Term
| Kraeplin - early research |
|
Definition
dementia praecox vs. manic depession
deterioration vs. remission |
|
|
Term
|
Definition
"Schizophrenia"
split mindedness not split personality
4 A's - loose associations, affect, autism, ambivalence |
|
|
Term
| Schneider - early research |
|
Definition
hearing one's own thoughts, talking aloud, command hallucinations
somatic hallucinations
having one's thoughts controlled, spead other's thoughts
having one's actions controlled |
|
|
Term
| Schizophrenia epidemiology |
|
Definition
1/1000
age: 15-25
gender : equal
race : no difference
tends to run in families
10% succeed in suicide |
|
|
Term
|
Definition
excessive dopamine
disturbance of ego organization |
|
|
Term
| features of schizophrenia |
|
Definition
cerebral atrophy
abnormal EEG
immunological abnormalities |
|
|
Term
|
Definition
| guilt, passive, few friends, introverted, avoid sports |
|
|
Term
| Intermediate schizophrenia |
|
Definition
| somatic symptoms, poor occupational and social functioning |
|
|
Term
|
Definition
| anxious, abstract, peculiar, bizarre, hallucinations, rage |
|
|
Term
| Psychotic symptoms necessary for a Dx of schizophrenia |
|
Definition
hallucinations
delusions
incoherence
catatonia
flat effect |
|
|
Term
| Criteria for a Dx of schizophrenia |
|
Definition
Psychotic symptoms
Disturbance in work, self care and social relations
Six month duration |
|
|
Term
|
Definition
| Erotomanic, grandiose, jealous of one's sexual partner, persecutory, somatic |
|
|
Term
|
Definition
abnormalities in brain structure or neurochemistry
primary brain disease
secondary to other systemic disease such as infection, endocrine illness, toxic process |
|
|
Term
|
Definition
acute in onset
fluctuating cognitive loss
widespread CNS dysfunction
impaired ability to communicate
transient and reversible if cause of dysfunction is found |
|
|
Term
|
Definition
10% of hospital patients
30% of ICU patients
20% of burn patients
most commonly occurs in elderly, brain damaged and those with a Hx of delirium |
|
|
Term
| Intracranial causes of delirium |
|
Definition
epilepsy and post ictal states
brain trauma
infections - meningitis and encephalitis
hemorrhages |
|
|
Term
| Extracranial causes of delirium |
|
Definition
Drug ingestion or withdrawal
Endocrine dysfunction
Non-endocrine causes
Misc- vit deficiency, electrolytes |
|
|
Term
|
Definition
severe restlessness and anxiety
fluctuating confusion and fear
visual hallucinations and illusions
distracted and disoriented
worse in the evening - "sundowning"
febrile and flushed
cardiac irregularities
nausea and vomiting |
|
|
Term
|
Definition
loss of cognitive and intellectual abilities severe enough to impair social and occupational performance
impairment of memory, abstract thinking, judgment and personality change |
|
|
Term
|
Definition
5% significant dementia and unable to care for selves after age 65
10% mild dementia after 65
5X more in 80's than 70's
20 billion in cost
60% of nursing home residents |
|
|
Term
|
Definition
defects in orientation when severe
memory loss, especially short term
perceptual and reasoning problems
personality change
usually alert and attentive
aphasia
constructional problems |
|
|
Term
|
Definition
hypothyroidism
syphilis
subdural hematoma
normal pressure hydrocephalus
all must be detected and treated quickly |
|
|
Term
|
Definition
severe intellectual loss for which no cause has been found
progressive and deadly due to CNS decline
more common in women
40% positive family Hx
amyloid plaque and neurofibrillary tangles |
|
|
Term
|
Definition
fronto-temporal dementia
severe mood lability
can be static for long periods
sparing of parietal and occipital lobes |
|
|
Term
|
Definition
stair step deterioration
secondary to CV disease and HTN
males more common
treat HTN and anticoagulate |
|
|
Term
|
Definition
decrease in dopamine in substantia nigra
200/100,000
pill rolling tremor
cogwheel rigidity
memory loss
40% develop dementia
Lewy body |
|
|
Term
|
Definition
choreaform movements
6/100,000
brain atrophy and degeneration
psychosis
genetic Hx |
|
|
Term
|
Definition
Viral infection of the brain
progressive dementia
ataxia, stiffness and dysarthria |
|
|
Term
|
Definition
New Guinea
secondary to cannibalism
viral spread |
|
|
Term
| NPH (normal pressure hydrocephalus) |
|
Definition
Dementia, urinary incontinence, ataxia
Tx by shunting fluid |
|
|
Term
|
Definition
Multifocal lesions
viral infection and disturbance of the immune system
50/100,000
more in women and cold climates
age 20 to 40
psychiatric issues common |
