34 Clinical Aspects of Motivation and Emotion

Question 1

What are general areas of the brain that are implicated in depression

Answer 1

the baseline resting awareness and train of thought attributed to prefrontal cortex, the amygdala related to threat awareness and over dramatization of negative points and the hippocampus in tying in emotion and memory to response to stimuli

Question 2

What other factors are important in considering outside of brain regions when understanding what contributes to depression?

Answer 2

many different developmental, environmental and experiential factors that contribute to depression

Question 3

What is the importance of major depressive in clinical practice.

Answer 3

it is often not recognized, treated or treated correctly by patients that are seen by physicians in a primary care setting.

Question 4

Name the areas that are implicated in participating in emotion and their contributions.

Answer 4

orbitofrontal and ventromeidal PFC (social cognition, social comparison); dorsolateral PFC (develops plans, strategize) ; insula (awareness of body state), amygdala and hippocampus (general emotion/ fear) and anterior cingulate cortex (comparing plan with plan execution)

Question 5

How are the ventral striatum and dopamine pathways important to understanding depression?

Answer 5

medial prefrontal network
reward network
dorsolateral prefrontal network
default mode network

(ventral striatum is important for reward processing and vigilance to stimulus, assigning valence to stimulus (hyoactivity in striatum) and dopamine pathways that are important for survival motivation do not work properly)

Question 6

What affects does the medial prefrontal network have in depression.

Answer 6

is abnormally increased in depression: includes medial PFC, ACC and amygdala, processing of emotional stimuli (overly negative coding)

Question 7

What role does the reward network play in depression?

Answer 7

is abnormally decreased in depression: **involved in integration and evaluation of external stimuli and coding for reward, includes OFC, ventral striatum (overall lower activity)

Question 8

What role does dorsolateral prefrontal network play in depression?

Answer 8

probably decreased in depression, includes dlPFC, involved in voluntary cognitive control (fixation on negative stimuli)

Question 9

What role does the default mode network play in depression?

Answer 9

normally decreases when undertaking cognitive tasks, but abnormally active in depression, likely involved in self-referential processing (recollection, imagination and understanding of others’ mental states): includes medial prefrontal network and other structures,

Question 10

Which cortico-striatal-pallido-thalamic loops participate (neural networks) in executive function vs. emotional regulation and reward? (limbic or prefrontal loops?)

Answer 10

executive function, emotional regulation, and reward

prefrontal loop (executive function) and limbic loop (emotion regulation and reward)

Question 11

What systems are important to the chemical imbalances that are part of depression?

Answer 11

systems that increase leeks of serotonin, dopamine (reward), glutamate (excessive activity in in appropriate places) cytokines (inflammatory response) and others (serotonin and dopamine networks decrease with depression)

Question 12

How are depression and the HPA axis connected?

Answer 12

abnormalities of the HPA axis are found in severe depression where the increased activity of the amygdala stimulates HPA axis and the hippocampus is less sensitive to negative feedback from cortisol

Question 13

What are the effects of chronic stress on the hippocampus?

Answer 13

abnormal neuron formation and atrophic dendritic tree leading to hippocampal atrophy in depression

Question 14

What does current research say about the cause of depression?

Answer 14

depression is a failure in neuroplasticity- high levels of glucocoritcoids block brain-derived neutrophic factor which is necessary for neuronal remodeling (antidepressant treatments address this fault)

Question 15

What synaptic changes are seen in depression?

Answer 15

in depression, internalization of glutamate receptors is observed (rapid antidepressants such as ketamine or electric shock treatment can cause a massive release of neurotransmitter, restoring synapses

Question 16

Contrast top-down and bottom up regulation.

Answer 16

top-down focuses on psychotherapies that target conscious controls to changing behaviors where bottom-up therapies focus on the molecular level corrections such as antidepressants, ECT and DBS

Question 17

What is the clinical diagnosis for major depressive episode?

Answer 17

two or more weeks of depressed mood, loss of interest or pleasure, suicidal ideation, poor concentration or difficulty making decisions, guilt or worthlessness, increase or decreased sleep, increased/ decreased weight, psychomotor agitation or retardation and fatigue that are not due to other medical issues or substance abuse/withdrawal

Question 18

What cortical areas would you attribute to loos of interest or pleasure, poor concentration, guilt or worthlessness and sleep/weight/fatigue problems?

Answer 18

interest/pleasure (striatum), concentration (dlPFC) guilt or worthlessness (social cognition and vmPFC) and sleep/weight/fatigue (HPA axis)

Question 19

Depression is associated with ___ emotional bias which is associated with _______ activation of the amygdala with _____ stimuli and _____ activation of ventral striatum with _____ emotional stimuli.

Answer 19

negative, increased, negative, decreased, positive