Pre Midterm Behavior science Flashcards
1
Q
What is a mental disorder?
A
A disturbance in an individuals mood, associated with stress or impairment.
2
Q
What is Intermittent Explosive disorder?
A
IED is catorized by either; Recurrent behavior outbursts representing an inability to control ones emotions occurring twice weekly, on average, for a period of 3 months. -or-
2. Three behavioral outbursts involving damage or
destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.
3
Q
What is Provisional diagnosis used for?
A
When the Pt is expected to have the disease but duration criteria has not yet been made or the Pt information is not available. e.g. “Bulimia Nervosa. Provisional”
4
Q
What is the difference between unspecified and other specified?
A
“Unspecified”: Clinician chooses not to specify why a patient fails to meet criteria for a specific disorder.
“Other specified”: Clinician DOES choose to specify why a patient fails to meet criteria for a
specific disorder.
5
Q
All anxiety disorder share what in common?
A
The anxiety is excessive in duration and free from reasonable cues.
6
Q
What is the physiological cause of anxiety?
A
Stimulation of the Hypothalamic-pituitary-adrenal axis by the amygdala, causing the release of cortisol
7
Q
Panic Disorder
A
Recurrent and unexpected panic attacks. For at least one month the individual must show fear of future attacks or avoidance behavior.
8
Q
Agoraphobia
A
Because of fear that escape may be difficult, an
individual excessively fears at least 2 of the following situations: Agoraphobia situations:
•Using public transportation
•Being in open spaces
•Being in enclosed spaces
•Standing in line or being in a crowd
•Being outside of the home alone
9
Q
Generalized Anxiety Disorder
A
Uncontrolled anxiety about multiple events
occurring the majority of days for > 6 months.
Several (at least 3) of the following*
• restless, on edge • fatigued
•↓concentration
• irritability
• muscle tension
• insomnia
Usually pts are seen by physicians due to physical symptoms.
10
Q
OCD
A
Unwanted recurrent thoughts, images or actions that increase anxiety.
Recurrent actions that reduce anxiety.
May be the result of reduced serotonin levels.
OveractivePrefrontal-striatal overactivity
•orbital prefrontal→ant. cingulate→caudate nucleus→thalamus “loop”
11
Q
What is PANDAS?
A
In rare cases, OCD begins after a streptococcal infection, known as PANDAS*
*Pediatric Autoimmune Neuropsychiatric Disorders
Associated with Streptococcal Infections
12
Q
What are two additional therapies to treat OCD?
A
Psychosurgery: Surgical (or radiation) lesioning
of either the:
•ant. cingulate gyrus (cingulotomy)
•ant. limb of the internal capsule (capsulotomy).
Deep Brain Stimulation:
Electrical impulses are delivered by an indwelling brain electrode attached to an implanted thoracic pacemaker
13
Q
Excoriation disorder
A
Recurrent skin picking resulting in skin lesions
•Attempts to stop picking
•Picking results in significant distress/functional
impairment
14
Q
Tricholtillomania
A
Obsessive pulling out of ones hair, pulling causes significant distress and impairment.
15
Q
PTSD
A
Exposure to traumatic event results in any of the following symptoms at ANY time: 1) Intrusion Symptoms •dreams •recollections •feeling event reoccur •psychological or physiological distress when encounters symbols 2) Avoidance Symptoms avoidance of thoughts, places, or conversations, that are reminders of event. 3) Negative Alterations in Cognition and Mood •negative beliefs/expectations •negative emotional state •anhedonia or inability to experience positive emotion •detachment from others •dissociate amnesia 4) Alterations in Arousal and Reactivity •sleep disturbance •irritable and angry •reckless or self-destructive behavior •concentration problems •hypervigilance •exaggerated startle response
16
Q
Acute stress disorder
A
PTSD symptoms for a duration of 3 days to 1 month after exposure to stress. Symptoms start and resolve within 30 days after event.
17
Q
Adjustment disorder
A
Development of significant (and disproportional)
emotional/behavioral symptoms Due to an identifiable psychosocial stressor (often
an ordinary life experience)
•acute onset (symptoms develop within 3 months of stressor onset)
•brief duration (symptoms resolve within 6
months after stressor termination)
18
Q
Somatic symptom Disorder
A
at least 1 distressing/disruptive somatic symptom
at least 1 of the following indicators of excessive thoughts/feelings/behaviors about the somatic symptom:
Disproportionate thoughts about the seriousness of the symptom
•High levels of anxiety about the symptom
•Excessive time/energy devoted to the symptom
•Persistent symptomatology (usually >6 mos)
19
Q
Illness anxiety disorder
A
Preoccupation with having/acquiring a serious
illness despite NOT having somatic symptoms
(or, if present, symptoms are only mild in
intensity).
•There is high anxiety about health, and the
person is easily alarmed about personal health
status.
•Excessive health-related behaviors are
performed or health care is avoided.
•Illness preoccupation has been present >
6 mos.
Specify whether:
•Care-seeking type
•Care-avoidant type
20
Q
Conversion Disorder
A
Medically unexplained symptoms, altered voluntary motor or sensory fxn, incompatibility between symptoms and neurological findings.
Sudden onset after trigger, La Belle Indifference.
Usually short duration without recurrence.
There is usually a motivation to having the symptoms.
21
Q
Factitious disorder
A
Pts fakes symptoms in absence of reward, can be done on self or imposed on another individual, “by proxy” Can be detected by dramatic symptoms and incomplete/inconsistent medical Hx.
22
Q
Malingering
A
Factitious disorder with the goal of achieving a benefit.
23
Q
Dissociative Amnesia (Psychogenic amnesia)
A
Memory loss for autobiographical information,
which doesn’t occur as part of another disorder.
Localized: Total loss of personal memory during a circumscribed period.
Selective: Some (but limited) recall of personal
memories during a circumscribed period of time.
Generalized: Loss of personal memory of entire life up to and including event.
