Week 5 Lectures Flashcards
1
Q
4a’s
A
abnormal associations, autistic thinking/behavior, abnormal affect, ambivalence
2
Q
first rank symptoms
A
auditory hallucinations, thought insertion/withdrawal/broadcasting, made feelings/behaviors/impulses, delusional perception
3
Q
Schizophrenics die sooner/later
A
sooner
4
Q
T/F Men have a higher incidence of schizophrenia than women.
A
T
5
Q
T/F Men have a higher prevalence of schizophrenia than women.
A
F –> only incidence
6
Q
Prodromal psychosis
A
attenuated psychotic symptoms before the onset of overt psychosis –> visual and auditory illusions, mild paranoid ideas or ideas of reference, functional decline and evidence of negative symptoms, cognitive difficulty
7
Q
T/F for a diagnosis of schizophrenia must affect life/occupation.
A
T
8
Q
What kind of hallucinations are most common with schizophrenia?
A
Auditory but also visual, olfactory, gustatory, somatic/tactile
9
Q
disorder of salience
A
hypothesis that hyperdopaminergic mesolimbic pathways led to aberrant salience being attributed to random stimuli leading to delusions in schizophrenia
10
Q
delusions
A
persecutory and delusions of reference most common: grandiose, somatic, religious, nihilistic
11
Q
Tx of catatonia
A
benzodiazepines
12
Q
Negative symptoms of schizophrenia
A
alogia, flat affect, anhedonia, avolition, asociality
13
Q
Deficit syndrome
A
in 25% of schizophrenics, severe persistent negative symptoms are most prominent problem
14
Q
Mood symptoms of schizophrenia
A
25-33% depression, related to suicide rate, anxiety, social phobia, ocd
15
Q
___% of schizophrenics complete suicide
A
5
16
Q
Schizoaffective disorder
A
period of psychosis that persists beyond mood symptoms, major depressive episode, or mixed episode while also meeting criteria for schizophrenia
17
Q
Cognitive deficits of schizophrenia
A
global deficit is 1-2 standards below population norms –> verbal/visual learning and memory, attention, speed of processing, executive function
18
Q
When is schizophrenia related cognitive deficits first detectable?
A
age 6-7 first testing w/dramatic decline between 12-17
19
Q
Phases of schizophrenia
A
premorbid, prodromal, psychotic, stable
20
Q
Tx of schizophrenia
A
antipsychotics (1st and 2nd generation)
21
Q
___ generation antipsychotics occupy what receptors?
A
D2
22
Q
Best antipsychotic
A
clozapine (atypical) –> improves cognition, improves negative symptoms but causes agranulocytosis
23
Q
receptors targeted by atypical antipsychotics
A
D2 and serotonin
24
Q
effectiveness differences between 1st and 2nd generation
A
none except clozapine
25
side effect profile of antipsychotics
1st gen = tardive dyskinesia and eps, 2nd gen = metabolic syndrome
26
Rule of thirds for schizophrenia
1/3 - treatment refractory, episodic relpase, good response with prolonged remission
27
good outcome prognostic factors
later/acute onset, shorter illness duration, better premorbid functioning, greater support, affective symptoms, female gender, paucity of negative symptoms
28
T/F schizophrenia is associated with grossly enlarged ventricles
T
29
T/F schizophrenia is associated with less gray matter
T
30
T/F schizophrenia is associated with normal white matter tracts
F --> reduction in organization
31
T/F schizophrenia is associated with normal rate of gray matter loss
F --> faster rate
32
neurodevelopmental model of schizophrenia
deleterious events in utero disrupt brain development, coupled with genetic vulnerability and later environmental factors (substances, stress) can lead to schizophrenia
33
4 leading genes in schizophrenia
disc1, dysbindin, neuregulin, comt
34
behaviors or laboratory measures that represent the activity of something that is disrupted by the function of a gene, short of overt symptomatology
endophenotypes (e.g. high cholesterol in one family)
35
Pre pulse inhibition
how much can suppress startle response --> schizophrenics cannot as well (Neuregulin1)
36
VGlut1
schizophrenics tend to have higher Vglut1 which results in increased glutamine levels coupled with dysbindin reduction which may lead to hyperexcitability
37
When in the year do schizophrenics tend to be born?
winter (also cities)
38
Neuronal migration and schizophrenia
not all neurons end up where they are supposed to end up in neuroembryonic development (Disc1 plays a role in this process)
39
Schizophrenics tend to have higher/lower expression of genes involved in presynaptic expression and an over/underexpression of genes involved in nt expression.
