EHR522 weeks 10-13

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Questions and Answers

What is one way to control the pressure of glomerular filtration?

Changing the diameter of the afferent arterioles (correct)

Increasing the surface area of the glomerular capillaries

Changing the diameter of the efferent arterioles

Reducing the permeability of the filtration membrane

The glomerular capillaries have a smaller surface area than the skin.

False

What is the normal GFR in mL/min?

120-125

The adult kidneys produce about __________ L of filtrate daily.

180 Signup and view all the answers

Match the following statements about the regulation of glomerular filtration with their corresponding reasons:

GFR is tightly regulated to maintain extracellular homeostasis = The kidneys need a relatively constant GFR GFR affects blood pressure = The body as a whole needs a constant blood pressure Signup and view all the answers

What is the function of the visceral layer in the glomerular capsule?

It clings to the glomerular capillaries and contains filtration slits Signup and view all the answers

The renal tubule is about 5cm long.

False Signup and view all the answers

What is the purpose of the nephron loop in the renal tubule?

The nephron loop, also known as the hairpin loop, is a part of the renal tubule where the filtrate is processed further. Signup and view all the answers

The ______________ layer of the glomerular capsule contains filtration slits.

visceral Signup and view all the answers

What is the approximate volume of fluid filtered by the kidneys from the bloodstream every day?

200 litres Signup and view all the answers

The kidneys produce erythropoietin and renin, important molecules for regulating red blood cell production and blood pressure.

True Signup and view all the answers

What is the primary function of the kidneys in maintaining the body's internal environment?

Regulating the total volume of water in the body, osmolality, ion concentrations, acid-base balance, excreting wastes, and producing essential molecules. Signup and view all the answers

The kidneys are located in a ______________ position.

retroperitoneal Signup and view all the answers

Match the following kidney functions with their descriptions:

Regulating ion concentrations = Maintaining the body's internal environment Producing erythropoietin = Regulating red blood cell production Excreting metabolic wastes = Removing toxins and excess substances from the body Signup and view all the answers

What is the largest component of urine by weight, apart from water?

Urea Signup and view all the answers

Urine transport, storage, and elimination occur simultaneously

False Signup and view all the answers

What is the process called when urine is released through the urethra?

micturition Signup and view all the answers

The ureters begin at the level of ______________ as a continuation of the renal pelvis.

L2 Signup and view all the answers

Match the following constituents of urine with their relative concentrations in descending order:

Urea = 1st Sodium = 2nd Potassium = 3rd Creatinine = 6th Uric acid = 7th Signup and view all the answers

What happens to ADH secretion by the posterior pituitary when the body is overhydrated?

It decreases Signup and view all the answers

Aldosterone targets the principal cells of the proximal portion of the DCT.

False Signup and view all the answers

What is the role of ANP in the body?

ANP reduces blood sodium, thereby decreasing blood volume and blood pressure. Signup and view all the answers

When aldosterone is released, it targets the _______________________ of the collecting duct and cells of the distal portion of the DCT.

principal cells Signup and view all the answers

Match the following hormones with their functions:

ADH = Conserves water Aldosterone = Increases sodium reabsorption ANP = Decreases blood sodium Insulin = Regulates blood sugar Signup and view all the answers

What is the result of adaptive hyperfiltration in the remaining nephrons?

Damage to the glomeruli of the remaining nephrons Signup and view all the answers

There is a direct correlation between the absolute serum levels of blood urea nitrogen (BUN) or creatinine and the development of uraemic symptoms.

False Signup and view all the answers

What is the typical progression of symptoms in patients with chronic kidney disease?

Anorexia, nausea, vomiting, fatigue, pericarditis, peripheral neuropathy, and central nervous system abnormalities Signup and view all the answers

The build-up of toxins in the blood can negatively affect ______________ activities and inhibit systems such as the sodium-potassium pump.

cellular enzyme Signup and view all the answers

Match the following complications of chronic kidney disease with their descriptions:

Metabolic acidosis = Impaired generation of ammonia and hydrogen ion excess Anaemia = Decreased production of erythropoietin Volume overload = Inability to regulate extracellular fluid volume Hypertension = Volume overload and congestive heart failure Signup and view all the answers

What is a benefit of peritoneal dialysis for patients with cardiac instability?

It does not involve major fluid shifts. Signup and view all the answers

Peritoneal dialysis can cause obesity due to the absorption of calories from the dialysate.

True Signup and view all the answers

What is the preferred treatment option for end-stage renal disease (ESRD)?

Kidney transplantation Signup and view all the answers

Following kidney transplantation, patients are placed on _______________________ medication.

immunosuppression Signup and view all the answers

Match the following immunosuppression medications used in kidney transplantation with their classes:

Prednisone = Glucocorticosteroid Cyclosporine = Calcineurin inhibitor Rapamycin = mTOR inhibitor Belatacept = Costimulatory blocker Signup and view all the answers

What is a common consequence of excess fluid consumption in individuals with deteriorating renal function?

