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NEUROPSYCH Flashcards

1
Q

Categories of Psychiatric Disorders

A
  • Neurodevelopmental disorders
  • Neurocognitive disorders
  • Personality disorders
  • Psychosis
  • Depressive Disorders
  • Bipolar Disorders
  • Anxiety diorders
  • Trauma or stressor related diorders
  • Substance use disorders
  • Somatic symptom and related disorders

Obsessive compulsive Disorders

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2
Q

Neurodevelopmental disorders

A

Inborn conditions of the CNS

Includes:

  • ADHD
  • ASD
  • Intellectual Disability
  • Specific Learning Disorders
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3
Q

ADHD

A
  • Inattention
  • Hyperactivity and/or
  • impulsitivity
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4
Q

ASD

A

Social impairment and sterotypic behaviors

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5
Q

Intellectual Disability

A

impairments in adaptive functioning + documented subpar intellect, usually via IQ testing

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6
Q

Specific Learning Disorder

A

formerly called dyslexia

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7
Q

Neurocognitive Diorders

A

Conditions affecting the CNS that impacts a person’s cognitive capacity, which includes memory, language, attention, perception, and executive functons. formerly called dementia describes a long term cognitive decline

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8
Q

Delirium

A

Neurologic diagnosis of encephalopathy - a global disruption off brain function

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9
Q

Personality disorders

A

enduring pattern of inner experience and behavior that is inflexible, pervasive, causes distress or dysfunction, and is stable in late adolescence/early adulthood onwards.

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10
Q

Cluster A (odd and eccentric)

A

tendency towards psychosis; may represent prodrome or residual symptoms of schizophrenia

  • Paranoid
  • Schizoid
  • Schizotypal
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11
Q

Paranoid

A

suspicious and distrubing

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12
Q

Schizoid

A

detached and lacking in emotion

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13
Q

Schizotypal

A

distorted and magical thinking

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14
Q

Cluster B (“emotional and erratic’)

A

tendency towards Mood disorders

  • Histrionic
  • Narcissistic
  • Antisocial
  • Borderline
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15
Q

Histrionic

A

attention seeking and emotional

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16
Q

Narcissistic

A

self important, lacking in empathy, needing admiration

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17
Q

Antisocial

A

disregard for laws and rights of others; with evidence of conduct disorder before 15 years of age

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18
Q

Borderline

A

unstable sense of self; tends to be impulsve; associated with self-harm, turbulent relationships, and emotional outbursts

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19
Q

Cluster C (“fearful and ansious”)

A

tendency towards anxiety disorders

  • dependent
  • avoidant
  • obsessive
  • compulsive
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20
Q

Dependent

A

clingy and submissive

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21
Q

Avoidant

A

socially inhibited with feelings of inadequacy

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22
Q

Obsessive compulsive

A

perfectionist and rigid

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23
Q

Anxiety Disorders

A

Can include 2 phenomenoms:

  • fear, which is mediated by the amygdala and is connected to the sympathetic nervous system
  • worrying, which is a cognitive processess mediated by the cortico-striatal pathway
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24
Q

Panic Disorders

A

presence of 1 panic attack + 1 month of more of persistent worrying or maladaptive change in behavior in response to the attack

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25
Q

Panic Attack

A

A panic attack is a spontaneous episode of anxiety characterized by a combination of psychological and physiologic symptoms

Psychological:

  • derealizaion,
  • fear of losing control

Physiologic:

  • palpitations
  • tachycardia
  • trembling
  • shortness of breath
  • choking
  • chest pain,
  • nausea
  • abdominal distress
  • dizziness
  • chills/heat sensation
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26
Q

Generalized Anxiety Disorder

A

Excessive anxiety and worry occuring for most days than not in a span of at least 6 months restlessness, being easily fatigue, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbances

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27
Q

Agoraphobia

A

Modifier for a panic disorder but is now a stand alone diagnosis marked fear or anxiety in situations where escape is deemed diffcicult

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28
Q

Social anxiety disorder

A

Consistent fear or anxiety about social situations in which the individual is subject to the possibility of scrutiny by others

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29
Q

Acute stress disorder and PTSD

A

exposure to actual or threatened death, serious injury, or sexual violence.

