Card Set Information
What is the prevalence of alcohol abuse?
What is the prevalence of alcohol dependence?
What is the lifetime prevalence of illicit substance abuse?
20% of people
What is the lifetime prevalence of illicit substance use of one or more times?
40% of people
What is the prevalence of people who haves used an illicit substance in the past year?
What is the # of Americans who require treatment for alcohol abuse?
What is the # of Americans >12yo who require treatment for drug abuse?
5.5 million (27%)
What percent of hospital admissions have drug/ETOH as a factor?
What percent of deaths have drug/ETOH as a factor?
What percent of MVA's, murders, and DV cases have ETOH as a factor?
What is the definition of intoxication?
a specific syndrome ofmaladaptive behavioral or psychologicalchanges due to the recent ingestion of orexposure to a substance that acts of the CNS
Substances inducing intoxication identified in the DMS IV?
: steroids, nitrous oxide
What factors play a role in the clinical picture of intoxication?
individual degree of tolerance
time since last dose
person's expectations as to the effect
What is the definition of neroadaptation?
underlying CNS changes that occur following repeated use of a drug such that a person develops tolerance and/or withdrawal
What is the definition of tolerance?
need to use greatly increased amount in order to achieve desired effect
markedly diminished effect being associated with continued use of the same amount
What is withdrawal?
maladaptive behavioral change with physiological and cognitive effect that occurs when concentration of a substance declines in the body
What is the definition of substance abuse?
= maladaptive pattern of use leading to clinically significant impairment or distress
manifests as at least 1 of the following:
failure to fulfill role obligations/poor work performance
use in hazardous situations
substance related legal problems
persistent or recurrent social/interpersonal problems
(also have never met criteria for dependence)
What is substance dependence?
= maladaptive pattern of use leading to clinically significant impairment or distress manifests as at least 3 of the following within 12mo:
need for more to achieve same effect
decreased effect with same amount
characteristic withdrawal syndrome
using substance to avoid withdrawal symptoms
substance taken in larger amt or for longer time than intended
persistent unsuccessful attempts to cut down or control use
great deal of time spent obtaining using, or recovering from use
important social, occupational, recreational activities given up or reduced
use is continued despite persistent/recurrent physical or psychological problems
Define early, sustained, partial, and full remission.
: no criteria met for >1mo and <12mo
: occasional criteria met
: no criteria met
(i.e. early full, early partial, etc)
What factors contribute to the learning and phsyiologic basis for dependence?
hippocampal and limbic memory circuit
acute increases of levels of neurotransmitters in the brain:
increased dopamine in limbic area
ventral tegmental dopamine neurons synapsing on the nucleus accumbens
some drugs increase serotonin and/or NE
brain cells downregulate receptors and/or decrease production of neurotransmitters that are in excess of normal levels
What factors predict treatment outcome?
frequency, intensity, and duration of treatment
What percent of people are eventually able to abstain/not meet criteria after treatment for drug dependence?
What percent of people with substance related disorders have a mental disorder?
What type of patient would be best suited for substance dependence treatment with hospitalization?
risk of severe withdrawal
severe/multiple medical comorbidities
requires restricted access to drugs
with psychiatric illness and suicidal ideation
What type of patient would be best suited for substance dependence treatment with residential treatment facility?
do not require intensive medical/psychiatric monitoring
require a restricted environment
step down unit
What type of patient would be best suited for substance dependence treatment in an outpatient program?
no risk of med/psycho comorbidity
highly motivated patient
What methods are useful for substance dependence treatment in ambulatory setting and relapse prevention?
modify persistent/habitual behaviors
relapse prevention model
motivation enhancement therapy
: focus on benefits of stopping vs benefits of ongoing use
What is a common clinical presentation of alcohol intoxication?
legal definition = BAL 0.08-0.10 g/dL
anterograde memory loss (blackouts)
What is clinical picture of delirium tremens?
: within 72hrs of last drink
alternating level of consciousness
What is the treatment for alcohol withdrawal based on CIWA score?
What factors are on the CIWA scale? Scores?
(vital signs checked but not part of score)
score 0-9 = absent/minimal WD
score 10-19 = mild/moderate WD
score >20 = severe WD
At what CIWA scores do you start medication?
: start PRN benzos
: start PRN + scheduled benzos
: consider ICU transfer
: score >10 start meds, recheck 1hr)
What medications are used to treat ETOH dependence? Mechanism of action?
