Psychiatry - Pathology

ekadar's version from 2016-04-23 12:57

Neurotransmitter changes in psych disorders

Question Answer
Anxiety NT change↑ NE, ↓ GABA/serotonin
Depression NT change↓ NE/serotonin/DA
Alzheimer's NT change↓ ACh
Huntington's NT change↓ GABA/ACh, ↑ DA
Schizophrenia NT change↑ DA
Parkinson's disease NT change↓ DA, ↑ serotonin/ACh


Question Answer
HypnaGOgicHallucination that occurs while GOing to sleep
HypnoPOMPicHallucination that occurs while waking from sleep
"POMPous upon waking"
SchizophreniaPeriods of psychosis, disturbed behavior and thought, and decline in fn'ing that lasts >6 months
↑ DA, ↓ dendritic branching
Schizophrenia dx2 or more for > 6 months:
Positive syms:
- delusions
- Hallucinations (often auditory)
- disorganized speech (loose associations)
- disorganized or catatonic behavior
Negative sxs: flat affect, social withdrawal, lack of motivation, lack of speech or thought
Brief psychotic disorder<1 month (schizophrenia-like)
Usually stress related
Schizophreniform disorder1-6 months of sxs
Schizoaffective disorderat least 2 weeks of stable mood w psychotic sxs + a major depressive, manic, or mixed (both) episode.
2 subtypes: bipolar or depressive
5 subtypes of schizophrenia- Paranoid (Delusions)
- Disorganized (with regard to speech, behavior, and affect)
- Catatonic (automatisms)
- Undifferentiated (elements of all types)
- Residual
Schizophrenia epidemiologyGenetics and environment play a role
frequent cannabis use in teens
Presents in men: early 20s
women: late 20s, early 30s
Pts are at increased risk for suicide
Delusional disorderFixed, persistent, nonbizarre belief system lasting > 1 month - functioning is otherwise not impaired
Shared psychotic disorder (folie a deux)development of delusions in a person in a close relationship with someone w delusional disorder. Often resolves upon separation


Question Answer
Dissociative identity disorderFormerly known as multiple personality disorder
Presence of 2 or more distinct identities or personality states
More common in women and assoc w history of sexual abuse
Depersonalization disorderPersistent feelings of detachment or estrangment from one's own body, a social situation, or the environment
Dissociative fugueAbrupt change in geographic location with inability to recall the past, confusion about personal identity, or assumption of a new identity
Assoc w traumatic circumstances - natural disasters, wartime, trauma
→ significant distress or impairment
(not the result of substance abuse or general medical condition)
Mood disorderAbnormal range of moods or internal emotional states and loss of control over them
Includes: major depressive disorder, bipolar disorder, dysthymic disorder, and cyclothymic disorder
Psychotic features may be present
Manic episodeElevated activity and craziness lasting at least a week - it's often disturbing to the patient
Dx of manic episodeHospitalization or at least 3 or the following: (manics DIG FAST)
Irresponsibility - seeks pleasure without regard to consequences (hedonsitic)
Flight of ideas (racing thoughts)
↑ in goal-directed Activity/pyschomotor Agitation
↓ need for sleep
Talkativeness or pressured speech
Hypomanic episodeLike manic episode except mood disturbance is not severe enough to cause marked impairment in social/occupational fn'ing or to necessitate hospitalization - no psychotic features
Bipolar disorderDefined by the presence of at least 1 manic (bipolar I) or hypomanic (bipolar II) episode
Depressive sxs always show up eventually - pt's mood/functioning usually returns to normal between episodes
Antidepressants can lead to ↑ mania
high suicide risk
Tx of bipolar disordermood stabilizers (lithium, valproic acid, carbamazepine)
atypical antipsychotics
Cyclothymic disorderDysthymia and hypomania
milder form of bipolar disorder lasting at least 2 years
Major depressive disorder episode frequency & length6-12 months
Episodes characterized by at least 5 of the 9 SIGECAPS for 2+ weeks
(sxs must include pt-reported depressed mood or anhedonia and occur more frequently as the disorder progresses)
SIGECAPSDepression screening
Sleep disturbance
loss of Interest (anhedonia)
Guilt or feelings of worthlessness
loss of Energy
loss of Concentration
Appetite/weight changes
Psychomotor retardation or agitation
Suicidal ideations
Depressed mood
Dythymiamilder form of depression lasting at least 2 years
Seasonal affective disorderSxs assoc w winter season
Improves with full-spectrum bright-light exposure
Atypical depressionMood reactivity (being able to experience improved mood in response to positive events)
"reversed" vegetative symptoms - hypersomnia, weight gain
leaden paralysis - heavy feeling in arms/legs
long-standing interpersonal rejection sensitivity
tx: MAO inhibitors, SSRIs
Postpartum "blues"50-85% incidence
depressed affect, tearfulness, and fatigue starting 2-3 days after delivery
resolves within 10-14 days
Tx: supportive
Postpartum depression10-15% incidence
depressed affect, anxiety, poor concentration starting within 4 weeks after delivery
Lasts 2 weeks to a year or more
Tx: antidepressants, psychotherapy
Postpartum psychosis0.1-0.2% incidence
Delusions, hallucinations, confusion, unusual behavior, possible homicidal/suicidal ideations/attempts
Lasts 4-6 weeks
Tx: antipsychotics, antidepressants, possible inpatient hospitalization