|
|
Term
| Delerium and Dementia treatment options |
|
Definition
cholinesterase inhibitors
namenda
vitamin E
ginkgo biloba
NSAID |
|
|
Term
| Onset criteria for Dx of mental retardation |
|
Definition
| onset before the age of 18 |
|
|
Term
|
Definition
IQ of 50-55 to 70
used to be called "educable"
composed of 85% of this population
can acquire academic skills up to a 6th grade level |
|
|
Term
| moderate mental retardation |
|
Definition
IQ of 35-50 to 50-55
used to be called "trainable"
composed of 10% of this population
can acquire academic skills up to a 2nd grade level |
|
|
Term
| severe mental retardation |
|
Definition
IQ of 20-25 to 35-40
composed of 3-4% of this population |
|
|
Term
| profound mental retardation |
|
Definition
IQ below 25
composed of 1-2% of this population |
|
|
Term
| Unspecified mental retardation |
|
Definition
| untestable or too impaired to cooperate with testing |
|
|
Term
| most common disorders associated with mental retardation |
|
Definition
ADHD
mood disorders
pervasive developmental disorders
stereotypic movement disorders
mental disorders due to a general medical condition |
|
|
Term
| healthy personality trait |
|
Definition
|
|
Term
| healthy personality trait |
|
Definition
| varied repertoire of coping strategies |
|
|
Term
| healthy personality trait |
|
Definition
| response in a given situation is primarily driven by current (rather than past) conditions |
|
|
Term
| healthy personality trait |
|
Definition
| responds more to external reality than internal beliefs |
|
|
Term
| DSM-IV-TR definition of personality disorder (PD) |
|
Definition
| an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment |
|
|
Term
|
Definition
10-15% of the general population meet criteria
20-30% of pts in primary care
up to 50% of psychiatric outpatients |
|
|
Term
| general characteristics of all PDs |
|
Definition
| symptoms appear early in life |
|
|
Term
| general characteristics of all PDs |
|
Definition
| symptoms appear across a variety of different kinds of interpersonal interactions and are stable across time |
|
|
Term
| general characteristics of all PDs |
|
Definition
| symptoms feel normal to the pt and are what they expect, they are ego-syntonic |
|
|
Term
| general characteristics of all PDs |
|
Definition
| maladaptive interpersonal patterns increase under stress |
|
|
Term
| general characteristics of all PDs |
|
Definition
| individual's maladaptive patterns tend to elicit maladaptive interpersonal behavior from others |
|
|
Term
| general characteristics of all PDs |
|
Definition
| individual tends to blame others for the problems and often other ppl are more distressed by the pt's behavior than the pt themselves |
|
|
Term
| differential diagnosis of PDs |
|
Definition
| among individuals meeting full criteria for one PD, 60% will meet full criteria for at least one additional PD |
|
|
Term
| cluster A (odd, eccentric) |
|
Definition
paranoid PD
schizoid PD
schizotypal PD |
|
|
Term
| cluster B (dramatic, emotional) |
|
Definition
antisocial PD
borderline PD
histrionic PD
narcissistic PD |
|
|
Term
| cluster C (anxious, fearful) |
|
Definition
avoidant PD
dependent PD
obsessive-compulsive PD |
|
|
Term
|
Definition
| pattern of excessive distrust and suspicion of others |
|
|
Term
|
Definition
| sees others as having malevolent intent |
|
|
Term
|
Definition
| preoccupied with concerns and fears about others trustworthiness |
|
|
Term
|
Definition
| reluctant to confide in others |
|
|
Term
|
Definition
| reads hidden derogatory or threatening meanings into neutral comments or events |
|
|
Term
|
Definition
| unable to forget and forgive insults or slights |
|
|
Term
| how to handle paranoid PD |
|
Definition
| Be very open about what you are doing and why you are doing it. Avoid becoming defensive or dismissive. |
|
|
Term
| how to handle paranoid PD |
|
Definition
| Acknowledge patient’s feelings and concerns. May take a slightly more distant stance (overtures of friendliness will likely be met with suspicion). |
|
|
Term
|
Definition
| neither desires or enjoys close relationships |
|
|
Term
|
Definition
| little interest in sexual activities with another person |
|
|
Term
|
Definition
| appears to be insensitive to praise or criticism |
|
|
Term
|
Definition
| appears cold, detached or unemotional |
|
|
Term
| how to handle schizoid PD |
|
Definition
| Maintain a professional style and interest in their well-being. Respect patient’s privacy. Make sure to ask questions about all important areas, as they may not volunteer important information. They are unlikely to follow advice just to please you; be particularly careful to explain the reasoning for the advice. |