Antabuse (disulfiram) = inhibits aldehyde dehydrogenase and dopamine beta hydroxylase
naltrexone = opioid antagonist of Mu receptors
Campral (acamprosate) = unknown MOA, thought to stabilize neuron excitation/inhibition, interact with GABA and Glu receptor?
What monitoring is required when using antabuse (disulfiram)?
Hep C serology (initial)
psych effects (psychosis, depression confusion, anxiety)
What monitoring is required when using naltrexone?
Alcohol vs benzo intoxication?
similar but less cognitive/motor impairment with benzos
What drug properties make it more likely to promote addiction?
more lipophilic --> faster onset
What side effects are common with TCA's?
antihistaminic (sedation and weight gain),
anticholinergic (dry mouth, dry eyes, constipation, memory deficits and potentially delirium),
antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)
Describe serotonin syndrome
abdominal pain, diarrhea, sweats,
tachycardia, HTN, myoclonus, irritability,
delirium. Can lead to hyperpyrexia,
cardiovascular shock and death.
What are the most common side effects of SSRI's?
sexual dysfunction (30%+!), anxiety,
restlessness, nervousness, insomnia, fatigue or
Very little risk of cardiotoxicity in overdose
Can develop a discontinuation syndrome with
agitation, nausea, disequilibrium and dysphoria
You warn a patient about discontinuation syndrome with SSRI's, what do you tell them?
Can develop a discontinuation syndrome with
agitation, nausea, disequilibrium and dysphoria
What are the IM antipsychotics?
What are the tertiary TCA's?
= tertiary amine group
block primarily serotonin receptors
What are the secondary TCA's?
= metabolites of tertiary amines
Which SSRI's are non-sedating? Other non-sedating antidepressants?
Which antidepressants are sedating?
Mirtazapine (esp. low dose)
(also associated with wt gain)
Which psych meds are useful in treating neuropathic pain?
What are the indications for starting mood stabilizers?
intermittent explosive disorders
What is the only medication shown to reduce suicide rate?
What is the rate of completed suicide in BAD?
What is lithium effective for?
long-term prophylaxis of mania and depressive episodes (>70% of BAD I pts)
reducing suicide rate
What factors predict a positive response to lithium?
Prior long-term response or family member with good
Classic pure mania
Mania is followed by depression
What tests do you want before starting lithium?
pregnancy test (1st trimester only)
What birth defect is associated with lithium?
only with use during 1st trimester
What should be monitored when taking lithium?
: steady state >5d, check levels 12hrs after last dose
: check levels q3mo, check TSH and creatinine q6mo
(goal blood level = 0.6-1.2)
What is the goal blood level of lithium?
What are common lithium side effects?
Most common are GI distress including reduced
appetite, nausea/vomiting, diarrhea
Polyuria/polydypsia secondary to ADH
antagonism. In a small number of patients can
cause interstitial renal fibrosis.
Hair loss, acne
Reduces seizure threshold, cognitive slowing,
What does lithium toxicity look like at different levels?
Mild- levels 1.5-2.0 see vomiting, diarrhea,
ataxia, dizziness, slurred speech,
Moderate-2.0-2.5 nausea, vomiting,
anorexia, blurred vision, clonic limb
movements, convulsions, delirium,
Severe- >2.5 generalized convulsions,
oliguria and renal failure
What factors predict a positive response with valproic acid?
rapid cycling patients (females>males)
comorbid substance issues
Patients with comorbid anxiety disorders
What tests do you want to get before starting valproic acid?
How do you monitor valproic acid?
: steady state 4-5d, check 12hrs after last dose, repeat CBC and LFT's
(goal blood level = 50-125)
What is the goal blood level of valproic acid?
What are valproic acid side effects?
Thrombocytopenia and platelet
Nausea, vomiting, weight gain
Increased risk of neural tube defect 1-2%
vs 0.14-0.2% in general population
secondary to reduction in folic acid
What mood stabilizers are indicated for rapid cyclers and mixed pts?
valproic acid (Depakote)
What are 1st line mania meds?
What tests do you want to get before starting carbamazepine?
How do you monitor carbamazepine?
start/change med: steady state >5d, check 12hrs after last dose, repeat CBC and LFT's
(goal blood level = 4-12 mcg/mL)
What is the goal blood level of carbamazepine?
What drug induces its own metabolism?
