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Schizophrenia, Depression & Anxiety Flashcards

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1
Q

Schizophrenia Spectrum

A

1% of U.S. population, 1 of 3 hospital beds
-costs $65 billion in treatment, family, and societal cost (including hospitals, institutions, law enforcement, judicial cost)

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2
Q

schizophrenia

A

catotonia: not moving, appear frozen
paranoia: someone out to get them (someone crazy like hitler)

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3
Q

DSM-V criteria for schizophrenia

A

at least 2 of the following symptoms last for at lease ONE month
-delusions (you are god-like), hallucinations, disorganied speech, disorganized or catatonic behavior, or negative symptoms (flat affect, avolition, anhedonia)

  • decrease in functioning: work, social, self-care
  • signs must be present for at least 6 months
  • other mood disorders must be ruled out
  • disturbance is not substance-induced or caused by physical factors
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4
Q

postive symptoms schizophrenia

A

delusions, hallucinations, disorganized speech, disorganized or catatonic behavior

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5
Q

negative symptoms schizophrenia

A

flat effect, lack of motivation, inability to experience pleasure, lack of logical thought

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6
Q

schizophrenia medication

A

phenothiazine used to deepen anesthia

  • chorpromazine (thorazine) used later that same year
  • produced a state of calm while maintaining consciousness
  • -called this neuroleptic state
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7
Q

Classification of Antipsychotic Drugs

A
  • traditional
  • atypical - (2nd generation)
  • third generation
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8
Q

Traditional

A

Thorazine, Compazine, Serentil

  • effective at reducing the positive symptoms
  • antagonist to dopamine receptors
  • also antagonist to acetylcholine, histamine, and norepinephrine
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9
Q

acetylcholine

A

memory

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10
Q

histamine

A

sedation

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11
Q

norepinephrine

A

sedation

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12
Q

traditional side effects

A
  • feeling of anxiety
  • neuroleptic-induced parkinson’s
  • *tremor at rest, limb rigidity, slowing of movement
  • tardive dyskinesia
  • *involuntary movements of the face, tongue, trunk, & limbs
  • *sucking and smacking of lips and twisting of the tongue
  • decrease cognitive function
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13
Q

Atypical

A

clozapine

  • relieves both the “positive” and “negative” symptoms
  • no motor effects
  • less cognitive impairment
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14
Q

Clozapine side effects

A
  • sedation
  • extreme weight gain
  • decreased WBC
  • immune function; can be fatal
  • discontinuation of use cause delusions, hallucinations, hostility and paranoia
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15
Q

Third generation

A

Aripiprazole (Abilfy)

  • works as both an agonist and antagonist to dopamine and serotonin
  • helps both the positive and negative symptoms
  • no serious side effects to date
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16
Q

A good prevention program should!

A
  • combine school and community based efforts
  • link prevention programs with school curriculums
  • involve the family and care givers
  • integrate system and agencies
  • increase funding for researchers and teachers
  • learn what is really happening at ground level!
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17
Q

What is the lifetime prevalence of schizophrenia?

A

1%

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18
Q

How many prescriptions for antipsychotic drugs were filled by U.S. pharmacies in 2011?

A

55,000,000

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19
Q

The primary mechanism by which all antipsychotic drugs control symptoms of psychosis is by antagonizing ______.

A

dopamine receptors

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20
Q

______ are false perceptions and ______ are false beliefs.

A

hallucinations, delusions

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21
Q

Which antipsychotic drug is most likely to be prescribed for children and adolescents?

A

risperidone

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22
Q

When was the first antipsychotic drug discovered? Was this

drug developed initially to treat psychosis?

A

Chlorpromazine was discovered in 1951. It was not devel- oped initially to treat psychosis. It was developed as an anesthetic in surgery.

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23
Q

What has been the trend in the number of inpatients in psychiatric hospitals in the United States over the last century?

A

The population in psychiatric hospitals was increasing until 1951, when chlorpromazine was introduced. After, the number of inpatients declined precipitously (even as the general U.S. population was increasing).

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24
Q

Currently, physicians are more likely to prescribe second- generation antipsychotics instead of first-generation anti- psychotics. Why does this occur? Does the scientific evi- dence support the view that second-generation antipsychotics are superior to first-generation antipsychotics?

A

The prevailing wisdom among physicians who prescribe second-generation antipsychotics is that there are reduced side effects with these drugs. However, recent large clinical trials have revealed that there appears to be little difference in effectiveness or side effects for either antipsychotic drug class. Both types control symptoms, and both may lead to serious side effects.

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25
Q

Chronic use of antipsychotic drugs can result in a syndrome that includes involuntary movements of the mouth, tongue, trunk, arms, and legs. This syndrome is called

A

tardive dyskinesia

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26
Q

all antipsychotic drugs decrease ______

A

dopamine

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27
Q

Which of the following are the most potent D2 receptor antagonists?

