Week 5/7 Flashcards
describe overall bipolar disorders + characterized as
- mental health conditions characterized by periodic, intense emotional states affecting a person’s mood, energy, ability to function
- these periods last from days to weeks, and are called mood episodes
1) manic/hypomanic
2) depressive episodes
while ppl w/o bipolar disorder experience mood fluctuations, mood changes that are commonly lived experience typically last a few hrs rather than days, and are not accompanied by extreme changes in behaviour or changes in functioning (ADL, social interactions, work, school, etc).
bipolar 1 diagnosis diagnosis
at least one manic episode
* the lifetime experience of a major depressive is NOT a requirement
1) inflated self-esteem or grandiosity
2) decreased need for sleep
3) more talkative than usual or pressur eto keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility, as reported or observed
6) increase in goal-directed activity or psychomotor agitation
7) excessive involvement in activities that high potential for painful consequences
manic episodes
- period of at least one wk for most of the day, everyday
- extremely high-spirited or irritable, possess more energy than usual, and experiences at least 3 of the following behaviours
1) inflated self-esteem or grandiosity
2) decreased need for sleep
3) more talkative than usual or pressur eto keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility, as reported or observed
6) increase in goal-directed activity or psychomotor agitation
7) excessive involvement in activities that high potential for painful consequences
mania and psychosis of bipolar 1
mania and psychosis
- approx 50-95% of ppl w bipolar disorder experience psychosis
- psychotic features usually appear during manic rather than depressive episodes
- mood congruent delusions (ex: grandiosity) and mood incongruent (ex: paranoia) are the most common psychotic feature
- hallucinations and vivid perceptions are also common (typically auditory)
initial euphoria of mania gives way to agitation and irritability. utter exhaustion eventually happens, and many people ultimately collapse into depression.
*depression and the agitated state of mania is a dangerous combination that can lead to extreme behaviours such as violence and suicide
what constitutes a manic episode + how many manic episodes are required for BP1
A) a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 wk and present most of day nearly every day.
B) during period of mood disturbance and increased energy or activity 3+ of these sympt are present:
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility as reported or observed
- increase in goal-directed activity or psychomotor agitation
- excessive involvement in activities have a high potential for painful consequences
C) mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D) episode is not attributable to the physiological effects of a substance or another med condition
what is bipolar 2
expressed at least one hypomanic episode and at least one major depressive episode
what is classified as hypomania
- persistently increased energy or activity levels
- same symptoms as mania, except less severe
- short duration (may last only 4 days)
- does not cause significant impairment
- never accompanied with psychotic features
for bipolar 2 what is classified as a major depressive episode
5+ of the symptoms (at least one is 1 or 2)
1 depressed mood
2. diminished interest in activities
3. significant wt loss or gain
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue/loss of energy
7. feelings of worthlessness or guilt
8. decreased concentration/indecisiveness
9. suicidal ideation/attempt
what is a main thing surrounding hypomanic episode
not attributable to the physiological effects of a substance or another medical condition
s/s of a manic episode
- high energy or excessive activity
- overly good mood
- irritability or impatience
- fast erratic takling
- racing thoughts
- inability to concentrate
- little need for sleep
- feelings of power
- poor judgement
- reckless spending
- high sex drive
- alcohol or drug abuse
- aggression
- refusal to admit there is a problem
what is cyclothymic disorder
- has symptoms of hypomania alternating w symptoms of mild to moderate depression
- at least 2 yrs in adults and 1 yr in children
- hypomanic and depressive symptoms do not meet criteria for either bipolar 1, bipolar 2, or major depression
- symptoms are disturbing enough to cause social and occupational impairment
individuals w this tend to have irritable hypomanic episodes and children w this experience irritability and sleep disturbances
rapid cycling
what is rapid cycling
have at least 4 changes in mood episodes in a 12 month period
can occur within the course of a month or even in a 24 hour period
bipolar 1 disorder summary
- mania
- persistently elevated, expansive, or irritable mood and persistently increased activity or energy that is present for most of the day, nearly every day, for a period of at least 1 wk - neither psychosis not the lifetime experience of major depressive episode is a requirement
summary of bipolar 2 disorder
- requires at least 1 or more episodes of major depression and at least one hypomanic (milder form of elevated mood than mania) episode
summary of cyclothymic disorder
at least 2 yrs of both hypomanic and depressive periods without every fulfilling the criteria for an episode of mania, hypomania, or major depression
cannot have had a manic or depressive episode
bipolar disorders genetic
- risk for individuals w an affected parent is 15-30% higher
- concordance rate among identical twins is around 70%
neurobiological bipolar disorder etiology
- neurotransmitters (dopamine, NE, serotonin) causal factors w mania and depression. too few = depression, too much = mania.