What are the side effects of carbamazepine?
Rash- most common SE seen
Nausea, vomiting, diarrhea, transaminitis
Sedation, dizziness, ataxia, confusion
AV conduction delays
Aplastic anemia and agranulocytosis (<0.002%)
Water retention due to vasopressin-like effect
which can result in hyponatremia
What drugs increase carbamazepine levels?
(antihistamine, antiarrhythmic, antifungals, anti-TB meds, etc.)
acetazolamide, cimetidine (both can cause rapid toxic reactions),
clozapine (may act synergistically to suppress BM), diltiazem, INH,
fluvoxamine, occasionally fluoxetine, erythromycin, clarithromycin,
fluconazole, itraconazole, ketoconazole, metronidazole,
propoxyphene, verapamil, diltiazem.
what drugs decrease carbamazepine levels?
What specific indication does lamotrigine have?
What tests do you want to get before starting lamotrigine? How do you monitor?
: start with 25mg daily, increase q2wks
must retitrate if med stopped >4d
What are the side effects of lamotrigine?
Sedation, dizziness, ataxia and confusion
The most severe are toxic epidermal necrolysis and
Stevens Johnson's Syndrome. The character/severity of
the rash is not a good predictor of severity of reaction.
Therefore, if ANY rash develops, discontinue use
Blood dyscrasias have been seen in rare cases.
What drugs increase lamotrigine levels?
valproic acid (2x amt!)
What is a "rapid cycler"?
4 or more depressive or manic episodes/year
What are the indications for antipsychotics?
bipolar disorder (mood stabilization and/or when psychotic features are present)
augmenting agent in treatment-resistant anxiety disorders
What are the key pathways affected by dopamine in the brain?
mesocortical (ventral tegmentum/cortex)
mesolimbic (ventral tegmentum/limbic)
negrostriatal (substantia nigra/basal ganglia)
tuberoinfundibular (hypothal/ant pit)
What does dopamine suppress?
What are Parkinsonian movements and what causes them?
caused by dopamine hypoactivity:
What are the low potency/low affinity typical antipsychotics?
Which antipsychotics are considered wt neutral?
Which antipsychotics can lead to transaminitis?
What antipsychotic carries risk of QT prolongation?
What are some wt neutral psych meds?
What is the risk of agranulocytosis with clozapine?
What monitoring is used for clozapine use?
weekly blood draws for 6mo
then blood draws q2wks for 6mo
What is the annual risk of tardive dyskinesia with antipsychotic use?
5% per yr
What agents are useful to treat EPS?
anticholinergics (benzotropine, trihexyphenidyl, diphendydramine)
dopamine facilitators (amantadine)
What clinical risk is akathisia associated with?
What are the indications for anxiolytic prescription?
generalized Anxiety disorder
substance-related disorders and
insomnias and parasomnias.
(often use anxiolytics in combination with SSRIS or SNRIs for treatment)
What is the appropriate benzo taper schedule?
decrease no more than 5mg Diazepam dose equivalents q1-2wks
What % of people smoke cigarettes?
25% current smokers
25% former smokers
What % of deaths are related to tobacco smoking?
most important preventable cause of disease/death in USA
45% of smokers die of tobacco induced disorders
What % of schizophrenic pts smoke cigarettes?
How should you approach a psychotic pt?
Acknowledge you believe they are experiencing what
they are reporting
Try not to collude with the pt
Try to establish rapport before confronting psychotic
Don’t be overly friendly or it can feed into the paranoia
What is required to "rule in" the diagnosis of depressed mood disorder with psychotic features?
Pt needs to currently meet criteria for a major
depressive episode and not have other reasons for
psychosis for example
What general medical conditions lead to psychotic disorders?
What is the lifetime prevalence of delusional disorder?
What are the subtypes of delusional disorder?
See erotomanic delusions more often in
See persecutory delusions more often in
How long must a person stop using a substance to determine if mood symptoms were SIMD?
What is the lifetime prevalence of schizoaffective disorder?
What is the annual risk of TD?
3-5% per year for typical antipsychotics
highest in older women with affective disorders
risk of dystonic reaction highest in young males
Who is at greatest risk for dystonic reaction while using antipsychotics?
What are other psychiatric disorders that can mimic psychotic illness?