|
|
Term
|
Definition
| These are not people who are anxious about social situations; rather, they are uninterested. Negligible need for social contact or social support. |
|
|
Term
|
Definition
| discomfort with close relationships, lack of close friends or confidantes |
|
|
Term
|
Definition
| odd beliefs or magical thinking (not consistent with individual's culture) |
|
|
Term
|
Definition
| odd perceptual experiences |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| social anxiety that trends toward paranoid fears |
|
|
Term
| how to handle schizotypal PD |
|
Definition
| If possible, avoid confronting the odd beliefs or behaviors and simply accept their reality. If the beliefs or behaviors are causing the medical problem, confront gently. Screen for more florid forms of psychosis. |
|
|
Term
|
Definition
| Can be seen as a lifelong, subsyndromal variant of schizophrenia. Person does not have active hallucinations or delusions, but is persistently odd in how they see the world and relate to others. E.g. client who wears two hats, openly states that she has good style despite two separate outdated floral patterns on worn-out shirt and pants, believes that her thinking can influence the microclimate around her house, and primarily talks to her acquaintances about old episodes of The X-Files, about which she has encyclopedic knowledge (does not confide in them about any personal difficulties). |
|
|
Term
|
Definition
| persistent disregard for the rights of others |
|
|
Term
|
Definition
| repeatedly engaging in illegal actions |
|
|
Term
|
Definition
|
|
Term
|
Definition
| impulsivity and irresponsibility |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how to handle antisocial PD |
|
Definition
| They are unlikely to follow the rules of a clinician-patient relationship. Set and enforce clear boundaries. Be mindful of the possibility of drug-seeking or malingering |
|
|
Term
|
Definition
| Can be covered up by more florid illness or psychopathology. By definition starts before age 15 but cannot be diagnosed before age 18. Very difficult to treat, not least because the patient does not see himself (typically himself – 3 x’s as many men) as having a problem. Problematic behavior often decreases by the time patient is in his 30s. |
|
|
Term
|
Definition
| desperation to avoid abandonment |
|
|
Term
|
Definition
| intense, unstable, all good or all bad relationships |
|
|
Term
|
Definition
|
|
Term
|
Definition
| frequent suicidality or self-injury |
|
|
Term
|
Definition
|
|
Term
|
Definition
| intense, poorly controlled anger |
|
|
Term
|
Definition
| Relationship with the health care provider is also likely to be intense and either idealizing or devaluing. |
|
|
Term
| how to handle borderline PD |
|
Definition
| Avoid rescuing or abandoning. Instead, be predictable and stable. Establish realistic expectations. Set and enforce clear boundaries |
|
|
Term
|
Definition
| desire to be center of attention at all times |
|
|
Term
|
Definition
| often seductive or sexually provocative |
|
|
Term
|
Definition
| rapidly shifting emotions |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how to handle histrionic PD |
|
Definition
| Take the dramatic nature of their communication into account when assessing symptoms, but also avoid dismissing concerns due to patient “crying wolf.” |
|
|
Term
| how to handle histrionic PD |
|
Definition
| Maintain clear boundaries; neither excessively formal nor too casual. Be mindful and set appropriate limits if patient is sexually provocative. |
|
|
Term
|
Definition
| sees self as superior and expects others to do the same |
|
|
Term
|
Definition
| only wants to associate with high-status people or institutions |
|
|
Term
|
Definition
| strong sense of entitlement |
|
|
Term
|
Definition
| willing to use others to achieve own ends |
|
|
Term
|
Definition
|
|
Term
| how to handle narcissistic PD |
|
Definition
| Avoid confronting the entitlement directly. Instead, frame your suggestions with a statement about the patient deserving the best care possible. |
|
|
Term
|
Definition
| These individuals are very difficult for many clinicians to like. They can demean and condescend to clinicians, but can also be very flattering and deferential if they perceive the clinician to be high-status. |
|
|
Term
|
Definition
| very strong fears of criticism and rejection that lead to avoidance of activities involving interpersonal contact |
