Psychiatry Flashcards
Schizophrenia is typically acute or chronic? tend to get better or worse?
Chronic/worse
What does psychosis mean?
A break from reality
3 hallmark symptoms of schizophrenia?
Hallucination/Delusion (false believe that are not correctable by facts)/Thought disorders
Compare with delirium or drug abuse, schizophrenia doesn’t have ?
Clouding of consciousness
Diagnostic criteria for schizophrenia?
2 or more following each with at least 1 month—>delusion/hallucination/disorganized or catatonic behavior/negative symptoms/disorganized speech
Loss of job or freedom or relationships
How long does the symptoms persist to be diagnosed as schizophrenia?
At least 6 months
What is schizoaffective and mood disorder exclusion?
Exclude symptoms that might be caused by other illness like depression or bipolar (in diagnosing schizophrenia)
What are positive symptoms regarding schizo?
Symptoms that are gained by the pt like delusion or hallucinations (response to antipsychotic)
What are negative symptoms (low DA in frontal lobe) regarding schizo?
Loss of behavior that we normally have like motivation/social skill/emotions and what not
What is catatonic schizo?
Stupor or extreme agitation
What is disorganized schizo?
incoherent speech/bizarre behaviors and what not
What is residual schizo?
All negative symptoms
Progression of schizo?
Prodromal—>psychotic—>residual (symptoms gets worse with every episode)
How much is contributed by genetic regarding schizo?
50%
Which gender is more prone to schizo?
Equal (age of onset is earlier for men)
The ___ you are on antipsychotic drugs, the more likely for you to develop tardive dyskinesia
Longer
___ at birth increase risk for later schizo
Viral infection
Schizo: low ___ activity resulting in ___ enlargement? and high activity in ___?
frontal lobe/lateral and 3rd ventricle/ventromedial cortex
What are the 2 theories for schizo?
Neuro degenerative/developmental problem
Symmetry or asymmetry for brain is normal? and you see __ in schizo pt?
Asymmetry is normal/symmetry
What amygdala finding for schizo?
Higher than normal activity when experiencing fear (everything is a threat! RUN!)
Schizo is from high or low DA in mesolimbic tract? (DA hypothesis)
High
Which area is DA originated in the brain?
Ventral tegmental area
What is DA hypothesis?
High DA in mesolimbic and low in mesocortical pathway—>affect tuberoinfundibular and nigrostriatal pathway when treating with DA
What is 5HT’s role in schizo?
High 5HT also produces symptoms like hallucination and delusion
Glutamate is excitatory or inhibitory in CNS?
Excitatory
What is the glutamate hypothesis?
NMDA receptor (glutamate receptor) sits on GABA internueron—>dysfunctional NMDA receptor—>low firing—>low stimulation of GABA—>less inhibition—>high DA—>schizo
What is the normal pattern of GLU-GABA-GLU-DA-limbic?
High GLU—>high GABA—>low GLU (2nd)—>low DA—>low DA in limbic
GLU-GABA-GLU-DA-limbic (+ symptoms) in schizo?
1st GLU dysfunction—>low GABA—>high 2nd GLU—>high DA in VTA—>high DA in limbic
Normal pattern of GLU-GABA-GLU-GABA-DA-frontal lobe?
2nd GLU is low—>2nd GABA is low—>DA is high in VTA—>high DA in frontal lobe—>alert
GLU-GABA-GLU-GABA-DA-frontal lobe (- symptoms) in schizo?
high 2nd GLU—>high 2nd GABA—>low DA in VTA—>low DA in frontal—> - symptoms
Does schizo pt has prominent mood symptoms?
No, otherwise the pt would be diagnosed with mood disorders (exception is schizoaffective disorder)
What’s the mechanism of antipsychotic?
Block D2 receptors in mesolimbic pathway
What is the front line treatment for antipsychotic, 1st or 2nd gen?
2nd gen (contraindicated with existing metabolic disorders)
What is injectable depot for antipsychotic?
Long lasting form that includes both 1st and 2nd gen
What treatment is offered when the schizo pt is not psychotic?
Psychotherapy like CBT or family
Premature birth is defined as less than __ weeks?
37 weeks
What score is used to predict the likelihood of the new born?
APGAR—>Appearance/pulse/grimace/activity/respiration (8-9 is normal)
Is baby blues pathological?
Nah, it’s quite normal
What is the rate of understanding of expressive language of the baby every year?
25% every year—>by age of 4, a person should be able to understand 100% of the kid’s expressive language
Social smile starts at ?
12 weeks (3 months)
Stranger anxiety starts at ?
9 months
___ in the first 3 years is important for the child’s later development?
Attachment and safe environment
What is Moro reflex?
