Unit_4_Psych, Mood, Personality, Addiction Disorder Flashcards
What is SIG E CAPS?
- Sleep (too much/too little)
- Interest (decrease)
- Guilt (increase)
- Energy (decrease)
- Concentration (decreased)
- Appetite (up/down)
- Psychomotor agitation/retardation
- Suicidal Ideation
What does SIG E CAPS describe?
a Major Depressive Episode
MDE
A major Depressive Episode requires _____1_____ or _____2_____ and at least _____3_____ of the criteria for at least 2 weeks, causing serious impairment in functioning.
- depressed mood
- diminished interest (anhedonia)
- needs 5/9 of the SIG E CAPS
What acronym describes Mania and Hypomania?
DIGFAST
What is DIGFAST?
- Distractibility
- Irritability/moody
- Grandiosity
- Flights of Ideas
- Activities (agitation or high risk for bad shit)
- Sleep (decrease need for)
- Talkativeness
What is hypomania?
> 4 days, not marked by impairment in functioning, not psychotic!
If a pt. is psychotic, can they also be hypomanic?
NO!
Hypomania is not ~ psychotic
What is Bipolar 1?
pt. must have MANIA, but ALSO have HYPOMANIA or a MDE.
What is bilpolar 2?
pt. only has HYPOMANIA and MDE
If a pt. only has a MDE, but no Mania or Hypomania, what is this called?
MDE.
simple as shit!
___________: hypomania and subsyndromal depression
Cyclothymia: hypomania and subsyndromal depression
___________: subsyndromal depression
Dysthymia: subsyndromal depression
To be consider Schizophrenia, how long must a Pt. have Sx?
> 6 months
What are the major Sx of Schizophrenia? (5)
- Delusions
- Hallucinations
- Disorganized thinking or speech
- Grossly disoranized or abnormal MOTOR behavior
- Negative Sx
What are negative Sx? (in general)
Sx of loss/decrease of func. i.e.:
- loss/decrase speech,
- flatten affect
- lack of emotions
- asocial
perception like experiences that occur without an external stimulus is known as?
Hallucinations
____________ disorder: if psychotic (Schizo) symptoms are present throughout, but mood symptoms are present majority of time = MDE + psychotic episode
Schizoaffective
What is the time-frame of Schizophreniform disorder?
> 1 month, but less than 6 months
If the pt. has Sx of Schizophrenia for less then one month, what can you call this?
Brief Psychotic disorder.
need to be >6 months for Schizophrenia.
1 month< Schizophreniform disorder <6 months
What are the two major Pharmacotherapy for Psychosis?
Typical & Atypical Anti-psychotics
What is the MOA of typical Anti-psychotics?
= 1st-gen.
Dopamine pathway; D2 antagonism
What is the MOA of ATYPICAL Anti-psychotics?
=2nd-gen.
Serotonin pathways
Psychosis: ?
Characterized by derangement of personality and loss of contact with external reality.
primarily a disorder in thinking.
With regards to Psychosis:
1) Hear voices and have other sensations that are not real = _____________.
2) Believe they are influenced by unseen forces around them = _______________.
3) Being tormented, harmed, followed, tricked, or spied on = _____________
4) Have other disorders in thought, typically idiosyncratic associations that are evidenced in disorganized speech or writing = ____________________
- Hallucinations
- Paranoid Delusions
- Persecutory Delusions
- formal thought disorder
The inability to discern what is real and not real, to think clearly, have normal emotional responses, and act normally in social situations is known as?
Schizophrenia
what are the positive Sx of Schizophrenia?
- Hallucinations, generally auditory.
- Delusions, belief that external forces conspiring against them.
What are the negative Sx of Schizophrenia?
- Inability to pay attention, loss of sense of pleasure, loss of will or drive, disorganized or impoverished thoughts and speech, flattened affect, social withdrawal.
- Cognitive deficits
What is the prevalence of Schizophrenia?
1% of world population; 2.4 million people.
What is the age of onset of Schizophrenia?
late adolescence, early adult. cont. on thru-out life.
manifests as early/dev behavioral dysfunction, social & educational difficulties.
What are the causes of Schizophrenia?
d/t multiple genes interacting with each other and the environment leading to disruption in normal brain dev.
What are some genetic causes of Schizophrenia?
high level of concordance between monozygotic twins.
- Polygenetic disorder
- NOT completely caused by genes!
What are some environmental causes of Schizophrenia?
virus, malnutrition post birth, birth complications, drug abuse (even weed), other unknown psychosocial factors.
What are some drugs that can cause Sx that resemble Schizophrenia?