Physical amnesia is usually retrograde, psychogenic is usually retrograde.
24
Q
Dissociative Fugue
A
Fugue: Purposeful travel or bewildered
wandering associated with amnesia for identity or
other autobiographical information.
25
Dissociative Identity disorder
Diagnostic Criteria
1) Disruption of identify characterized by >2
distinct personalities states:
•The Primary (host)
•An Alter
2) Inability to recall personal information
(as evidenced by frequent memory gaps in host while alters take control)
26
Depersonalization/derealization disorder
Either (or both) of the following:
Depersonalization: Experiences of unreality,
detachment or being an outside observer with
respect to one’s thoughts, feelings, sensations, body or actions.
Derealization: Experiences of unreality or
detachment with respect to surroundings (e.g.,
objects seem unreal or dreamlike)
27
Continued drug use and relapse is due to 5 factors, what are they?
1) Drugs stimulate the brains Dopaminergic reward pathway.
2) Stimulation of the reward pathway stimulates the pre-frontal cortex, altering self control.
3) Drug use may cause brain changes that result
in physical withdrawal symptoms upon drug
cessation. This discomfort may drive relapse.
4)Repeated drug use decreases the availability
of dopamine. This is associated with feelings
of anhedonia, which often leads to relapse.
(AKA the “protracted abstinence syndrome”)
5) Drug use has been paired with environmental
(and internal) cues, and these cues cause
physiological changes that trigger drug-
seeking behavior.
28
What are the CAGE and FOY questions of alcohol abuse?
C: Do you feel the need to CUT back on your drinking?
A: Do you get ANNOYED with others for criticizing your drinking?
G: Do you ever feel GUILTY about drinking?
E: Do you ever need an EYE opener (a drink in the
morning)?
yes to 2 or more is very suspicious
FOY “Has concern about your drinking behavior
been expressed by your Family, Others, or Yourself?”
29
What are the acceptable drinking limits for Men and Woman?
Men= 4 drinks/day or 14/week Woman=3/day or 7/week
30
When do withdrawal effects take place?
within 72 hrs of cessation of drug and may last up to 2 weeks
31
Substance use disorder
A maladaptive pattern of substance use as manifested by >2 of the following 11 symptoms n a 12-month period:
(1) Taken in a larger amount (or for longer) than
intended
(2) Persistent unsuccessful attempts to cut back
(3) Time consuming (obtaining, using, recovering)
(4) Cravings for the substance
(5) Reduction of important activities
(6) Failure to fulfill major obligations
(7) Use in physically hazardous situations
(8) Social/interpersonal problems related to
substance
(9) Use despite having physical/psychological
problem related to substance
problem related to substance
(10) Tolerance (↓effect of a dose due to repeated use)
(11) Withdrawal syndrome
32
What is the difference between drug Abuse and dependance?
Abuse is a pattern of use despite negative consequences. Dependance is a pattern of drug use involving compulsive drug seeking behavior.
33
Explain the Schedule of drugs?
Schedule I: Drugs with a high harm risk and NO
safe, accepted medical use.
•Examples: heroin, marijuana, LSD, and Ecstasy
Schedule II: Drugs with a high harm risk but with
safe and accepted medical use. These drugs are
highly addictive. Examples: most opioids and stimulants and some barbiturates.
Schedule III, IV, V: Drugs with a harm risk less
than Schedule II drugs with safe and accepted
medical uses in the U.S.
34
What are the major sedatives?
Alcohol, Benzo's, Barbituates: Sedatives result in dis-inhibition, and repository depression. Withdraw can result in extreme ANS hypersensitivity
35
What is formication?
The sensation of Bugs crawling under your skin from alcohol withdrawal.
36
What two drugs are commonly given to combat alcoholism?
Disulfiram (Antabuse) inhibits the enzyme that
breaks down acetaldehyde.
•After alcohol consumption, acetaldehyde
accumulation causes a toxic reaction (e.g.nausea) lasting 30-60 min.
Naltrexone (Revia): An opioid receptor
blocker that reduces the pleasurable effects of
alcohol.
Acamprosate
(Campral): An NMDA receptor
blocker that reduces craving for alcohol by
decreasing the uncomfortable feelings associated
with protracted abstinence.
37
What are the signs of Inhalants?
Rashy, red and runny nose, chemical smell, face discoloration
• Inhalants can result in significant morbidity
(organ failure) and mortality (“sudden
sniffing death”).
• No withdrawal syndrome is recognized.
38
What are the key symptoms of Stimulants?
```
PSYCHOLOGICAL
• euphoria and grandiosity
• psychomotor acceleration & stereotypes
•paranoia & hallucinations
•paranoia & hallucinations
PHYSICAL
• elevated heart rate & bp (life threatening)
• appetite loss and insomnia
• mydriasis
• seizures
```
39
What are the major symptoms of stimulant withdrawal?
* dysphoric mood (MUST BE SEEN)
* fatigue and psychomotor slowing
* hypersomnia with vivid unpleasant dreams
* increased appetite
40
What are the Sx of Opiod intoxication?
```
• initial intense rush followed by:
■euphoria and drowsiness
■dysphoria (as
the high dissipates)
■dysphoria (as the high dissipates)
• miosis
• unconscious
• respiratory depression
```
41
What drug can be used for Tx of opiod overdose?
| What about long term Tx for Opioid abstinence therapy?
Naloxone; short acting opioid antagonist
| naltrexone: (a long-acting opioid receptor blocker) to block opioid effects if relapse occurs.
42
Sx of Opioid withdrawal?
* dysphoria
* nausea, vomiting, diarrhea
* muscle aches, lacrimation and rhinorrhea
* piloerection, sweating, fever
* yawning
* pupillary dilation
43
What are two replacement therapy drugs for Opioid addiction?
Methadone (schedule II) and Buprenorphine (Schedule III) Buprenorphine can be available from a Dr's office, vs Methadone which needs a federal Tx program for dispersal.
