NT changes with disease

1. Anxiety

2. Depression

3. Alzheimers

4. Huntingtons

5. Schizophrenia

6. Parkinsons

7. Mania

1. Decreased: GABA, 5-HT

a. Increased: NE

2. Decreased: NE, 5-HT, Dopamine

3. Decreased: ACh

4. Decreased: GABA, ACH

a. Increased: Dopamine

5. Increased: Dopamine

6. Decreased: Dopamine

a. increased: Ach, Serotonin

7. Increased: 5-HT and NE

Kluver-Bucy Syndrome

Due to?

Features?

associated?

Bilateral Lesion to Amygala Features

1. No Fear and extremely curious

2. Forgetful

3. Put everything in their mouth

4. strong sex drive

associated: HSV-1

1. Healed Fractures on Xrays

2. Cigarette burns

3. subdural hematomas

4. multiple bruises

5. Retinal hemorrhage/detachment

*must report

ADHD

1. onset?

2. treatment options?

Limited attention span and poor impulse control

1. Before 7

2.

a. Methylphenidate (ritalin)

b. Amphetamines (Dexedrine)

c. Atomoxetine (nonstimulant SNRI)

Conduct Disorder

a. Violates social norms (destroy property, theft)

b. iif > 18 = Anti-social personality disorder

Oppositional Defiant Disorder

a. does NOT violate social norms

b. defiant behavior towards authority

Tourette's Syndrome

1. onset?

2. description?

3. treatment?

1. Before 18

a. "tic" > 1 yr

2. sudden, rapid, recurrent, nonrhythmic motor movement or vocalization

a. Coprolalia = obscene speech

Treatment

1. Haloperidol (Anti-psychotic)

2. Fluphenazine

3. pimozide

4. Tetrabenzine

Separation Anxiety Disorder

1. onset?

2. desription?

3. common sign?

7-9 yrs

2. Fear of leaving home or separation of attachment figure

3. Physical complaints to avoid school

Autism

a. Language impairment and avoidance

b. below normal intelligence

c. Greater focus on objects than people 

Aspergers

a. No language impairment or avoidance

b. Normal intelligence

c. all-absorbing interest in specific thing 

*Persuasive Development Disorders 

Rett's Disorder vs. Childhood Disentigration disorder

1. who/onset?

2. signs/symptoms? 

Retts

a. Girls (1-4)

b. Lose Developed skills 

c. Lose verbal languag + Ataxia and MR

e. *WRINGING-HAND MOVEMENTS*

CDD

a. Boys 3-4

b. Regression after 2yrs normal development

c. Lose Expressive/receptive language

d. Lose bowel/bladder control, motor, social

*Persuasive Development Disorders

Eating Disorders

1. Anorexia nervosa

2. Bulemia nervosa

3. binge eating disorder

4. compulsive eating disorder

1. Excessive dieting (+/- purging)

a. *BODY IMAGE DISTORTION

b. Decreased Body weight c. amenorrhea, anemia, electrolyte imbalance

2. Binge eating (+/- Purging)

a. Body weight MAINTAINED

b. Russell's Sign: dorsal hand callusus from vomit induction

3. Psychological problem

a. Negative feelings towards food

b. No purging

4. Fantasize about food (type of OCD)

a. no purging

Delirium

a. ACUTE onset : Decreased Consciousness

b. Mental status changes, Hallucinations, Disorganized thinking

c. sleep disturbances

d. ABNORMAL EEG

Dimentia

a. GRADUAL onset ; Dec. Intellectual ability - Consciousness not affected

b. Memory deficits, aphasia, apraxia, etc.

c. No sleep Disturbances

d. Normal EEG

Wernicke-Korsakoff syndrome

1. deficient?

2. triad

3. complications?

