NU664C/ NU 664C Final Exam (2026/2027 Update) Family Psychiatric Mental Health I | Questions & Answers | Verified Solutions | Regis

…..DLDD NU664C/ NU 664C Final Exam (2025/2026 Update) Family Psychiatric Mental Health I | Questions & Answers | Verified Solutions | Regis Q. What are the subtypes of Depressive Disorders to know? Answer Persistent (Dysthymia), Melancholic, Atypical, Psychotic, Postpartum, Childhood Depression. Q. What characterizes Persistent Depressive Disorder (Dysthymia)? Answer Chronic, low-grade depression lasting at least 2 years (or 1 year in children) with symptoms like low self-esteem, poor concentration, fatigue, and hopelessness. Q. How do the symptoms of Persistent Depressive Disorder compare to Major Depression? Answer Symptoms are less severe than major depression but longer-lasting. Q. What is a common treatment for Persistent Depressive Disorder? Answer SSRIs and cognitive-behavioral therapy. Q. What are the key features of Melancholic Depression? Answer Profound loss of pleasure (anhedonia), lack of mood reactivity, early morning awakening, weight loss, and psychomotor changes. Q. Who is more likely to experience Melancholic Depression? Answer Common in older adults and hospitalized patients. Q. What treatments are effective for Melancholic Depression? Answer Medications and electroconvulsive therapy (ECT). Q. What distinguishes Atypical Depression from other types? Answer Mood can improve in response to positive events, with features like increased appetite, weight gain, excessive sleep, and heavy limbs. Q. What demographic is more commonly affected by Atypical Depression? Answer Younger individuals and those with bipolar disorder. Q. What is the treatment for Atypical Depression? Answer SSRIs or MAOIs. Q. What defines Psychotic Depression? Answer Severe depression with delusions or hallucinations, which can be mood-congruent or mood-incongruent. Q. What is the treatment approach for Psychotic Depression? Answer Combined treatment with antidepressants and antipsychotics or ECT. Q. What is Postpartum Depression and when does it onset? Answer Onset during pregnancy or within four weeks after delivery, characterized by sadness, anxiety, irritability, and difficulty bonding with the baby. Q. How does Postpartum Depression differ from 'baby blues'? Answer It is more intense and long-lasting than 'baby blues'. Q. What are the symptoms of Childhood Depression? Answer Irritability, academic decline, withdrawal from peers, somatic complaints, and low self-esteem. Q. What are common risk factors for Childhood Depression? Answer Family history and environmental stressors. Q. What neurobiological factors are involved in depression? Answer Dysregulation of serotonin, norepinephrine, and dopamine; structural brain changes include decreased hippocampal volume and hypoactivity in the prefrontal cortex. Q. What genetic factor is associated with depression? Answer The serotonin transporter gene (5-HTTLPR). Q. What are the side effects of SSRIs? Answer GI upset, sexual dysfunction, insomnia. Q. What distinguishes SNRIs from SSRIs? Answer SNRIs inhibit serotonin and norepinephrine reuptake and may cause hypertension. Q. What are examples of atypical antidepressants? Answer Bupropion (activating, seizure risk) and mirtazapine (sedating, weight gain). Q. What treatments are considered for Treatment-Resistant Depression? Answer Augmentation with lithium, atypical antipsychotics, or T3; also consider TMS or ECT. Q. What is ECT and when is it effective? Answer Effective in severe or treatment-resistant depression, catatonia, or suicidal ideation; may increase monoamine availability and neuroplasticity. Q. What are the key differences between Bipolar Depression and Major Depressive Disorder (MDD)? Answer Bipolar depression often presents with hypersomnia, hyperphagia, psychomotor retardation, and a family history of bipolar disorder; antidepressant monotherapy may trigger mania. Q. How does normal grief differ from Major Depressive Disorder? Answer Normal grief includes emotional pain with preserved self-esteem, while MDD includes pervasive anhedonia, guilt, feelings of worthlessness, and suicidal ideation unrelated to the deceased. Q. What is the difference between Persistent Depressive Disorder and Major Depressive Disorder? Answer Dysthymia involves chronic low mood for 2+ years with intermittent symptoms, while MDD involves discrete episodes with significant impairment and more acute symptomatology. Q. What are the symptoms of Major Depressive Disorder (MDD)? Answer Depressed mood, anhedonia, appetite/sleep changes, psychomotor changes, fatigue, guilt/worthlessness, poor concentration, suicidal ideation. Q. What are the symptoms of Premenstrual Dysphoric Disorder? Answer Mood lability, irritability, and depression during the luteal phase. Q. What are the main features of Disruptive Mood Dysregulation Disorder (DMDD)? Answer Severe temper outbursts and chronic irritability in children. Q. What distinguishes Depression with Psychotic Features? Answer Presence of mood-congruent or incongruent delusions/hallucinations. Q. What is the Kindling Hypothesis in relation to depression? Answer Each episode of depression increases vulnerability to future episodes, with neurobiological sensitization to stressors over time. Q. What constitutes treatment resistance in depression? Answer Inadequate response to at least two antidepressants at adequate dose/duration. Q. What are some contributing factors to treatment resistance in depression? Answer Non-adherence, comorbid anxiety, substance use, personality disorders, and incomplete diagnosis. Q. What are some strategies for managing treatment-resistant depression? Answer Medication switch or augmentation (lithium, atypical antipsychotics, T3), ECT, TMS, and psychotherapy (CBT, IPT). Q. What does the STAR*D trial support regarding depression management? Answer Multi-step management approach. Q. What are the types of delusions in Delusional Disorders? Answer Grandiose, somatic, persecutory, jealous, and erotomanic. Q. What characterizes Schizoaffective Disorder? Answer A major mood episode (depressive or manic) concurrent with schizophrenia symptoms, with delusions or hallucinations present for 2 weeks in the absence of mood symptoms. Q. is the Dopamine Hypothesis in relation to schizophrenia? Answer Positive symptoms are linked to hyperactivity of dopamine in the mesolimbic pathway, while negative symptoms are related to hypoactivity in the mesocortical pathway. Q. What are the DSM-5-TR criteria for schizophrenia? Answer Two or more of the following for at least 1 month: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms; duration of 6 months. Q. What is required for a diagnosis of Delusional Disorder? Answer One or more delusions for 1 or more months, with functioning not markedly impaired and no prominent hallucinations, disorganized behavior, or negative symptoms. Q. What defines Panic Disorder? Answer Recurrent unexpected panic attacks with at least one month of worry or behavioral change. Q. What neurobiological factors are associated with Panic Disorder? Answer