY DISORGANIZED or CAATONIC BEHAVIOR
-Characterized by stupor/inactivity, mania and either rigidity or extreme flexibility
COGNITIVE SYMPTOMS
- Disorganized/slow thinking, poor understanding, concentrating, expressing thoughts and memory
SOCIAL/OCCUPATIONAL DYSFUNCTION
-Work, interpersonal relations and self care
what percent of the US population suffers from a depressive illness?
10%
how many people at a given time in the US are depressed?
8 million people
what percent of people have more than one episode of depression during their life?
70%
what is the average age of onset for depression?
28 years old
*Women are 2x more affected than men
Define an episode of depression
- Unpleasant mood (dysphoria)
- Mental anguish - can’t stop thinking about a sad theme
- Inability to experience pleasure (anhedonia)
- Loss of interest in the world
- Disturbed sleep (insomnia / sometimes hypersomnia) - typically, early morning awakenings
- Diminished appetite and loss of weight (sometimes overeating)
- Loss of energy
- Decreasedsexdrive
- Restlessness (psychomotor agitation)
- Slowing down of thoughts and actions (psychomotor retardation)
- Difficultyinconcentration
- Inability to decide
- Feeling of worthlessness, guilt
- Pessimisticthoughts
- Thoughts about dying and suicide
- Constipation, decreased salivation, variation of the symptoms during the day, usually worse in the morning
40-60 % of depression is classified as what?
melancholic depression
describe melancholic depression
- Depression (worse in the morning)
- Insomnia (early morning wakening)
- Anorexia with significant weight loss
- Psychomotor agitation and mental pain
- Lack of interest in almost all activity and lack of response to pleasurable stimuli
- When severe, complete loss of capacity for joy (anhedonia)
- Patients have abnormalities in sleep pattern
- Sometimes psychomotor retardation, emotional and intellectual under-activity
- Sometimes state of agitation and persistent preoccupation with perceived deficiencies and inadequacies of one’s character
What are the tx options for affective disorders?
- MAOI’s
- tricyclic antidepressants
- SSRI’s
- ECT
how long does it usually take for antidepressants therapeutic effect to occur?
3-4 weeks and sometimes up to 8 weeks
what tx option i used when antidepressants are not effective?
ECT - causes epileptic seizure
what are the prophylactic tx options for affective disorders?
- lithium
- carbamacepine
- lamotrigine
- valproate
- other anti epileptics?
*mood stabilizers!
what is dysthymia?
less ever compared to major depression
it includes not disabling long term chronic symptoms
pt is not functioning well and is not feeling good
what is the pathogenesis for depression?
polygenetic - there is a genetic factor
morbidity rate of depression is higher in 1st degree relatives of patients with depressive illness than in general population
what is the most efficient tx for depression?
a combination of mediation and psychotherapy
how many people in the US have bipolar disorder?
2 million
men and women equally affected
what has an earlier onset - unipolar (depression) or bipolar disorder?
bipolar
the depressive episodes in unipolar depression are______ similar to the ones seen in bipolar
similar
describe manic episodes
• elevated expansive, or irritable mood, lasting at least one week • over–activity • over – talkativeness (pressure of speech) • increased energy and libido • socialintrusiveness • grandiosity • distractibility • flightofideas • decreasedneedforsleep • recklessspending • sometimes with delusions and hallucinations
what is the pathogenesis for bipolar disorder?
polygenetic - there is a genetic factor
morbidity rate of depression is higher in 1st degree relatives of patients with depressive illness than in general population
what is a tx option for bipolar disorder?
antipsychotics
what are the anatomical abnormalities seen in patients with affect disorder using fMRI and PET technology?
- area in prefrontal cortex, below the genu in the corpus callosum
in the subgenal region (below the genu in the corpus callosum around the prefrontal cortex), reduced activity occurs during _____ and increased activity occurs during _____
depressive phase
manic phase
the subgenal region of the prefrontal cortex is important for ____
mood states
has connections with other regions of the brain involved in emotional behavior:
- amygdala
- lateral hypothalamus
- nucleus accumbens, noradrenergic, serotonergic and dopaminergic system
