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Flashcards in Behavioral Week 2 Deck (92):
1

5 Types of CAM treatments:

1. Whole medical systems
2. Mind-body medicine
3. Biologically based
4. Manipulative and body-based
5. Energy medicine

2

St. John's Wort use:

-Antidepressant

3

Fatty Acid use:

-Antiinflammatory

4

Vitamin D use:

-Depression
-rule out cause of depression

5

Light Therapy use:

-Seasonal depression

6

Depression treatment w/ regard to 1 Carbon Cycle:

-Use: Folate, L-methylfolate, S-adenosyl methionine (SAMe)
-Increases neurotransmitters

7

2 most and least hereditary psych disorders

Most: Schizophrenia, ADHD
Least: Depression, Anxiety

8

Functions of 4 Dopamine Pathways:

1. Nigrostriatal: movement
2. Mesolimbic: reward and perception
3. Mesocortical: executive function
4. Tuberoinfundibular: pituitary prolactin

9

Hyperactivity of 4 Dopamine Pathways:

Nigrostriatal --> dyskinetic movement
Mesolimbic --> addiction, hallucinations
Mesocortical --> hypervigilance, insomnia
Tuberoinfundibular --> hypOprolactinemia

10

Hypoactivity of 4 Dopamine Pathways:

Nigrostriatal --> dyskinetic movement, parkinsonism
Mesolimbic --> amotivation, apathy
Mesocortical --> inattention
Tuberoinfundibular --> hypERprolactinemia

11

4 Genes associated with Schizophrenia

COMT, Tyrosine Hydroxylase, D2R, D3R

12

2 Genes associated with ADHD

DRD4 and DRD5

13

3 Genes associated with MDD

DAT, DRD4, COMT

14

MDD: Resting activity is low in ____ and high in ___

Low: DLPFC - dorsolateral prefrontal cortex

High: Amygdala/VMPFC - ventralmedial prefrontal cortex

15

NE hypERfunctioning in limbic pathways cause ___, ___ and ___.

Panic, worry, hyperarousal

16

NE hypOfunctioning in frontocortico pathways cause ___ and ___

ADHD and Depression

17

___ activity opposes ___ activity in limbic pathway

NE opposes Serotonin 5HT

18

What does poor serotonin activity do to your affect?

Cause negative affect states (Depression, anxiety, Eating Disorder, Bipolar)

19

What does COMT Met and Val alleles lead to?

Met alleles --> low degradation --> high NE in limbic area --> anxiety in limbic areas

Val alleles --> high degradation --> low NE in cortex --> inattention

20

How does X inactivation affect neurotransmitters?

No X-inactivation --> high COMT --> low NE and DA in cortex --> depression

21

Lack of empathy (antisocial, narcissistic) is associated with what neurological function changes?

Overactive Cingulates
Hypoactive MPFC

22

2 Genes associated with hypofrontality

COMT, DAR

23

What are the Cluster A personality disorders?

Psychotic-like:
-Paranoid
-Schizoid
-Schizotypal

24

What are the Cluster B personality disorders?

Dreaded, behavioral :
-Antisocial
-Histrionic
-Narcissistic
-Borderline

25

What are the Cluster C personality disorders?

Anxious:
-Avoidant
-Dependent
-Obsessive-compusltive

26

Difference between homeopathy and naturopathy

Homeopathy: stimulate body's self-healing response

Naturopathy: noninvasive treatments

27

What are 3 CAM treatment that have effectiveness treating depression?

L-methylfolate
S-adenosyl methionine (SAMe)
St. John's Wort

28

What's the difference between Schizoid and Schizotypal PD?

Schizoid: trouble relating, have no interest in interactions

Schizotypal: oddities in behavior and thoughts

29

What is an age related requirement for Antisocial PD?

Evidence of a Conduct Disorder with onset before age 15

That leads to pervasive pattern of disregard for or violation of rights of others after age 15

30

What characterizes Borderline PD?

Pervasive Instability: of relationships, self-image, behaviors, and affects

5+/9 Symptoms needed

31

Which PD are more prevalent in women?
In men?