|
|
Term
|
Definition
| need to be sure they will be liked before entering into a relationship |
|
|
Term
|
Definition
| ongoing fear of shame or ridicule within intimate relationships |
|
|
Term
|
Definition
| sees self as inadequate, inept and inferior |
|
|
Term
|
Definition
| very reluctant to take risks or try new things |
|
|
Term
| how to handle avoidant PD |
|
Definition
| Patient will be very fearful of you disliking him/her. Be calm, transparent, and reassuring. Reassure that care-seeking was appropriate. A matter-of-fact, relaxed style is helpful |
|
|
Term
|
Definition
| These folks are very, very afraid of other people – not that others will hurt them, but that others won’t like them or will think they are stupid. They will be scared in your office, and likely terrified if they end up in the ER. |
|
|
Term
|
Definition
| requires excessive advice and reassurance to make decisions |
|
|
Term
|
Definition
| needs others to assume responsibility for significant life tasks and functions |
|
|
Term
|
Definition
| feels uncomfortable or helpless when alone due to fears of being unable to care for self |
|
|
Term
|
Definition
| intensely fearful of being left alone to care for self |
|
|
Term
| how to handle dependent PD |
|
Definition
| Avoid making decisions for the patient, even when that is what s/he wants. Instead, offer options and support the patient in making a decision. This will be a slow process. Schedule regular visits, reward independence. |
|
|
Term
| obsessive-compulsive PD trait |
|
Definition
| preoccupied with details and order more than the main point of the task |
|
|
Term
| obsessive-compulsive PD trait |
|
Definition
| perfectionistic to a level that impairs functioning |
|
|
Term
| obsessive-compulsive PD trait |
|
Definition
| overconscientious and rigid around moral and ethical questions |
|
|
Term
| obsessive-compulsive PD trait |
|
Definition
| unable to discard worthless objects |
|
|
Term
| obsessive-compulsive PD trait |
|
Definition
| sees money as something to hoard for possible future calamities |
|
|
Term
| obsessive-compulsive PD patient |
|
Definition
| Often have lengthy lists at appointments or need to share minute detail. They may become quite upset about scheduling or billing errors, and expect perfect outcomes. |
|
|
Term
| how to handle obsessive-compulsive PD |
|
Definition
| May assume a consultant role to give patient maximum amount of control. Set a routine, outline options for the patient. Be prepared for many questions, and schedule extra time if necessary. |
|
|
Term
| 3 C's needed for a situation of abuse |
|
Definition
Child
Caretaker
Circumstance |
|
|
Term
|
Definition
| sexual abuse, with the victim under the age of 12, must be reported to DHS even if there is no caretaker |
|
|
Term
| In a case of child sexual abuse, DHS must notify law enforcement within what timeframe? |
|
Definition
|
|
Term
|
Definition
| observable substantial impairment in the ability to function within normal range of performance and behavior based on age |
|
|
Term
| indicators of illegal drugs in a child's body |
|
Definition
low birth weight
failure to thrive
rib malformation, eye problems, cleft palate
skin problems
dental problems
decreased physical growth
delayed motor development |
|
|
Term
| major precursor to child abuse and neglect fatalities |
|
Definition
|
|
Term
|
Definition
in the course of employment examines, attends, counsels or treats a child
reasonably believes a child has suffered abuse |
|
|
Term
|
Definition
any person who believes a child has suffered abuse
a mandatory reporter who is off duty |
|
|
Term
|
Definition
dependent adult
caretaker
allegation of abuse |
|
|
Term
|
Definition
| lower education, black, large metro area, west (highest rates) |
|
|
Term
|
Definition
| higher education, white, large metro area, northeast (highest rates) |
|
|
Term
|
Definition
| Repeated and increased use of a substance leading to physical and mental deterioration. Cessation of the substance leads to unpleasant symptoms and urges to resume use. |
|
|
Term
|
Definition
| After repeated use, a given dose produces a decreased effect and larger doses are needed to produce the original effect. |
|
|
Term
|
Definition
| When one drug is substituted for another and creates similar physiological and psychological effects. |
|
|
Term
|
Definition
| Someone close to the substance abuser facilitates addictive behavior by supporting substance use either directly or indirectly. |
|
|
Term
|
Definition
Maladaptive pattern of substance use.
