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Neuro Psych

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What are the characteristics of Elevated mood (mania, hypomania)? Expansiveness, flight of ideas, decreased sleep, heightened self-esteem, and grandiose ideas
What are the characteristics of depressed mood (depression)? Loss of energy and interest, feelings of guilt, loss of appetite, difficulty concentrating and thoughts of death or suicide
What % of depression is missed in cases? 50%
Explain mood Mood is the sustained internal emotional state of a person
Explain affect Affect is the observed expression of the emotion
Name the major depressive disorders Disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder (dysthmia), premenstrual dysphoric disorder
What is the leading cause for disability according to the NIH? According to the NIH MDD is the leading cause of disability for people ages 15-44 and affects about 14.8 million
What is the average onset for MDD? Average onset for MDD is about 40 years with 50% between 20-50
Onset of Bipolar I ranges? Onset for Bipolar I ranges from 5 to 50 yrs old with a mean of 30 years
What is the monoamine most associated with the treatment of depression? SSRIs e.g. fluoxetine
What might happen with the depletion of serotonin? It may precipitate depression, some pts with suicidal impulses have low CSF concentrations of serotonin metabolites and low concentrations of serotonin uptake site on platelets
What is reduced in depression and increased in mania? Dopamine
Drugs such as reserpine or diseases that reduce dopamine concentrations Are associated with depressive symptoms
Drugs such as Bupropion, amphetamines, wellbutrin Reduce the symptoms of depression
Recent theories on dopamine in depression include? The mesolimbic dopamine pathway may be dysfunctional and the D1 receptor may be hypoactive
GABA's role in depression, explain its effects GABA has an inhibitory effect on monoamine pathways comme mesocortical and mesolimbic; Reduction in GABA levels have been seen in plasma, CSF, and brain; Chronic stress may reduce GABA levels; GABA may be upregulated by antidepressants, GABAergic meds
What are the effects of NMDA antagonists? They have antidepressant effects
How may GLUTAMATE possibly cause severe depression Glutamate may work in conjunction with hypercortisolemia to mediate the deleterious NEUROCOGNITIVE EFFECTS of severe recurring depression
The most consistent brain abnormality described in MRI Increased frequency of abnormal hyperintensities in subcortical regions (basal ganglia, thalamus, periventricular) More common in Bipolar I and the elderly and correspond with deleterious neurodegenerative effects of recurrent mood episodes
In depressive episodes what is correlated with intrusive ruminations? Increase glucose metabolism
MDD is also known as what? according to USMLE & KAPLAN Unipolar disorder
What % of MDD have suicidal ideations and die from suicide? 60% of suicidal ideation and 15% die from suicide
Hormonal changes in MDD Increased CRF, under or over-stimulation of thyroid hormones, sex hormones and hypercortisolism (linked to severe depression)
Biological factors in MDD Includes heredity, altered neurotransmitter activity (DA, NE, 5HT and abnormalities of the limbic HPA axis)
Psychosocial factors in MDD Include loss of primary attachment figure (parent in childhood, loss of loved one comme spouse or child in adulthood), low self-esteem tendency to negatively interpret ordinary life events
What are the major comorbidities of MDD Alcohol abuse, dependence, panic disorder, obsessive-compulsive disorder (OCD) and social anxiety disorder
For diagnosing MDD: Criteria A: 5 or more symptoms present during SAME 2 WEEK PERIOD representing change from previous functioning and at least 1 must be either Depressed mood or loss of interest or PLEASURE (1 THRU 5) 1: DEPRESSED MOOD MOST OF THE DAY; 2: MARKEDLY DEMINISHED INTEREST OR PLEASURE IN all or almost all activity; 3: SIGNIFICANT WEIGHT LOSS (not dieting) OR WEIGHT GAIN; 4: INSOMNIA OR HYPERSOMNIA; 5: PSYCHOMOTOR AGITATION;
For diagnosing MDD: Criteria A: 5 or more symptoms present during SAME 2 WEEK PERIOD representing change from previous functioning and at least 1 must be either Depressed mood or loss of interest or PLEASURE (6 THRU 9) 6: FATIGUE OR LOSS OF ENERGY 7: FEELINGS OF WORTHLESSNESS OR GUILT (MAY BE DELUSIONAL) 8: DIMINISHED ABILITY TO THINK/CONCENTRATE 9: RECURRENT THOUGHTS OF DEATH, SUICIDAL IDEATIONS OR ATTEMPTS
