Psych Lectures (Final Exam) Flashcards
definition of psychiatric disorder
a syndrome involving defined alteration in cognition, mood, perception and/or behavior
list of DSM 5 mental disorder classifications
- neurodevelopment disorders (ID, Autism, ADHD)
- schizophrenia spectrum and other psychotic disorders.
- bipolar and related disorders
- depressive disorders
- anxiety disorders
- Obsessive-Compulsive and related disorders
- trauma and stressor assoc. disorders
- somatic symptom and related disorders
- feeding and eating disorders
- substance and addictive disorders
- neurocognitive disorders (ie delirium and dementia)
- personality disorders
lifetime risk of have a psychiatric disorder?
50%
annually how many people are affected by psychiatric disorders
25%
prevalence of psychiatric in a clinical setting
> 25%
those with severe psychiatric illness most likely have ____ psychiatric diagnoses
2 or more
which race and ethnic groups have the highest rates of mental disorders?
HA! THEY ARE EQUAL
what percentage of patients that will have a psychiatric disorder are symptomatic by age 24?
75%
what percentage of schizophrenic patients receive adequate treatment
25%
what percentage of people with current mental disorder receive treatment of any kind
fewer than 50%
In 2010 mental disorders accounted for ____ % of years lived with disability?
22.7%
life expectancy of patients with chronic mental illness is shortened by an average of __ years
25
what percentage of suicides are associated with diagnosable psychiatric disorders`
90%
components of mental status
general description (appearance, attitude, behavior/motor activity)
mood and affect
speech
thought (form and content)
perception
cognition (alertness, orientation, memory, abstraction, concentration, fund of knowledge)
insight
judgment
cost of schizophrenia to society per year
100 billion/year
diagnosis criteria for schizophrenia
2 or more for 6 months
1-delusions 2-hallucinations 3-disorganized speech 4-disorganized or catatonic behavior 5-negative symptoms
schizophrenia criteria with duration < ONE MONTH
brief psychotic disorder
schizophrenia criteria with duration < SIX MONTHS
schizophreniform disorder
positive symptoms
presence of phenomena not normally present
ex. hallucinations, delusions, disorganization
negative symptoms
absence of phenomena normally present
ex. alogia (poverty of speech), affective flattening, anhedonia (inability to experience pleasure), avolition (inability to initiate goal directed behavior)
schizophrenia course
prodrome: withdrawal, eccentricity, depression/anxiety
active phase: active psychotic symptoms
residual phase: less intense positive symptoms
exacerbations: occur throughout lifetime
suicide rate in schizophrenia
5%
percentage of schizophrenic patients that usually do well at long term follow up
20%
zero symptoms is a rarity
lifetime prevalence of schizophrenia
1.3%
schizophrenia
monozygotic twins % concordance
46%
schizophrenia
dizygotic twins % concordance
14%
name two hypotheses for schizophrenia
dopamine (strong D2 blockade effacacious drug; drugs that enhance DA transmission worsen)
glutamate
schizophrenia treatment
FGAs/typicals: haloperidol
SGAs/atypicals: clozapine, risperidone
adverse effects
FGAs (typicals)
extrapyramidal symptoms (dystonia, akathesia, parkinsonian symptoms)
tardive dyskinesia (involuntary movements of tongue, lips, jaw and extremities)
how are SGAs diff’t from FGAs?
block 5HT (serotonin receptor)
less strongly D2
more strongly D1, D4
lower incidence of EPS, TD and NMS
more sedating, weight gain, metabolic syndrome
risperidone side effect
hyperprolactinema
olanzapine side effect
diabetes
ziprasidone side effect
QTc prolongation
depressive disorder criteria
5 or more of 9 depressive symptoms
2 or more weeks
one of 5 symptoms must be
- depressed mood
- marked loss of interest or pleasure
Depressive symptoms
Depressed mood +
Sleep Interest Guilt Energy Concentration Appetite Psychomotor (slowing or agitation) Suicide
increased risk of depression for first degree relatives?
3x
depression concordance rates in monozygotic twins
60%
recurrent depression concordance rates in monozygotic twins
33%
MDD lifetime prevalence
1/8 or 16-17%
depression accounts for ___ percentage of ALL disability in the world
11%
average lost work days/year per employee with MDD
27.2days/year
mood disorders account for ___ % of suicides
45-75%
lifetime risk of suicide in severe MDD (hospitalized depression)
15%
protective factors against completed suicide
positive family/social connections
positive treatment connections
spiritual beliefs
sense of responsibility towards others
investment in meaningful goals
which classes of antidepressants are less frequently used
TCAs
MAOi
ECT
6-12 unilateral or bilateral
response rate 75-85%
complementary and integrative tx for MDD
light therapy exercise folates omega 3 FA st. johns wort acupuncture sleep deprivation yoga tai chi
when do personality traits become disorders?