Limbs extend when the infant is startled
What age should the child learn to say “No”?
2
What age should the child go to bathroom by themselves?
4-5
What age should the child be able to identify gender?
3
What age is parallel play and cooperative play for children?
under 3/around 4
Age when child develop self conscience/morality/empathy
6
Age when peers relationship becomes really important
7-11
Is it legal to provide minors with sexual counseling and contraception w/o parental knowledge?
Yes
What is Tourette’s syndrome?
Inherited involuntary tics/ADHD/OCD
Depression and suicide are more common in __ population?
Elderly
What is ADHD combined type?
Poor attention/hyperactive and impulsive
Is ADHD inattentive type easy to detect?
No, ppl just inattentive, some can get by
Symptoms must start before age __ to be able to be diagnosed with ADHD? and in ___ settings?
Before 12/2 or more settings
What is the diagnostic criterions for ADHD on DSM 5?
6 inattention symptoms and/or hyperactivity for 6 months that reduce functioning—>like loses things/forgetful
For ADHD, as you grow older, you lose ___ symptoms and just have ____ symptoms
lose hyperactivity and impulsivity/just have inattentive
How much of ADHD is attributed to genetics? what are some of the genes that are involved?
at least 76%/DA and NE genes
What is the neurodevelopmental delay theory of ADHD?
Proning of neurons happen later for ADHD pts—>that might be why some outgrow the hyperactivity and impulsivity
What is the MRI of ADHD pt look like comparing with control?
No activity in anterior cingulate/other parts of the brain are firing/brain is working inefficiently
In ADHD pts, __ and ___ have low activity in frontal cortex?
DA and NE
Environmental factors for ADHD?
smoking and alcohol in pregnancy/head injury/lead poisoning/how you were raised
What is the #1 disorder that ADHD pt also have?
Anxiety
Kids who are on ADHD medication stunt ___?
growth—>a bit shorter than they should be
What are the 3 non stimulant drugs for treating ADHD?
Atomoxetine (NE reuptake inhibitor)/Guanfacine and Clonidine (alpha 2 NE agonists)
What are the side effects of the non stimulant drugs for treating ADHD?
Sedative/the alpha 2 NE agonists lower BP
For preschool ADHD pt, how do you treat them?
Behavioral therapy first/can use amphetamines
How to treat children and teen ADHD pts?
Slow release methylphenidate first—>then slow release amphetamines—>if not then use immediate release stimulants—>lastly use non stimulants
How to treat adult ADHD pts?
Use non stimulants first—>if not then slow release methylphenidate or amphetamines—>lastly immediate release stimulants
What is the mechanism of guanfacine and clonidine?
Bind to alpha 2 receptor and increase GLU neuronal firing
What is the DSM 5 definition of major depression disorder?
5 of SIGME CAPS symptoms for 2 week period/must have either depressed mood or loss of interest
What is SIGME CAPS stand for?
Sleep/Interest/Guilt/Mood/Energy/Concentration/Appetite/Psychomotor/Suicidal
What is atypical depression?
Weight gain and hypersomnia/leaden paralysis (dragging through the day)
What is melancholic type depression?
Diurnal variation—>more depressed in the AM, better in the PM/anhedonia is key
What is masked depression?
Pts are stoic and do not realize that they are sad
What is the monoamine deficiency theory of depression?
Low monoamine—>low DA/5HT/NE
What is the monoamine receptor excess theory of depression?
Low level of transmitter—>high level of receptor—>neuronal firing decreases
What are some psychosocial factors for depression?
Resilience for stress/personality/low self-esteem
Successful treatment for depression ___ receptors?
Down-regulate
Low genetic risk/high genetic risk population seem similar when?
there are multiple episodes of depression
The more episodes of depression you have, the ___ you will get
worse
Stress increase glucocorticoids—->decrease ___ —->cause neuron atrophy
decrease brain neurotrophic factors
Increase 5HT and NE—->decrease glucocorticoids—>increase ___?
Increase brain neurotropic factors
Alpha 2 agonist in pre frontal cortex does?
Increase connection and improve cognitive function—>treat ADHD
After many episodes of depression—>atrophic neurons can or can not be rescued?
They can not be rescued
What parts of the brain has low level and what parts has high level for depression pt?
Low level in dorsolateral prefrontal cortex and high level in amygdala
List 3 reasons why women is more prone to have depression than men
MAO-A gene locates on X chromosome (women has 2 X)/estrogen stimulates 5HT—>loss estrogen—>low 5HT/women are better at communication—>more easy to detect depression
Which 5HT receptor is agonized and what are antagonized in treating depression?
5HT 1a is agonized and the rest are antagonized
How long does antidepressant need to start working?