Delirium‐ pts often have paranoia, visual
Paranoid personality disorder and schizotypal
personality disorder can dance very near the edge of
Obsessive compulsive disorder‐ at times obsessions
can be difficult to discern from psychosis
What are examples of mood congruent symptoms of psychosis?
delusions or hallucinations consistent
with themes of a depressed mood such as:
For manic mood themes:
special relationship to a deity
What are examples of mood incongruent symptoms of psychosis?
delusions of control
What are the mood disorders with psychotic features?
MDD with psychotic features
Bipolar disorder, manic or mixed
How often do psychotic features occur in MDD pts?
18.5% of MDD pts have psychotic features
What are the remission rates for psychotic and nonpsychotic depressed pts?
: 95% remission
: 83% remission
In what % of bipolar pts who are manic or having a mixed episode experience psychotic features?
~25% of bipolar I pts
What is the definition of schizophrenia?
Two or more of the following present for a
significant portion of the time during a 1 month
Hallucinations* (See link on website for examples)
grossly disorganized or catatonic behavior*
negative symptoms (affect flattening, alogia, avolition,
Only one criteria needed if delusions bizarre or
hallucinations consist of a voice keeping a running
commentary or two voices talking to each other
Must cause significant social/occupational dysfunction
Continuous signs of disturbance for 6 months
What are the schizophrenia subtypes?
: preoccupation with one or more delusions or frequent auditory hallucinations
: disorganized speech, behavior and flat or inappropriate affect are all present
: motoric immobility or excessive activity, extreme negativism, peculiar movements, echolalia or echopraxia
What is the lifetime prevalence of schizophrenia?
What is the typical age of onset of schizophrenia?
(only 10% of cases have onset >45yo)
What do twin studies show about schizophrenia?
about 50% heritability
(40-50% twin concordance)
What is the pathophysiologic theory behind schizophrenia?
Possibly due to aberrant neuro‐developmental processes such as increase in normal age‐associated pruning frontoparietal synapses that occur in adolescence and young adulthood
Excessive activity in mesocortical and mesolimbic dopamine pathways
What percent of schizophrenics have met criteria for some form of drug/ETOH abuse/addiction?
What are the odds that a schizophrenic pt has an alcohol or drug use disorder?
4-6x greater odds vs rest of pop
>3x greater odds ETOH abuse vs pop
>6x greater odds drug abuse vs pop
What % of schizophrenic patients return to pre-illness level of social and vocational functioning?
What percent of schizophrenic pts die by suicide?
What is the general clinical picture of the schizophrenic population?
1/3 have severe symptoms & social/vocational impairment
and repeated hospitalizations
1/3 have moderate symptoms & social/vocational
impairment and occasional hospitalizations
1/3 have no further hospitalizations but typically have
residual symptoms, chronic interpersonal difficulties and
most cannot maintain employment
What are the symptoms of a manic episode?
D = Distractibility and easy frustration
I = Irresponsibility and erratic uninhibited behavior
G = Grandiosity
F = Flight of ideas
A = Activity increased with weight loss and increased libido
S = Sleep is decreased
T = Talkativeness
What is the prevalence of OCPD?
What is the prevalence of avoidant PD?
What is the prevalence of paranoid PD?
What is the prevalence of histrionic PD?
What is the prevalence of antisocial PD?
What is the prevalence of borderline PD?
What is the prevalence of schizoid PD?
What is the prevalence of dependent PD?
What is the prevalence of schizoid PD?
What is the prevalence of schizotypical PD?
What is the prevalence of narcissistic PD?
What are the mature defense mechanisms?
: deal with stress or conflict through dedication to meeting other’s needs
: anticipate possible adverse events and prepare for them
: deal with stress by seeing irony
: channel potentially maladaptive impulses into socially acceptable behavior
: avoid thinking about stressor
: turn to others for support
What are neurotic defense mechanisms?
: transfer negative feelings about one object to another
: blame problems on another
: rely excessively on details to maintain distance from painful emotions
: expel disturbing thoughts from consciousness
: do opposite of what you feel
What are primitive defense mechanisms?
: refuse to acknowledge aspect of reality
: excessive day-dreaming
: indirectly express aggressive feelings towards others
: engage in inappropriate behavior without consideration of consequences
: compartmentalize opposite affective states
: falsely attribute unacceptable feelings to another
: falsely attribute to a second individual who in turn projects back to patient
What is the prevalence of personality disorders in the adult US pop?
