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ESUN MS2Unit3 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Schizophrenia is typically acute or chronic? tend to get better or worse?

A

Chronic/worse

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2
Q

What does psychosis mean?

A

A break from reality

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3
Q

3 hallmark symptoms of schizophrenia?

A

Hallucination/Delusion (false believe that are not correctable by facts)/Thought disorders

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4
Q

Compare with delirium or drug abuse, schizophrenia doesn’t have ?

A

Clouding of consciousness

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5
Q

Diagnostic criteria for schizophrenia?

A

2 or more following each with at least 1 month—>delusion/hallucination/disorganized or catatonic behavior/negative symptoms/disorganized speech
Loss of job or freedom or relationships

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6
Q

How long does the symptoms persist to be diagnosed as schizophrenia?

A

At least 6 months

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7
Q

What is schizoaffective and mood disorder exclusion?

A

Exclude symptoms that might be caused by other illness like depression or bipolar (in diagnosing schizophrenia)

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8
Q

What are positive symptoms regarding schizo?

A

Symptoms that are gained by the pt like delusion or hallucinations (response to antipsychotic)

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9
Q

What are negative symptoms (low DA in frontal lobe) regarding schizo?

A

Loss of behavior that we normally have like motivation/social skill/emotions and what not

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10
Q

What is catatonic schizo?

A

Stupor or extreme agitation

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11
Q

What is disorganized schizo?

A

incoherent speech/bizarre behaviors and what not

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12
Q

What is residual schizo?

A

All negative symptoms

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13
Q

Progression of schizo?

A

Prodromal—>psychotic—>residual (symptoms gets worse with every episode)

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14
Q

How much is contributed by genetic regarding schizo?

A

50%

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15
Q

Which gender is more prone to schizo?

A

Equal (age of onset is earlier for men)

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16
Q

The ___ you are on antipsychotic drugs, the more likely for you to develop tardive dyskinesia

A

Longer

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17
Q

___ at birth increase risk for later schizo

A

Viral infection

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18
Q

Schizo: low ___ activity resulting in ___ enlargement? and high activity in ___?

A

frontal lobe/lateral and 3rd ventricle/ventromedial cortex

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19
Q

What are the 2 theories for schizo?

A

Neuro degenerative/developmental problem

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20
Q

Symmetry or asymmetry for brain is normal? and you see __ in schizo pt?

A

Asymmetry is normal/symmetry

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21
Q

What amygdala finding for schizo?

A

Higher than normal activity when experiencing fear (everything is a threat! RUN!)

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22
Q

Schizo is from high or low DA in mesolimbic tract? (DA hypothesis)

A

High

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23
Q

Which area is DA originated in the brain?

A

Ventral tegmental area

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24
Q

What is DA hypothesis?

A

High DA in mesolimbic and low in mesocortical pathway—>affect tuberoinfundibular and nigrostriatal pathway when treating with DA

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25
Q

What is 5HT’s role in schizo?

A

High 5HT also produces symptoms like hallucination and delusion

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26
Q

Glutamate is excitatory or inhibitory in CNS?

A

Excitatory

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27
Q

What is the glutamate hypothesis?

A

NMDA receptor (glutamate receptor) sits on GABA internueron—>dysfunctional NMDA receptor—>low firing—>low stimulation of GABA—>less inhibition—>high DA—>schizo

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28
Q

What is the normal pattern of GLU-GABA-GLU-DA-limbic?

A

High GLU—>high GABA—>low GLU (2nd)—>low DA—>low DA in limbic

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29
Q

GLU-GABA-GLU-DA-limbic (+ symptoms) in schizo?

A

1st GLU dysfunction—>low GABA—>high 2nd GLU—>high DA in VTA—>high DA in limbic

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30
Q

Normal pattern of GLU-GABA-GLU-GABA-DA-frontal lobe?

A

2nd GLU is low—>2nd GABA is low—>DA is high in VTA—>high DA in frontal lobe—>alert

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31
Q

GLU-GABA-GLU-GABA-DA-frontal lobe (- symptoms) in schizo?

A

high 2nd GLU—>high 2nd GABA—>low DA in VTA—>low DA in frontal—> - symptoms

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32
Q

Does schizo pt has prominent mood symptoms?