Peripheral oedema, congestive heart failure, and pulmonary congestion Signup and view all the answers

Haemodialysis is a process of ultrafiltration and clearance of toxic solutes from the blood, and it does not require vascular access.

False Signup and view all the answers

What is the primary access method for haemodialysis that provides the best long-term vascular access and has the lowest risk of complications?

Fistula Signup and view all the answers

A ______________ is an artificial tube placed in the arm or leg when veins are too small or delicate for a fistula to be effective.

Graft Signup and view all the answers

Match the following vascular access methods for haemodialysis with their descriptions:

Fistula = Joining an artery to a vein through a small operation Graft = An artificial tube placed in the arm or leg Central venous catheter = A temporary access method used when other options are not possible Signup and view all the answers

What is the recommended amount of moderate to vigorous physical activity per week for patients with CKD?

At least 150 minutes Signup and view all the answers

Resistance training programs are only effective in improving muscular strength in patients with early stages of CKD.

False Signup and view all the answers

Which type of sports is generally not recommended for transplant recipients?

Contact sports, such as football Signup and view all the answers

Patients with ESRD can tolerate high-intensity exercise training from the beginning.

False Signup and view all the answers

What are the benefits of exercising during dialysis treatment?

Reduced likelihood of cramping and hypotension during dialysis, enhanced exercise compliance, and reduced boredom associated with dialysis treatments Signup and view all the answers

What is the recommended frequency of cardiorespiratory exercise for transplant recipients?

3-5 days/week Signup and view all the answers

Exercise should be deferred if the patient is experiencing shortness of breath related to excess _______________________ status.

fluid Signup and view all the answers

In patients with ESRD, exercise intensity should be guided by ______________.

RPE Signup and view all the answers

Match the following exercise recommendations with their corresponding benefits:

Exercising during dialysis treatment = Reduces the likelihood of cramping and hypotension during dialysis Exercising on non-dialysis days = Larger adaptations usually occur Exercising immediately before or after dialysis = Not recommended due to fluid overload or fatigue Signup and view all the answers

Match the following exercise types with their recommended frequency for transplant recipients:

Cardiorespiratory exercise = 3-5 days/week Resistance exercise = 2-3 days/week Flexibility exercises = daily Signup and view all the answers

What is a common symptom of Schizophrenia?

All of the above Signup and view all the answers

Major Depressive Disorder (MDD) is a mental illness that involves intense and disturbing thoughts and feelings.

False Signup and view all the answers

What is the goal of treatment for Schizophrenia?

The goal of treatment for Schizophrenia is to ease the symptoms and reduce the risk of relapse. Signup and view all the answers

A number of ________________________ mechanistic theories have been developed to explain MDD.

pathophysiological Signup and view all the answers

Match the following medications with their corresponding types:

Olanzapine = Second generation antipsychotic Sertraline = SSRI Chlorpromazine = First generation antipsychotic Signup and view all the answers

What is a characteristic of binge-eating episodes?

Eating until feeling uncomfortably full Signup and view all the answers

Schizophrenia affects more females than males.

False Signup and view all the answers

What are the four domains of behaviors and presentations of persons with Schizophrenia?

Positive Symptoms, Negative Symptoms, Cognitive Symptoms, and Mood Symptoms Signup and view all the answers

Schizophrenia is a severe mental illness that affects how a person thinks, acts, expresses emotions, perceives _______________, and relates to others.

reality Signup and view all the answers

Match the following symptoms of Schizophrenia with their descriptions:

Delusions = False, mixed or other unusual beliefs that aren’t based in reality or fact. Hallucinations = Disorganised thinking or speech Disorganised thinking = Hearing or seeing things that aren’t real. Negative Symptoms = Absence of normal thinking or behaviours Signup and view all the answers

What is a characteristic of psychotic disorders?

Abnormal thinking and perceptions Signup and view all the answers

A psychologist can prescribe medication.

False Signup and view all the answers

What is the name of the mental illness characterized by periods of mania followed by periods of depression?

Bipolar Disorder Signup and view all the answers

What is the main characteristic of Generalised Anxiety Disorder (GAD)?

Excessive worry about actual circumstances, events or conflicts Signup and view all the answers

Schizoaffective Disorder is the concurrent presence of schizophrenia and a ______________ disorder.

mood Signup and view all the answers

Anorexia Nervosa is only characterised by restriction of energy intake relative to requirements.

False Signup and view all the answers

Match the following mental illnesses with their characteristics:

Psychotic Disorders = Abnormal thinking and perceptions Mood Disorders = Disturbance in a person's emotional state Anxiety Disorders = Feeling of excessive worry and fear Trauma- and Stressor-Related Disorders = Develops after experiencing a traumatic or stressful event Signup and view all the answers

What is the primary risk factor for the development of Generalised Anxiety Disorder (GAD)?

