Psychiatric Disorders Flashcards
what is the definition of wellness when it comes to psychiatric disorders?
the integrated and coordinated function of many neurotransmitter systems
What are the meaningful outcomes of psychiatric disorders?
functional status and quality of life
What is a psychiatric disorder?
a CNS disease characterized by disturbances in emotion, cognition, motivation and socialization
Are their specific biological markers and syndromes to diagnose someone with psychiatric disorders?
no, because there are heterogenous syndroms (different from one person to the next). Diagnosis is made on clinical observations and criteria (DSM-V)
why is mental health important to physical health?
Physical and mental health is two-way and perpetual. Someone with physical health issues, if mental health declines, physical health does too
why do anxiety and sleep disorders have a very high co-occurence?
- an excess of stimulating neural flow relative to calming neural flow
- overlap between physical and psychiatric symptoms are high
What is the difference between a short term symptom of anxiety vs an anxiety disorder?
people with anxiety disorders are anxious all of the time when there is nothing to be concerned about in that moment. Also not transient.
what does GAD stand for?
Generalized Anxiety Disorder
What is the diagnostic criteria for GAD?
- excessive anxiety & worry occurring more-days-than-not for at least 6 months
- person finds it difficult to control the worry and associated with 3 or more of the following 6 symptoms:
(a) restlessness or feeling keyed up or on edge
(b) being easily fatigued
(c) difficulty concentrating or mind going blank
(d) irritability
(e) muscle tension
(f) sleep disturbance
What is gravol used for? how does it work?
- off label use as a sleep aid
- acts as CNS depressant causing drowsiness and sedation due to antihistamine and anticholinergic
What are the stages of sleep?
1,2,3,4 and REM
Which stages of sleep are considered Delta Sleep?
3 and 4
What happens during delta sleep?
muscle atonia & restorative
where in the brain does the circadian rhythm originate?
suprachiasmic nucleus
how do sleep medications affect sleep cycles?
Most medications that help people sleep alter sleep cycles. The medication may not be as restorative
What neurotransmitters contribute to alertness or wakefulness?
- domapine –> alerting effect
- norepinephrine, acetylcholine, histamine, substance P and cortisol
*there is usually an excess in one of these in people who have sleep issues
true or false: improvement of sleep disorders without medication is ideal
TRUE
what are the steps of Sleep Hygiene/Sleep Stimulus Control?
- Establish regular times to wake up and to go to sleep
- sleep only as much as necessary to feel rested
- Go to bed only when sleepy. Avoud long periods of wakefulness in bed
- If you do not fall asleep within 20-30 minutes, leave the bed and do something relaxing
- Avoid daytime naps
- Schedule worry time during the day. Do not take your troubles to bed.
- Exercise routinely, but not close to bedtime
- Minimize sensory stimulation in the bedtime (light, sound, temp)
- Reduce the use of alcohol, caffeine and nicotine - especially in the evening
- Avoid large quantities of liquids in the evening
- Do something relaxing and enjoyable before bedtime
What is the effect that changes in Anxiety, Depression, Pain, and Sleep Disorder symptoms can have on each other
- these problems can further aggravate each other. For example, people with chronic pain may have higher instances of depression, anxiety and sleep disorders.
- if we treat one, we can help something else indirectly. ex. helping someone sleep can help with anxiety
True or False: Addressing Reversible Causes and Utilizing Sleep Hygiene techniques to treat insomnia is secondary to treatment with a drug
FALSE: jumping right into a medication is not the best thing to do
What neurotransmitters do drugs used to treat insomnia target?
- enhance/restore: GABA, Serotonin
2. Inhibit/normalize: Histamine, Ach, NE, DA, substance P, Corticotropin Releasing Factor - Cortisol
How do benzodiazapines work in treating insomnia?
They are GABA agonists
What is a Non-Benzo GABA agonist?
zopiclone
What are other drugs other than benzodiazapines that can be used to treat insomnia?
- antihistamines
- antidepressents (i.e Trazodone)
- Melatonin agonists (i.e. valerian)
what are the two major symptom groups commonly seen in anxiety disorders?
- physical/somatic &
- psychic/psychologic/cognitive
what are 3 neurochemical models which can explain insomnia?
- Noradrenergic model -autonomic nervous system is hypersensitive/ excess locus ceruleus firing
- GABA model - Gab under performing
- Serotonin model - serotonin under performing
what is the goal of anxiety treatment?
reduce duration and severity of symptoms and improve overall functioning
what are some physical symptoms of anxiety disorders?
- restlessness
- fatigue
- muscle tension
- sleep disturbance
- irritability
What are some psychologic/ Cognitive symptoms of anxiety disorders?
- increased anxiety
- worries are hard to control
- on edge
- poor concentration
What is the difference between antidepressants and BZDs in treating physical symptoms of anxiety?
