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129 Cards in this Set
- Front
- Back
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what are the 2 criteria necessary for a mental disorder?
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abnormal behavior
harmful dysfunction |
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What is the DSM IV criteria for a mental disorder?
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a behavior or psychological syndrome that is associated with:
1.) present distress (painful sxms) OR 2.) disability (impaiment in one or more important areas of functioning) OR 3.) a significant increase in suffering, death, pain, disability or an important loss of freedom |
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Conditions that are excluded from consideration as a mental disorder include those that:
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1.) are culturally/socially expected in response to a particular event (like grief)
2.) deviant behavior 3.) conflicts beween the individual and society |
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Kraeplin argued that there were ____ causes for all psychiatric disorders, while Freud argued that there were ______ causes for all psychiatric disorders.
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Kraeplin - organic causes
Freud - psychological or functional causes |
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What is the role of psychiatry?
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1.) to dx & tx mental disorders
2.) to assess psychological factors in health and illness |
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How does psychiatry differ from other areas of medicine?
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often the cause of disease is idiopathic and may be related to functional disorders from psychological problems. The etiology isn't always clear or consistent between people. The txs are often inadequate, ineffective or only partially effective.
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What 6 components help to shape the psychiatric assessment?
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1. self-report of pt
2. report of pts friends/families/others 3. observation of pt 4. pt/family hx 5. PE 6. lab tests |
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What mental disorders are biologic or genetic in etiology
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A SAD BM
Autism Schizophrenia Alcoholism Depression Bipolar MR |
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What is Axis I of the DSM IV TR criteria
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Axis I = Clinical disorders including mental disorders including learning disabilities
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What is Axis II of the DSM IV TR criteria
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Axis II = Personality disorders and MR
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what are the 2 criteria necessary for a mental disorder?
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abnormal behavior
harmful dysfunction |
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What is the DSM IV criteria for a mental disorder?
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a behavior or psychological syndrome that is associated with:
1.) present distress (painful sxms) OR 2.) disability (impaiment in one or more important areas of functioning) OR 3.) a significant increase in suffering, death, pain, disability or an important loss of freedom |
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Conditions that are excluded from consideration as a mental disorder include those that:
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1.) are culturally/socially expected in response to a particular event (like grief)
2.) deviant behavior 3.) conflicts beween the individual and society |
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Kraeplin argued that there were ____ causes for all psychiatric disorders, while Freud argued that there were ______ causes for all psychiatric disorders.
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Kraeplin - organic causes
Freud - psychological or functional causes |
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What is the role of psychiatry?
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1.) to dx & tx mental disorders
2.) to assess psychological factors in health and illness |
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How does psychiatry differ from other areas of medicine?
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often the cause of disease is idiopathic and may be related to functional disorders from psychological problems. The etiology isn't always clear or consistent between people. The txs are often inadequate, ineffective or only partially effective.
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What 6 components help to shape the psychiatric assessment?
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1. self-report of pt
2. report of pts friends/families/others 3. observation of pt 4. pt/family hx 5. PE 6. lab tests |
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What mental disorders are biologic or genetic in etiology
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A SAD BM
Autism Schizophrenia Alcoholism Depression Bipolar MR |
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What is Axis I of the DSM IV TR criteria
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Axis I = Clinical disorders including mental disorders including learning disabilities
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What is Axis II of the DSM IV TR criteria
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Axis II = Personality disorders and MR
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What is Axis III of the DSM IV TR criteria
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Axis III = Acute medical conditions & physical disorders
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What is Axis IV of the DSM IV TR criteria
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Axis IV = Psychosocial and Environmental disorders
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What is Axis V of the DSM IV TR criteria
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Axis V = Global Assessment Functioning
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In addition to assessing the whole picture, biopsychosocial, what else is important to assess in a psychiatric setting?
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The physical health of the pt - 30-50% of psychiatric patients have medical diseases concurrent with psychiatric sxms.
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Remember, what question is important to ask repeatedly as you're conducting a psychiatric interview?
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Ask pt how they feel, repeatedly
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What is the only allowance to find a person not guilty by reason of insanity?
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if person did not know right from wrong at the time of crime
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the secret to collecting a good history is:
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engaging the patient & empathetic listening
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the prefrontal cortex serves what function?
