What is defined as the following?

•  a "break from reality"
• It is a symptom not an illness.
• Manifested by disturbances in the formation and content of thoughts.
• Caused by a variety of conditions that affect the functioning of the brain.
• Includes hallucinations, delusions, and thought disorder

1. Affective flattening
2. alogia (speaking very little or lack of spontaneous content in conversation, called "poverty of speech")
3. Avolition (loss of ability to initiate goal-directed activity)
4. anhedonia (loss of the ability to experience emotions)
5. Attentional impairment

What is defined as:

• alternation of full manic and depressive episodes
• average onset 18 y/o
• high risk for suicide

What is defined as

• alternation of major depression with hypomania
• average onset 22 y/o

What is defined as:

• 2 or more psychotic symptoms for 1 month (shorter if treated)
• some signs for at least 6 months
• impairment in social or occupational functioning
• not due to medical, neuro, or substance induced

What disorder is described?

• begins before adulthood
• exposure and response prevention therapies and serotonin-related drugs are helpful
• preoccupation with specific thoughts and inability to resist repeated behaviors

simple phobia

fear of spiders

What personality d/o is defined as:

• suspicious, jealous, but not psychotic or unlawful
• pervasive distrust and suspiciousness, interpret motives as evil

paranoid

(cluster A)

What personality d/o is defined as:

• unemotional, cold, indifferent
• detached from social relationships

schizoid

(cluster A)

What personality d/o is defined as:

• odd behavoirs, magical beliefs, not paranoid
• discomfort with close relationships, cognitive/perceptual distortions, eccentric behavior

schizotypal

(cluster A)

What personality d/o is defined as:

• aggressive, unlawful, impulsive
• disregard for, and frequent violations of, others rights

antisocial

(cluster B)

What personality d/o is defined as:

• unstable, chaotic, impulsive, NOT aggressive or unlawful
• instability of relationships, self image, emotions, control over impulses

borderline

(cluster B)

What personality d/o is defined as:

• dramatic, seductive, but NOT chaotic
• excessive emotionality and attention seeking

histrionic

Cluster B

What personality d/o is defined as:

• self-centered, entitled, lacks empathy, NOT unlawful or chaotic
• grandiosity, need for admiration

Narcissistic

cluster B

What personality d/o is defined as:

• needs people but fears relationships
• social inhibition, feelings of inadequacy, hypersensitive to negative evaluation

avoidant

cluster C

What personality d/o is defined as:

• needs relationships, indecisive, fears abandonment
• excessive need to be taken care of, leading to submissive and clinging behavior

dependent

cluster C

What personality d/o is defined as:

• rigid, perfectionist, inefficient
• preoccupied with orderliness and perfectionism at expense of flexibility

obsessive-compulsive

Cluster C

delusion that one is capable of "inserting" thoughts into other individual's minds, or that others can perceive them (telepathy)

(concern in schizophrenics)

delusion that thoughts are being inserted into one's mind by someone else

(concern with schizophrenics)

when individuals believe they are not in control of their environment

(concern with schizophrenics)

visual, olfactory, somatic/tactile, gustatory, auditory

(concern with schizophrenics)

• ApoE-2, ApoE-3, ApoE-4

• ApoE-4 has strongest tie to increased AD risk

dementia involves atrophy of the brain

delirium is usually acute onset

Typical - treat only positive symptoms

Atypical - treat positive and negative symptoms, broad receptor spectrum

Chlorpromazine (Thorazine)

Dopamine receptor antagonist

Risperidone, Olanzapine, Quetiapine, Clozapine, Ziprasidone, Aripiprazole (new partial DA agonist)

• reduce the effects of dopamine by blocking dopamine receptors, or by reducing the effects of dopamine together with serotonin (5-HT)

Parkinsonism

Acute dystonia

Acute akathisia (feeling of inner restlessness)

tardive dyskinesia

involuntary movements of tongue, lips, face, trunk, and extremeties

neuroleptic malignant syndrome

syndrome is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction

AD is more common in ______

AD is categorized as a _______ dementia

women

cortical

_____ is a clouded state of consciousness involving:

• acute onset, fluctuating, reversible disturbance
• difficulty in concentration
• disruption of the sleep-waking cycle
• incoherent speech
• memory impairment for recent events
• perceptual disturbances (delusions and hallucinations)
• mood/activity swings
• disorganized thoughts

Problematic - causes clinically significant distress or problems for self or others; may be difficulties in social life, work, law

Persistent - pattern is stable and long-standing; present since early childhood or adolescence and continues into adulthood

Pervasive - pattern is inflexible; present in broad range of situations

What is defined as:

• discontent when not the center of attention
• inappropriately sexually seductive or provocative
• exaggerated expressions; theatrical displays of emotion and self-dramatization
• easily influenced by others and circumstances

Histrionic

Cluster B

What is defined by:

• unlawful behavior, repeated acts that are grounds for arrest
• deceitfulness, lying, use of aliases, or conning others for pleasure or profit
• impulsivity, failure to plan
• recklessness, disregard for the safety of self and others
• lack of remorse; indifference to hurting, mistreating, or violating the rights of others

antisocial

Cluster B

must be at least 18 y/o w/ hx of conduct disorder before age 15!!

