Term
| Under Paul McHugh's alternative nosology to the DSM IV, how would a Personality disorder be classified? |
|
Definition
As a "Vulnerability"
DVBE
1) Diseases are things patients "have" (AD, Schizo, Bipolar)
2) Vulnerabilities are what patients are "like" (pers. anx.)
3) Behaviors are things patients "do" (Addiction, Anorexia)
4) Events are things that "happen" to patients (PTSD, Grief) |
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Term
| What kind of classification is introversion/extroversion in terms of psychiatric diagnosis? |
|
Definition
Dimensional (instead of Categorical)- high, mid, low, ect.
DSM V will focus on these criteria |
|
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Term
What do each of the following principles mean in the context of Psychiatric diagnosis?
1) Occam's razor
2) Implicit hierarchy
3) Formulation |
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Definition
1) Simplest explanation to account for all symptoms
2) Person with psychosis and anxiety probably has a psychotic disorder with anxiety rather than an anxiety disorder with psychosis
3) Clinical picture of the patient's situation.
Remember, Identify principle reason, clinical significant, secondary causes and use a wide differential and specify subtype. |
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Term
| What axis would "mental retardation" fit on? |
|
Definition
| Axis 2- personality disorder |
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Term
| What is the neurobiological basis of the disorder that presents with abnormal sleep patterns, lack of interest, guilt, cognitive symptoms and disturbed mood? |
|
Definition
Unipolar Depression (these are 5 of 9 symptoms)
- Abnormal level of inhibition of sub-cortical responses to positive emotional stimuli by "left medial-orbital PFC"- TOP DOWN |
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Term
| What is the neurobiological basis of the psychiatric disorder that presents with inflated self-esteem, distractibility, excessive involvement in pleasurable activities, decreased need for sleep and pressured speech? |
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Definition
This is Bipolar disorder (could be 1 or 2 depending on mania vs. hypomania)
- Disturbance in left and right OFPFC-amygdalar connections (Uncinate fasciculus) resulting in heightened sub-cortical responses to positive emotional stimuli.
- SCN sleep disturbances |
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Term
A patient presents to your office with a feeling of choking. She is trembling and sweaty and complains that she is nauseous and thinks that she is going to die.
What is the neurobiological basis of this disorder and how do the different treatments work? |
|
Definition
Panic disorder (this is a panic attack)
- Abnormal processing of information in amygdala (either in early appraisal/Ant. cingulate and OFC or later appraisal/limbic system and MLPFC/VLPFC)
1) SSRIs directly dampen amygdala response
- Benzos for short term use
2) CBT works upstream of amygdala by
- "de-condition" contextual fear at hippocampus
- strengthen MPFC inhibition of amygdala |
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Term
A patient presents to your office complaining of difficulty sleeping. They complain that they keep having flashbacks to a particularly disturbing memory and that they "jump out of their skin" when people touch their shoulders from behind. They refuse to talk about their father.
What is the neurobiological basis and treatment of this condition? |
|
Definition
PTSD- flashback, hyper-arousal and avoidance
- Dysfunction in HPA axis (receives amygdalar input) with glucocorticoid receptor sensitization
- Hippocampal atrophy
Combined therapy is best!
1) SSRI
2) Exposure-based CBT and eye-movement desensitization and reprocessing (EMDR) |
|
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Term
A patient presents to your office complaining that they cannot leave their house in the morning without completing 8 different motor acts, and that it is debilitating for them.
What is the neurobiological basis/treatment of this condition? |
|
Definition
OCD- Obsessions OR Compulsions with "ego-dystonic" response (I don't want to!). Not so much anxiety.
