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