Term
| Somatoform disorders (two definitions) |
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Definition
Definition 1: When one or more somatic symptoms causes distress and results in significant disruption in one's daily life leading to excessive thoughts, feelings, and behaviors related to these concerns and this state of being symptomatic is persistent.
Definition 2: When the severity of one or more sign and/ or symptom (typically limited to those that suggest a neurologic condition) cannot be explained using appropriate investigations, nor can they be attributed to the patient's use of substances or participation in culturally sanctioned behaviors (trances, hypnosis, or ceremonial traditions). |
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Term
| Patients typically do not respond to medical reassurance. Patient continues to seek another opinion, demanding re-testing, and requesting medicines that are unwarranted. |
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Definition
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Term
| Features of somatoform disorders |
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Definition
- Many doctors have been consulted
- Many diagnostic tests already done
- Many treatments tried and failed
- "I am here because I heard you will really listen to me and other doctors just think it is in my head"
- Iatrogenic symptom presentation
- Extensive use of medical system
- Poly pharmacy
- Multiple physician visits without a notation of a consistent primary care provider |
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Term
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Definition
Characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and dispropriationate thoughts, feelings, and behaviors regarding those symptoms.
- Sx present for 6+ months. |
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Term
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Definition
Preoccupation with severe, prolonged discomfort without adequate medical explanation. A co-existing medical condition does not completely explain the cause of the pain.
- Main complain in 1+ anatomical sites.
- Pain causes significant distress in the patient's life.
- Pain related to psychological factors. |
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Term
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Definition
Prolonged, exaggerated preoccupation with health and fear of having a serious illness.
- They misinterpret non-pathological bodily symptoms.
- Fears persist despite appropriate medical evaluation.
- Fears present for 6+ months. |
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Term
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Definition
Loss or impairment of function suggestive of a physical disorder that is instead an expression of a psychological conflict or need.
- At least one neurological symptom.
- Psychological factors associated with onset and severity of symptoms.
- Causes significant distress or dysfunction in daily life.
- La belle indifference - causal disregard toward alarming severe symptom is not the same as anosognosia. |
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Term
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Definition
- Intentional production or feigning of signs or symptoms
- The motivation for the behavior is to assume the sick role (primary gain)
- No external incentives for the behavior present
- Either predominantly psychiatric or predominantly physical complaints |
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Term
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Definition
- Intentional production or feigning of signs or symptoms to achieve personal gain
- Multiple vague complaints that do not conform to a known medical condition yet they get better when their objective is obtained
- Patients pretend they are ill with an obvious external incentive |
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Term
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Definition
- Non anatomical
- Regional pain
- Overreaction to pain
- Distraction testing cannot reproduce response
- Voluntary weakness |
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Term
| Factors highly correlated with the somatic patient |
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Definition
- Development of secondary gain by being "sick"
- Poor self image secondary to abuse history
- Impaired social skills or low emotional IQ
- Impaired occupational skills
- Ongoing unresolved disability claims |
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Term
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Definition
The emotional processing part of the brain. Comprised of the
- Basal ganglia
- Deep temporal lobe (amygdala)
- Medial frontal lobe (nucleus accumbens)
- Subgenual cingulate (Brodmann's area 25)
- Lateral prefrontal cortex
- Various connecting tracts |
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Term
| Serotonin transporter protein |
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Definition
| Encoded by the SLC6A4 gene on chromosome 17. Variations in the length of the promotoer region of the gene (5-HTTLPR) have been associated with various psychiatric disorders. The serotonin transporter protein recycles serotonin for re-use in pre-synaptic neurons. Studies into this area have shown mixed results. |
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Term
| What is the posed endocrine basis for depression? |
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Definition
Increased levels of cortisol are associated with decreased hippocampal volume. Decreased hippocampal volume is seen in depression. Increased cortisol is seen in depression.
-Estrogen is increased in females at puberty, and appears to sensitize neurotransmitter systems. Women have roughly double the risk of depression. Post-partum depression affects 10% of mothers. |
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Term
| What is the effect of Ketamine on depression? |
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Definition
| Blocks NMDA receptors and rapidly and dramatically improves depression in otherwise resistant patients. NMDA receptors are responsible for neuronal learning (long term potentiation). |
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Term
| What is the posed inflammatory basis for depression? |
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Definition
| Inflammatory cytokines (IL-1 and TNF) are increased in patients with depression. They decrease the availability of serotonin, and stimulate NMDA pathways. |
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Term
| Criteria for a major depressive episode |
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Definition
Five or more of the following:
- Depressed mood
- Loss of interest or pleasure (Anhedonia)
- Insomnia or hypersomnia
- Psychomotor agitation or slowing
- Fatigue/ loss of energy
- Feelings of worthlessness or guilt
- Difficulty concentrating
- Recurrent thoughts of death/ suicidal ideation or plan
- Symptoms present for at least 2 weeks |
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Term
| Dysthymic Disorder (Persistent depressive disorder) |
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Definition
- Depressed mood on more days than not for the past two years.
