FNU Schizophrenia Discussion

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Chapter 12 Musculoskeletal Function Introduction • Bones, joints, muscles, ligaments, tendons, and connective tissue • Used for movement, form, stability, and protection of vital organs • Role in homeostasis with storage of calcium and other minerals Bones • Site for fat and mineral storage and hematopoiesis • Five types • • • • • Long Short Flat Irregular Sesamoid bones • Periosteum • Covers compact bone surfaces Bone Remodeling • Repairs aging bone and fractures • Adjusts for factors like changes in activity • Osteoclastic reabsorption, then rebuilding with osteoblasts • Osteoid • Controlled by cytokines, hormones, and osteoprotegerin (OPG) • RANKL • Role of vitamin D in bone metabolism Joints • Cartilage • Tough, flexible connective tissue • Hyaline, elastic, and fibrous types • Lack of calcification, blood vessels, or nerves • Diffusion between chrondocytes • Classified by degree of movement • Synovial, amphiarthroses, and synarthrose Muscles • Skeletal, smooth, and cardiac types • Attach to bone with tendons • Play key role in movement • Anatomy and physiology • Skeletal muscle fiber components • Process of muscle contraction • Connective tissues for muscles • Physiologic changes with aging Developmental Hip Dysplasia • Result of abnormal acetabular and proximal femur development • Risk factors and forces during birth • Clinical manifestations • Less than 12 months • Hip instability, asymmetric leg creases, etc. • Older than 12 months with walking • Altered gait, excessive lordosis, etc. • Treatment: reducing the femoral head Osteogenesis Imperfecta (1 of 2) • Rare connective tissue disorder • Results in fragile bones • Clinical manifestations • Excessive and atypical bone fractures • Effects from bone deformities Osteogenesis Imperfecta (2 of 2) • Diagnosis • History and physical exam • Molecular genetic testing • Treatment • Bisphosphonate therapy • Lifestyle considerations Spinal Deviations • Abnormal curvatures • Scoliosis, lordosis, and kyphosis • Clinical manifestations • Asymmetrical hip and shoulder alignment, thoracic cage or gait • Back pain, fatigue, respiratory compromise • Diagnosis: spinal X-rays • Treatment • Exercises, analgesics, spinal bracing, surgical correction Fractures (1 of 2) • Break in rigid structure of the bone • Applied stress is greater than bone strength • Fracture types • Simple • Comminuted • Greenstick • Compression • Fracture healing phases • Inflammatory, reparative, and remodeling Fractures (2 of 2) • Complications • Compartment syndrome, fat embolism, osteomyelitis, and osteonecrosis • Clinical manifestations (partial list) • Deformity, site swelling, limb immobility, crepitus, pain • Diagnosis: history, physical exam, and X-rays • Treatment • Immobilization, surgical repair, and physical therapy Dislocation • Separation of two bones at a joint • Clinical manifestations (partial list) • Discolored, deformed, or visible abnormal joint • Limited movement, swelling or bruising, intense pain • Diagnosis: • History, physical exam, X-rays, and MRI • Treatment • Immobilization, joint reduction, PSA, and rehabilitation Sprains • Injury to a ligament • Often involves stretching or tearing • Clinical manifestations • Pain, joint stiffness, limited function, disability, difficulty bearing weight, discoloration • Diagnosis: history and physical exam • Treatment • Ice, immobilization, elevation, rest, NSAIDs, rehabilitation Strains • Injury to muscle, tendon, or myotendinous junction • Often involves stretching or tearing • Clinical manifestations • Pain, stiffness, difficulty moving affected muscle, skin discoloration, edema • Diagnosis • History, physical, MRI, and ultrasound • Treatment: similar to that for sprains Child Abuse • Incidence and prevalence • Suspicion for circumstances of physical abuse • History • Denial of trauma, inconsistencies, suspicious caregiver explanations or behaviors • Physical examination • Bruising, human bite marks, oral injuries, burns, fractures, etc. • Same diagnostic tests and treatment as other traumatic injuries Bursitis • Inflammation of fluid-filled, saclike structures cushioning the joint • Types • Acute bursitis • Chronic bursitis • Septic bursitis • Diagnosis: history and physical exam • Treatment • Pain relief, healing promotion, prevention