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Social Behavioral Week 4a Flashcards

1
Q

Schizophrenia’s Genomics

A

C4 gene on chromosome 6

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2
Q

Schizophrenia Risk Factors

A

-family hx, perinatal complications/infx, late winter/early spring births have higher likelihood of schizophrenia, international setting, higher rates in NE and W, immigration of second generation higher risk, use of stimulant/hallucinogenic drugs and marijuana

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3
Q

Schizophrenia Mortality

A

increase in heart ds of 50%, reduced lifespan of 20 years

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4
Q

Schizophrenia Pathoohysiology

A

increased brain dopamine, loss of brain mass (dorsolateral prefrontal cortex deficit, enlarged ventricles, decreased temporal lobe), loss of brain connections, neurodevelopmental disorder

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5
Q

Schizophrenia Genetics

A

10-12x higher risk in first degree relative, .5-1% in general population versus 3-7% in first degree relative, 40-50% in MZ twins

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6
Q

Schizophrenia Etiology

A

increased in higher latitude, influenza, borna ds virus, borrelia, toxoplasmosis, tretovirus, poliomyelitis

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7
Q

Schizophrenia Etiology

A

-schizophrenogenic mother: emotionally withholding, domineering, rejecting-conflicting verbal vs body language

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8
Q

Pathophysiology Dopamine Changes in Schizophrenia

A

Drugs that increase DA cause psychosis, DA elevated in untreated Schizophrenia

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9
Q

Serotonin (5HT) elevated in ___, and stimulates DA

A

Schizophrenia

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10
Q

Glutamate decreased in ___, may increase DA

-PCP blocks glutamate via NMDA receptor

A

Schizophrenia

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11
Q

GABA decreased in frontal and hippocampus (modulates DA and Glu)

A

Schizophrenia

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12
Q

Ach-Nicotinic decreased in frontal, hippocampus, thalamus, striatum

A

Schizophrenia

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13
Q

Cholinergic function associated with

A

memory

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14
Q

Norepinephrine decreased (may worsen negative sx)

A

Schizophrenia

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15
Q

Loss of superior temporal gyrus (Wernicke’s area) in Schizophrenia

A

associated with auditory hallucinations

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16
Q

Basal Ganglia Schizophrenia

A

movement and emotions, contributes to paranoia and hallucinations

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17
Q

Frontal Lobe Schizophrenia

A

difficulty in planning actions and organizing thoughts

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18
Q

Limbic System Schizophrenia

A

agitation

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19
Q

Occipital Lobe Schizophrenia

A

some disturbances to make it difficult to interpret complex images, motion, and reading emotion in others

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20
Q

Hippocampus Schizophrenia

A

mediates memory and learning that is intertwined and impaired in Schizophrenia

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21
Q

Schizophrenia Dx

A

Chronic illness (>6 months), deterioration from previous function level, complex sx (>2): hallucinations, delusions, speech disorganization, disorganized behavior, negative sx

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22
Q

Differential Dx Schizophrenia

A

Other psych disorders (mood/ASD), SUD (amphetamines, etc), General medical disorder (brain tumor, metabolic/endocrine/infx/neurologic),steroids, anticholinergics, disulfiram, dementia, shizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, note–schizotypal personality

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23
Q

Schizophrenia History

A

family hx, pregnancy hx, travel, substance use, personality and academic problems in childhood adolescence, hx of gross/fine motor, hx of traumatic brain injury

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24
Q

Recent Hx for Schizophrenia

A

cognitive problems, behavior problems, positive sx, social isolation, unable to manage complex challenges like college/military