Family history Signup and view all the answers

Binge-Eating Disorder is characterised by eating a very large amount of food in a discrete time window, and by having little to no control of eating behaviour during that ______________.

episode Signup and view all the answers

Match the following anxiety disorders with their descriptions:

Generalised Anxiety Disorder = Excessive worry about actual circumstances, events or conflicts Social Anxiety Disorder = Fear of being judged or evaluated by others Panic Disorder = Sudden, unexpected feelings of intense fear Selective Mutism = Failure to speak in certain situations Signup and view all the answers

What is a benefit of exercise in the treatment of Major Depressive Disorder (MDD)?

More effective than SSRI treatment in achieving MDD remission over the long-term Signup and view all the answers

Resistance training has been extensively studied in the context of MDD treatment.

False Signup and view all the answers

What is the proposed mechanism by which exercise may reduce anxiety?

Exposure to physical training increases tolerance to anxious symptoms and decreases anxiety sensitivity Signup and view all the answers

A growing body of evidence suggests that exercise can reduce depression through both ______________ and psychological mechanisms.

biological Signup and view all the answers

Match the following lifestyle factors with their potential impact on MDD symptoms:

Dietary modification = May act additively or synergistically with exercise to improve MDD symptoms Smoking cessation = May reduce MDD symptoms Sleep hygiene = May improve MDD symptoms Signup and view all the answers

What is the effect of exercise on PTSD symptoms?

Positive impact Signup and view all the answers

There are currently guidelines on the implementation of exercise as a component of standard therapy in PTSD.

False Signup and view all the answers

What are some of the neurobiological mechanistic explanations for the role of exercise in improving Schizophrenia symptoms?

Neurogenesis, synaptogenesis, increased cortical capillary blood supply, increased production of neurotrophic factors, and increased activity and production of neurotransmitters. Signup and view all the answers

The European Psychiatric Association (EPA) Guidelines on Physical Activity for Severe Mental Illness recommend a frequency of ______________ times per week.

2-3 Signup and view all the answers

What is the recommended intensity of exercise for patients with Schizophrenia?

Moderate-to-vigorous intensity Signup and view all the answers

Match the following neurobiological mechanisms of exercise with their descriptions:

Neurogenesis = The formation of new neurons in the brain Synaptogenesis = The formation of new synapses between neurons Increased cortical capillary blood supply = The increase in blood supply to the brain Signup and view all the answers

Yoga has been shown to have a similar benefit to people with Schizophrenia as aerobic exercise.

True Signup and view all the answers

Exercise has been shown to have a small-to-moderate effect size on ______________ symptoms.

PTSD Signup and view all the answers

What is the reduction in life expectancy for those with Schizophrenia when compared to the general population?

15-25 years Signup and view all the answers

Most people with Schizophrenia have high levels of physical activity and aerobic fitness.

False Signup and view all the answers

What is the correlation between maximum aerobic capacity and global functioning in people with Schizophrenia?

There is a correlation between maximum aerobic capacity and global functioning (social, occupational, and psychological domains) in people with Schizophrenia. Signup and view all the answers

Exercise appears to have a favourable impact on the _______________________ symptoms associated with Schizophrenia.

positive, negative, cognitive, and mood Signup and view all the answers

Match the following statements about exercise in Schizophrenia treatment with their corresponding benefits:

90 minutes of moderate-to-vigorous aerobic exercise each week = Psychiatric symptoms are significantly reduced Higher intensity aerobic exercise = Better outcomes for people with Schizophrenia Group settings and greater supervision = Outcomes for patients with Schizophrenia appear to be improved Consideration of comorbid conditions and unique situation = Individualized exercise prescription Signup and view all the answers

Antipsychotics are typically effective at reducing all symptoms of Schizophrenia.

False Signup and view all the answers

What is the role of social support in the initiation and maintenance of an exercise program for people with Schizophrenia?

Social support plays a significant role in the initiation and maintenance of an exercise program for people with Schizophrenia. Signup and view all the answers

What is the primary factor to consider when prescribing exercise intensity for people with Schizophrenia?

Individual's unique situation Signup and view all the answers

Which of the following is a common misconception about people with mental illness?

All of the above Signup and view all the answers

People with mental illness are more likely to be perpetrators of violence than victims.

False Signup and view all the answers

What is one way to build a positive relationship with someone with a mental illness?

Treat people with respect Signup and view all the answers

When communicating with someone with a mental illness, it's important to focus on the ______________, not the condition.

person Signup and view all the answers

Match the following strategies with their corresponding actions in de-escalation:

L = Listen to the issue and hear the person's concerns O = Offer reflective comments to show you have heard their concerns W = Wait until the person has expressed their frustration and explained their feelings I = Incline your head to show that you are actively listening and provide a non-threatening posture E = Express empathy and concern Signup and view all the answers

Substance abuse is a major determinant of violence, regardless of whether it occurs within the context of a concurrent mental illness or not.

