Psychiatric Conditions

What are the different classifications of bipolar disorder?

- bipolar I - bipolar II - cyclothymic - otherwise specified

How long does a behavior have to persist in order for it to be considered mania?

1 week

What percentage of people continue to have symptoms of schizophrenia after being treated with anti-psychotics?

25-50%

How many symptoms of panic does a person have to have in order to call it a panic attack?

4+ sudden onset peak within 10 minutes

How many suicides in 2017?

47,173 10th leading cause of death in US

In order to diagnose Major Depressive Disorder, how many symptoms does the pt need to have?

5 that last at least 2 weeks

What else is targeted by some antipsychotics besides dopamine?

5HT2A (serotonin)

What is required to diagnose someone with schizophrenia?

6 months or longer with a characteristic symptom or two or more characteristic symptoms

Restriction of energy intake relative to requirements, leading to a significantly low body weight is know as what?

Anorexia Nervosa

Recurrent episodes of binge eating followed by inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. is known as

Bulimia Nervoa

Blocking ___ results in EPS and hyperprolactinemia.

D2

The code that psychiatrist use to guide themselves to make a diagnoses

DSM-5

What are examples of SSRI's

Fluoxetine, paroxetine, sertraline (zolof), citalopram

What side effects leads to early discontinuation of SSRIs?

GI side effects decreased sex drive

the medical specialty concerned with the prevention, diagnosis, and treatment of mental illness is called what?

Psychiatry

the study of the causes, processes, and manifestations of mental disorders. The behavioral manifestation of any mental disorder.

Psychopathology

What are the symptoms of major depressive disorder?

SIG E CAPS S = sleep I = interest G = guilt E = energy C = concentration A = appetite P = psychomotor S = suicidal

What is a Antidepressant treatment example

SSRIs - also used for pretty much all mood disorders (panic attacks, OCD, PTSD, SAD, etc.)

What is the treatment for anxiety (anxiolytics)?

SSRIs TCAs MAOIs benzodiazepines

T/F: Its important to see if the pt has a hx of prior suicided attempts and history of violence and impulsivity

T

What drugs cause mydriasis?

TCAs typical antipsychotics SSRIs

What is the most notorious psychotropic medication that causes angle-closure glaucoma via ciliary body rotation and increase chance of glaucoma?

Topiramate (Topamax)

Despite causing metabolic syndrome, clozapine is a great antipsychotic. What life-threatening conditions is a side effect of clozapine?

agranulocytosis - people on this drug are closely followed

What are the sedatives?

alcohol barbiturates benzodiazepines

What is anticholinergic syndrome?

an emergency anticholinergic symptoms caused by medication

What are the negative symptoms of schizophrenia?

anhedonia alogia apathy avolition asociality flat affect

How is schizophrenia treated?

antipsychotics

Waht is cyclothymic bipolar disorder?

at least 2 years of numerous periods of hypomanic and depressive symptoms

What is the alternative to the high/low potency antipsychotics?

atypical antipsychotics

What type of antipsychotic is associated with metabolic syndrome?

atypicals cause: - weight gain - type 2 DM - hyperlipidemia

What is the most common type of hallucination?

auditory

What is otherwise specified bipolar disorder?

bipolar features that don't meet criteria of the other three types

What drugs impair color perception and contrast discrimination?

carbamezapine lorazepam

What drugs cause ocular dystonias?

carbamezapine (especially in polytherapy) topiramate SSRIs (rare) high potency antipsychotics

What is Serotonin syndrome?

caused by taking a lot of SSRIs confusion agitation cardiovascular side effects GI side effects uncoordinated motor

What antipsychotic is known to cause pigmentation of the eyelids, interpalpebral conjunctiva, and cornea?

chlor-promazine

What antispsychotic is known to cause retinopathy?

chlor-promazine - or other antipsychotics at high dosages

What antipsychotics are known to cause cataracts?

chlor-promazine thio-ridazine smoking (schizophrenics often smoke)

What is the least potent antipsycotic?

chlor-promazine (Thorazine)

What two atypical antipsychotics cause metabolic syndrome?

clozapine olanzapine

What are the stimulants?

cocaine amphetamines

What are the symptoms of schizophrenia?

delusions hallucinations disorganized speech disorganized/catatonic behavior negative symptoms

What is the difference between delusions and hallucinations?

delusions = paranoid, nihilistic, grandiose - example of guy who asked lady to marry him hallucinations = imagined sensation (auditory, visual, tactile, olfactory)