- At least 2 symptoms from the depressive symptom cluster |
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Term
| Seasonal Affective Disorder |
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Definition
| Clear association of symptoms with a time of year (usually winter). September through April is common. |
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Term
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Definition
| Occurring within 4 weeks of delivery. |
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Term
| Pre-mentrual Depressive Disorder |
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Definition
- Worsening of symptoms several days before menses
- Mood lability, irritability, anger feeling "keyed up," depressive symptoms
- Significantly interferes with work, school, social activities, or relationships |
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Term
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Definition
| Anhedonia, weight loss, sleep disturbance, psychomotor slowing, guilt. |
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Term
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Definition
| Mood reactivity (better during parts of the day), leaden paralysis, rejection sensitivity |
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Term
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Definition
| Meets criteria for a major depressive episode, but with evidence of nihilistic or bizarre thoughts (I'm already dead; my organs have shriveled) |
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Term
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Definition
| Often are associated with major depressive episodes, but feature at least one manic or hypomanic episode |
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Term
| Schizoaffective Disorders |
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Definition
| Associated with depressive or manic symptoms, but psychotic symptoms persist even when mood symptoms are clear. |
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Term
| Conditions commonly associated with depression |
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Definition
- Stroke
- Huntington Disease
- Alzheimer Disease
- Parkinson Disease
- Traumatic Brain Injury
- Neurosyphilis
- Cushing Disease
- Hypothyroidism |
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Term
| Epidemiology of Depression |
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Definition
- 1 Year: 3-10% risk
- Lifetime risk: 8-18% risk
- Twice as common in adult females
- Lower incidence in married couples
- More prevalent in socioeconomic classes |
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Term
| Inheritance risk of Depression |
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Definition
-Risk of major depressive episode is 2-4x higher if a first degree relative has depression.
- Prevalence is 25-30% in those with a depressed family member
- Twin concordance = 37% |
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Term
| Serotonin Reuptake Inhibitors/ Serotonin and Norepinephrine Reuptake Inhibitors (SSRI/ SNRI) |
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Definition
- Generally first line therapy
- Fewer side effects than tricyclic medications
- Side effects: Sexual, nausea, somnolence, weight gain, potential drug interactions |
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Term
| Tricyclic antidepressants |
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Definition
- Original medication treatment
- Still highly effective for melancholic symptoms
- High side effect burden due to antihistaminergic, anticholinergic, and adrenergic interactions.
- Overdose is more lethal than SSRI/ SNRI |
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Term
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Definition
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Term
| Monoamine Oxidase Inhibitors (MAOI's) |
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Definition
- Tranylcypromine
- Phenylzine
Mechanism of Action:
- Irreversibly inhibit monoamine oxidase, thereby slowing NE metabolism.
Usage:
- Effective for atypical depression
Side effects:
- Slowed NE metabolism requires effort to moderate NE production: Limit dietary tyramine
- Higher risk of serotonin syndrome when used with other serotonergic drugs or Meperidine. |
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Term
| Electro-convulsive Therapy |
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Definition
- Reserved for treatment-resistant depression
- Effective for melancholic/ psychotic depression
- Never used for coercion or punishment
- Adverse effects: Memory, headache, anesthesia
- Therapy is typically 8-12 "acute" sessions (3x per week) then possibly maintenance to avoid relapse.