What is the heritability of personality disorders?
overall ~50% (same as "normal" personality traits)
Personality disorder Mean
What PD has the highest heritability?
borderline personality disorder
What is the criteria of schizoid PD?
• Pervasive pattern of detachment from
social relationships and restricted
expression of emotion with
or more the
• Neither desires nor enjoys close
• Almost always chooses solitary
• Little if any interest in sexual
experiences with another person
• Takes pleasure in few in any activities
What is the criteria of schizotypal personality disorder?
• A pervasive pattern of social and
interpersonal deficits with reduced
capacity for close relationships as well as
cognitive or perceptual distortions and
eccentricities of behavior with
or more of
• Ideas of reference
• Odd beliefs or magical thinking
• Unusual perceptual experiences
including bodily illusions
• Odd thinking and speech
• Suspiciousness or paranoid
• Inappropriate or constricted affect
• Behavior or appearance that is odd
• Lack of close friends other than
• Excessive social anxiety that does
not diminish with familiarity
What is the criteria of antisocial personality disorder?
• A pervasive pattern of disregard
for and violation of the rights of
since the age
of 15 years
indicated by 3
more of the following:
• Failure to conform to social norms
with respect to lawful behaviors
• Deceitfulness and conning others
for personal profit or pleasure
• Impulsivity or failure to plan ahead
• Irritability or aggressiveness as
indicated by repeated fights or
• Reckless disregard for safety of
self or others
• Consistent irresponsibility
• Lack of remorse
• There is evidence of Conduct
Disorder with onset before age 15
What neuroimaging supports a theory of defective emotional learning being the basis of antisocial personality disorder?
decreased amygdala and orbitofrontal cortex responses to emotionally provocative stimuli
What is the definition of borderline PD?
• Pervasive pattern on instability of
interpersonal relationships, self image and
affects and marked impulsivity as
or more of the following:
• Frantic efforts to avoid abandonment
• Unstable and intense interpersonal
relationships characterized by
alternating between extremes of
idealization and devaluation
• Identity disturbance
• Impulsivity in at least two areas that are
• Recurrent suicidal behaviors, gestures
or threats or self-mutilating behaviors
• Affective instability due to a marked
reactivity of mood
• Chronic feelings of emptiness
• Inappropriate anger
• Transient, stress-related paranoia
What is the definition of histrionic PD?
• Pervasive pattern of excessive
emotionality and attention seeking
indicated by >5 of the following:
• Uncomfortable in situations in which he
is not the center of attention
• Interaction with others often
characterized by inappropriate sexually
• Displays rapidly shifting and shallow
expression of emotion
• Consistently uses physical appearance
to draw attention to self
• Has a style of speech that is excessively
impressionistic and lacking in detail
• Shows self-dramatization and
• Is suggestible
• Considers relationships to be more
intimate than they are
What is the definition of narcissistic PD?
• A pervasive pattern of grandiosity (in
fantasy or behavior), need for
admiration, lack of empathy as
indicated by >5 of the following:
• Grandiose sense of self-importance
• preoccupied with fantasies of unlimited
success, power, brilliance or beauty
• Believes he is special and can only be
understood or should associate with
other special or high status people
• Requires excessive admiration
• Has a sense of entitlement
• Is interpersonally exploitive
• Lacks empathy
• Is often envious of others and
believes others are envious of him
• Shows arrogant, haughty
behaviors or attitudes
What is the definition of avoidant personality disorder?
• A pervasive pattern of social
inhibition, feelings of inadequacy
and hypersensitivity to negative
evaluation as indicated by
• Avoids social occupations that involve
significant interpersonal contact
• Is unwilling to get involved with people
unless certain of being liked
• Is preoccupied with being criticized in
• Shows restraint in intimate relationships
because of fear of being shamed or
• Inhibited in new interpersonal situations
because of feeling inadequate
• Views self as socially inept and
• Is unusually reluctant to take personal
risks or engage in any new activities
because they may prove embarrassing
What is the definition of dependent PD?
• A pervasive and excessive need to be
taken care of that leads to submissive and
clinging behaviors and fears of separation
as indicated by >5 of the following:
• Has difficulty making everyday decisions
without an excessive amount of
• Needs others to assume responsibility
for most major areas of his life
• Has difficulty expressing disagreement with
others because of fear of loss of approval
• Difficulty initiating projects on his own because
of lack of self confidence
• Goes to excessive lengths to obtain nurturance
and support from others
• Feels uncomfortable or helpless when alone
• Urgently seeks another relationship as a source
of care and support when a relationship ends
• Is unrealistically preoccupied with fears of being
left to take care of himself
What is the definition of obsessive-compulsive PD?