A

No, otherwise the pt would be diagnosed with mood disorders (exception is schizoaffective disorder)

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33
Q

What’s the mechanism of antipsychotic?

A

Block D2 receptors in mesolimbic pathway

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34
Q

What is the front line treatment for antipsychotic, 1st or 2nd gen?

A

2nd gen (contraindicated with existing metabolic disorders)

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35
Q

What is injectable depot for antipsychotic?

A

Long lasting form that includes both 1st and 2nd gen

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36
Q

What treatment is offered when the schizo pt is not psychotic?

A

Psychotherapy like CBT or family

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37
Q

Premature birth is defined as less than __ weeks?

A

37 weeks

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38
Q

What score is used to predict the likelihood of the new born?

A

APGAR—>Appearance/pulse/grimace/activity/respiration (8-9 is normal)

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39
Q

Is baby blues pathological?

A

Nah, it’s quite normal

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40
Q

What is the rate of understanding of expressive language of the baby every year?

A

25% every year—>by age of 4, a person should be able to understand 100% of the kid’s expressive language

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41
Q

Social smile starts at ?

A

12 weeks (3 months)

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42
Q

Stranger anxiety starts at ?

A

9 months

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43
Q

___ in the first 3 years is important for the child’s later development?

A

Attachment and safe environment

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44
Q

What is Moro reflex?

A

Limbs extend when the infant is startled

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45
Q

What age should the child learn to say “No”?

A

2

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46
Q

What age should the child go to bathroom by themselves?

A

4-5

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47
Q

What age should the child be able to identify gender?

A

3

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48
Q

What age is parallel play and cooperative play for children?

A

under 3/around 4

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49
Q

Age when child develop self conscience/morality/empathy

A

6

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50
Q

Age when peers relationship becomes really important

A

7-11

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51
Q

Is it legal to provide minors with sexual counseling and contraception w/o parental knowledge?

A

Yes

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52
Q

What is Tourette’s syndrome?

A

Inherited involuntary tics/ADHD/OCD

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53
Q

Depression and suicide are more common in __ population?

A

Elderly

54
Q

What is ADHD combined type?

A

Poor attention/hyperactive and impulsive

55
Q

Is ADHD inattentive type easy to detect?

A

No, ppl just inattentive, some can get by

56
Q

Symptoms must start before age __ to be able to be diagnosed with ADHD? and in ___ settings?

A

Before 12/2 or more settings

57
Q

What is the diagnostic criterions for ADHD on DSM 5?

A

6 inattention symptoms and/or hyperactivity for 6 months that reduce functioning—>like loses things/forgetful

58
Q

For ADHD, as you grow older, you lose ___ symptoms and just have ____ symptoms

A

lose hyperactivity and impulsivity/just have inattentive

59
Q

How much of ADHD is attributed to genetics? what are some of the genes that are involved?

A

at least 76%/DA and NE genes

60
Q

What is the neurodevelopmental delay theory of ADHD?

A

Proning of neurons happen later for ADHD pts—>that might be why some outgrow the hyperactivity and impulsivity

61
Q

What is the MRI of ADHD pt look like comparing with control?

A

No activity in anterior cingulate/other parts of the brain are firing/brain is working inefficiently

62
Q

In ADHD pts, __ and ___ have low activity in frontal cortex?

A

DA and NE

63
Q

Environmental factors for ADHD?

A

smoking and alcohol in pregnancy/head injury/lead poisoning/how you were raised

64
Q

What is the #1 disorder that ADHD pt also have?

A

Anxiety

65
Q

Kids who are on ADHD medication stunt ___?

A

growth—>a bit shorter than they should be

66
Q

What are the 3 non stimulant drugs for treating ADHD?

A

Atomoxetine (NE reuptake inhibitor)/Guanfacine and Clonidine (alpha 2 NE agonists)

67
Q

What are the side effects of the non stimulant drugs for treating ADHD?

A

Sedative/the alpha 2 NE agonists lower BP

68
Q

For preschool ADHD pt, how do you treat them?

