Lecture 9 (Quiz 2)

Question 1

In psychopathology there is a Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5), this DSM 5 organizes psychiatric diagnosis into 5 dimensions or axes, what fall under each of the 5 and examples of each?

Answer 1

• Axis 1: All phycological disorders except for mental retardation and personality disorders. (Depression, anxiety, bipolar, ADHD, autism, anorexia/bulimia, schizophrenia and drug dependence.)
• Axis 2: Personality disorders and mental retardation. (Paranoid, schizoid, antisocial, narcissistic, dependent, obsessive-compulsive personality disorders and intellectual disabilities.)
• Axis 3: Conditions requiring acute medications and physical disorders. (brain injuries/physical disorders [alzheimers]).
• Axis 4: Psychosocial and environmental factors (Stress).
• Axis 5: Global Assessment of Functioning -OR- Children’s Global Assessment Scale for children/teens under 18.

Question 2

During a Mental Status Examination (MSE) what 6 things are measured and what are subtypes within these groups?

Answer 2

• Mood: Extremes
• Affect: Expression of appearance/mood.
• Thought: Thought process (organization), thought content (relevant), perception (interpretation)
• Appearance: Hygiene/motivation
• Cognitive function: Assessment (orientation, concentration, memory, fund of knowledge, abstraction, judgement and insight).
• Dental Problems: **Due to Cost and Fear.

Question 3

Besides a Mental Status Examination (MSE), what other 2 (3 subtypes) types of tests can be used and what does each do?

Answer 3

• EEG: Electroencephalogram, useful for seizures by measuring surface activity.
• Brain Imaging:
  CT: Computer tomography, taken in sections and can give a 3D-like image. (not good for function analysis)
  MRI: Magnetic Resonance Imaging, uses magnets, depends on BOLD (Blood-Oxygen Levels) analyzes blood flow activity (increased blood flow where active).
  PET: Positron Emission Tomography, uses a radioactive particle that can be scanned (ligand), good for knowing what your looking for such as chemical levels in Parkinson’s disease.

Question 4

What is a symptom that relates to reality/ recognizing what reality is, or the way they process information is abnormal and Indicates a degree of severity? What is the most common psychotic disorder and is termed the “Cancer” of mental illness?

Answer 4

• Psychosis

- Schizophrenia (1% of US, costs 40 billion/year)

Question 5

What are the requirements four requirements for the DSM 5/Schizophrenia?

Answer 5

• Symptoms must persist for 6 months.
• Active psychosis.
• Organics and drugs aren’t involved.
• Deteriorating functionality.

Question 6

There are 4 sub-types of Personality Disorders (Disorganized, Catatonic, Paranoid, and Residual), what makes each unique?

Answer 6

• Disorganized Type: Blunted affect (lack of expression in their face), Incoherence, Bizarre motor actions (playing with hair), No delusions.
• Catatonic Type: Bizarre posture that is often ridged and non-responsive.
• Paranoid Type: Positive symptoms (very interactive and aggressive, violent), Paranoia/Desulsions, Respond well to anti-psychotic drugs.
• Residual Type: Negative symptoms (Isolated/ Lack of communication), Not responsive to many medications, Usually a later stage of Schizophrenia.

Question 7

There is a biology of schizophrenia, what are the physical findings (5)?

Answer 7

• Physical Findings: Enlarged ventricular pattern (ventricles of the brain are larger),
  Decrease in Corpus Calosum (connects the two hemispheres of the brain), Decrease in Frontal Lobe perfusion (decrease in blood flow), Altered startle reflex, Don’t yawn.

Question 8

What types of medications do you use to treat schizophrenia? What are the side effects of these psychiatric drugs called, and what are they?

Answer 8

• D-2 Antagonist (block D-2 receptors) and also 5HT2 Antagonist (block 5HT2 receptors).
• Extrapyramidal Side Effects: Tardive Dyskinesia, Parkinson’s-like tremors, sleepiness, restlessness, disrupt endocrine, can cause a pseudo depression and weight gain.

Question 9

There are three types of schizophrenia medication (Phenothiazines, Butyrophenones and Atypicals) what are examples of each and what are the benefits/side-effects of each?