- though recent research shows the complexity of the neurotransmitter sys and it is not as simple as too much or too little.
brain structure and function + bipolar disorder
functional imaging shows dysfunction in prefrontal cortex, hippocampus, and amydala
what 10 classes of drugs cause substance related and addictive disorders + why is this
alc, caffeine, cannabis, hallucinogens (LSD), inhalants, opioids (heroin), sedatives, hypnotics, stimulants (cocaine), tobacco
taken in excess have a common direct activation of brain reward sys - this is involved in reinforcement of behaviours and production of memories
produce intense activation of the reward system - pharmacological reward pathway are diff for each drug
what are substance use disorders
- encompass broad range of behaviours from problematic use (binge drinking), to substance dependence
- substance use is best thought as a behavioural disorder: use of substance becomes conditioned, underlying change in brain circuits persist beyond detoxification, results in compulsive drive to use which render the choice not to use more and more difficult
- acute intoxication states of particular substances can constitute a life-threatening medical emergency
- diagnosis can be applied to all 10 substances except caffeine
4 behavioural characteristics of substance dependence
- impaired control
- takes more than should
- express desire to cut down
- spend great deal of time obtaining substance, using, or recovering
- daily activities revolve around substance
- craving substance - social impairment
- failure to fulfill major role obligations at work, school, home - risky use
- use in situations where it is physically hazardous - increased dosing
- requiring more of the substance over time to achieve desired effects
opioid withdrawal timeline tell me about it
start - take last dose
72 hrs - physical symptoms peak (chills, fever, body aches, diarrhea, insomnia, muscle pain, nausea, dilated pupils)
1 wk - physical symptoms start to lessen (tiredness, sweating, body aches, anxiety, irritability, nausea)
2 wk - psychological and emotional symptoms (depression, anxiety, irritability, restlessness, trouble sleeping)
1 mo - cravings and depression (symptoms can linger for wks or months)
8 principles of harm reduction
- accept that drug use is apart of our world
- drug use is complex, multi-faceted phenomenon
- success is not necessarily cessation, focus on quality of life
- non-judgemental and non-coercive care
- ensure those who use drugs or have history w drugs have a voice in policy/program creation
- PWUD are primary agents of reducing their drug use
- realities of social inequalities affect both people’s vulnerabilities to and capacity for dealing w drug-related harm
- do not minimize or ignore the harm and danger associated w illicit drug use
side effects of opioids
drowsiness and confusion
itchiness
constipation
n/v
tolerance, dependence, addiction
resp depression
list of common opioids
- morphine
- hydromorphone (dilaudid)
- oxycontin/oxycodone (percocet)
- fentanyl
- carfentanil
- suboxone/sublocade
- methadone
- heroin
- codeine
what is fentanyl
is an opioid that can cause dangerously slow breathing, leading to overdose or death.