Shoulder Injuries • Adhesive capsulitis • Idiopathic loss of active and passive range of motion • Presents as severe, diffuse pain • Shoulder impingement syndrome • Compression of structures around glenohumeral joint with shoulder elevation • Development from repetitive work or sports activities Epicondylitis • Tendinopathy of tendon just distal and anterior to epicondyle • Lateral • Pain in lateral elbow and forearm with gripping or wrist extension • Medial • Pain in the medial elbow with wrist flexion and forearm pronation • Underlying problem • Thickened and scarred tendon Wrist Injuries • Carpal tunnel syndrome • Compression of median nerve in the carpal tunnel • Manifests as pain or paresthesia, worse at night • de Quervain tendinopathy • Common cause of wrist pain in adults • Involves wrist tendons on radial side • Manifests as swelling and pain on distal radial side Hand Injuries • Dupuytren’s contracture • Thickening and contracture of the palmar fascia • Fibroblast proliferation and abnormal collagen deposition • Trigger finger • Abnormal thickening of flexor tendon at the metacarpophalangeal joint • Manifests as pain and “catching” with flexing Hip Injuries • Slipped capital femoral epiphyses • Common cause of hip pain in adolescents • Femur head slipping backwards off neck of bones • Meralgia paresthetica • Compression of nerve supplying sensation to upper, outer thigh • Manifests as burning pain, numbness, and tingling over thigh Osgood-Schlatter Disease • Osteochondritis of tibial tubercle • Occurs in adolescents with rapid growth spurts • Result of overuse injury • Repetitive strain and chronic avulsion • Manifests as anterior knee pain • Diagnosis • History and physical exam • Treatment • Resolves with conservative measures Low Back Pain (1 of 2) • Mechanical vs. nonmechanical causes • Intervertebral disc issues • Herniated intervertebral disk • Spondylolysis and spondylolisthesis • Spinal stenosis • Manifestations depend on cause, effects on surrounding tissues • Radiculopathy and sciatica Low Back Pain (2 of 2) • Serious underlying disorders of low back pain • Cauda equina, spinal infections, metastatic cancer, tumors • Diagnosis • History, physical exam, spinal X-rays, CT, MRI • Nerve conduction study, myelogram, electromyography • Treatment • Analgesics, NSAIDs, muscle relaxants, physical therapy, heat/cold application, traction Osteoporosis (1 of 3) • Progressive loss of bone strength • Due to low bone mass and quality • Increased risk for fractures • Imbalance between osteoblast and osteoclast activities • Factors for development of osteoporosis • Aging • Deficiency of estrogen and androgen Osteoporosis (2 of 3) • Different types of bone density and structure • Different impact of osteoporosis • Conditions and factors impacting bone homeostasis maintenance • Fracture as first manifestation • Advanced manifestations • Skeletal deformity and kyphosis Osteoporosis (3 of 3) • Diagnosis • History, physical exam, and DEXA scan • WHO criteria • T- and Z-scores • Screening • FRAX tool for identifying at-risk patients • Treatment • Proper nutrition, behavior and lifestyle changes, pharmacologic therapies, etc. Rickets and Osteomalacia (1 of 2) • Rickets • Softening and weakening of bones • Extreme and prolonged vitamin D, calcium, or phosphate deficiency • Osteomalacia • Deficient mineralization affecting the bone matrix Rickets and Osteomalacia (2 of 2) • Clinical manifestations • Delayed fontanelle closure, craniotabes, skeletal deformities, fractures, delayed growth and motor development, etc. • Diagnosis • History, physical exam, serum mineral levels, Xrays, bone density study • Treatment • Providing deficient mineral • Dietary intake and supplementation • Positioning, bracing, and surgery for deformities Paget’s Disease • Abnormal bone destruction and remodeling • Clinical manifestations (partial list) • Bone pain, skeletal deformities, fractures, headache, hearing and vision loss, neck pain • Diagnosis • History, physical exam, X-rays, bone scan, laboratory tests • Treatment • Pharmacologics, calcium and vitamin D supplementation, surgical management Osteoarthritis • Localized joint disease characterized by: • Deterioration of articulating cartilage and underlying bone • Bony overgrowth • Clinical manifestations • Joint pain, tenderness, and stiffness, limited joint range of