Abpsych

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Sanchejq
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152093
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Abpsych
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2012-05-04 06:44:36
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  1. Schizophrenia
    • type of psychosis characterized by
    • hallucinations
    • delusions
    • disturbances in thoughts/speech, emotion,behavior,socialization

    its hero (is diff in everyone)
  2. Delusions (positive symptom)
    • irrational beliefs.
    • Grandeur: famous or powerful
    • persecutions: out to get them
    • capgras: replaced by dbl
    • cotards: believes they are dead
  3. hallucinations (positive symptom)
    • sensory experience in the absence of external events.
    • most common sense use is auditory but all are effected.
    • brocas area affected in auditory hallucinations

    metcognition: examining your own thoughs, believe theyre coming from someone else
  4. positive symptoms of Z
    • Excessive/distortion of norm behavior.
    • Hallucinations and delusions.
    • exagerations
    • 50-70% experience
  5. reasons for positive symptoms
    • motivational: deal with/relieve anxiety/stress.
    • disctracts person from upsetting aspects of the world (hallucinations)

    deficit: brain dysfunction
  6. negative symptoms of Z
    • absent behavior
    • 25% experience
    • avolition (apathy): lack of initiation and persistance
    • alogia: relative absence of speech
    • anhedonia: lack of pleasure or indifference
    • affective flattening: little motion

    25% of z have flat affect
  7. Paranoid Type
    • –Delusions
    • and hallucinations

    •Grandeur or persecution

    • –Intact
    • cognitive skills

    • –Intact
    • affect

    • –Little
    • to no disorganized behavior

    • –Best
    • prognosis

    • –Stronger
    • familial link?
  8. disorganized type
    • –Marked
    • disruptions

    •Speech

    •Behavior

    • –Flat
    • or inappropriate affect

    • –Hallucinations
    • and delusions

    • •Fragmented-not organized around a
    • central theme

    • –Develops
    • early

    –Chronic


    • –Few
    • remissions
  9. catatonic type
    • –Unusual
    • motor responses

    • –Odd
    • mannerisms with bodies and faces

    • –Echolalia:
    • repeat or mimic words of others

    –Echopraxia: repeat or mimic movements of others

    •4 Possible subtypes

    • –Negative
    • withdrawal: immobility, posturing, mutism

    • –Automatic:
    • routine obedience, waxy flexibility

    • –Repetitive/echo:
    • grimacing, perseveration, echolalia

    • –Agitated/resistive:
    • excitement, impulsivity, combativeness
  10. undifferentiated type
    •Do not fit into other subtypes

    •Major symptoms

    • •Fail to meet criteria for paranoid,
    • disorganized or catatonic
  11. residual type
    • •One or
    • more past episodes

    •No major symptoms

    •Persistent, less extreme symptoms

    • –Negative
    • or bizarre beliefs

    • –Social
    • withdrawal

    –Inactivity

    • –Flat
    • affect
  12. ADHD what is it
    in DSM need to have at least 6 symptoms to be diagnosed

    –Inattentive

    • •Seem not to listen, careless
    • mistakes, don’t pay attention to details.
    • Aren’t “noticers”

    –Hyperactive

    • •Fidget, trouble staying still,
    • talkative, loud, on the go, restless

    –Impulsive

    • •Impatient, interrupt, can’t wait
    • turn, grab, cut in line

    •Impairments

    –Behavioral: difficult to parent

    –Cognitive: gaps in skills and knowledge

    –Social: unpopular, socially rejected

    –Academic: underachieve
  13. symptoms of ADHD
    • –Different
    • symptom manifestations?

