Psych Lectures (Final Exam) Flashcards
1
Q
definition of psychiatric disorder
A
a syndrome involving defined alteration in cognition, mood, perception and/or behavior
2
Q
list of DSM 5 mental disorder classifications
A
- 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
3
Q
lifetime risk of have a psychiatric disorder?
A
50%
4
Q
annually how many people are affected by psychiatric disorders
A
25%
5
Q
prevalence of psychiatric in a clinical setting
A
> 25%
6
Q
those with severe psychiatric illness most likely have ____ psychiatric diagnoses
A
2 or more
7
Q
which race and ethnic groups have the highest rates of mental disorders?
A
HA! THEY ARE EQUAL
8
Q
what percentage of patients that will have a psychiatric disorder are symptomatic by age 24?
A
75%
9
Q
what percentage of schizophrenic patients receive adequate treatment
A
25%
10
Q
what percentage of people with current mental disorder receive treatment of any kind
A
fewer than 50%
11
Q
In 2010 mental disorders accounted for ____ % of years lived with disability?
A
22.7%
12
Q
life expectancy of patients with chronic mental illness is shortened by an average of __ years
A
25
13
Q
what percentage of suicides are associated with diagnosable psychiatric disorders`
A
90%
14
Q
components of mental status
A
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
15
Q
cost of schizophrenia to society per year
A
100 billion/year
16
Q
diagnosis criteria for schizophrenia
A
2 or more for 6 months
1-delusions 2-hallucinations 3-disorganized speech 4-disorganized or catatonic behavior 5-negative symptoms
17
Q
schizophrenia criteria with duration < ONE MONTH
A
brief psychotic disorder
18
Q
schizophrenia criteria with duration < SIX MONTHS
A
schizophreniform disorder
19
Q
positive symptoms
A
presence of phenomena not normally present
ex. hallucinations, delusions, disorganization
20
Q
negative symptoms
A
absence of phenomena normally present
ex. alogia (poverty of speech), affective flattening, anhedonia (inability to experience pleasure), avolition (inability to initiate goal directed behavior)
21
Q
schizophrenia course
A
prodrome: withdrawal, eccentricity, depression/anxiety
active phase: active psychotic symptoms
residual phase: less intense positive symptoms
exacerbations: occur throughout lifetime
22
Q
suicide rate in schizophrenia
A
5%
23
Q
percentage of schizophrenic patients that usually do well at long term follow up
A
20%
zero symptoms is a rarity
24
Q
lifetime prevalence of schizophrenia
A
1.3%
25
schizophrenia
| monozygotic twins % concordance
46%
26
schizophrenia
| dizygotic twins % concordance
14%
27
name two hypotheses for schizophrenia
dopamine (strong D2 blockade effacacious drug; drugs that enhance DA transmission worsen)
glutamate
28
schizophrenia treatment
FGAs/typicals: haloperidol
| SGAs/atypicals: clozapine, risperidone
29
adverse effects
| FGAs (typicals)
extrapyramidal symptoms (dystonia, akathesia, parkinsonian symptoms)
tardive dyskinesia (involuntary movements of tongue, lips, jaw and extremities)
30
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
31
risperidone side effect
hyperprolactinema
32
olanzapine side effect
diabetes
33
ziprasidone side effect
QTc prolongation
34
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
35
Depressive symptoms
Depressed mood +
```
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor (slowing or agitation)
Suicide
```
36
increased risk of depression for first degree relatives?
3x
37
depression concordance rates in monozygotic twins
60%
38
recurrent depression concordance rates in monozygotic twins
33%
39
MDD lifetime prevalence
1/8 or 16-17%
40
depression accounts for ___ percentage of ALL disability in the world
11%
41
average lost work days/year per employee with MDD
27.2days/year
42
mood disorders account for ___ % of suicides
45-75%
43
lifetime risk of suicide in severe MDD (hospitalized depression)
15%
44
protective factors against completed suicide
positive family/social connections
positive treatment connections
spiritual beliefs
sense of responsibility towards others
investment in meaningful goals
45
which classes of antidepressants are less frequently used
TCAs
| MAOi
46
ECT
6-12 unilateral or bilateral
| response rate 75-85%
47
complementary and integrative tx for MDD
```
light therapy
exercise
folates
omega 3 FA
st. johns wort
acupuncture
sleep deprivation
yoga
tai chi
```
48
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
49
PDs are ego-syntonic or dytonic?
