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Neurology > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is psychosis?

A
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2
Q

What is the age of onset of Schizophrenia?

A

15-25 in males
25-35 in females

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3
Q

What are the neurologic findings associated with schizophrenia?

A

1) Hyperactivity of dopaminergic, serotonergic, and noradrenergic systems; increased evidence for disordered glutamate utilization
2) Enlargement of lateral and third ventricles of the brain
3) Abnormalities of the frontal lobes

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4
Q

Schizophrenia – General

A

Chronic psychiatric disorder characterized by episodes of psychosis and abnormal behavior >6 months

Two or more of following symptoms for at least one month:
• Hallucinations
• Delusions
• Disorganized speech
• Disorganized behavior
• Negative symptoms

Symptoms must be causing functional impairment and are not due to any other medical condition or substance abuse

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5
Q

Catatonic Schizophrenia

A

Motor disturbances with strange posturing, incoherent speech; can involve extreme motion or no motion

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6
Q

Paranoid Schizophrenia

A

Delusions (e.g. persecutory), but with better social functioning than other types and best prognosis

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7
Q

Disorganized Schizophrenia

A

Inappropriate emotional responses (e.g. emotional blunting), disheveled appearance. Severe impairment and poor prognosis.

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8
Q

Undifferentiated Schizophrenia

A

Characteristics of multiple subtypes.

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9
Q

Residual Schizophrenia

A

One or more psychotic episodes in the past, residual flat affect, withdrawal, off behavior or thinking, but no severe psychotic symptoms.

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10
Q

Is memory and orientation normal in Schizophrenia?

A

Yes

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11
Q

Positive Symptoms

A

Thoughts, sensory perceptions, behaviors that are abnormal

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12
Q

Negative Symptoms

A

Thoughts, sensory perceptions, behaviors that are present in a normal person but are absent in a person with mental illness

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13
Q

Schizophrenia Positive Symptoms

A
  • Delusions
  • Loose associations
  • Strange behavior
  • Hallucinations, typically auditory (e.g. hearing voices)
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14
Q

Schizophrenia Negative Symptoms

A
  • Social withdrawal
  • Flat affect
  • Lack of motivation
  • Thought blocking (starts talking then stops and is unable to continue with what he was saying)
  • Poverty of speech (alogia)
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15
Q

Schizophrenia Treatment

A
  • Antipsychotic agents (e.g. Dopamine receptor blockers); atypical antipsychotics lack side effects of earlier ones
  • Psychosocial (therapy)
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16
Q

Which responds better to typical antipsychotics – negative or positive Schizophrenia symptoms?

A

Positive symptoms; negative symptoms respond better to the atypical agents.

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17
Q

Schizophrenia prognosis

A

Treatment non-compliance is not good, earlier onset can interfere with brain development.

Suicide is common; more than 50% attempt rate.

Better prognosis with family support (low-expressed emotion, that is, they are not critical of the person, understand the disorder) and absence of comorbid substance abuse.

18
Q

Is there a difference in ethnic prevalence of mood disorders?

A

No but patients in lower socioeconomic classes often come to the attention of providers later and may be misdiagnosed

19
Q

Pathophysiology of Depression

A
  • Altered neurotransmitter activity
  • Depression is associated with decreased levels of serotonin, norepinephrine, and possibly dopamine (it is not the increase in these NTs that improves the depression; it is believed that there are more downstream cellular effects)
  • Limbic H-P axis abnormalities
20
Q

Major Depressive Disorder Presentation

A

• History of sustained, depressed mood with anhedonia, and may feel guilty/worthless; must exhibit five or more of below symptoms for longer than two weeks with a symptom-free period lasting longer than two months
SIG E CAPS:
• Sleep disturbances (usually too little)
• Loss of Interests
• Guilt/worthlessness
• Loss of Energy
• Loss of Concentration
• Appetite changes /weight (usually loss)
• Psychomotor retardation or agitation
• Suicidal Ideation

21
Q

MDD with melancholic features (melancholia)