• A pervasive pattern of preoccupation
with orderliness, perfectionism and
mental and interpersonal control at
the expense of flexibility, openness
as indicated by >4 of the following:
• Preoccupied with details, rules, lists,
order or schedules to the extent that the
major point of the activity is lost
• Shows rigidity and stubbornness
• Perfectionism that interferes with task
• Excessively devoted to work and productivity to
the exclusion of leisure activity and friends
• Over conscientious and inflexible about matters
of morals or ethics
• Is unable to discard worn or worthless objects
even those without sentimental value
• Reluctant to delegate tasks
• Adopts miserly spending style toward self and
What are considered "ego-syntonic" personality disorders?
e.g. antisocial PD
--> harder to treat b/c ego-syntonic
What symptoms improve specifically when serotonin levels increase?
sense of well being
What therapies are effective for treating borderline PD's?
What are common comorbid disorders of people with antisocial PD?
What are common comorbid disorders of people with borderline PD?
alcohol and drug dependence
anxiety disorders, PTSD
What affect does comorbid personality disorder have?
negative prognostic significance for Axis I disorders (e.g. mood and anxiety disorders)
What are common reasons different ages of pts seek therapy?
: behavioral, school, family issues
: as above and issues of separation and peer relationships
: all of above plus career issues
: all of above plus issues of changing relationships, family alignments, health, work and social status
: all of above plus end of life issues
quality of therapist/client relationship effects
outcome more than specific therapy
What brain-imaging changes are seen with mindfulness based stress reduction programs for 8wks?
changes in grey matter concentration in brain regions involved in learning and memory processes, emotional regulation
What brain changes are associated with PTSD and MDD?
decreased density or volume of hippocampus
What is resistance?
ideas unacceptable to conscious; prevents therapy from proceeding
What is free association?
patient says what comes to mind uncensored.
Clues to unconscious
What brain changes were seen with 6wks of interpersonal therapy?
increased blood flow to R basal ganglia and posterior cingulate activity
CBT is as effective as medication therapy for which conditions?
less severe depression
What mental status exam questions test attention?
months of year backward
countdown from 20
What are the most sensitive tests for delirium?
serial 7's (attention)
What level of risk does substance dependence/abuse plan in violent crime?
30x increase risk of violence
Antisocial personality disorder with co morbid
substance abuse or dependence carries greater than
100X the risk compared to the general population.
What level of risk does schizophrenia play in violent crime?
Mental illness carries a 9X greater risk than the general
population particularly paranoid schizophrenia and
confused states related to medical problems.
% of children with clinically significant psych disorders
What drugs are FDA approved for pediatric OCD?
Lifetime risk of depression?
Point prevalence of depression?
Comorbidity with depression?
25% of pts with major medical comorbidity will develop MDD (highest with stroke and MI)
often comorbid with anxiety disorder
Depression age of onset?
What % of MDD become BPAD?
% of MDD who commit suicide?
(higher rate with dysthymic disorder)
What is rapid cycling? % of BPAD?
rapid cycling = >4 mood episodes (any type) <12mo
10-20% of BPAD
70-90% = women
Lifetime risk of BPAD?
: 1% (men = women)
: 0.5% (women > men)
Age of onset of BPAD?
What antidepressants have highest switch rate to mani?
% of BPAD who commit suicide?
Lifetime risk of dysthymic disorder?
Point prevalence of dysthymic disorder?
male = female
often comorbid personality disorders
Prevalence of cyclothymic disorder?
Criteria for atypical depression:
wt gain, increased appetite
long-standing interpersonal rejection sensitivity
What meds does atypical depression respond to?
What mood disorders have highest rates of comorbid susbtance use?
BPAD I > BPAD II > MDD
Age of onset of anxiety disorders? M v F?
teens, early 20's
female > male (2:1)
Neuroanatomy involved in anxiety?
: emotionally salient stimuli
medial prefrontal cortex
: modulation of affect
Tx for PTSD?
Neuroanatomy of PTSD?
hypoactivation of medial prefrontal cortex including orbitofrontal cortex and anterior cingulate cortex (affect regulation)
(tx with paroxetine increases anterior cingulate cortex function)