- BZDs work quickly (fast onset and rapid elimination) while antidepressants can increase physical symptoms at first but have superior long-term benefits
why is prescribing bezodiazepines a cause for concern?
they have the highest risk for dependency due to their quick onset and accelerated clearance
how do antidepressants work in treating anxiety?
- modulate 5HT, NE and DA normalizes gene expression –> more BDNF and less CRF (decrease in cortisol)
what can happen when benzodiazepines are stopped suddenly?
- since they can suppress REM sleep, this leads to reduced sleep quality and leads to REM rebound when these drugs are stopped suddenly (bad dreams).
what is the key target neurotransmitter targeted by antidepressants ?
serotonin (5HT). Some also target NE
what is a major depressive episode?
- causes significant distress/dysfunction
- not due to drugs/medication
- not due to bereavement
- persists for > 2 months
- feature functional impairments
- must include depressed mood or anhedonia
- 5 or more of the following consistently through a 2 week period: depressed most of the day, anhedonia, weight loss, sleep disturbance, psychomotor changes, fatigue, feelings of worthlessness or guilt, inability to concentrate or make decisions, thoughts of death
what happens neurologically in depression?
- hippocampus decreases in size and increased activation of the amygdala by -ve stimuli
- reduced activation of the nucleus accumbens by rewarding stimuli
what is the first step in diagnosing/investigating depression?
- doing a global assessment that looks at other potential causes such as medical, substance-related, drugs/hormones, stresses/losses
what clinical tool is used to screen for a measure of depression severity?
questionnaires and scales
Why must medical pharmacologic work-up include tests on thyroid function?
if thyroid is under performing, then other drugs will not work unless it is functioning properly. If not adhering to thyroid drug, then may cause depression to get worse
What are the benefits and disadvantages of using benzodiazepines for depression?
- reinforces doctor, patient, pharmacist relationship
- fast acting and solves problems but may be difficult for the patient to accept that we must deal with the actual cause of depression
- also has a potential for abuse
- a “band-aid” solution
what do antidepressants target in depression?
- they target/enhance the function of serotonin, NE and Dopamine
- they increase the amts of neurotransmitter in the synapse
why is taking antidepressants important when things are getting better?
There is evidence that the longer someone takes antidepressants, the better their function will get and less likely they will have a depressive relapse
can you become addicted to antidepressants?
no
to what degree does St.John’s wort work towards treating depression?
- effective for mild to moderate depression but poor evidence in moderate to severe depression
- also has potential for interacting with other medications
what main mechanisms do drugs exert their effects at the site of synaptic transmission?
- affect reuptake into the nerve ending or uptake into a glial cell
- affect degredation
- all try to increase amt of neurotransmitter in the synapse
what is a vegetative symptom in depression?
changes in appetite and sleep that commonly occur in patients experiencing depression
what does BDNF have to do with depression?
treatments which are effective for depression have been associated with increases in BDNF which contributes to the growth and health of brain neurons
how long is necessary for symptoms to be present to diagnose ADHD?
6 months
is ADHD genetic?
yes, 80% responsible
what part of the brain “under performs” in ADHD patients
locus ceruleus (alarm centre) which affects the ability to pay attention and stay focused
describe the neuropathology of ADHD
- small increase in cerebrum growth
- reduced numbers of cerebellar purkinji neurons
- ## reduced cell size and increased density in limbic areas of the brain
true or false: there is increased risk of ADHD with fetal alcohol syndrome, lead poisoning, meningitis, obstetric adversity, maternal smoking, adverse or absent parent-child relationship
TRUE
what types of medication work in treating ADHD
- stimulants that target dopaminergic and noradrenergic (norepinephrine) tracts –> block NE and DA reuptake
- methylphenidate (Ritalin)
- amphetamines
what are some adverse effects of stimulants?
- decrease appetite
- increase blood pressure, anxiety, irritability, difficulty falling asleep, stomach complaints, headache
- may worsen tics
why are “drug holidays” recommended in treatment of ADHD?
recommended in order to
- assess ongoing medication use
- allow for minimization of possible growth retardation
what negative impacts occur with untreated or under treated ADHD?
- academic & behavioural consequences
- poor driving record
- physical injuries
- poor job performance
- drug abuse
what are the core symptoms present in ADHD?
- Inattention
- distractibility
- impulsivity
- hyperactivity
what are the symptoms that ADHD patients usually continue to have in adulthood?
- inattention
2. distractibility
what are some non-drug strategies to combat ADHD?
- limiting triggers (i.e refined sugar)
- addressing deficiencies (iron, zinc)
- collaborative support system and school
By normalizing the function of dopamine & NE, what does it do for ADHD patients?
- increases their capacity to select restraint
- increases person’s control over decision-making
