module 7 Flashcards
a neurotransmitter that helps regulate mood, arousal, and cognition.
secreted by the nuclei
-made by brainsterm: Raphe nuclei
serotonin
- regulates mood, arousal, attention, and cognition
-made by Brainstem: locus coeruleus
norepinephrine
-neurotransmitter that regulates mood, arousal, cognition, and motor control
-made by brainstem: substantia nigra
Dopamine
made by the Dopaminergic diffuse modulatory systems arise from the substantia nigra and the ventral tegmental area
helps regulate sleep, arousal, and attention
-made by basal forebrain: basal nucleus of Meynert
acetylcholine (ACh)
The medial septal nuclei and basal nucleus of Meynert project widely upon the cerebral cortex, including the hippocampus.
-Cholinergic diffuse modulatory systems arise from the basal forebrain and brainstem
Low levels of serotonin, norepinephrine, and dopamine have been associated with
Depressive symptoms
Low concentrations of serotonin with high levels of norepinephrine have been associated with
Anxiety symptoms
Too much dopamine with low concentrations of serotonin in certain areas of the brain lead to symptoms of
psychosis and mania
low concentration levels of acetylcholine.2
Dementia
Common risk factors in patients with anxiety and related disorders include
family history of anxiety, personal history of anxiety or mood disorder, childhood stressful life events or trauma, being female, chronic medical illness, and behavioral inhibition.
Obsessions which are repeated and unwanted thoughts that could lead to certain actions or habits (compulsions) could signify
- characterized by intrusive thoughts and ritualistic behavior
obsessive–compulsive disorder.
may include thoughts of hurting someone else, sexual thoughts, excessive concern about contamination/germs/disease, and mental rituals (e.g., counting, praying, repeating).
obsessions
can manifest as repetitive acts of washing, cleaning, checking (e.g., doors, locks, appliances), arranging, and repeating (e.g., counting, touching, praying) as well as hoarding, collecting, and saving.
compulsions
Excessive worry persisting over a 4-week period suggests a possible
generalized anxiety disorder
Hyperthyroidism, cardiopulmonary disorders, and traumatic brain injury (TBI) are common comorbid conditions that accompany
excessive or uncontrollable anxiety
often presents with recurrent sudden episodes/spells/attacks of intense fear or discomfort that are unexpected or with intervening periods of living in fear or worrying of having another attack or facing the consequences of the attack.
panic disorder
anticipatory anxiety in social situations.
social anxiety disorder
Characterized by reexperiencing, avoidance, persistent negative alterations in cognition and mood, and alterations in arousal and reactivity.
ptsd
personal history of a depressive episode, a family history of first-degree family members with depression, personal history of recent stressful life events or significant childhood adversity, chronic and/or disabling medical illness, and female gender.3
most common risk factor for depression
characterized by at least 2 weeks of depressed/irritable mood, with at least four of the following: anhedonia, insomnia or hypersomnia, decreased self-esteem, low energy, poor concentration or indecision, changes in appetite, feeling slowed or restless, and thoughts of death or suicid
Major depressive disorder (MDD)
little interest or pleasure in doing things
(anhedonia
characterized by depressive/irritable mood lasting for at least 2 years with at least two of the aforementioned depressive symptoms
Persistent depressive disorder (PDD)
present with both depressive episodes, such as in major depressive disorder (MDD), as well as manic or hypomanic episodes. Symptoms of manic episodes include euphoric/irritable mood, grandiosity, decreased need for sleep, talkativeness, racing thoughts, distractibility, increased goal-directed behavior or agitation, and an increase in reckless pleasure-seeking (having unprotected sex, spending excess money, foolish investments
bipolar disorder
can be mimicked by medical conditions and substance use. Screening for heart disease, stroke, diabetes, thyroid problems, and alcohol/drug use is crucial to clarifying the diagnosis
-Parkinson disease, traumatic brain injury (TBI), recent myocardial infarction (MI) or stroke, and hypothyroidism may mimic depressive symptoms. Additionally, alcohol use and recent substance use may present in a similar way to depressive symptoms
depressive symptoms
particularly recurrent/chronic depression, is frequently comorbid with anxiety, personality disorders, and substance use.
depression
are concerning for major vascular neurocognitive disorders, wherein vascular occlusion damages structusres important for memory
Sudden-onset memory problem
Rapid-onset memory problems after a head injury should raise suspicion for
a major neurocognitive disorder due to TBI.