Hyperactive amygdala, decreased GABA activity, and increased norepinephrine. Q. What are the first-line treatments for Panic Disorder? Answer SSRIs (block serotonin reuptake) and benzodiazepines (enhance GABA; rapid onset but risk of dependence). Q. What is Social Anxiety Disorder characterized by? Answer Fear of social evaluation, treated with SSRIs or CBT. Q. What are some CBT techniques used in treating anxiety disorders? Answer Cognitive restructuring, exposure therapy, and thought records. Q. What are cognitive distortions? Answer Patterns of negative thinking, including all-or-nothing thinking, catastrophizing, and overgeneralization. Q. What is all-or-nothing thinking? Answer Viewing situations in black-and-white categories; if something isn't perfect, it's seen as a total failure. Q. What is catastrophizing? Answer Expecting the worst-case scenario or exaggerating the consequences of a situation. Q. What is overgeneralization? Answer Drawing broad, negative conclusions based on a single event. Q. What are the subtypes of Obsessive-Compulsive and Related Disorders? Answer Body Dysmorphic Disorder, Trichotillomania, Excoriation Disorder, Hoarding Disorder. Q. What characterizes Body Dysmorphic Disorder (BDD)? Answer A preoccupation with perceived physical defects that are not observable or appear slight to others, leading to distress and repetitive behaviors. Q. What are common behaviors associated with Body Dysmorphic Disorder? Answer Repetitive behaviors such as mirror checking and skin picking, or mental acts like comparing appearance. Q. What is Trichotillomania? Answer A disorder involving recurrent pulling out of one's own hair, resulting in noticeable hair loss. Q. What are common sites for hair pulling in Trichotillomania? Answer Scalp, eyebrows, and eyelashes. Q. What is a key feature of Excoriation (Skin-Picking) Disorder? Answer Recurrent skin picking that results in skin lesions and may lead to tissue damage, infection, and scarring. Q. What can trigger skin picking in Excoriation Disorder? Answer Stress, boredom, or perceived imperfections. Q. What defines Hoarding Disorder? Answer Persistent difficulty discarding possessions, leading to accumulation that congests living areas and causes distress. Q. What are common traits associated with Hoarding Disorder? Answer Indecisiveness, perfectionism, and procrastination. Q. What is the clinical classification of these disorders in DSM-5? Answer They are classified under Obsessive-Compulsive and Related Disorders. Q. What are common treatments for OCD and related disorders? Answer Cognitive Behavioral Therapy (CBT), SSRIs, and sometimes behavioral habit reversal training. Q. What are the DSM-5 criteria for OCD? Answer Obsessions (intrusive thoughts) and/or compulsions (repetitive behaviors) that are time-consuming (1 hour/day) and cause significant distress. Q. What is the duration for excessive worry in Generalized Anxiety Disorder (GAD)? Answer 6 months or more. Q. What are the symptoms associated with Panic Disorder? Answer Recurrent unexpected panic attacks and concern or change in behavior following the attacks. What defines Social Anxiety Disorder? An intense fear of social situations. What neurobiological dysfunction is associated with OCD? Dysfunction in the cortico-striato-thalamo-cortical circuit. What are the first-line treatments for anxiety disorders? SSRIs (e.g., fluoxetine, sertraline) and SNRIs (e.g., venlafaxine, duloxetine), along with CBT. What are common side effects of SSRIs? Gastrointestinal upset, insomnia, and sexual dysfunction. What is a potential risk associated with MAOIs? Risk of hypertensive crisis with tyramine. What non-pharmacologic treatments are recommended for anxiety disorders? CBT, exposure therapy, mindfulness, and supportive psychotherapy. What is the role of benzodiazepines in anxiety treatment? Short-term use for acute anxiety. What medications can be used for performance anxiety? Buspirone and beta-blockers. What are the risk factors for suicide? Adolescents, older adults, impulsivity, mood disorders, substance abuse. What are the key components assessed in suicidal ideation? Ideation, plan, means, intent. What does the Interpersonal-Psychological Theory of Suicide propose? It explains suicide through perceived burdensomeness, thwarted belongingness, and acquired capability. What is perceived burdensomeness in the context of suicide? The belief that one is a burden on others, leading to the thought that their death would be worth more than their life. What does thwarted belongingness refer to? The feeling of disconnection from others or lacking meaningful relationships. What is acquired capability for suicide? A developed tolerance for pain and fear of death due to exposure to trauma, self-harm, or violence. What is a high-risk indicator for suicide according to the Interpersonal-Psychological Theory? The presence of perceived burdensomeness, thwarted belongingness, and acquired capability. What assessment tool can be used to screen for perceived burdensomeness and thwarted belongingness? The Interpersonal Needs Questionnaire (INQ). What pathophysiological factor is associated with suicide risk? Dysregulation in the serotonin system, particularly 5-HT1A receptors. What are some high-risk diagnoses for suicide? Mood disorders, psychotic disorders, PTSD, borderline personality disorder. What is the focus of Trauma-Informed Care? Emphasizes safety, trustworthiness, peer support, and collaboration. What are the physiological changes associated with PTSD? Changes in the HPA axis, increased norepinephrine, and decreased cortisol regulation. What does allostatic load refer to? The cumulative biological burden resulting from chronic stress. What are the symptoms of dissociation? Includes depersonalization (feeling detached from self) and derealization (feeling the world is unreal). What are common symptoms of trauma? Nightmares, sleep disturbances, and hyperarousal. How do cultural factors influence trauma? They affect symptom expression and help-seeking behaviors. What are common treatments for trauma-related disorders? Trauma-focused psychotherapy, EMDR, and SSRIs. What are the protective factors against suicide? Support, pregnancy, and religious beliefs. What is the Columbia Suicide Severity Rating Scale (C-SSRS) used for? To assess suicidal ideation, plan, intent, and means. What is the Tarasoff Duty to Warn? Mental health professionals have a duty to warn/protect identifiable victims from patient threats. What does Section 12 of MA Law entail? It allows clinicians to initiate emergency evaluations/hospitalizations and mandates reassessment by a psychiatrist within 72 hours. What are the three requirements for informed consent? Disclosure of condition, risks/benefits, alternatives; capacity to understand; and voluntariness without coercion. What are developmental milestones for infants? Cooing by ~6 weeks, babbling by ~6 months, first words by ~12 months. What are red flags for developmental delays in children? Absence of social smile by 2 months, lack of babbling by 9 months, no walking by 18 months, or