True Signup and view all the answers

What is one reason why people with mental illness may hesitate to disclose their condition?

All of the above Signup and view all the answers

What should you do after de-escalating a situation?

Work with the consumer/patient to resolve their concerns Signup and view all the answers

When communicating with someone with a mental illness, it's important to ______________ eye contact to connect with the person.

maintain Signup and view all the answers

Study Notes

Renal Physiology

The kidneys filter around 200 liters of fluid from the bloodstream daily, allowing toxins, metabolic wastes, and excess ions to leave the body in urine while returning needed substances to the blood.
The kidneys maintain the body's internal environment by regulating water volume and solute concentration, ion concentrations, acid-base balance, and excreting metabolic wastes and foreign substances.
They also produce erythropoietin and renin, important molecules for regulating red blood cell production and blood pressure, and convert vitamin D to its active form.

Kidneys – Location and External Anatomy

The kidneys are bean-shaped and lie in a retroperitoneal position, extending from T12 to L3, with the right kidney slightly lower than the left.
The ureter, renal blood vessels, lymphatics, and nerves join each kidney at the hilum and occupy the sinus.
Each kidney has an adrenal gland atop it, an endocrine gland that is functionally unrelated to the kidney.

Renal Corpuscle

The renal corpuscle consists of a glomerular capsule with parietal and visceral layers.
The visceral layer clings to the glomerular capillaries and contains filtration slits, allowing filtrate to enter the capsule space.

Renal Tubule and Collecting Duct

The renal tubule is approximately 3cm long and has three major parts: the proximal convoluted tubule, the nephron loop, and the distal convoluted tubule.
The terms proximal and distal indicate the relationship of the convoluted tubules to the renal corpuscle.
The meandering nature of the renal tubule increases its length and enhances its filtrate processing capabilities.

Classes of Nephrons

Nephrons are divided into two major groups: cortical and juxtamedullary.
Cortical nephrons (85% of nephrons) are located entirely in the cortex, while juxtamedullary nephrons originate close to the cortex-medulla junction and play a crucial role in producing concentrated urine.

Glomerular Filtration Rate (GFR)

The huge surface area and high permeability of the filtration membrane explain how the relatively modest 10 mmHg NFP can produce large amounts of filtrate.
The adult kidneys produce about 180L of filtrate daily, translating to a normal GFR of 120-125 mL/min.

Regulation of Glomerular Filtration

GFR is tightly regulated to serve two crucial and sometimes opposing needs: maintaining extracellular homeostasis and maintaining blood pressure.
Increased GFR increases urine output, reducing blood volume and blood pressure.

Reabsorptive Capabilities of the Renal Tubules and Collecting Ducts

Aldosterone fine-tunes reabsorption of sodium in response to decreased blood volume or blood pressure, or high extracellular potassium concentration.
Atrial Natriuretic Peptide (ANP) reduces blood sodium, decreasing blood volume and blood pressure.

Urine – Chemical Composition

Water accounts for about 95% of urine volume, with the remaining 5% consisting of solutes.
The largest component of urine by weight, apart from water, is urea, derived from the breakdown of amino acids.
Other nitrogenous wastes in urine include uric acid, creatinine, and other solutes.
Unusually high concentrations of any solute or the presence of abnormal substances may indicate pathology.

Urine Transport, Storage, and Elimination

The ureters transport urine from the kidneys to the bladder.
Urine is stored in the bladder until its release through the urethra is convenient, a process called micturition.

Pathophysiology of Chronic Kidney Disease (CKD)

Mild renal insufficiency often has a normal or near-normal serum creatinine concentration.
Homeostatic mechanisms permit the serum concentration of sodium, potassium, calcium, and phosphorus to remain within the normal range, especially in mild to moderate renal failure.
Adaptive hyperfiltration, initially beneficial, results in long-term damage to glomeruli, manifesting as proteinuria and progression to renal failure.

Pathophysiology of CKD (continued)

Gradual decline in renal function is initially asymptomatic, with the damaged kidney responding with higher filtration and excretion rates per nephron, masking symptoms until only 10-15% of renal function remains.
Progressive renal failure causes loss of excretory and regulatory functions, leading to End-Stage Renal Disease (ESRD) and uraemic syndrome.
Manifestations of the uraemic state include anorexia, nausea, vomiting, fatigue, pericarditis, peripheral neuropathy, and central nervous system abnormalities (ranging from loss of concentration to seizures, coma, and death).

Pathophysiology of CKD (continued)

No direct correlation exists between the absolute serum levels of blood urea nitrogen (BUN) or creatinine and the development of these symptoms.
Patients may present with peripheral oedema, pulmonary oedema, and congestive heart failure.
To continue life, uraemic patients require Renal Replacement Therapy (RRT) using haemodialysis, peritoneal dialysis, or renal transplantation.
The loss of the excretory function of the kidney results in the build-up of toxins in the blood, affecting cellular enzyme activities and inhibiting systems such as the sodium-potassium pump.

