Week 8 (Test 3) Flashcards
characterized as major depression that recurs at the same time each year usually just before and during winter, with a full spontaneous remission during spring and summer
seasonal affective disorder (SAD)
What’s the treatment for seasonal affective disorder (SAD)?
Bright artificial light phototherapy
When, during the day, do statistically significant more natural deaths occur?
after midnight
Significantly more myocardial infarctions and strokes occur around what time? why?
9 am At this time, blood pressure, heart rate, vascular tone, platelet aggregation and blood coagulability are all increased while coronary flow and fibrinolytic activity are decreased.
The master body clock is anatomically located in the _______.
SUPRACHIASMATIC NUCLEUS OF THE HYPOTHALAMUS
Where does the suprachiasmatic nucleus of the hypothalamus get its info from?
3% of the ganglion cells in the ganglion cell layer have melanopsin and they project to the SCN via the Retino- Hypothalamic Tract (RHT)
Where does the suprachiasmatic nucleus of the hypothalamus send its signals?
SCN output signals are transmitted to the central sympathetic intermediolateral cell column (IML) of the spinal cord and to the central parasympathetic dorsal motor nucleus of the vagus (DMV)
What are the Primary neurons of the olfactory system?
olfactory nerves
Where would you find secondary neurons of the olfactory system?
olfactory bulb (they are called mitral cells)
What’s the Final destinations of olfactory info?
pyriform cortex and amygdala.
The septal area communicates with the amygdala via two fiber tracts:
stria terminalis Diagonal band of Broca
What’s the function of the Papez circuit?
links the limbic system and the cortex
List the important parts of the Papez circuit.
hippocampus–> fornix–> mammillary body–> anterior nucleus of thalamus–> cingulate gyrus–>
amygdala is important for:
Subjective feeling/memory Emotion Like /Dislike
hippocampus is important for:
New memory Short term memory Learning
-bilateral temporal lobe lesion No emotional response Visual agnosia Orally examine subjects Hypersuxuality
Kleuver-Bucy syndrome
Mammillary body degeneration is a common finding. Chronic alcoholism Vit. B. (thiamine) deficiency
Korsakoff syndrome
What is the limbic system responsible for?
5 F’s: Feeding Fleeing Fighting Feeling Sex
Anterior hypothalamus is responsible for:
Parasympathetic Heat loss Thirst/drinking ADH/Oxytocin Circadian Sleep Reproduction, sex
Medial hypothalamus is responsible for:
Satiety Emotion Endocrine
What are the hormones released by the posterior pituitary ?
oxytocin and vasopressin (antidiuretic hormone)
Functions of the hypothalamus:
TAN HATS to bed T: Thirst A: Adenohypophysis (Ant. pituitary) N: Neurohypophysis (post. Pituitary) H: Hunger A: Autonomic T: Temperature S: Sexual urges to bed: Circadian rhythm
Identifies genetic influence even when many genes and much environmental variance is involved. Many genes, each with small effect, combine to produce observable differences among individuals in a population.
Quantitative Genetics
What’s the weakness of using family studies?
This type of study can’t distinguish environmental vs genetic effects
What do you need to make a diagnosis of Schizophrenia?
Two or more of the following, each active for at least ONE month. At least one of these must be 1,2, or 3: 1) Hallucinations 2) Delusions 3) Disorganized speech (Grossly bizarre language) 4) Catatonia or grossly disorganized behavior 5) Negative symptoms; affective flattening, alogia, avolition Continuous signs of disturbance persists for 6 months, with at least 1 month of active symptoms, may include residual symptoms
What are the positive symptoms of schizophrenia?
delusions and hallucinations
What are the negative symptoms of schizophrenia?
blunted affect social withdrawal lack of motivation
For a patient suspected of having schizophrenia, what else should be on your differential diagnosis?
Drug intoxication -Cocaine -Amphetamine -PCP -“Bath Salts” Medical Conditions Other psychiatric disorders
Patient has schizophrenia and also has prominent mood (manic or depressive syndrome) at times
Schizoaffective disorder
Huntington’s is an autosomal dominant disease effecting which chromosome? It’s a triplet repeat disease. What is the sequence of the triplet repeat?
chromosome 4 CAG
Prominent delusions without hallucinations or language disturbance Usually starts later in life (40s or 50s) Uncommon Often paranoid, may have medical fixation (delusions of parasites or worms)
Delusional Disorder
If a patient has had psychosis that meets schizophrenia criteria for more than six months, What’s the diagnosis?
