Neuropsychiatric conditions Flashcards

Question

What is the course of impairment in Sz?

Answer 1

• A year behind at the start of school, with some decline/slower gains by the end • Deterioration with first episode • mixed findings about decline vs leveling out – Decline varied between people, and between domains over 10 years from diagnosis. – Verbal knowledge, memory ↓ – speed, XF, visuospatial more stable

Answer 2

• Major depression (MDD/ clinical/ unipolar depression) - a depressed mood that lasts for at least 2 weeks. • Bipolar disorder - (manic depression) – alternating periods of feeling low (depressed) and high (manic). • Psychotic depression - depressed mood with psychotic symptoms, e.g. hallucinations, delusions, and paranoia • Dysthymia - a less severe depression, lasts for years • Mixed depression and anxiety - combined symptoms

Answer 3

A. - a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week. Enough to impair social/occupational functioning, need hospital. May involve delusions (esp. grandiose, persecutory) or hallucinations (esp. auditory) B. - during the period of mood disturbance, 3+ of the following symptoms have been persistent and significant (4 if mood is only irritable): 1) increased self-esteem or grandiosity 2) decreased need for sleep 3) more talkative than usual or pressure to keep talking 4) flight of ideas; sense of racing thoughts 5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., reckless buying sprees, sexual indiscretions, business investments)

Answer 4

– ~ 2 % of Australians experience BPD at some stage – Sex ratio (F:M) 1:1 for BPD I (mania and depression), but 2:1 for BPD II (milder mania, more depression) – onset childhood to 50 years. Mean age 21, most cases 15-24. Average period from 1st symptoms to diagnosis about 12 years – onset after 50 may relate to medical triggers like CVD

Answer 5

A. 5+ of the following for a 2 week period; represents a change from previous functioning; must include symptom 1 or 2 1. * depressed mood nearly every day 2. * Diminished interest or pleasure in all or most activities 3. Significant unintended weight loss or gain, e.g. 5 % 4. Insomnia or sleeping too much nearly every day 5. Agitation or psychomotor retardation noticed by others 6. Fatigue or loss of energy 7. Feelings of worthlessness or excessive guilt 8. ↓ ability to think or concentrate, or indecisiveness 9. Recurrent thoughts of death B. Symptoms cause significant distress or impairment in social, occupational, other important areas C-E. Not attributable to substances, medical conditions, or psychiatric conditions

Answer 6

• Affective component –Feelings • Behavioural component –Too much or too little • Cognitive component –Content –Detail, inefficiency, slowing

Answer 7

• Prior to puberty – Weight gain; irritability; anxiety on separation; somatic complaints • Adolescents – Irritability; rebelliousness; conduct problems; falls in grades; change in friends • In the elderly – Agitation; more likely to deny expression; hypochondriacal concerns; problems in memory and concentration

Answer 8

• Short-term – ~ 50 % have full remission in 6-12 months • Longer term – 90 % no longer have full form 2 years later • A recurring problem – ⩾40–75% lifetime recurrence Chiu, 2017 – Average interval of ~ 5 years between episodes – Some have recurrence within a year, some stay free – With repeated episodes, common trend to shorter remissions and longer episodes

Answer 9

Genetic findings • heritability ~ 40%. Increases to ~ 70% in twins with recurrent and severe major depression • may inherit a generic liability, not a specific form of depression ``` Medical factors • low thyroid function; • stroke, CVD, TBI, epilepsy, PD • blood vessel disease; diabetes and/or hypertension; • some steroid and hormonal treatments; • chronic pain ```

Answer 10

• “MDD caused by imbalance of one or more MAs” Support • People and animals given drugs that reduce MAs, like reserpine, often show depression-like behaviour • People with MDD have low levels of MAs; drug treatments increase levels of MAs; depression eases. • depleting dietary building blocks (precursors) of serotonin associated with relapse in recovered patients • People who complete suicide have lower brain stem levels of serotonin and/or its by-products Limitations • Reducing precursors doesn’t make heathy people depressed • antidepressant drugs don’t work for many • Reserpine only induces depression in a small minority • drugs increase MAs very fast, but changes in mood take several weeks • ideal/ problem levels still unknown • Some antidepressants don’t increase synaptic MAs; some drugs that increase MAs don’t reduce depression