Pathophysiology of CKD (continued)

The loss of the regulatory function of the kidneys results in the inability to regulate extracellular fluid volume and electrolyte concentrations, adversely affecting cardiovascular and cellular functions.
Most patients with advanced CKD are volume overloaded, resulting in hypertension and often congestive heart failure.
Other malfunctions in regulation include impaired generation of ammonia and hydrogen ion excess, resulting in metabolic acidosis and decreased production of erythropoietin, the primary reason for anaemia in ESRD patients.

Diagnostic Testing and Treatment

The decision to begin dialysis is determined by factors including cardiovascular status, electrolyte levels, chronic fluid overload, severe and irreversible oliguria, anuria, significant uraemic symptoms, and abnormal laboratory values.
RRT does not correct all signs and symptoms of uraemia and often results in other concerns and side effects.

Haemodialysis

Haemodialysis is the most common form of RRT, with approximately 95% of all patients undergoing haemodialysis in a centre or at home.
In other countries, some patients prefer home-based methods such as peritoneal dialysis.
Haemodialysis is a process of ultrafiltration (fluid removal) and clearance of toxic solutes from the blood, necessitating vascular access by one of three methods: fistula, graft, or central venous catheter.

Haemodialysis (continued)

Fistula is the most common access method, providing the best long-term vascular access and having the lowest risk of complications.
Graft is an artificial tube placed in the arm or leg, allowing patients to travel and dialyse on their own schedules.
Patients with cardiac instability may also be placed on peritoneal dialysis because this method does not involve the major fluid shifts experienced with haemodialysis.

Peritoneal Dialysis

Complications of peritoneal dialysis are due to increased intra-abdominal pressure resulting from instillation of dialysate into the peritoneal cavity, including infection, hernias, low back pain, obesity, and gastroesophageal reflux.
Patients may absorb as many as 1,200 kcal from the dialysate per day, contributing to the development of obesity and hypertriglyceridaemia.

Long-Term Complications of Dialysis

(No specific information provided in the text)

Kidney Transplant

Transplantation of kidneys is the preferred treatment of ESRD.
The source of the kidneys available for transplant can be a living relative, an unrelated individual, or a cadaver.
Because of the shortage of organs available for transplantation and improvements in immunosuppression medications, living non-related transplants are becoming more frequent.
Following transplantation, patients are placed on immunosuppression medication, including combinations of glucocorticosteroids, calcineurin inhibitors, mTOR inhibitors, cell cycle inhibitors, costimulatory blockers, and induction agents.

Kidney Transplant (continued)

New immunosuppression medications are constantly being developed, allowing for minimisation of side effects through alteration of therapies or combinations of therapies.

Research Data

Among patients with CKD, researchers have shown that various exercise training interventions of 4-6 months are associated with marked improvements in cardiorespiratory fitness, reductions in markers of inflammation, and improvements in muscle strength.
Resistance training programs lead to improvements in muscular strength in all stages of CKD.
Changes in plasma lipids in response to exercise training seem to be attenuated in patients with CKD, and body composition changes are variable.

Research Data (continued)

Other benefits associated with exercise training include a reduction in depression scores and improvements in health-related quality of life indices.
Improvements in heart rate variability have also been reported, with a shift toward greater vagal tone following exercise training.
In general, the findings of significant benefits from exercise training in CKD patients seem to be stronger in the ESRD population, possibly because most of the exercise studies to date have been done in this cohort.

Exercise Recommendations

Patients with CKD who are not on dialysis have been shown to benefit from exercise training programs using standard exercise prescriptions for the general population, so long as the individuals are screened properly, start at a low to moderate intensity, and progress gradually.
With regard to patients with ESRD, the timing of exercise in relation to the dialysis treatment should be considered.
Exercising during treatment (intra-dialytic exercise) is recommended since it has significant physiologic benefit, enhances exercise compliance, and reduces the boredom associated with dialysis treatments.

Exercise Recommendations (continued)

Exercising immediately before or after dialysis is generally not well tolerated and therefore not recommended.
Research in haemodialysis patients demonstrates that larger adaptations usually occur when exercise is completed on non-dialysis days, but that intra-dialytic exercise is likely to produce better adherence rates.
Exercise should be deferred if the patient is experiencing shortness of breath related to excess fluid status.

Exercise Recommendations (continued)

Vigorous non-contact sports and activities are generally well tolerated by transplant recipients who have exercise trained to attain adequate muscle strength and cardiorespiratory endurance through a comprehensive conditioning program.
Cardiorespiratory exercise should be prescribed 3-5 days/week as recommended for the general population.
Resistance exercise should be performed 2-3 days/week.
Flexibility exercises should be performed whenever CKD patients exercise train; however, because of the stiffness that patients with ESRD experience after prolonged periods of sitting in dialysis chairs, they should be encouraged to stretch daily.