For diagnosing MDD: Criteria B symptoms cause clinically significant distress or impairment in social, occupational or other important areas of function
For diagnosing MDD: Criteria C the episode is not attributable to the physiological effects of a substance or another medical condition (CRITERIA A-C REPRESENT A MAJOR DEPRESSIVE EPISODE)
For diagnosing MDD: Criteria D THE OCCURRENCE OF THE MAJOR DEPRESSIVE EPISODE IS NOT BETTER EXPLAINED BY SCHIZOAFFECTIVE DISORDER, SCHIZOPHRENIA, SCHIZOPHRENIFORM DISORDER, DELUSIONAL DISORDER OR OTHER SPECIFIC OR UNSPECIFIC SCHIZOPHRENIA SPECTRUM
For diagnosing MDD: Criteria E THERE HAS NEVER BEEN A MANIC EPISODE OR A HYPOMANIC EPISODE
A major risk factors for MDD & MDE Adverse childhood experiences is a risk factor for MDD Stressful life events in MDE
Diseases that are complicated by MDE diabetes, morbid obesity and cardiovascular disease
MDD can not be diagnosed if the criteria for manic or hypomanic episodes have never been met
What always occurs in adjustment disorder with depression mood? in response to an identifiable psychosocial stressor and the full criteria for MDD can not be met
In nonpathological sadness MDE criteria are not met for number of symptoms (5 out of 9) duration ( most of the day, nearly every day for at least two weeks) and clinically significant distress or functional impairment
Persistent depressive disorder (dysthymia) PDD Depressed mood plus two or more symptoms meeting criteria for persistent depressive episode for 2 years or more
What are the MDD Differential diagnosis irritability is confined to the MDEs but IN DISRUPTIVE MOOD DYSREGULATION DISORDER severe, recurrent temper outbursts (average 3) occur accompanied by persistently irritable or angry mood most of the day, in DMDD diagnosis not made after 18 or before 6
Other MDD differential diagnosis Premenstrual dysphoria disorder which is temporally connected to the menstrual cycle in the final week of menses and becomes minimal or absent in the week postmenses Grief characterized by the feeling of emptiness and loss may accompany positive emotions
Treatment for Mood disorders Hospitalize your pt when risk of suicidal, homicidal, or psychotic decompensated behavior combination of PSYCHOTHERAPY AND PHARMACOTHERAPY SHORT TERM THERAPY ECT USED AS LAST RESORT FOR RESISTANT DEPRESSION NOT RESPONDING TO AT LEAST 4 TX
Specifiers ? a number of specifiers are provided to increase diagnostic specificity, create more homogeneous subgroups assist in treatment selection and improve prediction of prognosis
Depressive disorder with Anxious distress specifier : presence of at least 2 during majority of days of current or most recent episode feeling keyed up or tense; feeling unusually restless; difficulty in concentrating because of worry; fear that something awful will happen; feeling that the individual might lose control of him/herself;
depressive disorder with Melancholic features specifier: A - one of the following is present during the most severe period of current episode B - three or more of A: lack of pleasure in all or almost all activities. Lack of reactivity to usually pleasurable stimuli. B: distinct quality or depressed mood, depression that is worse in the morning, morning awakening, marked psychomotor retardation, anorexia, guilt
Depressive disorder with atypical features specifier: A: mood reactivity B: weight gain/increase appetite, hypersomnia, leaden paralysis, long-standing pattern of sensitivity to interpersonal rejection that results in occupational or social impairment C: criteria for melancholic or catatonic not met
What are the psychotic features specifier for depressive disorder with mood-congruent features the content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment
What are the psychotic features specifier for depressive disorder with mood-incongruent features the content of delusions and hallucinations does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment, or the content is a mixture of mood congruent and mood incongruent themes
Depression disorder with catatonia specifier 3 or more of the following: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, echopraxia
Depression disorder with peripartum onset specifier Applied to current episode of major depression if the onset of mood symptoms occurs during pregnancy or in the four weeks following delivery