44
Gender Dysphoria
```
•A marked incongruence between one’s
assigned
(natal) gender and one’s
experienced
gender.
•The incongruence results in clinically significant
distress or functional impairment.
•Symptoms endure at least 6 months.
Often detected at 2-4 yrs of age, much more common male to female then female to male.
```
45
Gender Dysphoria physical etiology?
Insufficient exposure to androgens in Utero, sexually dimorphic nucleus is smaller then should be for males, closer to size of womans
46
Gento pelvic pain/Penetration disorder
Difficulties with vaginal penetration or vulvovaginal/pelvic pain during vaginal intercourse
or penetration attempts.
47
What is a paraphilia?
An intense and persistent (>6 mos) deviant sexual interest.
48
Transvestitism
sexual arousal from wearing the opposite-sex's clothing
49
Frotteurism
Sexual arousal from touching or rubbing
| against a non-consenting person
50
Sexual Masochism
Sexual arousal from
receiving
psychological/
physical suffering
51
Binge Eating Disorder
(as per bulimia criteria) at least
1/wk for 3 mos.
2.Binging is associated with >3 of the following:
•Rapid eating
•Rapid eating
•Eating until uncomfortably full
•Eating when not physically hungry
•Eating alone due to shame about quantity
•Feeling disgusted/guilt/depressed after binge.
3.No inappropriate compensatory behavior
52
What is the diagnostic questions for eating disorders?
SCOFF
S: Sick (induce vomiting?)
C:Control (lose control?)
O: One (1 “stone” loss in 3 mos?)14lbs (6.5kgs)
F:Fat (believe fat?)
F: Food(food dominates?)
Yes to >2 items suggests an eating problem
53
What is polysomnography (PSG)?
```
PSG
involves measuring a variety of
physiological parameters including brain
waves, muscle contractions, breathing, etc.
during sleep
```
54
Insomnia Disorder
Difficulty initiating or maintaining sleep for >3 mos.
55
Hypersomnolence Disorder
Excessive sleepiness despite sufficient sleep for
>3 mos.
►Etiology: Non-specific (and unidentified brain
causes)
►Treatment: Stimulants (e.g.,methylphenidate) to promote wakefulness.
56
What is central sleep Apnea?
Central sleep apnea is a series of cessation of breathing per night from CNS dysregulation. Whereas Obstructive sleep apnea is from obstruction of the airway from excess tissue in the throat.
57
How do we distinguish Obstructive sleep apnea form constructive sleep apnea?
A PSG distinguishes OSA from CSA based on
whether thoracic movements occur at the start of
apneic episode:
•OSA (thoracic effort occurs)
•CSA (no thoracic effort occurs)
Tx=Acetazolamide
58
Non REM sleep arousal disorder
Repeated episodes of incomplete awakening
from sleep with either of the following
a) Sleep Walking: Rising from bed and walking
about with a blank and staring face,
unresponsiveness, and difficulty awakening.
b) Sleep Terrors: Abrupt terror arousal's (usually
with panicky scream), intense fear and autonomic
arousal, and unresponsiveness to comforting by others.
Episodes occur within the first 1/3 of sleep
59
REM Sleep Behavior Disorder (RSBD)
Vocalizations and/or complex motor
movements occur during REM sleep.
►REM sleep atonia is confirmed by PSG.
►The disturbance is not induced by a substance.
RSBD Features
•Typically action-filled, violent dreams
•Immediately awake, oriented and alert with
detailed dream recall
•Most common in males >50 years old
•Course is progressive and associated with
neurodegenerative disease (e.g., Parkinson’s disease, Lewy body dementia)
60
Restless leg syndrome
Urge to move legs in response to uncomfortable sensations with all the following features:
•occurs/worsens during inactivity
•nocturnal worsening of symptoms
•temporary relief from discomfort by moving
•Patient is aware of symptoms and complains of
insomnia
61
Paranoid personality disorder
•suspicion that others are being exploitative or
deceptive
•unjustified doubts about loyalty/trustworthiness
•unjustified doubts about loyalty/trustworthiness
•reluctance to confide
•reads hidden threatening meanings into remarks
•reacts angrily to perceived insults
62
What is a delusional disorder?
A psychotic disorder characterized by:
•A psychotic disorder characterized by:
•>1 month of a delusion
•No other psychotic symptoms
63
What are the subtypes of delusional disorder?
•Persecutory (belief of malevolent treatment)
•Grandiose (belief of having some great [but
unrecognized] talent or insight or having made some important discovery)
•Erotomanic (belief of somebody being in love
with the individual)
•Jealous (belief of infidelity by partner)
•Somatic (belief involving bodily functions or sensations)
64
Schizoid Personality Disorder
```
•lacks desire for close relationships/intimacy
•lacks close friends
•prefers solitary activities
•prefers solitary activities
•derives pleasure in few activities
•indifference to praise/criticism
•emotional coldness, detachment or flat affect
Interpersonal detachment is a theme
```
65
Schizotypal Personality Disorder
•social and interpersonal deficits with acute discomfort for close relationships
•odd speech/thinking
•beliefs in paranormal phenomenon
•beliefs in paranormal phenomenon
•ideas of reference
•odd appearance/behavior
•unusual perceptual experiences
•suspiciousness (often results in social anxiety)
Theme is eccentric: considered premorbid personality of schizophrenic
66
Histrionic Personality Disorder
* needs to be center of attention
* uses physical appearance to draw attention
* inappropriately seductive/provocative behavior
* shallow and rapidly shifting emotions
* impressionistic speech but lacks detail
* exaggerated emotional expression
* considers relationships more intimate than they are. EXCESSIVE emotionality
67
Borderline personality disorder
```
•unstable intense relationships with alternating idealization and devaluation (“splitting”).