limited vocabulary by 24 months. What distinguishes autism spectrum disorder from other developmental delays? Autism spectrum disorder involves persistent deficits in communication, social interaction, and the presence of restricted interests or repetitive behaviors that impair daily functioning. What are the key features of Piaget's Sensorimotor Stage? Object permanence and exploration through senses (0-2 years). What cognitive abilities are developed during the Preoperational Stage according to Piaget? Symbolic thinking, egocentrism, and magical thinking (2-7 years). What is a key feature of the Concrete Operational Stage in Piaget's theory? Logical reasoning about concrete events (7-11 years). What cognitive skill is associated with the Formal Operational Stage? Abstract reasoning and problem-solving (12+ years). What is the first stage of Erikson's Psychosocial Development? Trust vs. Mistrust (0-1 year), where the infant is dependent on consistent caregiving. What happens during the Autonomy vs. Shame stage of Erikson's theory? Children (1-3 years) develop increased independence. What is the focus of the Initiative vs. Guilt stage in Erikson's Psychosocial Development? Children (3-5 years) assert power and control. What are clinical red flags of insecure attachment? Avoidance of caregiver, failure to seek comfort, ambivalence, or extreme fearfulness in routine interactions. What developmental milestones are typical for infants? Cooing around 6 weeks, babbling around 6 months, and first words around 12 months. What are common developmental milestones for toddlers? Parallel play, walking around 12-15 months, and using two-word phrases around 2 years. How does low birth weight relate to child development? It is associated with developmental delays, learning difficulties, and attention problems. What did Bowlby emphasize in Attachment Theory? The evolutionary function of attachment as crucial for survival. What attachment styles did Ainsworth identify in her Strange Situation experiment? Secure, avoidant, ambivalent, and disorganized. What did Harlow's studies with rhesus monkeys demonstrate about attachment? Comfort and contact are more important than food in forming attachments. What is the core idea of Bowlby's attachment theory? Early attachment experiences with caregivers shape emotional and social development. What are the implications of secure attachment in infancy? It leads to resilience, emotional regulation, and stable relationships in adulthood. What can result from disruption or inconsistency in attachment according to Bowlby? It may contribute to later psychopathology such as anxiety, depression, and difficulties in interpersonal relationships. What is the significance of secure attachment in trauma recovery? It acts as a protective factor and promotes engagement in psychotherapy. What does the ambivalent attachment style indicate about a child's behavior? The child is highly distressed when the caregiver leaves and is not easily soothed upon return. What cognitive skill is demonstrated when a child understands that pouring water into a taller glass doesn't change the amount? Conservation of volume, a key feature of the Concrete Operational Stage. What is an example of symbolic thinking in the Preoperational Stage? A child using a banana as a phone during play. What is a key feature of the Formal Operational Stage as it relates to moral dilemmas? A teen can discuss hypothetical moral dilemmas and think about future or political ideas. What behaviors characterize a disorganized child? Disoriented and inconsistent behaviors, often seen in contexts of trauma or abuse. What did Harry Harlow's studies on infant monkeys reveal about attachment? Monkeys preferred cloth surrogates over wire surrogates, demonstrating that contact comfort is more crucial than physical nourishment in forming attachment. How can insecure or disorganized attachment manifest in psychiatric settings? It may manifest as borderline personality disorder, PTSD, or anxiety disorders. What is the importance of understanding a patient's attachment style in therapy? It informs therapeutic rapport building, trauma-informed care, and psychotherapy approaches. What are key nonverbal cues in therapeutic communication? Posture, eye contact, and silence. What are some techniques used in therapeutic communication? Active listening, therapeutic silence, empathy, reflection, and advanced empathy. What is the goal of trauma communication in therapy? To avoid retraumatizing the client and to use grounding techniques. What components are included in a Mental Status Exam (MSE)? Appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, and judgment. How is abstract thinking tested in a Mental Status Exam? By using proverbs. What role does the hippocampus play in behavior? It is involved in the consolidation of short- to long-term memory. What function does the amygdala serve? It processes fear, aggression, and emotional memory. What is the function of the prefrontal cortex? It is responsible for executive functioning, personality, and impulse control. What is Wernicke's area and what happens if it is damaged? Located in the dominant temporal lobe, damage causes receptive aphasia. What are the implications of enlarged ventricles in schizophrenia? They indicate reduced gray matter and disrupted fronto-temporal connectivity. How does depression affect the prefrontal cortex? It shows hypoactivity in the prefrontal cortex and reduced hippocampal volume. What neurotransmitter is associated with mood regulation and is low in depression? Serotonin (5-HT). What is the role of dopamine in the brain? It is involved in reward, motivation, and motor control. What is the significance of GABA in anxiety disorders? It is a major inhibitory neurotransmitter with reduced function in anxiety disorders. What is the PMHNP scope of practice? Full psychiatric evaluations, diagnosis, treatment planning, and prescribing. What does a biopsychosocial formulation integrate? It integrates biological, psychological, and social factors influencing illness. What are the standards of practice for psychiatric mental health nursing? Personal integrity, professional resilience, moral reflexivity, and ethical mindfulness. What brain region is responsible for executive functioning? The dorsolateral prefrontal cortex (PFC). What are the cognitive effects of hypoactivity in depression? Poor concentration, indecisiveness, and decreased cognitive flexibility. What role does the Anterior Cingulate Cortex (ACC) play in depression? Regulates emotion, motivation, and error detection; hypoactivity contributes to anhedonia, apathy, and reduced emotional regulation. How does depression affect the hippocampus? Depression is associated with reduced hippocampal volume, leading to memory problems and feelings of hopelessness, possibly due to chronic cortisol exposure and neuroinflammation. What is the function of the amygdala in the context of depression? Regulates fear and threat perception; hyperactivity in depression results in negative bias, rumination, and increased emotional reactivity. What