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25
Schizophrenia Dx Examination
PE unremarkable, special attention to movement (soft neuro signs, look for neuro illness, baseline tx), odd behavior/dress/hygiene, oreintation intact, affect flat /odd/incongruent
26
Schizophrenia Dx Exam 2
disorganized thought and speech, associations are loose, ideas may be very complicated, idiosyncratic, even bizarre, suspicious ideas, poor insight, odd movements
27
Schizophrenia Laboratory
-CT/MRI, STD screening, CBC, urine drug screen, plasma drug levels, vitamin B12 level, thyroid functions
28
Schizophrenia Tx
housing, employment, social skills training, family education, counseling, self-support groups and activities (clubhouses)
29
Schizophrenia Acute Tx
-outpatient medical psychiatric care, psychotherapy, outreach and case mngment, medication
30
Schizophrenia Recovery Process
individual and group therapy, consumer drive support groups and clubhouses, experiential and developmental learning
31
SAMSHA TX Schizophrenia
-assertive community tx for heavy utilizers of hospital (high-intensity case management, support, medical), integrated tx for mental illness and SUD, family psychoeducation, illness management and recovery, supported employment
32
First generation antipsychotics
-thorazine, haldo, mellaril, stelazine, prolixin, navane
33
AE of First Generation Antipsychotics
Anti-cholinergic, adrenergic and histaminic: sedation, CVD, GI, sexual AE, urinary retention, weight gain, dm
34
AE Clozapine
1% agranulocytosis, seizures, weight gain, dm
35
Second Generation Antipsychotics
clozapine, risperidone, paliperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, asenapine, iloperidone
36
2nd Generation Effectiveness
D2 blockade and more 5HT2 blockade, but weight gain, dm, premature death, stroke and pneumonia in elderly
37
Clozapine
superior to all other agents (FGA and SGA)
38
Olanzapine and Risperidone
more effective
39
Risperidone
significant movement problems, prolactin elevations, weight gain and dm
40
Olanzapine
less movement issues, more weight gain, more dm and dyslipidemia, sedation
41
Quetiapine
low level of movement issues, weight gain and dm, marked sedation and increasing abuse/overuse as 'sleeper'
42
ziprasidone
very low level of movement problems, +/- weight gain and dm, may cause prolonged QT
43
Aripiprazole
partial DA agonist, 5HT effects, low movement effects, +/- weight gain/dm
44
Most risk of weight gain antipsychotics
clozapine, olanzapine
45
moderate risk of weight gain antipsychotics
quetiapine, risperidone
46
least risk of weight gain antipsychotics
aripiprazole, ziprasidone, ?haloperidol
47
Premature death risk in antipsychotics
antipsychotics
48
Future Schizophrenia Meds
-glutamate NMDA activators, dopamine modulators, 5HT modulators, cholinergic agonists
49
Disorders similar to what drugs: Schizophrenia, anhedonia, paranoia, compulsive behavior
cocaine and methamphetamine
50
Disorders similar to what drugs: anxiety, panic attacks, mania and sleep disorders
stimulants
51
Disorders similar to what drugs: delusions and hallucinations
LSD, ecstasy and psychedelics
52
Disorders similar to what drugs: depression and mood disturbances
alcohol, sedatives, sleep aids and narcotics
53
Disorders similar to what drugs: antisocial behavior
PCP and Ketamine
54
SSRIs effective in uncomplicated panic T/F
true
55
Prevalence of SUD in social anxiety disorder
48%
56
Prevalence of social anxiety disorder in SUD
20%
57
Tier 1: Straight Forward Ds
-short term anxiety (limited benzos), book depression (SSRI/NSRI), ADHD (stimulants/non-stimulants)
58
Tier 2
Chronic atypical depression and chronic anxiety and pain, developmental disabilities with OCD, stabilized bipolar
59
Tier 3
complex/safety, advanced experience -chronic schizophrenia/psychosis, bipolar/OCD/substance, boderline personality disorder/chemical dependency/pain, poly SUD/mood dysphoria
60
If pt. was assigned to preferred modality what % improve
50%
61
If pt. prefers medication and given therapy what percent improve
7%
62
If pt. preferred therapy and got medications what percent improved
25%
63
Neurochemical Factors for Models of Cause/Pathology
TBI location and duration, in utero exposure/birth trauma, genetic, metabolic thyroid/dm, drug of abuse
64
Environmental Stress
trauma and response, attachment, developmental stage
65
SSRI's Response
60% respond, 30% in remission
66
SSRI's AE most common
60-70% sexual dysfunction (also have GI and agitation/sedation)
67
NSRI AE
more energy/agitation, still have sexual dysfunction
68
3 Options to block 5Ht2
Trazadone, mirtazepine and atypical antipsychotics
69
Mirtazepine MOA
blocks 5Ht2, 5Ht3 and Alpha2 antagonism
70
Buproprion MOA
NE and DA specific reuptake, help with anxiety unless you are a smoker
71
Buspirone MOA
partial agonist of 5HT, less sexual AE mild/moderate control of 5HT
72
TCAs AE
80% more dry mouth than arrythmias
73
Med to tx TICS/severe anxiety
typical antipsychotics
74
MAOIs
Parnate to Selegeline
75
GABA Specific
Valproic Acid/Topiramate, Lamictal, Gabapentin
76
Major Depressive Disorder Comorbidities
anxiety, pain, CVD, metabolic ds, SUD
77
MDD Tx Exercsie
-reverses hippocampal atrophy, releases endorphins
78
MDD Tx Sleep
-sleep deprivation decreases resiliency, circadian rhythm disturbance effect
79
Cognitive Behavioral Therapy
Thoughts->emotions->depression or behaviors->emotions->depression
80
BDNF low levels
more depression
81
MDD 5HT
stress response
82
MDD NE
arousal, energy levels
83
MDD DA
pleasure, concentration
84
MDD glutamate
increased in depressive states to facilitate overactivity of the stress response pathways

Social Behavioral (2 decks)

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