NURS 6242 EXAM I

The Prefrontal Cortex (PFC) is heavily involved in h____-o_____ e______ functioning. Major functions include:

• pl_____

• jud_____

• d_____-m_____

• imp____ control

• att______

• mem___

• org_______

• emot_____ reg_____

• inhibiting inapp_____ b_______

planning

judgment

decision making

impulse control

attention

memory

organization

emotional regulation

inhibiting inappropriate behavior

Reduced prefrontal cortex can contribute to:

• imp______

• p___ j_______

• difficulty regulating e______

• dis______ des_____-m_____

impulsivity

poor judgment

difficulty regulating emotions

disorganized decision-making

The A_____ is central to emotional processing and threat detection.

Amygdala

Major functions of the amygdala include:

• f___

• t____ detection

• e______ saliance (how intensely a stimulus grabs your attention and drives behavior because of the e______ significance)

• f____ or f_____

• processing e______ s_______ stimuli

fear

threat detection

emotional saliance

emotional significance

fight or flight

processing emotionally significant stimuli

Psych conditions relevant to the amygdala include:

• anx____

• P___

• F___ conditioning

• Hyp_________

anxiety disorders

PTSD

Fear conditioning

Hypervigilance

For patients with PTSD, heightened threat processing (overactive a______, hypoactive p______ c_____) can contribute to:

• hyp________

• exxagerated s____ r_____

• irri______

• p______ perception of d_____

amygdala, prefrontal cortex

hypervigilance

exxagerated startle response

irritability

persistent perception of danger

The Hippocampus is important for:

• m_____ formation

• l______

• cont______ m_____

• retrieval of m_______

memory formation

learning

contextual memory

retrieval of memories

Hippocampus functioning can be affected by c____ s_____ and t____. The hippocampus helps the brain distinguish what happened in the p___ and d____ that is happening r___ n__.

chronic stress

trauma

past

danger ; now

the psychological and neural process by which the brain binds an event to its surrounding environment, internal state, and temporal setting to make that memory easier to retrieve or understand later

contextualizing memories

T/F: difficulty contextualizing memories can contribute to trauma-related symptoms.

TRUE

E________” changes in gene expression without changing the underlying DNA sequence.

Epigenetics

If DNA is the i_______ m______, Epigenetics are changes in which the i_______ are turned o_ or o___.

instruction manual

instructions turned on or off

Environmental factors that can influence gene expression include:

• s____

• tr____

• nut_____

• sl____

• env_______ exposures

stress

trauma

nutrition

sleep

environmental exposures

T/F: Epigenetics leaves everlasting changes on the DNA sequence.

FALSE

P_______: observable characteristics of an individual, a reaction between genotype and environment

Phenotype

Examples of phenotype include:

• observable p______ characteristics

• b________ characteristics

• some d_____ m________

observable physical characteristics

behavioral characteristics

some disease manifestations

A____ p_____: electrical signal that travels along a neuron

action potential

Basic sequence:

1: resting n_____

2: d_________

3: r_________

4: signal travels along a____

resting neuron

depolarization

repolarization

signal travels along axon

The action potential allows n_____ to communicate information over d____.

neurons

distance

What is the difference between action potential and neurotransmitter release?

action potential = electrical signaling within the neuron

neurotransmitter release = chemical signaling between neurons

L___-g____ C______: open when a l____/neurotransmitter binds to the receptor

L____ = key for c____ or receptor to open

ligand-gated channels

ligand = key for channel or receptor to open

V____-g____ C_____: open in response to a change in membrane v____.

