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BMB 2 > BMB 5 > Flashcards

BMB 5 Flashcards

1
Q

Basic def of addiction involves?

A

1) compulsive use, 2) loss of control 3) continuing to use substance even with adverse effects

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2
Q

substance use disorder invovles 2 of these 12 within a year

A
  • longer/larger amounts
  • tries to cut down but cant
  • time spent on obtaining or recovering from susbt
  • craving
  • recurrent use/ cant fulfill obligations at work etc
  • continued use depsite social issues
  • given up activities
  • recurrent use in phys hazardous situation
  • used despite phys/psyc health issues
  • tolerance (need higher amount, get less effect)
  • withdrawal

(mod is 4-6 sx, severe is 6+, less is substance abuse rather than disorder)

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3
Q

countertransference

A

physician has personal opinions about pt, need to understand this

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4
Q

What % of indivs who need addiction care actually receive it?

A

10%

80% of ppl 18-21 qualify for subst abuse, 10% go on to dev addiction, so need to address

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5
Q

What is detox?

A

occurs prior to tx, getting of drug, may incl withdrawal

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6
Q

Screening for substance use

A

CAGE (eg cut down, Angry, Guilt etc etc)
and others
-score of 10 on MAST

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7
Q

SBIRT method of screening for subst

A

screening-ask how many x etc

  • brief intervention, talk about health impact
  • referral to tx
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8
Q

models of tx

A
  • harm reduction (eg dd)
  • responses to behavior (med team consequences)
  • moral model- good/bad (but not good success)
  • learning model- redevelop habits, puts emphasis on pt control and can incr denial
  • self-med model: tx underlying psychopath
  • DISEASE MODEL: most accepted, genetic predisposition, stresses self care, BUT need to treat/emphasize co-morbidities also
  • integrative: AA, dual dx, biopsychosocial, multivariant (effective, targets many aspects of life that contr to addiction), abstinence may be necessary
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9
Q

impt elements of tx

A
  • patients support system// family
  • tx should be generalizable (hard to transition from nature to city life, need to treat near home)
  • make sure pt has motivation to be stable and handle relapses when discharging
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10
Q

Schizophrenia stats and DUP

A
  • deadly, 20 yr life lost, 10%
  • DUP is duration of untreated psychosis (72 wk), worse px if wait longer
  • want to tx earlier, can look like dementia in later stages
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11
Q

early psychosis signs and risks

A
  • drop in school performance, trouble thinking clearly, suspiciousness w others, decline in self care, spending more time alone, incr sens to sounds/sight, mistaking noises for voices, overly intense new ideas, strange/lack of feelings, flat/inapprop affect, preocc w vague philo/poli ideas (starts in subtle episodes)
  • risks: depr/anx, sleep disturbance, irritability, SOCIAL WITHDRAWAL, odd beh, susp
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12
Q

dx criteria for schizoprenia spectrum

A

2+ for a significant period during a month, and at least one of the first 3:
-delusions
-halluc (usu aud)
-disorg speech
-disorg/catatonic beh
-neg sx
(low self care, rule out other disorders eg schizoaffective/mood, continuous for 6 mo incl psychotic sx active phase, not organic factor)

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13
Q

genetics of schizo

A

twin studies, genetics, also env complications (inflam/nutr/infxn/viral/head trauma etc), two hit model of genetics and env

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14
Q

schizo peak age of onset, mort, comorbid

A

peak age onset 15-30, mort higher that general pop, high risk suicide after 1st episode, younger onset is poorer px, most have chronic med cond

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15
Q

schizo structural abnormalities

A

enlargement of lateral ventricles, reduced PFC vol incl HC, thalamus, sup temp gyrus etc
-less activation in PFC, HC, frontal area etc

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16
Q

schizo NTs

A
  • issue with DA (hypoactive AND hyperactivity), tx with D2 receptor blockade
  • glutamate and its NMDA-r target
17
Q

What are the 4 main DA pathways in the brain?

A

1) nigro-striatal
2) mesolimbic
3) meso-cortical
4) tubulo-infindibular

18
Q

nigrostriatal path and drug involvement

A

DA path inv in movement (subst nigra to BG), need DA and ACh

-when D2 blockers given, too much ACh causing dyskinesia/akatheisia (extrapyramidal sx), tx with anticholinergics

19
Q

mesolimbic DA path

A

reward circuit (VTA to Nacc), inv in + sx in schizo

20
Q

meso-cortical DA path

A

motivation and emotion (VTA to cortex), inv in - sx in schizo

21
Q

why dgive D2/D3 partial agonists in schizo?

A

already DA deficieint, so blocking DA would make it worse, give partial agonists to give DA to the receptors that need to respond to DA

22
Q

tubulo-infundibular path for DA (PRL, and med sxe involved)

A

from hypothal to psot pit

  • inv in prolactin reg
  • D2 blockers can cause too much PRL (sxe of glactorrhea and amenorrhea–side effect of D2 blockade since DA normally would have neg feedback on PRL)
23
Q

negative sx of schizo

cog sx

A 
many, including 
alogia (lack of speech)
avolition (cant init/do activities)
anhedonia (diminished pleasure exp)
-cog: most correlated with fxnl impairment, attnl, memo, EF, lang, prior to onset of psyc sx
24
Q

what might indicate good px of psychosis

A

good pre-morbid fxning, no personality disorder, precipitating stressors, abrupt onset, later onset, confusion prominent, FHx of mood disorder (not psychosis)

25
Q

Leading cause of poor px in patients with schizo?

A

more frequent psychotic episodes and logner duration of untreated psychosis

26
Q

Brief psychotic disorder

A

same sx as schizo, but usu resolves in less than a month, usu with stressor

27
Q

Schizophreniform disorder

A

Similar but less than 6 months (1-6), may not impair social/occupational fxning

28
Q

Schizoaffective disroder

A

similar but major mood episode during schizo epi, may have psychosis first, then mood issue, then psychosis (sandwich of sx), look at predominating disorder (eg depr)

29
Q

Delusional disorder

  • def
  • etiology (cause)
  • pop
  • px
A

delusion 1 mo+, accompanied by approp affect (eg famous person in love with them)

  • not same genetics/etiology as schizo, immigrants/social isolation
  • middle to late life, females
  • better long term px than schizo, lower SES
30
Q

Typical (1st gen) and atypical (2nd gen) D2 receptor antagonist tx for psychotic disroders?

A
  • typical D2 antags- have high affinity, motor sxe, haloperidol/thorazine/perphenazine
  • atypical: SERT/DA, only bind somewhat so allow for balance (risperidone, olanzapine, quetiapine, ziprasidone; aripiprazoel and cariprazine have partial DA antag activity)
31
Q

Which drug has antihistamine effect at low doses and can be used for insomnia?

A

Quetiapine

32
Q

When is clozapine used, and what is the sxe risk?

A

-only used if youve tried and failed 2 second gen antipsychotics, carries big risk of agranulocytosis

33
Q

Which antipsychotic can cause agranulocytosis (last resort)

A

clozapine

34
Q

other good therapies for psychosis

A

psychotherapy, fam support, community resources etc

35
Q

For what sx should psychotic pts be hospitalized?

A 
any of the four:
-onset of 1st episode
-danger to self or others
-unable to care for self
-no social supports
Want to tx early!
36
Q

concerns about diagnosing psychotic disorders

A

-offending pt, stigmas, incorrect label

BMB 2 (8 decks)

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