Week 5/7

Question 1

describe overall bipolar disorders + characterized as

Answer 1

• mental health conditions characterized by periodic, intense emotional states affecting a person’s mood, energy, ability to function
• these periods last from days to weeks, and are called mood episodes

1) manic/hypomanic
2) depressive episodes

while ppl w/o bipolar disorder experience mood fluctuations, mood changes that are commonly lived experience typically last a few hrs rather than days, and are not accompanied by extreme changes in behaviour or changes in functioning (ADL, social interactions, work, school, etc).

Question 2

bipolar 1 diagnosis diagnosis

Answer 2

at least one manic episode
* the lifetime experience of a major depressive is NOT a requirement

1) inflated self-esteem or grandiosity
2) decreased need for sleep
3) more talkative than usual or pressur eto keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility, as reported or observed
6) increase in goal-directed activity or psychomotor agitation
7) excessive involvement in activities that high potential for painful consequences

Question 3

manic episodes

Answer 3

• period of at least one wk for most of the day, everyday
• extremely high-spirited or irritable, possess more energy than usual, and experiences at least 3 of the following behaviours

1) inflated self-esteem or grandiosity
2) decreased need for sleep
3) more talkative than usual or pressur eto keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility, as reported or observed
6) increase in goal-directed activity or psychomotor agitation
7) excessive involvement in activities that high potential for painful consequences

Question 4

mania and psychosis of bipolar 1

Answer 4

mania and psychosis
- approx 50-95% of ppl w bipolar disorder experience psychosis
- psychotic features usually appear during manic rather than depressive episodes
- mood congruent delusions (ex: grandiosity) and mood incongruent (ex: paranoia) are the most common psychotic feature
- hallucinations and vivid perceptions are also common (typically auditory)

initial euphoria of mania gives way to agitation and irritability. utter exhaustion eventually happens, and many people ultimately collapse into depression.

*depression and the agitated state of mania is a dangerous combination that can lead to extreme behaviours such as violence and suicide

Question 5

what constitutes a manic episode + how many manic episodes are required for BP1

Answer 5

A) a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 wk and present most of day nearly every day.
B) during period of mood disturbance and increased energy or activity 3+ of these sympt are present:
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility as reported or observed
- increase in goal-directed activity or psychomotor agitation
- excessive involvement in activities have a high potential for painful consequences
C) mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D) episode is not attributable to the physiological effects of a substance or another med condition

Question 6

what is bipolar 2

Answer 6

expressed at least one hypomanic episode and at least one major depressive episode

Question 7

what is classified as hypomania

Answer 7

• persistently increased energy or activity levels
• same symptoms as mania, except less severe
• short duration (may last only 4 days)
• does not cause significant impairment
• never accompanied with psychotic features

Question 8

for bipolar 2 what is classified as a major depressive episode

Answer 8

5+ of the symptoms (at least one is 1 or 2)
1 depressed mood
2. diminished interest in activities
3. significant wt loss or gain
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue/loss of energy
7. feelings of worthlessness or guilt
8. decreased concentration/indecisiveness
9. suicidal ideation/attempt

Question 9

what is a main thing surrounding hypomanic episode

Answer 9

not attributable to the physiological effects of a substance or another medical condition

Question 10

s/s of a manic episode

Answer 10

• high energy or excessive activity
• overly good mood
• irritability or impatience
• fast erratic takling
• racing thoughts
• inability to concentrate
• little need for sleep
• feelings of power
• poor judgement
• reckless spending
• high sex drive
• alcohol or drug abuse
• aggression
• refusal to admit there is a problem

Question 11

what is cyclothymic disorder

Answer 11

• has symptoms of hypomania alternating w symptoms of mild to moderate depression
• at least 2 yrs in adults and 1 yr in children
• hypomanic and depressive symptoms do not meet criteria for either bipolar 1, bipolar 2, or major depression
• symptoms are disturbing enough to cause social and occupational impairment

individuals w this tend to have irritable hypomanic episodes and children w this experience irritability and sleep disturbances

rapid cycling

Question 12

what is rapid cycling

Answer 12

have at least 4 changes in mood episodes in a 12 month period
can occur within the course of a month or even in a 24 hour period

Question 13

bipolar 1 disorder summary

Answer 13

1. mania
   - persistently elevated, expansive, or irritable mood and persistently increased activity or energy that is present for most of the day, nearly every day, for a period of at least 1 wk
2. neither psychosis not the lifetime experience of major depressive episode is a requirement

