Schizophrenia/anx/OCD/trauma and stress Flashcards
Considerations in diagnostic criteria for schizophrenia
- schizophrenia is last in the diagnostic algorithm
- psychotic MDD and autism/bipolar
Diagnostic criteria for schizophrenia
- 2+ ~ delusions ~ hallucinations ~ disorganized speech ~ grossly disorganized or catatonic ~ negative symptoms AND ~ social occupational dysfunction ~ at least 6 mo ~ other schozioeffective disorders and depressive disorders excluded
Dopamine hypothesis
- mesolimbic: hyperdopaminergia-> positive symptoms
- mesocortical: hypodopaminergia-> negative symptoms
Nuclei involvement in schizophrenia
Mediodorsal nucleus
Pulvinar
- make connections to the prefrontal cortex
Structural abnormalities in schizophrenia
- enlarged ventricles
- decreased limb in abs hippocampus structures
- PFC
- MDN (thalamus)
- normal number of pyramidal cells, decreased arborization
Wisconsin card sorting test
Illustrates hypofrontality
Schizophreniform criteria
- normal presentation of schiz, but between 1-6 mo.
Brief psychotic disorder
- similar presentation to schiz, but 1 day - 1 mo.
Schizoaffective disorder
- schiz presentation but includes major depressive disorder AND a psychotic syndrome
- may be separated by instances
Delusional disorder
- non-bizarre delusions lasting greater/= than 1 month
- psychotic criteria not fully met
- other symptoms present briefly relative to delusion
Panic disorder
- recurrent, unexpected attacks which are intense and peak in minutes and include 4 of the physical symptoms
- at least one attack has been followed by a month of:
~ persistent concern about additional attacks
~ significant alteration of behavior to avoid - OFTEN associated with lines, having an appointment, feeling trapped
Common substance triggers of panic attacks
Methylxanthines Sympathomimetics MSG Stimulants Thyroid hormones Antipsychotics Withdrawal
Drug triggers of panic
- ABCs
- a2 blocker (yohimbine)
- beta agonists (IsoproTERRORnol)
- CO2 (false suffocation alarm)
- Sodium Lactate
Panic disorder trt
- SSRIs, SNRIs (titrate up)
- TCAs effective but nasty (cardiotoxicity)
- Buspirone works for GAD but NOT panic disorder
Agoraphobia
- being in places they can’t escape, being outside or alone
GAD
- majority of days spent in worry or anxiety for at least 6 mo
- cant stop
- social functional impairment
- oft includes tension, conc lapse, sleep disturbances, restless fatigue, irritability
GAD trt
- SSRIs/SNRIs first line (TCAs effective but nasty)
- Buspirone
- benzos (effective but addicting)
- antihistamines
- psychodynamic and behavioral therapy
Social anxiety disorder
- marked by performance, potential scrutiny or humiliation
- attacks triggered
- duration for 6 mo +
Social anxiety trt
- therapy first line over drugs
- cog/BH
- social skill dev
- systematic desensitization
- SSRIs, SNRIs, MAOIs
Phobias
- blood runs in blood
- flooding
- benzo for acute attack
Separation anxiety
- in kids: 4 week duration, in adults 6 mo
- excessive worry about loosing attached persons, kidnapping et al
OCD definitions
- Compulsion: impulses/thoughts that are intrusive, causing anxiety or distress
~ not about actually worrying things - Obsession: repetitive behaviors they are driven to perform
~ acts are aimed at reducing stress (contamination fear: excessive hand washing)
OCD neuroassociative conditions
- head trauma
- huntingtons
- Sydenham’s chorea
- epilepsy
OCD trt
- behavioral therapy
- response prevention
- SSRIs improve therapy efficacy
- ECT
- cingulotomy
Body dysmorphic disorder
- preoccupation with one or more perceived flaws
- excessive mirror checking/grooming (causes impairment)
- NOT eating disorder
Hoarding (presentation, etiology)
- stress associated with throwing anything away
- predominantly female, tends to be familial
Trichotillomania/excoriation
- compulsively pulling out ones hair
- much more often in females
- skin-picking
- stopping -> distress. More in females
Trauma and stress disorders (5)
PTSD Acute stress disorder Reactive attachment disorder Disinhibits social engagement disorder Adjustment disorder
PTSD criteria
- Reexperiencing intrusive symptoms
- efforts to avoid thoughts and feelings
- negative alterations in cognitions or mood (selective amnesia, exaggerated negative beliefs)
- arousal symptoms
- duration of > 1 Mo
- more likely in kids
Bio abnormalities in PTSD
- decreased REM
- hypo-pit axis dysreg
- NE and 5HT
- reduced hyppocampal volume
PTSD trt
- trt symptoms NOT disorder
- SSRIs for depressive assoc, benzos for panic, beta blockers may reduce incidence of development, prazosin for nightmares
- psychotherapy and group
Acute stress disorder criteria and trt
- similar presentation to PTSD, 3 days - 1 month following trauma
- highest rates among interpersonal events like rape
- cog/BH -> reduces risk of PTSD development
- benzos, beta blockers
Reactive attachment disorder
- inhibited, emotionally withdrawn, not seeking comfort from adult care givers when distressed
- minimal social and emotional and resp to others, limited positive affect
- between 9 mo and 5 years
Disinhibited social engagement disorder
- child has no reticence in approaching strangers
- not limited to impulsive behavior
- assoc with extreme insufficiency of care
Disruptive mood disorder and premenstrual dysmorphic disorder time frame
- at least 1 year with cycling symptoms
~ DMDD: three times a week
~ PMDD: at least 4 mo