A

first-generation (traditional) antipsychotics

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28
Q

A Phase 1 clinical trial typically includes ______.

A

first-generation (traditional) antipsychotics

29
Q

Sally has been admitted to the hospital because she is experiencing psychotic symptoms. Her physician believes that schizophrenia is the cause of her symptoms and starts her on antipsychotic medication. When should she start to experience relief from her psychotic symptoms?

A

a few days

30
Q

An antidepressant drug has been available for sale for about a year. The FDA has been tracking suicides in adolescents who take this drug. They decide to put a black box warning on this drug given this data. Where did this data come from?

A

postmarketing testing

31
Q

Generic drugs typically cost ______ less than brand name drugs.

A

80%

32
Q

Fred and Jim both are experiencing symptoms of psychosis. A physician determined that the cause of Fred’s psychosis is drug-induced since he had recently taken a large dose of cocaine. A physician determined that the cause of Jim’s psychosis is due to the mental disorder of schizophrenia. What is the probable prognosis for these two individuals?

A

Fred’s prognosis is better than Jim’s prognosis. The cause of Fred’s psychosis is correctable. Once the cocaine leaves Fred’s body, his psychotic symptoms should abate, and he may not even need treatment with an antipsychotic drug. By contrast, Jim’s prognosis is more serious given that schizophrenia is typically a lifelong mental disorder that will probably require continuous antipsychotic drug treat- ment to keep symptoms under control

33
Q

Your mother goes to the pharmacy to fill a prescription. The pharmacist tells her that the brand-name drug will cost $32, while the generic version costs $4. She wants to save the money and take the generic, but she is worried that the brand-name drug will work better. What would you say to her?

A

You would tell her that the generic drug is a copy of the brand-name drug. The Food and Drug Administration (FDA) ensures that all generics are the same in terms of safety, strength, route of administration, quality, perfor- mance characteristics, intended use, and how dosing should occur.

34
Q

mental disorder

A

is a clinically significant behavioral or psychological syndrome with key features including distress, disability or impaired functioning, violation of social norms, and dysfunction.

35
Q

Psychotherapeutic drug

A

can be extremely helpful to patients, since these drugs decrease symptoms of depression, stabilize mood, or decrease anxiety

36
Q

Major depressive disorder

A

is a mental condition with symptoms including persistent sadness, loss of pleasure, decreased energy, feeling worthless, experiencing guilt, or withdrawal from others.

-risk of suicide`

37
Q

bipolar disorder

A

a mental disorder with symptoms including both depression and mania. mood is not stable but instead swings from one extreme to the other. Bipolar disorder has manic episodes, which are periods of significantly elevated mood and increased energy

38
Q

bipolar disorder symptoms

A

Significant activity levels, fast speech, decreased need for sleep, increased anxiety, and increased tension may be present. During a manic episode, the individual will act or think in atypical ways.

-risk of suicide

39
Q

generalized anxiety disorder

A

anxiety and worry persist across all contexts. These worries are excessive and long-lasting. The person may wake up worried, spend most of the day worried, and have difficulty falling asleep because of worry. The worries may be about relationships, health, finances, or daily hassles. Of course, constant worry is exhausting.

40
Q

signs of anxiety are chronicle, anxiety disorder may be present

A

muscle tension, sympathetic nervous system activity, apprehension, and increased vigilance

41
Q

Phobias

A

are disproportionate fears of an object or situation. The person is often aware that their fear is irrational but nevertheless goes to great lengths to avoid the phobic object or situation

42
Q

social anxiety disorder

A

individual fears unfamiliar people or social scrutiny

43
Q

posttraumatic stress disorder (PTSD)

A

When individuals are exposed to severe or chronic stress

44
Q

panic disorder

A

is an anxiety disorder not tied to a particular object or situation. Panic disorder is characterized by frequent panic attacks, which are sudden feelings of doom, apprehension, and terror. Resembles symptoms of a heart attack.

45
Q

panic attack

A

Heart palpitations, rapid breathing, chest pain, nausea, dizziness, lightheadedness, chills, sweating, and trembling are reported. The person may feel that he or she is losing control or dying

46
Q

Antidepressant drugs

A

psychotherapeutic drugs that reduce symptoms of depression. Persistent sadness, loss of pleasure, and decreased energy are symptoms of depression that abate with antidepressant drug treatment.