Question 14

summary of bipolar 2 disorder

Answer 14

• requires at least 1 or more episodes of major depression and at least one hypomanic (milder form of elevated mood than mania) episode

Question 15

summary of cyclothymic disorder

Answer 15

at least 2 yrs of both hypomanic and depressive periods without every fulfilling the criteria for an episode of mania, hypomania, or major depression

cannot have had a manic or depressive episode

Question 16

bipolar disorders genetic

Answer 16

• risk for individuals w an affected parent is 15-30% higher
• concordance rate among identical twins is around 70%

Question 17

neurobiological bipolar disorder etiology

Answer 17

• neurotransmitters (dopamine, NE, serotonin) causal factors w mania and depression. too few = depression, too much = mania.
• though recent research shows the complexity of the neurotransmitter sys and it is not as simple as too much or too little.

Question 18

brain structure and function + bipolar disorder

Answer 18

functional imaging shows dysfunction in prefrontal cortex, hippocampus, and amydala

Question 19

what 10 classes of drugs cause substance related and addictive disorders + why is this

Answer 19

alc, caffeine, cannabis, hallucinogens (LSD), inhalants, opioids (heroin), sedatives, hypnotics, stimulants (cocaine), tobacco

taken in excess have a common direct activation of brain reward sys - this is involved in reinforcement of behaviours and production of memories

produce intense activation of the reward system - pharmacological reward pathway are diff for each drug

Question 20

what are substance use disorders

Answer 20

• encompass broad range of behaviours from problematic use (binge drinking), to substance dependence
• substance use is best thought as a behavioural disorder: use of substance becomes conditioned, underlying change in brain circuits persist beyond detoxification, results in compulsive drive to use which render the choice not to use more and more difficult
• acute intoxication states of particular substances can constitute a life-threatening medical emergency
• diagnosis can be applied to all 10 substances except caffeine

Question 21

4 behavioural characteristics of substance dependence

Answer 21

1. impaired control
   - takes more than should
   - express desire to cut down
   - spend great deal of time obtaining substance, using, or recovering
   - daily activities revolve around substance
   - craving substance
2. social impairment
   - failure to fulfill major role obligations at work, school, home
3. risky use
   - use in situations where it is physically hazardous
4. increased dosing
   - requiring more of the substance over time to achieve desired effects

Question 22

opioid withdrawal timeline tell me about it

Answer 22

start - take last dose
72 hrs - physical symptoms peak (chills, fever, body aches, diarrhea, insomnia, muscle pain, nausea, dilated pupils)
1 wk - physical symptoms start to lessen (tiredness, sweating, body aches, anxiety, irritability, nausea)
2 wk - psychological and emotional symptoms (depression, anxiety, irritability, restlessness, trouble sleeping)
1 mo - cravings and depression (symptoms can linger for wks or months)

Question 23

8 principles of harm reduction

Answer 23

1. accept that drug use is apart of our world
2. drug use is complex, multi-faceted phenomenon
3. success is not necessarily cessation, focus on quality of life
4. non-judgemental and non-coercive care
5. ensure those who use drugs or have history w drugs have a voice in policy/program creation
6. PWUD are primary agents of reducing their drug use
7. realities of social inequalities affect both people’s vulnerabilities to and capacity for dealing w drug-related harm
8. do not minimize or ignore the harm and danger associated w illicit drug use

Question 24

side effects of opioids

Answer 24

drowsiness and confusion
itchiness
constipation
n/v
tolerance, dependence, addiction
resp depression

Question 25

list of common opioids

Answer 25

- morphine - hydromorphone (dilaudid) - oxycontin/oxycodone (percocet) - fentanyl - carfentanil - suboxone/sublocade - methadone - heroin - codeine

Question 26

what is fentanyl

Answer 26

is an opioid that can cause dangerously slow breathing, leading to overdose or death. More toxic than other opiods Can get a persription Analgesic Also can be produced illegally - and can be mixed w other drugs - dealers and whatnot try to get ppl hooked and addicted Opioid naïve individuals are at very high risk of overdosing Seemingly mixed in more and more street drugs There is no quality control in illegal labs - where they can be made Making it more dangerous - and leading to unprecedented amount of side effects

Question 27

how much more potent is fentanyl to heroin

Answer 27

20-40%

Question 28

why is fentanyl dangerous

Answer 28

- can't smell, see, or taste it - 50-100x more toxic than morphine - anything can be cut w fentanyl