Depression disorder with seasonal pattern specifier Lifetime pattern of mood episodes in recurrent major depressive disorder when there has been a regular temporal relationship between the onset of major depressive episodes in major depressive disorder and particular time of year
Depression disorders and remission specifier in partial remission Symptoms of the immediately previous major depressive episode are present but full criteria are not met or there is a period lasting less than 2 months without significant symptoms of a major depressive episode following the end of such episode
Depression disorders with severity specifiers with severity judged to be mild, moderate, or severe mild is few symptoms are in excess to meet the criteria, moderate is between that of mild and severe symptoms with minor impairment on social or occupation and severe is the number of symptoms is substantially in excess of those required for diagnosis
Diagnosing major depressive episodes with at least 5 symptoms Depressed mood + Suicidal ideation Decreased interest (anhedonia) Guilt, worthlessness w/o cause Decreased energy Decreased concentration Decreased/increased appetite Psychomotor retardation Decreased/increased sleep
Depression disorders and remission specifiers in full remission During the past 2 months no significant signs or symptoms are present
For diagnosing Bipolar I: Criteria A Criteria has been met for at least one manic episode (Criteria A-D under mania)
For diagnosing Bipolar I: Criteria B The occurrence of the manic and major depressive episode (s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic
For diagnosing Bipolar II: Criteria A Criteria has been met for at least one hypomanic episode and at least one major depressive episode
For diagnosing Bipolar II: Criteria B There has never been a manic episode
For diagnosing Bipolar II: Criteria C The occurrence of the hypomanic episode(s) and the major depressive episode(s) is not better explained by schizoaffective, schizophrenia, schizophreniform, delusional or other specific or unspecific schizophrenia spectrum and other psychotic disorder
For diagnosing Bipolar II: Criteria D The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, and or other important areas of functioning
For diagnosing Manic episode: Criteria A DISTINCT PERIOD OF ABNORMALLY AND PERSISTENTLY ELEVATED, EXPANSIVE, OR IRRITABLE MOOD LASTING AT LEAST 1 WEEK and present most of the day, nearly every day OR any duration if HOSPITALIZATION is necessary
For diagnosing Manic episode: Criteria B DURING THE PERIOD OF MOOD DISTURBANCE and increased energy or activity, 3 OR MORE OF THE FOLLOWING symptoms AND 4 IF THE MOOD IS ONLY IRRITABLE have persisted, present to a significant degree and noticeable changed INFLATED SELF-ESTEEM OR GRANDIOSITY, DECREASED NEED FOR SLEEP MORE TALKATIVE THAN USUAL or pressure to keep talking, FLIGHT OF IDEAS, DISTRACTIBILITY, INCREASE IN GOAL-DIRECTED ACTIVITY, EXCESSIVE INVOLVEMENT IN PLEASURABLE ACTIVITIES WITH HIGH PAIN TOL
For diagnosing Manic episode: Criteria C The mood disturbance is sufficiently severe to cause MARKED IMPAIRMENT IN OCCUPATIONAL FUNCTIONING, SOCIAL ACTIVITIES OR RELATIONSHIPS, OR HOSPITALIZATION TO PREVENT HARM TO SELF OR OTHERS
For diagnosing Manic episode: Criteria D The episode is NOT DUE TO THE DIRECT EFFECTS OF SUBSTANCE OR A GENERAL MEDICAL CONDITION
Bipolar disorder involves episode of both? Discrete episodes of both depression and mania or depression and hypomania
What are the neurological changes in mania Increase norepinephrine, serotonin, and slight dopamine
The difference between Bipolar I and Bipolar II BIPOLAR I is a mood disorder in which depression and a complete set of MANIA symptoms and BIPOLAR II is characterized by episodes of both depression and HYPOMANIA
Define hypomania Hypomania is defined as periods of elevated mood, euphoria and excitement that DO NOT cause the person to become disconnected from reality, IT IS NOT SEVERE ENOUGH TO CAUSE MARKED IMPAIRMENT IN SOCIAL AND OCCUPATIONAL FUNCTIONING AND HOSPITALIZATION
For diagnosing Hypomanic episode: Criteria A A DISTINCT PERIOD OF abnormally and PERSISTENTLY ELEVATED, EXPANSIVE OR IRRITABLE MOOD and persistently increased activity or energy, LASTING at least 4 consecutive DAYS and present most of the day, nearly every day.
