mental health disorder

anxiety is characterized by

excessive fear and anxiety, as well as related behavioral disturbances

anxiety involves

an emotional response (fear or anxiety) that is disproportionate to the actual threat
and causes significant distress or impairment in daily functioning.

types of anxiety disorders

• generalized

• panic

• social anxiety

• agoraphobia

• separation anxiety disorder

generalized anxiety disorder (GAD)

Excessive, persistent worry about everyday life or at least 6 months, causing significant distress or impairment in social, occupational, or other important areas of functioning.

panic disorder

recurrent, unexpected panic attacks with physical symptoms

social anxiety disorder

intense fear of social situations and being judged

specific phobia

extreme fear of a specific object or situation

separation anxiety disorder

excessive fear of separation from attachment figures

GAD symptoms

Excessive worry, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances (e.g., trouble falling asleep or staying asleep

generalized anxiety disorder - treatment

first line: cognitive behavioral therapy (CBT)

• helps address dysfunctional thinking patterns, teaches relaxation techniques, and coping strategies.

GAD medications

1. SSRIs

2. SNRIs

3. Hydroxyzine - antihistamine SHORT TERM

4. Buspirone - non-benzo treatment - LONG TERM lower risk of dependence

5. Benzodiapepines - SHORT TERM!! use of dependence

insomnia - def

Difficulty falling or staying asleep, or waking up too early, occurring at least 3 nights per week for at least 3 months, causing significant distress or impairment in daily functioning.

insomnia symptoms

Difficulty falling or staying asleep, or waking up too early, leading to un refreshing sleep.

insomnia treatment

Cognitive Behavioral Therapy for Insomnia (CBT-I): Helps improve sleep hygiene and addresses negative thoughts related to sleep.

insomnia - medications

1. Non-benzodiazepine sedative-hypnotics (e.g., zolpidem) for short-term use

2. Melatonin agonists (e.g., ramelteon) for sleep onset insomnia.

3. Sedating antidepressants: Mirtazapine (for comorbid depression and insomnia) and Trazodone, Doxepin (for sedative effects)

4. Antihistamines (e.g., diphenhydramine) for short-term relief.

5. Benzodiazepines (e.g., lorazepam, temazepam) for short-term use, avoided due to dependence risk.

narcolepsy - def

sleep disorder characterized by excessive daytime sleepiness and sudden, uncontrollable sleep attacks occurring at least 3 times per week over a period of 3 months

narcolepsy - symptoms

Excessive daytime sleepiness, sleep attacks
• Cataplexy (muscle weakness triggered by strong emotions)
• Sleep paralysis and vivid hallucinations

narcolepsy treatment

First-line therapy: Stimulants (e.g., modafinil) to improve wakefulness during the day.
• Supportive therapy: Scheduled naps, maintaining a regular sleep schedule.

mood disorders - def

Mental health conditions marked by persistent disturbances in emotional state, including depression (low mood) and mania/hypomania (elevated mood), that significantly impact
daily functioning

mood disorders examples

1. major depressive disorder (MDD)

2. bipolar

3. cyclothymic disorder

4. persistent depressive disorder (PDD)

5. disruptive mood dysregulation disorder

6. prementral dysphoric disorder (PMDD)

major depressive disorder (MDD) - def

Mental health condition characterized by a persistent low mood and loss of interest or pleasure in daily activities (anhedonia), lasting for at least 2 weeks.

MDD - symptoms

• Depressed mood most of the day, anhedonia, significant weight changes, insomnia or hypersomnia, fatigue, feelings of worthlessness, thoughts of death or suicide.

• Symptoms must be present for at least 2 weeks and cause significant distress or impairment in daily functioning

MDD treatment

cogntiive behavioral therapy (CBT)

medications:

• SSRIs - fluxetine

• SNRIs - venlafaxine

• TCAs - imipramine

• MAOIs - phenelzine

MDD - other treatments

• Electroconvulsive Therapy (ECT): For severe, treatment-
  resistant depression.

• Transcranial Magnetic Stimulation (TMS): For patients who do not
  respond to medications or therapy.

• Ketamine therapy: An emerging treatment option for resistant
  depression.