- Alexander loop dysfunction (lateral-OFC..Anterior Cing..Caudate...Gpi...Thalamus...OFC)
1) DBS of anterior cingulate
2) SSRI/Exposure-based CBT
3) Placebo effect ZERO. |
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Term
| How can you tell for sure if a patient is depressed? |
|
Definition
>2 weeks with impedance to social function
**most common is atypical (hyperphagia/hypersomnia)
NEED depressed mood or anhedonia + 4 others of
SIGECAPS
1) Sleep insomnia
2) Interest (loss)
3) Guilt
4) Energy (lack)
5) Cognitive
6) Appetite
7) Psychomotor (retardation/agitation)
8) Suicidal thoughts |
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Term
| A patient comes in that looks depressed. What else is on your differential? |
|
Definition
1) Adjustment disorder
2) Bipolar (1 or 2)
3) ** Dysthymia (chronic, but not severe)
- presents earlier and lasts a LONG time
4) Hypothyroidism
5) Bereavment
6) Psychotic |
|
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Term
| How can you distinguish between Cyclothymia and Bipolar disorder? |
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Definition
| Cyclothymia is chronic >2 years and not as severe |
|
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Term
What is the lifetime prevalence of MDD in females and males?
Is age a determining factor in presenting symptoms? |
|
Definition
1) F is 20% and M is 10X with average age of onset at 30 (> Dysthymia) and high relapse rates
2) Adolescents are irritable and dysphoric while Adults have Anhedonia
- 25% have manic episodes later in life |
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Term
| What treatment options are available for MDD? |
|
Definition
Diagnose, Educate, Treat, Re-evalutate at 1-2w (PRIORITIZE LETHALITY)
1) SSRI
2) CBT/IPT
3) ECT (serious and/or refractory cases)
4) Surgery/ventral anterior cingulate DBS (similar for OCD) |
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Term
| What does "DAMP ARTS" mean in the context of depression? |
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Definition
| Drug, Alcohol, Mania, Psychosis, Alternative Reasons To be Sad |
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Term
| Why should you never mix MAOIs with SSRIs when treating depression? |
|
Definition
Serotonin syndrome (elevated pulse, BP, confusion)
Also, on their own MAOIs can cause hypertensive crisis, or "cheese effect" upon tryamine ingestion. |
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Term
| Why do you often see hyperprolactemia and extrapyramidal symtpoms when treating patients with anti-psychotics? |
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Definition
| The tuberoinfundibular and nigrostriatal pathways are also effected from baseline. |
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Term
| Why is it dangerous to use TCAs to treat depression? |
|
Definition
| These drugs are "dual-agents" and inhibit re-uptake of 5-HT/NA and can cause arrythmia and Torsades de pointes. |
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Term
A patient presents with a 1 month history alogia, affective flattening, delusions of grandure and persistent neologisms.
What is the neurobiological basis for this disease? |
|
Definition
Schizophrenia- you have 3 out of 5 (you need 2)
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Disorganized/catatonic behavior
5) Negative symptoms
-Too much DA activity (D2) mediated in mesolimbic DA path because of too little inhibition by mesocortical DA path (D1) causes positive and negative symptoms. |
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Term
| Distinguish between Hallucinations, Illusions and Delusions. |
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Definition
1) Hallucinations are seeing/hearing things that are not actually there
2) Illusions are misinterpretations of real things
3) Delusions are fixed, false beliefs about the world ("there is poison in my food!") |
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Term
| What are the basic elements of a SOAP note? |
|
Definition
1) Subjective
CC/HPI/PMH/PPS/FH/SH/ROS
2) Objective
MSE/PE/Labs/Rads
3) Assessment
Discussion of case/Differential
4) Plan
Further assessment/Testing/Treatment |
|
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Term
| What are the basic components of an MSE? |
|
Definition
1) Appearance/Behavior
2) Mood/Affect
3) Speech
4) Thought (process and content)
5) Perceptions (hallucinations, illusions, dissociation)
6) Cognitive/Sensorium
7) Insight/Judgment |
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Term
| How should you assess Appearance/Behavior in an MSE? |