under and under
40
dopamine hypothesis of schizophrenia
hyper dopamine activity results in schizophrenia (cocaine and amphetamines mimic it and antipsychotics target D2 receptor and reduce symptoms)
41
Pts with higher/lower dopamine levels do better on antipsychotics.
higher
42
Glutamate hypothesis of schizophrenia
NMDA glutamate receptor antagonists (ketamine, PCP) mimic schizophrenia and receptor blockade can lead to hyperactive glutamergic activity in pyramidal cells --> neurotoxicity, secondary hyperdopaminergia
43
There is reduction/increase in NMDA receptor expression in schizophrenia
reduced
44
T/F schizophrenics have lower mismatch negativity
T
45
polygenic
hundreds of thousands of genes may contribute to risk for a nosologic entity
46
T/F most addicts report making annual attempts to quit but relapse most often follows after brief interval
T
47
Polydrug addiction
some alleles predispose to drug addiction without regard to pharmacologic class (but there are also specific alleles for specific drugs too)
48
which ions are regulated by nicotine receptors (NachRs)
calcium and sodium
49
Which subunit of nicotine receptors cannot form pentamers on their own
alpha 5
50
consequence of alpha5 variant on nicotine addiction
nicotine addiction risk allele becomes desensitized and fluxes calcium less well than the wild type--> hypofunctional --> if can develop positive allosteric regulators for this allele, might be able to reduce nicotine addiction
51
hypoactive alpha5 allele increases/reduces aversive consequences of nicotine
reduces --> therefore increases risk of addiction
52
The Lys allele for ALDH2 frequency in asians is ____% and conveys risk for _____
30 --> toxicity risk from acetaldehyde accumulation --> reduces risk of alcoholism
53
Alcohol's euphoric properties are mediated by what receptor?
Gaba A (along with with barbituates, benzos, and neurosteroids)
54
Which GABA subunit has a variation that conveys risk for alcohol addiction?
alpha2
55
pretreatment with neurosteroid has what effect on alcohol consumption
reduced euphoria
56
schizophrenia cognitive endophenotypes
failure to activate dorsolateral frontal cortex, large lateral ventricles, impaired gamma oscillations and delayed latency in eeg
57
disc1
translocation in scottish kindred associated with schizophrenia and uni/bipolar illness
58
ank3
associates with voltage gated sodium and potassium channels at nodes of ranvier and orients these channels --> null mutant develops tremor and ataxia --> bipolar risk gene
59
l type calcium channel cacna1c
mutations that increase calcium flux (GOF) cause timothy syndrome including autistic features and prolonged QT --> bipolar risk gene
60
Anorexia nervosa
Restriction of food intake relative to caloric requirements leading to the maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected, intense fear of gaining weight, disturbance in way experience body weight or shape, absence of 3 consecutive menstrual cycles due to underweight status
61
Anorexia subtypes
restricting: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior, and bingeating/purging: during the last three months, recurrent binge/purge episodes
62
When does AN onset?
often after crisis in family, school, sexuality
63
Which nt is implicated in AN and bulimia?
serotonin --> positive response to antideprx in bulimia
64
Tx of AN
inpatient medical treatment, maybe atypical antipsychotics in tx resistant AN
65
Maudsley family therapy
20 sessions over 6-12 months for adolescents (NOT ADULTS --> independent counseling) --> 3 phases: 1. parents control refeeding, 2. return to independent eating, 3. focus on general issues
66
% Full recovery from AN
1/3- 1/2
67
Bulimia
recurrent episodes of binge eating during 2hour period, lack of control over eating, compensatory behavior --> 1/ week for 3 months & not during episode of AN -->AN binge subtype (need below weight for dx)
68
BN fail to activate _____ circuits to the same degree as healthy controls in right/left inferolateral prefrontal cortex indicating _____
frontostriatal on left cortex meaning less self-regulation
69
T/F first binge usually in response to severe caloric deprivation during dieting
t
70
Complications of bulimia
hypokalemia, erosion of enamel, electrolyte imbalance, parotid gland enlargement from elevated serum amylase
71
Tx of bulimia
behavior therapy, antidepressants (desipramine, fluoxetien), interpersonal psychotherapy, cognitive therapy
72
Firstline tx of bulimia
cbt
73
Binge eating disorder
recurrent episodes of binging with lack of self control --> 1/week for three months
74
Tx of choice for binge eating
CBT --> but no weight loss so + Behavioral weight loss--> structure eating, etc. + ssri
75
Purging disorder
regular occurrence of inappropriate compensatory behaviors + normal body weight + no binging
76
Atypical anorexia
all criteria for AN except significantly low weight such as bariatric surgery pts
77
Subthreshold bulimia
all criteria for BN but not as many purges as required
78
LSD/acid
hallucinations with micropsia or macropsia, synesthesia, derealization, depersonalization--> unknown dosage on the street --> 45 minute onset with 4-12 hours experience
79
Clinical manifestations of lsd
euphoria/lability and ego fragmentation --> expanded consciousness, unlocking secrets of universe
80
Mx of lsd
involves post-synaptic serotonin-2 receptor
81
Chronic consequences of lsd
no permanent damage, unmasks psychiatric vulnerabilities, state of panic due to fear of imminent insanity
82
Tx of lsd bad trips
ride the wave, reassurance benzodiazepines
83
PCP (wet, angel dust, peace, hog)
detachment from reality/dissociative, analgesia with alertness, staring gaze, flat faces, rigid muscles --> smoked or snorted
84
onset of pcp
5 minutes....4-6 hours effect with plateau at 45 minutes --> 24-48 hours for recovery
85
clinical manifestations of pcp
euphoria, disconnection, flat affect, uncommunicative --> vertical nystagmus, slurred speech, rolling gate, numbness, depersonalization of body
86
are large doses of pcp lethal?