- Dopamine agonism (cocaine, amphetamine)
- Norepinephrine agonism (cocaine, amphetamine)
- Serotonin agonism (hallucinogens, LSD)
- NMDA antagonism (dissociative anesthetics, phencyclidine, ketamine)
- Acetylcholine antagonism (anticholinergics, atropine)
What is the Dopamine theory of Schizophrenia?
dysreg of dopamine –> psychosis
What is the Glutamate model of Schizophrenia?
glutaminergic hypoactivity –> psychosis.
Glutamate binds dopamine neurons → produce regional hyperactivity and hypoactivity in dopamine neuron release
What regards to the Dopamine theory of Schizophrenia, the Mesolimbic System ~ ___________ Sx?
POSITIVE
What regards to the Dopamine theory of Schizophrenia, the MESOCORTICAL System ~ __________ Sx?
Negative
What regards to the Dopamine theory of Schizophrenia;
Mesolimbic system: dopamine neurons from the _____1_____ release dopamine to _____2_____ → regulate reward pathways and emotional processes associated with _____3_____ symptoms
- VTA
- Nucleus Accumbens
- POSITIVE
What regards to the Dopamine theory of Schizophrenia;
Mesocortical system: dopamine neurons from the VTA and _____1_____ release dopamine to _____2_____ → regulate areas involved in __________3___________ → NEGATIVE symptoms
- substantia nigra
- prefrontal cortex
- cognitive processing and motor control
w.r.t the glutamate model; Glutamate binds dopamine neurons → produce regional hyperactivity and hypoactivity in dopamine neuron release →
Persistent elevation of dopamine in nucleus accumbens (_____1_____ system) and decreases in dopamine release in prefrontal cortex (____2____ system)
- mesolimbic
2. Mesocortical
w.r.t the glutamate model; Glutamate binds dopamine neurons → produce regional hyperactivity and hypoactivity in dopamine neuron release →
Persistent elevation of dopamine in _____1_____ (mesolimbic system) and decreases in dopamine release in _____2______ (mesocortical system)
- nucleus accumbens
2. prefrontal cortex
What is the GAGAergic model of Schizophrenia?
reduced parvalbumin positive interneurons in laminar III of prefrontal cortex.
Reduced parvalbumin positive interneurons in laminar III of prefrontal cortex is which model of Schizophrenia?
GAGAergic model of Schizophrenia
What are the Main Neuropathological Findings in Schizophrenia? (4)
1) decreased size and packing density of pyramidal neurons in PFC
2) Reduced GABAergic interneuron proteins and neuronal function in layer III of DLPFC
Inhibitory interneuron deficit - in number, expression of various peptides and proteins, and migration from cortical subplate
3) Decreased dendritic spines and presynaptic axonal inputs
4) Decreased cortical gray matter and enlargement of lateral ventricles
What drug is most effective at Tx Schizophrenia at the Mesolimbic pathway?
1st gen Anti-Psychotics; most effective in reducing positive symptoms (delusions, hallucinations, disordered cognition)
__________ pathway: dopaminergic tract (substantia nigra → striatum)
Nigrostriatal
Nigrostriatal pathway plays a central role in what?
planned and coordinated movements
_______________ pathway: hypothalamic neuronal release of DA in pituitary → inhibit prolactin release*
Tuberoinfundibular
w.r.t. that symptomatology of psychoses, activation of 5HT2A receptors → __________ effects
hallucinatory
Where are 5HT2A receptors located?
5HT2A-R located on glutamate pyramidal neurons in cortical regions and on dopamine nerve terminals in striatum
What is the Epidem of mood disorders?
- Neuropsychiatric disease account for half of all causes of disability worldwide.
- Depression affects 120 million people worldwide
- Anxiety disorders are the most common psychiatric illness in the US followed by mood disorders.
w.r.t. Bipolar disorders, what are some characteristics of manic mood and behaviors?
euphora, grandiosity, pressured speech, impulsivity, excessive libido, recklessness, social intrusiveness, diminished need for sleep.
w.r.t. Bipolar disorders, what are some characteristics of DYSPHORIC mood and behaviors?
- depression
- Anxiety
- Irritability
- Hostility
- Violence
- Suicide
What are the subtypes of depression? (3)
- Atypical
- Psychotic
- Melancholic
What is Aytypical Depression?
mood reactivity, leaden paralysis, reverse neurovegetative Sx (increase appetite, wt. gain, hypersomnia)
What is Psychotic Depression?
often ~ auditory hallucinations, nihilistic delusions
What is Melancholic Depression?
mood worse in the morning.
early morning awakening
anorexia, wt. loss, guilt, psychomotor retardation
What is the ddX for Mood Disorders:
Mood Sx → Medical Illness ?