|
Definition
1) A
- Clothes
- posture
- grooming/apparent age
- accessories
2) B
- Gestures/Eye contact
- Impulsivity
- Agitation, Attitude (open/guarded),
- Neuro |
|
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Term
| How should you assess Mood/Affect in an MSE? |
|
Definition
1) M
- subjective feeling state using patient's words
- reactivity
2) A
- Flat/Blunted/Restricted/Broad
- Quality/State (dysphoric, euthymic, elevated, euphoric)
- Congruence
- Lability/Appropriateness |
|
|
Term
| How should you assess Speech/Thought in an MSE? |
|
Definition
1) S
- Volume
- rate/latency
- coherence/accents
- productivity (poverty)
- production (dysarthria, aphasia)
2) Thoughts
- Word usage (clanging, echolalia, neologisms)
- Stream of thought
- Continuity/Content (obsessions, ideas of reference)
- Hope/Guilt/Esteem
- Lethality |
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Term
| How should you assess Perceptions in an MSE? |
|
Definition
1) Hallucinations
2) illusions
3) Dissociation (de-realization)
4) Sensory difficulties |
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Term
| How should you assess Cognition/Sensorium in an MSE? |
|
Definition
- alert
- orientation (person, place, time)
- attention
- memory
- general knowledge
- reading/writing/language |
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Term
| What anxiety disorders should not be treated with Benzodiazepines? |
|
Definition
1) OCD and PTSD
** Use them for short-term treatment in PD, GAD, social an specific phobias **
** All anxiety disorder need polytherapy!** |
|
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Term
| Which anxiety disorders are resistant to SSRI treatment? |
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Definition
Social Phobia and Specific Phobias (fear conditioning)
Use a straight behavioral approach (CBT)
** remember, these ALWAYS take 4-6 weeks to work |
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Term
True or False:
Generalized Anxiety disorder is a common anxiety condition effecting 3-8% of the population that involves an abnormal amgydalar response to benign stimuli and is commonly co-morbid with MDD. |
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Definition
False!
The epidemiology (more prevalent than PD) and MMD comment are true but this is a "worry" disease, not a "fear condition."
GAD is not responsive to CBT |
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Term
| Which anxiety disorders are most responsive to CBT? |
|
Definition
"Fear Disorders" like PD and Phobias (durable treatment)
GAD responds less well |
|
|
Term
| What are the major components of an Assessment/Plan? |
|
Definition
Fun Days Free Days Can Trump Price
1) Formulation
2) DD by axis
3) Further work-up
4) Disposition
5) Commitment
6) Biological, Psychological (CBT, relaxation) and Social treatments (family therapy, self-help)
**conclude with expectations and prognosis** |
|
|
Term
| What forms of psychotherapy are most effective at treating bipolar disorder? |
|
Definition
1) CBT
2) Psycho-education for patient and family
3) Family-focused
4) Interpersonal and Social Rhythms Therapy (IPSRT) |
|
|
Term
| What is the most common presentation of bipolar disorder and how do you treat? |
|
Definition
Bipolar depression (looks like MDD but with manic episodes)
1) Anti-psychotics and Mood stabilizers are main-stay
2) Lamitrigone works for BP depression
3) NOT SSRI Monotherapy |
|
|
Term
| How can you definitely diagnose a manic episode? |
|
Definition
If it is less than 1 week, no impairment and no psychosis, but has other symptoms, it is hypomanic
If you see it, it means BP 1
1) Abnormal mood for at least 1 week (elevated or irritable)
2) Can see psychosis and depression, but MUST have impairment
3) 3 or more (4 if irritable) of the following
- Inflated self-esteem
- Decreased sleep need
- Talkative
- Racing thoughts
- Distractible
- Psychomotor agitation
- Pleasurable activity involvement |
|
|
Term
| How does the distribution of bipolar disorder differ from major depression? |
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Definition
| Equal male:female with no racial bias, presenting earlier. |
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Term
| What are the important co-morbid conditions associated with bipolar disorder? |
|
Definition
1) GME
- Thyroid
- Migraine
- Obesity
- CVD
2) Psychiatric
- Personality
- Anxiety
- S/A |
|
|
Term
A patient is refusing to maintain their body weight, with a substantial fear of being fat. She has not had her period in 3 months and seems to only see herself as "ugly" in the mirror.