when traits are so maladaptive that they significantly impair one’s work life and social lifer, or cause major subjective distress
PDs are ego-syntonic or dytonic?
ego-syntonic
cluster a
accusatory, awkward, aloof
- paranoid
- schizoid (lack of interest in social relationships)
- schizotypal (odd behavior or thinking)
cluster b
bad to the bone
- antisocial (pervasive disregard for the law and rights of others)
- borderline (PRAISE)
paranoid relationship inability abandonment fears impulsive suicidal gestures, splitting emptiness
- histrionic (attention seeking)
- narcissistic (grandiosity, need for admiration, lack of empathy)
cluster c
coward, compulsive, clingy
avoidant (social inhibition)
obsessive-compulsive
dependent
prevalence of PD in general population
1-5%
prevalence of PD in outpatients mental health facilities
10-30%
prevalence of PD in psychiatric inpatients
15-30%
antisocial gender prevalence?
male
borderline gender preference
female
PD onset
late adolescence, early adulthood
bipolar lifetime risk
3%
bipolar lifetime suicide risk is elevated by ____x
20 fold
bipolar episode types
manic or hypomanic
depressive
mixed
mania criteria
1 week of elevated/irritable mood
at least 3 (4 if only irritable) DIGFAST Distractibility Impulsivity/Injudicious behavior Grandiosity Fast (racing) thoughts Activity, agitation Sleep (decreased need) Talking rapidly/pressured speech
secondary mania (phenocopies)
substance use -alcohol, cocaine, amphetamine, caffeine (stimulants)
Rx: antidepressants, steroids, ACTH
neuro: MS, frontal lobe syndromes, temporal lobe epilepsy, encephalitis, Huntingtons
endocrine: hyperthyroidism, cushings
infectious: HSV or HIV encephalitis, neurosyphillis
autoimmune: SLE
hypomania
4 days of elevated/irritable mood
at least 3 (4 if only irritable)
not assoc. w/significant distress/impairment
DIGFAST Distractibility Impulsivity/Injudicious behavior Grandiosity Fast (racing) thoughts Activity, agitation Sleep (decreased need) Talking rapidly/pressured speech
bipolar 1
at least one episode of mani
bipolar 2
at least one episode of hypomania and one episode of major depression
cyclothymia
2+ years of most days with some depressive/hypomanic sx, fewer than 2 month of euthymia, no depressive/manic episode
rapid cycling
4+ episodes within a 12-month period
comorbidity in bipolar disorder is common
esp w/ which conditions?
substance abuse
anxiety disorders
SSSSSScreening for hypomania
sex sleep socializing speeding spending special projects
bipolar peak age of onset
15-19
small secondary peak ~age 50
1/3 of patients with wait ___ years for correct diagnosis
10 years
schizophrenia heritability
60-80%
anorexia nervosa
restriction of energy intake relative to requirements leading to markedly low body weight
bulimia nervosa
recurrent binge eating
recurrent compensatory behaviors to prevent weight gain
binge eating disorder
bingeing without compensatory behaviors
assoc. overweight/obesity
mean age onset
AN
BN
BED
AN-19
BN-20
BED-25
% of IBW criteria for AN
85%
% of IBW increased mortality
65%
% of IBW inpatient level of care
75%
AN BMI
<17.5
complication of restricting/malnutrition
msk (osteopenia, osteoporosis, fractures)
cardiac (arrhythmias, bradycardia, hypotension, orthostasis, hypothermia, MVP, CHF)
brain (low serotonin)
derm (dry skin)
GI (constipation, motility)
heme (pancytopenia)
endo (hypoglycemia, low LH, FSH, estrogen, testosterone)
mortality AN, BN
4% AN, 4% BN
chronicity AN, BN
20% AN, 26% BN
improvement
34% AN, 26% BN
recovery AN, BN
47% AN, 47% BN
what percentage of Americans have experienced a traumatic event?
how many go on to develop PTSD?
70%
20-30%
PTSD criteria
sx duration more than a month
HARD hyperarousal avoidance reexperience distress
lifetime PTSD prevalence
8%
annual PTSD prevalence?