A

Behavioral therapy first/can use amphetamines

69
Q

How to treat children and teen ADHD pts?

A

Slow release methylphenidate first—>then slow release amphetamines—>if not then use immediate release stimulants—>lastly use non stimulants

70
Q

How to treat adult ADHD pts?

A

Use non stimulants first—>if not then slow release methylphenidate or amphetamines—>lastly immediate release stimulants

71
Q

What is the mechanism of guanfacine and clonidine?

A

Bind to alpha 2 receptor and increase GLU neuronal firing

72
Q

What is the DSM 5 definition of major depression disorder?

A

5 of SIGME CAPS symptoms for 2 week period/must have either depressed mood or loss of interest

73
Q

What is SIGME CAPS stand for?

A

Sleep/Interest/Guilt/Mood/Energy/Concentration/Appetite/Psychomotor/Suicidal

74
Q

What is atypical depression?

A

Weight gain and hypersomnia/leaden paralysis (dragging through the day)

75
Q

What is melancholic type depression?

A

Diurnal variation—>more depressed in the AM, better in the PM/anhedonia is key

76
Q

What is masked depression?

A

Pts are stoic and do not realize that they are sad

77
Q

What is the monoamine deficiency theory of depression?

A

Low monoamine—>low DA/5HT/NE

78
Q

What is the monoamine receptor excess theory of depression?

A

Low level of transmitter—>high level of receptor—>neuronal firing decreases

79
Q

What are some psychosocial factors for depression?

A

Resilience for stress/personality/low self-esteem

80
Q

Successful treatment for depression ___ receptors?

A

Down-regulate

81
Q

Low genetic risk/high genetic risk population seem similar when?

A

there are multiple episodes of depression

82
Q

The more episodes of depression you have, the ___ you will get

A

worse

83
Q

Stress increase glucocorticoids—->decrease ___ —->cause neuron atrophy

A

decrease brain neurotrophic factors

84
Q

Increase 5HT and NE—->decrease glucocorticoids—>increase ___?

A

Increase brain neurotropic factors

85
Q

Alpha 2 agonist in pre frontal cortex does?

A

Increase connection and improve cognitive function—>treat ADHD

86
Q

After many episodes of depression—>atrophic neurons can or can not be rescued?

A

They can not be rescued

87
Q

What parts of the brain has low level and what parts has high level for depression pt?

A

Low level in dorsolateral prefrontal cortex and high level in amygdala

88
Q

List 3 reasons why women is more prone to have depression than men

A

MAO-A gene locates on X chromosome (women has 2 X)/estrogen stimulates 5HT—>loss estrogen—>low 5HT/women are better at communication—>more easy to detect depression

89
Q

Which 5HT receptor is agonized and what are antagonized in treating depression?

A

5HT 1a is agonized and the rest are antagonized

90
Q

How long does antidepressant need to start working?

A

About 8 weeks

91
Q

How is shock treatment used for depression

A

Really effective/used for severe depression/lots of side effects

92
Q

What are some neurostimulation techniques for depression?

A

Vagus nerve stimulation (like a pacemaker)/transcrainal magnetic stimulation (wave a magnet over your head)

93
Q

What are the populations with highest suicide rate?

A

teen/middle age/older white dudes (most is middle age)

94
Q

What are some precursor symptoms of suicide?

A

Insomnia/anxiety/irritability/hopeless

95
Q

What is the risk triad for suicide?

A

Ideation/plan/intention

96
Q

Which gender attempt suicide more and which succeed more?

A

Women attempt more/men succeed more

97
Q

Which gender attempt suicide more and which succeed more?

A

Women attempt more/men succeed more

98
Q

What seasons have higher suicide rate?

A

Spring and fall

99
Q

What is the significance of short and long allele for 5HT reuptake pump regarding suicide?

A

s/s less resilience—>more prone to depression and therefore suicide
l/l is protective

100
Q

What is victim-precipitated homicide?

A

Use other to kill you (e.g. by cops)

101
Q

Can you detain suicidal pt against their wills? and will you be responsible if you fail to recognize that your pt is suicidal?

A

Yes and yes

102
Q

Antidepressant might increase risk of suicide if you are age ___ and under

A

24

103
Q

What can you give the pt to lower their suicide risk?