*particularly important during the action potential.

electrical/v_____ change opens the gate

Voltage-gated channel

voltage

voltage

The R____ N_____ are a cluster of cells located along the middle of the brainstem that produce and distribute most of the serotonin in the central nervous system

ralphe nuclei

Serotonin (__-___)

Major functions include:

-m____

-an_____

-s____

-app_____

-imp____ regulation

5-HT

mood

anxiety

sleep

appetite

impulse regulation

S______ S_______ R______ I______: increase s_____ signaling by inhibiting s_____ reuptake; blocks S___ (reuptake transporter)

• sertraline

• escitalopram

• fluoxetine

• paroxetine

• citalopram

Selective Serotonin Reuptake Inhibitor

blocks SERT

Serotonin systems are involved in:

• d______

• a_____ disorders

• O__

• P____

depression

anxiety disorders

OCD

PTSD

L____ c_____: a tiny, blue-pigmented nucleus in the brainstem that serves as the brain's primary factory for producing norepinephrine

locus coeruleus

Functions of norepinephrine:

• a_______

• e_____

• vig_____

• att______

• aro____

• s____ r_____

alertness

energy

vigilance

attention

arousal

stress response

Abnoraml norepinephrine signaling can contribute to:

• a______

• hyp________

• a_____ problems

• d_____-related fatigue

anxiety

hyperarousal

attention problems

depression-related fatigue

S_____-n________ reuptake inhibitors: class of prescription medications primarily used to treat major depression, anxiety disorders, and certain types of chronic pain

serotonin-norepinephrine

Dopamine is associated with:

• r_____

• mot______

• rein_________

• m______

• sal_____

• psy______

reward

motivation

reinforcement

movement

salience

psychosis

Altered dopamine signaling is relevant to:

• p_____ symptoms

• m_______

• an_______

• r_____ processing

psychotic symptoms

motivation

anhedonia

reward processing

GABA = primary i________ neurotransmitter. It’s overall effect is to r_____ n_____ exc_______.

inhibitory

reduce neuronal excitability

GABA =

A. the brains gas pedal

B. the brains gear switch

C. the brains brake pedal

c. the brains brake pedal!

Benzodiazepines enhance the effects of G___-__ receptors, which produces:

• a______

• s_______

• m_____ relaxation

• antic________ effects

anxiolysis

sedation

muscle relaxation

anticonvulsant effects

G_______ = the primary excitatory neurotransmitter, the brain’s gas pedal

Glutamate

Glutamate is important for:

• l_____

• m______

• syn_____ pl_______

• ex_______ neurotransmission

learning

memory

synaptic plasticity

excitatory neurotransmission

AGONIST SPECTRUM:

• a drug binds to a receptor, activates the receptor

• produces the maximal receptor response

Full agonist (turned all the way up!!!)

AGONIST SPECTRUM

• A drug that binds to a receptor, does NOT activate it, and blocks activation by an agonist

Antagonist

AGONIST SPECTRUM

• A drug that binds to a receptor, activates it, produces less than maximal response

Partial Agonist

T/F: A partial agonist acts the same in every environment

FALSE!

A partial agonist can act differently depending on the environment

T/F: If full agonist activity is present, a partial agonist can functionally reduce overall stimulation by competing for the receptor.

TRUE!

Many neurotransmitter receptors are G-protein-coupled receptors (GPCRs). They generally:

• b___ l_____

• activate __ protein

• trigger i________ s_______

• alter c_____ a_____

bind ligand

activate g protein

trigger intercellular signaling

alter cellular activity

M______ h_______: a traditionally proposed idea that depression is associated with altered/insufficient signaling involving:

• serotonin

• norepinephrine

• dopamine

monoamine hypothesis

A______: a minimal level of sedation that makes you feel very relaxed while you stay awake, able to talk, and able to follow instructions

Anxiolysis

B___-d_____ n______ factor (BDNF): a vital protein often called "miracle-gro for the brain" because it supports the survival, growth, and maintenance of neurons It also promotes neuroplasticity, boosts memory and learning capacity, and improves mood.

Brain-derived neurotrophic factor (BDNF)

Reduced BDNF is linked to m____ d_______, anxiety, chronic stress, and neurodegenerative conditions like A______’s and P________’s disease. Stress actually downregulates BDNF in critical areas like the h_______.