For diagnosing Hypomanic episode: Criteria B during the period of mood disturbance and increased energy and activity, AT LEAST 3 OR MORE (4 IF MOOD IS ONLY IRRITABLE) INFLATED SELF-ESTEEM OR GRANDIOSITY, DECREASED NEED FOR SLEEP, MORE TALKATIVE THAN USUAL, FLIGHT OF IDEAS, DISTRACTIBILITY, INCREASE IN GOAL DIRECTED ACTIVITY OR PSYCHOMOTOR AGITATION, EXCESSIVE INVOLVEMENT IN PLEASURABLE ACTIVITIES WITH HIGH PAIN Toleran
For diagnosing Hypomanic episode: Criteria C The episode is associated with an UNEQUIVOCAL CHANGE IN FUNCTIONING THAT IS UNCHARACTERISTIC of the individual when not symptomatic.
For diagnosing Hypomanic episode: Criteria D The DISTURBANCE IN MOOD AND the CHANGE IN FUNCTIONING are OBSERVABLE BY OTHERS
For diagnosing Hypomanic episode: Criteria E The episode is NOT SEVERE ENOUGH TO CAUSE MARKED IMPAIRMENT IN SOCIAL OR OCCUPATIONAL FUNCTIONING, or to necessitate HOSPITALIZATION, OR PSYCHOTIC SIGNS OR SYMPTOMS.
For diagnosing Hypomanic episode: Criteria F The episode is NOT DUE TO THE DIRECT PHYSIOLOGICAL EFFECTS OF A SUBSTANCE
For diagnosing MDE: Criteria A: 5 or more symptoms present during SAME 2 WEEK PERIOD representing change from previous functioning and at least 1 must be either Depressed mood or loss of interest or PLEASURE (1 THRU 5) 1: DEPRESSED MOOD MOST OF THE DAY, OBJECTIVE OR OBSERVED BY OTHERS 2: MARKEDLY DEMINISHED INTEREST OR PLEASURE IN all or almost all activity 3: SIGNIFICANT WEIGHT LOSS (not dieting) OR WEIGHT GAIN 4: INSOMNIA OR HYPERSOMNIA 5: PSYCHOMOTOR AGITATION
For diagnosing MDE: Criteria A: 5 or more symptoms present during SAME 2 WEEK PERIOD representing change from previous functioning and at least 1 must be either Depressed mood or loss of interest or PLEASURE (6 THRU 9) 6: FATIGUE OR LOSS OF ENERGY 7: FEELINGS OF WORTHLESSNESS OR EXCESSIVE OR inappropriate GUILT (MAY BE DELUSIONAL) 8: DIMINISHED ABILITY TO THINK OR CONCENTRATE or indecisiveness 9: RECURRENT THOUGHTS OF DEATH, SUICIDAL IDEATIONS OR ATTEMPTS
For diagnosing MDE: Criteria B SYMPTOMS CAUSE CLINICALLY SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL OR OTHER IMPORTANT AREAS OF FUNCTION
For diagnosing MDE: Criteria C The episode is not attributable to the physiological EFFECTS OF A SUBSTANCE (E.G., DRUG OF ABUSE, MEDICATION) OR TO ANOTHER MEDICAL CONDITION (E.G., HYPOTHYROIDISM)
How many episodes must a patient have to be diagnosed with Bipolar disorder? At least 4 episodes within a 12 month period
UNIPOLAR point prevalence, gender differences, lifetime prevalence, onset, SES, relationships, family history Men 2 to 3%, women 5 to 9%, Women 2x men (stress of childbirth, hormones, abused as children), Men 10%, women 20%, Mean age 40, Low SES, Prevalent among those with no close relationships, separation, divorce, Higher risk if parents depressed or alcoholics