ego-syntonic
50
cluster a
accusatory, awkward, aloof
1. paranoid
2. schizoid (lack of interest in social relationships)
3. schizotypal (odd behavior or thinking)
51
cluster b
bad to the bone
1. antisocial (pervasive disregard for the law and rights of others)
2. borderline (PRAISE)
```
paranoid
relationship inability
abandonment fears
impulsive
suicidal gestures, splitting
emptiness
```
3. histrionic (attention seeking)
4. narcissistic (grandiosity, need for admiration, lack of empathy)
52
cluster c
coward, compulsive, clingy
avoidant (social inhibition)
obsessive-compulsive
dependent
53
prevalence of PD in general population
1-5%
54
prevalence of PD in outpatients mental health facilities
10-30%
55
prevalence of PD in psychiatric inpatients
15-30%
56
antisocial gender prevalence?
male
57
borderline gender preference
female
58
PD onset
late adolescence, early adulthood
59
bipolar lifetime risk
3%
60
bipolar lifetime suicide risk is elevated by ____x
20 fold
61
bipolar episode types
manic or hypomanic
depressive
mixed
62
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
```
63
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
64
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
```
65
bipolar 1
at least one episode of mani
66
bipolar 2
at least one episode of hypomania and one episode of major depression
67
cyclothymia
2+ years of most days with some depressive/hypomanic sx, fewer than 2 month of euthymia, no depressive/manic episode
68
rapid cycling
4+ episodes within a 12-month period
69
comorbidity in bipolar disorder is common
| esp w/ which conditions?
substance abuse
| anxiety disorders
70
SSSSSScreening for hypomania
```
sex
sleep
socializing
speeding
spending
special projects
```
71
bipolar peak age of onset
15-19
small secondary peak ~age 50
72
1/3 of patients with wait ___ years for correct diagnosis
10 years
73
schizophrenia heritability
60-80%
74
anorexia nervosa
restriction of energy intake relative to requirements leading to markedly low body weight
75
bulimia nervosa
recurrent binge eating
| recurrent compensatory behaviors to prevent weight gain
76
binge eating disorder
bingeing without compensatory behaviors
assoc. overweight/obesity
77
mean age onset
AN
BN
BED
AN-19
BN-20
BED-25
78
% of IBW criteria for AN
85%
79
% of IBW increased mortality
65%
80
% of IBW inpatient level of care
75%
81
AN BMI
<17.5
82
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)
83
mortality AN, BN
4% AN, 4% BN
84
chronicity AN, BN
20% AN, 26% BN
85
improvement
34% AN, 26% BN
86
recovery AN, BN
47% AN, 47% BN
87
what percentage of Americans have experienced a traumatic event?
how many go on to develop PTSD?
70%
| 20-30%
88
PTSD criteria
sx duration more than a month
```
HARD
hyperarousal
avoidance
reexperience
distress
```
89
lifetime PTSD prevalence
8%
90
annual PTSD prevalence?
4%
91
PTSD gender preference
women
though traumatic events are more commonly experienced by men
92
median time to remission from PTSD
25months
93
heart rate response to loud tones in PTSD
increased
94
what kind of memory is impaired in PTSD
declarative (diminished hippocampal volume)
95
predisposed traits (PTSD)
hippocampal volume
dorsal ACC activity
neurological soft signs
96
acquired traits (PTSD)
rostral ACC activity
| heart rate response
97
neurological soft signs abnormalities in PTSD
motor sequencing
figure copying
sensory integration
98
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
99
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)
100
very early onset AD in 30s
autosomal dominant
- APP
- Presenilin 1
- Presenilin 2
101
early onset AD in 50s
homozygous APOe4 mutations
102
late onset AD beyond 65
sporadic
103
types of dementia
alzheimers (55%)
vascular
dementia of lewy body
frontotemporal lobar degeneration
104
alzheimers is caused by ____ and ___
Amyloid: amyloid bodies build up in neurons
Tau: microtubule component builds up to form neurofibrillary tangles, cognitive disruption
105
Major dementia disorder
requires 1 domain affected (memory, language, executive function, attention, social, visuospatial, etc) and significant functional impairment
106
Mild dementia
1 domain affected, no significant functional impairment
107
AD costs the US ???
