Psyche

Question 0

delusions

Answer 0

fixed, false beliefs that are completely unshakeable.

Question 1

Psychosis

Answer 1

illogical, disorganized/nonsensical speech or writing;

often includes hallucinations (of any modality), and delusions.

Question 2

Psychotic disorders

Answer 2

• schizophrenia, schizoaffective disorder
• delusional disorder
• depression, mania, delirium
• dementia
• anorexia nervosa (? - debated)

Question 3

organic mental illness

Answer 3

problems in behavior related to damaged brain structure (traumatic injury, cancer, other organ problems); Dx w/ MRI.
*usually impair cognitive operations

Question 4

Examples of organic mental disorders

Answer 4

• delirium
• dementia
• amnesic disorders
• mental retardation, learning disorders

Question 5

functional mental disorders

Answer 5

disorders of responding to lessons learned, but coding is correct (no structural problems);

• • psychosocial Tx most helpful to reverse.
    ie: phobias

Question 6

Adjustment disorder

Answer 6

shift in mood (w/ anxiety or depression) that is temporary (less than 6 weeks), related to increased stress.

Question 7

Borderline Personality Disorder

Answer 7

• will likely change to “Chronic Emotional Dysregulation” in time;
  Sx: rapid mood changes and slow to return to baseline, esp. w/ interpersonal relationships; + frequent anxiety and panic attacks.
  Cause: overactive amygdala & under-active frontal lobe.
  Tx: psychotherapy to teach how to conceptualize interactions

Question 8

Bipolar type I disorder

Answer 8

Full mania lasting at least 1 week, usually alternating with periods of depression (not always)
Tx: anticonvulsants, antidepressants may provoke mania

Question 9

Bipolar type II disorder

Answer 9

aka: hypomania;
disorder of alternating mood changes, with depression and manic episodes less than full mania (less out of control, no psychosis or delusions); with at least 1 episode of major depression.

Question 10

cyclothymia

Answer 10

disorder w/ ONLY periods of hypomanias and dysthymias (= minor reduced mood but not full depressions), more cyclic pattern.

Question 11

Mixed state dysthymia

Answer 11

Hyperactive state with simultaneous depression/emotional pain.
** VERY high risk for suicide**
(subtype/form of manifestation of bipolar disorder)

Question 12

symptoms of (full) mania

Answer 12

Mood & thoughts: euphoric, flight of thoughts, grandiosity, paranoia
Bx: decreased sleep need/unconcerned insomnia, pressured speech, hyperactivity, poor judgement, decreased inhibition/impulsive, inappropriate behavior (sexual or other)

Question 13

conditions that may mimic mania

Answer 13

Drugs: amphetamines, cocaine, alcohol, corticosteroids
Metabolic: Cushing’s disease, hypERthyroidism
Neuro: stroke, brain trauma, neoplasms, epilepsy, neurodegen.
Infection: influenza, encephalitis, neurosyphilis, AIDS

Question 14

Characteristics of panic attacks

Answer 14

1. false positive rxn (abnormal rxn to normal stimulus)
2. sudden onset, aversive
3. lasts 10-15 minutes
4. degrades performance, trigger avoidance strategies
5. 4+ physical symptoms
   => circular nature (attack–> fear & hyper-vigilant –> more attacks)

Question 15

obsessive-compulsive and related disorders (5)

Answer 15

1. Obsessive-Compulsive disorder
2. Body Dysmorphic disorder - ie: anorexia nervosa
3. Hoarding disorder - excessive attachment of emotional value to objects
4. Trichotillomania (hair pulling disorder)
5. Excoriation (skin picking) disorder

Question 16

Trauma & stress-related disorders (3)

Answer 16

1. Post-Traumatic Stress Disorder
   (Hx of traumatic experience, heightened arousal & re-experience trauma memories, > 6 weeks)
2. Acute Stress Disorder (like PTSD, but < 6 weeks)
3. Adjustment Disorder (less severe, not from TRAUMATIC event, but some stressful event)

