Term
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Definition
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Term
| Identify and define the concept of normality |
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Definition
Statistical Normality
Clinical Normality
Societal Standards of Normality
Adaptive Concept of Normality |
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Term
| The three basic clinical principles important to the biopsychosocially-oriented assessment of patients |
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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 |
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Term
| Discuss the four general concepts concerning psychopathology (as presented in class and in the handout). |
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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 |
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Term
| Describe the DSM-IV (Diagnostic and Statistical Manual, Fourth Edition) multiaxial diagnostic system (Axes I – V). |
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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. |
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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). |
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Definition
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Term
| State the three general criteria of the DSM-IV definition of a mental disorder. |
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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) |
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Term
| Discuss the hierarchical method in determining differential diagnosis for psychiatric symptoms. |
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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 |
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Term
| Lifetime prevalence rates for MDD, Dysthymic Disorder, Bipolar I and II, and Cyclothymic disorder and compare prevalence in men and women |
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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% |
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Term
| diagnostic criteria of Major Depressive Episode |
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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 |
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Term
| diagnostic criteria of Manic Episode |
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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 |
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Term
| diagnostic criteria of hypomanic episode |
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Definition
same criteria as manic except only 4 DAYS
no social impairments |
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Term
| diagnostic criteria of mixed episode |
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Definition
both criteria (MDE and Manic) are met nearly every day for at least 1 WEEK
may need hospitalization |
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Term
| diagnostic criteria/clinical features of MDD |
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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) |
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Term
| diagnostic criteria/clinical features of Dysthimic Disorder |
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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) |
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Term
| diagnostic criteria/clinical features of Bipolar I |
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Definition
hx of one manic or mixed episode
can have psychotic symptoms (congrunet/incongruent) |
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Term
| diagnostic criteria/clinical features of Bipolar II |
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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) |
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Term
| diagnostic criteria/clinical features of Cyclothymic disorder |
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Definition
| 2 years with many HYPOmanic eps and numerous depressive symptoms that doesn't qualify as MDE |
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Term
| depressive symptoms caused by GMC |
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Definition
hypothyroidism
parkinsons
pancreatic cancer
stroke |
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Term
| manic episodes assoc with GMC |
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Definition
levodopa
sympathomimetics
cocaine
bromocriptine
yohimbine
thyroid hormones
pencyclidine (PCP)
Hyperthyroidism
puerperal psychosis
posttraumatic encephalopathy
general paresis |
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Term
| diagnostic criteria for ALL dementias (Alzheimer's and Vascular and Lewy Body and frontotemporal) |
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Definition
Memory Impairment
Either Aphasia (language), Apraxia (motor), Agnosia (object), or Exec Fun Disturbance |
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Term
| examples of aphasia, apraxia and agnosia |
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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 - ??? |
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Term
| define executive function |
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Definition
ability to plan, organize, sequence, monitor and do complex goal directed activity.
allows person to act independently of their environment |
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Term
| neuroanatomical pathways mediating executive function |
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Definition
| cortex ---> Straitum ---> globus pallidus ---> thalamus ----------> back to cortex |
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Term
| clinical features of Alzhemiers |
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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) |
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Term
| pathological featuers of Alzheimer's |
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Definition
decreased sAPPalpha
increased Abeta ****
alzheimer's amyloid hypothesis: beta-secretase produces sAPPbeta that gama-secretase turns into Abeta (very neurotoxic!!) |
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Term
| FDA approved medications for Alzheimer's (MOA?) |
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Definition
cholinesterase inhibitors
NMDA glutamate receptor antagonist |
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Term
Dementia of Alzheimer's type
Vascular Dementia
Lewy Body Dementia
Frontotemporal Dementia |
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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 |
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Term
Delirium
Dementia
Amnestic Disorders |
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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 |
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Term
| diagnostic eval of pts suspected of having a cognitive impairment disorder (MMSE? CLOX?) |
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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 |
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Term
| tx for dementia and amnestic disorders |
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Definition
dementia - cholinesterase inhibitors and NMDA glutamate receptor antags
give thiamines to amnestic pts suffering from wernicke's-korsokoff's syndrome (alcohol withdrawel) |
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Term
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Definition
Don't use antidepressants (hypomanic state induced)
use depakote (valproic acid) |
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Term
| define psychosis and its symptoms |
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Definition
loss of ability to distinguish fantasy from reality
hallucinations
delusions
formal thought disorders |
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Term
| epidemiology and lifetime prevalence of schizophrenia |
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Definition
lifetime prevalence 1% and equal in males and females
presents earlier in males, bimodal dist in females |
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Term
| diagnostic criteria/clinical features of schizophrenia |
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Definition
| 6 mo or more (1mo of active phase symptoms) with schizo symptoms |
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Term
| diagnostic criteria/clinical features of schizophreniform disorder |
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Definition
| more than 1 month but less than 6 with schizo symptoms |
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Term
| diagnostic criteria/clinical features of brief psychotic disorder |
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Definition
| less than 1 mo but more than 1 day with schizo symptoms |
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Term
| shared psychotic disorder |
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Definition
| transmission of delusion from someone with the original delusion (september 11 was done by US idea given |
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Term
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Definition
Delusions
Hallucinations
Bizarre behaviors
Disorganized speech or behavior
USE TYPICAL ANTIPSYCH'S (THORAZINE AND HALOPERIDOL) |
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Term
| neg symptoms of schizo (5 A's) |
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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) |
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Term
which type of hallucination most common in schizo?
what about delirium? |
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Definition
auditory hallucinations
visual hallucinations |
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Term
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Definition
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Term
| antipsychotic for delirium |
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Definition
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Term
| dopamine system in limbic area relates to what psychotic symptom? |
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Definition
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Term
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Definition
sustained contraction (or spasm) of any muscle/part of the body
e.g. teen boy took mom's medicine ended up with toricollitis |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
| males are twice as likely as females to develop __________ dependence and abuse. |
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Definition
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Term
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Definition
| intoxicating effects higher when levels are rising |
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Term
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Definition
benzodiazepines and barbituates
do not give them to alcoholics! |
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Term
| tx alcohol intoxication with |
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Definition
| haloperidol (antipsychotic) |
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Term
| life threatening substance abuse problems |
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Definition
alcohol withdrawal
opiod intoxication |
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Term
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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 |
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Term
| how to tx alcohol withdrawal |
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Definition
benzodiazepine
antipsychotics (for perceptual disturbances)
THIAMINE (Wernicke-Korsakoff's syndrome)
Wernicke - alcohol withdrawal delirium
Korsakoff - alcohol induced persisting amnestic disorder |
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Term
| classic triad of Wernick-Korsakoff syndrome |
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Definition
ataxia
nystagmus
amnesia
GIVE THIAMINE!! |
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Term
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Definition
| amphetamine and cocaine intox |
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Term
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Definition
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Term
| pupils do the opposite during...... |
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Definition
withdrawal and intoxication
e.g. opiod myosis (constriction) during intox; have mydriasis during withdrawal |
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Term
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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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