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Psychopathology - TEST 1
Psychiatric Int; DSM-IV; Mood disorders; Dementia; Schizophrenia; Substance Abuse
63
Psychology
Professional
12/12/2011

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Term
DSM - IV
Definition
Term
Identify and define the concept of normality
Definition
Statistical Normality
Clinical Normality
Societal Standards of Normality
Adaptive Concept of Normality
Term
The three basic clinical principles important to the biopsychosocially-oriented assessment of patients
Definition
a) genetic/biological factors are of major importance in the pathogenesis and treatment of certain psychiatric disorders and in determining  the  patient’s   resilience or vulnerability to stress

b) certain problematic developmental experiences and conflicted relationships within the family/social system may confer vulnerabilities to certain types of psychiatric illness; positive developmental experiences/relationships and good social support may provide a buffering effect

c) current life stresses may precipitate the onset of certain psychiatric disorders and symptoms or contribute to relapses of preexisting conditions
Term
Discuss the four general concepts concerning psychopathology (as presented in class and in the handout).
Definition
A single symptom by itself does not diagnose a mental disorder.

No single pathological symptom is pathognomonic for any particular mental disorder.

The more numerous the features you detect, the more certain you can be of the diagnosis.

Psychiatric diagnoses should never be used to label and stigmatize patients.1
Term
Describe the DSM-IV (Diagnostic and Statistical Manual, Fourth Edition) multiaxial diagnostic system (Axes I – V).
Definition
Axis I: Clinical Psychiatric Disorders and 2
other conditions that may be a focus of clinical attention (include V- Code Conditions- don’t  confuse  these  with  Axis  V)

Axis II: Personality Disorders, Mental Retardation, and borderline intellectual function (a V-Code Condition)

Axis III: General Medical Conditions (GMC)
includes GMC’s   that   are   potentially   relevant   to   the   understanding   or   management  of  the  individual’s  mental  disorder

Axis IV: Psychosocial and Environmental Problems
Includes psychosocial and environmental problems that may affect the diagnosis, treatment and prognosis of Axis I and II disorders.

Axis V: Global Assessment of Functioning (GAF)4
Describes overall level of psychological, social, occupational functioning; provides one way to track clinical progress; does not include limitations due   to   physical   (or   environmental)   limitations.     A   GAF   of   “0”   indicates   that there is inadequate information to rate the GAF.
Term
Describe on which Axis a particular psychiatric disorder or condition is listed (be able to do this for each disorder as it is presented throughout the course).
Definition
Term
State the three general criteria of the DSM-IV definition of a mental disorder.
Definition
1. A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual

2. Associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom (functional  impairment  helps  distinguish  “eccentric”  behavior   from psychiatric illness)

3. Not merely an expectable and culturally sanctioned response to a particular event (e.g., bereavement after the death of a loved one)
Term
Discuss the hierarchical method in determining differential diagnosis for psychiatric symptoms.
Definition
1. Disorders diagnosed in infancy

2. Cognitive Impairment Disorders (Delirium, Dementia, & Amnestic disorders)

3. Mental disorders due to GMC

4. Substance Related Disorders

5. Schizo

6. Mood Disorders

7. Anxiety Disorders

8. other
Term
Lifetime prevalence rates for MDD, Dysthymic Disorder, Bipolar I and II, and Cyclothymic disorder and compare prevalence in men and women
Definition
MDD - 16.6% (women 25% chance, men 12%)

DD - 2.5% chance

Bipolar I - 1% (female = male)

Bipolar II N/A

Cyclothymic disorder - 0.4-1.0%
Term
diagnostic criteria of Major Depressive Episode
Definition
MUST have either depressed mood or loss of interest/pleasure

FIVE or more of the following symptoms present for 2 WEEKS
-significant weight change
-psychomotor agitation/retardation
-pervasive loss of energy/fatigue
-feelings of worthlessness
-difficulty concentrating
-sleep disturbance
-recurrent thoughts of death/suicide

D SIG E CAPS
Term
diagnostic criteria of Manic Episode
Definition
at least 1 WEEK

3 or more of the following
-inflated self-esteem
-dec need for sleep
-more talkative than usual
-flight of ideas
-distractibility
-inc in goal-directed activity
-excessive inv in pleasurable activities