yes w/high dose--> hyperacusis, amnesia, hostility, muscle rigidity, excess salivation/no gag, increased bp/pulse, coma/convulsions
87
Mx of pcp
nmda receptor antagonist (like ketamine) --> blocks activity of excitatory gluatmate + also other receptors
88
chronic consequences of pcp
no permanent damage, 2-3 weeks of dysfunction after abstinence --> dulled thinking, dulled reflexes, loss of impulses
89
Tx of pcp
NO REASSURANCE --> benzodiazepines prophylactic against seizures, antipsychotics, acidification of urine, gastric suction
90
Metamphetamine/ecstasy/molly/MDMA
club drug --> elation and freedom //adjunct in psychotherapy to increase empathy --> pills/wafers
91
Clinical manifestations of ectasy
loss of boundaries, disinhibition, promotes intimacy, cognitive distortions (slower, apathy), perceptual distortions (hallucinations, spatial relations altered), increased anxiety, tachycardia, dehydration, clenched jaw/bruxism, dry mouth
92
Mx of ecstasy
dopamine and serotonin release
93
Chronic consequences of ecstasy
long lasting/permanent destruction of serotonergic pathways --> depression
94
Tx of ecstasy
dehydration, reassurance, support, education
95
Anticholinergics
usually due to polypharmacy --> atropine, benadryl, tcas, sleep ais
96
anticholinergic delirium
wax and waning consciousness, impulsivity, impaired judgement, hallucinations
97
Clinical manifestations of anticholinergics
fever, warm/dry skin, fixed dilated pupils, tachycardia, decreased peristalsis, atonic bladder
98
Tx of anticholinergic delirium
discontinue offending agent, protect pt against harm, gastric lavage, parenteral physostigmine
99
Drug of choice in controlling anticholinergic delirium
haldol
100
Inhalants
volatile hydrocarbons --> toluene, gasoline, kerosene, nitrous oxide, amyl/butyl nitrates/poppers --> GABA a
101
Clinical manifestations of inhalants
stimulation, disinhibition, nystagmus, muscular incoordination, perceptual distortions, misperceptions
102
Long term consequences of inhalants
CNS damage --> demyelination and cerebellar atrophy --> impairments in memory, attention, concentration, intelligence
103
Which part of the brain is active in alterations of unpleasantness of pain?
anterior cingulate cortex
104
which part of the brain is active in perception of pain itself?
primary somatosensory cortex
105
T/F Need specific hypnotic suggestions to change perception of unpleasantness.
T
106
Which side of the brain is specifically related to verbal mediation of hypnotic suggestions, working memory functions, and reinterpretation of the sensory experience?
Left
107
treatments that promote welllness, those used alongside conventional care, and those used to replace conventional treatments
complementary and alternative medicine
108
T/F most patients who take cam do not bring it up with their doctor.
T
109
T/F Patients with DSM IV diagnoses have a significantly higher use of CAM
T
110
What % of pts with depression or anxiety who treat with CAM also take traditional meds?
67%
111
Omega 3
may play a role in pro-inflammatory state in body --> reduction in western society (EPA and DHA are efficacious in treating psychiatric conditions)
112
Which omega 3 fatty acids may help in tx of mood disorders?
DHA and EPA
113
T/F omega 3 supplementation can help with bipolar mania
F --> only in treating depressive symptoms
114
Major side effects of omega 3 augmentation.
bleeding risk, high doses can increase risk of mood cycling in bipolar, GI upset
115
Which B vitamins are relevant to mood enhancement?