1: Thiamine Deficient (B1)

a. mamillary body damage

Triad

a. Opthalmoplegia

b. Ataxia

c. Confusion

Complications:

a. Confabulation (inventing the truth)

b. psychosis

c. Korsakoff Syndrome (personality changE)

CAGE Questionnare

1. Cutback

2. Annoyance

3. guilt

4.eye opener

1. Dissociative Identity disorder

2. Dissociate Fugue

3. Depersonalization disorder

1. Multiple Personalities

a. associated: sexual abuse

2. Abrupt change in geographic location results in

a. confused about previous identity b. assume new identity

b. associated: traumatic events

3. feel detached from body, social situation, environment

*Dissociative Disorders

Abuse: significant impairment of life

a. Failed obligations (work/home/school)

b. Legal problems, physical hazard

c. **Continued use despite the above

Dependence: 3+ of the following in 1 yr

1. increased amts in use

2. energy expendature to obtain substance

3. withdrawel

4. tolerance

5. Desire to persist

6. reduced interaction in other aspect of life due to substance

1. Precontemplation a. don't acknowledge problem

2. contemplation: acklowledge problem

3. Preparation/determination = a. getting ready for change

4. Action/willpower: changing behaviors

5. Maintenance: maintaining the behavior change

6. Relapse: return to drug behaviors

Delirum Tremens

1. occur?

2. signs?

3. treatment?

Life-threatening Alcohol withdrawel

1. 2-5 Days after last drink 2. (in order of appearence)

a. Autonomic Signs: Tachycaria, tremor, anxiety, seizure

b. Psychotic signs: Hallucinations, delusions

Treatment: Benzodiazepines

Shizophrenia

1. Description?

2. NT elevated?

3. DX requirements?

a. > 6 months duration

b. Function impaired (vs. dellusions)

2. Dopamine

3. Require 2 or more

*Positive Symptoms* - weirdness

a. Delusion

s b. Hallucinations (often auditory)

c. Disorganized speech (loose associations)

d. Catatonic or disorganized behavior

*"Negative Symptoms" - withdrawal of normal behavior

a. Lack of movement/speech/thought/motivation

b. poor grooming, social withdrawel

Schizophrenia time course and different names:

1. < 1 month

2. 1-6 months

3. > 6 months

1. Brief Psychotic disorder a. stress related

2. Schizophreniform disorder

3. Schizophrenia

Delusional Disorder

1. Folie a deux

Fixed, persistant nonbizzare belief system

a. > 1 month

b. FUNCTION NOT IMPAIRED (vs. Schizophrenia)

ex. women believes shes married to movie star when, in fact, she's not.

1. this belief system is shared b/w people in close relationship

Differentiate the following

1. Schizotypal

2. Schizophrenia

3. Schizoaffective

4. Schizioid

5. Schizophreniform

1. Interpersonal awkwardness (Cluster A Disorder)

a. odd thoughts and appearance.

2. Delusions, hallucinations > 6 mo

3. Shizo symptoms + mood disorder

4. Social Withdrawal ; NO psychosis (Cluster A disorder)

5. Shizo symptoms >1 month but < 6 mo

Neuroleptic Malignant Syndrome

1. SE of ?

2. Features

3. antidote?

1. Anti-psychotics

2.

a. Muscle Rigitidy

b. Myoglobinuria

c. Hyperpyrexia

d. Mental status change

e. Autonomic instability

2.

a. Dantrolene (block Ca at SR)

b. Bromocriptine (D-Agonist)

*Anti-psychotics block D2

Persistent elevated, expansive, or irritable mood lasts 1 week.

Require 3 of following

1. Distractibility

2. irresponsibility (spend tons of money)

3. Graniosity

4. Flight of ideas - racing thoughts

5. inc. Activity / agitation

6. Decreasedneed for sleep

7. talkative, feel need to speak.

"DIG FAST"

Bipolar Disorder Categories?

associations?

treatment?

Bipolar I: Presence of 1 manic episode

Bipolar II: Presene of a Hypomanic episode

*Pt mood returns to normal between episodes associated:

Antidepressents

a. Misdiagnosed and treated as depression treatment

1. Lithium*

2. Valproic Acid

* 3. Carbamazepine*

4. Atypical Antipsychotics *mood stabilizer

Transference a. Pt. projects about person in their life into doctor

Countertransference a. Doctor projects feelings about someone in their life into pt.