Question Answer
Electroconvulsive therapyTx for major depressive disorder that's refractory to other tx
Tx for pregnant women with major depressive disorder
For immediate response therapy for things like acute suicidality, depression with psychotic features, and for catatonia
side effects: disorientation and temp anterograde/retrograde amnesia that usually resolves in 6 months
Anxiety disorderAnxiety over something that's not that big of a deal - interferes with daily life
30% lifetime risk for women and 19% for men
Includes: panic disorder, phobias, OCD, PTSD
Panic disorder definitionpresence of recurrent periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following: (PANICS):
Palpitations, Paresthesias
Abdominal distress
Intense fear of dying or losing control, L-I-ght headedness
Chest pain, Chills, Choking, disConnectedness
Sweating, Shaking, Shortness of breath
Strong genetic component
Panic disorder txcongnitive behavioral therapy, SSRIs, venlafaxine, benzodiazepines (risk of tolerance, physical dependence)
Tx of social phobiaSSRIs
Obsessive-compulsive disorderRecurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress
Relieved by performance of repetitive actions (compulsions)
Ego dystonic: behavior inconsistent with one's own beliefs and attidues
Assoc w Tourette's disorder
Tx: SSRIs, clomipramine
PTSDDisturbance lasts > 1 month
Tx: psychotherapy, SSRIs
Acute stress disorderPTSD lasts between 2 days and 1 month
Generalized anxiety disorderUncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event
Assoc w sleep disturbance, fatigue, GI disturbance, and difficulty concentrating
Adjustment disorderEmotional sxs (anxiety, depression) causing impairment following an identifiable psychosocial stressor and lasting < 6 months
MalingeringPt consciously fakes or claims to have a disorder in order to attain a specific 2° gain (skipping work, drugs)
Poor compliance with tx or follow-up of diagnostic tests
Factitious disorderPatient consciously creates physical and/or psychological sxs in order to assume "sick role" and to get medical attention (1° gain)
Munchausen's syndromeChronic factitious disorder with predominantly physical signs and sxs
Characterized by history of multiple hospital admissions and willingness to receive invasive procedures
Munchausen's syndrome by proxyWhen illness in a child or elderly is caused by a caregiver
Motivation is to assume a sick role by proxy
It's a form of child/elder abuse
Somatoform disordersPhysical sxs with no identifiable physical cause
Sxs not intentionally produced or feigned
more common in women
Somatization disorderVariety of complaints in multiple organ systems
At least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic
Over a period of years, developing before age 30
Conversion disorderSudden loss of sensory or motor fn often following an acute stressor
Pt is aware of but sometimes indifferent toward sxs
More common in females, adolescents, and young adults
HypochondriasisPreoccupation with and fear of having a serious illness despite medical evaluation and reassurance
Body dysmorphic disorderPreoccupation with minor or imagined defect in appearance → significant emotional distress or impaired fn'ing
Pts often repeatedly seek cosmetic surgery
Pain disorderProlonged pain with no physical findings
Pain is predominant focus
All the "schizo-"sSchizoid- content with social isolation
Schizotypal - odd thinking
Schizophrenic - greater odd thinking than schizotypal
Schizoaffective - schizophrenic psychotic sxs + bipolar or depressive mood disorder
Schizophrenia time course< 1 month - brief psychotic disorder, usually stress related
1-6 months - schizophreniform disorder
>6 mo - schizophrenia

