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PC705 Pathophysiology #10
Psychotic & Non-psychotic Mental Disorders
Terms in this set (22)
Women and mental illness
Increased prevalence of depression & anxiety due to biologic & vulnerability reasons
Life stresses and life demands contribute. History of abuse or violence contribute. Hormonal differences contribute. Gender differences in Hypothalmic-Pituitary-Arendal Axis.
Schizophrenia can have late onset (>in women)
Increased rate of major depressions & dereased dysthymias
Rarely is bipolar late onset, but earlier experience symptoms will persist into old age.
Higher likelihood to experience side effects of medications - Tardive Dyskinesias
Antidepressant doses must be lower due to kidney and renal function.
Must also be titrated with increased doses slowly
Thoughts, behaviors, and feelings disordered & disconnected from reality = psychosis.
Altered perceptions of reality
Affects 4 in 1,000 people in U.S.
1st Diagnosed between 15-54 years old.
Women show s/s on average between 25-35 years old
Men show s/s on average between 15-25 years old.
Multifactorial - genetics, epigenetics, environmental
1) Dopamine affects - decreased neurological activity
3) Gestational - Pyramidal cells are not aligned, 2nd trimester flu infection, obstetric complications, birth in urban area, birth during a famine, advanced paternal age
4) Neurological factors - Neuro developmental alteration in limbic system and prefrontal regions, abnormal blink & pupil reflexes.
+ Signs = Reality Distortion, Delusions, Hallucinations, Loose associations, changes in speech patterns, grossly disorganized behavior (catatonic)
- Signs = Deficit, loss or decrease normal functions, Restricted affect, Avolition, Antisocial behavior, Poverty of speech, Autism, Dull emotional affect.
Diagnosis: 2 or more of following -
Delusions, Hallucinations, Disorganized Speech (must have one of these)
Grossly abnormal psychomotor behavior
Disruption in work, interpersonal relations or self care.
Major Depressive Disorder (MDD)
Definition: Dysthymia (1-2 symptoms lasting 2 years or more)
Persistent impaired function that lasts at least 2 weeks.
Etiology: Women>Men, genetic susceptibility, affects all ages, races & genders. Negative bias on life.
Neurobilogical: Neurotransmission alteration & hypocampal & prefrontal lobe deregulation. Hypothalamus-Pituitary-Adrenal Axis Dysfunction. Decreased amount & activity of Seratonin
Criteria: 5 or more in these in a 2 week period of the following -
Hallmark signs: Depressed mood, lack of interest and pleasure.
Sleep disturbances (too much or too little)
In children criteria = irritable mood and depression
Recurring cyclic depression & elation
Severe enough to produce psychosis at times
High suicide rate
In children = irritability, cyclic mood changes, and associated ADHD
Etiology: Risk inherited and acquired.
60-85% heritable (10x risk if 1st degree relative has it)
Advanced paternal age
Associated with alcohol and drug use.
In depressive state = decreased neurotrasmission
In mania state = excess neurotrasmission
(Seratonin, Norepinephrine, Dopamine)
Can have mixed mood states = Mood destabilization
Impaired emotional processing = from probably neuologic mechanisms.
BP1 - An episode of mania with major depression present but not required for diagnosis
BP2 - Past or present episode of hypomania and major depression
(Hallucinations & Delusions often seen with severe prolonged mania states)
Mania = expansive, irritable, elevated mood, grandiosity, decreased need for sleep, talkativeness, flight of ideas, "thought are racing", distractibility, increased goal activities at social/work/school/sexual settings, psychomotor agitations.
Difference is in severity and duration
Hypomania = 4 days, less severe
Mania = 7 days
Irrational, debilitating fears.
Heritability and biochemical causes.
Deficient seratonin pathways
Physical manifestations resemble illnesses like hyperthyroidism and medication effects, which must be ruled out before diagnosis.
Panic, General and PTSD affect women > men
Acute episodes of recurrent, unexpected, insense fear.
2-3 x more common in women
May be anticipatory waiting for the next panic attack.
Avoidance is usual coping mechanism
Physical - Dyspnea, palpitations, tachycardia, chest pain, N/V, hyperventilation, choking.
Cognitive/Psych - fear of dying, impending doom, loss of control, depersonalization
Behavior - Hyperkenisias, pressured speech, increased startle response,
Can last 5-10 minutes, up to an hour.