  1. Intrusion symptoms: memories, dreams
  2. negative mood/ cognitive changes - inability to experience positive emotions
  3. Dissociative symptoms - depersonalization, derealiation
  4. avoidance symptoms -
  5. Arousal symptoms - sleep disturbancem irritability, angry outbursts, hypervigilance, problem with concentration, exaggerated startle response

Acute: 3 days to 1 month

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30
Q

Post traumatic:

A

more than 1 month, involves more long term negative alterations to cognitive schemes and mood and may be delayed in manifestation

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31
Q

Adjustment disorder

A

refers to the development of out-of-proportion emotional or behavioral symptoms in response to an identifiable stressor (not necessarily life threatening) within 3 months of its onset.

Modifiers:

  1. with depressed mood
  2. with anxiety
  3. with mixed anxiety and depressed mood
  4. With disturbance of conduct
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32
Q

Conversion disorder or functional neurological symptom disorder

A

development of neurologic deficits incompatible with recognized neuromedical conditions

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33
Q

Illness Anxiety disorder

A

formerly called hypochondriasis, this involves preoccupation with having serious illness despite having minimal symptoms

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34
Q

OCD

A

Obsessions are recurrent, intrusive, specific, and distressing thoughts bringing about anxiety to a patient

Compulsions are repetitive actions, whether mental or actual, which the patient cannot stop doing and is usually a way for him or her to control the anxiety brought about by obsessions. It is usually not a logical response to the content of the obsession.

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35
Q

Absolute psychiatric indications for admission

A
  • Harm to self
  • Harm to others
  • Non-compliance to medications
  • Social Emergencies
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36
Q

Psychosis

A
  • Hallucinations
  • Delusions
  • Disorganized Behavior
  • Disorganized speech
  • Negative sx: Flattening of affect, avolition, alogia, extreme social withdrawal

**2 out of 5 symptoms must be fulfilled for a psychotic disorder

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37
Q

Pathophysiology of psychosis

A

Result of dopamine dysregulation in the brain.

Dopamine is influenced by serotonin and glutamate

Positive Symptoms: Increased Dopamine in the MESOLIMBIC TRACT

Negative symptoms: DECREASED DOPAMINE in the MESOCORTICAL TRACT

Dopamine is also found in the nigrostriatal tract - blockafe causes EPS

Dopamine also inhibits prolactin release in the TUBEROINFUNDIBULAR TRACT - blockade causes hyperprolactinemia which leads to amenorrhea-galactorrhea syndrome and gynecomastia

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38
Q

Brief psychotic episodes

A

1 day to 1 month

Usually bot not always, an isolated episode associated with a stressor. Not usually associated with negative symptoms

Tx: short course antipsychotics

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39
Q

Schizophreniform

A

1 month to 6 months

around 2/3 progress into schizophrenia

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40
Q

Schizophrenia

A

greater than 6 months with 1 month of active symptoms

More likely to see negative symptoms.

More likely to have gradual cognitive and functional decline related to chronic neurodegenerative process

Tx; Log-term maintenance with anti-psychotics

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41
Q

Schizoaffective disorder

A

2 or more weeks of psychotic symptoms alone with the eventual development of a major mood episode (fulfills criteria for MDD/bipolar) still in the temporal context of the psychosis

classified as depressed type or bipolar type

usually treated with a combination of antipsychotics and antidepressant/mood-stabilzier

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42
Q

Delusional disorder

A

psychosis which is only has delusions as its primary symptom.

It more commonly involves non-bizarre delusions

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43
Q

Substance or medication induced psychosis

A

MAP and other stimulant withdrawal

cannabis

steroid

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44
Q

Psychosis secondary to another medical condition

A

can arise from epilepsy, sle.

