Pyschiatry II Flashcards
Which gene mutations are associated with schizo?
COMT/tyrosine hydroxylase/DA D2R/D3R
The ___ number of risk genes—->the high risk of getting schizo
Higher
Gene mutations that are responsible for hypofrontal activity of schizo?
COMT and DA D3R
Gene mutations that are responsible for hyper ventromedial cortex activity of schizo?
DA D2R/tyrosine hydroxylase/MAO
What are the significance of DA and NE in ADHD?
DA helps to block out out things/NE helps you to concentrate
Gene mutations that are associated with hypofrontal activity of ADHD?
DA D4/5R
What is the precursor of 5HT?
Tryptophan
5HT is from __ in the brain?
Raphe nuclei
Low 5HT causes hyperactivity in __ of the brain?
Amygdala
What gene mutations are associated with 5HT dysfunction?
5HT2a/5HTTLPR (reuptake transporter)/tryptophan hydroxylase
Where is NE originated in the brain?
Locus coeruleus
High NE gives you?
Hyperarousal/panic/worry
Dysfunction of what transmitters give you reduced + affect (loss of interest/happiness and what not)?
NE and DA
Dysfunction of what transmitters give you increased - affect (fear/irritability and what not)?
NE and 5HT
What is the brain activity of PTSD pt comparing with control?
High mid anterior cingulate and amygdala/low frontal activity
In MDD, what gene mutation is responsible for the increase NE and anxiety in limbic areas?
COMT Met alleles—>low degradation—>high NE (COMT Val alleles does the opposite)
What parts of the brain light up when you are empathizing?
Medial prefrontal cortex (hypoactive means you lack empathy)
Memorizing enhance or disrupt empathetic response?
Disrupt (maybe why doctors are not unempathetic when treating pts)
COMT is responsible for what transmitters?
DA and NE
What are the 3 methods under whole medical systems of CAM?
Ancient healing system/homeopathy (use small dose to stimulate self healing/naturopathy (like massage/exercise/acupuncture and what not)
What are some examples of mind-body medicine of CAM?
meditation and relaxation
What are some examples of biologically based practices of CAM?
Dietary supplements (vitamins) and herbal remedies
What are some examples of manipulative and body based practices of CAM?
chiropractic and osteopathic manipulation
What are some examples of energy medicine of CAM?
Qi gong
What is St John’s wort used for?
CAM for depression
Which vitamin deficiency is associated with depression?
D (so they say)
What cluster A of personality disorder?
Psychotic like—->paranoid/schizoid (detachment from social relationships)/schizotypal (odd)
What is cluster B of personality disorder?
Behavioral disorder—>antisocial (like conduct disorder)/histrionic (overly dramatic, attention seeking)/narcissistic (need for admiration/entitlement/risky disorder)/borderline (instability of relationships, moods, self image or thought)
What is cluster C of personality disorder?
Anxious—->avoidant (from social circumstances)/depdent/obsessive compulsive
Which cluster is more common in PD?
Cluster A and C
What happens if a child is deprived of maternal nurturing in the beginning? does parenting behaviors affect the risk of the children developing PD?
The child tends to become impulsive and aggressive/yes
What would you see if you follow PD pt over 4 years?
Some of them might not meet the PD criterion anymore (remission) but their impairment in functioning still persist
What is the treatment for cluster B?
mood stabilizers/antipsychotics/benzodiazepine might worsen the condition
What is DSM 5 definition of mania?
abnormally happy for over 1 week/3 symptoms of DTRHIGH for at least 2 weeks/cause dysfunction
What is DTRHIGH for mania?
Distractible/talkative/racing thoughts/hyperactive/impulsive/grandiose/hyposomnic
What is hypomania?
Mild mania/change in function and personality for at least 4 days/no psychosocial consequences
Can a biopolar pt be manic and depressed at the same time?
Ye, ‘tis called mixed episode
What is bipolar 1 disorder?
Must have mania/do not need to have depression
How frequent is rapid cycling of bipolar?
4 or more episodes per year
What is bipolar 2 disorder?
Must have hypomania/spend most of the time depressed
What is cyclothymia?
Minor depression/have hypomania for more than 2 years/from hypomania to minor depression—>crash and suicidal
What is dysthymia?
Chronic low level depression for 2 years
What is kindling hypothesis for mania and seizure disorder?
The more you get, the worse you get
You have ___ transmitter and ___ receptor when you are manic?
high/low
Which gender is more prone for bipolar 1 and 2?
equal for 1/more women for 2
Try not to use ___ when the pt is bipolar? what do we use instead and why?
Antidepressant/SGA/tune down mania and also has some built in antidepressant
Does psychotherapy work for mania?
Nein
What are some medication for bipolar 1?
Li/divalproex/carbamazepine/lamotrigine/SGA
What is the physical and psychological manifestations of anxiety?
physical—>hyperventilation/numbness and tingling in the extremities/sleep disturbance
psychological—>restlessness/worry/irritability
Is socially triggered panic attack considered as panic disorder?
Nein nein
What is the diagnostic criteria of anxiety disorder?
Persistent/interfere normal functioning/cause distress
Some causes of anxiety of disorder?