Endocrine, infections, CNS, metabolic disorders.
What is the ddX for Mood Disorders:
Mood Sx → Substance abuse ?
ocaine, alcohol, amphetamine/stimulants, hallucinogens, benzodiazepines
What is the ddX for Mood Disorders:
Mood Sx → ADRs of medications ?
- amantadine
- methyldopa withdrawal
- interferon
- steroids
- chemo agents
Is major depression d/t a chemical imbalance in the brain?
NO!!!!
there is no single area of brain pathogy
What is a main theory concerning Etiology and Pathophysiology of major depression?
Neurobiological vulnerability + genetics + general health status + Character/coping style + stressful life events → alteration of structure and function of emotion/cognition.
Altered gene expression of important neuronal growth factors
What are major neural circuitry thought to be involved in the etio and pathophys of major depression? (3)
- Frontal cortex and Hippocampus
- Striatum & Amygdala
- Hypothalamus
w.r.t. major depression, what is the frontal cortex and hippocampus ~w/ ?
memory, worthlessness, hopelessness, guilt, suicidality.
w.r.t. major depression, what is the Striatum & Amygdala ~w/ ?
anhedonia, anxiety, motivation
w.r.t. major depression, what is the Hypothalamus ~w/ ?
insomnia/hypersomnia, energy, appetite, libido
Is bipolar disorder more environmental or more genetic?
Bipolar = More Genetic
what are the gender risk factors for suicide?
Men = 79% of completed suicides,
but women attempt suicide 2-3x more often than men
What is the EpiDem of suicide?
- 11th leading cause of death in ALL AGES in the USA.
- 2nd leading cause of death for 25-34 year olds.
- 42,000 deaths annually
What is the dX criteria for a personality disorder?
Enduring pattern of inner experience and behavior that deviates markedly from expectations of individuals culture. In at least 2 areas:
1) Cognition: ways of perceiving and interpreting self, other people, and events
2) Affectivity: range, intensity, lability, and appropriateness of emotional response
3) Interpersonal functioning
4) Impulse control
What are some other consideration for the dX of a Personality Disorder?
Enduring pattern is inflexible and pervasive across a broad range of personal and social situations
Enduring pattern leads to significant distress or impairment in social, occupational, or other important areas of functioning
Pattern is stable and of long duration (in adolescence or early adulthood)
Not better accounted for as another mental disorder
Not due to physiologic effects of a substance or a general medical condition
There are ten DSM-5 personality disorders and the 3 clusters into which they are grouped. What is Cluster A called and what ware the associated personality disorders?
Cluster A: “Weird”
- Paranoid
- Schiziod
- Schizotypal
There are ten DSM-5 personality disorders and the 3 clusters into which they are grouped. What is Cluster B called and what ware the associated personality disorders?
Cluster B: “Wild”
- Antisocial
- Borderline
- Histrionic
- Narcissistic
There are ten DSM-5 personality disorders and the 3 clusters into which they are grouped. What is Cluster C called and what ware the associated personality disorders?
Cluster C: “Worried”
- Avoidant
- Dependent
- Obsessive-Compulsive.
Are Axes used in the DSM-5?
No.
What is a “Axis II” disorder?
personality disorder and intellectual disabilities.
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Paranoid
Paranoid: distrustful, suspicious
Vigilant, “The Survivor”
Cluster A
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Schizoid
Schizoid: interpersonal detachment
Solitary, “The Loner”
Diagnostic criteria:
Restricted range of expression of emotions, pervasive pattern of detachment from social relationships
Cluster A
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Schizotypal
Schizotypal: odd thoughts and behavior, interpersonal awkwardness.
Idiosyncratic, “The Different Drummer”.
Acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior
Cluster A
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Antisocial
Antisocial: disregard and violation of others rights
Adventurous, “The Challenger”.
Pervasive pattern of disregard/violation of rights of others
Cluster B
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Borderline
Borderline: instability of relationships, self image, effects.
Mercurial, “Fire and Ice”.
Often due to childhood abuse, problems with mentalizing.
Similar to bipolar disorder and PTSD
Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.
Cluster B
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Histrionic
Histrionic: emotionality and attention seeking
Dramatic, “Life of the Party”
Cluster B
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Narcissistic
Narcissistic: grandiosity and lack of empathy
Self-Confident, “Star Quality”
Cluster B
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Avoidant
Avoidant: worries of inadequacy and being judged negatively.