Question 29

what is carfentanil

Answer 29

synthetic opioid 100x more toxic than fentanyl and is not intended for human use Not for human use, but for vet use Labs have redesigned it for human use

Question 30

signs of opioid overdose

Answer 30

tiny pupils no or slow breathing snoring, gurgling, vomiting cold or clammy skin does not respond blue or purplish lips or fingernails

Question 31

nasal spray naloxone

Answer 31

- non-addictive - ready to use, needle-free - concentrated 4 mg dose - targets opioids specifically - widely available for free, no prescription needed - provides opportunity for engagement on substance use using compassionate harm reduction approach

Question 32

how does naloxone reverse overdose

Answer 32

has stronger affinity to opioid receptors than opioids, such as heroin or oxycodone, so it can known the opioids off the receptors for a short time (30-90 min). allows person to breathe again and reverse the overdose

Question 33

5 steps to responding to opioid overdose

Answer 33

1. try and wake person up 2. call 911 3 give naloxone 4. perform rescue breathing and CPR 5. are they awake and breathing 6. recovery position

Question 34

side effects of naloxone

Answer 34

- increased bp - muscle, bone, joint pain - headache - nasal dryness - nasal swelling, pressure, nasal congestion - could lead to opioid withdrawal

Question 35

opioid withdrawal s/s

Answer 35

body aches diarrhea fast hr agitation fever runny nose sweating high bp yawning nausea shivering or chills sneezing abdo cramps goosebumps

Question 36

what do anxiety disorders share features of

Answer 36

excessive fear - fear is emotional response to real or perceived imminent threat - anticipation of future threat - persons response to anxiety can be maladaptive or adaptive

Question 37

describe mild anxiety

Answer 37

- norm experience in everyday living - allows an individual to perceive reality in sharp focus - sees, hears, and grasps more information and problem solving becomes more effective - may experience slight discomfort, restlessness, irritability, or mild-tension-relieving behaviour (nail biting, foot tapping, etc.)

Question 38

describe moderate anxiety

Answer 38

- perceptual field narrows and some details are excluded from observation - sees, hears, and grasps less info and may demonstrate selective inattention - tension, pounding heart, increased HR, BR, voice tremors, shaking

Question 39

severe anxiety

Answer 39

- perceptual field greatly reduced - may focus on one particular detail or many scattered details and has difficulty noticing their environment even when pointed out - behaviour becomes automatic (wringing of hands, pacing) - nausea, dizzy, insomnia, trembling, hyperventilation, experience impending dread/doom

Question 40

what is panic

Answer 40

- unable to process environment and lose touch w reality, could even experience hallucinations - pacing, running, shouting, withdrawal, erratic, uncoordinated, impulsive

Question 41

what is social anxiety disorder

Answer 41

(social phobia) fearful or anxious about or avoidant of social interactions and situations involving possibility of being scrutinized

Question 42

what is panic disorder

Answer 42

recurrent unexpected panic attacks and is persistently concerned or worried about having more panic attacks or changes his or her behaviour in maladaptive ways bc of the panic

Question 43

what is agoraphobia

Answer 43

- fear and anxiety about 2 or more of the following: - using public transportation, being in open spaces, being in enclosed places standing in line or being in a crowd, or being outside of the home alone.

Question 44

Generalized anxiety disorder

Answer 44

- persistent and excessive anxiety and worry about various domains of life, including work and school performance, that the individual finds difficult to control physical symptoms: restlessness, feelings keyed up or on edge, being easily fatigued, diff concentrating, mind going blank, irritability, muscle tension, sleep disturbance

Question 45

how long do you have to have had anxiety to be characterized as generalized anxiety disorder

Answer 45

for at least 6 mo

Question 46

generalized anxiety disorder diagnostic criteria

Answer 46

A) excessive anxiety and worry occuring more days than not for at least 6 mo, about a number of events or activities B) individual finds it difficult to control the worry C) anxiety and worry are associated with 3 or more of the following: 1) restlessness or feeling keyed up or on edge 2) being easily fatigued 3) difficulty concentrating or mind going blank 4) irritability 5) muscle tension 6) sleep disturbance D) anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning E) disturbance is not attributable to physiological effects of substance or a medical condition F) disturbance is not better explained by another mental disorder, contamination or other obsessions in OCD, separation from attachment figures in separation anxiety, reminders of traumatic events in PTSD, gaining wt, physical complaints in somatic symptom disorder, etc...