Women: paranoid, avoidant, dependent

Men: antisocial

32

Psychopharmacolgy can treat what PDs?

Cluster B: Antisocial, narcissistic, histrionic, borderline

Avoidant (Cluster C)

33

Psychotherapy works for which one Cluster B PD?

Borderline PD only
-3 psychodynamic and 2 cognitive behavioral models

34

What are 3 risk factors for Personality Disorders?

1. Not married
2. Impoverished
3. Poorly educated

35

Prevalence of different clusters of PD

A and C more common in general
B least common, but more common in the hospital

36

Benzodiazepines can exacerbate conditions in what cluster of PD?

Cluster B

37

What psychotherapy models work for treating Cluster C PDs?

CBT and Psychodynamic

38

Criteria for Mania vs Hypomania

Mania: 3+/7 symptoms for 7+ days of expansive mood

Hypomania: 3+/7 symptoms for 4+ days

39

DTRHIGH

-Distractible
-Talkative
-Racing thoughts
-Hyperactive
-Impulsive
-Grandiose
-Hyposomnic

40

What is the difference between Bipolar 1 and Bipolar 2?

Bipolar 1: Mania + MDE

Bipolar 2: Hypomania + MDE

41

What is the criteria for Cyclothymia?

2+ years of hyponamia + minor depressions (relative decrease seems large)

42

What is Kindling Hypothesis?

Related to Bipolar
-Too much neuronal limbic firing
-Once you get mania, you get more episodes

43

Gender differences in Bipolar

Bipolar 1: men = women
Bipolar 2: women > men

44

How do Atypical Antipsychotics treat Bipolar?

-D2 receptor block--treats Mania
-5HT2a receptor block--treats depression

45

What are the anti-manic agents?

-Lithium
-Divaproex
-Carbamezepine
-Atypical antipsychotics (Risperidone, Aripiprazole, Lurasidone)

46

Neurotransmitter changes associated with Anxiety Disorders:

-Low 5HT
-Low GABA
-High NE
-High Glutamate

47

GAD DSM-5 Diagnostic criteria

-Anxiety/worry more days than not for 6+ months, about 1+ event/activity
-3+ symptoms

48

Gender difference for anxiety disorders:

Women > men except in OCD

49

When are Beta Blockers used in anxiety?

Symptomatic relief of performance anxiety

50

Busipirone mechanism of action:

5HT1a receptor agonist
-Only approved for GAD

51

Psychotherapy models used for GAD:

CBT or Psychodynamic
CBT has most evidence

52

Frontline GAD medications:
2nd line?

SSRIs, sometimes SNRI
-2nd line = Benzos

53

Panic Attack DSM-5 Criteria

-Initially abrupt, unexpected, untriggered, peaks within minutes
-4+ of symptoms

54

Agoraphobia criteria:

Fear/Anxiety about 2+ situations for 6+ months

55

Emergency treatment for panic disorder:

Fast-acting Benzodiazepines (alprazolam)

56

What is Systematic Desensitization and Flooding?

Systematic Desensitization: Step by step increase in facing fears; type of CBT

Flooding: Immediately facing fears

57

Obsession vs Compulsion

Obsession: recurrent/persistent, intrusive and unwanted thoughts or urges that the patient WANTS TO NEUTRALIZE

Compulsion: repetitive behavior or activity that patient performs in RESPONSE to obsession

58

First drug approved for OCD

Clomipramine (a TCA)

59

OCD vs. OCPD

OCD patients have insight into their behavior

OCPD patient's don't. The're rigid, moralistic. Have no compulsions

60

Most common cause of PTSD:

Death of a loved one

61

Most likely thing to cause a PTSD:

Assault

62

PTSD Criterions A-E

A. Exposure
B. Re-living of events
C. Avoidance of associated stimuli
D. Negative cognition and mood changes
E. Alterations in arousal/reactivity

63

Acute Stress Disorder criteria:

PTSD criteria but, >3 days and

64

What drug can stop nightmares in PTSD?

