Adult Psychopathology Midterm

delirium environmental risk factors

increased in context of functional impairment, immobility, history of falls, low levels of activity, and use of drugs and medications with psychoactive properties

Alzheimer’s prevalence

• accounts for 60-90% of dementias

• increases exponentially in 65 and older (11%), and 85 and older (32%)

Alzheimer’s environmental risk factors

• low education, midlife hypertension, obesity, hearing loss, late-life smoking, depression, physical inactivity, social isolation, and diabetes

• cerebrovascular pathology

• TBI (specifically in men)

frontotemporal risk factors

• genetic and physiological age

  • 40% have a family history of early onset NCD

  • 10% show autosomal dominant inheritance pattern

  • many individuals with known familial transmission don’t have a known mutation

  • motor neuron disease is associated with more rapid deterioration

frontotemporal onset

• common cause of early-onset NCD in individuals younger than 65

• commonly present in individuals who are 60, but age of onset varies from 30s to the 90s

frontotemporal life expectancy

live 6-11 years after developing symptoms, and 3-4 years after diagnosis

Alzheimer’s life expectancy

live 10 years after diagnosis, but disease was probably present in the individual for about 10 years prior

Levy Bodies risk factor

• no family history, but may be some risk genes

• biomarkers may consider diagnostic weight

• abnormal aggregates of alpha-synuclein in brain stem can confirm diagnosis (only post-mortem)

Lewy Bodies prevalence

• accounts for 0-9.7% of dementias

• 0-1.2% of general older adults population

Lewy Bodies life expectancy

5-7 years after diagnosis

Lewy Bodies onset

mid 70s

vascular environmental risk factors

influenced by neuroplasticity factors (i.e. education, physical exercise, mental activity

vascular genetic and physiological risk factors

• hypertension, diabetes, smoking, obesity, high cholesterol levels, high homocysteine levels, etc.

• cerebral amyloid angioplasty, leading to cerebral hemorrhage

• structural neuroimaging necessary for diagnosis; no other established biomarkers

delirium genetic and physiological risk factors

• major and mild NCDs can increase risk and complicate course

• older adults are more susceptible

alzheimer’s genetic and physiological risk factors

• age

• genetic predisposition (60-80% of attributable risk)

vascular course

cognitive decline in a stepwise fashion

vascular diagnosis

must use structural neuroimaging; no other established biomarkers

vascular onset

can develop at any age, but increases exponentially 71-79 (0.98%); 80-89 (4.09%); 90-older (6.19%)

TBI risk factors

• age older than 40, lower pre-cognitive abilities, pre-injury depressive symptoms, pre-injury unemployment, and injury severity

• longer duration of posttraumatic amnesia, evidence of traumatic intracranial abnormalities on early computed tomography or MRI studies, and neurogenetic profile

TBI course modifiers

• recovery is variable, depending not only on the specifics of the injury but also on pre-injury and post-injury factors

• age, prior history of TBI, neurological, psychiatric, and substance use comorbidities, genetics, etc.

TBI diagnosis

• caused by impact to the head or displacement of the brain

  • CT scan can reveal petechial hemorrhages, subarachnoid hemorrhage, or evidence of contusion

TBI prevalence

• 2% of population lives with ____ associated disability

• males account for 59%

  • most common etiologies include falls, struck by/against events, vehicular accidnts, and assaults

parkinson’s environmental risk factors

exposure to pesticides, solvents, and possibly TBI

parkinson’s genetic and physiological risk factors

• older age at onset, increasing severity of disease, prominent gait symptoms, severe autonomic disturbance, REM sleep behavior disorder, being a man, and having fewer years of formal education

  • gene mutations

parkinson’s onset

increases with age 65-69 (0.4%) to between 80 and 89 (1.4%)

substance/medication induced risk factors

• older age, longer use, persistent use past 50 years

• alcohol: long-term nutritional deficiencies, liver disease, vascular risk factors, cardiovascular and cerebrovascual disease

  • sedative, hypnotic, or anxiolytic induced may be increased in individuals with long-term anxiety disorders or sleep impairment who have been taking benzos or other hypnotic medications

HIV risk factors

• injection drug use, unprotected sex, and unprotected blood supply

  • inadequate control of ___ in the CNS, evolution of antiretroviral drug-resistant viral strains, effects of long-term systemic and brain inflammation, effects of comorbid factors (aging, SUD, hypertension, diabetes, past history of CNS trauma, co-infections)