• major depression

• Alzheimers and Parkinsons

• hippocampus

The modern model considers neurotransmitter imbalance as a potential cause for major depression in addition to:

• reduced B____ levels

• altered neurop_______

• infl_______

• H__/s___ pathways

• E__________ s_____

• N____ circuitry

• G____ and epi_______

reduced BDNF levels

altered neuroplasticity

inflammation

HPA/stress pathways

Environmental stress

Neuronal circuitry

Genetic and epigenetic

BDNF supports:

• n_____ survival

• g____

• syn___ pl_____

• l_____ and m______

neuronal survival

growth

synaptic plasticity

learning and memory

The h_______-p______-a_____ (HPA) axis is your body's main neuroendocrine system that controls your reaction to stress

hypothalamic-pituitary-adrenal (HPA)

Treatment of depression is thought to involve:

• increasing of n________ levels

• changes in n_____ a______

• changes in n___________y

neurotransmitter levels

neural adaptation

neuroplasticity

Classic melancholic features include:

• marked d____ pl____ or anh_____

• loss of r_____ to pleasurable s_____

• e___-m_____ awakening

• d______ worse in the m______

• psy_______ changes

• exc______/in_______ guilt

• decreased a_______ or significant w____ l____

marked decreased pleasure or anhedonia

loss of reactivity to pleasurable stimuli

early-morning awakening

depression worse in the morning

psychomotor changes

excessive/inappropriate guilt

decreased appetute or significant weight loss

Atypical depression is associated with:

• the classic “r______” v_______ pattern:

  • Hyper_____

  • Hyperp_____

  • w____ gain

• Also:

  • l____ p_____

  • r_______ sensitivity

  • m____ reactivity

reversed vegetative pattern: hypersomnia, hyperphagia, weight gain

leaden paralysis

rejection sensitivity

mood reactivity

FIRST LINE MEDICATIONS FOR DEPRESSION:

• S____’S

• S____’S

SSRI’S

SNRI’S

SSRI’S

• s______

• esc______

• flu______

• paro_______

• citalo_____

sertraline

escitalopram

fluoxetine

paroxetine

citalopram

SNRI’s:

• v_______

• d_____

• des__________

venlafaxine

duloxetine

dessvenlafaxine

Diagnostic criteria for Bipolar __ Disorder includes:

• At least ONE lifetime manic episode (distinct period of abnormally and persistently elevated, expansive, or irritable mood, and persistently increased activity or energy). It must last for at least 1 week (present most of the day, nearly every day) or any duration if hospitalization is required.

Bipolar I Disorder

Key point: Bipolar I = M_____

MANIA

Diagnostic Criteria for Bipolar II Disorder:

• H_______ - at least one episode, at least 4 days; featuring persistently elevated, expansive, or irritable mood and increased activity or energy

• M_____ D_______ E_______ - Lasts at least 2 weeks requiring 5 or more symptoms representing a change in functioning, including depressed mood or loss of interest/pleasure

Hypomania

Major Depressive Episode

Key Point: Bipolar II = H_______ + D________

HYPOMANIA + DEPRESSION

DIGFAST for Manic Symptoms

• D______: difficulty maintaining attention

• I________: risky or impulsive behavior (excessive spending, sexual indiscretions)

• G________: inflated self-esteem

• F____ of i____: rapidly shifting from one idea to another with understandable connections

• A_____: increased goal-directed a_____ or psychomotor agitation

• S____ deficit: decreased need for rest

• T_______: pressured or excessive speech

Distractibility

Impulsivity

Grandiosity

Flight of ideas

Activity

Sleep deficit

Talkative

Flight of ideas/Circumstantial thinking occurs when a patient’s thoughts move from one topic to another with understandable association, rapid shifts; while flight of ideas/circumstantial thinking includes extensive irrelevant details before eventually getting back to the original point.

Flight of ideas = rapid shift

Circumstantial thinking = excessive, unnecessary detail but eventually returns to the original point.

T/F: Mania can include psychosis.

TRUE!