Prazosin (a1 inhibitor)

65

Risk factors for TBI:

-Male
-Age 0-4, 15-24, 65+
-Lower SES, metropolitan area
-Recurrent TBI

66

Which are primary causes of TBI?
-Edema
-Diffuse axonal injury
-Vascular tear
-Seizure
-Ischemia, hypoxia
-Intracranial, extracerebral hemorrhage
-Necrosis, apoptosis
-Inflammation
-Vasospasm
-Focal cortical contusions

-Diffuse axonal injury
-Vascular tear
-Focal cortical contusions
-Intracranial, extracerebral hemorrhage

67

Which are secondary causes of TBI?
-Edema
-Diffuse Axonal Injury
-Vascular Tear
-Seizure
-Ischemia, hypoxia
-Intracranial, extracerebral hemorrhage
-Necrosis, apoptosis
-Inflammation
-Vasospasm
-Focal cortical contusions

-Ischemia, hypoxia
-Vasospasm
-Edema
-Necrosis, apoptosis
-Inflammation
-Seizure

68

Glasgow Comas Scale:
Severe = ___
Moderate = ___
Mild = ___

Severe = 3-8
Moderate = 9-12
Mild = 13-15

69

What functions do the Glasgow Coma Scale test?

-Eye opening
-Verbal response
-Best motor response

70

Examples of emotional and behavioral changes after TBI

1. Post-traumatic agitation
2. Personality changes
3. Psychiatric disorders
4. Substance misuse disorders

71

What is akasthesia

Can't sit still, restlessness

72

What is the most disruptive behavior post TBI

Post-traumatic agitation, behaviors

73

Trauma to lateral orbitofrontal cortex can cause what kind of behavioral changes?

Social comportment

74

Trauma to dorsolateral prefrontal cortex can cause what kind of behavioral changes?

Executive function

75

Trauma to the anterior cingulate cortex can cause what kind of behavioral changes?

Motivated behavior

76

PTSD is more likely to be seen with what degree of TBI?

Mild

77

TBI increases risk for what psychiatric disorders?

Depression, Anxiety

78

What are classes of medications used to treat post TBI agitation?

-Beta blockers
-Antiepileptics/anticonvulsants
-Antidepressants (SSRI, TCA)
-Antipsychotics

79

In Depression:
What 2 neutotransmitter abnormalities cause:
decreased positive affect?
increased negative affect?

Decreased negative: NE, DA

Increased positive: NE, 5HT

80

Dyssomnia vs. Parasomnia:

Dyssomnia: timing, quality, amount of sleep

Parasomnia: abnormal physiology or behavior associated with sleep

81

Insomnia DSM-5 Criteria

-1+ of: initiating, maintaining, or early morning waking w/ inability to return to sleep
-3+ nights/week for 3+ months

82

Age and Gender pattern of Insomnia:

-Increases with age

-Women report insomnia 50% more

83

Endogenous causes of Insomnia:

-High NE from locus ceruleus
-High 5HT from Raphe nucleus
-High DA from VTA
-High Histamine from tuberomamillary nucleus
-Low GABA, melatonin, adenosine tones

84

What is the relation between Insomnia and Anxiety?

-Anxiety can lead to insomnia
-Fight or flight response to getting in bed

85

What are the 4 steps in managing Insomnia?

1= Diagnosis, informed consent, education
2= Behavioral counseling (sleep hygiene, stimulus control)
3=Psychotherapy
4=Pharmacotherapy

86

What kind of therapies are used in Insomnia Stage 3 Management?

-Sleep restriction therapy
-Cognitive therapy
-Behavioral therapy

87

1st line pharmacotherapy for Insomnia:

Melatonin, antihistamines

88

For insomnia, what's used first between:
Benzodiazepine Receptor Agonists (BZRAs) and Benzodiazepines?

BZRAs 3rd line, Benzos 4th line
-Zolpidem, Zaleplon, Ezopiclone

89

Patient's with restless legs get what kind of pharmacotherapy?

D2 agonists

90

Insomnia patients w/ Apnea do NOT get what pharmacotherapy?

Sedatives

91

What does 5HT2a blocking do for Insomnia?

Creates deeper sleep patterns

92

What can be done to promote a more accurate circadian clock?

Antagonize 5HT1d and 7 receptors