B9 and B12 aka folate and cobalamin
116
Which B vitamin deficiency is strongly associated with depression?
folate/b9
117
Which B vitamin deficiency is strongly associated with peripheral neuropathy?
cobalamin/b12
118
Which b vitamin might be viable as a depression prophylactic
b12/cobalamin
119
Which B vitamin might have value as an adjunct in tx of depression?
B9/folate
120
Which B vitamin might help slow cognitive decline in MCI
both b9 and b12
121
SAMe
universal methyl group donor which helps in DNA construction, nt, etc --> aberrant methylation associated with CNS and psychiatric disorders
122
Effect of SAMe on brain
increased serotonin availability --> as good as traditional antidepressants
123
____ depletes SAMe stores in brain
levodopa for parkinsons
124
Contraindication for SAMe
avoid in bipolar disorder--> risk of inducing mania
125
Suboptimal levels what vitamin may increase risk for depression?
D3
126
N-acetylcysteine
replenishes anti-oxidants for anti-inflammation --> maybe useful in bipolar as adjuvant
127
Tryptophan supplementation
limited evidence for deprx but reduces serotonin syndrome with SSRI combined use
128
St. John's Wort
mimics traditional pharmacologics in tx of deprx --> equal efficacy to TCA with fewer side effects than TCAs//equivalent to SSRIs --> mild/moderate depression
129
Contraindications for st johns wort
bipolar, in combo with ssri (serotonin syndrome), CYP3a induction (need low hyperforin formulation)
130
Kava
ceremonial drink that is relaxing due to increase GABA transmission; reduces anxiety
131
Side effects of kava
gi upset, fatigue, facial swelling, liver damage, platelet response
132
Kava drug interactions
coma with alcohol, benzos, muscle relaxants; may inhibit p450
133
Chamomile
inhibits gaba metabolizing enzymes --> mild use for anxiety
134
Gingko biloba
exerts anti oxidant and anti-inflammatory effects via anti PAF; increases cerebral bloodflow --> no good evidence for clinical value
135
Risks of gingko biloba
bleeding risk when consumed with antiplatelet or anticoagulants
136
acupuncture and depression
not very good evidence
137
yoga and depression
no good studies but yoga breathing does stimulate vagus nerve--> increases alertness, focus, integration, calm, decreases worry, fear, and cortisol
138
Which parts of the brain are activated with mindfulness meditation?
prefrontal cortex and anterior cingulate cortex, dorsalmedial prefrontal cortex
139
half life of nicotine
1.5 hours
140
main metabolism of nicotine
liver CYP2A6
141
T/F after brief nicotine exposure, receptors become desensitized
T
142
T/F route of administration affects speed of access of nicotine to brain
T --> smoking is fast, gum is not
143
risk of addiction from tobacco
>30%
144
nicotinic effects on dopamine
direct via nAChRs and indirect via GABA and Glu receptors --> increases phasic dopamine and inhibits tonic firing of dopamine --> creates a larger difference between basal dopamine and phasic/burst dopamine --> greater feeling of good
145
most widely used measure of nicotine addiction
fagerstrom test
146
Tx of nicotine addiction
cold turkey, cessation counseling, NRT, Bupropion, varenicline
147
Cold turkey effectiveness
high relapse rate; only 5% long-term abstinence
148
most effective non pharmacologic tx of nicotine addiction
behavior therapy > brief advice > no therapy
149
contraindications for nicotine pharmacotherapy
smokers < 10/day, pregnant/breastfeeding, adolescents
150
which nicotine replacement has the best abstinence at 6 months?
spray --> but NRT works generally 2x better than placebo
151
contraindications for nicotine gum
TMJ or dental problems --> fixed dosage for 12 weeks
152
nicotine inhaler
vaporizes --> 80puffs/20 minutes vs 10 puffs for cigarette --> Rx only
153
nicotine nasal spray
8 doses/day for 12 weeks --> nasal irritation and Rx only
154
Contraindication for nicotine patch
skin disorders
155
Bupropion
antideprx that was repurposed for smoking cessation --> consistent abstinence over time//dose proportional
156
T/F combination therapy with NRT and/or pharmacologics like bupropion is moe effective than a simple titrative approach
T
157
Varenicline
partial agonist at alpha4beta2 nAChR -> reduces craving and withdrawal symptoms --> antagonist effect, blocks satisfaction and rewarding effects of nicotine
158
adverse effects of varenicline
nausea, vomiting, abdominal symptoms, effects on depression and suicide, serious cardiovascular effects