HIV prevalence

25% of individuals will have signs and symptoms that meet criteria for mild NCD, and in fewer than 5% would meet criteria for major NCD

prion environmental risk factors

• cross-species transmission

  • transmission by corneal transplantation, cadaveric dura mater grafts, contaminated neurosurgical instruments, cadaver-derived human growth hormone, blood transfusion

prion genetic and physiological risk factors

autosomal dominant genetic mutation in the ___ protein group (PRNP)

prion prevalence

relatively rare (1 in 1 million people affected), but rapidly progressive

prion age of onset

onset ranges from teenage to late life, but most prevalent in ages 67

huntington’s genetic and physiological risk factors

• autosomal dominant expansion of the CAG trinucelotide

  • repeat length of 40 or more is associated with this disease, with longer repeat lengths in the 36-39 range is considered to be partially penetrant

huntington’s prevalence

5.7 per 100,000 in North America

huntington’s age of onset

early, around 40 and includes choreic movements

schizophrenia prevalence

• about 2.2 million people have this in the US, 51 million worldwide

• 0.3-0.7% lifetime risk for developing this

schizophrenia age of onset

onset often occurs in early adulthood (early to mid 20s in males, late 20s for females)

schizophrenia behavioral genetics risk

• higher rate of schizophrenia among offspring of individuals with schizophrenia

• BUT monozygotic twins do not have 100% chance of both developing it

  • implies a diathesis-stress model!

schizophrenia neuroanatomy and neurobiology

• overabundance of dopamine

• serotonin, glutamate, and GABA play a role

• enlarged ventricles, decreased brain volume and blood flow to cortical areas

schizophrenia gender differences

• women have milder overall course and later onset

• men are more likely to receive treatment

schizophrenia cultural considerations

• form, content, and level of fear of symptoms can vary cross culturally

• less-industrialized countries perceive individuals with schizophrenia differently

  • course of the illness is more benign (less harmful, less scary, less isolating, etc.

schizophrenia environmental risk factors

• season of birth (late winter/spring and in some cases, summer)

• more common for children growing up in urban environment, refugees, and socially oppressed groups

schizophrenia genetic and physiological risk factors

• risk alleles (both common and rare)

• pregnancy and birth complications with hypoxia

• greater parental age

schizophrenia prevalence of symptoms

• positive symptoms

  • fluctuate in severity

  • persecutory delusions most common

  • 75% report hallucinations (auditory more common, visual more severe)

schizophrenia comorbidity

• depression = comorbid rate of 45%

• anxiety = comorbid rate of 43%

• suicidality = 4-10% with ___ die by suicide

• substance use = lifetime history 50%, 25-35% have a recent history)

schizophrenia relapse

• 50-75% who discontinue meds will relapse within 1 year

schizophrenia age of onset

• often occurs between 16 and 25 years of age

  • uncommon in children

delusional disorder prevalence

• 0.2% lifetime prevalence rate

• 1-4% of inpatient admissions

• more common in older adults

delusional disorder cause

• unknown etiology

• appears distinct from schizophrenia

  • BUT about 1/3 of people with this diagnosis of 1-3 months duration will also receive a diagnosis of schizophrenia

• potential biochemical factors (HVA, dopamine metabolite)

delusional disorder risk factors

familial relationship with schizophrenia and schizotypal PD

brief psychotic disorder prevalence

• 2-7% of cases of first-onset psychosis worldwide

• 9% of cases of first-onset psychosis in US

• 2x more common in FEMALES than males

• can appear in adolescence or early adulthood, onset can occur across lifespan

brief psychotic disorder age of onset

average age of onset of 30

brief psychotic disorder cause

• unknown

  • relatively uncommon diagnosis

• may be a genetic link, especially in those who have family with BPD

• poor coping skills plus a major stress or traumatic event

brief psychotic disorder risk factors

• temperamental

  • preexisting personality disorders and traits may predispose someone to the development of the disorder

schizophreniform prevalence

• about fivefold less than that of schizophrenia (developed countries)

  • higher incidence in under developed countries

• about 1/3 with this diagnosis recover within 6 months

  • BUT, 2/3 will go on to receive diagnosis of schizoaffective or schizophrenia

schizophreniform cause

• unknown etiology

  • may have underlying genetic, neuroanatomy, or stress causes

schizophreniform genetic and physiological risk factors

relatives of individuals with ___ have an increased risk for schizophrenia

schizoaffective prevalence

• 1/3 as common as schizophrenia

• lifetime prevalence of 0.3%

• higher in FEMALES than males

• typically early adulthood onset, but can range

schizoaffective cause

• unknown etiology

• no tests or biological measures can assist in making diagnosis

schizoaffective genetic and physiological risk factors

• for individuals with schizophrenia, there may be an increased risk for ____ in first-degree relatives

  • risk for ____ is higher in individuals with first-degree relatives with schizophrenia

substance/medication induced prevalence

• unknown rate in general population

• between 7 and 25% of individuals presenting with first episode of psychosis have thi

substance/medication risk factors

heavy, long term use of substances are factors in onset of psychosis

psychotic disorder due to another medical condition cause

• variety of medical conditions

  • neurological conditions

  • endocrine conditions

  • metabolic conditions

  • fluid or electrolyte imbalances

  • hepatic or renal diseases

  • autoimmune disorders with CNS involvement

psychotic disorder due to another medical condition risk factors

identification and treatment of underlying medical condition has greatest impact on course