What is the pathology of this condition? |
|
Definition
Anorexia Nervosa
- Familial (>50% genetic) with 5-HT abnormalities and HPA axis abnormalities, but in <1% of population
If this was Bulimia, you would see a propensity towards binge eating with a lack of control during these periods and some sort of compensatory behavior. Bulemic patients also are not always underweight. |
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Term
| I patient has been binge-eating but has not been exhibiting compensatory weight loss. Whats going on? |
|
Definition
| Binge eating disorder- 2 times per week for 6 months and less severe than Bulemia nervosa |
|
|
Term
| What is the difference between the most likely co-morbidity of Anorexia and Bulemia? |
|
Definition
1) AN is MDD
2) BN is Psychotic |
|
|
Term
| What are the major (+) and (-) Symptoms are Schizophrenia? |
|
Definition
(+)
1) Perceptions (75% have hallucinations)
2) Thought content (delusions)
3) Form of thought (word salad, neologisms)
4) Behavior (psychomotor-catatonic)
(-)
1) Amotivation
2) Asociality
3) Affect
4) Alogia (poverty of speech or mutism) |
|
|
Term
| What is the perceived etiological basis for each of the (+) symptoms of schizophrenia? |
|
Definition
1) Perceptual
- Efferent copy is frontal cortex does not communicate to Auditory cortex (self vs. other)
2) Thought content (Delusions)
- NMDA-R dysfunction and DA signal:noise regulation causes misplaced salience
3) Form of though
- GABA/DA/Glut in PFC causes cognitive dysfunction that leads to world salad and loose associations
4) Behavioral
- unk |
|
|
Term
| How can you tell Schizophrenia from Bipolar disorder? What cognitive symptoms do you see in Schizophrenia? |
|
Definition
1) SCZ involves less energy and less pressured speech
2) Bombarded with thoughts and WM issues (DLPFC)
**PFC activation ability predicts clinical prognosis** |
|
|
Term
All of the following are predictive epidemiological features of Schizophrenia EXCEPT:
1) Gender
2) Winter births
3) Life stresses
4) Age
5) Race |
|
Definition
Race
1) Men get it earlier
2) Winter and birth complications DO
3) Stress precipitates it
4) Peaks at adolescence and early adulthood. |
|
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Term
| What neuroanatomical changes do you see in Schizophrenia? |
|
Definition
Fewer neurons and synaptic pruning without gliosis
1) Whole brain atrophy
2) Enlargement of lateral and 3rd ventricles
3) Decreased cortical grey matter (hippocampus and superior temporal gyri)
4) PFC volume reduction (subtle) |
|
|
Term
| What are the 5 major stages of early Schizophrenia? |
|
Definition
1) Pre-morbid- cognitive abnormalities in school
2) Pro-dromal- unusual pre-ocupations and perceptual disturbance
3) Acute/Florid/Psychotic
4) Stabilization/Convalescent
5) Maintenance |
|
|
Term
| What psychotic disorders are often confused for Schizophrenia? |
|
Definition
1) Schizoaffective
- Do you see mood/depression/mania?
2) Delusional
- Non-bizzare delusions and no hallucinations (RARE)
3) Schizophreniform
- Early <6m and progresses
4) Brief Psychotic Disorder
- <1m but >1d |
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Term
| What are the basic principles of suicide management? |
|
Definition
SAID Dead
1) Screen for ongoing risk
2) Assess current risk
3) Identify Protective factors
4) Determine level of risk and treatment plan
5) Document plans and communicate to others |
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Term
| What co-morbidities are predictive of suicide risk? |
|
Definition
1) Psychiatric
- MDD
- Bipolar
- Schizoaffective
2) Substance
- Alcohol
- S/A |
|
|
Term
| What protective factors should be identified when considering suicide risk? |
|
Definition
1) Social Support
2) Kids at home
3) Coping skills
4) Life satisfaction
5) Spirituality
6) Sense of familial responsibility |
|
|
Term
What treatments are available for each of the following adolescent psychiatric conditions?