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large association area integrating inputs from much of neocortex, limbic, hypothalamic and brainstem regions - serves as executive fxn
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What are frontal lobe abnormalities?
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Schizophrenia
Autism spectrum Mood disorders OCD SAM-O |
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What is frontal lobe syndrome?
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it is a syndrome resulting from damage to the frontal lobe which impairs motivation, attention and sequencing
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What does frontal lobe syndrome result in?
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slowed thinking
decreased curiosity poor judgement social withdrawal irritability |
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Phineas Gage is an example of what disorder?
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frontal lobe syndrome
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Where is the limbic system anatomically situated?
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between diencephalon & telencephalon
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The limbic system is connected to the:
a.) hypothalamus b.) amygdala c.) hippocampus d.) cingulate gyrus e.) all |
e. all
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What part of the limbic system mediate learning & memory?
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amygdala & hippocampus
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What type of personality changes would occur if a patient had a lesion on her amygdala?
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fearfulness
suspicion possible paranoia |
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The basal ganglia consists of:
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caudate
putamen globus pallidus substantia nigra |
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Huntington's disease results in: _____________ damage.
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atrophy of the caudate nucleus
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Parkinson's disease results in ___________ damage.
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neuronal loss in the substantia nigra
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Blockade or chronic change of dopamine receptors in the basal ganglia area leads to what movement problems?
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EPS
Tardive dyskinesia |
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Where does language lateralize in most people?
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neocortex, left hemisphere for most people
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Trace the input of information into the brain under the control of "attention" circuitry
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- mediated by multiple brain systems
- sensory input first to RAS arising in brain stem - midline circuitry passes info through thalamus which functions as a gate or filter |
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What are the pleasure systems of the brain?
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ventral tegmental area
nucleus accumbens prefrontal cortex amygdala hippocampus |
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What is the chemical anatomy of the basal ganglia?
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Caudate & putamen contain very high concentrations of dopamine receptors, esp D2
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what are the three subsystems that primarily use dopamine?
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nigrostriatal
mesolimbic tuberoinfundibular |
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Virtually all antidepressants increase the amount of what 2 neurotransmitters?
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Serotonin or norepinephrine
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Virtually all benzodiazepines act on what neurotransmitter?
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GABA receptors that are linked to chloride channels
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what is a neurohormone?
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a neurotransmitter that is released directly into the blood stream rather than into the extraneuronal space in the brain
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A neuromodulator is longer or shorter effect than that of a neurotransmitter?
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longer - more of a fine-tuning effect
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What are the three major types of neurotransmitters?
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Biogenic amines
Amino acids Peptides |
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What are examples of the bioamine neurotransmitters?
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these are the 3 catecholamine neurotransmitters (epi, norepi & dopamine) along with serotonin, histamine and acetylcholine
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the nigrostriatal tract is a ______ tract
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dopaminergic tract
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What happens when the D2 receptors at the end of the nigrostriatal tract are blocked by dopamine inhibiting drugs like antipsychotics?
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Parkinsonian like symptoms begin to emerge
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D2 receptors in the caudate nucleus suppress the activity of the caudate nucleus, but when D2 receptors have reduced activity, what happens?
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the caudate nucleus is no longer inhibited so it becomes active which paradoxically slows motor activity resulting in the bradykinesia of Parkinsons
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what might the mesolimbic-mesocortical tract's function be?
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may be involved in mediating the antipsychotic effects of antipsychotic medications
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The tuberoinfundibular tract allows dopamine to inhibit what hormone?
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prolactin
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what is the dopamine hypothesis of schizophrenia?
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drugs that block dopamine receptors have antipsychotic effects while drugs that stimulate dopamine can induce psychotic effects
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Which is the more important and abundant of the two adrenergic neurotransmitters?
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norepinephrine
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Where are the major concentration of noradrenergic and adrenergic cell bodies?
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compact locus ceruleus in the pons
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how do the tricyclics, effexor, wellbutrin and serzone work?
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block reuptake of norepi and serotonin and increase concentrations of norepi in synaptic cleft
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The major site of serotoninergic cell bodies is in the:
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upper pons & midbrain
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serotonin neurons project:
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to the basal ganglia, limbic system, and cerebral cortex
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Tricyclics and MAOIs fxn by:
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blocking the reuptake and metabolism of serotonin
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SSRIs include:
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fluoxetine, paroxetine, sertraline, fluvoxamine, citralopam
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what is the SSRIs big advantage?