    • •Boys are more likely to be
    • aggressive and hyperactive

    • •Girls are more likely to be
    • inattentive & internalize

    • •In
    • adolescence & adulthood Sx
    • manifest differently

    • –Impulsivity: greater risk for teen pregnancy
    • &STDs, car wrecks & tickets, trouble w/the law, drugs & alcohol

    • –Hyperactivity: feeling of restlessness, job changes,
    • many relationships
  14. ADHS facts
    • onset age 3 or 4
    • boys 3:1 ratio fot getting it


    • • ~50%
    • have problems as adults

    • –Inattention
    • persists

    • –Hyperactivity,
    • impulsivity decline or manifest differently

    • –more
    • likely to get arrested, divorced, fired

    • •High
    • comorbidity

    • –80%
    • of children have 1 or more other disorders

    • •Depression, anxiety, learning
    • differences, ODD

    • –90%
    • of adults

    • •Mood disorders, anxiety, substance
    • abuse
  15. cause of ADHD
    genetics: high fam component, low environment component.

    • 4 trans out of wack:
    • dopamine
    • norepinephrine
    • gaba
    • serotonin

    NEUROBILOGICAL: smaller brain volume. inactivity and abnormal develop in frontal cortex and basal ganglia

    TOXINS: allergens and food add. matermal smoking

    PSYCHOSOCIAL: negative feedback. peer rejection. social isolation. low self esteem
  16. treatment of ADHD: biological
    • •Goals: Reduce impulsivity and
    • hyperactivity. Improve attention

    • •Stimulants: Effective for 70%
    • Example: Ritalin, Adderall, Vyvanse,
    • Focalin, Metadate

    • •Other Medications: Strattera (SNRI) Non-stimulant
    • (less abuse potential)
    • Imipramine -antidepressant
    • Clonidine - antihypertension


    • •Effects
    • of Medications: Improve compliance. Decrease
    • negative behaviors. May
    • not affect learning and academic performance. Benefits
    • are not lasting following discontinuation

    • •Side
    • effects : headache,
    • insomnia, drowsiness, irritability, sweating, dry mouth, not themselves,
    • “cracked out”
  17. treatment of ADHD: behavioral and combined
    BEST combo is meds with behavioral Tx.

    • •Behavioral
    • Treatment

    • –Reinforcement
    • programs

    •Reward—appropriate behaviors

    •Punish—inappropriate behaviors

    • –Parent
    • training

    • –Social
    • skills training

    –Coaching
  18. Tx of schizophrenia
    Antipsychotic meds: to reduce positive symptoms. effective for about 60%. first line of treatment. side effects are common, acute, permanent. (this is why 74% stop taking meds within 18 months of discharge

    tardive dyskinesia: involun. movements of face etc (video). irreversible!

    Transcranial stimulation: wire coils charge brain. interrupts communication that brings about audity hallucinations. temporary

    Psychosocial (must be combo with meds): Behavioral (token economies in impatient units). Community care progs. social and living skills traning. behavioral fam therapy. vocational rehabilitation.
  19. stats about schizophrenia
    • chronic.
    • life expextancy is less than average: suicide and accidents
    • 1:1 f to m

    females: later age of onset. better outcomes

    • development: early childhood shows abnormalities.
    • prodromal phase: 85% experience it. occurs 1-2 years before serious symptoms. less severe yet unsual.
    • ideas of reference: related to them
    • magical thinking: special abilities
    • illusions

    POOR overal PROGNOSIS
  20. natural history of Z. (map on PP)
    • birth-10: premorbid
    • 10-20: prodromal: psychotic like
    • 20-30: onset/deteritoration: pos/neg symptoms, cog/mood symptoms.
    • 30a and on: chronic: pos/neg symptoms, cog symptoms
  21. prevalence of Z
    • occurs in all cultures.
    • higher prev in AA: misdiagnosis, bias and stereotyping,
  22. cause of Z
    • Genetic
    • influences: Inherited
    • vulnerability for schizophrenia. Polygenetic
    • influences. No 1 gene is responsible; thousands
    • of gene variances combine to produce vulnerabilty. Risk
    • increases with genetic relatedness. Parent’s
    • severity increases likelihood for children. Do
    • inherit: general predisposition. Do
    • not inherit: specific forms
  23. neurobio infuelnces of Z
    • Brain Structure: Enlarged ventricles. Reduced
    • tissue volume. Hypofrontality : less active FL. Dorsolateral prefrontal cortex

    • theories:Several
    • neurotransmitters. Striatial D2 receptors (excess). Prefrontal
    • D1 receptors (deficit). Glutamate


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