•frantically avoids abandonment
•intense uncontrolled anger
•marked reactivity of mood
•chronic feelings of emptiness
•unstable self-image
self-damaging impassivity
•suicidal gestures/self-mutilation
•transient stress-related dissociative/paranoid Sx
Theme Instability
```
68
Narcissistic Personality Disorder (NPD)
```
•grandiose sense of self-importance
•preoccupied with success
•requires admiration
•sense of entitlement
•interpersonally exploitative
•lacks empathy and has haughty attitudes
Theme=grandiosity, a narcissistic blow to personality may result in rage
```
69
Antisocial Personality Disorder (ASPD)
```
•repeated unlawful acts
•deceitfulness
•irritability and aggressiveness
•irritability and aggressiveness
•reckless disregard for safety of self or others
•irresponsibility (employment or financial)
•lack of remorse
Theme=disregard for others
```
70
Avoidant Personality Disorder
•avoids interpersonal and occupational
activities for fear of criticism
•unwilling to start relationship unless certain of
being liked
•restraint within relationship for fear of ridicule
•reluctance to engage in new activities
•negative self-image
71
Dependent Personality Disorder
* indecisive
* others must take responsibility for life
* difficulty disagreeing
* difficulty initiating due to low confidence
* excessive lengths to keep/gain support
* feels helpless when alone
* urgently seeks another relationship if one ends
72
Obsessive-Compulsive Personality Disorder (OCPD)
* preoccupation with details, rules, lists, orderliness, or schedules until point of activity is lost
* perfectionism interferes with task completion
* excessive devotion to work
* rigid and stubborn
* over conscientious, scrupulous
* reluctance to delegate or to work with others
* hoarding and miserly behavior
73
What is Papez circuit?
mamillary bodies, MTT,
Ant nuc of thalamus,
Cingulate gyrus, cingulum,
hippocampus, fornix
74
What are the three areas of the association cortex?
Cingulate – just above the corpus callosum
–Temporal lobe
–Orbital prefrontal
– just above the eyes, near midline
75
Stages of play
* Solitary Play <18 mos of age (sensorimotor)7
* Parallel Play 18 mos - 2 yrs (symbolic)
* Cooperative Play 3 - 4 yrs (associative or imaginary)
76
What was the diff between Locke and Jean Jacques Roussea
Locke=Tabula rossa
| Roussea=The child is endowed with an innate moral sense – a noble savage
77
What did John B. Watson and B.F. Skinner believe
Human nature was completely malleable
78
Richard J. Herrnstein & Charles Murray
There are substantial individual and group differences in intelligence; these differences profoundly influence the social structure and organization of work in industrial societies; and
they defy easy remediation.
79
What did the The New York Longitudinal Study, Thomas & Chess 1986 determine?
Generally, the first two years of life provide a poor
basis for predicting a person’s eventual traits. As
people grow older, however, continuity of personality gradually increases.
80
What traits have been seen as relatively stable from infancy to adulthood?
1. Activity Level
2. Regularity of biological functions
3. Approach to novel stimuli
4. Adaptability to environmental change
5. Intensity of reaction
6. Threshold of responsiveness
7. Mood - Positive, Negative, Neutral
8. Distractibility
9. Attention span and persistence
81
What are the stages to the Denver II exam?
```
Compares a child's performance on a variety of tasks when compared to a child of similar age.
Four Scales
• Gross Motor
• Fine Motor Adaptive
• Personal - Social
• Language
```
82
What are some developmental red flags?
1. Abnormal or absent primitive reflexes at birth
2. Persistent fisting at 3 months
3. Failure to reach for objects at 6 months
4. Absent smile at 3 months
5. Absent babbling at 6 months
6. Persistent mouthing of objects at 12 months
7. Advanced non-communicative speech (e.g.
echolalia) at 1.5 years
8. Regression from any previously acquired skills
9. Lack of normal developmental progression
83
What is sense of attachment/bonding associated with?
Not as closely related to feeding as thought.
•comforting body contact
•familiarity, predictability, and reliability
•sensitive responsiveness of parent
•child’s temperament
84
What are the categories of attachment?
1.Securely Attached Child seeks interaction with mother upon her return.
2.Insecurely Attached: Anxious Avoidance Child avoids interaction with mother upon her
return. (Comfort denied to child.)
3.Insecurely Attached: Anxious Resistant Child shows resistance when mother returns. Child
may seek and then resist physical interaction.
(Parental inconsistency)
4.Insecurely Attached: Disorganized Child exhibits confusion when mother returns. Child may avoid, resist, or be fearful of mother. (Abuse,Parental Depression)
85
What is the neo cortex responsible for?
* cold, non-emotional
* enables fast, fine discriminations
* required for hypothetical thinking
86
What is the Parietal-Temporal-Occipital association
| cortex used for?
• integrating multimodal sensory info
• LEFT - language, arithmetic sequential processes
• RIGHT - spatial, recognizing faces parallel
processes
–prosody : subtle aspects of speech:
tone, pitch, rhythm
– right sided lesions: “neglect” syndrome
87
Dorso-Lateral Convexity Prefrontal Association cortex
```
THINKING
•delay of spatial responses in monkeys Wisconsin General Test Apparatus - WGTA
• evaluating future outcomes
•abstract thinking
•abstract thinking
• planning
• working memory
• extinction
• suppressing responses
Lesions to the dorso lat cortex makes monkeys perform poorly on knowing what plat a treat is under.
```
88
The Orbital prefrontal Cortex is responsible for what?
FEELING
| – Limbic connections lesions lead to ‘release’, euphoria inappropriate social behavior (Gage)
89
Hypothalamus pre-optic area
• receptors monitor blood chemistry
• maintain homeostasis by regulating internal systems (endocrine, autonomic NS) by changing behavior by changing behavior (via drives and motivational systems)
• basic mechanisms of mood, affect, emotion
• electrical stimulation in some areas is aversive, in other areas-rewarding
(e.g. Medial Forebrain Bundle)
90
What is the role of GABA?
GABAa receptor complex opens Cl channel hence
hyperpolarizing - inhibitory also contains receptors for both benzodiazepines and barbiturates.