Exercise Recommendations (continued)

Cardiorespiratory exercise should be prescribed at a moderate to vigorous intensity (50-80% VO2 reserve) for patients with CKD who are not receiving dialysis.
In patients with ESRD, exercise intensity should be guided by RPE, because heart rates are highly variable in this patient population as a result of fluid shifts and vascular adaptations to fluid loss during the dialysis treatment.
Many ESRD patients may initially tolerate only a few minutes of very low-level exercise, which means that any formal warm-up and cool-down intensities are less relevant.

Here are the study notes for the text:

Types of Mental Illness

Psychotic disorders:
- Characterized by abnormal thinking and perceptions
- Examples: Schizophrenia, Schizoaffective Disorder
Mood disorders:
- Characterized by disturbances in emotional state
- Examples: Major Depressive Disorder, Bipolar Disorder
Trauma- and stressor-related disorders:
- Characterized by anxiety and fear responses to traumatic events
- Examples: Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder
Anxiety disorders:
- Characterized by excessive worry and fear
- Examples: Generalized Anxiety Disorder, Panic Disorder, Phobias
Feeding and eating disorders:
- Characterized by disturbances in eating patterns
- Examples: Anorexia Nervosa, Binge-Eating Disorder

Schizophrenia

Characterized by disruptions in thinking, acting, and expressing emotions
Affects about 1% of the Australian population
More common in males than females
Can be caused by genetic susceptibility and environmental influences

Diagnosis of Schizophrenia

Requires at least two symptoms present for at least one month
Symptoms include:
- Delusions
- Hallucinations
- Disorganised thinking or speech
- Disorganised or abnormal motor behaviour
- Negative symptoms
Must have significant impact on daily functioning

Symptoms of Schizophrenia

Positive symptoms:
- Added thoughts or actions not based in reality
- Examples: delusions, hallucinations, disorganised speech
Negative symptoms:
- Lack of normal thinking or behaviors
- Examples: lack of interest, social withdrawal, diminished emotional expression
Cognitive symptoms:
- Impairment in executive and cognitive function
Mood symptoms:
- Abnormal emotional states
- Examples: depression, anxiety

Management of Schizophrenia

Goal is to ease symptoms and reduce risk of relapse
Treatments include:
- Medications: antipsychotics
- Psychotherapy: addressing behavioral, psychological, social, and occupational problems
- Hospitalisation: for severe symptoms or risk of harm to self or others
- Electroconvulsive therapy: for severe depression or catatonia

Major Depressive Disorder (MDD)

Characterized by sad, empty, or irritable mood
Accompanied by changes that significantly affect daily functioning
Affects about 10% of the Australian population
Slightly more common in females than males

Diagnosis of MDD

Must experience at least five symptoms for two weeks
Symptoms include:
- Depressed mood
- Loss of interest or pleasure in activities
- Changes in appetite or sleep
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Difficulty concentrating or making decisions
- Recurring thoughts of death or suicide

Aetiology of MDD

Complex mental illness involving genetic, environmental, and psychosocial factors
Risk factors include:
- Abuse
- Age
- Chronic disease or illness
- Conflict
- Death or loss
- Family history
- Gender
- Major events
- Stress
- Substance misuse

Management of MDD

Range of management strategies available
Includes:
- Pharmacological interventions: SSRIs, SNRIs
- Exercise interventions
- Psychotherapy: addressing behavioral, psychological, social, and occupational problems
- Transcranial magnetic stimulation
- Electroconvulsive therapy

Post-Traumatic Stress Disorder (PTSD)

Characterized by intense and disturbing thoughts and feelings
Typically caused by exposure to traumatic event
Symptoms usually occur within three months of exposure
Affects about 12% of the Australian population
Women are twice as likely as men to be diagnosed with PTSD

Diagnosis of PTSD

Must experience symptoms for at least one month
Symptoms include:
- Intrusive thoughts or memories
- Avoidance of stimuli associated with trauma
- Cognitive and mood changes
- Physical and emotional reactions
Symptoms must significantly interfere with daily functioning

Aetiology of PTSD

Multifactorial, involving genetic, environmental, and psychosocial factors
Risk factors include:
- Exposure to traumatic events
- Occupations related to traumatic events
- Pre-existing mental illnesses or family history of mental illness
- Substance misuse/abuse
- Limited support systems
- Family history of PTSD

Management of PTSD

Range of management strategies available
Includes:
- Trauma-focused therapy
- Cognitive processing therapy
- Prolonged exposure therapy
- Medications: SSRIs, SNRIs### Exercise in MDD Treatment
Supervised exercise programs by professionals are more successful
Exercise is as effective as SSRIs in treating MDD
Over the long-term (6 months), exercise is more effective than SSRIs in achieving MDD remission
Most studies focus on aerobic exercise, but resistance training also improves MDD symptoms
Lifestyle factors like dietary modification, smoking cessation, and sleep hygiene can act additively or synergistically with exercise to improve MDD symptoms