Sensitive, “The homebody”
Cluster C
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Dependent
Dependent: need to be taken care of.
Devoted, “The Good Mate”
Cluster C
What are the traits of the following DSM-5 Personality disorder and what cluster is it in?
Obsessive-Compulsive
Obsessive-Compulsive: orderliness, perfection, need to be in control.
Conscientious, “The Right Stuff”
Cluster C
What are the Sx of Alcohol withdrawal?
Tachycardia, diaphoresis, tremulousness.
Can be life-threatening!
What are the Sx of Opioid withdrawal
Muscle aches, nausea, lacrimation, rhinorrhea, pupillary dilation, piloerection, diarrhea - Not life threatening
T/F?
ADHD is a type of learning disorder.
FALSE!!
ADHD is NOT as learning disorder, intellectual disability, or oppositional behavior..
What are the three major types of ADHD?
- Hyperactive
- Inattentive
- Combined
Which type of ADHD is more common in girls?
Inattentive type
What type of ADHD in commonly undX?
Inattentive Type
Describe inattentive type ADHD:
- Fails to give close attention to details, difficulty sustaining attention.
- Doesn’t appear to listen, struggles to follow instructions.
- Difficulty with organization, avoids tasks with lots of thinking.
. Loses things, easily distracted, forgetful.
Describe hyperactive type ADHD:
- Fidgets, squirms, difficulty remaining seated.
- Difficulty engaging in activities quietly, talks excessively.
- Blurts out answers before questions have been completed, interrupts others, difficulty waiting or taking turns.
What are common comorbidities of ADHD?
substance abuse, anxiety disorders, depression, learning disorders, oppositional behavior
What drugs is the the standard of care for Tx of ADHD?
Stimulants.
Amphetamines: Adderall, Vyvanse
Methylphenidates: Ritalin, Concerta
Adderall, Vyvanse are what type of stimulants?
Amphetamines
Ritalin, Concerta are what type of stimulants?
Methylphenidates
Other than stimulants, what other drugs can you Tx ADHD with?
- Atomoxetine (Strattera)
- Bupropion (Wellbutrin)
- Alpha agonists (guanfacine, clonidine). Mostly affect hyperactive symptoms
__% of pt. continue to have ADHD Sx into adulthood?.
65%
In adults with ADHD; Hyperactivity tends to ____1____ with time
Inattentive symptoms, restlessness and impulsivity ____2____
- decrease
2. remain
____________ : fluctuating confusion, inattention, misperceptions (illusions or hallucinations)
Delirium: fluctuating confusion, inattention, misperceptions (illusions or hallucinations)
____________ : sleep-like state form which the patient can be aroused only by vigorous stimuli
Stupor: sleep-like state form which the patient can be aroused only by vigorous stimuli
____________ : sleep-like state where the patient is unresponsive to external stimuli, and there are no sleep-wake cycles
Coma: sleep-like state where the patient is unresponsive to external stimuli, and there are no sleep-wake cycles
____________ : where sleep-wake cycles are re-established but there is no sign of cognitive function
Vegetative state: where sleep-wake cycles are re-established but there is no sign of cognitive function
What are the non-REM stages of sleep?
- Stage 1
- Stage 2
- Slow Wave sleep
What is the REM stage of Sleep?
Active period of sleep with intense braine activity (20-30% of sleep).
- EEG is rapid and desynchronized .
-Rapid eye movements, decreased muscle tone, increased BP, pulse, and respirations
Most recallable dreams
During what stage of sleep can you best recall your dreams?
REM
Is REM sleep similar to the waking state?
YES! b/c EEG is rapid and desynchronized
What is the deepest level of sleep?
Slow wave sleep: deepest level of sleep, most difficult to arouse a person, people groggy several minutes after awakening
EEG has very slow delta waves
Night terrors, nocturnal enuresis can occur
What are the criteria for est. of brain death?
- Unresponsive
- Cerebrally modulated motor response are absent during application of painful stimulus.
- brainstem refelcs are absent (pupils, corneals, oculocephalic, oculovestibular, cough, gag, respiratory effort/apnea test)
4) All of the following must be present:
- Core body temp of 90F.
- Toxicology tests find no explanation for low neurological state.
- Adequate BP and pulse.
- No voluntary movements or response to pain.
What are two important ethical/legal/cultural issue that are present during the organ transplantation from a brain death or Cardiac death pt.?
- Surg team harvest the organ from the brain/cardiac death pt. may not be involved in the det. of death.
- documentation is important!