Genetic, psychological, biological alterations.
Synaptic placticity - changes lead to learned anxiety
Learned anxiety cause of increased stress in early childhood.
Usual onset is late adolescence or early adulthood.
Worry that is chronic and persistent with physical signs and symptoms.
Physical: lightheadedness, diaphoresis, palpitations, stomach upset, head ache, restlessness, fatigue, muscle tension/pain, disturbed sleep.
Cognitive: impaired concentration, irritability
Psych: Worry with no area of life unaffected.
Women > Men
Increased risk with family history (30%)
Hyperactive brain circuit - alterations in Seratonin & Norepinephrin
Obsessive Compulsive Disorder (OCD)
Compulsive spectrum disorders
Persistent involuntary thoughts that provoke anxiety & involuntary rituals
Over 50% of people affected have chronic progressive form.
2.2% risk in general population
Increases to 9.2% with 1st degree relative affected.
Strong persisent intrusive thoughts & compulsions related to obsessions.
Dirt, germ, contamination form
Obsessional form (no compulsions)
"Washers" make of 25-50% of people with disorder.
Uncertainty is hallmark sign related to discrepancies between external information & personal beliefs.
Increased glucose metabolism of frontal lobe
Found in children
Related to function of neurological system and brain
Language & speech
Result in permanent disability.
Attention Deficit Hyperactivity Disorder (ADHD)
Most common psychiatric diagnosis in children.
Related to poor concentration and focus & over-activity affecting social interactions and academic performance.
Boys affected 2 x more then girls
Increase incidence of learning disabilities in this group.
Affects 3-7% of school age kids.
Poor at organizing tasks
Acting without thinking
Observed behavior inappropriate to age and developmental stage that is present in various situations.
No single gene mutation
Abnormal gene coding in the CNS Dopamine function (suspected)
Environmental contamination - smoking during pregnancy, ETOH or drug use, low birth weight.
Social and communication deficite
66-75% have intellectual impairment
Males > Female by 4 to 1
Pervasive Developmental Disorders : Aspergers, Rhett Syndrome
Clinical manifestations: develop slowly
30% Show up between 18 - 24 months
Deficient social communication
1. Needs some support
2. Needs substantial support
3. Needs very substantial support
No known cause for 80% of cases.
Chromosomal abnormalities accounts for 5% of cases
Multigene and environmental triggers account for the rest
C or S-like lateral curvature
Women > Men
Structural - happens when pt bends to affected side.
Nonstructural - vertebral rotation and curvature that does not correct itself with bending
Asymmetry of shoulder, hips & chest wall
Possible Resp distress depending on severity
Metabolic bone disease related to bone density
Greatest complication risk is fractures
Pathophysciology: The rate of bone resorption is greater than bone produection. Loss of bone mass & width.
Etiology: Decrease in estrogen, poss calcium intake, disuse (non-weight bearing)
Risk factors: Diet high in phosphorus, caffeine, alcohol, nicotine and some prescribed drugs
Clinical manifestations: Decreased height, muscle wasting, kyphosis, fractures, pain, bone deformity
Diagnosed with Gradations of Bone Mineral Density by Radiographic Absorptiometry. T score =/< -0.25 = osteoporosis.
Degenerative Joint Disorder, most common form of arthritis, most debilitating musculoskeletal disorder in U.S.
Men > Women
Women more severe than men.
> 40 years old at diagnosis
After age 55 women > men
Obesity is risk factor
Pathophysiology: Loss of articular cartilage which calcifies and wears away. Bone spurs also occur. Mostly on weight bearing joints
Clinical manifestations: Local joint pain, AM stiffness, crepitus, asymmetrical, pain, effusion in synovial membrane, decreased ROM,
Hand involvement: Heberden nodules (distal fingers), Bouchard nodules (proximal)
Knee involvement: Genu Varus (bowed) or Genu Valgus (knocked)
Systemic autoimmune inflammatory disease.
Cause unknown - genetic predisposition with added inflammatory causes, possible viral trigger
Alloantigen Human Leukocyte antigen DR4 (HLA-DR4) is found in 70% of people with RA
Begins with general systemic inflammation, joint pain, dereased ROM, and stiffness, joint involvement - metacarpal, phalangeal, proxima interphalangeal
Inflammatory increase of immune cells in synovial joints causing granular tissue to form on articular cartilage leading to pannis formation (vascular tissue) which can erode articular cartilage leading to bone erosion and bone cysts & fissures.