neurotransmitter is linked to mood regulation and what are the effects of low levels? Serotonin (5-HT) regulates mood, anxiety, and sleep; low levels result in sadness, anxiety, and irritability. What impact does norepinephrine (NE) have on mood, and what occurs with low levels? Norepinephrine impacts arousal, energy, and focus; low levels lead to fatigue and decreased interest. What is the role of dopamine (DA) in depression, and what are the consequences of low levels? Dopamine is involved in motivation and reward; low levels result in anhedonia and lack of pleasure. What is the 5-HTTLPR polymorphism and its significance in depression? A gene variation on chromosome 17; the short allele (s/s genotype) is associated with decreased serotonin transport efficiency and greater vulnerability to depression under stress. What does the Kindling Hypothesis propose regarding depression? Early episodes are triggered by stressors, but with repeated episodes, the brain becomes sensitized, leading to episodes occurring autonomously. What are the first-line medications for treating depression? SSRIs (e.g., fluoxetine, sertraline) and SNRIs (e.g., venlafaxine, duloxetine) are commonly used for their favorable side effect profiles. What augmentation strategies are used when first-line treatments fail? Lithium, atypical antipsychotics (e.g., aripiprazole), T3 (triiodothyronine), and psychostimulants. What are common adverse effects to monitor with SSRIs? Sexual dysfunction, gastrointestinal upset, and varying effects on sedation or insomnia. What defines Treatment-Resistant Depression (TRD)? Inadequate response to 2 or more antidepressant trials of adequate dose and duration. What is Electroconvulsive Therapy (ECT) and its effectiveness? Highly effective for psychotic depression, catatonia, and urgent suicidality; increases GABA activity and resets cortical-thalamic circuits. What is Transcranial Magnetic Stimulation (TMS) used for? A non-invasive treatment approved for Major Depressive Disorder (MDD) that stimulates the left dorsolateral prefrontal cortex. How does Ketamine/Esketamine function in treating depression? They are NMDA receptor antagonists with a rapid onset, indicated for acute suicidal ideation and treatment-resistant depression. What are the clinical implications of the Kindling Hypothesis? Early treatment is critical to prevent recurrence of depressive episodes and reduce illness progression. What are the effects of combining serotonergic agents? Increased risk of serotonin syndrome, particularly when combining SSRIs with triptans or MAOIs. What are the potential benefits of lithium in depression treatment? Acts as a mood stabilizer and has evidence for suicide prevention. What role do atypical antipsychotics play in depression treatment? Used as augmentation strategies when first-line treatments fail. What is the significance of monitoring gastrointestinal upset during antidepressant treatment? It is a common side effect, especially during the initiation of treatment. What is the relationship between genetics and environmental factors in depression? Genetic polymorphisms, like the 5-HTTLPR, can modulate the risk of depression in response to environmental stressors. What are the core symptoms required for a schizophrenia diagnosis according to DSM-5-TR? At least 2 core symptoms for at least 1 month, including delusions, hallucinations, or disorganized speech, with functional decline. What is the minimum duration for schizophrenia symptoms to be considered for diagnosis? Symptoms must last for at least 6 months, including prodromal/residual periods. What is a grandiose delusion? Belief in exceptional abilities, fame, or power, such as insisting one is a world-renowned scientist despite lacking qualifications. What characterizes a persecutory delusion? Belief that one is being harmed, harassed, or conspired against, like a student believing professors are plotting against them. Define somatic delusion and provide an example. False belief about bodily functions or sensations, such as insisting insects are crawling under one's skin. What is a referential delusion? Belief that unrelated events or comments are directed specifically at oneself, like thinking a news anchor is sending secret messages. What are the subtypes of schizophrenia according to DSM-5-TR? Formal subtypes were removed, but clinical descriptions include catatonic, disorganized, paranoid, and undifferentiated. What is schizoaffective disorder? A condition featuring mood symptoms (depression or mania) alongside schizophrenia symptoms, with psychosis persisting for ≥2 weeks without mood symptoms. What are the diagnostic features of OCD? Obsessions are recurrent, intrusive thoughts; compulsions are repetitive behaviors performed to reduce distress, causing significant impairment. Name a related disorder to OCD and describe it. Body Dysmorphic Disorder: Preoccupation with a perceived physical flaw. What is the neurobiological dysfunction associated with OCD? Dysfunction in the orbitofrontal cortex, caudate nucleus, and anterior cingulate cortex, with serotonin dysregulation implicated. What is the first-line treatment for OCD? SSRIs and Cognitive Behavioral Therapy (CBT). What characterizes panic disorder? Sudden onset of intense fear with physical symptoms, followed by 1+ month of concern or behavioral change. What brain structures are involved in the neurobiology of anxiety disorders? Amygdala, hippocampus, and locus coeruleus, along with serotonin, norepinephrine, and GABA systems. How is the amygdala related to anxiety disorders? Hyperactivity in the amygdala is linked to anxiety disorders, PTSD, and phobias. What is the role of the orbitofrontal cortex in OCD? It is involved in decision making, and dysfunction here is associated with OCD symptoms. What is the role of the caudate nucleus in OCD? It is involved in habit learning, and its dysfunction can contribute to compulsive behaviors. What is the anterior cingulate cortex's function in relation to OCD? It is involved in error detection, and dysfunction may lead to difficulties in recognizing compulsive behaviors. What is the significance of serotonin in OCD? Serotonin dysregulation is most implicated in the neurobiology of OCD. What is the difference between schizoaffective disorder and mood disorders with psychotic features? In schizoaffective disorder, psychosis persists for ≥2 weeks without mood symptoms, unlike mood disorders where psychotic symptoms occur only during mood episodes. What are the symptoms of catatonic schizophrenia? Immobility, mutism, negativism, echolalia, or echopraxia. What defines disorganized schizophrenia? Disorganized speech, behavior, and flat or inappropriate affect. What is the role of the amygdala in anxiety disorders? Hyperactivity in the amygdala is linked to anxiety disorders, PTSD, and phobias, and it plays a central role in initiating the fight-or-flight response. What is the function of the hippocampus in relation to fear? The hippocampus is responsible for memory consolidation and contextualizing fear; chronic stress or trauma can lead to hippocampal