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45
Q

Treatment for psychosis

A

use of antipsychotic medication

Psychotherapy

Psychosocial intervention

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46
Q

Anti-psychotics

A

Dopmanine receptor antagonists

Serotonin and dopamine antagonists (atypical)

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47
Q

Dopamine receptor anataonists or typical anti psychotics

A
  • haloperidol
  • chlorpromazine
  • fluphenaine
  • flupenthixol decanoate or depot drugs

injected monthly

Side effects: EPS, Akathisia, tardive dyskinesia, Neuroleptic malignant syndrome (NMS)

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48
Q

Akithisia

A

subjective feeling of restlessness

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49
Q

tardive dyskinesisa

A

a hyperkinetic disorder due to upregulation of D2 receptors resulting from chronic DRA use

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50
Q

Neuroleptic malignant syndrome

A

(“FEVER”)

  • Fever
  • Encephalopathy
  • Vitals Unstable
  • Elevated muscle enymes
  • Rigidity
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51
Q

Serotonin and dopamine antagonists (SDA) or atypical antipsychotics

A
  • Risperidone
  • olanzapine
  • quetiapine
  • clozapine
  • amisulpride
  • aripiprazole
  • asenapine
  • paliperidone

MORE EFFECTIVE FOR NEGATIVE SYMPTOMS

side effects: Metabolic syndrome, sedation, with less EPS

Clozapine can lower seizure threshold and has idiosyncratic reaction of AGRANULOCYTOSIS.

Olanzapine, known for having the highest weight gain

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52
Q

Depression

A

at least 5 of nine symptoms for a span of atleast 2 weeks

TWO CORE SYMPTOMS.

    1. Depressed mood
    1. Anhedonia or inability to find pleasure in anything

THREE PSYCHOLOGICAL SYMPTOMS

    1. Recurrent thoughts of death or suicidality
    1. feelings of worthlessness or inappropriate guilt
    1. Difficulty on concentration

FOUR SOMATIC or BODY RELATED SYMPTOMS

    1. Disturbances in appetite or weight
    1. Disturbance in sleep
    1. Psychomotor retardation or agitation
    1. Fatigue
53
Q

Pathophysiology of Depression

A

Hypofunctioning of the serotonegc, dopaminergic, and norepinehrinergic circuits of the brain Not necessarily just a lack of those NT

Psychological and social factors play a big role in depression and may be the ones responsible for the biological changes in the brain especially in those genetically vulnerable through epigentic and neurohormonal factors

Subtypes of major depression:

  • with atypical features
  • with melancholic features
  • with anxious distress
  • with psychotic features
  • with catatonia
  • with postpartum onset
  • with seasonal pattern
54
Q

Teatment of Depression

A

Mild: Psychotherapy

Moderate or Severe: combined pharmacology and psychotherapy

Severe: Electroconvlsive therapy

55
Q

Antidepressants

A
  • SSRI
  • TCA
  • MAO
56
Q

SSRI

A
  • Escitalopram
  • setraline
  • fluoxetine
  • paroxetine

*Duloxetine: SNRI

Side effects: GI disturbances, headcahe, restlessness

57
Q

TCA

A
  • Imipramine
  • clomipramine
  • amytryptylline

Side effects: Prolongation of the QT interval in the ECG, leading to arrhythmias

58
Q

MAO

A

Isocarboxazid

Side effects: Combining this with tyramine-containing food such as cheese will cause hypertensive crisis.

59
Q

Bipolar 1 Disorder

A

diagnosed if the patient has a single manic episode.

A depressive episode preceding or following the manic episode is common. but is NOT necessary for diagnos

60
Q

Manic episode

A

when a person has abnormally and persistently elevated expansive or irritable mood for a period of atleast 1 week + 3 symptoms.

61
Q

symptoms of Mania: Mood elevation or irritability +

A
    1. inflated self-esteem or grandiosity
    1. decreased need for sleep
    1. Pressured speech
    1. Flight of ideas or racing thoughts
    1. Distractability
    1. Increased goal-directed activity or psychomotor agitation
    1. Excessive involvement in activities with high potential for adverse consequences
62
Q

Bipolar 2 disorder

A

diagnosed if the patient has at least one hypomanic episode + at least one Major depressive episode

63
Q

hypomanic episode

A

same symptoms of mania but is not severe enough to warrant hospitalization or severe functional impairment, minimum of 4 days duration

64
Q

Pathophysiology of Bipolar

A

dysregulation of the monoamine neurotransmitters which include dopamine, serotonin, and norepinephrine overlap with elevated dopamine psychosis - some psychotic episodes

does not involve cognitive and functional decline.

