Theme 3 - Modulatory systems in Psychiatry Flashcards Preview

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Flashcards in Theme 3 - Modulatory systems in Psychiatry Deck (62)
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1

What is the pathway for reward in the brain?

mesocorticolimbic

2

What is tolerance?

Diminished response to the effects of a given amount of drug following repeated exposures to the drug.

3

In what brain system does addiction?

Mesolimbic dopaminergic system

4

What structure releases what substance in addiction?

Dopamine released from nucleus accumbens

5

What effect does alcohol have on the DAergic system?

disinhibition of ventral tegmental DA neurons

6

What effect do opiates have of on the DAergic system?

inhibit GABAergic neurons in VTA which disinhibits VTA DA neurons

7

What effect do psychostimulants have of on the DAergic system?

direct effect on DA neurons in nucleus accumbens

8

What effect do nicotine have of on the DAergic system?

increases nuclesus accumbens DA directly and indirectly

9

How does cocaine affect dopamine levels in nucleus accumbens?

Blocks reuptake transporters

10

How do amphetamines affect dopamine in the nucleus accumbens?

DA transporters run in reverse

11

What receptors does alcohol affect?

GABAa - agonist
NMDA - anatgonist

12

What brain structure is linked to the physical dependance upon opiates?

Locus coereolus

13

What receptors are linked to alcohol dependence?

GABAa - downregulated
NMDA - upregulated
SO when you stop pissing up get excitation symptoms such as tremors, agitation, seizures

14

6 examples of disorders associated with neurosis?

Anxeity
Depressive
Obsessive
Compulsive
Adjustment
Somatisation

15

4 disorders associated with psychosis

Organic
Bipolar
Schizophrenia
Depressive

16

What is defined as
An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions and hallucinations?

Psychosis

17

What is the time limit for a psychotic episode?

1 week

18

What is defined as Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background

delusion

19

What is defined as a perception experienced in the absence of external stimulus?

Hallucination

20

Schizophrenia is a minimum of 1 of these symptoms

a Thought echo, insertion, withdrawal or broadcast

b Delusion of passivity or delusional perception
(e.g. the toilet flushed and then I knew)

c Running commentary hallucination or 2 voices discussing the patient

d Persistent delusions of other kinds

21

Schizophrenia it at least 2 of these symptoms for at least one month

e Persistent hallucinations in any modality with accompanying brief delusions

f Breaks in thought resulting in abnormal speech (eg. incoherent, neologisms)

g Catatonic behaviour eg. Excitement, posturing, waxy flexibility, negativism

h Negative symptoms not due to depression or medication

In the absence of an organic disorder

22

At least 5 causes of organic psychosis

Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Cerebral trauma
Cerebrovascular disease
Demyelination: Multiple sclerosis etc
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Immunological: SLE
Acute drug intoxication: eg. Ketamine, Cannabis, LSD, PCP, Amphetamine,
Toxins eg. lead
Dementias

23

What are the 2 types of schizophrenia and types of symptoms associated with each?

Acute - positive symptoms
Chronic - negative symptoms

24

Percentage prognosis of schizophrenia?

20% - complete recovery and off treatment
25% - perisitant symptoms after first episode
+50% - relapsing remitting

25

At least 5 things that give a good prognosis of schizophrenia

Female
Married
Family history of affective disorder
Good premorbid function
Acute onset
Life event at onset
Early treatment
Affective symptoms
Good treatment response

26

At least 5 things for a poor prognosis of schizophrenia

Male
Single
Family history of schizophrenia
Premorbidly schizoid
Slow onset
Long duration untreated
Negative symptoms
Obsessions
High Expressed Emotion in the family
Substance misuse

27

Two structural changes to brain associated with schizophrenia

Ventricular enlargement
reduced brain volume

28

What 3 neurophysiological phenomina are associated whith schizophrenia?

Hypofrontality
Hyper-excitable sensory cortex
Abnormal neural oscillations

29

What are 4 neurocognitive effects associated with schizophrenia?

Lower IQ
Attentional deficits (e.g. Stroop Test)
Working memory (e.g. Wisconsin Card Sorting Test)
Planning and information processing deficits

30

What are the 4 affective episodes?

Major Depressive Episode
Manic Episode
Hypomanic Episode
Mixed affective episode

31

give 9 symptoms of depression

Depression of mood
Anhedonia
Psychomotor retardation
Agitation / restlessness
Anxiety / preoccupation
Diurnal variation of mood
Insomnia
Feelings of guilt , self-reproach worthlessness
Somatic symptoms
Hypochondriasis
Weight loss
Suicidal thoughts

32

What are the DSM V criteria of a major depressive episode?