atrophy, observed in depression and PTSD. What is the primary function of the locus coeruleus? The locus coeruleus is the primary source of norepinephrine (NE) in the brain, activating in response to stress and arousal, mediating vigilance and autonomic responses. What are the consequences of dysregulation in the locus coeruleus? Dysregulation is associated with panic disorder and hyperarousal symptoms in PTSD. What is serotonin's role in mental health? Serotonin (5-HT) regulates mood, sleep, appetite, and impulse control; deficits are linked to depression, anxiety, and OCD. How do SSRIs and SNRIs relate to serotonin? SSRIs and SNRIs are antidepressants that target serotonin systems to alleviate symptoms of depression and anxiety. What is norepinephrine's role in the brain? Norepinephrine (NE) mediates alertness, focus, energy, and response to stress; dysregulation contributes to depression, anxiety, and ADHD. What medications act on norepinephrine systems? Medications such as SNRIs and bupropion act on norepinephrine systems. What is the function of gamma-aminobutyric acid (GABA)? GABA is the primary inhibitory neurotransmitter in the brain, promoting calming and anti-anxiety effects by reducing neural excitability. How do benzodiazepines affect GABA? Benzodiazepines and other anxiolytics enhance GABA activity, reducing acute anxiety and panic symptoms. What are the clinical implications of decreased serotonin and norepinephrine? In depression, there is decreased serotonin and norepinephrine along with hippocampal volume loss. What characterizes anxiety disorders in terms of brain activity? Anxiety disorders are characterized by amygdala hyperactivation, low GABA function, and heightened norepinephrine from the locus coeruleus. What is the impact of PTSD on neurotransmitter regulation? PTSD involves dysregulation of the hippocampus, amygdala, and locus coeruleus, with altered norepinephrine and serotonin levels. What are the first-line treatments for depression and anxiety? SSRIs and SNRIs are the mainstay treatments; cognitive-behavioral therapy (CBT) is equally effective. What is the risk associated with benzodiazepines? Benzodiazepines are recommended for short-term use only due to the risk of dependence, especially in the elderly or those with substance use disorders. What is social anxiety disorder? Social anxiety disorder is characterized by intense fear of embarrassment or judgment in social settings. What treatments are effective for social anxiety disorder? Social anxiety disorder is treated with CBT, SSRIs, or beta-blockers for performance anxiety. What is cognitive restructuring in CBT? Cognitive restructuring involves identifying and challenging maladaptive thoughts and replacing them with more balanced cognitions. What is exposure therapy? Exposure therapy gradually confronts feared stimuli or memories to reduce avoidance behaviors and emotional distress. What are the types of exposure therapy? Types include imaginal exposure (recalling feared situations), in vivo exposure (direct confrontation), and interoceptive exposure (exposing to feared bodily sensations). What is the goal of relaxation training? Relaxation training aims to physiologically reduce tension and anxiety through practices like deep breathing and mindfulness meditation. What are the criteria for a manic episode in bipolar disorder? A manic episode requires ≥1 week of elevated or irritable mood plus 3+ symptoms causing functional impairment. What medications are commonly used for bipolar disorder? Mood stabilizers like lithium and valproate, and atypical antipsychotics such as quetiapine and lurasidone are commonly used. What distinguishes Bipolar I from Bipolar II disorder? Bipolar I requires at least one manic episode (with or without depression), while Bipolar II requires at least one hypomanic episode and one major depressive episode. What is defined as rapid cycling in bipolar disorder? Rapid cycling is characterized by having four or more mood episodes in a year. What precautions should be taken when prescribing antidepressants to patients with bipolar disorder? Antidepressant monotherapy should be avoided as it can trigger mania; always co-prescribe with a mood stabilizer if needed. What are the DSM-5 criteria for diagnosing ADHD? Onset must be before age 12, with at least six symptoms of inattention and/or hyperactivity lasting six months, impairing functioning in at least two settings. What are the first-line medications for treating ADHD? Stimulants such as methylphenidate and amphetamine are first-line; non-stimulants include atomoxetine, guanfacine, and clonidine. What are common side effects of ADHD medications? Decreased appetite, insomnia, elevated blood pressure, tics, or irritability. Which screening tools are commonly used for ADHD? Vanderbilt, Conners, and SNAP-IV are used in primary care and school settings. What neurobiological factors are associated with ADHD? Dysfunction in the prefrontal cortex and dopaminergic and noradrenergic systems, along with delayed cortical maturation affecting attention and impulse control. What are the key symptoms of PTSD? Symptoms include intrusion, avoidance, negative alterations in mood/cognition, and hyperarousal, lasting more than one month after trauma exposure. What are the first-line treatments for PTSD? SSRIs and trauma-focused cognitive behavioral therapy (CBT) are first-line treatments; EMDR is also evidence-based. What differentiates Acute Stress Disorder from PTSD? Acute Stress Disorder has the same symptom clusters as PTSD but lasts from three days to less than one month post-trauma. What is the SAD PERSONS scale used for? It is a mnemonic-based tool to assess suicide risk factors. What does a score of 0-2 on the SAD PERSONS scale indicate? Low risk, may discharge with outpatient follow-up. What are high-risk indicators on the Columbia Suicide Severity Rating Scale (C-SSRS)? Active suicidal ideation with a specific plan and intent, recent suicide attempt, access to means, and lack of protective factors. What constitutes a high-risk profile for suicide? Active suicidal ideation, specific plan, access to means, and clear intent to act. What protective factors can reduce suicide risk? Social support, family involvement, religious beliefs, and future orientation and hope. What management strategies should be employed for individuals at high risk for suicide? Involve family, create a safety plan, remove access to means, and consider hospitalization if necessary. What is the duration criteria for PTSD? Symptoms must persist for more than one month following trauma exposure. What is the role of trauma-focused CBT in treating PTSD? It is a first-line treatment that helps patients process trauma and reduce symptoms. What are the key components of the Columbia Suicide Severity Rating Scale (C-SSRS)? It assesses suicidal ideation and behavior, categorizing risk as low, moderate, or high based on structured questions. What should be done if a patient presents with a high-risk profile for suicide? Immediate intervention is required, including possible hospitalization, safety planning, and