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Flashcards in Psychiatric Disorders Deck (52):
1

Define: wellness

it is based upon the integrated and coordinated function of many Neurotransmitter systems

2

Define: disorder

Imbalance of the Neurotransmitter systems which impart function and quality of life

3

Define: Psychiatric disorders

They are CNS diseases characterized by disturbances in emotion, cognition, motivation, and socialization.

4

How are mental and physical health integrated?

If one's physical health is suffering, that can lead to low self esteem, unhappiness, and head towards anxiety and depression disorders.
If one's mental health is suffering, that means that they may not have the motivation to keep their body healthy which will lead to a decrease in physical health.

5

T or F: every disorder of the same kind is exactly the same (ex. every depression disorder is the same)

False: There is lots of differentiation between cases

6

How are psychiatric disorders treated?

-hollistic approach
-pharmacologic treatment (drugs)
-non-pharmacologic treatment (ways to improve one's life that will improve their health)

7

T or F: co occurrence is very low for anxiety and sleep disorders

False: very high

8

Can anxiety be good?

Yes - a normal amount of anxiety is healthy. It allows us to prepare for or react to environmental changes. Part of all of us should be adaptive and transient.

9

When does anxiety become bad?

When it is excessive, it can become persistent, severe, and impair function.

** it is critical to understand the distinction between short term symptom variance vs. an anxiety disorder

10

What is the criteria to base whether or not someone has an anxiety disorder?

-Excessive anxiety/worry occurring more days than not for about 6 months about a number of different issues.
-The person finds it difficult to control the worry, and both are associated with three or more of the anxiety symptoms.

11

What are the 6 anxiety symptoms?

-restlessness or feeling keyed up or on edge
-being easily fatigued
-difficulty concentrating or mind going blank
-irritability
-muscle tension
-sleep disturbance

12

Describe dimenhydrinate (Gravol)

-most effective for motion sickness
-an antihistamine, also anticholinergic
-acts as a CNS depressant, often causing drowsiness and sedation side effects
-off-label use as a sleep aid

13

How many stages of REM sleep are there?

4 (The last 2 are the most restorative sleep to arouse)

14

T or F: sleep medications do not alter your natural sleep cycles

False - of course they do lol

15

Explain the difference between REM and Non-REM sleep

Non-REM sleep is enabled by primary serotonergic tracts in medulla and dorsal raphe nucleus.
REM sleep is turned on by cholinergic tracts and turned off by noradrenergic areas

16

What kind of affect does dopamine have?

alerting

17

What other chemicals can cause wakefulness?

Norepinephrine, acetylcholine, histamine, substance P, corticotropin releasing factor (cortisol)

18

What can insomnia be related to?

situational, medical, psychiatric or pharmacologic factors

19

What types of sleep disorders are there?

-difficulty in falling asleep
-difficulty in maintaining sleep
-non-restorative sleep

20

When is a sleep disorder deemed to be chronic instead of short term?

usually after 3 weeks

21

List 11 non-pharmacologic ideas of sleep hygiene that can help aid someone with a sleep disorder

1. establish regular times to wake up and go to bed
2. sleep only as much as needed to feel rested
3. go to bed only when sleepy and avoid long periods of wakefulness in bed
4. if you do not fall asleep within 20 minutes, leave the bed and do something relaxing.
5. avoid daytime naps
6. schedule worry time during the day (don't take your troubles to bed)
7. exercise routinely but not before bed
8. minimize sensory stimulatotion in the bedtime (light,sound,temp)
9. reduce use of alcohol, caffeine, and nicotine, especially in the evening
10. avoid large quantities of liquids in the evening
11. do something relaxing and enjoyable before bedtime

22

What are examples of situational problems that can cause insomnia?

-stressors
-jet lag
-shift work

23

What are examples of medical problems that can cause insomnia?

-cardiovascular
-respiratory
-pain
-endocrine
-GI
-neurologic
-pregnancy

24

What are examples of psychological problems that can cause insomnia?

-all disorders
-including substance abuse

25

What are examples of pharmacological problems that can cause insomnia?

-anticonvulsants
-adrenergic blockers
-diuretics
-SSRI
-steroid stimulants

26

What 4 disorders are all related?

-sleep disorders
-depression
-chronic pain
-anxiety

27

What needs to be enhanced to better someone's sleep quality?

GABA
Serotonin

28

What needs to be inhibited to better someone's sleep quality?

histamine, acetylcholine, norepinephrine, dopamine, substance P, cortisol

29

How do benzodiazepines treat insomnia?

GABAa agonists

30

What is an example of a non-benzo GABAa agonist?

zopiclone

31

What other types of medications can be use to treat insomnia?

antihistamines
antidepressants (incl. trazodone)
melatonin and related agonists (valerian)

32

What types of medications can be used to treat anxiety?

antidepressants, bronchodilators, steroids, herbals, thyroid, stimulants

33

Describe the Noradrenergic model

autonomic nervous system is HyperSensitive or Overactive - excessive NE, glutamate, Locus Ceruleus firing

34

Describe the GABA model

normalizing GABA can favourably impact 5HT, NE, DA

35

Describe the serotonin model

increasing/normalizing 5HT reduces LC firing and NE excess hence reducing overstimulation

36

What are the physical symptoms of an anxiety disorder?

restlessness, fatigue, muscle tension, sleep disturbance, irritability

37

What are the psychologic symptoms of an anxiety disorder?

increased levels of anxiety, worries hard to control, on edge, poor concentration

38

What do the physical symptoms of anxiety respond to?

-Respond quickly to GABAa agonists
-antidepressants may have superior long-term benefits, but can increase physical symptoms at first and benefits take time
-effectiveness of BZD contributes to dependence liability, esp with fast onset and rapid elimination (lorazepam)

39

What do the psychologic symptoms of anxiety respond to?

-some quick easing with BZD, not sustained
-antidepressants work more slowly but are treatments of choice for chronic anxiety symptoms - transient increase in symptoms may challenge adherence
-psychoeducation, psychotherapy, meditation, exercise, etc are often vital for optimal management

40

Describe benzodiazepines

-all have muscle relaxant, anxiolytic, sedative/hypnotic and anticonvulsant properties
-all decrease CNS excitability via enhancing GABA (GABA agonists)
-onset speed correlates with lipid solubility
-variable half lives

41

Describe drugs with a longer half life

It means they have slower drug elimination. It can increase having a hangover effect from the drug.

42

Describe drugs with a shorter half life

It means they have faster drug elimination. it can increase the rebound symptoms, and causes a risk of drug dependency.

43

Do benzodiazepines work too well?

-Unauthorized dosage increase and eventual dependency is common to all patients exposed to this medication.

44

Do lorazepam and alprazolam have short or long half lives?

short

45

Diazepam has ____ onset

rapid

46

Higher risk for ______ with quick onsent and accelerated clearance (liver induction)

dependency

47

Describe how antidepressants can be used to treat anxiety

-mechanism not fully understood
-modulation of 5HT, NE, and DA normalizes gene expression which means more BDNF and less CRF (decreases cortisol)

48

Describe 5HT modulation

short & long-term

49

Describe NE modulation

indirect & direct

50

Describe DA modulation

indirect & direct

51

What is BDNF?

fertilizer for brain, helps grow and repair tissues

52

What is a pharmacist's role in sleep/anxiety disorders?

-educate about non-drug strategies
-educate about the importance of thorough assessment and of appropriate pharmacologic strategies
-educate about appropriate time-frames for response, and minimizing side effects
-promote adherence to a therapeutic plan