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minimal side effects
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The permissive hypothesis postulates:
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that low levels of serotonin permits abnormal levels of norepinephrine to cause depression or mania
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where are a major group of acetylcholine neurons located?
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nucleus basalis Meynert, Broca's area, septal nucleus, basal ganglia
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Ach plays a major role in:
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memory & learning
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T/F GABA is an excitatory neuron
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F - inhibitory
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Many anxiolytic drugs act as:
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GABA agonists, thus increasing inhibitory tone within the CNS
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The loss of long-tract GABA neurons connecting the caudate nucleus to the globus pallidus release the globus from inhibitory control thus...
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freeing the globus pallidus to produce choreiform movements seen in Huntingtons
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What is the most important concept when thinking about the glutamate system?
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keeping it in balance. Too much & its neurotoxic; too little and one has impaired cognitive performance
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The hallmarks of delirium include:
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disorientation
confusion global cognitive impairment |
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1/3 of elderly patients admitted to the hospital with a primary dx of delirium die within:
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1 month
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What is a pharmacologic strategy for the management of delirium?
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high potency antipsychotic such as haldol (1 or 2 mg PO/IM q2-4H), a benzo 1-2 mg PO q1 H)
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What medicine should be avoided in delirium?
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older antipsychotics with significant anticholinergic effects
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What is the tx for anticholinergic delirium?
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Physostigmine salicylate 1 or 2 mg IV or IM
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The firm dx of Alzheimer's disease requires what?
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pathological verification - brain small, atrophic, accumulation of neurofibrillary tangles and neuritic plaques, amyloid deposits in BVs
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the two systems of neurotransmitters neurons that are primarily involved in Alzheimer's Disease are:
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cholinergic system in basal forebrain (nucleus basalis of Mynert); adrenergic system in locus ceruleus
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What is the most consistent neurotransmitter abnormality in Alzheimer's disease?
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reduction in acetylcholine
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to dx Alzheimer's disease, what needs to be present as confirming evidence?
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full & mini MSE & proof of decline in function by comparing to previous level of functioning/employment/etc
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Schizophrenia has been described as a splitting of the ______ but not of the ________.
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split mind, not split personality
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positive symptoms refer to:
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psychotic sxms such as:
delusions hallucinations disorganized bizarre behavior agitation, restlessness, purposelessness inappropriate affect |
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negative symptoms refer to:
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emotional blunting
restricted affect apathy poor hygiene impoverished or disturbed social relations psychomotor retardation poveraty of speech |
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what resolves in the chronic stage of schizophrenia
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positive symptoms are largely gone although remnants of delusional systems are usually present; negative symptoms predominate; poor functional level
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what are the 3 dimensions of schizophrenia?
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The psychotic dimension, disorganized dimension, negative dimension
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Schizophrenia has been described as a splitting of the ______ but not of the ________.
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split mind, not split personality
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positive symptoms refer to:
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psychotic sxms such as:
delusions hallucinations disorganized bizarre behavior agitation, restlessness, purposelessness inappropriate affect |
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Schizophrenia has been described as a splitting of the ______ but not of the ________.
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split mind, not split personality
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negative symptoms refer to:
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emotional blunting
restricted affect apathy poor hygiene impoverished or disturbed social relations psychomotor retardation poveraty of speech |
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positive symptoms refer to:
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psychotic sxms such as:
delusions hallucinations disorganized bizarre behavior agitation, restlessness, purposelessness inappropriate affect |
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what resolves in the chronic stage of schizophrenia
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positive symptoms are largely gone although remnants of delusional systems are usually present; negative symptoms predominate; poor functional level
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what are the 3 dimensions of schizophrenia?
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The psychotic dimension, disorganized dimension, negative dimension
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negative symptoms refer to:
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emotional blunting
restricted affect apathy poor hygiene impoverished or disturbed social relations psychomotor retardation poverty of speech |
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what resolves in the chronic stage of schizophrenia
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positive symptoms are largely gone although remnants of delusional systems are usually present; negative symptoms predominate; poor functional level
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what are the 3 dimensions of schizophrenia?
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The psychotic dimension, disorganized dimension, negative dimension
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the psychotic dimension refers to what in schizophrenia?