Trauma/personality/learned anxiety/30-40% genetic/more women than men
What transmitters are low for anxiety disorder?
5HT is low—>that’s why antidepressants works well/low GABA/high NE—>alert and freaking out
What is the DSM 5 diagnostic criteria for General Anxiety Disorder?
Persistent worrying about more than 1 event for at least 6 months/have at least 3 symptoms of anxiety
What do people who worry a lot sometime turn to?
Alcohol (or turkey but unlikely)
What do you treat GAD with?
CBT/antidepressant/buspirone (get rid of autoreceptor of 5HT)/benzodiazepine
GAGB allows more ___ channel to open?
Cl-
DSM 5 diagnostic of panic disorder?
Abrupt unexpected surge of intense fear within mins/have at least 4 symptoms of panic/recurrent/consequence and maladaptive change in behaviors
Diagnostic criteria for agoraphobia (panic disorder)?
anxiety for public space for over 6 months
Treatment for panic disorder?
CBT (systemic desensitization or flooding)/benzodiazepines/SSRI and SNRI
DSM 5 diagnostic criteria of specific and social phobia?
Specific—>disproportionate fear of something/avoid it/over 6 months
Social—>same thing but just afraid of being in social situation (fear of embarrassment and what not)
Treatment for phobia?
CBT (systemic desensitization and flooding)/SSRI or SNRI/MAOi
DSM 5 diagnostic criteria of OCD?
Obsessions and compulsions/time consuming/distress
What is the obsession and compulsion in OCD?
Obsession—>recurrent thoughts/urges that are intrusive and unwanted—>undo or neutralize them with a thought or action
Compulsion—>repetitive behavior in response to an obsession/reduce anxiety/insight
Which gender is more prone to OCD?
Equally
What is the worst anxiety disorder?
OCD
What syndrome usually comes with OCD?
Tourette’s syndrome
Treatment for OCD?
CBT (exposure and response prevention)/acceptance and commitment therapy therapy for obsession (desensitize thoughts)/high dose SSRI/clomipramine/benzo does not work
What is OCPD?
Anxiety without insight—>harder to treat
What are variables associated with PTSD?
proximity/harm by other ppl/severity/repetition
DSM 5 diagnostic criteria for PTSD?
Exposure to traumatic event (don’t have to be there)/symptoms over 1 month/distress/flashback/avoid stimuli/- change in cognition/jumpy/poor concentration and insomnia
DSM 5 diagnostic criteria for ASD?
Like PTSD but symptoms are from 3 days to 1 month
Treatment for PTSH and ASD?
Treat right away, don’t wait/relive or seal over events (eye movement desensitization and reprocessing)/SSRI/TCA/MAOi/prazosin for nightmares
What is mild Traumatic Brain Injury (TBI)?
disruption of brain function or focal neurological deficits/LOS
The most causes of TBI is ?
Fall
What is primary TBI?
From force of the impact
What is secondary TBI?
Ischemia/hypoxia/over time/magnify primary cause
What is diffuse axonal injury?
Focal lesion result from primary cause/shearing of brain tissue—>disruption of pathway in the midline structure
What is neurometabolic cascade after trauma?
Disruption of the homeostasis of energy supply and metabolism—>mismatch (low vascular supply and high demand)
Are the all the NTs level go up or down after TBI?
Go up
What are the 3 things Glasgow Coma Scale look for?
Eye opening/verbal response/best motor response (the hight the # the better)
What scale is used to track recovery of TBI?
Ranchos Los Amigos Level
What are the stages 1-6 of Ranchos Los Amigos Level?
Coma/vegetative state/minimally conscious/confusional (post traumatic amnesia)/post confusional (no amnesia/start therapy)/social competency (back to community)
Can you typically categorize the emotional and behavioral changes according to DMS 5 with TBI pts?
No, they come in small elements
What is post traumatic agitation and its treatment?
RLAS IV/agressive/akathisia
Treatment—>pindolo (beta blocker)/antiepileptic/SSRI or TCA/no FDA approved medication
What might be some emotional changes with TBI pts?
No awareness of inappropriate behaviors/depression and anxiety
PTSD is more common in mild or severe TBI?
Mild (even if you don’t remember the event)
What is dyssomnia?
Problem in timing/quality/amount of sleep
What is parasomnia?
Problems in physiology or behavior associated with sleep (abnormal stuff that happen to you at night)
What is the DSM 5 diagnostic criteria for insomnia?
Problem falling or maintaining sleep/wake up too early and can’t fall back to sleep/cause distress
Prevalence of insomnia increase with __?
Age
Causes of insomnia?
High excitatory NTs and low inhibitory NTs at night
Insomnia sometimes comes down to ___?
Anxiety—>worry about not be able to sleep—->then you don’t sleep
Withdraw of ___ drugs can cause insomnia?
Sedating drugs
Insomnia pts have a risk of ___ abuse
Alcohol/substance—>whatever helps to go to sleep
Insomnia management?
Diagnosis/behavioral counseling/sleep restriction therapy/drugs
Pharmacotherapy for insomnia?
Ramelteon and Tasimelteon (non habit forming)/zolpidem/benzo (habit forming)
Panic disorder/phobia/GAD/PTSD/OCD are all part of the ___ disorder?
Anxiety