Schizophrenia
If a patient has had psychosis that meets schizophrenia criteria for less than six months, What’s the diagnosis ?
Schizophreniform disorder
The ______ of schizophrenia have been associated with a reduction of dopamine activity in the mesocortical pathways.
negative symptoms
Overactivity of the mesolimbic pathway has been implicated in development of _________ of schizophrenia
positive symptoms
All antipsychotics block ____.
D2 receptors
What is the most effective drug for schizophrenia ?
Clozapine
What is the only antipsychotic that increases nausea ?
Aripiprazole
What are the severe side effects of Clozapine?
it can cause agranulocytosis (loss of neutrophils) and seizures
Metabolic risk much worse with ______ antipsychotic drugs.
Metabolic risk much worse with “-pine” drugs Clozapine Olanzapine Quetiapine
EPS [Extrapyramidal symptoms (EPS: Parkinsonism, dystonia, akathisia)] risk much worse with _____ antipsychotic drugs.
EPS risk worse with “-done/ole’s”
Which antipsychotics have the worst weight gain side effects?
Olanzapine and clozapine
Which antipsychotics put patients at the least risk for diabetes, weight gain, and hyperlipidemia?
Aripiprazole and ziprasidone
Which antipsychotics put patients at greatest risk for diabetes, weight gain and hyperlipidemia?
Clozapine and olanzapine
If antipsychotics caused extrapyramidal parkinson like symptoms, how would you treat?
Lower the dose, switch drug, or use anticholinergics (benztropine), or amantadine (a dopamine agonist)
If antipsychotics caused extrapyramidal Tardive dyskinesia (TD; involuntary movements) like symptoms, how would you treat?
Not much helps so prevention best; clozapine may help
If antipsychotics caused extrapyramidal Akathisia (uncomfortable restlessness) like symptoms, how would you treat?
Propanolol, lorazepam for short term symptomatic relief
Describe how antipsychotics effect prolactin.
They can increase it and cause gynecomastia (breast swelling) and galactorrhea (milky discharge) via blockade of tuberoinfundibular dopamine receptors
How would you treat a patient with Neuroleptic Malignant Syndrome (NMS)?
stop the drugs causing it and then the patient needs ICU management
-Discrete episodes of losing control of aggressive impulses -Acute onset, remit spontaneously -Individual describes as spell or attack -Genuine regret or remorse; no impulsiveness between attacks
Intermittent explosive disorder
Intermittent Explosive Disorder cannot be diagnosed before the age of ___.
6
Chronic, psychiatric condition characterized by uncontrollable, self-inflicted, hair pulling, resulting in noticeable hair loss
Trichotillomania
Fascination with, interest in, curiosity about or attraction to fire and its situational contexts; Deliberate and purposeful fire setting on more than one occasion
pyromania
Recurrent skin picking resulting in skin lesions.
Excoriation (Skin-Picking) Disorder
One or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness
dissociative amnesia
Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information
fugue
•Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions
–(e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
depersonalization
•Experiences of unreality or detachment with respect to surroundings
–(e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
derealization
•Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
Dissociative Identity Disorder
What is the preferred medication for patients with parkinson’s disease who develop psychotic symptoms from their dopaminergic treatments (such as L-Dopa or dopamine agonists)?
quetiapine b/c it is a ‘fast off’ antipsychotic with little risk for EPS symptoms or elevated prolactin
what’s the treatment for an acute dystonic reaction?
intramuscular (IM) benztropine (Cogentin™) 2mg or diphenhydramine (Benadryl™) 50 mg.
What’s the treatment for a patient with Akathisia?``
propranolol
What’s the best option when a patient has Tardive Dyskinesia?
switch to clozapine, as it doesn’t cause TD and often improves the movements
Deep sleep occurs in which part of the night?
non-REM
first third of the night
When does REM sleep occur?
latter half of the night
What would you see on a Polysomnogram if the patient was awake but had their eyes closed?
alpha waves
Describe stage 1 non REM sleep
slow eye movements
Myoclonic (aka Hypnic) Jerks
Many deny sleeping, easy arousal
What woud you see on a polysomnogram of a patient in stage 1 of non-REM sleep?
theta waves
What woud you see on a polysomnogram of a patient in stage 2 of non-REM sleep?
Sleep Spindles and K Complexes
What woud you see on a polysomnogram of a patient in stage 3 of non-REM sleep?
delta waves