There is return to baseline functioning during the interim, at least in the microbiological aspect

65
Q

treatment for bipolar disorder

A

Mood stabilizers are the first line treatments for bipolar disorder. However, this is commonly augmented with atypical antipsychotics

For pregnant: ATYPICAL antipsychotics

Antidepressants are used with caution. (push into manic episode)

Psychotherapy

66
Q

Mood Stabilziers

A
  • Lithium
  • Valproic Acid
67
Q

Lithium

A

Modulatory effects on intracellular secondary messengers of monoamine neurons

Cheap but effective but has a narrow therapeutic range (0.8 to 1.2 mEqs)

Toxicity: Gi disturbances, tremors, delirium, acne, weight gain, diabetes insipidus, hypothyroidism, kidney damge and teratogenesis

68
Q

Valproic Acid

A

Antiepileptic drug that prevents overfiring of monoamine neurons by stabilizing the membrane

Wider Tx range than lithium, but is also teratogenic: neural tube anomalies

69
Q

Delirium

A

neurobehavioral sequelae of a physiologic derangement that affects global brain functions, should always be ruled out of patients with psychiatric symptoms

corresponds to the neurologic diagnosis of encephalopathy

70
Q

Features of Delirium

A

Disturbance in sensorium and cognition.

  • May be hyperactive or hypoactive type
  • Changes in sensorium (drowsiness reversed sleep-wake pattern) are seen in severe cases
  • Impairment in attention and presence of disorientation
  • May involve psychotic symptoms
  • May result to agitation

Tends to develop over short period of time (acute) and tends to fluctuate throgh the day.

71
Q

Common precipitants of Delirium

A
  • Uremia
  • hepatic encephalopathy
  • Hypoxia, including severe anemia
  • Metabolic derangements (electrolytes, glucose, etc.) Sepsis
  • Substance toxicity/withdrawal, including anesthetics
72
Q

Treatment for delirium

A

Treat underlying etiology

Psychotropics are given to control the delirium

Atypicals: low doses Benzodiazepines for anxiolysis and sedation

73
Q

Substance Related Disorders

A

assess three dimensions.

  • Acute Effects
  • Pattern of substance Use
  • Underlying psychiatric disorder
74
Q

Wernicke Korsakoff syndrome

A
  • ophthalmoplegia
  • confusion
  • ataxia

caused by thiamine deficiency from chronic alcoholism

75
Q

Characterize Substance Use disorder

A
  • Tolerance
  • Withdrawal
  • craving
  • Failed attempts to cut down
  • taken in larger amounts or longer
  • Great deal of time is spent to obtain the substance
  • Failure to fulfill major role obligations at work,school
  • Important occupations are given up because of substance use
  • Recurrent use in situations where it is physically hazardous
  • Use of continued despite knowledge of having persistent or recurrent physical or psychological problem
  • Continued use despite social problems
76
Q

Mild Use disorder

A

2-3 symptoms

77
Q

Moderate use disorder

A

4-5 symptoms

78
Q

Severe use disorder

A

6 or more

79
Q

Early remission of use disorder

A

3-12 months off the substance

80
Q

Sustained remission of use disorder

A

greater than 1 year

81
Q

Chlorpromazine

A

Antipsychotics (typical)

200mg, 1 tab HS to BID

82
Q

Fluphenazinedecanoate

A

Antipsychotics (depot drug)

25mg/ml, 1mL IM every month

83
Q

Flupentixol

A

Antipsychotics (depot drug)

20mg/ml, 1ml IM every month

84
Q

Biperiden

A

Antipsychotics for EPS/akathisia

2 mg tab, 1 tab OD PRN

85
Q

Risperidone

A

Antipsychotics (ATYPICAL)