A

Antidepressant/lithium/clozapine

104
Q

ADHD kids are more sensitive to immediate or distant reinforcers?

A

Immediate—>they do not like delayed gratification (I want it RIGHT MEOW!)

105
Q

What is direct contingency management for ADHD behavioral therapy?

A

You do some good, you get some good, vice versa

106
Q

What is incredible years program?

A

It is part of behavioral parent training for ADHD—>focus on parent-child interactions

107
Q

What is incredible years program?

A

It is part of behavioral parent training for ADHD

108
Q

What is the DSM 5 criterions for ODD (oppositional defiant disorder)?

A

At least 4 symptoms of angry/defiant/vindictive for at least 6 months (occurs with a person that is NOT a sibling)/has to cause distress in individual or ppl around him/reduce functioning

109
Q

What is the DSM 5 criterions for ODD (oppositional defiant disorder)?

A

At least 4 symptoms from angry/defiant/vindictive for at least 6 months

110
Q

What are the 3 specifiers for ODD?

A

Mild: happen in 1 setting/moderate: 2 settings/severe: 3 settings

111
Q

ODD kids have the concept of ___ that makes them attribute incidences as hostile

A

Hostile attribution bias

112
Q

What does problem-solving skills training focus on for ODD?

A

why do you think the other kid was hostile at you? what was the evidence? address hostile attribution bias

113
Q

What is the DSM 5 criterions for conduct disorder?

A

At least 3 symptoms of aggression to ppl and animal/destruction of property/theft/violation of rules in the past 12 months (at least 1 in the past 6 months)/has to be problematic

114
Q

What is the DSM 5 criterions for conduct disorder?

A

At least 3 symptoms of aggression/destruction of property/theft/violation of rules in the past 12 months (at least 1 in the past 6 months)

115
Q

What are the specifiers for onset of conduct disorder?

A

Childhood onset: 1 symptoms before 10/teen: no symptoms before 10

116
Q

Conduct disorder pt must have at least 2 symptoms of the following antisocial emotions

A

Lack of guilt/no empathy/don’t care about performance/low to no affect

117
Q

What is multisystemic therapy for conduct disorder?

A

Addresses multiple levels—>individual/school/parents and so on

118
Q

What is multidimensional treatment foster care for conduct disorder?

A

Take the kid out of the family and make him live in a foster care/treat parents to be better

119
Q

What is multidimensional treatment foster care for conduct disorder?

A

Take the kid out of the family and make him live in a foster care/treat parents to be better

120
Q

What is functional family therapy for conduct disorder?

A

understand the function of misbehaviors (why is he doing this)

121
Q

What are the characteristics of Autism?

A

impair in social interaction and communication/lacking joint attention/limited interest (obsess with one thing)/really picky eater/repetitive movements/insist on routines

122
Q

Autistic children has impairment in ___ and ___? and they are lacking ___ attention

A

social interaction and communication/lacking joint attention

123
Q

What is the difference between Asperger’s and Autism?

A

Asperger has higher than normal IQ/Autism has a lower IQ

124
Q

Autism is more prevalent in male or females?

A

Males

125
Q

Diagnosis of Autism is from?

A

Multi modal assessment (observe the child in different settings in different areas)

126
Q

Diagnosis of Autism is from?

A

Multi modal assessment (observe the child in different settings in different areas

127
Q

What are the 3 criteria for diagnosing people with intellectual disability (ID)?

A

Low IQ/deficits in adaptive functioning (like communication or social skills)/start before 18/separated into mild, moderate, severe and profound (require assistance)

128
Q

What are some challenging behaviors of Autism that are the reasons that these pts are put in a special residential places?

A

Self injury on purpose/destruction behavior/pica (eating non-nutritive things/pt is not a kid/eating is not a tradition)

129
Q

What are some challenging behaviors of Autism that are the reasons that these pts are put in a special residential places?

A

Self injury on purpose/destruction behavior

130
Q

What is complementary and alternative medical treatment (CAM)?

A

Treatment methods that are used for other things are used for Autism—>does not help

ESUN MS2Unit3 (11 decks)

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