initiation of treatment. What is the purpose of the Cultural Formulation Interview (CFI) in DSM-5? To explore the cultural definition of the problem, perceptions of cause, context, support, and factors affecting help-seeking. What are some barriers to help-seeking identified in the CFI? Language barriers, stigma in the community, lack of culturally competent providers, and belief in spiritual or moral causes of illness. How can stigma affect treatment in collectivist cultures? In collectivist cultures, such as Chinese culture, mental illness may bring shame on the entire family, leading to delayed treatment or non-disclosure of symptoms. What are the ethical principles outlined in legal and ethical issues? Autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity. What is the difference between capacity and competency in a clinical context? Capacity is determined by the clinician, while competency is determined by the court. What does the Tarasoff ruling establish? The duty to warn identifiable third parties of serious threats. What does Section 12a of Massachusetts law allow? Emergency transport by clinician or police. What does Section 12b of Massachusetts law permit? Psychiatrist admission involuntarily for up to 3 days. What is the purpose of Section 35 in Massachusetts law? Civil commitment for substance use for up to 30 days. What neurotransmitter is primarily associated with Major Depressive Disorder (MDD) and what are its effects? Serotonin (5-HT) is decreased, leading to low mood, sleep issues, and appetite changes. What are the effects of decreased norepinephrine (NE) in Major Depressive Disorder (MDD)? Fatigue, inattention, and psychomotor slowing. What role does dopamine (DA) play in Major Depressive Disorder (MDD)? Dopamine is decreased, resulting in anhedonia and low motivation. What is the effect of glutamate in Major Depressive Disorder (MDD)? Glutamate is dysregulated, leading to neurotoxicity and cognitive dysfunction. How does GABA affect mood in Major Depressive Disorder (MDD)? GABA is decreased, resulting in poor inhibition of negative emotion. What neurotransmitter levels are altered in Bipolar Disorder during mania? Dopamine (DA) is increased, leading to euphoria and impulsivity. What are the effects of increased norepinephrine (NE) in Bipolar Disorder? Hyperactivity and irritability. What happens to serotonin (5-HT) levels in Bipolar Disorder? Serotonin is decreased, causing mood instability. What is the role of glutamate in Bipolar Disorder? Glutamate is increased, leading to increased excitability. How does GABA affect mood regulation in Bipolar Disorder? GABA is decreased, resulting in reduced mood regulation. What is the dopamine dysregulation pattern in Schizophrenia? Dopamine is increased in the mesolimbic area and decreased in the mesocortical area. What symptoms are associated with increased dopamine in Schizophrenia? Hallucinations. What cognitive deficits are linked to decreased glutamate (NMDA) in Schizophrenia? Cognitive deficits and negative symptoms. How does GABA affect executive control in Schizophrenia? GABA is decreased, leading to disinhibited dopamine and poor executive control. What neurotransmitter changes are seen in Generalized Anxiety Disorder? GABA is decreased, leading to hyperarousal and restlessness. What is the effect of increased norepinephrine (NE) in Generalized Anxiety Disorder? Somatic symptoms and vigilance. How does serotonin (5-HT) affect emotional regulation in Generalized Anxiety Disorder? Serotonin is decreased or dysregulated, leading to poor emotional regulation. What role does CRF (Corticotropin-Releasing Factor) play in anxiety disorders? CRF is increased, affecting stress reactivity via the HPA axis. What are the effects of increased norepinephrine (NE) in PTSD? Hypervigilance and startle response. How does serotonin (5-HT) contribute to symptoms in PTSD? Serotonin is decreased, leading to irritability and depressive symptoms. What is the effect of increased dopamine (DA) in PTSD? In some cases, it leads to intrusive memories. How does glutamate affect memory in PTSD? Glutamate is increased, contributing to traumatic memory consolidation. What is the role of GABA in PTSD? GABA is decreased, resulting in impaired fear extinction. What neurotransmitter changes are associated with OCD? Serotonin (5-HT) is decreased or dysregulated, leading to intrusive thoughts and compulsions. What is the effect of increased dopamine (DA) in OCD? Dopamine is increased in the basal ganglia, leading to repetitive behaviors. What imaging technique uses magnetic fields to create detailed brain images? MRI (Magnetic Resonance Imaging) identifies structural abnormalities. What is the purpose of fMRI (Functional MRI)? It measures blood flow changes during brain activity to observe real-time brain function. What does a CT (Computed Tomography) scan identify? It identifies tumors, strokes, and bleeding. What does PET (Positron Emission Tomography) assess? It assesses functional abnormalities by measuring metabolic activity. What is the purpose of EEG (Electroencephalography)? It detects abnormal brain wave patterns. What does DTI (Diffusion Tensor Imaging) assess? It tracks movement of water along white matter tracts to assess connectivity. What is the goal of CBT (Cognitive Behavioral Therapy)? To target dysfunctional thoughts to change behavior. What is the focus of DBT (Dialectical Behavior Therapy)? It combines CBT with mindfulness and emotion regulation. What does Motivational Interviewing (MI) aim to achieve? It enhances motivation for change by resolving ambivalence. What is the purpose of ACT (Acceptance and Commitment Therapy)? It encourages acceptance of thoughts and commitment to values. What is the focus of Family Therapy? It addresses family systems and dynamics to improve communication. Piaget: Sensorimotor Stage Ages: birth to age 2 The stage during which children learn through senses and motor activities. Coordination of sensory input and motor responses Development of object permanence Piaget Perioperations Subperiod Deferred Imitation, symbolic play, Graphic imagery, mental imagery, and language. Piaget Concrete Operations 7-11 years old Begin abstract thought Plays games with rules Cause and effect relationship Conservation of quantity, weight, volume, inclusion/seriation Piaget Formal Operations 12-adult; ability to think abstractly; thinking operates in a formal, logical manner Kohlberg's Theory of Moral Development Moral development takes place in stages and awareness of other people increases at each stage Preconventional: Punishment/obedience Conventional: Act in ways to maintain good relationships with others. Postconventional: Develop ethical principles that are self-accepted. Erikson's Psychosocial Theory stage theory of psychosocial development, lifespan consists of eight dilemmas that must be solved correctly in order to solve the next dilemma Trust vs. Mistrust (Erikson) 0-1 years. Erikson's first stage during the first year of life, infants learn to trust when they are cared for in a consistent warm manner. Can be associated with