200 Billion
108
AD risk factors
```
age
family hx
brain injury
low education
APOE4
cardiovascular risk factors
```
109
medications shown to slow AD
donepezil
galantamine
rivastigmine
memantine
110
ADHD is a syndrome with the following"
inattention
hyperactivity (+/-)
impulsivity
111
ADHD prevalence age 8-11
10%
112
percentage of children that have ADHD persist into adolescence
75%
prevalence 7.5% adolescents
113
percentage of adolescence that have ADHD persist into adulthood
50%
prevalence 3-5% adults
114
ADHD TX
education
medication
1. methylphenidate (Ritalin)
2. amphetamine (adderall)
3. atomoxetine (strattera) NE reuptake inhibitor
4. clonidine (alpha 2a receptor agonist)
psychosocial tx
115
comorbid conditions with ADHD
Learning Disorders (reading, math, written expression)
116
anxiety, emotion
emotion -> motivator, warns of danger, no tx
117
anxiety, symptom
symptom-> subjective experience of dread, accompanying somatic symptoms, may or may not require tx
118
anxiety, syndrome
syndrome-> accompanies physical illness, precedes performance, assoc. w/self medication, tx short term
119
anxiety disorder
SPECTRUM
GAD
panic disorder
Social anxiety disorder
requires long-term tx
120
lifetime prevalence of GAD
5%
121
GAD remission rate
33%
122
GAD comorbidity rate with other psychiatric disorders
65%
123
at any given moment ___% meet criteria for GAD
1.6%
124
lifetime prevalence panic disorder
3%
125
social anxiety disorder prevalence
13%
126
social anxiety disorder gender preference
women
127
physical symptoms of social anxiety disorder
```
blushing
profuse sweating
trembling
difficulty talking
nausea
stomach discomfort
```
128
panic disorder
overwhelming experience of apprehension, tear
attacks are time limited but increase in frequency
129
function of amygdala
plays a general role in emotion processing
detect and avoid danger
130
percentage of Americans reporting illicit drug use
10%
131
percentage of Americans reporting binge drinking
25%
132
percentage of Americans reporting tobacco use
25%
133
percentage of Americans reporting drinking during first trimester
20%
5% -second
5%-third
134
mediators of reward in acute substance abuse
dopamine
| opioids
135
impulsive substance use for
pleasure
136
compulsive substance use for
withdrawal avoidance
137
gold standards alcohol screening tools
AUDIT/AUDIT-C (10q)
DAST (28 items)
CRAFFT (adolescents)
138
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
139
pregnancy alcohol screening tool
```
1.TWEAK
tolerance
worried
eye-opener
amnesia
kut down
```
```
2.T-ACE
tolerance
annoyed
cut down
eye-opener
```
140
CAGE
not so great
| only for severe alcoholism
141
medical management
| alcohol use disorder
disulfiriam (aldehyde dehydrogenase inhibitor)
naltrexone (MOR antagonist; side effect headaches, nausea)
acamprosate (glutamate neuro-modulator; side effect diarrhea)
142
medical management
| opioid use disorder
```
naltrexone ER (MOR antagonist; side effect headaches, nausea)
naloxone (MOR partial antagonist; side effect constipation, sweating)
methadone (MOR agonist)
```
143
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)
144
MOR
mu opiod receptor
145
psychological homeostasis
bandwidth of nml function
flexibility
resilience
repair
146
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)
147
what two principles are mental life governed by
1) pleasure principle (primary)
| 2) reality principle (secondary)
148
Insight oriented psychotherapy
start with feelings, go to thoughts originating from it
149
CBT
start with thoughts, go to feelings
150
Transference
redirection of feelings/desires from the past of patient to the therapist
151
Counter-transference
association of feelings to desire from therapist to patient
152
Resistance
understand forces that oppose patient’s purpose and goal
153
Free association
trying to show unconscious processes
154
Dialectical behavior therapy
individual and group therapy for borderline personality to reduce self-harm and hospitalizations
155
% of people use psychotherapy each year,
3%
156
% of people receive fewer than 10 sessions
70%
157
five class of antidepressants with representative drug from each class
1. SSRIs (sertraline, paroxetine, fluoxentine, citalopram, escitalopram)
2. SNRIs (venlafaxine, duloxetine)
3. atypical/NDRIs
antidepressants (buproprion)
4. TCAs (amitriptyline, clomipramine)
5. MAOIs (iproniazid, moclobemide, befloxatone, brofaromine)
158
what are the most common antidepressants
atypicals
159
SSRI examples
SSRIs ( fluoxentine, paroxetine, sertraline, citalopram, escitalopram)
"Flashbacks paralyze senior citizens."