2mg tab, 1 tab HS to BID

86
Q

Olanzepine

A

Antipsychotics (ATYPICAL)

10mg tab, 1 tab HS to BID

87
Q

Clozapine

A

Antipsychotics (ATYPICAL)

100mg tab, 1-3 tabs HS or divided through the day (slow uptitrated, for treatment resistant psychosis)

serial CBCs must be done

88
Q

Escitalopram

A

Antidepressants

10 mg tab, 1 tab OD

89
Q

Setraline

A

Antidepressants

50 mg tab, 1 tab OD

90
Q

Fluoxetine

A

Antidepressants

20 mg tab, 1 tab OD`

91
Q

Sodium Valproate + Valproic Acid

A

Bipolar 1

500mg tab, 1 tab BID to TID

92
Q

Lithium carbonate

A

Bipolar 1

450mg tab, 1 tab BID

93
Q

Haloperidol LActate

A

for agitation

5mg +/- diphenhydramine 50 mg cocktail IM PRN

**Diphen may cause delirium in geriatrics because of anticholinergic effects

94
Q

Haloperidol lactate

A

For delirium

5mg IV PRN

95
Q

Clonazepam

A

for insomnia

2mg tab, 1/4 to 1/2 tab PRN

*requires yellow prescription

96
Q

Diphenhydramine

A

For insomnia

50mg tab, 1/2 to 1 tab HS PRN

97
Q

Quetiapine

A

for insomnia

25 mg tab, 1 tab HS

98
Q

Neurotransmitter primarily involved in the reward pathway?

A

Dopamine

99
Q

Group of signs and symptoms occurring when a substance is reduced in amount after heavy and prolonged use

A

Withdrawal state

100
Q

Lifetime prevalence of alcohol dependence

A

14%

101
Q

At least 2 years of alternating depression and hypomanic episodes

A

Cyclothymia

102
Q

DSM -5 Criteria for Manic Episode

A
103
Q

DSM-5 criteria for hypomania

A
104
Q

DSM-5 criteria for Major depressive episode

A
105
Q

DSM-5 Bipolar I

A
106
Q

DSM 5- Panic Disorder

A
109
Q

DSM-5 Acute stress disorder

A
113
Q

Which class of medication is the preferred long term treatment for panic disorder?

A

Antidepressants

114
Q

Timeline for Acute Stress Disorder

A

3 days to 1 month

116
Q

If there is a decrease in the dopamine levels in the tuberoinfundibular area, what will maifers?

A

Breast enlargement among male patients

117
Q

DSM 5 -MDD

A
118
Q

Clonazepam relieves anxiety symptoms by…

A

acting on the GABA receptor complex

119
Q

What receptor does escitalopram acts on?

A

Serotonin

120
Q

What receptor does risperidone acts on?

A

Dopamine and serotonin

121
Q

What receptor does Donepezil acts on?

A

Acetylcholine

122
Q

What receptor does Desvenlafaxine acts on?

A

Serotonin and Norepinephrine

123
Q

What receptor does haloperidol acts on?

A

Dopamine

125
Q

Most depressive disorders begin by age:

A

18-25

126
Q

Which pathway is affected with the patient with schizophrenia manifests with impaired cognitive functions?

A

Mesocortical pathway

127
Q

Decreased dopamine activity in this tract produces negative symptoms of schizophrenia

A

mesocortical

128
Q

The EPS side effects of medications for schizophrenia is caused by blocking the receptors in the…

A

nigrostriatal pathway

129
Q

Which receptors/do most of the atypical antipsychotics block?

A

5HT2A and D2

130
Q

Drug of choice for agitated psychotic patients

A

Haloperidol + Diphenhydramine

131
Q

Strongest predictor of violence

A

Past history of violence or criminal behavior

132
Q

Strongest risk factor for suicide

A

Past suicide attempts

133
Q

According to WHO, DALY stands for?

A

Disability Adjusted Life years

134
Q

What is the most important neurotransmitter involved in the etiology of seizures?

A

GABA

135
Q

Most common cause of Dementia?

A

Alzheimer’s disease

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