BIPOLAR point prevalence, gender differences, lifetime prevalence, onset, SES, relationships, family history Men and women less than 1%, Rates are effectively equal, Men and women 1%, Mean age 30, Higher SES, More prevalent among single and divorced, Higher risk if parent has bipolar
Cyclothymic Disorder is characterized by? ALTERNATING MOOD SWINGS FROM periods of MILD OR MODERATE DEPRESSION TO periods of HYPOMANIC symptoms Often not recognized by the person (ego- syntonic)
For diagnosing Cyclothymic: Criteria A LEAST 2 YEARS with NUMEROUS PERIODS WITH HYPOMANIC SYMPTOMS that do not meet criteria for a hypomanic episode AND NUMEROUS PERIODS WITH DEPRESSIVE SYMPTOMS that do not meet the criteria for major depressive episode (1 YEAR IN CHILDREN / ADOLESCENTS).
For diagnosing Cyclothymic: Criteria B During the 2-year period, the hypomanic and depressive periods have been present for at least half the time and the individual has NOT been WITHOUT THE SYMPTOMS FOR MORE THAN 2 MONTHS AT A TIME.
For diagnosing Cyclothymic: Criteria C Criteria for a major DEPRESSIVE, MANIC or hypomanic episode have not been met.
For diagnosing Cyclothymic: Criteria D The SYMPTOMS in Criterion A are NOT BETTER explained by a psychotic disorder
For diagnosing Cyclothymic: Criteria E The symptoms are not attributable to THE PHYSIOLOGICAL EFFECTS OF A SUBSTANCE OR another MEDICAL CONDITION
For diagnosing Cyclothymic: Criteria F The symptoms cause clinically SIGNIFICANT IMPAIRMENT IN SOCIAL, OCCUPATIONAL OR OTHER IMPORTANT AREAS OF FUNCTIONING
Mixed features specifier Applies to the current manic, hypomanic, or depressive episode with Mixed Features (with at least three depressive symptoms), or a Depressive Episode with Mixed Features (with at least 3 listed manic/hypomanic symptoms).
For diagnosing Persistent Depressive Disorder/Dysthymia: Criteria A DEPRESSED MOOD FOR MOST OF THE DAY, FOR MORE DAYS THAN NOT, as indicated by either subjective account or observation by others, FOR at least 2 YEARS (1 YEAR IN CHILDREN & ADOLESCENTS and mood can be irritable)
For diagnosing persistent depressive disorder/dysthymia: Criteria B POOR APPETITE OR OVEREATING INSOMNIA OR HYPERSOMNIA LOW ENERGY OR FATIGUE LOW SELF-ESTEEM POOR CONCENTRATION or difficulty making decisions FEELINGS OF HOPELESSNESS
For diagnosing persistent depressive disorder/dysthymia: Criteria C DURING THE 2 YEAR PERIOD of the disturbance, THE individual HAS NEVER BEEN WITHOUT SYMPTOMS FOR MORE THAN 2 MONTHS at a time
For diagnosing persistent depressive disorder/dysthymia: Criteria D Criteria for a major depressive disorder may be continuously present for 2 years.