Clinically significant impairment/distress.
Over a 12 month period, one or more of following:
Fail to fulfill major role obligations.
Hazardous behavior.
Legal problems.
Continues despite social/interpersonal problems |
|
|
Term
|
Definition
Maladaptive pattern of substance use.
Clinically significant impairment/distress.
Over a 12 month period, three or more of following:
Tolerance
Withdrawal
Using more than intended.
Efforts/desire to control, but cannot.
Excessive time spent on obtaining substance.
Important activities given up because of substance.
Substance use continues despite knowledge of complications. |
|
|
Term
|
Definition
A reversible syndrome caused by ingestion or exposure to a substance.
Clinically significant maladaptive behavioral or psychological changes.
Develops during or shortly after use of the substance.
Cannot be attributed to any other medical or mental disorder. |
|
|
Term
|
Definition
A syndrome caused by cessation of (or reduction in) substance use that has been heavy or prolonged.
There is clinically significant distress or impairment of function.
Cannot be attributed to any other medical or mental disorder. |
|
|
Term
| The reward circuit pathway |
|
Definition
| Many substances (or activities) stimulate dopaminergic neurons that that project from the ventral tegmental area to the limbic system and the cerebral cortex |
|
|
Term
| Comorbidities with alcohol use |
|
Definition
depressive disorders - suicide
anxiety disorders - self medication
antisocial PD |
|
|
Term
| physical changes from alcohol intoxication |
|
Definition
| NYSTAGMUS, slurred speech, incoordination, unsteady gait, stupor or coma. |
|
|
Term
|
Definition
Cut down on drinking
Annoyed by criticism of drinking
Guilty about drinking
Eye opener
(more than one yes response makes alcoholism likely) |
|
|
Term
| physical findings in alcoholism |
|
Definition
palmer erythema
telangiectasias
enlarged fatty liver
asterixis |
|
|
Term
| Alcohol: long term physical complications |
|
Definition
GI bleeding (esophageal varices)
Malnutrution (vitamin defficient)
Pancreatitis (insufficiency)
Liver disease
Cardiomyopathy
Anemia
Aspiration pneumonia
Peripheral neuropathy
Head/neck/GI/lung cancers
Sleep disturbances
Subdural hematoma |
|
|
Term
| Alcohol: neuropsychiatric complications |
|
Definition
Alcohol-Induced Psychotic Disorder
Hallucinations during intoxication or withdrawal
Blackouts
Coma
Wernicke’s Encephalopathy
Alcohol-induced persisting amnestic disorder
AKA Korsakoff’s Syndrome
Alcohol-Induced Persisting Dementia
Fetal alcohol syndrome
Leading cause of intellectual disability in US.
1/3 of women with alcohol abuse disorders have a child with defects. |
|
|
Term
| Leading cause of intellectual disability in the U.S. |
|
Definition
|
|
Term
|
Definition
usually start within 72 hours, but occur up to one week from alcohol cessation
typically in 30's or 40's after 5 to 15 years of heavy drinking
20% mortality rate untreated
usually preceded by seizure |
|
|
Term
| Wernicke's Encephalopathy |
|
Definition
Triad: Gait, Ocular, Mental Status.
THIAMINE deficit (due to diet, malabsorption, reduced storage).
Reversible with early treatment.
Can lead to hemorrhage and death.
Most patients get a “banana bag” immediately in ED as preventive measure. |
|
|
Term
|
Definition
Use short acting benzodiazepines
Chlordiazepoxide
Lorazepam
Others
Also carbamazepine |
|
|
Term
|
Definition
Blocks aldehyde dehydrogenase causing acetaldehyde to accumulate
Drinking results in severe discomfort |
|
|
Term
|
Definition
Opioid anatagonist
Reduces relapse rate in those who get concurrent psychosocial treatment. |
|
|
Term
|
Definition
GABA/glutamate Mediated mechanism.
Reduces relapse rate in those who get concurrent psychosocial treatment.
No effect on liver. |
|
|
Term
| Neuropharmacology of Nicotine |
|
Definition
Highly toxic alkaloid.
Agonist of nicotinic acetylcholine receptors.
Rapid onset of action.
Dopaminergic reward circuit involved.