What is defined by:

• grandiose sense of self importance
• preoccupations with fantasies of success, wealth, power, brilliance, beauty, or ideal love
• beliefs related to being special or unique or only understood by other unique people
• requires excessive admiration; sense of entitlement
• lack of empathy
• envious of others
• arrogant behaviors

Narcissistic

Cluster B

What is defined by:

• unstable, intense relationships; extremes of idealization and devaluation
• identify disturbance; unstable self image
• impulsivity which is self-damaging, or deprecating
• recurrent suicidal threats or gestures; self-destructive or self-mutilating behavior
• inappropriate, intense anger; difficulty controlling anger

borderline

Cluster B

• poor treatment compliance
• focus of medical therapy is lost with regular "crises"
• clinician becomes demoralized ("nothing seems to work")

BPD is one of the most difficult conditions to treat and one of the most common PDs seens by adult mental health services

What cognitive deficits are present in patients with dementia?

(3A's)

Aphasia, apraxia, agnosia

difficulties with planning, organizing, sequencing, or abstracting information; loss of excutive function

Which disease following this progression path?

deterioration is slow during the early and later stages, but rapid during middle stage

AD usually onsets at what age range?

What is the average survival time?

60s or 70s

8 years

• Mainly: ACh - (major loss of nicotinic receptors), and glutamate
• also NE, serotonin, GABA

AD

glutamate inhibitor

Reminyl, Exelon, Aricept

(AChase inhibitors)

concussion, contusion:

occult head trauma if recent fall

highly correlated to BOXING!!!

Dementia pugilistica

What disorder presents as:

Depressed/irritable mood

PLUS presence of two of the following:

appetite probs, sleep probs, fatigue, poor concentration, feelings of hoplessness

Present for 2 year period, with NO evidence of Major Depressive Episode during 1st 2 years

NO MANIC or HYPOMANIC episode!

Dysthymic D/O

(type of depressive d/o)

What disease presents as:

• for at least 2 years w/ presence of numerous HYPOMANIC episodes and numberous periods with depressed mood or loss of interest or pleasure that did NOT meet criterion A of Major Depression
• During a 2 yr period of disturbance , never without hypomanic or depressive symptoms for more than 2 months at a time
• no evidence of MDD or Manic episode during the first 2 years of disturbance

Cyclothymia

(type of depressive d/o)

What disease presents as:

• only having positive symptoms from schizophrenia (delusions, hallucinations, disorganization)
• duration from one day to one month

What disease presents as the following:

• meets positive AND negative criteria from schizophrenia
• duration longer than ONE MONTH, LESS than 6 months

What d/o present as the following:

• meets criteria for major depressive or manic episode AND psychotic symptoms of schizophrenia
• 2 weeks of psychotic symptoms in absence of mood symptoms

What d/o is defined as:

excessive anxiety and worry, occuring more days than not, for AT LEAST 6 MONTHS, about a number of events or activities

fear of leaving home

commonly with panic attacks!

exposure therapy

sometimes agoraphobia with panic attacks can be treated with antidepressants

1. electrolytes
2. liver
3. kidney function tests
4. glucose
5. thyroid function tests
6. B12
7. folate
8. CBC
9. ESR
10. VDRL
11. HIV (if indicated)

What d/o must include one of the following occuring almost every day for two weeks?

 either depressed mood OR pleasure/interest loss

• Single episode: defined as abscence of mania or hypomania
• Recurrent: 2 major depression episodes, separated by at least a 2 month period with more or less normal function/mood

< 1 month

> 1 month

What d/o presents with memory impairment NOT due to delirium or dementia. 

It can have a physiological basis or be substance induced

caused by neuronal damage that results from thiamine deficiency in association with chronic alcohol abuse

Confabulation is a hallmark finding!

Panic d/o

periodic, discrete bouts of panic occur abruptly and peak within 10 mintues

memory dysfunction, with at least one additional cognitive deficit (aphasia, apraxia, agnosia, or executive dysfunction)

sufficiently severe to cause impairment of occupational or social functioning

• hx of stroke
• followed by onset of dementia w/i 3 months
• abrupt onset, step-wise deterioration
• CV dz - HTN, A-fib
• Depression, personality change
• Gait problems

meningioma

glioma

Transient global amnesia

usually lasts a few hours with full recovery

AD deficits are NOT due to:

1) other _____ conditions

2) _______ induced conditions

CNS

Substance

Chromosome 21 (controls amyloid plaque formation)

Chromosome 19 (50-90% chance of developing AD)

Environmental stress may also play a role

Choose one of the following:  Schizophrenia, Brief pscychotic D/O

Usually insidious onset

Choose one of the following:  Schizophrenia, Brief pscychotic D/O

Chronic course

Choose one of the following:  Schizophrenia, Brief pscychotic D/O

< 1 month duration

Do you have suicidal thoughts?

Do you have a substance abuse problem?

3x

heritability rates are higher for females