GABA is inhibitory or calming both cellulary and behaviorally.
91
How do Benzos affect Gaba?
Benzodiazapemes increase the binding of GABA, useful for anxiety, convulsions and alcohol WD
92
Where is the alpha 1 and 2 receptor found for GABA?
```
Alpha2 receptor (in limbic system) related to anxiety Alpha1 mediates sedation
it may be possible to get selective drugs
```
93
What is the relationship between Morphine and PTSD?
Morphine given during resuscitation or trauma
care to injured US military personnel reduced
the subsequent development of PTSD.
Presumably blocking the NE-mediated
consolidation of conditioned (learned) fear
94
What must be present to diagnose Schizophrenia?
at least 2 of the following 5
1. Delusions or
2. Hallucinations or
3. Disorganized speech (e.g. incoherence) or
4. Grossly disorganized or catatonic behavior or
5. Negative symptoms (flat affect, avolition,
alogia – (problems with speech, language))
C. Total Duration of disturbance must be at least
6 months, and may include prodromal or residual
periods
95
DOPAMINE and SCHIZOPHRENIA
People with schizophrenia have more DA receptors
| in their Limbic Systems especially in the nuc Accumbens NOT necessarily more dopamine
96
CHLORPROMAZINE
* The first specifically anti-psychotic drug -1955
* member of the phenothiazine family
* initially proposed as an anti-histamine
* after it was shown that the drug helps schizophrenia, the search began to find what the drug does in the brain
97
Explain the interplay between antiphyschotic drugs and Parkinsons?
Antiphyschotic drugs can be DA blocking, resulting in an excess of dopamine, causing parkinson like symptoms, Parkinsons drugs (L-DOPA) can make schizophrenia worse
98
What are the older classical schizo drugs?
(chlorpromazine, haldol) D2, D3 receptors, less expensive, Extra Pyramidal sign symptoms early: akathesia, dystonia pseudo-parkinsonism,
•late: tardive dyskinesia
99
What is the first Atypical antipsychotic?
Clozapine, D2,3,4 Receptor, expensive less neg side effects, good for resistant cases, no EPS
100
What are the The Later ‘Atypical’ Antipsychotic meds?
(olanzepine, quetiapine, ziprasidone)
• don’t require blood monitoring
• and have now become FIRST-LINE treatments
• Recent studies show disturbances in glucose handling leading to weight gain, and diabetes in some patients
• Just as with antidepressants, the older antipsychotics are becoming appreciated again
(also less advertised and less expensive)
101
What anatomical structures are altered in Schizophrenics?
people with schizophrenia may have enlarged ventricles and sulci, loss of white matter
(seen at post-mortem and in CT scans)
-frontal lobes FUNCTION badly in schizophrenia
as seen in PET scans, fMRI scans: HYPOfrontal
102
What do you need to tell a Pt before prescribing antiphyschotics?
• Not addicting
• “You may notice an inner feeling of restlessness or nervousness. If you do, please tell me. Do not just stop taking the medication. Most side effects can be treated.”
• Keep taking the medication even if you feel better
usually at least a year Avoid amphetamines, cocaine, L-Dopa
• You and your relatives need to know about the risk of Tardive Dyskinesia, and to sign a consent form.
103
What is the role of Nicotine, Tobacco alcohol, heroine on DA?
Nicotine, alcohol, marijuana, heroin Amphetamine, Caffeine trigger DA release
104
What is delusional disorder?
Delusional disorder – 1 month or longer, has never been schizoprenic, relatively normal functioning
types:erotomanic, grandiose, jealous,persecutory, somatic
105
Schizoaffective disorder
-Major mood disorder (mmd) present most of the time.
• -Active phase symptoms of Schizophrenia occur
both concurrently with a mmd (which must include depressed mood) and also for at least 2 weeks
without mmd
106
To have a major depressive episode a Pt must exhibit at least 5 of the following 9 for at least 2 weeks
SIGECAPS
| Sleep, Interest, Guilty, Energy, Concentration, Appetite, Pyschomotor activity, Suicidal Ideation.
107
Manic episode
```
Persistent,elevated and expansive mood for at least 1 week. 3 out of 7:
Inflated self esteem
decreased need for sleep
talkative,
racing ideas
Distracability
increased goal directed activities
excessively risky behavior
```
108
How does Bipolar I disorder differ from Bipolar II?
Bipolar I=at least 1 manic episode
| Bipolar II=at least 1 hypo manic episode and 1 Major Depressive episode
109
cyclothymic disorder
Numerous periods of hypomania and mild depression over 2 years
110
Major depressive disorder
2 weeks of at least 5 out of 9 SIG ECAPS, no manic states
111
Disruptive Mood dysregulation
Persistent irritability and frequent outbursts. ONLY used for ages 6=18
112
Locus Ceruleus
Contains inhibitory Opioid receptors, inhibited by Opiates. Reduced firing after injection with opioid, tolerance is achieved on continual use. Sometimes called a Trauma center, it is stimulated when monkeys are being Vigilant.
113
What is serotonin and who has low levels?
Serotonin is the civilizing neurotransmitter and is found to be low in people who are violently aggressively and in people who committed suicide.
Cell bodies are found in the Raphe Nucleus
114
What is the Monoamine theory of mood disorder?
Perhaps depression is a deficit of NE and a dysregulation of 5-HT, and
Perhaps Mania is the result of an excess of NE and dysregulation of 5-HT
115
Permissive theory of depression
A low level of 5-HT is involved in any affective disorder. Given a low level of 5-HT low NE leads to depression, high NE leads to mania
116
How do TCA's work? what was their original use?
TCA's were originally used as treatment for schizophrenia, they either work by blocking re-uptake of NE or serotonin.
117
What is the Tx for bipolar disorder?