1) Anxiety
2) Depression
3) Bipolar
4) ADHD
5) ODD/CD
6) PDD
7) Autism |
|
Definition
1) Modified CBT and SSRI/SNRI
2) Fluoxetine only pharm. with CBT and IPT
3) 2nd gen antipsychotics (age 10-17)/Mood stabilizer
4) Stimulants- Methyphenidate and mixed amphetamines
5) CBT + environmental intervention + Stimulants
6) Resperidone and intense behavioral treatment
7) HIGH dose CAMbox (zinc) or anti-psychotics |
|
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Term
What disorder presents in children younger than 7 with hyperactivity, inattention and impulsivity?
What are the significant co-morbidities? |
|
Definition
ADHD- Male: Female 3:1
2/3 won't "grow out of it"!
- Oppositional-defiant (40%) **
- Conduct (30%)- Oppositional + Actual physical violence
- Anxiety (20%)
- Depression (20%)
Treat with stimulants- methylphenidate and mixed amphetemines |
|
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Term
How can you tell whether a child suffers from Oppositional-Defiant Disorder or Conduct Disorder?
How do you treat them? |
|
Definition
CD involves physical fighting (often preceded by ODD), stealing, conning, ect.
Treat with CBT, environmental intervention and amphetamines (ADHD-co-morbid) |
|
|
Term
A 2 year old boy presents with lack of empathy, comfort-seaking and social behavior, as well as language impairments including echolalia. He is also having seizures.
What is going on and how can you tell? |
|
Definition
Autism- 5:1 male to female under 3 years old with social, language and interest impairments (not seen here, but would involve unusual commitment to specific task).
DD
1) Asperger's would look like this, but without language impairment (or intelligence issues, while Autism generally involves retardation)
2) Pervasive Developmental Disorder would present with some, but not all of Autism/Asperger symptoms (more difficult to rule out). |
|
|
Term
| When should Exposure and Response Prevention (ERP) Psychotherapy be applied? |
|
Definition
| OCD and Phobias- using graded exposure over time to extinguish automatic response |
|
|
Term
| What 4 aspects of social connection does IPT focus on to treat anxiety and depression? |
|
Definition
Focuses on disconnection between others and society
1) Grief/Loss
2) Role transition
3) Role dispute
4) Interpersonal Deficits
** much overlap with CBT |
|
|
Term
| How does Short-term psychotherapy differ from more traditional psychoanalysis? |
|
Definition
focuses on LEARNING skills to cope.
What
No interpretation of transference and therapist is NOT NEUTRAL |
|
|
Term
| What are the 3 "Odd-eccentric" (A) Personality Disorders? |
|
Definition
All exhibit social withdrawal, distrust, suspiciousness, distrust, discomfort with closeness
1) Paranoid- suspicious with unjustified doubt, easily feeling exploited.
2) Schizoid- shows little emotion, few pleasurable activities and lack of sexual interest
3) Schizotypal- psychotic symptoms, illusions, odd beliefs |
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|
Term
A 20 year old male patient presents to your office with evidence of social withdrawal, suspiciousness and detachment from others. They exhibit little sexual interest and show little emotion.
When asked why they don't have any friends, they respond "I am just a loner." They also seem indifferent to the criticism or praise of others.
What is most likely going on? |
|
Definition
Sounds like an Odd-eccentric Personality disorder (could also be MDD, but they are a bit young and it is not quite as consistent).