More toxic than other opiods
Can get a persription
Analgesic
Also can be produced illegally - and can be mixed w other drugs - dealers and whatnot try to get ppl hooked and addicted
Opioid naïve individuals are at very high risk of overdosing
Seemingly mixed in more and more street drugs
There is no quality control in illegal labs - where they can be made
Making it more dangerous - and leading to unprecedented amount of side effects
how much more potent is fentanyl to heroin
20-40%
why is fentanyl dangerous
- can’t smell, see, or taste it
- 50-100x more toxic than morphine
- anything can be cut w fentanyl
what is carfentanil
synthetic opioid 100x more toxic than fentanyl and is not intended for human use
Not for human use, but for vet use
Labs have redesigned it for human use
signs of opioid overdose
tiny pupils
no or slow breathing
snoring, gurgling, vomiting
cold or clammy skin
does not respond
blue or purplish lips or fingernails
nasal spray naloxone
- non-addictive
- ready to use, needle-free
- concentrated 4 mg dose
- targets opioids specifically
- widely available for free, no prescription needed
- provides opportunity for engagement on substance use using compassionate harm reduction approach
how does naloxone reverse overdose
has stronger affinity to opioid receptors than opioids, such as heroin or oxycodone, so it can known the opioids off the receptors for a short time (30-90 min). allows person to breathe again and reverse the overdose
5 steps to responding to opioid overdose
- try and wake person up
- call 911
3 give naloxone - perform rescue breathing and CPR
- are they awake and breathing
- recovery position
side effects of naloxone
- increased bp
- muscle, bone, joint pain
- headache
- nasal dryness
- nasal swelling, pressure, nasal congestion
- could lead to opioid withdrawal
opioid withdrawal s/s
body aches
diarrhea
fast hr
agitation
fever
runny nose
sweating high bp
yawning
nausea
shivering or chills
sneezing
abdo cramps
goosebumps
what do anxiety disorders share features of
excessive fear
- fear is emotional response to real or perceived imminent threat
- anticipation of future threat
- persons response to anxiety can be maladaptive or adaptive
describe mild anxiety
- norm experience in everyday living
- allows an individual to perceive reality in sharp focus
- sees, hears, and grasps more information and problem solving becomes more effective
- may experience slight discomfort, restlessness, irritability, or mild-tension-relieving behaviour (nail biting, foot tapping, etc.)
describe moderate anxiety
- perceptual field narrows and some details are excluded from observation
- sees, hears, and grasps less info and may demonstrate selective inattention
- tension, pounding heart, increased HR, BR, voice tremors, shaking
severe anxiety
- perceptual field greatly reduced
- may focus on one particular detail or many scattered details and has difficulty noticing their environment even when pointed out
- behaviour becomes automatic (wringing of hands, pacing)
- nausea, dizzy, insomnia, trembling, hyperventilation, experience impending dread/doom
what is panic
- unable to process environment and lose touch w reality, could even experience hallucinations
- pacing, running, shouting, withdrawal, erratic, uncoordinated, impulsive
what is social anxiety disorder
(social phobia)
fearful or anxious about or avoidant of social interactions and situations involving possibility of being scrutinized
what is panic disorder
recurrent unexpected panic attacks and is persistently concerned or worried about having more panic attacks or changes his or her behaviour in maladaptive ways bc of the panic
what is agoraphobia
- fear and anxiety about 2 or more of the following:
- using public transportation, being in open spaces, being in enclosed places standing in line or being in a crowd, or being outside of the home alone.
