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Social Behavioral > Social Behavioral Week 4a > Flashcards

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
Q

Schizophrenia Dx Examination

A

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

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26
Q

Schizophrenia Dx Exam 2

A

disorganized thought and speech, associations are loose, ideas may be very complicated, idiosyncratic, even bizarre, suspicious ideas, poor insight, odd movements

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27
Q

Schizophrenia Laboratory

A

-CT/MRI, STD screening, CBC, urine drug screen, plasma drug levels, vitamin B12 level, thyroid functions

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28
Q

Schizophrenia Tx

A

housing, employment, social skills training, family education, counseling, self-support groups and activities (clubhouses)

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29
Q

Schizophrenia Acute Tx

A

-outpatient medical psychiatric care, psychotherapy, outreach and case mngment, medication

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30
Q

Schizophrenia Recovery Process

A

individual and group therapy, consumer drive support groups and clubhouses, experiential and developmental learning

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31
Q

SAMSHA TX Schizophrenia

A

-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

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32
Q

First generation antipsychotics

A

-thorazine, haldo, mellaril, stelazine, prolixin, navane

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33
Q

AE of First Generation Antipsychotics

A

Anti-cholinergic, adrenergic and histaminic: sedation, CVD, GI, sexual AE, urinary retention, weight gain, dm

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34
Q

AE Clozapine

A

1% agranulocytosis, seizures, weight gain, dm

35
Q

Second Generation Antipsychotics

A

clozapine, risperidone, paliperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, asenapine, iloperidone

36
Q

2nd Generation Effectiveness

A

D2 blockade and more 5HT2 blockade, but weight gain, dm, premature death, stroke and pneumonia in elderly

37
Q

Clozapine

A

superior to all other agents (FGA and SGA)

38
Q

Olanzapine and Risperidone

A

more effective

39
Q

Risperidone

A

significant movement problems, prolactin elevations, weight gain and dm

40
Q

Olanzapine

A

less movement issues, more weight gain, more dm and dyslipidemia, sedation

41
Q

Quetiapine

A

low level of movement issues, weight gain and dm, marked sedation and increasing abuse/overuse as ‘sleeper’

42
Q

ziprasidone

A

very low level of movement problems, +/- weight gain and dm, may cause prolonged QT

43
Q

Aripiprazole

A

partial DA agonist, 5HT effects, low movement effects, +/- weight gain/dm

44
Q

Most risk of weight gain antipsychotics

A

clozapine, olanzapine

45
Q

moderate risk of weight gain antipsychotics

A

quetiapine, risperidone

46
Q

least risk of weight gain antipsychotics

A

aripiprazole, ziprasidone, ?haloperidol

47
Q

Premature death risk in antipsychotics

A

antipsychotics

48
Q

Future Schizophrenia Meds

A

-glutamate NMDA activators, dopamine modulators, 5HT modulators, cholinergic agonists

49
Q

Disorders similar to what drugs: Schizophrenia, anhedonia, paranoia, compulsive behavior

A

cocaine and methamphetamine

50
Q

Disorders similar to what drugs: anxiety, panic attacks, mania and sleep disorders

A

stimulants

51
Q

Disorders similar to what drugs: delusions and hallucinations

A

LSD, ecstasy and psychedelics

52
Q

Disorders similar to what drugs: depression and mood disturbances

A

alcohol, sedatives, sleep aids and narcotics

53
Q

Disorders similar to what drugs: antisocial behavior

A

PCP and Ketamine

54
Q

SSRIs effective in uncomplicated panic T/F

A

true

55
Q

Prevalence of SUD in social anxiety disorder

A

48%

56
Q

Prevalence of social anxiety disorder in SUD

A

20%

57
Q

Tier 1: Straight Forward Ds

A

-short term anxiety (limited benzos), book depression (SSRI/NSRI), ADHD (stimulants/non-stimulants)

58
Q

Tier 2

A

Chronic atypical depression and chronic anxiety and pain, developmental disabilities with OCD, stabilized bipolar

59
Q

Tier 3

A

complex/safety, advanced experience
-chronic schizophrenia/psychosis, bipolar/OCD/substance, boderline personality disorder/chemical dependency/pain, poly SUD/mood dysphoria

60
Q

If pt. was assigned to preferred modality what % improve

A

50%

61
Q

If pt. prefers medication and given therapy what percent improve

A

7%

62
Q

If pt. preferred therapy and got medications what percent improved

A

25%

63
Q

Neurochemical Factors for Models of Cause/Pathology

A

TBI location and duration, in utero exposure/birth trauma, genetic, metabolic thyroid/dm, drug of abuse

64
Q

Environmental Stress

A

trauma and response, attachment, developmental stage

65
Q

SSRI’s Response

A

60% respond, 30% in remission

66
Q

SSRI’s AE most common

A

60-70% sexual dysfunction (also have GI and agitation/sedation)

67
Q

NSRI AE

A

more energy/agitation, still have sexual dysfunction

68
Q

3 Options to block 5Ht2

A

Trazadone, mirtazepine and atypical antipsychotics

69
Q

Mirtazepine MOA

A

blocks 5Ht2, 5Ht3 and Alpha2 antagonism

70
Q

Buproprion MOA

A

NE and DA specific reuptake, help with anxiety unless you are a smoker

71
Q

Buspirone MOA

A

partial agonist of 5HT, less sexual AE mild/moderate control of 5HT

72
Q

TCAs AE

A

80% more dry mouth than arrythmias

73
Q

Med to tx TICS/severe anxiety

A

typical antipsychotics

74
Q

MAOIs

A

Parnate to Selegeline

75
Q

GABA Specific

A

Valproic Acid/Topiramate, Lamictal, Gabapentin

76
Q

Major Depressive Disorder Comorbidities

A

anxiety, pain, CVD, metabolic ds, SUD

77
Q

MDD Tx Exercsie

A

-reverses hippocampal atrophy, releases endorphins

78
Q

MDD Tx Sleep

A

-sleep deprivation decreases resiliency, circadian rhythm disturbance effect

79
Q

Cognitive Behavioral Therapy

A

Thoughts->emotions->depression or behaviors->emotions->depression

80
Q

BDNF low levels

A

more depression

81
Q

MDD 5HT

A

stress response

82
Q

MDD NE

A

arousal, energy levels

83
Q

MDD DA

A

pleasure, concentration

84
Q

MDD glutamate

A

increased in depressive states to facilitate overactivity of the stress response pathways

Social Behavioral (2 decks)

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