Lithium and anti-convulsants
| Quitapne: atypical anti sczychotic (for depressed phase of bipolar)
118
Explain the role of nuerogenesis in the hypocampus
Depressed animals have stunted nuerogenesis in the hippo-campus, improves with ALL antidepressant therapies, probably by stimulation of the brain derived nuetrophilic factor. If nuerogeneis is blocked then antidepressants dont work.
119
How is ECT administered?
6-12 Tx on alternative days, need 20 sec of seizure activity. performed with muscle paralysis for safety, respitory machines ready. Unilateral application reduces memory loss. Brief post-ictal memory loss. Low mortality (same as anesthesia).
Ok with pregnancy, elderly and even children and epileptics.
120
What do we see in Toddlers?
•Slow down in physical growth
•Decrease in appetite
•Struggle for autonomy and separateness from
parents–Terrible 2's
•Fears
•Gender Identity and Role Definition
•Move from Solitary Play in Infancy to Parallel Play, then to Cooperative Play
•Move from Sensorimotor Playin Infancy to Symbolic Play, then to Imaginary Play
121
What are the four language subtypes?
1. Phonemic system – sounds
2. Semantic system – meanings
3. Syntactic system – grammar
4. Pragmatic system – social rules
122
According to Piaget what 4 factors influence cognition?
1.Nervous system maturation
2.Experience or environmental stimulation
3.Social transmission of information
4.Equilibration: A cognitive process in which existing constructs are changed as a result of new
experiences, resulting in an advanced state of
cognitive balance.
123
What are Piaget's 4 stages of cognitive development?
1.Sensorimotor Stage – Birth to 2
Experiencing the world through senses and
actions
2.Preoperational Stage – 2-6
Representing things with words and images Lacking logical reasoning
3. Concrete Operational Stage – 7-11
Thinking logically about concrete events
4.Formal Operational Stage – 12 – adulthood
Abstract reasoning
124
Sensorimotor stage Birth-2 years (piaget)
•Primary Circular Reactions–Reflex actionmand response both involve baby’s own body, i.e. sucking thumb
•Secondary Circular Reactions –Action gets response from other person or object, leading
to repetition, i.e. cooing
•Tertiary Circular Reactions (12 months +)–Planned action gets pleasing result, leading to similar
new actions, i.e. step on squeaky toy, squeeze squeaky toy
125
Preoperational Stage – 2-6
•Representations - objects represented by words or images
•Ability to pretend
•Egocentric thought
•Centering – attends to a single obvious
feature without considering other features
•Lack of Conservation Abilities
–The understanding that the amount of a substance
remains the same even when its form is changed
126
Concrete operational stage 7-12
•Logical thinking about objects and events
•Mental manipulation of objects and processes
•Ability to consider more than one dimension
at a time (decentrate) THEREFORE,
•Conservation
127
Formal Operational Stage –12 to adulthood
```
•Abstract thinking
•Hypothesizing
•Higher order thinking
–Synthesizing
–Analyzing
–Evaluating
```
128
What are Kohlbergs stages of moral reasoning?
Stage 1: Punishment Orientation
Obeys rules to avoid punishment
Stage 2: Reward Orientation
Conforms to obtain rewards and favors
Stage 3: Good Boy/Good Girl
Conforms to avoid disapproval
Stage 4: Authority Orientation
Upholds social rules to avoid censure and guilt
Stage 5: Social Contract Orientation
Actions guided by commonly agreed upon principles, as essential to the public welfare – principles upheld to retain respect of peers, and thus, self-respect.
Stage 6: Ethical Principle Orientation
Actions guided by self-chosen ethical principles,
which usually value justice, dignity, and equality
–principles upheld to avoid self-condemnation.
129
What is the IMR in the US?
6.4/1000 ranked 29th in the nation
130
What are the leading causes of childhood death in the US?
```
1. Unintentional Injuries
–Motor Vehicle
–Drowning
–Pedestrian Incidents
2. Congenital Abnormalities
3. Homicide
4. Malignant Neoplasms
5. Diseases of Heart
```
Age 5-14
1. Unintentional Injuries
- Motor Vehicle
- Pedestrian Incidents
- Drowning
2. Malignant Neoplasms
3. Congenital Abnormalities
4. Homicide
5. Suicide
131
Adolescent Mortality, Age 15-19
```
Three leading causes of death (76% of all
deaths):
–Accidents - unintentional injuries
•Motor Vehicle Accidents (40%)
–Homicide (13.7%)
•Males 3-4x Females
•Blacks 7-8x Whites
–Suicide (10.9%)
•Higher for males
•Native American, Hispanics, Whites, Blacks
```
132
Explain Erik Ericksons theory of Pyschosocial development
Erik Erikson: Each stage of life has its own
psychosocial task – a crisis that needs resolution.
•The epigenetic principle: Each builds on the
previous one(s)
•Resolution of each crisis = Maturation
•With maturation, lower stages aquire new meanings In adolescence, the task is Identity vs Role Confusion
133
What does the WHO report about suicide rates?
The World Health Organization reports that ...
–In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 (both sexes).
–Suicide attempts are up to 20 times more
frequent than completed suicides.
Young people have increased their rates so that they are now at the greatest risk. Overall, suicide is the 10th leading cause of death for all Americans, and is the 3rd leading cause of
death for young people aged 15-34.
134
How do male and female suicide rates compare?
Males are four times more likely to die from suicide
than are females. However, females are 3x more
likely to attempt suicide than are males
135
What are the leading three causes of death for age 1-24
1. Unintentional Injuries
2. Homicide
3. Suicide
136
3 leading cause of death age 25-44
1. Unintentional Injuries
2. Cancer
3. Heart Disease
137
Leading 3 causes of death 45-66
1. Cancer
2. Heart Disease
3. Unintentional injuries
138
Leading 3 causes of death age 65 +
1. Heart disease
2. Cancer
3. Chronic lower respiratory Disease
139
What are Kubler-Ross's 5 stages of dying?
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
140
What are the stages of grief in the Western World?