For diagnosing persistent depressive disorder/dysthymia: Criteria E THERE HAS NEVER BEEN A MANIC, MIXED OR HYPOMANIC EPISODE, NOR HAVE THE CRITERIA FOR CYCLOTHYMIA BEEN MET
For diagnosing persistent depressive disorder/dysthymia: Criteria F The disturbance has not been better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
For diagnosing persistent depressive disorder/dysthymia: Criteria G The symptoms are not attributable to the PHYSIOLOGICAL EFFECTS OF A SUBSTANCE, or another MEDICAL CONDITION
For diagnosing persistent depressive disorder/dysthymia: Criteria H The symptoms cause SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL OR OTHER important AREAS OF FUNCTIONING
For diagnosing persistent depressive disorder/dysthymia specify if: With anxious distress, mixed features, melancholic features, atypical features, mood-congruent psychotic features, mood-incongruent psychotic features, peripartum onset, partial and full remission (same in MDD and depressive disorder in general)
persistent depressive disorder/dysthymia with Pure dysthymic syndrome full criteria for a major depressive episode have not been met in at least the preceding two years
persistent depressive disorder/dysthymia with persistent major depressive disorder Full criteria for a major depressive episode have been met throughout the preceding two year period
persistent depressive disorder/dysthymia with intermittent major depressive episodes with current episode full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in the preceding two years with symptoms below the threshold for a full major depressive episode
persistent depressive disorder/dysthymia with intermittent major depressive episodes without current episode Full criteria for a major depressive episode are not currently met, but there have been one or more major depressive episodes in at least the two preceding years
HE'S 2 SAD for persistent depressive disorder Hopelessness; Energy loss of fatigue; Self-esteem is low; 2 years minimum of depressed mood most of the day for more days than not; Sleep is increased or decreased; Appetite is increased or decreased; Decision making or concentration is impaired
SIGECAPS for major depressive episode Depressed mood + Suicidal ideation Decreased interests (anhedonia) Guilt, worthlessness w/o cause Decreased energy Decreased concentration Appetite decreased or increased Psychomotor retardation or agitation Sleep increased or decreased
Disruptive mood dysregulation disorder Occurs in children, onset must be before age 10, diagnosis not made before age 6 or after age 18 and MUST have been present for 12 months or more
Disruptive mood dysregulation disorder has two prominent clinical manifestations Frequent temper outbursts, typically in response to frustration, and which may be verbal or behavioral [occur on average, three or more times a week] Chronic, persistently irritable or angry mood that is present between the severe outbursts of temper
Premenstrual dysphoric disorder Mood lability, irritability, dysphoria, and anxiety symptoms occur repeatedly during the premenstruum and remit around the onset of menses or shortly thereafter, the following follicular phase must be symptom free
For diagnosing Premenstrual dysphoric disorder: Criteria A Menstrual cycles during the past year, at least 5 of 11 criterion B and C symptoms must be present in the final week b4 the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
For diagnosing Premenstrual dysphoric disorder: Criteria B Marked lability, irritability or anger or increased interpersonal conflicts. Depressed mood, feelings of hopelessness, or self-deprecating thoughts. Anxiety, tension, and/or feelings of being keyed up or on edge
For diagnosing Premenstrual dysphoric disorder: Criteria C Decreased interest in usual activities, Subjective difficulty in concentration, Lethargy, Marked change in appetite, Hypersomnia or insomnia, Feeling overwhelmed, Decreased interest in usual activities, Physical symptoms
For diagnosing Premenstrual dysphoric disorder: Criteria D The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others
For diagnosing Premenstrual dysphoric disorder: Criteria E Is not an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder
For diagnosing Premenstrual dysphoric disorder: Criteria F Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles
For diagnosing Premenstrual dysphoric disorder: Criteria G The symptoms are not attributable to the physiological effects of a substance OR another medical condition
What are the thyroid hormones used to treat mood disorders? Levothyroxine[Synthroid,Levothroid],asyntheticformof thyroxine (T4), has mood stabilizing effects in bipolar disorder patients. Liothyronine[Cytomel], T4 active metabolite triiodothyronine (T3), can augment the effects of antidepressant medication.