160
SNRI examples
venlafaxine
desvenlafaxine
duloxetine
161
Non-SRIs/NDPI/atypical
example
buproprion
162
5HT2 antagonist
antidepressant
trazodone
risk: orthostatic hypotension, insomnia, priapism, hepatoxicity
163
trazodone side effects
antidepressant
5HT2 antagonist
risk: orthostatic hypotension, insomnia, priapism, hepatoxicity
164
newest serotonergic agents (antidepressant)
SRI + post-synaptic 5HT activity
vilazodone
vortioxetine
165
TCA examples
secondary
- desipramine
- nortriptyline
- protripyline
tertiary
- imipramine
- amitriptyline
- clomipramine
166
TCA side effects
cardiac arrhythmias with overdose
tertiary > secondary
- weight gain
- sedation
- hypotension
- dry mouth
- constipation
anticholinergic sx
167
MAOi examples
```
iproniazid (first one!)
selegiline
phenelzine
tranylcypromine
isocarboxazid
```
168
benzo pros/cons
rapid onset
inexpensive
abuse liability
rebound/withdrawal
may hinder learning/CBT
169
SSRIs/SNRIs pros/cons
non addictive
delayed onset
sexual dysfunction
170
buspirone pros/cons
non-addictive
delayed onset
lower efficacy
171
bupropion pros/cons
smoking cessation
lowers seizure threshold
172
additional benefit of TCA and SNRI as compared to SSRI
pain reduction
neuropathies
fibromyalgia
173
blood pressure changes and antidepressants
increased -SNRIs
| orthostatic hypotension-MAOis and TCAs
174
serotonin syndrome
```
clonus
tremor
confusion
agitation
diaphoresis
hyperthermia
rhabdomylosis
renal failure
```
rapid onset
no unique lab findings
175
name 3 classes of anxiolytics and representative drug
1. antidepressants (mainstays for long-term treatment)-> SSRIs, SNRIs
2. benzodiazepines (diazepam, lorazepam, midazolam, clonazepam -> short term of panic attacks)
3. buspirone
176
which benzo is preferred for patients with hepatic disorders?
LORAZEPAM
think LL
liver lorazepam
177
off label tx for anxiety disorders
SGAs
Beta-Blockers (propranolol)
alpha-1 antagonist (prazosin)
anticonvulsants (gabapentin)
178
2 non motor side effects associated with antipsychotics?
weight gain
increase blood sugar
increase lipids
179
superior antipsychotic over other?
why not used more often?
clozapine (SGA)
side effect agranulocytosis
180
high potency FGA
high risks?
haloperidol
extrapyramidal sx
181
intermediate FGA
Perphenazine
182
low potency FGA
high risks?
chlorpromazine
hypotension
anticholinergic sx
sedation
arrhythmias
183
EPS
akathesia
acute dystonic rx
parkinsonism
tx: anticholinergic, b-blockers and benzos
184
clozapine side effects
agranulocytosis
lowered sz threshold
myocarditis
185
D1, D2 (essentially all antipsychotics) antagonist
| major risk?
```
neuroleptic malignant syndrome
FEVER
Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles
```
186
3 examples of mood stabilizers
lithium
lamotrigine
valproate
187
what mood stabilizer is excreted by the kidneys unchanged?
lithium
188
lithium
mood stabilizer
low therapeutic index
```
weight gain
polyuria
hypothyroidism
hyperparathyroidism
hypercalcemia
epsteins anomaly
```
189
factors affecting lithium levels
increase
- thiazide diuretics
- NSAIDS
decrease
- methylxanthines
- mannitol
190
valproate
metabolized by liver
```
GI side effect
weight
pancreatitis
hyperammonemia
platelet dysfunction
neural tube defects
```
191
lamotrigine
rash (SJS, TEN)
lamest of the options
lithium, valproate and SGAs are best for mania
192
psychopharm emergencies
```
NMS
serotonin syndrome
hypertensive crises
acute dystonias
SJS/TEN
cardiac arrhythmias
myocarditis
agranulocytosis
hepatoxicity
pancreatitis
hyperammonemia
priapism
seizures
```
193
MAOi is absolutely contraindicated with what?
meperidine