Generalized anxiety disorder
- persistent and excessive anxiety and worry about various domains of life, including work and school performance, that the individual finds difficult to control
physical symptoms: restlessness, feelings keyed up or on edge, being easily fatigued, diff concentrating, mind going blank, irritability, muscle tension, sleep disturbance
how long do you have to have had anxiety to be characterized as generalized anxiety disorder
for at least 6 mo
generalized anxiety disorder diagnostic criteria
A) excessive anxiety and worry occuring more days than not for at least 6 mo, about a number of events or activities
B) individual finds it difficult to control the worry
C) anxiety and worry are associated with 3 or more of the following:
1) restlessness or feeling keyed up or on edge
2) being easily fatigued
3) difficulty concentrating or mind going blank
4) irritability
5) muscle tension
6) sleep disturbance
D) anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
E) disturbance is not attributable to physiological effects of substance or a medical condition
F) disturbance is not better explained by another mental disorder, contamination or other obsessions in OCD, separation from attachment figures in separation anxiety, reminders of traumatic events in PTSD, gaining wt, physical complaints in somatic symptom disorder, etc…
describe OCD
characterized by the presence of obsessions and/or compulsions
obsessions
recurrent and persistent thoughts, urges, images that are experiences as intrusive and unwanted
compulsions
repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
5 subtypes of OCD
- contamination obsessions with cleaning compulsions
- obsessions w/o visible compulsions
- hoarding
- symmetry obsessions w ordering compulsions
- harm obsessions w checking compulsions
OCD diagnostic criteria
A) presence of obsessions, compulsions, or both:
obsessions are defined by (1) and (2):
1) recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
2) individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them w some other thought or action
compulsions are defined by (1) and (2)
1) repetitive behaviours or mental acts that individuals feel driven to perform in response to an obsession or according to rules that must be applied rigidly
2. behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B) obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
what are personality disorders
long-term patterns of behavior and inner experiences that differs from what is expected
begins by late adolescence or early adulthood and causes distress or problems in functioning
personalities affect at least 2 of what areas
- way of thinking about oneself and others
- way of responding emotionally
- way of relating to other people
- way of controlling one’s behaviour
describe Cluster A personality disorders
(odd or eccentric)
includes paranoid, schizoid, schizotypal
describe Cluster B personality disorders
(dramatic, emotional, erratic)
includes antisocial, borderline, histrionic, narcissistic
describe Cluster C personality disorders
includes avoidant, dependent, obsessive-compulsive
general personality disorder criteria
A) enduring pattern of inner experience and behaviour that deviates markedly from expectations of individual’s culture manifested in 2 or more of:
1) cognition
2) affectivity
3) interpersonal functioning
4) impulse control
B) enduring pattern is inflexible and pervasive across a broad range of personal and social situations
C) enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of funcitoning
D) pattern is stable and of long duration and its onset can be traced back to at least to adolescence or early adulthood
E) enduring pattern is not better explained as a manifestation or consequence of another mental disorder
F) enduring pattern not attributable to physiological effects of a substance or another medical condition
paranoid personality disorder
- pattern of being suspicious of others and seeing them as mean or spiteful
- often assume people will harm or deceive them and don’t confide in others
Cold, distant, suspicious, can’t see their role in conflict, project paranoia as anger
Pattern of internal feeling and external behaviour
Schizoid Personality disorder
- pattern of detachment from social relationships and expressing little emotion
- typically does not seek close relationships, chooses to be alone, and seems to not care about praise or criticism from others
cold distant, introverted, intense fear of intimacy, and closeness
schizotypal personality disorder
pattern of acute discomfort in close relationships, cognitive or perceptual distortions and eccentricities of behaviour
cold distant and introverted, intense fear of intimacy, disordered thinking (look like schizophrenia, but less intense and intrusive)
antisocial personality disorder
pattern of disregard for, and violation of, the rights of others
borderline personality disorder
- intense fear of abandonment or instability, diff tolerating being alone, inappropriate anger, impulsiveness, and swings that pushes others away
- may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger or have ongoing feelings of emptiness
trouble keeping stable relationships, mood are inconsistent, never neutral, black and white sense of reality, lacked nurturing growing up, so they want caretaking from other-manipulation (feel abandoned), can lead to compulsive behaviours
narcissistic personality disorder
pattern of grandiosity, need for admiration, lack of empathy
(lack of empathy, exploit others who fail to admire them)