A
  • Depression with profound anhedonia and dysphoria (depression)
  • Worse mood in the morning
  • Early morning waking
  • Psychomotor agitation or retardation
  • Weight loss or decreased appetite
  • Excessive or inappropriate guilt
  • Respond well to antidepressants and ECT
22
Q

MDD with atypical features

A
  • Mood reactivity (mood improves in response to positive events)
  • Weight gain or increased appetite
  • Hypersomnia
  • Leaden paralysis
  • Sensitivity to rejection
  • Difficult to treat; combination of psychotherapy and medications (esp. MAO inhibitors)
23
Q

Chronic MDD

A
  • >2 years
  • Generally refractive to treatment
24
Q

Postpartum-onset depression

A
  • Depressive, manic, or mixed episode occurring within the first 4 weeks after delivery
  • Not the postpartum “blues”, which is more common
  • High risk of recurrence in subsequent deliveries (30-50%)
  • Pharmacologic or psychotherapy or both
25
Q

MDD with catatonic features

A
  • Similar to those in schizophrenia (posturing, waxy flexibility, catalepsy (rigidness not in response to external stimuli), negativism, and mutism)
  • Generally observed in patients at the psychotic end of the mood order spectrum
26
Q

Dysthymic disorder

A
  • Mild depression for >2 years but not meeting MDD criteria
  • Cry frequently
  • Most effective treatment is insight-oriented psychotherapy, however, anti-depressants can also be used
27
Q

Seasonal Affective Disorder

A
  • Depression for at least 2 consecutive years during the same season and periods of depression are followed by non-depressed seasons
  • Broad-spectrum light therapy, antidepressants, or psychotherapy
28
Q

Is Major Depressive Disorder more prevalent in women?

A

Yes – 2x higher lifetime prevalence

29
Q

MDD Treatment

A
  • Psychotherapy
  • SSRI, MAO, TCAs
  • ECT is preferred therapy for refractory depression
  • Must be hospitalized if SI risk
30
Q

Anxiety becomes pathologic when…

A
  • Reaction is out of proportion to threat
  • Anxiety interferes with daily living
31
Q

Pathophysiology of anxiety

A

Involves the amygdala and is associated with increased activity of NE and decreased GABA and serotonin

32
Q

Do anxiety disorders affect more women than men?

A

Yes

33
Q

What is comorbid with GAD?

A

2/3 have comorbid depression
Many have another anxiety disorder

34
Q

What is age of onset for GAD?

A

Often before 20

35
Q

GAD Diagnostic Criteria

A
  • Excessive anxiety about various aspects of life
  • Present for more than 6 months
  • Unable to ease anxiety
  • Accompanied by three of following: feeling of being on edge, fatigue, difficulty concentrating, irritability, sleep disturbance (e.g. difficulty falling asleep, etc.), muscle tension
36
Q

GAD Treatment

A
  • CBT
  • Benzodiazepines
  • Busiprone (usually switched to from benzos to avoid dependency; however, the effects take 2 weeks to manifest)
  • SSRIs
  • SNRIs (e.g. venlafaxine)
37
Q

Manic Episode lasts at least 1 wek and incudes 3 of the following

A

D - Distractibility

I - Irresponsiblity - seeking pleasure witout regard to consequences

G - Grandiosity

F - Flight of ideas, racing thoughts

A - Increasen Activity/Agitation

S - Decreased need for slep

T - Talkativenes of pressured speech

38
Q

Like a manic episode, but mood disturbance is not severe enough to cuase marked impairment in social and/or occupational functioning or to necessitate hospitalization. NO psyhcotic features.

A

Hypomanic Episode

39
Q

Bipolar I

Bipolar II

A

At least 1 manic episode

At least 1 Hypomanic

40
Q

Tx of Bipolar

A

Lithium, Valproic Aci, Carbamazepine, Atypical Antipsychotics

41
Q

Dysthymia (chronic depression) and Hypomania Lasting at least 2 Years

A

Cyclothymic Disorder

Neurology (15 decks)

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