Social Behavioral Week 4a Flashcards
Schizophrenia’s Genomics
C4 gene on chromosome 6
Schizophrenia Risk Factors
-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
Schizophrenia Mortality
increase in heart ds of 50%, reduced lifespan of 20 years
Schizophrenia Pathoohysiology
increased brain dopamine, loss of brain mass (dorsolateral prefrontal cortex deficit, enlarged ventricles, decreased temporal lobe), loss of brain connections, neurodevelopmental disorder
Schizophrenia Genetics
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
Schizophrenia Etiology
increased in higher latitude, influenza, borna ds virus, borrelia, toxoplasmosis, tretovirus, poliomyelitis
Schizophrenia Etiology
-schizophrenogenic mother: emotionally withholding, domineering, rejecting-conflicting verbal vs body language
Pathophysiology Dopamine Changes in Schizophrenia
Drugs that increase DA cause psychosis, DA elevated in untreated Schizophrenia
Serotonin (5HT) elevated in ___, and stimulates DA
Schizophrenia
Glutamate decreased in ___, may increase DA
-PCP blocks glutamate via NMDA receptor
Schizophrenia
GABA decreased in frontal and hippocampus (modulates DA and Glu)
Schizophrenia
Ach-Nicotinic decreased in frontal, hippocampus, thalamus, striatum
Schizophrenia
Cholinergic function associated with
memory
Norepinephrine decreased (may worsen negative sx)
Schizophrenia
Loss of superior temporal gyrus (Wernicke’s area) in Schizophrenia
associated with auditory hallucinations
Basal Ganglia Schizophrenia
movement and emotions, contributes to paranoia and hallucinations
Frontal Lobe Schizophrenia
difficulty in planning actions and organizing thoughts
Limbic System Schizophrenia
agitation
Occipital Lobe Schizophrenia
some disturbances to make it difficult to interpret complex images, motion, and reading emotion in others
Hippocampus Schizophrenia
mediates memory and learning that is intertwined and impaired in Schizophrenia
Schizophrenia Dx
Chronic illness (>6 months), deterioration from previous function level, complex sx (>2): hallucinations, delusions, speech disorganization, disorganized behavior, negative sx
Differential Dx Schizophrenia
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
Schizophrenia History
family hx, pregnancy hx, travel, substance use, personality and academic problems in childhood adolescence, hx of gross/fine motor, hx of traumatic brain injury
Recent Hx for Schizophrenia
cognitive problems, behavior problems, positive sx, social isolation, unable to manage complex challenges like college/military
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
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
Schizophrenia Laboratory
-CT/MRI, STD screening, CBC, urine drug screen, plasma drug levels, vitamin B12 level, thyroid functions
Schizophrenia Tx
housing, employment, social skills training, family education, counseling, self-support groups and activities (clubhouses)
Schizophrenia Acute Tx
-outpatient medical psychiatric care, psychotherapy, outreach and case mngment, medication
Schizophrenia Recovery Process
individual and group therapy, consumer drive support groups and clubhouses, experiential and developmental learning
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
First generation antipsychotics
-thorazine, haldo, mellaril, stelazine, prolixin, navane
AE of First Generation Antipsychotics
Anti-cholinergic, adrenergic and histaminic: sedation, CVD, GI, sexual AE, urinary retention, weight gain, dm
AE Clozapine
1% agranulocytosis, seizures, weight gain, dm
Second Generation Antipsychotics
clozapine, risperidone, paliperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, asenapine, iloperidone
2nd Generation Effectiveness
D2 blockade and more 5HT2 blockade, but weight gain, dm, premature death, stroke and pneumonia in elderly
Clozapine
superior to all other agents (FGA and SGA)
Olanzapine and Risperidone
more effective
Risperidone
significant movement problems, prolactin elevations, weight gain and dm
Olanzapine
less movement issues, more weight gain, more dm and dyslipidemia, sedation
Quetiapine
low level of movement issues, weight gain and dm, marked sedation and increasing abuse/overuse as ‘sleeper’
ziprasidone
very low level of movement problems, +/- weight gain and dm, may cause prolonged QT
Aripiprazole
partial DA agonist, 5HT effects, low movement effects, +/- weight gain/dm
Most risk of weight gain antipsychotics
clozapine, olanzapine
moderate risk of weight gain antipsychotics
quetiapine, risperidone
least risk of weight gain antipsychotics
aripiprazole, ziprasidone, ?haloperidol
Premature death risk in antipsychotics
antipsychotics
Future Schizophrenia Meds
-glutamate NMDA activators, dopamine modulators, 5HT modulators, cholinergic agonists
Disorders similar to what drugs: Schizophrenia, anhedonia, paranoia, compulsive behavior
cocaine and methamphetamine
Disorders similar to what drugs: anxiety, panic attacks, mania and sleep disorders
stimulants
Disorders similar to what drugs: delusions and hallucinations
LSD, ecstasy and psychedelics
Disorders similar to what drugs: depression and mood disturbances
alcohol, sedatives, sleep aids and narcotics
Disorders similar to what drugs: antisocial behavior
PCP and Ketamine
SSRIs effective in uncomplicated panic T/F
true
Prevalence of SUD in social anxiety disorder
48%
Prevalence of social anxiety disorder in SUD
20%
Tier 1: Straight Forward Ds
-short term anxiety (limited benzos), book depression (SSRI/NSRI), ADHD (stimulants/non-stimulants)
Tier 2
Chronic atypical depression and chronic anxiety and pain, developmental disabilities with OCD, stabilized bipolar
Tier 3
complex/safety, advanced experience
-chronic schizophrenia/psychosis, bipolar/OCD/substance, boderline personality disorder/chemical dependency/pain, poly SUD/mood dysphoria
If pt. was assigned to preferred modality what % improve
50%
If pt. prefers medication and given therapy what percent improve
7%
If pt. preferred therapy and got medications what percent improved
25%
Neurochemical Factors for Models of Cause/Pathology
TBI location and duration, in utero exposure/birth trauma, genetic, metabolic thyroid/dm, drug of abuse
Environmental Stress
trauma and response, attachment, developmental stage
SSRI’s Response
60% respond, 30% in remission
SSRI’s AE most common
60-70% sexual dysfunction (also have GI and agitation/sedation)
NSRI AE
more energy/agitation, still have sexual dysfunction
3 Options to block 5Ht2
Trazadone, mirtazepine and atypical antipsychotics
Mirtazepine MOA
blocks 5Ht2, 5Ht3 and Alpha2 antagonism
Buproprion MOA
NE and DA specific reuptake, help with anxiety unless you are a smoker
Buspirone MOA
partial agonist of 5HT, less sexual AE mild/moderate control of 5HT
TCAs AE
80% more dry mouth than arrythmias
Med to tx TICS/severe anxiety
typical antipsychotics
MAOIs
Parnate to Selegeline
GABA Specific
Valproic Acid/Topiramate, Lamictal, Gabapentin
Major Depressive Disorder Comorbidities
anxiety, pain, CVD, metabolic ds, SUD
MDD Tx Exercsie
-reverses hippocampal atrophy, releases endorphins
MDD Tx Sleep
-sleep deprivation decreases resiliency, circadian rhythm disturbance effect
Cognitive Behavioral Therapy
Thoughts->emotions->depression or behaviors->emotions->depression
BDNF low levels
more depression
MDD 5HT
stress response
MDD NE
arousal, energy levels
MDD DA
pleasure, concentration
MDD glutamate
increased in depressive states to facilitate overactivity of the stress response pathways