Answer 9

• Phenothiazines: Chlorpromazine and Thioridazine. Positives: Least expensive, less extrapyramidal side effects, antiemetic (decreased nausea). Negatives: More sedation (drowsiness) and weight gain (anticholinergic effects).
• Butyrophenones: Haloperidol. Positives: Lacks anticholinergic side effects/action, inexpensive. Negatives: High extrapyramidal side effects.
• Atypical Drugs:
  Clozapine. Positive: Serotonin antagonist, Negatives: Can cause serious agranulocytosis, requires blood tests.
  Quetiapine and Olanzepine: Positives: newer drugs with less side effects. Negatives: Expensive$$$.

Question 10

Abraham Lincoln’s wife suffered from another form of schizophrenia called what?

Answer 10

• Schizoaffective (acute psychotic disorder)

Question 11

What type of disorders usually don’t involve drugs, last longer than two years, don’t have causative agents or triggers and are usually people that are of a younger age? What are the two types of disorders that fall into this category and what makes each unique?

Answer 11

• Minor Affective Disorders
• Depression-Dysthymia: Anhedonia (unable to feel pleasure), 6% of the population, Gender: Females:Males 2:1.
• Cyclothymia: Minor biopolar disorder, has no gender bias.

Question 12

Major depression and its subtypes of Postpartum depression (few weeks after 2/3 baby), and Seasonal Affective Disorder (SADs, thought to be 5HT related) belong to what type of disorders? What are the variable expressions of these types of individuals?

Answer 12

• Major Mood Disorders
• Profound retardation (extremely withdrawn), Psychotic episodes (psychosis), Tired/No energy, Lack of sleep, A little less than 50% will only have one episode, majority however are chronic. Episodes will last usually longer than 2 weeks. 2:1 ratio of females to males.

Question 13

With Major Mood Disorders (Major depression, Postpartum depression and Seasonal affective disorder), there are three drug types that can be used (Monoamine Oxidase Inhibitors [MAOI], Tricyclic Antidepressants and Monoamine Uptake Blockers [5HT, NE]), what specific drugs are in each of these categories and what are the positives and side-effects of each?

Answer 13

• Monoamine Oxidase Inhibitors (MAOI):
  
  • Drugs: Phenelzine and Selegiline.
  • Positives: Blocks metabolizing enzyme of monoamines.
  • Negatives: Altered autonomics, hypotension, weight gain, may interact negatively with foods that contain Tyramine (cheese and beer), may interact with OVC cold decongestants.
• Tricyclic Antidepressants:
  
  • Drugs: Amytriptyline, Desipramine, Doxepin.
  • Pos.: Long half life, only requires one dose per day. Blocks uptake of NE and 5HT.
  • Neg.: Dry mouth (anticholinergic effect), hypotension, withdraws with abrupt discontinuation.
• Monoamine Uptake Blockers: (5HT and NE)
  
  • 5HT Drugs: Fluoxetine (Prozac) and Sertraline.
  • Pos.: Wide margin of safety, usually well tolerated and no anticholinergic activity.
  • Neg.: Depression in adolescents (don’t give to teenagers/children), headaches, and sexual disfunction.
  • NE Drugs: Venlafaxine and Duloxetine.
  • Pos.: Well tolerated.
  • Neg.: CVS (Chorionic villus sampling) and CNS stimulant (insomnia/anxiety).

Question 14

What is a disorder where an individual will have high ups/activity (Manic) and also lows (depression)? What are the two main types of this disorder and what makes them different?

Answer 14

• Bipolar disorder
• Types:
  
  • Cyclothymia: Minor form of bipolar disorder, usually doesn’t require medication.
  • Major Manic Depressive: Large swings in emotions and usually requires treatment.

Question 15

There are three main types of drugs/treatment for individuals suffering from the Bipolar Disorder, what are they and what are the positives and side effects? **(These all act as mood stabilizers)

Answer 15

• Lithium Carbonate:
  
  • Pos.: Very potent, very effective, and very cheap.
  • Neg.: Slow onset, works through 2nd messengers (adenylyl cyclase), narrow therapeutic window, tremors, potential kidney damage, weigh gain, edema (excess fluid in cavities), compliance problems.
• Antiepileptic Agents (Anticonvulsants) *Usually used after Li. Carb. treatment:
  
  • Drugs: Valproic Acid, Carbamazepine, and Lamotrigene.
  • Pos.: Less side-effects than Li. Carb., has better compliance.
  • Neg.: Expensive, less potent than Li. Carb.
• Electro-Compulsive Shock Therapy: Useful on patients that aren’t responding to medication and is highly effective, however, if used more that 5 times (1 treatment/6 months), can cause damage to brain tissues.