BIL symmetric poly-arthritis involving smaller joints.
Hand involvement: Ulnar drift, Boutonniere deformity, Swan Neck Deformity
Rheumatoid Factor (RF) - antibody against RF of IgG. These two combine to create complexes that contribute to the disease
Anti-CCP ( cyclic citrullinated peptides ) - combine with RF = severe disease
CRP - Increased inflammation
ESR - Increased inflammation
Seronegative arthritis preceeded by urethritis, cervicitis, or dysentery.
Occurs in 20-40 year olds
S/P Dysentery Women = Men
S/P STI Chlamydia infection Men > Women
Epidemiology: Genetic susceptibility S/P bacterial infection: Chlamydia, Salmonella, Schigella
Oligoarthritis 2-6 weeks after untreated infection.
Affects knees & ankles, swelling of toes & Achilles tedon and plantar facia
Eye involvement - noncontagious conjunctivities or acute uvitis.
Ulcers to glans penis or meatus in men.
Labs: Increased ESR, Increased CRP, + for infectious agent
Inflammatory arthritis associated with psoriasis
Age onset - 30-55 years old
Genetic - STRONG FAMILY HISTORY as most important risk factor.
Immune features - T-cells & macrophages infiltrate joint tissue leading to inflammatory cytochines that increase production of synoviocites in joints and new blood vessel formation and an increase in inflammatory tissue
Same poly-arthritis as RA combine with soft tissue and peripheral joint disease - digit swelling and tendon inflammation
Skin & nail changes associated with psoriasis.
Juvenile Rheumatoid Arthritis
Chronic inflammation disease of children, resolves in adulthood with residual joint damage persisting
1) Systemic - 1-6 years old onset
2-147% of JRA cases
Rash, fever, lympadenopathy, polyarthritis, hepatospenomegaly, anemia, muscle atrophy, arthritis may continue past initial s/s resolve
2) Polyarticular - 8-16 years old onset
Girls > Boys
Affects 5 or more joints
Older when affected
Boys > Girls
Affects larger joints
At risk for progressive bone erosion
=/<4 joints affected
+ ANA (antinuclear antibodies) which increases risk of ocular disease destroys vision
Duchenne Muscular Dystrophy
Most common form of muscular dystrophy
x linked inheritance
Duchenne muscular dystrophy
Clinical Manifestations: slow motor development with progressive weakness and muscle wasting
sitting, standing, and walking are delayed
clumsy, frequent falls
difficulty with climbing stairs
Muscular weakness begins in pelvic girdle=waddling gait
climbing up the legs (Gower sign) when rising from the floor
walking on toes d/t weakness of anterior tibial and peroneal muscles
muscular atrophy and deformity of the skeleton
Late: compromised pulmonary function and kyphoscoliosis
incontinence of urine and stool
related to purine metabolism
Causes: purine synthesis or breakdown is accelerated
poor uric acid secretion in the kidneys
Mechanisms for crystal deposition:
low body temperatures
decreased albumin or glycosaminoglycan levels
changes in ion concentration and pH
Primary=unknown metabolic defect
Asymptomatic hyperuricemia=serum urate level is elevated but arthritic symptoms, tophi, and renal stones are not present; may persist throughout life
acute gouty arthritis=attacks develop with increased serum urate oncentrations; tends to occur with sudden or sustained increases of hyper uricemia but also can be triggered by trauma, drugs, and alcohol.
tophaceous gout=the third and chronic stage of the disease; can begin as early as 3 years or as late as 40 years after the initial attack of gouty arthritis. progressive inabliilty to excrete uric acid expands the urate pool until urate crystal deposits (tophi) appear in cartilage, synovial membranes, tendons, and soft tissue.
pain in the great toe (usually, but not always): Worse at night
Increase in serum urate concentration: hyperuricemia
Recurrent attacks of monorticular arthritis
tophi in and around the joints
renal disease, involving glomerular, tubular, and interstitial tissue and blood vessels
formation of renal stones (co-morbidity)
Chronic widespread joing and muscle pain, fatigue, and tender points
Diffuse, chronic pain
sleep disturbances; fatigue; depression and anxiety; decreased attention span and short term memory
Nine pairs (18) of tender points- must have tenderness in 11 of these tender points
THIS SET IS OFTEN IN FOLDERS WITH...
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