Of the Cluster A options, this is most likely Schizoid Personality Disorder |
|
|
Term
| What are the 4 cluster B, Dramatic personality disorders? |
|
Definition
All are emotionally labile, intense, irritable and impulsive.
1) Antisocial- lack of empathy or remorse, disregarding social norms and not experiencing guilt.
2) Borderline- Affective lability with impulsive actions, sensitive to rejection and self-destructive tendencies
3) Narcissistic
4) Histrionic- Excessively emotional, labile and attention seeking, with manipulation/seduction and little sense of empathy. |
|
|
Term
| When should you refer cases of dramatic personality disorders? |
|
Definition
1) Suicidal behavior
2) Impulsivity
3) Agression
4) Self-mutilation |
|
|
Term
| What are the 3 Anxious Fearful personality disorders? |
|
Definition
All involve fear of rejection, avoidance, submissive dependent and excessive self-control
1) Avoidance- painfully shy, with feelings of inadequacy, social anxiety and fear of rejection/criticism (vs. Antisocial)
2) Dependent- Specialize in submission and fear of abandonment
3) Obsessive-Compulsive Personality disorder
**NO PRESENCE OF OBSESSIONS OR COMPULSIONS** |
|
|
Term
| What is the difference between OCD and OCPD? |
|
Definition
OCD involves obsession and compulsions with "ego-dystonic" reaction.
OCPD people are more often comfortable with their obsessions and rationalize them as being "efficient." They are more likely to defend a particular behavior, than repeat it over and over again with distain. |
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|
Term
How should you differentially treat each of the following clusters of personality disorders?
1) Cognitive-Perceptual
2) Affective
3) Impulsive-Behavioral |
|
Definition
1) Anti-psychotics
2) SSRIs/antipsychotics for emotion dysregulation
- SSRIs/MAOIs for rejection sensitivity and emptiness
3) SSRI, Lithium, MAOI, antipsychotic |
|
|
Term
What are the clinical features of each of the following NT balances in terms of personality?
1) High NA and High 5-HT
2) High NA and Low 5-HT
3) Low NA and High 5-HT
4) Low NA and Low 5-HT |
|
Definition
1) Reactive anxiety, phobia, avoidance, dependence
2) Impulsive, external aggression, novelty-seeking, risk-taking
3) Withdrawal, rumination, obsessional
4) Depressive, self-directed aggression and suicide |
|
|
Term
| Which disorders begin presenting during adolescence with bias towards females (for the most part) and present in a "waxing/waning" form? |
|
Definition
Somatoform disorders
1) Conversion
2) Hypochondriasis- men predominance
3) Somatization
4) Pain
5) Body dysmorphic
6) Undifferentiated |
|
|
Term
Match each of the following clinical symptoms with their appropriate Somatoform disorder
1) Unexplained motor/sensory with "le belle" indifference
2) Persistent worry about undocumented medical ailment
3) Pain in arms and legs without cause
4) Persistent dislike of spot on face with compulsive scrubbing with soap
5) Pain in head, neck, hands, feet, nausea/vomiting without pain, difficulty with attention and sexual impersistence |
|
Definition
1) Conversion
2) Hypochondriasis (10% PC visits)
3) Pain disorder
4) Body dysmorphic
5) Somatization |
|
|
Term
| What are the "primary" and "secondary" gains associated with somatoform disorders? |
|
Definition
1) Primary is internal benefits with lowered anxiety about problem
2) Secondary is external benefits with lowered responsibility and heightened support from others. |
|
|
Term
| What are the 2 major theories of somatization pathophysiology? |
|
Definition
1) Amplification of bodily symptoms
- negative "somatic filter" that misinterprets physical sensations
2) Need for sick role
- cannot express concerns in any other wy |
|
|
Term
| What rights do patients have when they are about to be involuntary committed? |
|
Definition
1) Open hearings
2) Access to written testimony
3) 2nd opinion
4) Defense representation |
|
|
Term
| What do police power and Parens patriae mean? |
|
Definition
Ethical principles of involuntary committment.