Personality disorders

Question Answer
Personality traitAn enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and onself
Personality disorderInflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired fn'ing
Person is not aware of the problem
Usually early adulthood
Cluster A personality disordersOdd or eccentric w inability to develop meaningful social relationships
Genetic assoc w schizophrenia
ParanoidCluster A personality disorder
Pervasive distrust and suspiciousness
projection is the major defence mechanism
SchizoidCluster A personality disorder
voluntary social withdrawal
limited emotional expression
content with social isolation
ShizotypalCluster A personality disorder
eccentric appearance, odd beliefs or magical thinking
interpersonal awkwardness
Cluster B personality disordersDramatic, emotional, or erratic - genetic association with mood disorders and substance abuse
AntisocialCluster B personality disorder
conduct disorder for adults
BorderlineCluster B personality disorder
unstable mood and interpersonal relationships
sense of emptiness
splitting is a major defense mechanism
HistrionicCluster B personality disorder
excessive emotionality and excitability
attention seeking
sexually provocative
overly concerned with appearance
NarcissisticCluster B personality disorder
Grandiosity, sense of entitlement
lacks empathy and requires excessive admiration
often demands the "best" and reacts to criticism with rage
Cluster C personality disordersAnxious or fearful
Genetic assoc w anxiety disorders
AvoidantCluster C personality disorder
Hypersensitive to rejection
socially inhibited
feelings of inadequacy
desires relationships with others (vs. schizoid)
Obsessive-compulsive (personality disorder)Cluster C personality disorder
Preoccupation w order, perfectionism and control
ego-syntonic: behavior consistent with one's own beliefs and attitudes (vs. OCD)
Dependent (personality disorder)Cluster C personality disorder
Submissive, clinging
excessive need to be taken care of
low self confidence

Drug intox and withdrawals

Question Answer
Alcohol intoxSerum γ-glutamyltransferase (GGT) is sensitive indicator of use
AST is double ALT
Alcohol w/dmild- anxiety, tremor, seizures, insomnia. Severe- delirium tremons
Alcohol w/d treatmentbenzodiazapines
Opioid (morphine, heroin, methadone) intox CNS depression, n/v, constipation, pinpoint pupils, seizures
Opioid (morphine, heroin, methadone) o/d treatmentNaloxone, Naltrexone
Opioid (morphine, heroin, methadone) w/dsweating, dilated pupils, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea
Barbiturates intoxrespiratory depression
Barbiturates w/ddelirium, cardio collapse
Benzodiazepine intoxataxia, minor resp depression
Benzodiazepine intox txFlumazenil
Amphetamines intoximpaired judgment, pupillary dilation, prolonged wakefulness and attention, delusions, hallucinations, fever
Amphetamines w/dstomach cramps, hunger, hypersomnolence
Cocaine intoximpaired judgment, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death
Cocaine intox txBenzodiazepines
Cocaine w/dsuicidality, hypersomnolence, malaise, severe craving
PCP intoxBelligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, homicidality, psyhosis, delirium
PCP w/ddepression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep
LSD intoxMarked anxiety/depression, delusions, visual hallucinations, flashblacks, pupillary dilation
Marijuana w/dirritiability, depression, insomnia, nausea, anorexia
Heorin detoxMethadone (long-acting oral opiate)
Heroin detoxSuboxone (naloxone + buprenorphine), long-acting
Naloxonenot active when taken orally, withdrawal only if injected
Delirium tremensLife-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink
autonomic system hyperactivity (tachy, tremors, anxiety, seizures)
psychotic sxs (hallucinations, delusions)
Tx: benzodiazepines