What are the sex hormones used in the treatment of mood disorders? Estrogens may improve mood directly and augment the effects of antidepressants in postmenopausal women, increase monoamine availability by either lowering monoamine oxidase concentrations or raising the availability of L-tryptophan.
What are the effects of testosterone ? Testosterone and other androgens may improve mood and energy in hypogonadal men and increase libido in both hypogonadal men and postmenopausal women
Drugs that may be used during pregnancy Except PAROXETINE (SSRI), most TCAs, SSRIs, and atypical antipsychotics are generally considered to be safe for use during pregnancy. Lithium also despite the slightly increased risk for fetal heart defects
Sedatives work primarily by increasing what NT? y-aminobutyric acid
What are the ten classes of drugs in substance related disorders? Alcohol, caffeine, cannabis, phencyclidine (or pharmacologically similar substance), other hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, and tobacco.
What are the 6 effected areas in intoxication ? MEMORY; ORIENTATION; MOOD; JUDGMENT; BEHAVIOR, SOCIAL and OCCUPATIONAL FUNCTIONING
For diagnosing Substance induced psychotic disorder: Criteria A presence of one or both Delusions, Hallucinations
For diagnosing Substance induced psychotic disorder: Criteria B physical examination or laboratory findings of both 1: Symptoms in criterion A developed soon after substance intoxication or withdrawal or after exposure to a medication 2: Involved substance/medication use is capable of producing the symptoms in Criterion A.
For diagnosing Substance induced psychotic disorder: Criteria C The disturbance is not better accounted for by a Psychotic Disorder that is not substance induced
For diagnosing Substance induced psychotic disorder: Criteria D The disturbance does not occur exclusively during the course of a delirium.
For diagnosing Substance induced psychotic disorder: Criteria E The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
When should substance induced psychotic disorder be diagnosed ? only when the symptoms in Criterion A predominate in the clinical picture and when the symptoms are sufficiently severe to warrant independent clinical attention
What is cross tolerance? TOLERANCE OR RESISTANCE TO THE EFFECTS OF A SUBSTANCE THAT DEVELOPS THROUGH CONTINUED USE OF ANOTHER SUBSTANCE WITH SIMILAR PHARMACOLOGICAL ACTION
About ________ of psychiatric disorders are substance abuse disorders. 33%
substance abuse in newly admitted psychiatric inpatients or outpatients is roughly ? 50%
Who do physicians tend to underdiagnose substance abuse problems in? women, high-SES patients and other physicians
What is the most abused drug for all ages? Alcohol (10% )
Alcohol is implicated in 50% of all? Auto accidents not involving a pedestrian ◦ Auto accident deaths ◦ Homicides (killer or victim) ◦ Hospital admissions
The leading known cause of mental retardation/ intellectual disability (Down syndrome is second) is? Fetal alcohol syndrome
Which drug is to be used in treating alcohol dependence; for maintaining abstinence/preventing relapse by lowering the receptors of glutamate? Acamprosate in conjunction with psychosocial interventions (support groups) and alcohol abstinence
What anticonvulsant drug stimulates GABA blocks action of glutamate slows release of dopamine on NAc pathway? Topiramate
What drug prevents seizures in alcohol withdraw treatment? Benzodiazepines
What drug that is a MU opioid antagonist used to prevent relapse, and reduce severity of relapse in alcohol withdraw treatment ? in individuals with alcohol dependence Naltrexone (YOU WOULDNT KNOW BECAUSE YOU WERE ON YOUR PHONE!!)
Created by: marshall19