histrionic personality disorder
- pattern of excessive emotionality and attention seeking
- may be uncomfortable when they are not the center of attention, use physical appearance to draw attention to them have rapidly shifting or exaggerated emotions
avoidant personality disorder
pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
sensitive to rejection, avoid situations with any conflict (fear driven), become disturbed by their own social isolation
dependent personality disorder
pattern of submissive and clinging behaviour related to excessive need to be taken care of
can’ care for themselves, hard time making decisions
obsessive-compulsive personality disorder
- pattern of preoccupation w orderliness, perfectionism, and control
- may be overly focused on details or schedules, may work excessively not allowing time for leisure or friends, or may be inflexible in their morality and values (NOT the same as OCD)
adverse to change, bothered by disrupted routines, anxiety with completing asks, become uncomfortable in situations beyond their control
personality change due to another med condition
persistent personality disturbance that is judged to be due to the direct physiological effects of med condition (ex: frontal lobe lesion)
what are feeding and eating disorders
persistent disturbance of eating or eating related behaviour that results in altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning
anorexia
refuse to maintain height-weight ratio, intense fear of getting weight
-waxes and wanes chronic illness (high relapse potential)
50% 1-year relapse rate
bulimia
binge eating-self-induced vomiting, diuretics, excessive exercise (disturbances in body shape and weight)
binge eating
eat a lot then feel distressed
PICA
dirt, chalk, yarn, and glue (no nutritional value - starts early childhood and lasts some months, could be harmful (toxic), obstruction
anorexia nervosa diagnostic criteria
A) restriction of energy intake relative to requirements, leading to a significantly low body wt in context of age, sex, developmental trajectory, and physical health
B) intense fear of gaining wt or becoming fat, or persistent behaviour that interferes w wt gain, even though at a significantly low wt
C) disturbance in way in which one’s body wt or shape is experienced, undue influence of body wt or shape on self-evaluation, or persistent lack of recognition of the seriousness of current low body wt
2 types of anorexia nervosa
F50.01 Restricting type
- during last 3 mo individual has not engaged in recurrent episodes of binge eating or purging behaviour. this subtype describes presentations in which wt loss is accomplished primarily through dieting, fasting and/or excessive exercise
F50.02 Binge eating/purging type
- during last 3 mo had binging or purging episodes that were recurrent
F50.02 Binge-eating/purging type
during last 3 mo, the individual has engaged in recurrent episodes of binge eating or purging behaviour (ex: self induced, vomiting or misuse of laxatives, diuretics, or enemas)
bulimia nervosa diagnostic criteria
A) recurrent episodes of binge eating. characterized by:
- eating in a discrete period of time, an amount of food def larger than what most individuals would eat in a similar period of time under similar circumstances
- sense of lack of control over eating during the episode
B) recurrent inappropriate compensatory behaviours in order to prevent wt gain, such as self induced vomiting; misuse of laxatives, diuretics, fasting, excessive exersize
C) binge eating and inappropriate compensatory behaviours both occur, on avg, at least once a wk for 3 mo
D) self eval is unduly influenced by body shape and wt
E) disturbance does not occur exclusively during episodes of anorexia nervosa
bulimia nervosa remission types
1) partial remission
- after full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time
2) full remission
- after full criteria for bulimia nervosa were previously met, none have been for a long time
what is EDs etiology
- no single cause
- result from an attempt to regulate mood especially anxiety and depression
- heritability genetic component
- neurobiological - altered brain serotonin contribute to dysregulation of appetite, mood, and impulse control
- psychological: learned behaviour, family situation, trauma
- environment: culture, politics
what are the street names of methamphetamines
speed, chalk, ice, crystal, crystal meth, jib
what are amphetamines
- stim CNS
- used for ADHD
- white, odorless, bitter-tasting
- snorted, swallowed, smoked or injection
- feel alert and energetic, confident and talkative. little need for sleep or food
- intense surge of euphoria
how long does snorting/swallowing amphetamines take
snorting 3-5min
swallowing 15-20 min
BIG clinical sign of stim toxicity for amphetamines
**confusion/psychosis
- seizures
- rapid increase in HR, BP, and temp leading to circulatory collapse
- chest pain
what can crystal meth cause
Crystal meth can also cause meth mouth like in the pic - what this does is it dries out the salivary glands - this destroys enamel and leads to cavities and whatnot
Crystal meth is also incredibly dirty -> can see over 45-50 metabolites of other drugs if you do a panel - causes severe tissue necrosis when you inject it
When mixed w all diff drugs w diff MoA -> makes extremely hard to treat
clinical signs amphetamines
- tachycardia and irregular rhythm
- elevated BP
- increased rate of breathing
- hyperthermia (overdose can result in convulsions to death)
- overdose could result in stroke, heart attack, and additional organ damage