motion, enlarged and hard joints, crepitus • Diagnosis: history and physical exam • Treatment • Physical therapy, weight management, ambulatory aids, orthopedic devices, pharmacologic agents, surgery Rheumatoid Arthritis • Systemic, autoimmune condition involving multiple joints • Classic manifestations • Pain, stiffness, and swelling of several joints in symmetrical pattern • Characterized by remissions and exacerbations • Diagnosis • History, physical exam, serum rheumatoid and anti-CCP antibodies tests, other blood tests • Complex treatment strategies with support of interprofessional team Juvenile Idiopathic Arthritis • Category of childhood arthritis • No relationship to seropositive rheumatoid arthritis • Major clinical manifestations • Synovial thickening and fluid accumulation • Diagnosis and treatment similar to other arthritis forms Gout • Inflammatory disease from deposits of uric acid crystals • Clinical manifestations • Pain at affected joint, joint warmth, redness, swelling and tenderness, fever • Diagnosis • History, physical exam, serum and urine uric acid levels, synovial fluid analysis, joint X-rays • Treatment • Focused on lowering uric acid levels Ankylosing Spondylitis (1 of 2) • Progressive inflammatory disorder • Affects sacroiliac joints, intervertebral spaces, and costovertebral joints • Clinical manifestations • Five characteristics of inflammatory back pain • Pain in other joints, muscle spasms, fatigue, weight loss, etc. Ankylosing Spondylitis (2 of 2) • Diagnosis • History, physical exam, laboratory tests, and imaging studies • Treatment • NSAIDs, muscle relaxants, physical therapy, surgical repair • Lifestyle and behavior changes, coping strategies and support Muscular Dystrophy • Inherited, non-inflammatory disorders characterized by skeletal muscle degeneration • Nine different forms • General manifestations • Intellectual disability, muscle weakness, muscle spasms, drooling, ptosis, etc. • Diagnosis includes: • History, physical exam, muscle biopsy • Treatment includes: • Physical therapy, nutrition, muscle relaxants Fibromyalgia • Characterized by widespread muscular pains and fatigue • Clinical manifestations • Vary depending on weather, stress, fatigue, physical activity, time of day • Classification criteria • Treatment • Lifestyle behavior changes, heat application, massage therapy, acupuncture, analgesics, antidepressants, etc. Bone and Muscle Neoplasms • Osteosarcoma • Chrondrogenic tumors • Osteochondroma and chondrosarcoma • Fibrosarcoma • Myelogenic tumors • Giant cell tumor and Ewing’s sarcoma • Rhabdomyosarcoma Chapter 11 Neural Function Introduction • The nervous system manages: • Muscles, glands, and organs • Heart rate • Blood flow • Breathing • Digestion • Urination • Defecation Anatomy and Physiology • Intricate network of specialized cells and tissues • Receive and react to stimuli on physiologic and cognitive levels • Main components • Central nervous system • Peripheral nervous system Central Nervous System (1 of 2) • Brain and spinal cord • Encased by three meninges • Cerebrospinal fluid (CSF) • Neural tissue • Neuroglia and neurons • Neurons and impulse transmission • Electrical impulses of the neural system Central Nervous System (2 of 2) • Brain regions • Cerebrum • Diencephalon • Brain stem • Cerebellum • Components of the spinal cord • Spinal reflex arcs Peripheral Nervous System • Consist of the spinal nerves and cranial nerves • 31 spinal nerve pairs • Sensory and motor types of spinal nerves • Cervical, brachial, lumbar, and sacral plexuses • 12 pairs of cranial nerves Autonomic Nervous System (ANS) • Controls smooth muscles • Responsible for fight-or-flight response • Divisions • Sympathetic • Parasympathetic • Neurotransmitters and receptors • Motor portion of ANS • Preganglionic, myelinated neurons • Postganglionic, unmyelinated neurons Blood Supply to the CNS • Brain • Mostly from internal carotid arteries, anterior circulation • Spinal cord • Vertebral arteries, posterior circulation • Blood-brain barrier (BBB) • Prevents exposure to potentially harmful substances Hydrocephalus • Excess CSF within ventricles and subarachnoid spaces • Dilation of ventricles and compression of brain and blood vessels • Obstructive or communicating • Incidence and prevalence • Risk factors Hydrocephalus: Clinical Manifestations • Infants with unfused cranial