Biological and Psychological Mechanisms

Exercise reduces depression through biological and psychological mechanisms
Exercise can retard mechanistic pathways responsible for MDD development
There is a dose-response relationship between exercise volume and reduction in MDD risk/symptoms
The greatest differences in MDD risk are seen between sedentary and low-dose physical activity

Exercise Participation and Adherence

Exercise participation and adherence are lower in MDD patients
Strategies like motivational interviewing, action planning, and goal setting can optimize adherence

Exercise in Anxiety Disorders

Fewer RCTs have been performed to investigate the effect of exercise on anxiety
Research in anxiety has heavily favored aerobic exercise, with little on resistance training
Aerobic exercise is effective in reducing symptoms in those with diagnosed anxiety disorders and those with raised anxiety
Higher intensity aerobic exercise is more effective than lower intensity exercise

Physiological Mechanisms in Anxiety

Physiological mechanisms hypothesized to be responsible for exercise benefits in anxiety overlap with those proposed for MDD
These mechanisms include alterations in serotonergic and noradrenergic pathways, increased 5-hydroxytriptamine turnover, and increased atrial natriuretic peptide levels

Overcoming Anxiety Sensitivity

Exposure to exercise provokes anxious feelings in some individuals, but increases tolerance and decreases anxiety sensitivity
Exercise increases self-efficacy as patients see an increase in their ability to cope with physiological challenges
Engagement in exercise can lead to increased social interaction and distraction from anxious rumination

The Impact of Severe Mental Illness

People with Schizophrenia have a reduced life expectancy of 15-25 years compared to the general population, mainly due to cardiometabolic sequelae.
This reduction in life expectancy increases to 25-30 years when drug or alcohol abuse/misuse is combined with a Schizophrenia diagnosis.
Severe mental illness also results in a dramatic reduction in quality of life, leading to a significant non-fatal burden.

Exercise in Schizophrenia Treatment

People with Schizophrenia typically have reduced levels of physical activity and lower levels of aerobic fitness.
Barriers to exercise in Schizophrenia patients include fatigue, low motivation, lack of confidence, anxiety, and lack of resources and encouragement.
Exercise can improve aerobic fitness and reduce cardiometabolic risk factors in people with Schizophrenia.
Moderate-to-vigorous aerobic exercise of 90 minutes per week can reduce psychiatric symptoms, including positive, negative, cognitive, and mood symptoms.

Exercise in PTSD Treatment

There is limited data on the effect of exercise on PTSD symptoms, but exercise has been shown to have a positive impact.
There appears to be a dose-response relationship between exercise and PTSD symptoms, but the optimal exercise type, dose, and duration are unclear.

General Exercise Progression and Regression Principles for Mental Illness

Practical recommendations for exercise in mental illness include limiting competition, encouraging self-selection, focusing on moderate intensity, and avoiding overtraining.
It is essential to consider individual differences and unique situations when prescribing exercise for mental illness.

Healthcare Services and Providers

General Practitioners (GPs) are the primary point of contact for mental health services, with 13% of all GP encounters related to mental illness.
Community Mental Health Care Services provide a range of services, including housing, support groups, and access to other medical services.
In-Patient Hospital Care is available for people who require acute hospitalization due to mental illness.
Residential Care provides specialized mental health care in a domestic-like environment for a small percentage of people with mental illness.

Outcome Measures in Mental Illness

A range of questionnaires, such as the PHQ-9, Beck Depression Inventory (BDI), and Centre for Epidemiological Studies – Depression Scale (CES-D), are used to characterise the severity of mental illness.
The DASS-21 is a commonly used scale that assesses depression, anxiety, and stress.

Social stigma and shame reduce the likelihood of people seeking treatment for mental illness.
Different cultures have varying perspectives on mental illness, and unhelpful views include the perception that people with mental illness need to take ownership of their condition.

Violence and Mental Illness

The major determinants of violence are sociodemographic and socioeconomic factors, such as being young, male, and of low socioeconomic status.
Substance abuse is also a significant determinant of violence.

Positive Interaction and Communication

Building relationships, communicating effectively, and involving families and carers are essential for positive interaction and communication in mental health care.
Strategies for de-escalation include listening, offering reflective comments, waiting until the person has expressed their frustration, and expressing empathy and concern.

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This quiz covers the functions of the kidneys, including filtration, toxin removal, and maintaining bodily balance. It's a vital part of understanding overall health and physiology.

EHR522 weeks 10-13

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Questions and Answers

What is one way to control the pressure of glomerular filtration?

The glomerular capillaries have a smaller surface area than the skin.

What is the normal GFR in mL/min?

The adult kidneys produce about __________ L of filtrate daily.

Match the following statements about the regulation of glomerular filtration with their corresponding reasons:

What is the function of the visceral layer in the glomerular capsule?