1) Police power acts on behalf of society to prevent harm
2) Parens patriae acts for patient because they cannot take care of themselves |
|
|
Term
| What are the legal grounds for Involuntary commitment? |
|
Definition
1) Must be suffering from mental illness and be in need of treatment
2) Must be EITHER dangerous (suicidal, homicidal or self-injurous thoughts/acts) or unable to care for themselves
- In PA dangerousness consists of clear and present danger with "acts of furtherance" within the past 30 days. |
|
|
Term
| What are post-commitment consequences of 302? |
|
Definition
| no purchasing firearms, but this is civil not criminal offense |
|
|
Term
| What are 2 major long-term effects of drug abuse and their underlying mechanisms? |
|
Definition
1) Tolerance- Diminished after repeat exposure (shift DR curve right and down)
- Pharmokinetic- change in absorption, distribution, metabolism
- Pharmakodynamic- change in response system (receptor desensitization)
- Behavioral- conditioned tolerance
2) Sensitization- Enhancement of drug effects (shift DR curve left and up) |
|
|
Term
Match each of the following withdrawal symptoms with their causative drug.
1) Yawning, sweating, fitful sleep, nausea, vomiting, diarrhea, cramps/spasms
2) Anxiety, Irritability, depression, fatigue, sweating, loss of appetite, RHR, fever, death , delirium
3) Tension, irritability, headaches, difficulty concentrating, drowsiness, trouble sleeping, increased appetite, weight gain
4) Depressed mood, fatigue, generalized malaise, vivid unpleasant dreams, slowing of activity, increased appetite |
|
Definition
1) Endogenous opioids (Opioids)
2) Benzodiazepines (GABA-A)
3) Nicotine (nACh-R)
4) Cocaine (DA, 5-HT, NA) |
|
|
Term
What is each of the following drugs used for?
1) Naltrexone
2) Disulfiram
3) Acamprosate
4) Methadone maintenance (MMT) or Buprenorphine |
|
Definition
1) Opiate antagonist for alcohol
2) ADH inhibitor causes acetaldehyde buildup
3) Glu/GABA
4) Replacemetn for opiate dependence |
|
|
Term
| What is the associated neurotransmitter of the structure in the superior temporal gyrus that is atrophied in schizophrenic brains? |
|
Definition
Dopamine
This is the ventral straitum (or NcA of humans) that receives input from the VTA and the brainstem and sends outputs to the cortex/limbic (ADDICTION) |
|
|
Term
| What major brain function is affected by TrkB receptor deficiencies seen in Schizophrenia? |
|
Definition
Working Memory in DLPFC!
TrkB is important for GABA synthesis in DLPFC, which is important for cortical synchronization in working memory. |
|
|
Term
| What is the structure of the "Visceral high path" of amygdala input and what is its relevance to emotional responsiveness? |
|
Definition
Regulation of emotional responsiveness
1) Visceral afferents go to the Solitary tract, and then on to the thalamus.... insula.....MPFC
2) MPFC regulates amygdala response that was received via parabrachial nucleus from solitary tract as well |
|
|
Term
| Which of the anxiety disorders does not have a female predominance? |
|
Definition
OCD (equal at 2-3% lifetime)
Remember, Depression, Anxiety and S/A run together! |
|
|
Term
| Why are SSRIs preferred to older anti-depressents? |
|
Definition
Side Effects and Metabolism (save the kidneys!)
NOT MORE CLINICALLY EFFECTIVE |
|
|
Term
What is the appropriate treatment for each of the following anxiety disorders?
1) Panic
2) Social Phobia
3) Specific Phobia
4) OCD
5) PTSD
6) GAD |
|
Definition
ITP and Supportive therapies are not very effective
1) SSRI (long-term), Benzo (acute) and CBT
2) Straight behavioral (MAYBE SSRI)
3) Straight Behavioral (10% of pop)
4) SSRI or ERP (no benefit in combo and no placebo). CBT may also work less well.