sutures • Unusually large head, bulging fontanelle, vomiting, dilated scalp veins, lethargy, etc. • Older children and adults • Headache followed by vomiting, nausea, blurred vision or diplopia, and balance, coordination, or gait problems, etc. • Adults with normal pressure hydrocephalus • Gait dysfunction, cognitive impairment, and urinary incontinence Hydrocephalus: Diagnosis and Treatment • Diagnosis • History and physical exam • Neuroimaging • Treatment • Minimization of brain damage • Symptom management (reduce CSF) • Surgical removal or shunts for blockages Spina Bifida • Second most common birth defect in United States • Neural tube defect varying in severity • Incidence, risk factors, and complications • Forms • Spina bifida occulta • Meningocele • Myelomeningocele • Treatment • Surgery (meningocele, myelomeningocele) Cerebral Palsy (CP) • Nonprogressive disorders appearing in infancy or early childhood • Permanently affects motor movement and muscle coordination • Results from brain abnormalities or damage to cerebellum • Risk factors (partial list) • Prematurity, LBW, breech births, multiple fetuses, hypoxia, hypoglycemia CP: Clinical Manifestations • Classified according to movement disorder involved • Neurobehavioral signs • Developmental reflexes • Motor tone and posture • Spastic subtype • Dyskinetic subtype • Ataxic subtype • Complications CP: Diagnosis and Treatment • Diagnosis • History and physical exam • Head CT, MRI, and EEG • Vision and hearing screening • Treatment • Focuses on maximizing functions and minimizing complications • Muscle relaxants, Botox injections, antiseizure medications, pain management • Physical, occupational, and speech therapy Meningitis • Inflammation of the meninges, usually from infection • Transmission modes • Risk factors and complications • Clinical manifestations mimic influenza infection • Diagnosis • Throat cultures, lumbar puncture, PCR test • Head CT • Treatment • Antibiotics, antivirals, hydration, and fever management Encephalitis • Brain inflammation, usually from infection • Primary or secondary • Manifests as flulike symptoms • Diagnosis includes: • History and physical exam • Head CT and MRI, EEG • Lumbar puncture • Treatment: supportive • Prevention strategies Zika Virus Disease • Flavivirus transmitted primarily by mosquitoes • Manifests as flulike symptoms • Diagnosis • History and physical exam • Body fluid examination • Treatment: supportive • Importance of prevention Brain Injuries • Caused by: • Sudden and violent blow or jolt • Penetrating head wound • Disruption of normal brain function • Main causes of TBIs • Complications • Closed vs. open injuries TBIs: Clinical Manifestations • Vague and slow or sudden and severe development • Glasgow Coma Scale • Limitations • Neurobehavioral changes • Consciousness • Coma • Vegetative state • Minimally conscious state TBIs: Diagnosis and Treatment • Diagnosis • History and physical • Head CT and MRI • ICP monitoring • Treatment for mild injuries • Treatment for moderate to severe injuries • Hospitalization and intensive care • Prevention strategies Increased Intracranial Pressure • Increased volume (fluid or tissue) in cranial cavity • Monro-Kellie hypothesis • Explains pressure-volume relationship among: • ICP • Volume of CSF, blood, and brain tissue • Cerebral perfusion • Compensation mechanisms • Herniation complication ICP: Clinical Manifestations • Vary depending on age • Decreasing level of consciousness, vomiting, increasing BP, bradycardia, papilledema, fixed and dilated pupils, posturing • Infants • Separate sutures and bulging fontanelle • Children and adults • Behavior changes, severe headache, lethargy, neurologic deficits, seizures ICP: Diagnosis and Treatment • Diagnosis • History and physical exam • Head CT and MRI • ICP monitoring • Treatment • Depend on underlying etiology • Focus on resolving source • Strategies similar to those for TBIs Hematomas • Collection of blood in tissue from ruptured blood vessels • Classified by location • Epidural, subdural, intracerebral, and subarachnoid • Formation of hematomas and effects • Diagnosis • History, physical, head CT and MRI, cerebral angiogram, and intracranial pressure monitor • Treatment: surgical removal of blood Spinal Cord Injuries • Result from: • Direct injury to the spinal cord • Indirectly from damage to bones, tissue, or