4%
PTSD gender preference
women
though traumatic events are more commonly experienced by men
median time to remission from PTSD
25months
heart rate response to loud tones in PTSD
increased
what kind of memory is impaired in PTSD
declarative (diminished hippocampal volume)
predisposed traits (PTSD)
hippocampal volume
dorsal ACC activity
neurological soft signs
acquired traits (PTSD)
rostral ACC activity
heart rate response
neurological soft signs abnormalities in PTSD
motor sequencing
figure copying
sensory integration
PTSD treatment
Debriefing may or may not help, may actually worsen symptoms
CBT helps long-term
Can relieve symptoms with anxiolytics + adrenalin block
Meds: cycloserine is NMDA agonist for glutamate, may help together with CBT
anterior cingulate
PTSD
Dorsal anterior cingulate potentiates response to fear (active in PTSD)
Rostral anterior cingulate calms response to fear (less active in PTSD, smaller)
very early onset AD in 30s
autosomal dominant
- APP
- Presenilin 1
- Presenilin 2
early onset AD in 50s
homozygous APOe4 mutations
late onset AD beyond 65
sporadic
types of dementia
alzheimers (55%)
vascular
dementia of lewy body
frontotemporal lobar degeneration
alzheimers is caused by ____ and ___
Amyloid: amyloid bodies build up in neurons
Tau: microtubule component builds up to form neurofibrillary tangles, cognitive disruption
Major dementia disorder
requires 1 domain affected (memory, language, executive function, attention, social, visuospatial, etc) and significant functional impairment
Mild dementia
1 domain affected, no significant functional impairment
AD costs the US ???
200 Billion
AD risk factors
age family hx brain injury low education APOE4 cardiovascular risk factors
medications shown to slow AD
donepezil
galantamine
rivastigmine
memantine
ADHD is a syndrome with the following”
inattention
hyperactivity (+/-)
impulsivity
ADHD prevalence age 8-11
10%
percentage of children that have ADHD persist into adolescence
75%
prevalence 7.5% adolescents
percentage of adolescence that have ADHD persist into adulthood
50%
prevalence 3-5% adults
ADHD TX
education
medication
- methylphenidate (Ritalin)
- amphetamine (adderall)
- atomoxetine (strattera) NE reuptake inhibitor
- clonidine (alpha 2a receptor agonist)
psychosocial tx
comorbid conditions with ADHD
Learning Disorders (reading, math, written expression)
anxiety, emotion
emotion -> motivator, warns of danger, no tx
anxiety, symptom
symptom-> subjective experience of dread, accompanying somatic symptoms, may or may not require tx
anxiety, syndrome
syndrome-> accompanies physical illness, precedes performance, assoc. w/self medication, tx short term
anxiety disorder
SPECTRUM
GAD
panic disorder
Social anxiety disorder
requires long-term tx
lifetime prevalence of GAD
5%
GAD remission rate
33%
GAD comorbidity rate with other psychiatric disorders
65%
at any given moment ___% meet criteria for GAD
1.6%
lifetime prevalence panic disorder
3%
social anxiety disorder prevalence
13%
social anxiety disorder gender preference
women
physical symptoms of social anxiety disorder
blushing profuse sweating trembling difficulty talking nausea stomach discomfort
panic disorder
overwhelming experience of apprehension, tear
attacks are time limited but increase in frequency
function of amygdala
plays a general role in emotion processing
detect and avoid danger
percentage of Americans reporting illicit drug use
10%
percentage of Americans reporting binge drinking
25%
percentage of Americans reporting tobacco use
25%
percentage of Americans reporting drinking during first trimester
20%
5% -second
5%-third
mediators of reward in acute substance abuse
dopamine
opioids
impulsive substance use for
pleasure
compulsive substance use for
withdrawal avoidance
gold standards alcohol screening tools
AUDIT/AUDIT-C (10q)
DAST (28 items)
CRAFFT (adolescents)
CRAFFT
alcohol screening for adolescents
car relax alone forget (blackout) friends (say cut back) trouble (while using)
score of 2 or more positive
prefer paper or computer self-report
pregnancy alcohol screening tool
1.TWEAK tolerance worried eye-opener amnesia kut down
2.T-ACE tolerance annoyed cut down eye-opener
CAGE
not so great
only for severe alcoholism
medical management
alcohol use disorder
disulfiriam (aldehyde dehydrogenase inhibitor)
naltrexone (MOR antagonist; side effect headaches, nausea)
acamprosate (glutamate neuro-modulator; side effect diarrhea)
medical management
opioid use disorder
naltrexone ER (MOR antagonist; side effect headaches, nausea) naloxone (MOR partial antagonist; side effect constipation, sweating) methadone (MOR agonist)
medical management
nicotine use disorder
nicotine replacement therapy (first line)
bupropion (first line except bipolar I DO; warning mania in bipolar I)
varenicline (second line)
MOR
mu opiod receptor
psychological homeostasis
bandwidth of nml function
flexibility
resilience
repair
defense mechanisms
Intellectualization/rationalization: justify doing a or b through logic (may be healthy)
Sublimation: channel one desire into another pursuit (may be healthy)
Projection: believe someone is making you feel a certain way (less health)
Paranoia/psychosis (less healthy)
what two principles are mental life governed by
1) pleasure principle (primary)
2) reality principle (secondary)
Insight oriented psychotherapy
start with feelings, go to thoughts originating from it
CBT
start with thoughts, go to feelings
Transference
redirection of feelings/desires from the past of patient to the therapist
Counter-transference
association of feelings to desire from therapist to patient
Resistance
understand forces that oppose patient’s purpose and goal
Free association
trying to show unconscious processes
Dialectical behavior therapy
individual and group therapy for borderline personality to reduce self-harm and hospitalizations
% of people use psychotherapy each year,
3%
% of people receive fewer than 10 sessions
70%
five class of antidepressants with representative drug from each class
- SSRIs (sertraline, paroxetine, fluoxentine, citalopram, escitalopram)
- SNRIs (venlafaxine, duloxetine)
- atypical/NDRIs
antidepressants (buproprion) - TCAs (amitriptyline, clomipramine)
- MAOIs (iproniazid, moclobemide, befloxatone, brofaromine)
what are the most common antidepressants
atypicals
SSRI examples
SSRIs ( fluoxentine, paroxetine, sertraline, citalopram, escitalopram)
“Flashbacks paralyze senior citizens.”