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delusions, hallucinations, loss of boundaries
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the disorganized dimension refers to what in schizophrenia
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disorganized speech, disorganized or bizarre behavior, incongruous affect
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high relapses in schizophrenia occur in patients with what type of family dynamic?
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patients who have critical, hostile & over-involved families
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what is the stress diathesis model?
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constitutional factors determined by heredity interact with environmental factors that precipitate overt expression of clinical sxms
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what neuropathological sxms are occurring in the brains of schizophrenic patients?
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frontal & medial temporal lobe changes (esp in hippocampus & entorhinal cortex) that include:
nonspecific gliosis disordered orientation of pyramidal cells |
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Is dopamine suspected to be hypo or hyperactive in schizophrenia?
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hyperactive
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Increased dopamine receptors are found in what parts of the brain in schizophrenia?
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basal ganglia
caudate nucleus nucleus accumbens |
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the increase in dopamine receptors seen in schizophrenia may be due to what intervention?
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long term med use
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what is the role of serotonin in schizophrenia?
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second generation antipsychotics block dopamine & serotonin type 2 receptors - part of the puzzle?
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what is the glutamate hypothesis?
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concept that schizophrenia may be due to the neurotoxicity of glutamate overproduction
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ventricular enlargement in schizophrenia does/does not play a role in disease development.
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don't know.
ventricles, esp 3rd ventricle are enlarged in schizophrenia... but precede onset of disease and found in many other mental disorders |
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Besides enlarged ventricles, what other physiologic changes are present in the brains of schizophrenics?
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diffuse cortical atrophy
3-5% reduction in total brain area/volume reductions in temporal lobe, hippocampal, amygdala volumes |
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are physiologic changes found more often on the L or R side of the brain in schizophrenia?
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L
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What type of blood flow is typical in schizophrenia?
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hypofrontal - reduced flow to frontal lobes
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Cognitive tasks assigned to schizophrenic patients produce what results in the brain?
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dorsolateral prefrontal cortex failed to activate compared to "normal" patients, this area is impt in planning, problem solving, altering strategies/coping
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what dopaminergic tracts are believed to be involved in the production of sxms of schizophrenia?
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mesolimbic/mesocortical
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what tracts are involved in the side effects of antipsychotic medications?
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nigrostriatal
tuberoinfundibular |
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the positive sxms of schizophrenia result from pathology of the _______ while the negative symptoms result from damage to _______.
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limbic system
prefrontal cortex |
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first line of tx in schizophrenic patients?
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antipsychotic medications
(atypicals best) |
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The under-activity of the prefrontal cortex may cause:
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overactivity of the mesolimbic system thus causing positive symptoms.
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What neurotransmitter is dopamine linked to in a homeostatic relationship?
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acetylcholine
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When an antipsychotic mediation suppresses dopamine, what are the consequences?
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Acetylcholine is now under-suppressed and overactive, thus cholinergic sxms are present like EPS. anticholinergics are used to suppress
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Extrapyramidal effects of antipsychotics include acute dystonic rxns. What meds are most likely to cause?
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high potency medications, young men most likely at risk
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What is the Parkinsonian triad due to decreased dopamine?
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tremor
rigidity bradykinesia |
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how might akathisia be best treated?
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beta blocker
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T/F tardive dyskinesia is most likely to be irreversible
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true
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What are the risk factors that increase a schizophrenic's chance of developing tardive dyskinesia?
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total exposure
dose age gender (female) Hx of EPS |
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low potency antipsychotics typically produce:
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high levels of sedation
significant anticholinergic side effects significant orthostatic hypotension |
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high potency antipsychotics typically produce:
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high levels of extrapyramidal side effects
lower sedation less adverse anticholinergic effects less orthostatic hypotension |
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Clozapine is the most efficacious atypical antipsychotic but has the most health risks like:
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agranulocytosis - requires weekly CBC
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what are the characteristics of atypical antipsychotics
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- fewer side effects
- not as effective in reducing + sxms - better at reducing - sxms - unknown long term side effects |
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EPS sxms include:
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stiffness
slowed movements tremors restlessness |
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dopamine effects on the hypothalamic-pituitary pathway cause what sxms?
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decreased interest in sex
impotence increased prolactin amenorrhea abnormal lactation |