Question 17

Common comorbidities w/ anxiety disorders

Answer 17

1. Depression

Also: Substance abuse, Borderline personality disorder, fibromyalgia or asthma, chronic pain, etc.
* if resistant to Tx, may be caused by Pheochromocytoma!*

Question 18

structures of the Limbic System

Answer 18

1. Amygdala (central structure for anxiety!),
2. Thalamus, 3. hypothalamus
3. hippocampus, 5. olfactory bulb
   * * counteracted/controlled by frontal lobe **

Question 19

Neurotransmitters involved in Anxiety (3)

Answer 19

NE (norepinephrine), 5-HT (serotonin), GABA

Question 20

Anxiety disorders (5)

Answer 20

1. “GAD” (Generalized Anxiety Disorder) - multiple focuses of worry
2. Panic Disorder - panic attacks characterized w/ extreme avoidance Bxs.
3. Agoraphobia - fear of open spaces/where vulnerable.
4. Social Phobia
5. Specific phobia(s)

Question 21

best treatment for Anxiety disorders

Answer 21

1: Cognitive Behavioral Tx (“CBT”)

2. Dialectical Behavior Therapy
3. Pharmacological treatment:
   
   • SSRI +/- mirtazapine or buspirone
   • NOT anti-psychotics, nor benzodiazepines for long-term Tx*

Question 22

prodrome of schizophrenia

Answer 22

= the phase preceding clinical schizophrenia, w/ changes predictive of schizophrenia;
Sx: withdrawal from relationships, drop in school performance, odd beliefs (w/ normal insight)

Question 23

Epidemiology of Schizophrenia

Answer 23

1. Age: onset usually 19-24
2. Gender: M>F, but new cases after age 45 = female (estrogen may be psychoprotective)
3. Heterogenous etiology
   - significant genetic component (ie: monozygotic twins -> 50%), but no specific loci.
   - environment/upbringing = weak factor, except for certain cases
   (maternal complications/infection, early age pot abuse)

Question 24

gross pathological changes in brains of schizophrenic patients

Answer 24

1. thinner cortex (esp. frontal lobe) | 2. white matter abnormalities (poor communication w/ frontal lobe)

Question 25

Neurotransmitter changes in schizophrenia

Answer 25

1. Dopamine: hyperactive 2. Serotonin: increased 3. Glutamate: decreased, may cause negative Sxs

Question 26

Symptoms of Schizophrenia

Answer 26

Perception: hallucinations Thinking: disrupted --> delusions, paranoia Affect/Mood: blunted * w/ treatment, SE: severely blunted affect, decreased motivation, dyskinesias, etc.

Question 27

4 domains of cognition that may be affected by dementia

Answer 27

1. Language - poor understanding & word-finding (circumlocution) 2. Memory - forgetful, losing things 3. Visuospatial - poor recognition of ppl, places (get lost easily) 4. Executive function - impulsivity, poor judgement

Question 28

Vascular Dementia

Answer 28

onset w/in 3 months of stroke, see multiple/bilateral stroke damage on imaging.

Question 29

Dementia from infection

Answer 29

(rare!) - neurosyphilis - AIDS - Whipple disease - Prion disease

Question 30

Potential causes of organic, trauma/toxic dementia

Answer 30

- head trauma --> traumatic brain injury or subdural hematoma - Toxins: alcohol, medications (esp. anticonvulsants), heavy metal exposures

Question 31

metabolic causes of dementia

Answer 31

- hypothyroidism - hyperparathyroidism - multiple episodes of hypoglycemia - liver/kidney disease - vitamin deficiencies (Vit B1 or B12)

Question 32

Neurogenerative causes of dementia

Answer 32

- Alzheimer's Disease (affects 50% of ppl 85+, slow & progressive) - Frontotemporal (onset ~60s, esp. common w/ Down's syndrome) - Parkinson's disease - dementia w/ Lewy Bodies

Question 33

Normal pressure hydrocephalus

Answer 33

can be a cause of dementia, Signs: "3 Ws" - Wet, Wild, Wobbly