47
Q

antianxiety drugs

A

benzodiazepines (such as Xanax®, Ativan®, or Valium®)

48
Q

Benzodiazepines produce a calming effect

A

by increasing the activity of the inhibitory neurotransmitter, GABA, in the brain

49
Q

barbiturates

A

depressant drugs (commonly known as sleeping pills) were used to treat anxiety. However, use of barbiturates declined considerably after concerns arose about their use. While low doses of barbiturates decrease anxiety, higher doses of barbiturates can lead to general anesthesia, coma, and death. common to alc and opiates

50
Q

amygdala

A

structure in the center of the brain important for the regulation of strong emotions.
depressed=hyperactive

51
Q

Discontinuation syndrome

A

can occur for all types of anti- depressants, but it is more common with MAOIs. The most commonly reported symptoms include dizziness, nausea, vomiting, fatigue, chills, flu-like illness, sensory abnormalities, and sleep disturbances. The individual may experience crying spells, anxiety, irritability, and agitation.

52
Q

Worldwide, what is the approximate one-year prevalence rate for depression?

A

3%to5%

53
Q

The first psychotherapeutic medications used to treat mood and anxiety disorders were discovered in the

A

1950s

54
Q

Jordan is a combat veteran who served a tour of duty in Afghanistan. Since returning, he has experienced flashbacks of being in combat, nightmares, hyperarousal, and difficulty sleeping. Which diagnosis is most likely?

A

posttraumatic stress disorder

55
Q

Angelina is suffering from comorbid depression and anxi- ety. Her physician started her on an antidepressant drug, which she has taken as prescribed for about 7 days. At this point, Angelina would probably be experiencing:

A

side effects such as dry mouth and constipation

56
Q

Tolerance to the therapeutic effectiveness of antidepressants is typically observed with use that has occurred over

A

years

57
Q

The atypical antidepressants, such as Wellbutrin®, have a mechanism of action that is similar to the action of ______.

A

amphetamines

58
Q

Barbiturates are no longer used to treat anxiety disorders. When and why was use of barbiturates discontinued?

A

Barbiturates stopped being used to treat anxiety by the
1970s. Though popular in the 1950s and 1960s, these drugs were addictive and also led to too many accidental and intentional overdose deaths.

59
Q

What is the relationship between a country’s socioeconomic status and its rate of depression? Why might this relation- ship be observed?

A

Lower- to middle-income countries tend to have lower rates of depression than high-income countries. This counterintuitive relationship may be observed because for people living in developing countries, such as India and China, many individuals are poor. In the United States, there is great affluence and also great poverty. The poor in the United States may face the stark reality of their situation more often.

60
Q

Explain the relationship between antidepressant drug treatment and neurogenesis.

A

Depression, anxiety, and chronic stress can induce brain damage, as evidenced by neuronal death observed in struc- tures of the brain such as the hippocampus. Antidepressant drug treatment induces neurogenesis in the hippocampus. With several weeks of drug treatment, new neurons will form in this region of the brain. The timing of neurogenesis coincides with the long time that antidepressants must be taken before the patient reports beneficial symptom relief.

61
Q

Which psychotherapeutic drug is used prophylactically?

A

lithium

62
Q

Repeated use of which type of psychotherapeutic drug is most likely to result in tolerance development to its intended therapeutic effects?

A

benzodiazepines

63
Q

One concern with prescribing lithium is that ______.

A

the safety ratio is small

64
Q

A patient experiencing a manic episode is admitted to hospital. The patient is started on lithium but has been slow to respond. What other drug might also be used while the patient’s condition is difficult to manage (until the manic episode subsides)?

A

antipsychotic drug

65
Q

A patient experiencing a manic episode is admitted to hospital. The patient is started on lithium but has been slow to respond. What other drug might also be used while the patient’s condition is difficult to manage (until the manic episode subsides)?

A

GABA

66
Q

Focusing on the risk of overdose, which drug is the least safe?

A

barbiturate

67
Q

Mildred is 70 years old and has recently developed symptoms of generalized anxiety disorder. What medication would her physician likely prescribe for her? Be specific about ideal duration of action and dose when explaining your answer

A

Given Mildred’s age, her physician would likely prescribe a
short-acting benzodiazepine, but at a dose that would be less than would be prescribed for a younger patient. This choice would reflect the reduced metabolism capacity in elderly patients, especially for benzodiazepines.

68
Q

Every time you go to a party with your friend Stella, she tends to stay near the edge of the room and appears hesitant to join the group. What term describes this behavior, and what might this behavior reflect? What type of drug dis- cussed in this chapter might change her behavior?

A

Stella’s behavior is called thigmotaxis and might indicate anxiety. She may be experiencing some social anxiety. A benzodiazepine might change her behavior, making her more likely to leave the wall and interact with others.

69
Q

Elton has a prescription for a benzodiazepine. He also smokes, drinks alcohol, and sometimes snorts cocaine. Which recreational drug is most risky when combined with the benzodiazepine, and why?

A

Alcohol is the most risky drug to combine with the benzodiazepine because both are sedatives. When combined, they could suppress respiration, which could lead to a coma or even death.

Psychology (12 decks)

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