1. Acute disbelief
2. Grief Work; Phase of disorganization
3. Resolution: Phase of Reorganization
141
What is complicated Grief?
A chronic, heightened state of mourning
–Extreme focus on the loss and preoccupation with
one’s sorrow
–Intense longing for the deceased and problems
–Intense longing for the deceased and problems
accepting the death
–Detachment and withdrawal from social activities
–Bitterness, Irritability, Lack of Trust
–Depression, deep sadness, feeling that life holds no meaning
–Inability to carry out normal routines or to move
forward with life
142
What is Empathy?
•an active component of effective listening
-to put oneself in another person’s place
(emotionally)
143
What can happen to Empathy in medical students?
```
“Training out” of empathy
•reward conditioning
•time pressures
•role modeling
•hardening from clinical training
•“touchy-feely” side of medicine
```
144
What aspect of clinical training can result in loss of empathy?
Reward of conditioning skills
145
What are some ways to learn empathy?
```
•Put yourself in the patient’s shoes
emotionally
•“try to give me a sense of how that made
•Be genuine, even if awkward
•Pursue Feelings over Facts
```
146
What are the 4 physician styles?
1. Paternalistic (or Autocratic)
2. Shared Decision Making
3. “Consumer-Based”
4. “Friendship-Based”
147
Whats the Cardinal rule of Dr Pt relationship?
Once a Pt always a Pt
| and...No gifts over 25$
148
What are the ranking of chld abuse?
1. Neglect, other
2. Physical abuse
3. sexual abuse
4. Medical abuse
149
Physical Child Abuse (PCA)
•Definition: Acts of violence by adults against
| children.
150
How is childhood reporting of violence related to age?
Reporting decreases with age.
151
How does a child age and sex effect abuse?
Males are more likely to experience sever abuse, males under 12 more likely then girls under 12 to receive abuse, woman over 12 more likely the males over 12
152
When can child sexual abuse be committed by someone under 18?
Sexual abuse may also be committed by a person
under the age of 18 when that person is either
significantly older than the victim or when the
perpetrator is in a position of power or control
over another child.
153
What are the risk factors for childhood sexual abuse?
• Presence of stepfather
• Living without natural parents for extended time
• Mother frequently absent from home or from
home interactions (employed, disabled, ill)
• Parents with problems (marital, drugs, emotional,
isolated)
154
What are some of the red flags for child sexual abuse in children?
* Female, prepubescent
* Few close friends
* Few close friends
* Passive, quiet, trusting
* Depressed affect
* Needy
155
What are some of the family characteristics of Sexual abuse?
* Parents in conflict: Spouse abuse
* Stepfather or without natural father
* Stepfather or without natural father
* Mother disabled or ill
* History of sexual abuse in mother
* Unhappy family life
156
What is characteristic of marital violence?
-Age; Occurs most frequently between 18-30
-Gender
•Females more likely to be victims of homicide.
• Equal rates of violence overall, but females more
likely to be victims of severe violence
157
what is the RADAR for sexual abuse questioning?
```
R– Routinely screen
A– Ask questions
D–Document findings
A– Assess safety
R– Review and refer
```
158
Transference
The phenomenon of projecting (“transferring”) thoughts, feelings or wishes from the patient on to
the MD as though from the patient the MD were someone from the patient’s past
159
Countertransference
* Vice versa
* The patient engenders feelings in
* The patient engenders feelings in the MD as a result of the MD’s past experiences
* may be negative or positive (including overly idealizing or erotic)
* unconscious and therefore subject to repetition (Same type of patients can “push same buttons”)
160
What are factors that increase compliance?
```
•Good physician-patient relationship
•Feeling ill
•Limitation of usual activities
•Written instructions for taking medication
•Acute illness
•Simple treatment schedule
Short time spent in the waiting room
•Recommending one change at a time
•Benefits of care outweigh costs
•Peer support
```
161
What are factors that decrease compliance?
* Poor rapport
* Has few symptoms
* Little disruption of activities
* Verbal instructions
* Chronic illness
* Little peer support
* Complex treatment schedule
* Long time spent in waiting room
* Recommending multiple changes at the same time
* Believing costs outweigh benefits
162
What is the biopsychosocial model?
```
•1977, internist George Engel
•Biopsychosocial model
(1) Multiple determinants of disease
(2)There is a hierarchical organization of biologic
and social systems
```
163
Explain Yerkes-Dodson Law
The theory that there is a parabala of stress and fxn and that optimal fxn is determined by an optimal amount of stress and that before and beyond that the stress is too much, or too little.
164
How does chronic stress differ from short term?
Short term stress has an immediate surge of stress. that is then compensated and turned down during chronic stress.Parasympathetic pathways in the hypothalamus activate cholinergic neurons
165
What role does stress have on the immune system?
•Acute stress activates the immune system
•Chronic stress and the resultant excess levels
of glucocorticoids in the blood stream impair
immune system by damaging or destroying T
cells and inducing premature migration of T
cells from the thymus
166
REACTIVE ATTACHMENT DISORDER
The child has experienced a pattern of extremes of insufficient care
, as evidenced by at least 1 of the following:
1. Social neglect or deprivation–basic emotional needs persistently not met for comfort, stimulation, and affection
2. Frequent changes in primary caregivers
–limiting opportunities for stable attachments
3.Rearing in unusual settings that severely limit
opportunities to form selective attachments (e.g.
institutions
167
Oppositional defiant disorder
A pattern of (1) angry/irritable argumentative or defiant vindictiveness lasting at least 6 months, as evidenced by at least 4 symptoms from the following, and exhibited during interaction with
at least one person who is not a sibling:
1.Angry/Irritable Mood–Often loses temper Is touchy or easily annoyed Is often angy and resentful
2.Argumentative/Defiant Often argues with adults or authority figures. Actively defies rules and refuses to comply with requests from authority figures Deliberately annoys others. Blames others for his or her mistakes or misbehavior
3.Vindictiveness Has been spiteful or vindictive at least twice in past 6 months
168
Conduct Disorder
```
Aggression to people and animals
–Bullies, threatens, intimidates
–Initiates physical fights
–Has used a dangerous weapon
–Has been physically cruel to people
–Has been physically cruel to animals
–Has stolen while confronting a victim
–Has forced someone into sexual activity.