GIDDINESS
Term
diagnostic criteria of hypomanic episode
Definition
same criteria as manic except only 4 DAYS

no social impairments
Term
diagnostic criteria of mixed episode
Definition
both criteria (MDE and Manic) are met nearly every day for at least 1 WEEK

may need hospitalization
Term
diagnostic criteria/clinical features of MDD
Definition
one or more MDE's

pt NEVER has had manic, mixed or hypomanic ep

can have psychotic features (mood-congruent/incongruent)

masked depression (somatic symptoms)
Term
diagnostic criteria/clinical features of Dysthimic Disorder
Definition
2 years of DEPRESSED MOOD

no MDE's

children: disturbance must by at least 1 year

NEVER psychotic symptoms

can have MDE after 2 years (MDE and DD diagnosed)
Term
diagnostic criteria/clinical features of Bipolar I
Definition
hx of one manic or mixed episode

can have psychotic symptoms (congrunet/incongruent)
Term
diagnostic criteria/clinical features of Bipolar II
Definition
at least 1 HYPOmanic AND at least 1 MDE

more common in women

higher suicide rates

less frequent psychotic eps (compared to bipolar I)
Term
diagnostic criteria/clinical features of Cyclothymic disorder
Definition
2 years with many HYPOmanic eps and numerous depressive symptoms that doesn't qualify as MDE
Term
depressive symptoms caused by GMC
Definition
hypothyroidism
parkinsons
pancreatic cancer
stroke
Term
manic episodes assoc with GMC
Definition
levodopa
sympathomimetics
cocaine
bromocriptine
yohimbine
thyroid hormones
pencyclidine (PCP)

Hyperthyroidism
puerperal psychosis

posttraumatic encephalopathy
general paresis
Term
diagnostic criteria for ALL dementias (Alzheimer's and Vascular and Lewy Body and frontotemporal)
Definition
Memory Impairment

Either Aphasia (language), Apraxia (motor), Agnosia (object), or Exec Fun Disturbance
Term
examples of aphasia, apraxia and agnosia
Definition
Aphasia - transcortical aphasia (repeats), Anomia (can't remember object's name), Paraphasias (fluent but with errors "treen" instead of "train")

Apraxia - Constructional apraxia (draws half a face)

Agnosia - ???
Term
define executive function
Definition
ability to plan, organize, sequence, monitor and do complex goal directed activity.

allows person to act independently of their environment
Term
neuroanatomical pathways mediating executive function
Definition
cortex ---> Straitum ---> globus pallidus ---> thalamus ----------> back to cortex
Term
clinical features of Alzhemiers
Definition
gradual loss in memory, functionality (vascular is stepwise)

decreased ACh

genetics may show mutations in APP, Presenilin 1 mutation (most aggressive), Presenilin 2 mutation (chrom 1), and APOE (late onset, chrom 19)
Term
pathological featuers of Alzheimer's
Definition
decreased sAPPalpha
increased Abeta ****

alzheimer's amyloid hypothesis: beta-secretase produces sAPPbeta that gama-secretase turns into Abeta (very neurotoxic!!)
Term
FDA approved medications for Alzheimer's (MOA?)
Definition
cholinesterase inhibitors

NMDA glutamate receptor antagonist
Term
Dementia of Alzheimer's type

Vascular Dementia

Lewy Body Dementia

Frontotemporal Dementia
Definition
Vascular - stepwise deterioration (strokes); ischemic events; memory less impaired relative to loss of executive funciton; abrupt onset; focal neurological signs (broca's aphasia); behavioral disturbances; cardiovascular GMC (HTN, CAD, etc)

Lewy - cortical dementia; parkinsonism; transient confusion; visual hallucinations; much more loss of ACh (respond better to ACherase inhibs)

Frontotemporal - familial form; atrophy of frontal lobe; pick bodies; kluber-bucy personality traits
Term
Delirium

Dementia

Amnestic Disorders
Definition
Delirium - not primary psychiatric disorder (caused by GMC); impairment of conciuosness; change in condition; acute onset; fluctuates; can be caused by dementia or amnestic disorder

Dementia - gradual (alzheimer's) or acute (vascular); memory impairment; aphasia, agnosia, apraxia or EFD; social/occupational impairment

Amnestic Disorders - inability to learn or recal prev learned material; no other cognitive impairments!!; digit span recall intact; amnestic disorder usually caused by GMC or substance-induced
Term
diagnostic eval of pts suspected of having a cognitive impairment disorder (MMSE? CLOX?)
Definition
Memory impairment WITHOUT other significant accompanying cognitive defects and digit span recall unaffected in amnestic d/o

multiple cognitive defects in dementia, including executive function

delirium usually due to other GMC; rapid disturbance of conciousness and change in cognition
Term
tx for dementia and amnestic disorders
Definition
dementia - cholinesterase inhibitors and NMDA glutamate receptor antags

give thiamines to amnestic pts suffering from wernicke's-korsokoff's syndrome (alcohol withdrawel)
Term
tx of Bipolar I
Definition
Don't use antidepressants (hypomanic state induced)

use depakote (valproic acid)
Term
define psychosis and its symptoms
Definition
loss of ability to distinguish fantasy from reality

hallucinations
delusions
formal thought disorders
Term
epidemiology and lifetime prevalence of schizophrenia
Definition
lifetime prevalence 1% and equal in males and females

presents earlier in males, bimodal dist in females
Term
diagnostic criteria/clinical features of schizophrenia
Definition
6 mo or more (1mo of active phase symptoms) with schizo symptoms
Term
diagnostic criteria/clinical features of schizophreniform disorder
Definition
more than 1 month but less than 6 with schizo symptoms
Term
diagnostic criteria/clinical features of brief psychotic disorder
Definition
less than 1 mo but more than 1 day with schizo symptoms
Term
shared psychotic disorder
Definition
transmission of delusion from someone with the original delusion (september 11 was done by US idea given
Term
pos symptoms of schizo
Definition
Delusions