• Exercise: Regular physical activity has shown to reduce depressive
  symptoms.

bipolar disorder - def

A mood disorder characterized by episodes of mania or hypomania, often alternating with periods of depression. The specific criteria differ based on the type of bipolar disorder

bipolar disorder - symptoms

Alternating episodes of depression (low mood, fatigue, hopelessness, difficulty concentrating) and mania (elevated mood, increased energy, impulsivity, decreased need for sleep, racing thoughts, and risky behaviors).

bipolar disorder - hypomania

a less severe form of mania seen in Bipolar II, while Bipolar I involves more severe manic episodes, often requiring hospitalization.

bipolar disorder - treatment

• Mood Stabilizers: Lithium, valproic acid, carbamazepine.

• Antipsychotics: Risperidone, aripiprazole, olanzapine.

• Antidepressants: Used with caution to prevent triggering
  mania.

• Psychotherapy: CBT and psychoeducation to manage
  symptoms and prevent relapse.

BP 1

Manic episodes lasting 7+ days or requiring hospital care, with depressive episodes.

BP 2

Depressive and hypomanic episodes, no full mania

Cyclothymic disorder

2+ years of hypomanic and depressive symptoms that don't meet full criteria.

Persistent Depressive Disorder (PDD)

Chronic low mood lasting 2+ years, less severe than MDD.

disruptive mood dysregulation disorder

Severe temper outbursts and irritability in children/adolescents.

premenstrural dysphoric disorder (PMDD)

Severe mood swings and depression before menstruation, disrupting daily life.

serotonin syndrome - def

Serotonin Syndrome is a potentially life-threatening condition caused by excessive serotonin activity in the central nervous system, usually due to drug interactions or
overdose, particularly with SSRIs, SNRIs, MAOIs, or triptans.

serotonin syndrome - symptoms

• Cognitive: Agitation, confusion, delirium, hallucinations.

• Autonomic: Hyperthermia, tachycardia, hypertension, diaphoresis (sweating), nausea, vomiting.

• Neuromuscular: Hyperreflexia, clonus (especially in lower
  extremities), tremors, muscle rigidity.

serotonin syndrome types of treatment

1. Immediate discontinuation of serotonergic drugs.

2. Supportive care: Hydration, cooling measures, and sedation (e.g., benzodiazepines).

3. Serotonin antagonists: Such as cyproheptadine may be used in severe cases.

4. Monitoring: Hospitalization for severe cases to monitor vital signs and manage complications.

5. Prevention: Cautious use of serotonergic drugs, avoid polypharmacy, and monitor for early signs of serotonin excess

psychotic disorders - def

• Characterized by a disconnection from reality, often manifesting as hallucinations, delusions, or disorganized thinking

• can significantly impair a person's ability to function and often require treatment involving antipsychotic medications and psychotherapy.

different psychotic disorders

1. Schizophrenia

2. Schizoaffective Disorder

3. Delusional Disorder

4. Brief Psychotic Disorder

5. Substance-Induced Psychotic Disorder

6. Psychotic Disorder Due to a Medical Condition

Schizophrenia -def

Chronic and severe mental disorder characterized by distorted thinking, perceptions, emotions, and behavior

Schizoaffective Disorder

Combination of schizophrenia symptoms with mood disorder symptoms (depression or
mania)

Delusional Disorder

Presence of delusions (false beliefs) without other psychotic symptoms like hallucinations

Brief Psychotic Disorder

Sudden onset of psychotic symptoms lasting more than 1 day but less than 1 month,
often triggered by stress.

Substance-Induced Psychotic Disorder

Psychosis caused by drug or alcohol use, withdrawal, or intoxication.

Psychotic Disorder Due to a Medical Condition

Psychosis caused by a medical condition, such as a brain injury or infection.

schizo - symptoms - positive

• must persist for at least 6 months, with at least 1 month of positive symptoms

• Positive:
  - Delusions: False beliefs (e.g., paranoia, grandiosity).
  - Hallucinations: False sensory perceptions (e.g., auditory,
  visual).
  - Disorganized Speech/Behavior: Incoherent speech, erratic
  behavior

schizo - symptoms - negative

• Flat Affect: Reduced emotional expression.

• Avolition: Lack of motivation, neglect of personal hygiene.

• Anhedonia: Inability to experience pleasure.

• Social Withdrawal: Isolation and difficulty with relationships

schizo - cognitive

• Impaired Memory: Difficulty with recall and learning.

• Poor Executive Function: Difficulty planning, organizing, problem-solving.