- Short-term remission rate is 60%, often see relapse unless medication therapy continued. |
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Term
| Transcranial Magnetic Stimulation (rTMS) |
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Definition
- Pulsing magnetic coil induces pulses of electrical current in the brain beneath the coil
- Does not require anesthesia
- 20-30 sessions, 5x per week, 30 minutes per session
- Relatively high personnel and equipment costs
- Efficacy not clear; likely less than ECT
- Adverse effects include scalp sensitivity, headache |
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Term
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Definition
- Surgically implanted electrodes (subgenual cingulate)
- Remarkable remission in approximately 50%
- Remains experimental; needs a large, double-blind study |
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Term
| Cognitive/ Behavioral Therapy |
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Definition
- Identify and modify problem behavior
- Look for options instead of uniform negativity
- Highlight positives
- Examine expectations in relationships
- Identify distortions in thinking
- Limited number of sessions
- Repetitive exercises to "retrain" brain pathways |
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Term
| Interpersonal Psychotherapy |
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Definition
- Based on the relationships between individual and social circumstances
- 4 common areas of exploration:
1. Bereavement
2. Role transitions (losses)
3. Role disputes (relationship difficulties)
4. Interpersonal deficits (social isolation) |
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Term
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Definition
| Intense desire to re-experience the effects of a psychoactive substance even after long periods of abstinence |
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Term
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Definition
| Primary, chronic disease of brain rewards, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychosocial, social, and spiritual manifestations. This is reflected in an individuals pathologically pursuing reward and/ or relief by substance use and other behaviors. |
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Term
| Endogenous reward system of the brain |
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Definition
| Mesolimbic dopamine system |
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Term
| Components of the mesolimbic dopamine system |
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Definition
- Ventral tegmental area (where DA nerve cel bodies reside)
- Nucleus accumbens
- Prefrontal cortex (where dopamine nerve terminals terminate) |
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Term
| One partial cause of drug addiction |
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Definition
| Powerful and long-lasting memories of the drug experience that "hijack" synaptic plasticity mechanisms in the mesolimbic dopamine system. |
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Term
| What two areas of the mesolimbic system does the VTA directly project to? |
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Definition
- Prefrontal cortex (executive decisions)
- Nucleus accumbens (pleasure, reward) |
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Term
| Is the amygdala part of the mesolimbic system? |
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Definition
| No. However, it is connected with the prefrontal cortex. The amygdala participates in stress and anxiety responses. |
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Term
| What is the mechanism of action of Methylphenidate? |
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Definition
| Similar to cocaine in its enhancement of neurotransmission in the mesolimbic dopamine pathway by blocking the dopamine transporter. |
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Term
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Definition
| GABA interneurons. Function by disinhibition. AKA, they inhibit the tonic inhibition of the dopamine neurons, allowing them to release dopamine in the reward patwhay. |
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Term
| Target for cocaine, amphetamine, and methamphetamine |
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Definition
| Target the DA transporter in the presynaptic nerve terminals within the prefrontal cortex and the nucleus accumbens, thereby allowing DA to remain within the synaptic cleft for a prolonged period producing persistent activation of the mesolimbic dopamine reward system. |
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Term
| What happens when the D1 receptor is activated? |
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Definition
| The D1 receptors is a transmembrane receptor that when activated stimulates adenylyl cyclase. Activated adenylyl cyclase creates an increase in cyclic AMP. cAMP activates protein kinase A (PKA), which moves from the cytoplasm to the nucleus. PKA in the nucleus activates CREB, which along with CREB binding protein stimulates novel protein synthesis. Immediate early genes (c-Fos, Acute Fose proteins) are particularly activated by this pathway. Long term expression stimulates delta-FosB, which is implicated in long term changes/ addiction. |
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Term
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Definition
| A gene transcription factor that stimulates the production of brain derived neurotrophic factor (BDNF), which stimulates dendrite proliferation, creating a long lasting change in neuronal structure and function. |
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Term
| What is the difference between c-Fos and the acute FOS proteins compared to delta-FosB? |
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Definition
| c-Fos and the acute FOS proteins have short half lives. They stimulate production of delta-FosB, which is a very stable transcription factor that accumulates with c-Fos and acute FOS activation. Delta-FosB stimulates BDNF, which creates long lasting changes in neuronal structure and function which are implicated in addiction. |
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Term
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Definition
| Repeaded drug exposure causes drug tolerance. Cells, tissues, and the individual become less sensitive to drug effects after repeated exposure. |
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Term
| Short term drug tolerance |
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Definition
| Drug occupation of the receptor causes desensitization due to receptor internalization to the endosome. This is a short term loss of drug sensitivity (minutes to hours). |
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Term
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Definition
| Continuous drug exposure causes receptor down regulation due to degradation in the lysosome. This is a long term response lasting days, weeks, or months. Requires synthesis of new receptors. |
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Term
| Drug dependence is associated with: |
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Definition
- Drug withdrawal
- Disturbance of homeostasis
- Symptoms opposite in polarity to the effects of the drug |
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Term
| What percentage of the risk of addition may be contributed to genetics? |
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Definition
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Term
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Definition
| Personality traits: antisocial behavior, risk taking, thrill seeking, impulsivity, and inability to learn from mistakes. All are associated with increased risk for drug addiction. |
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Term
| Functional motility disorder |
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Definition
| Multiple physiological determinants contributing to a set of symptoms rather than a single disease entity. A group of functional bowel disorders in which abdominal discomfort or pain is associated with a change in bowel habit, and with features of disordered defecation or gastric function. |
