week 1 Flashcards
What is an explanatory model?
How the patient understands the disease through: Different across cultures. They guide thinking about psych processes.
- etiology
- illness belief
- symtom expression
- effective treatment
What is harmful dysfunction?
Harmful- is a term based on social norms
Dysfunctional- is a scientific term referring to failure
What is a psychiatric disorder?
Lies at the boundary between the natural biological world and constructed social world.
- both social and biological
Major Depressive Disorder DSM-5 basis?
At least 5 of following 9 symptoms that last at least 2 weeks. There must be patient reported depressed mood or anhedonia!
- depressive episodes may last 6-12 months
What the 9 symptoms of depression?
SIG E CAPS
- Depressed mood
- Sleep disturbance (increase/De)
- Loss of Interest (anhedonia)
- Guilt or feeling of worthlessness
- Energy loss and fatigue
- Concentration problems/indecisiveness
- appetite/weight changes
- Psychomotor retardation or agitation
- SI
What is Persistent Depressive disorder (DYSTHYMIA)?
Depression which is usually more mild and last a least 2 years. Plus symptoms: -Under or over-eating -Insomnia or hypersomnia -Low energy -Low self-esteem -Poor concentration or indecision -Hopelessness
What were the cognitive map of depressive symptoms across culture groups?
- Pacific northwest american indian psych clinic outpatients
- middle class adult psych clinic outpatients
- psych residents
What did the cognitive map show?
That all 3 groups had a different description of depression even their psychiatrists. This means that the all have different explanatory models for explaining illness and distress.
Etiology of MDD?
- Major depressive disorder is the result of a biochemical imbalance
- Results from interaction of psychic trauma and physiological mechanisms
What do Haitian Blacks and Pentecostalist Catholics believe causes MDD?
- Supernatural intervention
- gods retribution for moral transgression
Example of MDD as a symptom vs a disorder?
Hmong usually take a year to grieve the loss of a loved one. With behavioral and dietary proscriptions
what are precipitating circumstances?
Certain situations that expose a person to pathogens or agents of illness
- for Depression you have job loss, divorce, family conflict and chronic illness
what is the biomedical model for treatment of MDD?
Anti-depressant meds and psychotherapy
- CBT
- SSRI’s
- SNRI’s
- Mirtazapine
- bupropion
What are some alternative models of treatment for MDD?
Asians: acupuncture and herbs
Europeans: homeopathic/naturopathic meds
Christian- Faith healing
Biobehavioral health comorbidities?
- Schizt and substance about are the norm
- SA, trauma, depression and SI for american indians
ADHD 4 vs 5?
4- before the age of 7
5- several were present before the age of 12
- multiple settings
- no psychosis, depression or anxiety
What are the types of ADHD?
- Inattentive- struggles to sustain focus
- Hyper/impulsive- talks loud, interrupts, jumps around
Most common is mixed for boys and inattentive for gils
- hyper/impulsive= least
- 3:1 boys to girls
Family or genetic precursors to ADHD?
- In utero exposures to (Nicotine/EHOH/Weed)
- Birth Traumas (nuchal chord/extended hypoxia
- Frontal lobe trauma (TBI, mercury, heavy metals)
What is Oppositional defiant disorder (ODD)?
Enduring a pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms.
-TREAT: CBT or other psychotherapy
What is conduct disorder?
Repetitive and pervasive behavior violating the basic rights of others or societal norms.
Ex: Aggression to people and animals, destruction of property or theft.
-After 18 many of the pts meet the criteria for antisocial personality disorder
TREAT: CBT or other psychotherapy
What is separation anxiety disorder?
Common age between 7-9.
Fear of separation from home or loss of attachment figure. May lead to factitious physical complaints to avoid going or staying at school.
TREAT: CBT, play therapy and family therapy
What is the DDX for ADHD?
Learning disorders behavior disorders anxiety disorders mood disorders psychotic
Medical work up for ADHD?
- Neuro, EEG, seizures, TIC/Tourettes, migraines
- BMB for endocrine, thyroid and DMD
- drugs
- sleep disorders
What is tourettes syndrome?
Onset b4 18- ADHD/OCD association
Sudden, rapid, recurrent, nonrhythmic, stereotypes motor and vocal tics that persist for > 1 year!
TREAT: psychoeducation, behavioral therapy
What is Coprolalia?
Involuntary obscene speech.
Present in only 10-20% of Tourettes syndrome pts
What are some tests for ADHD?
Self report from ideally 3 teachers.
Processing speed and working memory vs IQ!
What are Cloninger Dimensions for ADHD?
Increased risk taking
decreased harm avoidance
Reward dependence
ADHD can present with other disorders, what are they?
- depression
- anxiety
- aggressive behaviors
- tic disorders
What the stages of treatment for ADHD?
Stage 0-6 0- Nonpharm 1- methylphenidate and amphetamines 2- the other 3- atomoxetine or A +amp 4- Buproprion or TCA 5- the other 6- alpha agonist
Pharmacotherpy for ADHD?
- Ritalin or long acting Concerta
- Dextroamphtamine sulfate like DEXEDRINE
- Amphetamine and dextroamphetamine (mixed amphetamine salts) (ADDERALL)
- Dexmethylphenidate (FOCALIN XR) which just an isomer of methyphenidate
What are some long acting biphasic products for ADHD?
Adderall XR
Ritalin LA/SR
Metadate
Focalin
What are some continuos treatments for ADHD?
Concerta
Daytrana patch
Vyvanse
What are some non-stimulant treatment and what stages are they used to treat?
3 and 4 - Atomoxetine (strattera) -non FDA atypical antidepressants - Bupropiron (Wellbutrin/Zyban) - Venlafaxine (Effexor) - Duloxetine (Cymbalta) of note Effexor has a more potent and shorter action on 5-HT thus he choses Cymbalta for SNRI's
What are used to treat stages 4 and 5?
TCA’s where 20-80% present with cardiac arrythmias and chlingergic SE
What are cholinergic SE’s?
What happens with you block cholinergics or parasympathetics.
Present with dry mouth, constipation, sedation and orthostatic HoTN
- desipramine
-imipramine
-amitriptyline and nortriptyline
-Mirtazepine
What is used to treat stage 6?
Alpha 2 Agonists: blood pressure agents used to calm hyperactivity, impulsivity and little focus
- Clonidine (Catapres)
Guanfacine (Tenex)
What can be used to treat both anxiety and ADHD?
Atomoxetine