What is considered normal anxiety?

diffuse, unpleasant, vague sense of apprehension - survival instinct often accompanied with by autonomic symptoms

What drugs causes oculogyric crisis?

diphenhydramine benzotropine

What is the conventional MOA of antipsychotic medications?

dopamine (D2) blockade in the limbic forebrain - blocks both acute and chronic symptoms

What is the general cause of substance related disorders?

dopamine reward system in brain creates addiction

What is bipolar II?

episode of hypomania with major depressive disorder

What is bipolar I?

episodes of mania (lots of energy and irritability) with major depressive disorder

What is considered generalized anxiety disorder (GAD)?

excessive anxiety about several events for the majority of the time over a 6 month period

What are the SE produced by D2 blockers?

extrapyramdial symptoms - blocks nigroestriatal pathway causes parkinon's-like symptoms

True or false. Abilify causes metabolic syndrome.

false

True or false. Antipsychotics kick in immediately.

false - blockade happens immediately, but it takes week to see effect

True or false. D2 blockers cause an decrease in prolactin levels.

false - elevate PRL by blocking tuberoinfundibular pathway

True or false. D2 blockers improve the negative symptoms of schizophrenia.

false - largely effective for positive symptoms by blocking mesolimbic pathway

True or false. Talking with the patient about their suicidal thoughts increases the risk of that patient committing suicide?

false, it lowers it. Just like how Dr. Davis did me

What are the most common methods of suicide?

firearm suffocation poisoning

What is the most potent antipsychotic?

haloperidol (Haldol)

What is anhedonia?

inability to enjoy activities you usually would enjoy

What are the three symptoms of substance-related disorders?

intoxication withdrawal tolerance

What is avolition?

lack of energy/drive

What is apathy?

lack of interest to pursue anything

What is asociality?

lack of relationships

What is the advantage of adding inhibition of 5HT2A to the dopamine antagonism mechanism of antipsychotics?

may reduce EPS improve efficacy for negative symptoms

Why is metabolism syndrome concerning for optometrists?

metabolic syndrome can cause DM DM is the most common cause of vision loss

What is schizoaffective disorder?

mood and psychotic symptoms coexist together - but not bipolar

What is the treatment for bipolar disorder (Mood Stabilizers)?

mood stabilizers: - lithium - valproic acid - carbamezapine - antipsychotics pg 41 for SEs

What is conversion disorder?

one or more symptoms of altered voluntary motor or sensory function. Clinical findings provide no evidence of incompatibility between the symptom and medical conditions.

What is the most common type of delusion?

paranoia

What is the treatment for severe anticholinergic syndrome?

physostigmine - anticholinesterase inhibitor

What is alogia?

poverty of speech and thought

What is considered panic disorder?

recurrent unexpected panic attacks at least one attack followed by a month of: - worrying about more attacks - worrying about implications of attacks - change in behavior after attack - presence or absence of agoraphobia (a person is worried abt having a panic attack in public places)

What is brief psychotic disorder (AKA schizophreniform disorder)?

schizophrenia that's symptoms present for less time

What is somatic symptom disorder?

serious concern for one's own symptoms or health For eg when I think I have HIV or sumn so i get tests done from being paranoid about it lol

Blocking ___ results in metabolic syndrome.

serotonin - causes weight gain

What is the disadvantage of the atypical antipsychotics?

severe reactions metabolic syndrome

What is the treatment for serotonin syndrome?

stop taking SSRIs cyproheptadine methysergide chlorpromazine dantrolene

Psychosis is a __ (disease; symptom) of a major mental disorder.

symptom

What low potency antipsychotic causes retinal pigmentation?

thio-ridazine (Mellaril)

What high potency antipsychotic causes eye pigment changes?

thio-thizene (Navane)

What antipsychotic is known to cause RP?

thioridazine

What is meant by flat affect?

unchanging facial expression non-responsive

Which atypical antipsychotic can cause QT prolongation (length on a EKG)?

ziprasidone

Higher potency antipsychotics have what affect on extrapyramidal symptoms? sedation? orthostatic hypotension? anticholinergic symptoms?

↑ extrapyramidal symptoms ↓ sedation ↓ orthostatic hypotension ↓ anticholinergic symptoms

Lower potency antipsychotics have what affect on extrapyramidal symptoms? sedation? orthostatic hypotension? anticholinergic symptoms?

↓ extrapyramdial symptoms ↑ sedation ↑ orthostatic hypotension ↑ anticholinergic symptoms