psychosis, addiction, and depression when negative. Autonomy vs. Shame and Doubt (Erikson) 1 - 3 years. Using new mental and motor skills, children want to choose and decide for themselves. Autonomy is fostered when parents permit reasonable free choice and do not force or shame the child. Aligns with Freud's anal stage. Can be associated with paranoia, OCD, and impulsivity when negative. Initiative vs. Guilt (Erikson) 3-6 yrs, good: sense of purpose, ability to initiate activities, ability to enjoy accomplishment, bad: fear of punishment, restrict himself, show off. Can be associated with conversion disorder, phobias, psychosomatic disorder, and inhibition. Industry vs. Inferiority (Erikson) 6-12 yrs, good: competence, exercise his/her abilities and intelligence in the world, be able to affect world in the way that the child desires bad: inadequacy, low self esteem. Can be associated with creative inhibition, Intertion. Identity vs. Role Confusion (Erikson) 13-19 yr, *most crucial* teens struggle with identity crisis, if healthy experimentation is fostered they attain identity achievement; if not, they face insecurity and low self-worth. Can be associated with delinquency, BPD, gender confusion. Intimacy vs. Isolation (Erikson) 20-40 yrs, good: love, intimate relationships, commitment. bad: avoidance of commitment, alienation, distancing oneself. Schizoid. Generativity vs. Stagnation (Erikson) 40-60 years. favorable resolution results in an individual capable of being a productive, caring, and contributing member of society. If this crisis is not overcome, one acquires a sense of stagnation and may become self-indulgent, bored, and self-centered. Midlife crisis, premature invalidism. Integrity vs. Despair (Erikson) 60- death. involves reevaluating what we have done in our lives. If we feel we have done well we have a sense of integrity, otherwise we experience gloom and doubt. Extreme alienation, despair. Confidentiality The act of holding information in confidence, not to be released to unauthorized individuals. Subpoena duces tecum can require docs to give relevant documents to the court. Permission should be gotten for each piece of info from the same individual. informed consent An ethical principle requiring that research participants be told enough to enable them to choose whether they wish to participate. Parent must be give IC for minors unless for VD, pregnancy, substance/etoh, and contagious disease. IC includes procedure, experimental, pain/risks, benefits, alternatives, questions, freedom to refuse/withdraw. Tarasoff 1 and 2 1:Provider must warn an individual if their patient informs them that they plan to kill or injure them. Also, notify police. 2: Provider must take action to protect the target individual by nonconsensual hospitalization or arrest of the patient. Acetylcholine A neurotransmitter that enables learning and memory and also triggers muscle contraction. Increased: Parkinsonism Decreased: Dementia Norepinephrine A neurotransmitter involved in arousal, as well as in learning and mood regulation. Increased: Anxiety. Decreased: Depression. Dopamine A neurotransmitter associated with movement, attention and learning and the brain's pleasure and reward system. Increased: Psychosis Decreased: Anhedonia, Parkinsons, Addiction. Serotonin (5-HT) Excitatory or inhibitory; involved in sleep, mood, anxiety, and appetite. Increased: Serotonin Syndrome Decreased: Depression, OCD, Anxiety Glutamate The most common neurotransmitter in the brain. Excitatory. Increased: Psychosis, lability, SZ. Decreased: Impaired memory, negative symptoms. GABA (gamma-aminobutyric acid) The primary inhibitory neurotransmitter in the brain. Decreased: Anxiety structural abnormalities of the brain in depression Hyperintensities in subcortical regions: ventricles, basal ganglia, an thalamus. (most common) Reduced hippocampus size. Neurotransmitters associated with depression. norepinephrine, serotonin, dopamine all low melancholic depression + tx of choice more common in hospitalized patients ~ anhedonia, intense guilt, early wakening, psychomotor, anorexia/weight, loss no delusions tx = TCAs** Atypical Depression + tx of choice Differs from classical forms of depression. Characterized by hypersomnia, overeating and mood reactivity (the ability to experience improved response to positive events vs. persistent sadness. No delusions. Associated with weight gain and sensitivity to rejection. Most common subtype of depression. Treatment: MAOIs/ SSRI Depression with psychotic features Mood disturbances w/ delusions or hallucinations. Varied sleep patterns. Fluctuation in appetite Severely impaired energy Auditory/visual hallucinations or delusions. Tx: SSRI/atypicals eg Sertraline with olanzapine. Dexamethasone suppression test blood analysis for cortisol levels after administration of synthetic glucocorticoid. Used to evaluate cortisol levels in Cushings disease which is highly comorbid with psych disorders. Generalized Anxiety Disorder (GAD) A disorder characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance. Onset: Gradual Triggers: None Panic Disorder An anxiety disorder marked by unpredictable minutes-long (15-30min) episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations, sweating, shaking, SOB. Fear of death. Onset: Sudden Triggers: May be without trigger/or triggers that caused previous attacks. Social Anxiety Disorder an anxiety disorder involving the extreme and irrational fear of being embarrassed, judged, or scrutinized by others in social situations Tx for anxiety disorders SSRI First line SNRI (Venlafaxine) Buspirone TCA Benzos fro short course Remeron Antipsychotics/anticonvulsants (tx resistant) (quetiapine second line GAD). Beta blockers (SAD) Hydroxyzine Neurobiology of Anxiety Amygdala (perihinal cortex, ventrolateral prefrontal cortex anterior insula) Hippocampus SAD- Medial temporal lobe: Amygdala hyper response Neurotransmitters associated with Anxiety Disorders Norepiniphrine High Serotonin low Dopamine low GABA low Schizoaffective Disorder Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder. Onset: Late teens/early adulthood. May be later if mood dominant. 