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Term
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Definition
A functional motility disorder with the following characteristics:
- At least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has 2 of 3 features:
- Relieved with defecation
- Onset associated with a change in frequency of stool
- Onset associated with a change in form (appearance) of stool
Other symptoms associated with diagnosis (though not required):
- Abnormal stool frequency (3+ BM/ day or < 3 BM/ day)
- Abnormal stool form (lumpy/ hard or loose/ watery)
- Abnormal stool passage
- Passage of mucus
- Bloating or feeling of abdominal distention
*Always presumes absence of a structural or biochemical explanation. |
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Term
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Definition
| Works as an antagonist specific for 5-HT3 receptors, which are found on neurons controlling gastrointestinal motility, and also in the amygdala and PFC of patients with IBS. Functionally, the drug reduces diarrhea in female IBS patients, and reduces activation of the amygdala and PFC in these patients. |
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Term
| Simply speaking, the amygdala is the |
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Definition
| Stress/ anxiety area of the brain |
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Term
| Psychosocial factors that influence IBS |
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Definition
- History of emotional, sexual, or physical abuse
- Stressful life events
- Chronic anxiety
- Maladaptive coping style |
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Term
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Definition
| Tricyclic antidepressants in low doses in conjunction with psychological therapies. |
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Term
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Definition
| Growing ability to filter and suppress irrelevant information and actions in favor of more relevant ones. |
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Term
| Core deficits in ADHD include |
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Definition
| Deficits in executive function; control of inhibitory responses; working memory; goald directed behavior; and emotional self control. |
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Term
| Last area of the brain to develop |
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Definition
| Temporal lobe (speech, language, reading, verbalization) |
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Term
| Human cortical development takes at least this long to complete (if not longer) |
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Definition
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Term
| First line therapies for ADHD are: |
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Definition
| Stimulant medications (Methylphenidate, Dextroamphetamine, and Atomoxetine) |
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Term
| Atomoxetine is used to treat ______; It works by this mechanism: |
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Definition
| Attention deficit hyperactivity disorder;it is primarily a Norepinephrine re-uptake inhibitor. |
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Term
| Methylphenidate and Dextroamphetamine are used to treat _______; They work by this mechanism: |
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Definition
| Attention deficit hyperactivity disorder; Both stimulate the release and inhibit the reuptake of dopamine and norepinephrine, thereby enhancing the activity of these neurotransmitter systems. |
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Term
| Nigrostriatal neurons originate in the: |
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Definition
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Term
| Nigrostriatal neurons densely innervate the |
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Definition
| Caudate nucleus and putamen |
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Term
| The Norepinephrine system in the brain has projections from the _______ to the _______ |
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Definition
| Locus coeruleus (pons); to the spinal cord, cerebellum, midbrain, hypothalamus, thalamus, the entire cerebral cortex, and the hippocampus. |
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Term
| The Norepinephrine system is involved in: |
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Definition
- Vigilance
- Attention, arousal, and sleep-wake cycle
- Learning and memory
- Anxiety
- Pain regulation |
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Term
| What is the heritability of ADHD? |
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Definition
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Term
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Definition
| A syndrome (mixture of symptoms) that may include: delusions, hallucinations, disordered speech and behavior, and distortions of reality. |
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Term
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Definition
| Disturbance of though; persistent beliefs that are illogical and probably wrong |
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Term
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Definition
| Sensory perceptions that do not result from an external stimulus |
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Term
| Psychosis is associated with: |
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Definition
- Drug abuse (cocaine, amphetamines, phencyclidine)
- Schizophrenia
- Other psychotic disorders (severe depression with psychotic features, dementias, manic phase of bipolar disorder) |
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Term
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Definition
| A group of chronic, devastating, disabling disorders that disrupt the capacity to think clearly and to feel normal emotions. |
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Term
| Symptoms of schizophrenia typically appear during what age ranges for males and females? |
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Definition
Males: Late teens - Mid 20s.
Females: Early 20s - 30 |
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Term
| Positive symptoms in schizophrenia are _______ by antipsychotic drugs |
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Definition
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Term
| Negative symptoms in schizophrenia are _________ by antipsychotic drugs |
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Definition
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Term
| Positive symptoms is schizophrenia tend to be _______ and include: |
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Definition
Acute
1. Auditory Hallucinations
2. Delusions (erroneous beliefs)
3. Disorganized speech and behavior
4. Agitation |
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Term
| Negative symptoms in schizophrenia tend to be _______ and include: |
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Definition
Chronic
1. Blunted affect
2. Emotional and social withdrawal (apathy)
3. Poverty of speech (alogia)
4. Lack of spontaneity and pleasure |
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Term
| Cognitive deficits which may appear years before symptoms of psychosis and diagnosis of schizophrenia include: |
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Definition
- Inability to plan and organize
- Slow verbal learning and memory
- Poor attention and working memory
- Loss of executive functions (reason and problem solving
- Reduced speed of processing of thoughts |
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Term
| What is the posed mechanism by which "positive" symptoms in schizophrenia develop? |
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Definition
| There is a "functional" increase in the 'tone' of the mesolimbic system affecting cortical dopaminergic neuronal transmission. |
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