SNRI examples
venlafaxine
desvenlafaxine
duloxetine
Non-SRIs/NDPI/atypical
example
buproprion
5HT2 antagonist
antidepressant
trazodone
risk: orthostatic hypotension, insomnia, priapism, hepatoxicity
trazodone side effects
antidepressant
5HT2 antagonist
risk: orthostatic hypotension, insomnia, priapism, hepatoxicity
newest serotonergic agents (antidepressant)
SRI + post-synaptic 5HT activity
vilazodone
vortioxetine
TCA examples
secondary
- desipramine
- nortriptyline
- protripyline
tertiary
- imipramine
- amitriptyline
- clomipramine
TCA side effects
cardiac arrhythmias with overdose
tertiary > secondary
- weight gain
- sedation
- hypotension
- dry mouth
- constipation
anticholinergic sx
MAOi examples
iproniazid (first one!) selegiline phenelzine tranylcypromine isocarboxazid
benzo pros/cons
rapid onset
inexpensive
abuse liability
rebound/withdrawal
may hinder learning/CBT
SSRIs/SNRIs pros/cons
non addictive
delayed onset
sexual dysfunction
buspirone pros/cons
non-addictive
delayed onset
lower efficacy
bupropion pros/cons
smoking cessation
lowers seizure threshold
additional benefit of TCA and SNRI as compared to SSRI
pain reduction
neuropathies
fibromyalgia
blood pressure changes and antidepressants
increased -SNRIs
orthostatic hypotension-MAOis and TCAs
serotonin syndrome
clonus tremor confusion agitation diaphoresis hyperthermia rhabdomylosis renal failure
rapid onset
no unique lab findings
name 3 classes of anxiolytics and representative drug
- antidepressants (mainstays for long-term treatment)-> SSRIs, SNRIs
- benzodiazepines (diazepam, lorazepam, midazolam, clonazepam -> short term of panic attacks)
- buspirone
which benzo is preferred for patients with hepatic disorders?
LORAZEPAM
think LL
liver lorazepam
off label tx for anxiety disorders
SGAs
Beta-Blockers (propranolol)
alpha-1 antagonist (prazosin)
anticonvulsants (gabapentin)
2 non motor side effects associated with antipsychotics?
weight gain
increase blood sugar
increase lipids
superior antipsychotic over other?
why not used more often?
clozapine (SGA)
side effect agranulocytosis
high potency FGA
high risks?
haloperidol
extrapyramidal sx
intermediate FGA
Perphenazine
low potency FGA
high risks?
chlorpromazine
hypotension
anticholinergic sx
sedation
arrhythmias
EPS
akathesia
acute dystonic rx
parkinsonism
tx: anticholinergic, b-blockers and benzos
clozapine side effects
agranulocytosis
lowered sz threshold
myocarditis
D1, D2 (essentially all antipsychotics) antagonist
major risk?
neuroleptic malignant syndrome FEVER Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles
3 examples of mood stabilizers
lithium
lamotrigine
valproate
what mood stabilizer is excreted by the kidneys unchanged?
lithium
lithium
mood stabilizer
low therapeutic index
weight gain polyuria hypothyroidism hyperparathyroidism hypercalcemia epsteins anomaly
factors affecting lithium levels
increase
- thiazide diuretics
- NSAIDS
decrease
- methylxanthines
- mannitol
valproate
metabolized by liver
GI side effect weight pancreatitis hyperammonemia platelet dysfunction neural tube defects
lamotrigine
rash (SJS, TEN)
lamest of the options
lithium, valproate and SGAs are best for mania
psychopharm emergencies
NMS serotonin syndrome hypertensive crises acute dystonias SJS/TEN cardiac arrhythmias myocarditis agranulocytosis hepatoxicity pancreatitis hyperammonemia priapism seizures
MAOi is absolutely contraindicated with what?
meperidine