2-week period of psychotic symptoms without mood symptoms. Schizophrenia A group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions. Onset: Late teens to early 30's Persistant psychosis that lasts at least 6 months. Prognosis of Schizophrenia -20-30% lead fairly normal lives -20-30% continue to experience moderate symptoms -40-60% remain significantly impaired for the rest of their lives; much poorer outcome than mood disorders 20% Life reduction expectancy. Neurobiology of Schizophrenia Enlarged lateral and 3rd ventricle Reduced brain symmetry Reduced size of limbic system (Amygdala, hippocampus, parahippocampal gyrus) Prefrontal cortex similar to lobotomized pts Reduced thalamic size Basal Ganglia/cerebellum-Gait/movement disorders. Secondary to antipyschotics? Neurotransmitters associated with schizophrenia dopamine and glutamate increased GABA decreased NMDA receptors non-functioning d/t dopamine and glutamate excess. Capgras syndrome The delusional belief that an acquaintance has been replaced by an identical-looking imposter. It is more commonly seen in schizophrenia, dementia, and brain trauma. Treatment of Schizophrenia Cognitive Behavior Therapy, medication, and training in life and social skills. Antipsychotics schizophreniform disorder Psychotic disorder involving the symptoms of schizophrenia but lasting less than 6 months. schizoid personality disorder A psychological disorder characterized by little interest or involvement in close relationships, even those with family members brief psychotic disorder Psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor. bipolar 1 disorder a type of bipolar disorder marked by full manic and major depressive episodes Manic episodes 1 week or more - Grandiose ideas, pressured speech, no sleep, distractibility, impulsive/high risk activities. Hospitalization common. Hypomanic 4+ days Depressive episodes 2 weeks or more. Bipolar 2 disorder Alternation of major depressive episodes with hypomanic episodes (not full manic episodes). No marked impairment of functioning No hospitalizations. Cyclothymic Disorder (Cyclothymia) Milder, chronic form of bipolar disorder Lasts at least 2 years in adults, 1 year in children/adolescents Numerous periods with hypomanic and depressive symptoms Does not meet criteria for mania or major depressive episode Symptoms do not clear for more than 2 months at a time Bipolar Treatment Full mania needs hospitalization Tx for acute mania First line: Lithium, depakote, olanzapine, risperidone, seroquel, abilify, ziprasidone, asenapine, paliperidonem, cariprazine. Second line: Carbamazepine, haldol monotherapy Combined lithium and depakote CBT/family therapy Lamictal superior depressive tx ECT, TMS, Magnetic SZ therapy kindling hypothesis episode of depression/mania is neurotoxic; over time, episodes get more severe, last longer, more easily triggered. Initial episodes may be triggered by events "kindling" but subsequent episodes may not need them. Neurobiology of BD Variations in gray matter volume in striatum, thalamus amygdala, hippocampus, and pituitary with functional defects. Etiology of BD HPA (Hypothalamix-pituitary-adrenal) disruptions. Calcium Channeling- Genetic abnormalities in voltage-gated calcium channels leading to increased intracellular calcium signaling. (e.g. Ca channel affecting drugs like AED's help BD). obsessive-compulsive disorder (OCD) a disorder in which repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly with an individual's functioning Onset 19 more in males Contamination OCD Most common. cleaning or hand-washing compulsions. Fear of germs Pathologic Doubt/Checking OCD Second most common. Doubt that you have completed a crucial task. (eg turn stove off, lock door) Intrusive/forbidden thoughts OCD Third most common. Obsessive thoughts without compulsions. Usually sexual or violent and morally reprehensible in some way. Symmetry/Ordering OCD Obsession with symmetry or precision can lead to a compulsion of slow behavior. Body Dysmorphic Disorder (BDD) Somatoform disorder featuring a disruptive preoccupation with some imagined defect in appearance ("imagined ugliness"). Typically facial issues, but can be identified in 5-7 different body regions. More in females. Hoarding Disorder OCD Persistent difficulty discarding or parting with possessions, regardless of their actual value Symptoms begin in childhood, but dcx isnt until 30's. Equal in males to females Trichtollomania Increased anxiety relieved by pulling hair. Can be focused (intentional) or automatic. Can cause trichophagy and trichobezoars leading to intestinal blockage or malnutrition. Typically in females onset at menarche. Excoriation Disorder Recurrent skin picking resulting in skin lesions Leads to distress or impairment. Mostly on face followed by hands, fingers, arms, and legs. 15% report SI, 12% Attempts More females age of 12 olfactory reference syndrome psychological disorder which causes the patient to imagine he or she has strong body odor Mean age 25 Male single. Tourette's Disorder developmental disorder featuring multiple dysfunctional motor and vocal tics OCD treatment Meds SRI: Clomipramine (Anafranil) 12 weeks High dose SSRI eg 80mg fluoxetine or 200 of sertraline Risperidone/aripiprazole after SSRI failure memantine, riluzole, ketamine, lamictal, NAC others OCD therapy Exposure and response prevention: Expose to stressful concepts and do not allow compulsive behaviors. CBT ADHD (Attention-Deficit Hyperactivity Disorder) A psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity Hyperactivity is the first symptom to remit in 40% of cases. Medications are first line (stimulants) Methylphenidate (Ritalin)/Ampetamine salts/Desmphetamine a stimulant used in treating ADHD increases the levels of neurotransmitters in your child's brain increases level of dopamine Warning for cardiac issues. SE - anorexia, wt loss, nausea, lack of appetite. growth stunting Monitoring: ECG, height/weight , BP, HR, Physical Exam, family hx of cardiac disease Height/weaight BP, HR quarterly + Yearly physical exam. Atomoxetine (Strattera) Non stimulant ADHD medication Norepi uptake inhibitor BBW Risk of suicidal ideation; monitor for suicidal thinking or behavior, worsening, or unusual behavior - Contraindications Glaucoma, pheochromocytoma, MAO I use within past 14 days - Warning Rare, but severe hepatotoxicity (most within 120 days of start of treatment) SE Headache, insomnia, somnolence, dry mouth, nausea, abdominal pain, decrease in appetite, nausea, etc. Priapism NOTE do not open capsule - irritant CYPD 2D6 substrate watch out for LIVER PROBLEMS Alpha Agonists ADHD Guanfacine (Intuniv) - ER- Should not be taken with hight fat meal. Side effects- Hypotension, fatigue, sedation Taken at bedtime 6-17 years old Taper dose Clonidine- Monitor for hypotension during initial dose and titrations. ER is not interchangeable with IR formulations. Side effects- Headache, fatigue, upper abdominal pain. Modafinil/Armodafinil (Provigil, Nuvigil) CNS Stimulant tx narcolepsy and ADHD Not FDA approved due to Steven Johsnon's Syndrome. Neuroanatomy of ADHD reduced brain volume in frontal lobe, hippocampus, basal ganglia, amygdala, cerebellum Prefrontal cortex Neurotransmitters associated with ADHD dopamine in the prefrontal cortex and peripheral norepinephrine Dysthymia (Persistent Depressive Disorder) a low-grade chronic depression with symptoms that are milder than those of severe depression but are present on a majority of days for 2 or more years. Decreased appetite Insomnia or hypersomnia major depressive disorder A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities. Treatments SSRI fluoxetine and esciralopram FDA approved for children . Lower dose for children prepubescent. delusions of persecution A false belief that some person or agency is trying in some way to harm one. Religious delusions the belief that one is an agent of or specially favoured by a greater being thought broadcasting A delusion that one's thoughts are being broadcast out loud so that they can be perceived by others.