Theft, destruction of property, violation of someones rights.
```
169
How does the acute stress response
differ from the chronic stress
response?
•“First response” addresses the body’s most
emergent survival needs
-Cannot sustain the response at such a high level
•Parasympathetic pathways in the
hypothalamus activate cholinergic neurons
•Dissipates the state of arousal
170
What role do the glucocorticoids play
| in the etiology of stress disorders?
•The hypothalamus secretes corticorophin-releasing hormone (CRH)
•The anterior pituitary secretes
adrenocorticotropic hormone (ACTH)
•The ACTH is transported to the adrenal cortex and
stimulates glucocorticoid secretion
•Glucocorticoids inhibit protein synthesis and
accelerate protein catabolism, increase lipolysis,
and decrease peripheral glucose utilization
•Enhance inflammatory cytokines
•Neurodegenerative
171
Stress and the immune system
•Acute stress activates the immune system
•Chronic stress and the resultant excess levels
of glucocorticoids in the blood stream impair
immune system by damaging or destroying T
immune system by damaging or destroying T
cells and inducing premature migration of T
cells from the thymus
172
What are the effects of stress on metabolic processes
* Nutrient stores are depleted faster
* Non-Insulin Dependent Diabetes Mellitus
* Inhibit testosterone release and sperm production in males production in males
* Decreased estrogen release and egg production in females
* Amenorrhea
173
Holmes and Rahe Social Readjustment Rating
| Scale
•Development of illness within 2 years
- 35% of those with low (<100)scores
- 50% of those with intermediate scores (200+)
- 80% of those with high scores (300+)
174
Positive or negative attribution has different physiological consequences
- Negative: increase cortisol, catecholamines growth hormone
| - Positive: catecholamines
175
What are the two major adaptations to stress?
•Direct Action
-Attempt to deal with danger through
confrontation, fleeing, avoidance
•Palliation
- Goal is to decrease visceral, emotional,
motor manifestations of stress
•Utilized when direct action too costly
-Use defenses of denial, rationalization etc
•Use mechanisms to decrease dysphoria: Drugs, alch, excercsie
176
What are the differences in the Ergotropic and Trophotropic systems?
Ergotrophic prepares the body for Sympathetic response, Trophotropic shifts back to normal, increases PSNS responce.
177
What is the effect of Stress on Heart attacks?
Being depressed increases your risk of dying from
your second heart attack by 84% in the next 10
years
178
What is a good template for a Mental Status Exam?
ASEPTIC
A: Appearance,Attitude, Accessibility. Behaviour
S:Stream of Mental Activity; Speech
E: Emotional State; Mood, Affect, Neurovegatative symptoms and Suicidality
P: Hallucinations, Pseudohallucinations ,Illusions
Depersonalization/Derealization
T:Thought (and Language): Disorders of Production, Form and Content of Thought
I: Insight and Judgement
C: Cognition: (Conscious??),Orientation, Memory, Intelligence(a comment), Concentration
179
What does the dying Pt experience?
* Isolation/aloneness
* fear (aloneness,pain)
* need for comfort
* anger (why me?)
* need for unconditional support/love
* resolution/reconciliation
* being understood/wishes respected
180
How is the heritability of Bipolar, Schizophrenia and Major Depressive disorder related?
Bipolar is the highest, then Schiz then Major depressive disorder.
181
In order to have a mild or major nuerocognitive disorder, a Pt must have what?
At least 1 of the following 6: complex attention, executive function, learning and memory, language
perceptual-motor, social cognition
182
Alzheimer's disease is characterized by what?
• Decline in MEMORY and learning and in at least One more of the 6 neurocognitive domains:
- Complex attention
- Executive function – planning, working memory
- Learning and memory
- Language – word fining, grammar, syntax
- Perceptual motor
- Social cognition – theory of mind
183
What is the difference between Amnesia and Dementia?
Both require a memory deficit –
Amnesia requires nothing else
Dementia requires at least one other deficit
184
What does standard error measure?
The precision of your sampling technique
185
What is the standard error of the mean?
The standard error of the mean is the precision of the sample mean SEM=SD/square root of N.
The smaller the SEM the more specific the sample SD is
186
How close to pop mean is sample mean?
The standard error of the sample mean tells us 95% of the time the population mean will lie within about 2 standard errors of the sample mean. This corelates to a 95% CI X+-2SEM
187
What is the difference between SD and SEM?
Standard deviation (s) - measures spread in the data Standard error(s=pn) - measures the precision of the sample mean
188
What is an alpha error?
Type I error: Claim H1 is true when in fact H0 is true
189
What is a Beta error?
Type II error: Do not claim H1 is true when in fact
| H1 is true
190
What is Power?
The probability of NOT making a type II error
191
Who is most likely to commit sexual abuse on a male child?
An acquaintance or friend
192
Whats the difference between P value and relative risk?
The relative risk tells you the magnitude of the disease-exposure association. The p-value
(calculated using either Fisher's exact test or the
statistic) tells you if the observed result can be explained by chance.
193
When is age adjusted for prematurity in the Denver II exam?
Age is adjusted for prematurity if child (1) was born more than 2 weeks early and (2) is less than 2 years of age
194
What are some developmental red flags?
1.Abnormal or absent primitive reflexes at birth
2.Persistent fisting at 3 months: neuromotor deficits
3.Failure to reach for objects at 6 months: motor,
visual, cognitive deficits
4.Absent smile at 3 months: visual loss,attachment
problems, maternal depression, childabuse/neglect
5.Absent babbling at 6 months: hearing deficit
195
Bilateral lesions of the hippocampus interfere with what?
conversion of short term to long term memory