5) SSRI + Exposure-based CBT and EMDR (maybe Lithium)
6) SSRT (CBT not as effective) |
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Term
| What features are unique about GAD as opposed to the other 5 anxiety disorders? |
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Definition
1) No amygdala involvement (worry, not fear!)
2) Resistant to CBT
3) 90% concordance with MDD (vs. 33% for PD)
4) Risk of HTN, migraines and Fibromyalgia
5) Greater cognitive component than PD |
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Term
| How can you distinguish between someone with a social phobia and someone with Schizoid personality disorder? |
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Definition
1) Social Phobia people WANT to meet people, but cannot handle the anxiety
2) Schizoid personalities have no interest and prefer to be "loners," even though they are also suspicious and anti-social. |
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Term
| What are the major issues with Benzodiazepine use for depression? |
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Definition
1) Lack of durable response (anxiety comes back when you stop)
2) Addictive (GABAaR tolerance)
3) Sedative effects |
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Term
| What is the overall neurobiological trend in mood disorder pathology? |
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Definition
Decreased prefrontal modulation of subcortical/limbic circuitry
1) Increased inhibition of subcortical responses to positive emotional stimuli by L- medialOFC in unipolar depression
2) Disconnectivity between amygdala and L/R OFC (uncinate fasciculus) in Bipolar leads to over-reactivity to positive emotional stimuli |
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Term
| What is the neurobiological basis of obsessions and compulsions in OCD? |
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Definition
Think about Alexander Loop
OFC...Anterior Cingulate...Caudate...Gpi/SNpr...Thal....OFC
Obsessions in PFC/OFC
Compulsions in Striatum
DBS the CINGULATE (like in MDD) |
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Term
| What are the 4 major classification dichotomies in terms of psychiatric diagnosis? |
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Definition
DSM IV is categorical, splitting and descriptive.
1) Categorical VS. Dimensional
- Personality needs dimensions in DSM-V
2) Reliability and Validity
- is it a clinically significant disorder that is consistently diagnosed by different physicians?
3) Lump vs. Splitting
- lumping makes diagnosis and nosology easier/splitting enhances precision and research
4) Descriptive vs. Etiological |
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Term
| What are 5 psychological theories of Depression etiology? |
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Definition
1) Psychoanalytic- maturation (anger turned inwards)
2) Behavioral- social skills (lack of reward)
3) Cognitive/Behavioral- attitudes(depressogenic schema)
4) Learned helplessness- attribution (punishment)
5) Attachment- object relations (dependency) |
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Term
All of the following physiological markers of depression have been identified, EXCEPT:
1) ACh
2) Cortisol
3) INF-a
4) Decreased BDNF
5) Circadian genes |
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Definition
| 1) in AD, but not depression |
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Term
| How might depression present other than with SIGECAPS directly? |
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Definition
1) Irritability or interpersonal/marital problems
2) Inadequate response to medical treatment |
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Term
| What are the important time-sensitive followups a physician should perform after starting someone on an SSRI? |
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Definition
1) Check for adherence and SE after 1-2 weeks
2) Alter dosing after 2-4 weeks if needed
3) If no response after 1 month, switch anti-depressent
4) If some response, keep on for 6 months
5) Maintenance indicated if there were previous multiple of severe MDEs. |
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Term
| The is the clinical course of bipolar disorder? |
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Definition
1) 50% of adult lives spent ill (2/3 depression)
2) Costs 8-10 years of life
3) Average, untreated episode lasts 4-6 months (15% are non-responders)
4) Rapid cycling if >4 times per 12 months |
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Term
| What are the relevant major epidemiological features of childhood/adolescent psychiatric disorders? |
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Definition
1) Common (15-20%)
2) Anxiety common in kids and Depression in Adolescents
3) Comorbidity is COMMON. |
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