About 8 weeks
How is shock treatment used for depression
Really effective/used for severe depression/lots of side effects
What are some neurostimulation techniques for depression?
Vagus nerve stimulation (like a pacemaker)/transcrainal magnetic stimulation (wave a magnet over your head)
What are the populations with highest suicide rate?
teen/middle age/older white dudes (most is middle age)
What are some precursor symptoms of suicide?
Insomnia/anxiety/irritability/hopeless
What is the risk triad for suicide?
Ideation/plan/intention
Which gender attempt suicide more and which succeed more?
Women attempt more/men succeed more
Which gender attempt suicide more and which succeed more?
Women attempt more/men succeed more
What seasons have higher suicide rate?
Spring and fall
What is the significance of short and long allele for 5HT reuptake pump regarding suicide?
s/s less resilience—>more prone to depression and therefore suicide
l/l is protective
What is victim-precipitated homicide?
Use other to kill you (e.g. by cops)
Can you detain suicidal pt against their wills? and will you be responsible if you fail to recognize that your pt is suicidal?
Yes and yes
Antidepressant might increase risk of suicide if you are age ___ and under
24
What can you give the pt to lower their suicide risk?
Antidepressant/lithium/clozapine
ADHD kids are more sensitive to immediate or distant reinforcers?
Immediate—>they do not like delayed gratification (I want it RIGHT MEOW!)
What is direct contingency management for ADHD behavioral therapy?
You do some good, you get some good, vice versa
What is incredible years program?
It is part of behavioral parent training for ADHD—>focus on parent-child interactions
What is incredible years program?
It is part of behavioral parent training for ADHD
What is the DSM 5 criterions for ODD (oppositional defiant disorder)?
At least 4 symptoms of angry/defiant/vindictive for at least 6 months (occurs with a person that is NOT a sibling)/has to cause distress in individual or ppl around him/reduce functioning
What is the DSM 5 criterions for ODD (oppositional defiant disorder)?
At least 4 symptoms from angry/defiant/vindictive for at least 6 months
What are the 3 specifiers for ODD?
Mild: happen in 1 setting/moderate: 2 settings/severe: 3 settings
ODD kids have the concept of ___ that makes them attribute incidences as hostile
Hostile attribution bias
What does problem-solving skills training focus on for ODD?
why do you think the other kid was hostile at you? what was the evidence? address hostile attribution bias
What is the DSM 5 criterions for conduct disorder?
At least 3 symptoms of aggression to ppl and animal/destruction of property/theft/violation of rules in the past 12 months (at least 1 in the past 6 months)/has to be problematic
What is the DSM 5 criterions for conduct disorder?
At least 3 symptoms of aggression/destruction of property/theft/violation of rules in the past 12 months (at least 1 in the past 6 months)
What are the specifiers for onset of conduct disorder?
Childhood onset: 1 symptoms before 10/teen: no symptoms before 10
Conduct disorder pt must have at least 2 symptoms of the following antisocial emotions
Lack of guilt/no empathy/don’t care about performance/low to no affect
What is multisystemic therapy for conduct disorder?
Addresses multiple levels—>individual/school/parents and so on
What is multidimensional treatment foster care for conduct disorder?
Take the kid out of the family and make him live in a foster care/treat parents to be better
What is multidimensional treatment foster care for conduct disorder?
Take the kid out of the family and make him live in a foster care/treat parents to be better
What is functional family therapy for conduct disorder?
understand the function of misbehaviors (why is he doing this)
What are the characteristics of Autism?
impair in social interaction and communication/lacking joint attention/limited interest (obsess with one thing)/really picky eater/repetitive movements/insist on routines
Autistic children has impairment in ___ and ___? and they are lacking ___ attention
social interaction and communication/lacking joint attention
What is the difference between Asperger’s and Autism?
Asperger has higher than normal IQ/Autism has a lower IQ
Autism is more prevalent in male or females?
Males
Diagnosis of Autism is from?
Multi modal assessment (observe the child in different settings in different areas)
Diagnosis of Autism is from?
Multi modal assessment (observe the child in different settings in different areas
What are the 3 criteria for diagnosing people with intellectual disability (ID)?
Low IQ/deficits in adaptive functioning (like communication or social skills)/start before 18/separated into mild, moderate, severe and profound (require assistance)
What are some challenging behaviors of Autism that are the reasons that these pts are put in a special residential places?
Self injury on purpose/destruction behavior/pica (eating non-nutritive things/pt is not a kid/eating is not a tradition)
What are some challenging behaviors of Autism that are the reasons that these pts are put in a special residential places?
Self injury on purpose/destruction behavior
What is complementary and alternative medical treatment (CAM)?
Treatment methods that are used for other things are used for Autism—>does not help