5 or more of the following symptoms for 1 week
Depressed mood most of the day, nearly every day
Diminished interest or pleasure
Weight loss / weight gain or appetite decrease / increase
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent suicidal ideation or a suicide attempt/plan

33

5 features of atypical depression

Mood reactivity
Significant weight gain
Hypersomnia
leaden paralysis
interpersonal rejection sensitivity

34

3 criteria for manic episode

abnormally and persistently elevated, expansive, or irritable mood

For a period lasting at least one week and present most of the day, nearly every day:

abnormally and persistently increased activity or energy

35

7 possible symptoms of a manic episode

Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or racing thoughts
Distractibility
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in high risk activities

36

2 Differences between a manic and hypomanic episode?

Same symptoms but hypomanic episode is for 4 days rather than 1 week
The episode is not severe enough to cause marked functional impairment or to necessitate hospitalization

37

What 3 features can be associated with both depression and mania?

Anxiety
Hallucinations/delusions
Catatonia

38

4 epidemiology features of major depressive disorder

onset 25-35
1 in 5
more females than males
8-19% suicide

39

Difference between the two types of bipolar disorder

Bipolar Disorder I
At least one manic episode

Bipolar Disorder II
At least one hypomanic episode
At least one major depressive episode

40

4 epidemiology features of bipolar disorder

15-24 onset
delayed diagnosis
familial aggregation
men and women affected equally BP I

41

7 typical symptoms of acute stress

Feelings of being numb or dazed
Insomnia
Restlessness
Poor concentration
Autonomic arousal
Anger/anxiety/depression
Withdrawal

42

2 abnormal response to stress

PTSD
Adjustment disorder

43

What is the difference between a normal response and an adjustment disorder, how long can the latter last?

Adjustment is out of proportion to stressor
Up to 6 months

44

6 symptoms of PTSD

Re-experiencing flashbacks/nightmares
Numbness/detachment
Avoidance
Hypervigilance/startle
Insomnia
Anxiety/depression

45

What is the average course of PTSD?

Usually immediate onset
Most recover within one year

46

6 physical symptoms of general anxiety disorder?

sweating
palpitations
dry mouth
epigastric discomfort
dizziness
trembling

47

6 psychological symptoms of GAD

Fearful anticipation
Irritability
Sensitivity to noise
Restlessness
Poor concentration
Worrying thoughts

48

Aietology of GAD in relation to parenting

Overprotective
Lack of warmth & encouragement
more critical and intrusive

49

5 Psychological symptoms of panic disorder

fear of losing control
dying
going mad
fainting
derealisation

50

As many physical symptoms of panic disorder as you can think of

Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes

51

What would be 4 differential diagnosis associated with panic disorder?

Endocrine - hypoglycaemia
Respiratory - asthma
Cardio - Arrythmia
Drugs

52

6 points on aetiology of panic disorders?

Precipitating events in 60-96% of cases
-Separation / loss
-Relationship difficulties
-New responsibilities

Traumatic early life events
-Early parental separation
-Traumatic childhood event – 3 fold increase
-Early sexual abuse (<5 years of age)

53

Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction what is this?

Initial short-lived sympathetic arousal

Followed by parasympathetic arousal

May result in vasovagal syncope

The subjective experience tends to disgust and repulsion rather than pure apprehension

54

4 aetiology points on phobias

unresolved unconscious conflict
classical conditioning
historically threatened species
observational

55

In appropriate anxiety in
Situations where the person is observed
Situations where there is potential for criticism
refers to what type of phobia

Social

56

5 symptoms of social phobia

Anticipatory anxiety
Feeling anxious
Blushing
Trembling (observed writing is a problem)
Relieved by alcohol (potential for abuse)

57

What brain structure is associated with fear and eliciting a stress a response?

Amygdala

58

What 2 other structures are excited by the amygdala in a stress response and what do they do?

Hypothalamus - HPA axis
Locus coeruleus - NE

59

What is the HPA axis?

Hypothalamus - releases CRH
Pituitary - releases ACTH
Adrenal cortex - releases cortisol

60

If the amygdala excited the HPA axis, what brain structure inhibits it?

Hippocampus

61

What brain structure is affected by chronic stress and how?

Too much glucocorticoid leads to cell death in hippocampus
Hippocampus cannot feedback to amygdala to limit cortisol production

62

Give 5 anxiety disorders

OCD
Phobias
GAD
PTSD
Panic disorder