If the patient affirms one-sided hand tremor or difficulty starting movements, consider
Parkinson disease
In a younger adult patient with unusual limb movements, you should assess the family history for .
Huntington disease
If family members or caregivers have noticed personality changes in the patient
consider frontotemporal dementia
A patient starting to have visual hallucinations may be suffering from .
Lewy body dementia
The mental status examination consists of six components:
appearance and behavior; speech and language; mood; thoughts and perceptions; insight and judgment; and cognitive function
The obtunded patient opens the eyes when tactile stimulus is applied and looks at you but responds to you slowly and is somewhat confused
Obtundation
The stuporous patient arouses only after painful stimuli. Verbal responses are slow or even absent. The patient lapses into an unresponsive state when the stimulus ceases.
Stupor
Watch for the anger, hostility, suspiciousness, or evasiveness of patients with paranoia; the elation and euphoria of mania;
-the flat affect and remoteness of schizophrenia; the apathy (dulled affect with detachment and indifference) of dementia; and anxiety or depression.
Hallucinations occur in schizophrenia, alcohol withdrawal, and systemic toxicity.
sx
, in which phrases or sentences are substituted for a word the person cannot think of, such as “what you write with” for “pen”
Circumlocutions
, in which words are malformed (“I write with a den”), incorrect (“I write with a bar”), or invented (“I write with a dar”).
Paraphasias
Wernicke aphasia, with impaired comprehension with fluent speech’
recessive
wernicke aphasia
with preserved comprehension with slow,nonfluent speech
expressive
Broca aphasia,
struggle with naming emotions
(alexithymia
Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought.” Blocking occurs in normal people.
-may be striking in schizophrenia.
blocking
the mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech.
-occurs in people with obsessions
Circumstantiality
Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!”
-occurs in schizophrenia and manic episodes
clanging
Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory
-is seen in Korsakoff syndrome from alcoholism
Confabulation
Tangential speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.
- is seen in schizophrenia, manic episodes, and other psychotic disorders.
Derailment (loosening of associations)
Repetition of the words and phrases of others
-occurs in manic episodes and schizophrenia.
echolalia
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected.
-is most frequently noted in manic episodes.
Flight of ideas
Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence.
-seen in severe psychotic disturbances (usually schizophrenia)
Incoherence
Invented or distorted words, or words with new and highly idiosyncratic meanings.
-are observed in schizophrenia, psychotic disorders, and aphasia.
Neologisms
Persistent repetition of words or ideas
-occurs in schizophrenia and other psychotic disorders.
Perseveration
False fixed personal beliefs that are not amenable to change in light of conflicting evidence; types of delusions include:
persecutory
grandiose
jealous
-erotomanic—the belief that another person is in love with the individua
-lsomatic—involves bodily functions or sensations
-unspecified—includes delusions of reference without a prominent persecutory or grandiose component, or the belief that external events, objects, or people have a particular and unusual personal significance (e.g., commands from the radio or television)
Delusion
Sense that one’s self or identity is different, changed, unreal; lost; or detached from one’s mind or body
Depersonalization
Sense that the environment is strange, unreal, or remote
Derealization
Persistent irrational fears accompanied by a compelling desire to avoid the provoking stimulus
phobias
are sensory awareness of objects in the environment and their interrelationships (external stimuli). They also refer to internal stimuli such as dreams or hallucinations
perceptions
Misinterpretations of real external stimuli, such as mistaking rustling leaves for the sound of voices.
-may occur in grief reactions, delirium, acute and posttraumatic stress disorders, and schizophrenia.
illusions
Perception-like experiences that seem real but, unlike illusions, lack actual external stimulation. The person may or may not recognize the experiences as false. Hallucinations may be auditory, visual, olfactory, gustatory, tactile, or somatic. False perceptions associated with dreaming, falling asleep, and awakening are not classified as hallucinations
-may occur in delirium, dementia (less commonly), posttraumatic stress disorder, schizophrenia, and substance use.
Hallucinations