Mania/hypomania causes marked impairment, may require hospitalization/, may include psychotic features while mania/hypomania does not cause marked impairment/hospitalization/psychosis.

mania = marked impairment, 7 days or any amount of time requiring hospitalization

hypomania = no marked impairment, 4 days, no psychosis

The significant difference between unipolar depression (or major depression) and bipolar depression is that bipolar depression alternates with periods of m____ or h_______.

mania

hypomania

The diagnosis between bipolar depression and unipolar depression can be extremely difficult and relies on an accurate l________ h_____.

longitudinal history

A depressive episode with m____/h______ symptoms occurring simultaneously is described using a m___-f____ specifier

manic/hypomanic

mixed features specifier

A patient experiencing a depressive episode with mixed features may report:

• d_____

• anh_____

• ho________

• decreased need for s____

• increased e_____

• racing t____

  • increased t_________

depression

anhedonia

hopelessness

decreased need for sleep

increased energy

racing thoughts

increased talkativeness

T/F: mixed presentations can be associated with increased suicide risk

TRUE

Medication induced hypomania/mania can occur when a patient taking an antidepressant (i.e. sertraline) reports:

• e_____/irr_____ mood

• increased e____

• decreased need for s____

• r_____ thoughts

• increased s____

• i_______

• increased g____ d_____ acitivty

elevated/irritable mood

increased energy

decreased need for sleep

racing thoughts

increased speech

impulsivity

increased goal-directed activity

T/F: If a full manic syndrome persists beyond the physiological effects of the medication, it can support a diagnosis of bipolar I disorder rather than merely attributing symptoms to the medication.

TRUE!

medication stopped, sx’s persist (at least 5 of DIGFAST) = MANIC episode

When treating a patient for depression and having concerns regarding significant activation or mania, we prioritize:

• assess s____

• assess for p_____ and s_____ behavior

• reassess the d_____

• review the a________ regimen

• consider discontinuing the offending a______when clinically appropriate

• treat the manic epsiode with appropriate m___-s______/anti____ therapy

assess safety

assess for psychosis and suicidal behabior

reassess the diagnosis

review the antidepressant regimen

consider discontinuin the offending antidepressant when clinically appropriate

treat the manic episode with appropriate mood-stabilizing/antimanic therapy

A useful framework for diagnosing PTSD includes:

• T____

• Int_____

• Av______

• N_____ C______/ M____

• Hyp________

Trauma

Intrusion

Avoidance

Negative Cognition / Mood

Hyperarousal

Trauma exposure for PTSD diagnosing includes exposure to actual or threatened:

• D____

• S____ I_____

• S_____ V______

** through qualifying direct, witnessed, learned, or repeated professional exposure circumstances.

Death

Serious Injury

Sexual Violence

Intrusion for PTSD diagnostic criteria includes:

• I______ memories

• N________

• Fl________

• Psy________ d______ when reminded

• Phys_________ reactions to reminders

Intrusive memories

Nightmares

Flashbacks

Psychological distress when reminded

Physiologic reactions to reminders

Avoidance for PTSD diagnostic criteria includes avoiding:

• t____-r______ thoughts

• f______

• m_______

• ext_____ reminders

trauma-related thoughts

feelings

memories

external reminders

Negative alterations in cognition/mood for PTSD diagnostic criteria includes:

• negative b_____

• persistent negative e______ s____

• d______

• r______ in_____

• difficulty e________ positive e______

  • t____-r_____ memory problems

negative beliefs

persistent negative emotional state

detachment

reduced interest

difficulty experiencing positive emotions

trauma-related memory problems

Hyperarousal/Reactivity diagnostic criteria includes:

• hyp________

• exaggerated s_____

• Irrit_____

• S___ disturbance

• Con________ problems

• Re______ behavior

hypervigilance

exaggerated startle

irritability

sleep disturbance

concentration problems

reckless behavior

PTSD symptoms must persist for more than month(s) and cause clinically significant d____/im________

1

First-line treatment for PTSD includes t____-f_____ therapies, including:

• p______ exp______

• c________ p_________ therapy

• t____- f_____ c_______ b_______ approaches

trauma focused therapises

prolonged exposure

cognitive processing therapy

trauma-focused cognitive behavioral approaches

Medication options for PTSD symptoms include:

• s______

• p_______

• fl_______

• ven______

sertraline

paroxetine

fluoxetine

venlafaxine

Panic Disorder consists of:

• r______, unex______ panic attacks

• persistent c_____ and/or m_______ behavioral changes related to the a_____

recurrent unexpected panic attakcs

persistent concern and/or maladaptive behavioral changes related to the attacks

T/F: People can have panic attacks without having panic disorder

TRUE

First Line Treatment for Panic Disorder:

• S____/SN___

• C___, specifically p____-f_____ C___

SSRI (fluoxetine, paroxetine)/SNRI (venlafaxine)

CBT; panic-focused CBT

B_________ can reduce acute panic symptoms but generally aren’t preferred as long-term first-line monotherapy because of dependence, tolerance, withdrawal and cognitive effects.

Benzodiazepines

O______ C_______ Disorder Obsessions: consists of recurrent intrusive thoughts, urges or images that are:

• u______

• int______

• difficult to c____

Obsessive-Compulsive Disorder

unwanted

intrusive

difficult to control

Examples of OCD obsessions include:

• fear of c_________

• fear of h______ someone

• need for sy_____

contamination

hurting

symmetry

OCD Compulsions are r_______ b______ or m_____ acts performed in response to obsessions or r___ r___.

Examples include:

• excessive w_____

• ch_____

• cou____

• repeating p____ mentally

repetitive behaviors or mental acts or rigid rules

excessive washing

checking

counting

repeating phrases mentally

An OCD compulsion is performed to reduce d_____ or p_____ a f_____ event.

distress or prevent a feared event

First-Line Treatment for OCD includes:

• P_______ (Ex______ and R______ Prevention ERP)

  • Medication: S____

Psychotherapy (Exposure and Response Prevention)

SSRI’s

OCD often requires a lower/higher dose of SSRI’s and shorter/longer treatment trials than depression, when tolerated and clinically appropriate.

higher

longer

Another evidence-based option for some patients with OCD is c_______ (Ana____), a tricyclic antidepressant, Inhibits reuptake of both serotonin and norepinephrine.

clomipramine Anafranil

Generalized Anxiety Disorder involves:

• e______ w_____ about multiple areas of l___

• worry is p______, e______ and difficult to c_____

• r_______

• f_____

• difficult c______

• irrit_____

• m_____ tension

• s____ disturbance

excessive worry about multiple areas of life

worry is persistent, excessive and difficult to control

restlessness

fatigue

difficulty concentrating

irritability

muscle tension

sleep disturbance

Diagnostic criteria for adults with GAD includes anxiety/worry occurs more days than not for at least __ month(s).

6 months

First Line Treatment for GAD includes:

1. S___’s/S____’s

   1. Esc________

   2. Ser______

   3. Par______

   4. Dul______

   5. Ven______

2. C__

SSRI’S/SNRI’S

Escitalopram

sertraline

paroxetine

duloxetine

venlafaxine

CBT

Benzodiazepines are useful for GAD and reserved for:

• s___-t___ use

• acute s____ s_____

• carefully s_____ s______

short-term use

acute severe symptoms

carefully selected situations

T/F: Benzo’s are the default long-term first-line treatment for chronic anxiety disorders

FALSE

SSRI’s

Examples: S______, Esc_______, Flu_____, Par_____, Cit_____

Mechanism: block s______ r_____ t________, resulting in increased s_________ signaling

Indications: M___, G___, P____ disorder, O___, P___

Sertraline, Escitalopram, Fluoxetine, Paroxetine, Citalopram

blocks seratonin reuptake transporters, resulting in increased serotonergic signaling

MDD, GAD, Panic Disorder, OCD, PTSD

Common side effects of SSRI’s include:

• N____/G_ upset

• H______

• I______ or s_______

• S____ dysfunction

• A______/anx___ early in treatment

Nausea/GI upset

Headache

Insomnia or somnolence

Sexual dysfunction

Activation/anxiety early in treatment

S______ S______: Agitation, confusion, or restlessness. Typically occurs within hours of taking a new drug or increasing a dose. Heavy sweating, high fever, shivering, and a rapid heart rate. Muscle rigidity, overactive reflexes (hyperreflexia), and muscle twitching or tremors.

Serotonin Syndrome