Other stimulatory neurotransmitters affected as well. |
|
|
Term
| meds used for smoking cessation |
|
Definition
| Bupropion and Varenicline |
|
|
Term
|
Definition
The most widely used psychoactive substance in the world.
Contained in many foods, drinks, medications.
Is a methylxanthine
Associated with:
Tobacco use
Alcohol use
Psychiatric patients |
|
|
Term
|
Definition
| after 250 mg or more of caffeine |
|
|
Term
|
Definition
Headache
Fatigue/drowsiness
Anxiety/depression
Nausea/vomiting
Also: Irritability, muscle cramps, craving, psychomotor impairment.
Avoid abrupt cessation; should taper over 1-2 weeks. |
|
|
Term
| Anabolic steroid withdrawal |
|
Definition
Mostly psychological changes: Depression, suicidal ideation, anxious, bodily concerns.
May need antidepressants, therapy or psychiatric hospitalization. |
|
|
Term
|
Definition
8.9% of Americans have used in the last month (increasing steadily).
Nearly 50% of US adults have used at least once over lifespan.
Most common “gateway” drug.
In teens, parental disapproval correlates inversely with rates of use.
Potency has increased in recent years.
More likely male, younger, white. |
|
|
Term
|
Definition
| physical changes within 2 hours: increased appetite, CONJUNCTIVAL INJECTION, dry mouth, tachycardia |
|
|
Term
|
Definition
| from chronic marijuana use |
|
|
Term
| Neuropharmacology of ampthetamines |
|
Definition
Ingested, injected, snorted, smoked.
Rapid onset.
Release dopamine (and other catecholemines) from presynaptic terminal.
Powerful effect on reward circuit pathway. |
|
|
Term
|
Definition
| physical changes: pupillary DILATION, tachycardia, HTN, N + V |
|
|
Term
|
Definition
| starts within hours or days of cessation: peaks at 2-4 days and resolves by 1 week |
|
|
Term
|
Definition
Not uncommon in rural areas.
Smoked, snorted, injected.
Synthetic drug sometimes manufactured locally.
Structural and functional brain damage occurs with chronic use. |
|
|
Term
|
Definition
Methamphetamine derivative.
Synthesized and patented in 1914; used by psychiatrists.
“Designer drug” surfaced in 1980s; assigned to DEA Schedule 1.
Effects last 4-8 hours and are similar to both amphetamines (dopamine) and LSD (serotonin): Elevated mood, increased sensory sensitivity, enhanced socialization, sympathomimetic response.
Direct permanent neurotoxicity unlikely, but metabolites known to be toxic. |
|
|
Term
|
Definition
Plant derivative first developed as a local anesthetic in the late 1800s.
Promoted as a cure for many ills and was active ingredient in Coca Cola until 1902.
“Studied” by Freud.
By 1914, adverse effects realized.
Users more likely:
Younger
Male
Black/Hispanic |
|
|
Term
| Neuropharmacology of cocaine |
|
Definition
Dopamine reuptake inhibition.
Snorted, smoked or injected.
Rapid onset and short duration (30-60 min).
“Crack” especially potent and addictive |
|
|
Term
|
Definition
Signs/symptoms similar to amphetamines.
Perforated nasal septum, seizures, cardiac events, and strokes all possible.
Death in some cases
“Speedball” |
|
|
Term
|
Definition
Essentially the same as amphetamines.
Known as the “crash”.
Craving can be intense.
May try to self-medicate with other substances. |
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Term
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Definition
Used for over 3500 years, mostly in the form of crude opium derived from plants.
Over 20 chemically distinct drugs, but all are Mu-opioid recepter agonists (reward circuit).
Demographics diverse, but most who are dependent are in their 30s or 40s, but started using substances early.
Many have comorbid psychiatric disorders.
Abuse of prescription opioids is problematic.
Ingested, smoked, snorted, or injected. |
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Term
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Definition
| physical changes: pupillary CONSTRICTION, drowsiness or coma, slurred speech, impaired attention/memory |
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Term
|
Definition
Usually accidental.
Medical emergency.
Can be reversed by naloxone (Narcan).
Often involves use of other CNS depressants as well. |
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Term
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Definition
Pupillary DILATION
Dysphoric mood
Nausea/vomiting
Muscle aches
Lacrimation/rhinorrhea
Piloerection or sweating
Diarrhea
Yawning
Fever
Insomnia |
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Term
|
Definition
| may alleviate some symptoms of opioid withdrawal |
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Term
|
Definition
treatment of opioid dependence
no needles used
able to function better than on heroin |
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Term
|
Definition
treatment of opioid dependence
requires special training
may be combined with naloxone to prevent IV misuse |
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Term
|
Definition
AKA, tranquilizers or anxiolytics.
