phrases lack sequential relations to each other.

derailment and incoherence

most severe thought disorder

word salad

neologisms

clang associations

2 categories of disorders of thought content

delusions (ideas)

false perceptions (sensory)

1. illusions - misinterprets actual stimulus

2. hallucinations - rare, perceptions lacking external stimuli, usually auditory

medical condition

primitive, non-causal, symbolic

many patient's drift into this process of thinking, esp. at times when its inappropriate

logical

linear

literal

subj. feelings of dread and foreboding w/o objective reason

somatic manifestations such as feeling lightheaded, palpitations, stomach discomfort

assc. with obsessions, phobias and compulsions

inappropriate or incongruous expressions of emotion (the emotion they show doesn't express what they feel)

flat or absent expression of emotion

MDD

bipolar I

bipolar II

Serotonin

Norepinephrine

for a 2-wk period, depressed mood or anhedonia plus other sxs

(wt loss, insomnia or hypersomnia, fatigue, psychomotor agitation or retardation, guilt, probs concentrating and suicidal thoughts)

Dx of Manic episode

for a 1-wk period, persistent elevated, expansive or irritable mood.

severe enough to cause marked impairment or to necessitate hospitalization or psychotic features are present

very similar to manic but doesn't have to last as long

not severe enough to cause marked impairment, to necessitate hosp and there are no psychotic features present

the essential feature is a clinical course char. by the occurence of 1+ depressive episodes and at least one hypomanic episode

(often have a better course than full blown mania)

15-25 for men

25-35 for women

part of why course is different for the two sexes

estimates are that btwn ____ and ____ of all homeless are afflicted with schizophrenia

delusions

hallucinations

disorganized speech or behavior

negative sxs

paranoid

disorganized

catatonic

echolalia

begin to take an interest in abstract ideas, philosophy, the occult or religion

violent

excludes homocide

exacerbations and remissions

the longer they have it, the worse it gets and the shorter the remissions are

behavior therapy

family-oriented therapy

case management

group therapy

individual therapy

antipsychotic meds

has features of both schizo and mood disorders

must have hallucinations and delusions for at least 2 wks in the absence of prominent mood sxs

char primarily by delusions (of non-bizarre nature)

erotomanic, grandiose, jealous, persecutory and somatic types

Alzheimer's dementia

Vascular dementia

Parkinson's disease

Lewy Body disease

Pick's disease

Huntington's disease

Age

FH

Gender: Female > male

Head trauma

down's syndrome

ed level/mental activity

cardiovascular disease

AD Top 10 warning signs

1. recent memory loss affecting job

2. diff performing familar tasks

3. probs with language

4. disorientation to time and place

5. poor or dec judgement

6. probs with abstract thinking

7. misplacing things

8. changes in mood or behavior

9. changes in personality

10. loss of initiative

early

middle

late

terminal

ACh Inhibitors

Memantine

family benefits -- report fewer behavioral problems

social benefits -- can delay nursing home placement btwn 16-24 mths

clinical benefits -- minimal improvement in MMSE

11th

3rd for younger folks

how often is a suicide completed?

how often is a suicide attempted?

16.1 minutes

39 seconds

31

24

Major Depressive Illness, affective d/o

alcoholism, drug abuse

suicide ideation, talk, prep

Modeling, h/o suicide in the family

firearms

25% of women OD

HIV/AIDs

Malignant cancers (esp those that are painful or disfiguring)

Chronic, painful, debilitating diseases

to alter the concentrations of certain NTs within the CNS.

Perhaps additionally and/or more importantly altering the composition of CNS receptors

MAO-Is

TCAs

SSRIs

2nd Gen. SSRIs

major or atypical depression

usually you only use it if they have failed with other conventional meds

tyramine containing foods

should also avoid decongestants, SSRIs, TCAs, meperidine

TCA OD

TOXIC TOXIC

buproprion (claim to fame no sexual dysfunction)

also smoke cessation, lower seizure threshold

Trazadone: highly anticholinergic

venlaflazine: for atypical depression

increase CNS threshold for excitation/activation.

increase gabaminergic transmission

BDZ

barbs

zolipidem - for those who can't fall asleep

zaleplon - used for mid-night wakenings

eszopiclone - can't fall asleep

long half life

rozeren and chlorohydrate

also benadryl, amitripyline, trazadone

a diffuse, unpleasant, vague sensation of apprehension, often accompanied by autonomic sxs such as diarrhea, sweating, HTN, tremors, tachy and acts as a response to a threat that is

unknown, internal or vague

Only social factor contributing to dev of panic disorder is...

discrete period of intense fear or discomfort in which 4+ of the following sxs dev abruptly peak within 10 mins

palpitations, sweating, trembling, sensation of SOB, feeling of choking, CP, N, feeling dizzy, derealization or depersonalization, fear of loss of control, fear of dying, paresthisias, chills or hot flashes

DSM IV criteria for panic disorder with/without agoraphobia

recurrent, unexpected panic attacks

worry

SSRIs

key is to start low and go slow

cognitive and behavioral therapies

what is the most common mental disorder among men?

animals

storms

heights

illness

injury

death

combat experience

assault

single

divorced

widowed

socially withdrawn

low SES

the inability to identify or verbalize emotional states

common with PTSD pts

the young and old

midlife does better

psychotherapeutic interventions

behavioral or cognitive therapy and hypnosis

restlessness

being easily fatigued

diff. concentrating

irritability

mm tension

sleep disturbance

buspar

BZP

SSRIs

sxs are severe enough to cause significant distress or impaired social, occupational or other functioning

sxs are not intentionally produced as a factitious disorder or malingering

onset of sxs before age 30 that occur over a period of several years that result in treatment being sought

at any time during the disturbances the individual must have 4 pain sxs, 2 GI sxs, 1 sexual sxs and 1 pseudoneurologic sxs

a single identifiable primary caretaker

appts should be scheduled regularly (once a mth) but brief in nature without ordering tests and lab work

1+ neurologic sxs that can't be explained by a known neurologic or medical disorder

housebound

Hypochonriasis Treatment of choice

group therapy

depressive

anxiety

or psychotic

etiology

prognosis

treatment of choice

Axis I

contains most of the conditions traditionally assc with psychiatry

V codes refer to conds that may be the focus of attn in treatment, but are not themselves mental illnesses

mental retardation and personality disorders

traits and defense mechanisms

(pervasive and chronic attributes)

allows us to identify other medical problems

cognitive

affective

behavioral