Answer 11

• “depression comes from neg distortions in perception, memory, and problem solving” • vulnerabilities formed thru observation or traumatic events triggered later by parallel experiences • Beck’s negative cognitive triad: dysfunctional schemas (belief systems) re the self, the world, and the future • E.g. I’m unloveable; no one loves me; no one will ever love me • those with dysfunctional attitudes similar to Beck’s ~ 7* more likely to develop depression, and ~2 * as likely to relapse • Chicken vs egg: maybe depression leads to depressive thoughts, not vice versa • CBT remains one of the most widely used and effective methods of treating depression

Answer 12

• Under stress, the HPA axis ↑ cortisol; ↑ glucose and ↓ other production like BDNF. When the crisis is over the HPA should restore normal activity • Chronic stress leads to atrophy of PFC, hippocampus and amygdala, possible inhibition of neurogenesis, compromised ability to “turn down” HPA axis activity • Effect of damage to those areas - compromised ability to process negative emotion, display adaptive behaviour, and lose drive to engage with the environment • HPA hyperactivity one of the most consistent findings in depression; it resolves with successful antidepressant treatment • Maybe HPA axis hyperactivity not a consequence but a risk factor for depression, caused by genetic liability and early life experience

Answer 13

• Micronutrients may influence brain function. Depressed and healthy controls can be distinguished by gut bacteria • Experimentally depleting rats’ gut microbiota leads to depression-like bvr; increasing gut microbiota reverses this • Faecal microbiota transplantation (FMT) from an anxious mouse produces anxious behaviour, FMT from a non-anxious mouse produces non-anxious behaviour • FMT from depressed humans into rats induced bvr features of depression • FMT for IBS from healthy to depressed people associated with significant gains in mood

Answer 14

• Both characterised by cognitive dysfunction; variable findings but deficits tend to involve sustained and divided attention, speed, executive functioning, verbal learning and memory. • ES generally greater in BPD than MDD • Residual impairment in attention and EF: – Some studies find comparable severity – Some find worse verbal memory, mental flexibility and inhibitory control in BPD • Most suggest BPD similar to MDD but more severe; EF and memory stronger in depressed patients

Answer 15

• DLB 2nd or 3rd most common form of dementia • hybrid of Alzheimer’s and Parkinson’s disease • Core features: 1. Fluctuating cognition with pronounced fluctuations in concentration and attention; 2. recurrent well-formed visual hallucinations; 3. REM sleep behavioural disorder 4. One or more spontaneous motor features of parkinsonism • Supportive features: – severe sensitivity to antipsychotics, falls, syncope, hallucinations in other modalities, systematised delusions, apathy, anxiety and depression

Answer 16

• Experienced by 82 % of women, 66 % of men by 79 % of sample • Early incidence: 22 % have VH, 26 % have parkinsonism. But early, recent VH far more specific for diagnosis • Recurrent, detailed, well formed. • Typically involve people or animals intruding into the home, but also involve perceptual distortions, e.g. misidentification syndromes, seeing faces emerging out of patterns on carpets, or backgrounds like trees • Can be enjoyable or frightening • VH not unique to DLB, e.g. delirium and other dementias, but distinguished by early onset, persistence, non mood-congruent nature • Hallucinations less common in other modalities • VH correlate with greater visuospatial problems; Capgras delusion and delusional misidentification; better response to medications

Answer 17

* A) Basic problem with visuoperception? But Posterior Cortical Atrophy defined by visuospatial problems due to occipito-parietal degeneration, and VH rare * B) DLB patients typically have hypoperfusion or hypometabolism in occipital lobes, possibly due to loss of cholinergic input. Primary visual cortex malfunctioning with abnormal sensory experiences * C) Fluctuating cognition – intrusions of dream imagery into wakefullness * Still contentious

Answer 18

• psychiatric symptom ≠ psychiatric condition. Consider: 1. Characteristics of the experience 2. Cultural context 3. Personal context: 1/3 to ½ of bereaved spouses report some level of hallucination involving the deceased

Neuropsychiatric conditions Flashcards

(42 cards)