Hallucinations

Bizarre behaviors

Disorganized speech or behavior

USE TYPICAL ANTIPSYCH'S (THORAZINE AND HALOPERIDOL)
Term
neg symptoms of schizo (5 A's)
Definition
due to mesocortical pathway; (A's)

Affective flattening

Alogia (general lack of additional, unprompted content seen in normal speech)

Avolition (lack of desire, motivation, persistence)

Anhedonia (inability to experience pleasure)

Attentional Impairment

USE ATYPICAL ANTIPSYCH'S (CLOZAPINE)
Term
which type of hallucination most common in schizo?

what about delirium?
Definition
auditory hallucinations

visual hallucinations
Term
NT status in delirium
Definition
incr DOPA and dec ACh
Term
antipsychotic for delirium
Definition
haloperidol (haldol)
Term
dopamine system in limbic area relates to what psychotic symptom?
Definition
hallucinations
Term
dystonia
Definition
sustained contraction (or spasm) of any muscle/part of the body

e.g. teen boy took mom's medicine ended up with toricollitis
Term
tardive dyskinesia (TD)
Definition
usually on pts that have been on anti psychotics for years

abnormal, involuntary, irregular choreoathetoid mvmts of head, limbs and trunk.

more common in females than males
Term
substance dependence
Definition
pattern of substance abuse leading to clinically significant impairment or distress manifested by 3 or more of the following sympotms

TOLERANCE

WITHDRAWAL

unsuccessful attempt to cut down

great deal of time spent getting substance

sacrifice important social, occupation, or recreational activities

continue to use despite knowledge of ill effects
Term
substance abuse
Definition
1 or more of the following symptoms

recurrent use --> fail at obligations
recurrent use --> leads to legal problems
recurrent use --> social or interpersonal problems
recurrent use in situations where its physically hazardous
Term
substance withdrawal
Definition
dev of reversible substance-specific syndrome after stopping heavy and prolonged use of substance

physiological dependent (tolerance and or withdrawal with REDUCTION in use)

psychological dependence (compulsion to use)

co-dependence (family members enable behavior that resists modificaiton
Term
CAGE questions
Definition
C: have you ever felt like you should CUT DOWN?

A: have people ANNOYED you by criticizing your drinking/drug use?

G: Have you ever felt GUILTY about your drinking/drug use?

E: Have you ever had a drink/drugs first thing in the morning to steady your nearves, get rid of a hangover, or feel better (EYE OPENER)?

pos in 1 or more w/in past year = inc risk of substance related problems
Term
CAGE questions
Definition
C: have you ever felt like you should CUT DOWN?

A: have people ANNOYED you by criticizing your drinking/drug use?

G: Have you ever felt GUILTY about your drinking/drug use?

E: Have you ever had a drink/drugs first thing in the morning to steady your nearves, get rid of a hangover, or feel better (EYE OPENER)?

pos in 1 or more w/in past year = inc risk of substance related problems
Term
males are twice as likely as females to develop __________ dependence and abuse.
Definition
alcohol
Term
melanby effect
Definition
intoxicating effects higher when levels are rising
Term
alcohol synergizes with
Definition
benzodiazepines and barbituates

do not give them to alcoholics!
Term
tx alcohol intoxication with
Definition
haloperidol (antipsychotic)
Term
life threatening substance abuse problems
Definition
alcohol withdrawal

opiod intoxication
Term
alcohol withdrawal
Definition
TREMULOUSNESS (shakes) most classical sign
at least 2 of the following after reduction in use

hand tremor

insomnia

nausea/vomit

anxiety

transient hallucinations

seizures

inc sympathetics (tachycardia, sweating)

psychomotor agitation
Term
how to tx alcohol withdrawal
Definition
benzodiazepine

antipsychotics (for perceptual disturbances)

THIAMINE (Wernicke-Korsakoff's syndrome)
Wernicke - alcohol withdrawal delirium
Korsakoff - alcohol induced persisting amnestic disorder
Term
classic triad of Wernick-Korsakoff syndrome
Definition
ataxia

nystagmus

amnesia

GIVE THIAMINE!!
Term
dilated pupils
Definition
amphetamine and cocaine intox
Term
pin-point pupils
Definition
opiod intox
Term
pupils do the opposite during......
Definition
withdrawal and intoxication

e.g. opiod myosis (constriction) during intox; have mydriasis during withdrawal
Term
opiod withdrawal
Definition
at least 3 of the following:

dysphoric mood
lacrimation
severe muscle aches
nausea/vomiting
diarrhea
yawning
pupillary dilation (mydriasis)
fever
insomnia
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