Primarily benzodiazepines and barbiturates.
GABA mediated mechanism.
Some used for amnestic properties as “date rape” drugs (e.g., flunitrazepam or Rohypnol).
Alcohol interactions and cross-tolerance.
Abusers more likely female, white, thirties. |
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Term
| Sedative hypnotics intoxication |
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Definition
| signs/symptoms the same as alcohol |
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Term
| overdose of sedative hypnotics |
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Definition
Barbiturates tend to cause worse respiratory depression than benzodiazepines.
More lethal if taken in combination with alcohol.
Benzodiazepine effects reversed by flumazenil |
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Term
| Sedative hypnotics withdrawal |
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Definition
Signs/symptoms same as alcohol.
Severity depends on dose and duration of use.
Usually begins within 3 days after cessation, but can be longer.
Need to taper or use medications to detoxify.
Seizures and DEATH possible. |
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Term
the "3 B's"
three substances that can cause seizures and death if stopped abruptly and not managed |
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Definition
Benzodiazepines
Barbituates
Booze |
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Term
|
Definition
Used for thousands of years, sometimes in social/religious rituals.
Some are plant derivatives (mushrooms and peyote), some are synthetics (LSD).
Users more likely male, white, young.
Overall, less morbidity and mortality than other substances.
Hallucinogen persisting perception disorder (flashbacks) in 15-80% of users. |
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Term
|
Definition
Serotonin mediated effect.
Ingested, snorted, smoked or injected.
Tolerance can develop (and diminish) quickly.
No withdrawal. |
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Term
| active ingredient in Peyote |
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Definition
|
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Term
| active ingredient in mushrooms |
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Definition
|
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Term
| Hallucinogen intoxication |
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Definition
| Physical changes: pupillary DILATION, sweating, tachycardia, palpitations, blurring of vision, tremors, incoordination |
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Term
| Phencyclidine Hydrochloride (PCP) |
|
Definition
AKA "angel dust"
Dissociative anesthetic closely related to ketamine.
NMDA mediated mechanism of action.
Easily synthesized.
More likely urban, male, white.
Usually smoked with rapid onset of action.
Withdrawal and physical dependence rare. |
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Term
|
Definition
can be unpredictable
physical changes: NYSTAGMUS |
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Term
|
Definition
Intoxication symptoms may recur as substance is reabsorbed in GI tract.
Sudden, severe, random violence is possible.
Should be monitored closely in controlled environment. |
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Term
|
Definition
“Huffing” of volatile hydrocarbons
Readily available, legal, cheap.
6% of all people in US have used at least once.
More likely young, white, suburban.
Look for residue on face/hands/clothes, unusual breath, irritation of airways. |
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Term
| Neuropharmacology of inhalants |
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Definition
Rapid onset; length of effect depend on substance inhaled.
Most are CNS depressants.
Other CNS depressants have additive effects.
The neurotoxic effects of the substance, along with hypoxia, can cause permanent cognitive impairment. |
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Term
|
Definition
Belligerence and assaultiveness
physical changes: NYSTAGMUS |
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Term
| Occular changes with intoxication |
|
Definition
amphetamines - dilated pupils
cocaine - dilated pupils
hallucinogens - dilated pupils
opioids - constricted pupils
alcohol - nystagmus
inhalants - nystagmus
PCP - nystagmus |
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Term
| management of agitation during acute intoxication |
|
Definition
IM antipsychotics (haloperidol, ziprasidone, etc).
Can add benzodiazepines.
Consider an anticholinergic as prophylaxis for EPS. |
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
| Sudden death - unexpected cause |
|
Definition
| approximately 10% of all death |
|
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Term
| Protracted life threatening illness |
|
Definition
>90% of deaths
predictable steady decline with a relatively short “terminal” phase - cancer
slow decline punctuated by periodic crises - CHF, emphysema, Alzheimer’s type dementia |
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Term
| Psychological stages of dying |
|
Definition
Shock and denial
Anger
Bargaining
Depression
Acceptance |
|
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Term
|
Definition
Self governance
Liberty rights
Privacy
Individual choice
Being one’s own person |
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Term
| most common place of death |
|
Definition
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