Conditioning

1. Classical

2. Operant

1. Natural Response elicited from learned stimulus

a. learned stimuli previously presented with natural stimuli then removed

2. action or repression of behavior elicited by reward or unwanted stimuli

a. positive reinforcement

b. negative reinforcement

c. Punishment

d. extinction

Severe Depression for 6-12 months

a. (+) for 5 of 9 of the following for 2+ weeks

b. depression: Decreased NE/Dopamine/5-HT

Criteria: PIG CASES

1. Pscyhomotor retardation/agitation

2. Interest loss (Anhedonia)

3. Guilt or feel worthless

4. Concentration loss

5. Appetite, weight changes

6. Suicidal thoughts

7. Energy Loss

8. Sleep disturbances

9. depressed mood

abnormal elevation in mood

a. 1 week duration b. 3 or more of the following criteria

Criteria: DIG FAST

1. Distractibility

2. Irresponsibility

3. Grandiosity

4. Flight of Ideas (racing thoughts)

5. Activity increased *goal-directed*

6. Sleep requirement decrease

7. Talkative

1. Dysthymia

2. Cyclothymic Disorder

1. Mild depression for 2 yrs

2. Dysthymia + hypomania for 2 yrs

Differentiate:

1. Malingering

2. Factitious Disorder

3. Somatoform Disorder

1. Fake claims for a secondary gain

a. goal: get off work, obtain drugs b. symptoms cease after gain

2. Consciously create medical conditions to become "sick pt.

a. goal = obtain medical attention

b. symptoms persist after treatment

3. Physical symptoms with no identifiable cause

a. symptoms not factitiously produced

b. unconsciousness drives illness production / motivation

Cluster A personality Disorders 

(3) 

"Weird" (Odd or eccentric)

1. Paranoid (distrust/suspicious)

defense: Projection

2. Schizoid 

a. voluntary social withdrawel, limited emotion

*content with isolation (vs. avoidant)

3. Schizotypal

a. Eccentric Apprearance + magial thinking

b. interpersonal awkwardness

Cluster B Personality Disorders

(4)

"Wild" (dramatic, emotion, erratic)

a. associated: substance abuse

1. Antisocial (Sociopath)

a. violate norms + rights

b. in childhood = conduct disorder

2. Borderline 

a. unstable mood / relationships 

b. self-mutilation, boredom, emptiness

3. Histrionic 

a. need attention + concerned w/ apperance

4. Narcissistic 

a need admiration and angered toward criticism 

Cluster C Personality Disorders

(3)

"Worried" (Cowardly, Compulsive, Clingy)

1. Avoidant

a. Feel Inferior and hypersensitive to rejection

b. desire relationships (vs. schizoid)

2. Obsessive-Compulsive 

a. Preoccupied with order, perfection, control

b. behavior consistent with ones beliefs (vs. OCD)

3. Dependent

a. submissive, clingy, need taken care of

a. low self confidence 

Persuasive Development Disorders 

(4)

Language Difficulty & failure to acquire, or early loss of, social skills

1. Autism

2. Aspergers

3. Ritts

4. Childhood Disentigration disorder

Obsessive Compulsive Disorder

is?

treatment? (2)

Recurring thoughts, feelings, sensations (obsession) that cause severe distress 

a. relieved by performing a repetitive action (compulsion)

*Inconsistent with own beliefs (vs. Obsession-compulsive personality disorder)

treatment?

1. Fluoxetine (SSRI)

2. Clomipramine (TCA) 

Post-Traumatic Stress Disorder

 duration?

vs. Acute stress disorder

treatment?

Persisent reexperiencing of previous traumatic event

a. leads to avoidance of stimuli associated w/ event

b.  > 1 month

*acute stress disorder (2 days - 1 month)

treatment: SSRI

Atypical Depression

characterized?

associated?

treatment?

Characterized by:

1. Hypersomnia

2. over-eating (vs. MDE)

3. Ability to improve mood w/ positive event (vs. MDE)

associated: weight gain / sensitive to rejection

TX: 

MAO-inhibitors

SSRIs

Somatiform disorders

subtypes? (5)

Physical symptoms but with no identifiable cause

a. illness production & motive are unonconscious

1. Somatization 

a. multiple organ systems (4 pain, 2 GI, 1 sexual, 1 pseudo-neuro)

2. Conversion 

a. sudden loss of sensory or motor function

3. Hypochondriasis 

a. fear of having serious illness

4. Pain Disorder

a. Pain w/o physical findings 

5. Body Dysmorphic Disorder

a. pre-occupied w/ minor defect (repeatedly seek cosmetic surgery)