Question 47

describe OCD

Answer 47

characterized by the presence of obsessions and/or compulsions

Question 48

obsessions

Answer 48

recurrent and persistent thoughts, urges, images that are experiences as intrusive and unwanted

Question 49

compulsions

Answer 49

repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

Question 50

5 subtypes of OCD

Answer 50

1. contamination obsessions with cleaning compulsions 2. obsessions w/o visible compulsions 3. hoarding 4. symmetry obsessions w ordering compulsions 5. harm obsessions w checking compulsions

Question 51

OCD diagnostic criteria

Answer 51

A) presence of obsessions, compulsions, or both: obsessions are defined by (1) and (2): 1) recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance as intrusive and unwanted, and that in most individuals cause marked anxiety or distress 2) individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them w some other thought or action compulsions are defined by (1) and (2) 1) repetitive behaviours or mental acts that individuals feel driven to perform in response to an obsession or according to rules that must be applied rigidly 2. behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive B) obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 52

what are personality disorders

Answer 52

long-term patterns of behavior and inner experiences that differs from what is expected begins by late adolescence or early adulthood and causes distress or problems in functioning

Question 53

personalities affect at least 2 of what areas

Answer 53

- way of thinking about oneself and others - way of responding emotionally - way of relating to other people - way of controlling one's behaviour

Question 54

describe Cluster A personality disorders

Answer 54

(odd or eccentric) includes paranoid, schizoid, schizotypal

Question 55

describe Cluster B personality disorders

Answer 55

(dramatic, emotional, erratic) includes antisocial, borderline, histrionic, narcissistic

Question 56

describe Cluster C personality disorders

Answer 56

includes avoidant, dependent, obsessive-compulsive

Question 57

general personality disorder criteria

Answer 57

A) enduring pattern of inner experience and behaviour that deviates markedly from expectations of individual's culture manifested in 2 or more of: 1) cognition 2) affectivity 3) interpersonal functioning 4) impulse control B) enduring pattern is inflexible and pervasive across a broad range of personal and social situations C) enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of funcitoning D) pattern is stable and of long duration and its onset can be traced back to at least to adolescence or early adulthood E) enduring pattern is not better explained as a manifestation or consequence of another mental disorder F) enduring pattern not attributable to physiological effects of a substance or another medical condition

Question 58

paranoid personality disorder

Answer 58

- pattern of being suspicious of others and seeing them as mean or spiteful - often assume people will harm or deceive them and don't confide in others Cold, distant, suspicious, can't see their role in conflict, project paranoia as anger Pattern of internal feeling and external behaviour

Question 59

Schizoid Personality disorder

Answer 59

- pattern of detachment from social relationships and expressing little emotion - typically does not seek close relationships, chooses to be alone, and seems to not care about praise or criticism from others cold distant, introverted, intense fear of intimacy, and closeness

Question 60

schizotypal personality disorder

Answer 60

pattern of acute discomfort in close relationships, cognitive or perceptual distortions and eccentricities of behaviour cold distant and introverted, intense fear of intimacy, disordered thinking (look like schizophrenia, but less intense and intrusive) 

Question 61

antisocial personality disorder

Answer 61

pattern of disregard for, and violation of, the rights of others

Question 62

borderline personality disorder

Answer 62

- intense fear of abandonment or instability, diff tolerating being alone, inappropriate anger, impulsiveness, and swings that pushes others away - may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger or have ongoing feelings of emptiness trouble keeping stable relationships, mood are inconsistent, never neutral, black and white sense of reality, lacked nurturing growing up, so they want caretaking from other-manipulation (feel abandoned), can lead to compulsive behaviours

Question 63

narcissistic personality disorder

Answer 63

pattern of grandiosity, need for admiration, lack of empathy (lack of empathy, exploit others who fail to admire them)

Question 64

histrionic personality disorder

Answer 64

- pattern of excessive emotionality and attention seeking - may be uncomfortable when they are not the center of attention, use physical appearance to draw attention to them have rapidly shifting or exaggerated emotions

Question 65

avoidant personality disorder

Answer 65

pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation sensitive to rejection, avoid situations with any conflict (fear driven), become disturbed by their own social isolation

Question 66

dependent personality disorder

Answer 66

pattern of submissive and clinging behaviour related to excessive need to be taken care of can' care for themselves, hard time making decisions

Question 67

obsessive-compulsive personality disorder

Answer 67

- pattern of preoccupation w orderliness, perfectionism, and control - may be overly focused on details or schedules, may work excessively not allowing time for leisure or friends, or may be inflexible in their morality and values (NOT the same as OCD) adverse to change, bothered by disrupted routines, anxiety with completing asks, become uncomfortable in situations beyond their control