• Attention Deficits: Difficulty concentrating.

schizo - treatment - first line

antipsychotic medications

1. Typical Antipsychotics (1st Gen): Used if atypical meds are ineffective, but with higher risk of movement side effects (e.g., haloperidol, chlorpromazine).
   2. Atypical Antipsychotics (2nd Gen): Preferred for positive and negative symptoms with fewer side effects (e.g., risperidone, aripiprazole)

schizo - supportive therapy

Cognitive Behavioral Therapy (CBT): Helps manage symptoms and reduce anxiety.
• Social Skills Training: Improves communication and social integration.
• Family Therapy: Educates and supports families in managing the condition.
• Community Support Programs: Vocational training and housing assistance to improve independent living.

first- generation (typical) antipsychotics - what are they

Older class of antipsychotic medications primarily used to treat positive symptoms of schizophrenia (e.g., hallucinations, delusions).

first- generation (typical) antipsychotics - how are they different

Work by blocking dopamine D2 receptors in the brain, reducing dopamine activity.
• More likely to cause extrapyramidal symptoms (EPS), such as tremors,
rigidity, and tardive dyskinesia (TD) and neuroleptic malignant syndrome (NMS)

first-gen examples

haloperidol, chlorpromazine

second-generation antipsychotics - what are they

Newer class of antipsychotics used to treat both positive and negative symptoms of schizophrenia (e.g., social withdrawal, lack of emotion).

second-generation antipsychotics - How they are different

• Block dopamine D2 receptors but also affect serotonin receptors, lower risk of EPS compared to first-generation drugs.

• Less likely to cause tardive dyskinesia and other movement disorders.

• Can have side effects like weight gain and metabolic syndrome.

second-gen examples

• risperidone, aripiprazole

adverse effects of antipsychotics

1. weight gain

2. sedation

3. anticholinergic effects

4. cardiovascular effects

5. hyperprolactinemia

Adverse effects: weight gain

Common with atypical antipsychotics, leading to increased risk of metabolic syndrome (e.g., diabetes, hypertension)

Adverse effects: sedation

Common side effect, particularly with first-generation antipsychotics

Adverse effects: anticholinergic effects

Dry mouth, blurred vision, constipation, urinary retention

Adverse effects: cardiovascular effects

Orthostatic hypotension, QT prolongation, and increased risk of arrhythmias

Adverse effects: hyperprolactinemia

Elevated prolactin levels can lead to menstrual disturbances, galactorrhea, and sexual dysfunction.

extrapyramidal symptoms (EPS) - what is it

Drug-induced movement disorders from antipsychotics (mainly first-generation)

extrapyramidal symptoms (EPS) - symptoms

Parkinsonism: Tremors, rigidity, slow movements.
• Dystonia: Muscle contractions, twisting movements e.g. head and neck
• Akathisia: Restlessness, inability to stay still

extrapyramidal symptoms (EPS) - treatment

Anticholinergics (e.g., benztropine, diphenhydramine)
• Beta-blockers (e.g., propranolol)
• Or switch to atypical antipsychotics.

Tardive Dyskinesia (TD) - What it is

Long-term side effect of antipsychotic use, causing irreversible involuntary movements

Tardive Dyskinesia (TD) - symptoms

• lip smacking, tongue thrusting, chewing movements

Tardive Dyskinesia (TD) - treatment

Discontinue or reduce antipsychotic use, switch to atypical antipsychotics
• Or use VMAT2 inhibitors(e.g., tetrabenazine).

Neuroleptic Malignant Syndrome (NMS) - what is it

A rare, life-threatening condition caused by antipsychotic medications, typically first-generation antipsychotics. It is a medical emergency requiring immediate intervention.

Neuroleptic Malignant Syndrome (NMS) - symptoms

• Hyperthermia: High fever.

• Altered mental status: Confusion, delirium, coma.

• Muscle rigidity: Lead-pipe rigidity.

• Autonomic dysregulation: Tachycardia, labile blood pressure, diaphoresis.

Neuroleptic Malignant Syndrome (NMS)- treatment

Immediate discontinuation of the antipsychotic medication.
• Supportive care: IV fluids, cooling measures, and monitoring vital signs.
• Medications: Dantrolene (muscle relaxant), bromocriptine (dopamine agonist), or amantadine.
• Intensive care may be required for severe cases