The renal tubule is about 5cm long.

What is the purpose of the nephron loop in the renal tubule?

The ______________ layer of the glomerular capsule contains filtration slits.

What is the approximate volume of fluid filtered by the kidneys from the bloodstream every day?

The kidneys produce erythropoietin and renin, important molecules for regulating red blood cell production and blood pressure.

What is the primary function of the kidneys in maintaining the body's internal environment?

The kidneys are located in a ______________ position.

Match the following kidney functions with their descriptions:

What is the largest component of urine by weight, apart from water?

Urine transport, storage, and elimination occur simultaneously

What is the process called when urine is released through the urethra?

The ureters begin at the level of ______________ as a continuation of the renal pelvis.

Match the following constituents of urine with their relative concentrations in descending order:

What happens to ADH secretion by the posterior pituitary when the body is overhydrated?

Aldosterone targets the principal cells of the proximal portion of the DCT.

What is the role of ANP in the body?

When aldosterone is released, it targets the _______________________ of the collecting duct and cells of the distal portion of the DCT.

Match the following hormones with their functions:

What is the result of adaptive hyperfiltration in the remaining nephrons?

There is a direct correlation between the absolute serum levels of blood urea nitrogen (BUN) or creatinine and the development of uraemic symptoms.

What is the typical progression of symptoms in patients with chronic kidney disease?

The build-up of toxins in the blood can negatively affect ______________ activities and inhibit systems such as the sodium-potassium pump.

Match the following complications of chronic kidney disease with their descriptions:

What is a benefit of peritoneal dialysis for patients with cardiac instability?

Peritoneal dialysis can cause obesity due to the absorption of calories from the dialysate.

What is the preferred treatment option for end-stage renal disease (ESRD)?

Following kidney transplantation, patients are placed on _______________________ medication.

Match the following immunosuppression medications used in kidney transplantation with their classes:

What is a common consequence of excess fluid consumption in individuals with deteriorating renal function?

Haemodialysis is a process of ultrafiltration and clearance of toxic solutes from the blood, and it does not require vascular access.

What is the primary access method for haemodialysis that provides the best long-term vascular access and has the lowest risk of complications?

A ______________ is an artificial tube placed in the arm or leg when veins are too small or delicate for a fistula to be effective.

Match the following vascular access methods for haemodialysis with their descriptions:

What is the recommended amount of moderate to vigorous physical activity per week for patients with CKD?

Resistance training programs are only effective in improving muscular strength in patients with early stages of CKD.

Which type of sports is generally not recommended for transplant recipients?

Patients with ESRD can tolerate high-intensity exercise training from the beginning.

What are the benefits of exercising during dialysis treatment?

What is the recommended frequency of cardiorespiratory exercise for transplant recipients?

Exercise should be deferred if the patient is experiencing shortness of breath related to excess _______________________ status.

In patients with ESRD, exercise intensity should be guided by ______________.

Match the following exercise recommendations with their corresponding benefits:

Match the following exercise types with their recommended frequency for transplant recipients:

What is a common symptom of Schizophrenia?

Major Depressive Disorder (MDD) is a mental illness that involves intense and disturbing thoughts and feelings.

What is the goal of treatment for Schizophrenia?

A number of ________________________ mechanistic theories have been developed to explain MDD.

Match the following medications with their corresponding types:

What is a characteristic of binge-eating episodes?

Schizophrenia affects more females than males.

What are the four domains of behaviors and presentations of persons with Schizophrenia?

Schizophrenia is a severe mental illness that affects how a person thinks, acts, expresses emotions, perceives _______________, and relates to others.

Match the following symptoms of Schizophrenia with their descriptions:

What is a characteristic of psychotic disorders?

A psychologist can prescribe medication.

What is the name of the mental illness characterized by periods of mania followed by periods of depression?

What is the main characteristic of Generalised Anxiety Disorder (GAD)?

Schizoaffective Disorder is the concurrent presence of schizophrenia and a ______________ disorder.

Anorexia Nervosa is only characterised by restriction of energy intake relative to requirements.

Match the following mental illnesses with their characteristics:

What is the primary risk factor for the development of Generalised Anxiety Disorder (GAD)?

Binge-Eating Disorder is characterised by eating a very large amount of food in a discrete time window, and by having little to no control of eating behaviour during that ______________.

Match the following anxiety disorders with their descriptions:

What is a benefit of exercise in the treatment of Major Depressive Disorder (MDD)?

Resistance training has been extensively studied in the context of MDD treatment.

What is the proposed mechanism by which exercise may reduce anxiety?

A growing body of evidence suggests that exercise can reduce depression through both ______________ and psychological mechanisms.

Match the following lifestyle factors with their potential impact on MDD symptoms:

What is the effect of exercise on PTSD symptoms?

There are currently guidelines on the implementation of exercise as a component of standard therapy in PTSD.