Question 68

personality change due to another med condition

Answer 68

persistent personality disturbance that is judged to be due to the direct physiological effects of med condition (ex: frontal lobe lesion)

Question 69

what are feeding and eating disorders

Answer 69

persistent disturbance of eating or eating related behaviour that results in altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning

Question 70

anorexia

Answer 70

refuse to maintain height-weight ratio, intense fear of getting weight -waxes and wanes chronic illness (high relapse potential) 50% 1-year relapse rate

Question 71

bulimia

Answer 71

binge eating-self-induced vomiting, diuretics, excessive exercise (disturbances in body shape and weight)

Question 72

binge eating

Answer 72

eat a lot then feel distressed

Question 73

PICA

Answer 73

dirt, chalk, yarn, and glue (no nutritional value - starts early childhood and lasts some months, could be harmful (toxic), obstruction

Question 74

anorexia nervosa diagnostic criteria

Answer 74

A) restriction of energy intake relative to requirements, leading to a significantly low body wt in context of age, sex, developmental trajectory, and physical health B) intense fear of gaining wt or becoming fat, or persistent behaviour that interferes w wt gain, even though at a significantly low wt C) disturbance in way in which one's body wt or shape is experienced, undue influence of body wt or shape on self-evaluation, or persistent lack of recognition of the seriousness of current low body wt

Question 75

2 types of anorexia nervosa

Answer 75

F50.01 Restricting type - during last 3 mo individual has not engaged in recurrent episodes of binge eating or purging behaviour. this subtype describes presentations in which wt loss is accomplished primarily through dieting, fasting and/or excessive exercise F50.02 Binge eating/purging type - during last 3 mo had binging or purging episodes that were recurrent

Question 76

F50.02 Binge-eating/purging type

Answer 76

during last 3 mo, the individual has engaged in recurrent episodes of binge eating or purging behaviour (ex: self induced, vomiting or misuse of laxatives, diuretics, or enemas)

Question 77

bulimia nervosa diagnostic criteria

Answer 77

A) recurrent episodes of binge eating. characterized by: - eating in a discrete period of time, an amount of food def larger than what most individuals would eat in a similar period of time under similar circumstances - sense of lack of control over eating during the episode B) recurrent inappropriate compensatory behaviours in order to prevent wt gain, such as self induced vomiting; misuse of laxatives, diuretics, fasting, excessive exersize C) binge eating and inappropriate compensatory behaviours both occur, on avg, at least once a wk for 3 mo D) self eval is unduly influenced by body shape and wt E) disturbance does not occur exclusively during episodes of anorexia nervosa

Question 78

bulimia nervosa remission types

Answer 78

1) partial remission - after full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time 2) full remission - after full criteria for bulimia nervosa were previously met, none have been for a long time

Question 79

what is EDs etiology

Answer 79

- no single cause - result from an attempt to regulate mood especially anxiety and depression - heritability genetic component - neurobiological - altered brain serotonin contribute to dysregulation of appetite, mood, and impulse control - psychological: learned behaviour, family situation, trauma - environment: culture, politics

Question 80

what are the street names of methamphetamines

Answer 80

speed, chalk, ice, crystal, crystal meth, jib

Question 81

what are amphetamines

Answer 81

- stim CNS - used for ADHD - white, odorless, bitter-tasting - snorted, swallowed, smoked or injection - feel alert and energetic, confident and talkative. little need for sleep or food - intense surge of euphoria

Question 82

how long does snorting/swallowing amphetamines take

Answer 82

snorting 3-5min swallowing 15-20 min

Question 83

BIG clinical sign of stim toxicity for amphetamines

Answer 83

**confusion/psychosis - seizures - rapid increase in HR, BP, and temp leading to circulatory collapse - chest pain

Question 84

what can crystal meth cause

Answer 84

Crystal meth can also cause meth mouth like in the pic - what this does is it dries out the salivary glands - this destroys enamel and leads to cavities and whatnot Crystal meth is also incredibly dirty -> can see over 45-50 metabolites of other drugs if you do a panel - causes severe tissue necrosis when you inject it When mixed w all diff drugs w diff MoA -> makes extremely hard to treat

Question 85

clinical signs amphetamines

Answer 85

- tachycardia and irregular rhythm - elevated BP - increased rate of breathing - hyperthermia (overdose can result in convulsions to death) - overdose could result in stroke, heart attack, and additional organ damage