blood vessels • Causes of injury • Primary and secondary injury • Edema and hemorrhagic necrosis • Spinal shock SCIs: Clinical Manifestations (1 of 2) • Significant loss of neurologic functioning • Spinal shock • Flaccid paralysis, lack of sensation, loss of reflex activity • Poor temperature control • Neurogenic shock • Loss of sympathetic tone in vascular smooth muscle • Massive vasodilation SCIs: Clinical Manifestations (2 of 2) • Autonomic dysreflexia • Loss of coordinated heart rate and vascular response • SCI dysfunction • Dependent on level, location, and severity of injury • American Spinal Injury Association (ASIA) classification (A-D classes) SCIs: Diagnosis and Treatment • Diagnosis • ABCDE assessment format • Neurologic evaluation and imaging studies • Treatment • Immediate strategies for intensive medical care • Multisystem chronic complications • Long-term strategies Cerebral Vascular Accident (1 of 2) • Interruption of cerebral blood supply • Ischemic or hemorrhagic types • Incidence and prevalence • Ischemic strokes • Thrombotic and embolic subtypes • Penumbra • Cascade of events for brain ischemia • Cytotoxic edema and vasogenic edema • Transient ischemic attacks (TIAs) Cerebral Vascular Accident (2 of 2) • Clinical manifestations • Sudden loss of focal brain function in ischemic strokes • Manifestation based on effect on anterior or posterior circulation • Diagnosis • History and physical exam • Head CT and MRI, cerebral angiography, EKG, and lab tests • Crucial to determine ischemic or hemorrhagic origin CVA: Treatment • Importance of early treatment • Ischemic strokes • Thrombolytic agents, angioplasty, or carotid endarterectomy, statin agent • Hemorrhagic strokes • Surgical repair of aneurysms or arteriovenous malformations, blood removal • TIA treatment strategies Cerebral Aneurysm • Localized outpouching of a cerebral artery • Causes and risk factors • Asymptomatic until compression or rupture • Risk of rupture • Diagnosis • Head CT or MRI • EEG • Cerebral arteriography • Treatment: surgical repair Arteriovenous Malformations • Arteries and veins connected in tangled mess • Causes and incidence • Presentations of intracranial hemorrhage, seizure, and headaches • Diagnosis • Head CT or MRI • Treatment • Excision, focused radiation therapy, or endovascular embolization Migraine Headaches • Severe headaches • Often associated with systematic complaints • Types • Migraine with or without aura • Results from wave of self-propagating neuronal and glial depolarization • Spreads across the cerebral cortex • Neurogenic inflammation leads to neuronal sensitization Migraine: Clinical Manifestations • Experience of a prodrome • Irritability, euphoria, depression yawning, food craving, constipation • Visual, sensory, language, and motor auras • Throbbing or pulsatile pain, nausea and vomiting • Photophobia and phonophobia • Triggers Migraines: Diagnosis and Treatment • Diagnosis • History and physical exam • International Headache Society criteria for diagnosis • Treatment • Pharmacotherapeutics for acute episodes and as prevention • CGRP antagonists and herbal medications • Clinical situations of possible underlying disorder Tension-Type Headaches • Result from hypersensitivity of nerve fibers • Episodic or chronic • Generally mild to moderate manifestations • Dull, full, or tight feelings • Diagnosis • History and physical exam • Treatment • Pharmacotherapeutic agents • NSAIDs, acetaminophen, aspirin, etc. • Preventive measures Cluster Headaches • Short bursts of unilateral orbital pain • Key features • Trigeminal distribution of the pain • Unilateral and same side autonomic features • Manifests with severe throbbing or stabbing pain, lacrimation, ptosis, sweating, etc. • Diagnosis: history and physical exam • Treatment • Oxygen and triptans to abort acute attack • Preventive therapy (e.g., verapamil) Seizure Disorders • Transient physical or behavioral alteration resulting from abnormal electrical brain activity • Potential causational mechanisms • Definitions of epilepsy • Incidence and prevalence • Febrile seizures in children Seizure Disorders: Clinical Manifestations • Focal and generalized seizure categories • Simple or complex focal seizures • Types of generalized seizures • Absence, tonic, clonic, myoclonic, atonic, and tonic-clonic • Unknown type category Seizure Disorders: Diagnosis and Treatment • Diagnosis • Thorough history and physical exam • Treatment • Focused on preventing and limiting duration • Safety precautions • Antiseizure agents for epilepsy • Effects and need for close monitoring Multiple Sclerosis • Debilitating inflammatory, immune-mediated condition • Demyelination and axonal degeneration of brain, spinal cord, and optic nerve • Progressive and irreversible • Genetic susceptibility for MS development • Theoretical explanation for demyelination • Immune involvement MS: Clinical Manifestations • Characterized by remissions and exacerbations • Sensory symptoms in limbs or face • Visual issues, motor spasticity, cognitive changes • Bladder, bowel, and sexual dysfunction • Sleep issues, brainstem symptoms, fatigue, pain • Experience of transverse myelitis MS: Diagnosis and Treatment • Diagnosis • No definitive test or cure for MS • Treatment • Focused on minimizing symptoms and maximizing quality of life • • • • Medications Physical and occupational therapy Assistive devices Coping strategies, support, proper nutrition, adequate rest Parkinson’s Disease • Neuron loss in substantia nigra and depletion of dopamine • Results in impairment in smooth, coordinated muscle movement • Structures of the basal ganglia • Causes and cascade of cellular level abnormalities Parkinson’s Disease: Clinical Manifestations • Key manifestations • Tremor, akinesia, rigidity, postural instability • Other motor dysfunction manifestations • Masked facial expression, slowing or stopping of automatic movements, micrographia, speech impediments • Nonmotor manifestations • Mood changes, cognitive dysfunction, and dementia Parkinson’s Disease: Diagnosis and Treatment • Diagnosis • No definitive test or cure • Treatment • Focused on controlling symptoms • Pharmacotherapeutic agents • Levodopa, dopamine agonists, MAO-B inhibitors, and amantadine • Anticholinergics • Deep brain stimulation Amyotrophic Lateral Sclerosis • Damage to motor neurons of cerebral cortex, brain stem, and spinal cord • Investigation of etiology • Early manifestations • Footdrop, lower-extremity weakness, hand weakness, dysarthria or dysphagia, etc. • Diagnosis: no definitive test or cure • Treatment • Drugs to slow progression • Supportive and palliative care Myasthenia Gravis • Autoimmune condition • Acetylcholine receptors impaired or destroyed by IgG autoantibodies • Manifests as muscle weakness and fatigue • Ocular dysfunction, affected bulbar muscles, limb involvement, etc. • Diagnosis • History, physical exam, and serum testing • Treatment • Symptom management Huntington’s Disease • Genetically programmed degeneration of neurons in the brain • Autosomal dominant disorder with defect on chromosome 4 in HTT gene • Clinical manifestations • Choreiform movements, psychiatric problems, and dementia • Treatment: • Focused on slowing progression and managing symptoms • Tetrabenazine, tranquilizers, antipsychotics, coping strategies, etc. Alzheimer’s Disease • Most common form of dementia among older adults • Degeneration/atrophy of healthy brain tissue • Decline in memory and mental abilities • Increasing incidence • Pathologic characteristics • Amyloid plaques • Neurofibrillary tangles • Loss of connections among neurons AD: Clinical Manifestations • Begins with mild memory loss and confusion • Subtypes of memory • Explicit memory • Semantic and episodic • Implicit memory • Procedural, priming and perceptual learning, associative and nonassociative learning • Specific pattern of memory loss • Impairment of problem solving, judgment, and executive functioning AD: Diagnosis and Treatment • Diagnosis • Involves ruling out other conditions • Diagnostic clinical criteria • Treatment • No cure or therapies to slow progression • Medications to manage symptoms and maximize functioning • Medications to control aggression • Other strategies Vascular Dementia • Progressive syndrome resulting from any disorder impairing cerebral blood flow • Often coexists with dementia • Common cause and finding • Cerebral small vessel disease • Manifestations dependent on coexisting disorders Dementia with Lewy Bodies • Formation of Lewy bodies • Made of proteins ubiquitin and synuclein • Essential manifestation of progressive dementia • Early impairment of attention, executive and visuospatial functioning • Clinical criteria for diagnosis • Pharmacologic and nonpharmacologic treatment strategies Frontotemporal Dementia • Disorder spectrum leading to focal degeneration of frontal and/or temporal lobes • Three forms of clinical manifestations • Behavioral variant FTD • Nonfluent and semantic primary progressive aphasia • Treatment • Nonpharmacologic treatment • Behavior modification techniques • Caregiver support Creutzfeldt-Jakob Disease • Rare, rapidly progressive form of dementia • Caused by an infectious prion • Long incubation period • Fatal within 1 year of onset • Manifests as ataxia, lack of coordination, muscle twitching, myoclonic jerks, spasticity • Treatment • Interleukins and immunomodulator agents • Custodial care, medications for symptoms, family counseling AIDS Dementia Complex • Dementia common in later stages of AIDS • Clinical manifestations • Encephalitis, behavioral changes, gradual decline in cognitive functioning • Progressive slowing of motor function • Staging system (0 to 4) • Aggressive antiretroviral therapy as cornerstone of treatment Brain Tumors • Life-threatening whether malignant or benign • Cause increase in ICP, difficult to access • Primary vs. secondary tumors • Manifests as headaches, nausea, vomiting, seizures, neurocognitive dysfunction, etc. • Diagnosis • History, physical exam, brain MRI, and biopsy • Treatment • Surgical removal, if possible • Radiation, chemotherapy, targeted drug therapy, and rehabilitation Depressive Disorders • Mood disorder commonly featuring persistent sad, empty, or irritable mood • Cognitive changes and somatic manifestations • Incidence and prevalence • Complex and multifactorial development • Genetic factors, alterations in neuroendocrine system, abnormal neurotransmitter functioning • Neural network model Depressive Disorders: Clinical Manifestations • Major depressive disorder (MDD) • Depressed mood, anhedonia • Changes in weight, sleep, and activity • Feelings of worthlessness or excessive guilt • Diminished ability to concentrate or indecisiveness • Impaired functioning • Persistent depressive disorder • Premenstrual dysphoric disorder Depressive Disorders: Diagnosis and Treatment • Diagnosis • History and physical exam • DSM-V criteria • Treatment • Psychotherapy and pharmacotherapy • SSRIs and herbal supplements • Other therapies • Relaxation and lifestyle management • For severe depression • Brain stimulation Bipolar Disorders (1 of 2) • Episodes of mania, hypomania, and major depression • Complex, multifactorial, and poorly understood pathogenesis • Connection with schizophrenia development • Genetic influence • Manifestations of mania • Inflated self-esteem, decreased need for sleep, talkative, flight of ideas, distractibility, etc. Bipolar Disorders (2 of 2) • Manifestations of depressive episodes • Same as in MDD • Bipolar I and II as subtypes • Hypomanic episode • 4 day duration of manic symptoms • Cyclothymic disorder • Pharmacotherapeutics as mainstay of treatment Schizophrenia (1 of 2) • Chronic, recurrent psychotic disorder • Characterized by: • Alterations in perception of reality, • Disorganized thinking or abnormal behavior • Disruptions in normal emotional states and expressions • Likely resulting from genetic, epigenetic, and environmental factors Schizophrenia (2 of 2) • Clinical manifestation categories • Positive, negative, and cognitive symptoms • Criteria for diagnosis • Related disorders • Schizoaffective disorder, schizotypal personality disorder, delusional disorder • Treatment • Pharmacotherapeutics • Psychosocial interventions Anxiety Disorders (1 of 2) • Group of disorders characterized by fear and anxiety • Incidence and prevalence • Types of anxiety disorders • Unknown biological basis • Genetic links Anxiety Disorders (2 of 2) • Manifestations by type of anxiety disorder • Panic disorder • Generalized anxiety disorder • Social anxiety disorder • Diagnosis • History and physical exam • DSM-V criteria • Treatment • Pharmacotherapy with psychotherapy • Behavioral techniques Obsessive Compulsive Disorders • Chronic, repetitive, intrusive thoughts or urges • Repetitive mental or behavioral acts • Obsessions and compulsions as manifestations • Themes • Treatment • Psychotherapy, family therapy, and psychoeducation • Pharmacotherapeutics, brain stimulation, and surgical techniques

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