Questions on Apraxia and mental illness Flashcards
An inability to perform learned voluntary acts is called what?
[Apraxia]
What is the difference between verbal apraxia and dysarthria?
[Verbal Apraxia involves difficulty planning, sequencing and coordinating the movements necessary for speech. Dysarthria involves motor difficulty and poor articulation of speech phonemes. It results from impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm]
Which of the following is (are) considered to be a major mental disorders?
[Major mental disorders are those in the following categories: Mood disorders (major depressive disorder, dysthymia, post-partum depression) and thought disorders (schizophrenia, delusional disorder, schizoaffective disorder). Personality disorders (paranoid, schizoid, schizotypal, antisocial) are different and not generally considered major mental disorders.]
What are some of the symptoms that one would typically see in a patient experiencing anxiety?
[autonomic fight or flight symptoms such as panic, dry mouth, reduced blood flow to the gut, hyperventilation, agitation, and cognitive symptoms such as poor memory and reduced concentration.]
What are the common uses for Phenothiazines ?
[Phenothiazines – anti-psychotics for thought disorders such as schizophrenia
What are the common uses for MAO (monoamineoxidase) inhibitors?
[MAO (monoamineoxidase) inhibitors – used for treating depression, but not a first-line choice in this day and age. Generally someone will be tried on a SSRI initially to see if they are responsive to that medication. SSRIs have a safer side effect profile.
What are the common uses for SSRIs?
[SSRIs (selective serotonin reuptake inhibitor) – generally the first line treatment for depression, anxiety, and OCD because they have a nice safety profile and are effective in many people. There is a ‘black box warning’ associated with prescribing these as there is an increased risk of suicide in adolescents and young adults in the first few weeks of starting a SSRI. The SSRI blocks the presynaptic transporter SERT (SER-serotonin, T-transporter) that manages the reuptake of serotonin from the synaptic cleft leaving more extracellular serotonin to bind with the postsynaptic receptors.
What are the common uses for SNRIs?
[ SNRIs (selective norepinephrine reuptake inhibitor) – a common choice for treating depression, anxiety, and OCD if a SSRI is not effective or contraindicated for some reason. They increase the pool of serotonin and norepinephrine by blocking the reuptake of both via and SERT and norepinephrine transporter (NET).
What are the common uses for Benzodiazepines?
[ – generally used for treating severe bouts of anxiety, but someone with an anxiety disorder might be put on a SSRI or SNRI on a regular basis to see if they might reduce the overall level of anxiety.
What are the common uses for Tri-cyclic antidepressants?
[Tri-cyclic antidepressants - used for treating depression, but not a first-line choice. Generally someone will be tried on a SSRI initially to see if they are responsive to that medication. SSRIs have a safer side effect profile.
In chronic anxiety and depression, there is thought to be an increase in the activity of the hypothalamic–pituitary–adrenal (HPA) axis. What is the mechanism of action at play?
[Stress has a direct impact on the paraventricular nucleus of the hypothalamus, and on balance you get an increased release of corticotropin-releasing hormone (CRH) which has an impact on the pituitary and adrenal glands. With increased activity in the paraventricular nucleus and increased secretion of CFH you have subsequent increased secretion of ACTH from the pituitary and increased secretion of cortisol from the adrenal gland. In part this causes the hippocampus to become dysfunctional so that it no longer can help downregulate the release of cortisol leading to a self-propagating problem.]
Symptoms associated with anxiety include?
[Objective behaviors: nervousness; rapid breathing; agitation; motor restlessness, increased vigilance; racing heart (tachycardia). Subjective moods: terror, panic, fear of death, sense of depersonalization. Biological symptoms: dizziness, trembling, sweating, dry mouth, hyperventilation; due to sympathetic ANS activation. Cognitive: poor memory, poor concentration. Treatments: benzodiazepines (GABA), selective serotonin reuptake inhibitor (SSRI), corticotropin releasing hormone (CRH) receptor antagonists – block subsequent release of ACTH and cortisol
Symptoms associated with depression include?
[Objective behaviors: poverty of speech, tearfulness, paucity of movement, agitation, no eye contact, poor self-care. Subjective moods: hopelessness, low self-esteem, guilt, suicidal thoughts, anxiety, life not worth living, feelings of worthlessness, irritability, rumination, excessive worry over physical health. Biological symptoms: fatigue, insomnia (hypersomnia), loss of appetite (increased appetite), reduced libido, pain. Cognitive: poor concentration, memory. Treatments: drugs (with/w/o psychotherapy) monoamine oxidase inhibitors (MAOI, phenelzine), tricyclic antidepressants (imipramine), SSRIs (fluoxetine “prozac”; paroxetine “paxil”), SNRIs and Atypicals (bupropion “wellbutrin”), Ketamine hydrochloride (“ketalar”), ECT (electroconvulsive therapy) Approximately 100,000 patients annually receive ECT in the United States.
The most likely target for DBS in a person with depression is what?
[Subgenual anterior cingulate cortex. The subgenual anterior cingulate cortex (Cg, BA25) – hyperactivity in this area leads to the positive symptoms you see in a depressed person (disturbances of sleep, change in appetite, loss of libido). Mayberg argues that the hyperactivity in this region leads to a decrease in activity in the dorsolateral prefrontal cortex (dFr, BA9 & 46) – this leads to the negative symptoms seen in depression (apathy, deficit in attention, deficits in executive function). DBS quiets the hyperactivity in BA25 and results in normalization of activity in DLPFC and remission from depression in some patients.]
Symptoms associated with schizophrenia include?
[Objective behaviors: odd mannerisms, purposeless movements; talking to self as third person; auditory hallucinations. Subjective moods: lack of emotional responsiveness; violent expressions; delusions, paranoia. Biological symptoms: auditory, verbal hallucinations, motor disturbances. Cognitive: disorganized language; abnormal train of thought, not goal directed. Damage to circuitry of the dorsolateral prefrontal cortex, hippocampus, amygdala, nu. accumbens, has been established. Possibly due to dopamine regulation deficit, drug treatments include phenothiazines (thorazine, haloperidol) which block both DA receptors and DA release and newer atypicals include clozapine, risperidone, aripiprazole (Abilify).
