Biology of Mental Disorders +Misc Flashcards
What does ABC STAMP LICKER DISCO stand for?
Appearance
Behavior
Cooperation
Speech Thought content Affect Mood Perception
Level of consciousness Insight Cognitive Killer Endings Reliability
Digit span
Information
Similarities
Comprehension
What are the different types of memories and the ways to test them
Unconscious: procedural - “write a sentence”
Immediate recall - repeat back these objects
Conscious: STM
-recent memory - @5 min repeat the objects back
- working memory: digit span
-
Long-term memory - semantic: comprehension
Episodic - information subscale assesses intellectual functioning
Remote memory is the ability to remember things that happened years ago (assessed via H&P)
The defense mechanism underlying feelings of persecution is
projection:
in which humans defend themselves against their own unconscious impulses or qualities (both positive and negative) by denying their existence in themselves while attributing them to others.[1] For example, a person who is habitually intolerant may constantly accuse other people of being intolerant. It incorporates blame shifting.
What is psychological projection
in which humans defend themselves against their own unconscious impulses or qualities (both positive and negative) by denying their existence in themselves while attributing them to others.[1] For example, a person who is habitually intolerant may constantly accuse other people of being intolerant. It incorporates blame shifting.
What are some proposed neurobiological mechanisms for suicide?
Low central serotonin - or serotonin upregulation
Loss of noradrenergic neurons or increased norepinephrine release from locus coeruleus.
Impaired glucocorticoid feedback inhibition, increased stress response.
Excess glutamate
Describe the suicide risk spectrum for
Low
Moderate
High
Severe
Low – Some suicidal thoughts, but no plan
says he/she won’t commit suicide
- Moderate – Suicidal thoughts, vague plan and says he/she won’t commit suicide
- High – Suicidal thoughts, specific and lethal plan and says he/she won’t commit suicide
- Severe – Suicidal thoughts, specific/ highly lethal plan and says will commit suicide
What are the members of the brain related to depression and how are each affected
Hippocampus and prefrontal cortex: cognitive abnormalities: -memory impairments, hopelessness,
worthlessness, guilt
Amygdala: anxiety and fear,
dysphoric emotions
Nucleus acumbens: anhedonia and
decreased motivation
Hypothalamus: neurovegetative
symptoms (sleep, appetite etc…)
ACtivated regions : thalamus, amygdala, orbital and medial prefrontal (subgenual cingulate cortex Cg25)
Deactivated region: (anterior cingulate cortex) - attention and sensory processing
What are anatomical observations in depression?
Increased:
Ventricular enlargement, increased CSF, periventricular hyperintensity
-thicker in orbitofrontal and subgenual cortex
Decreased:
Reduced volume in caudate and basal ganglia, hippocampus, frontal cortex and gyrus rectus
-thinner right lateral cortex (increased risk of MDD)
-thinner LEFT MEDIAL CORTEX (is actually correlated to current MDD)
What are anatomical observations of PTSD
- smaller hippocampal volume predisposes
- smaller pregenual anterior cingulate cortex volume may be a result
What is activated for OCD?
activated head of caudate, anterior cingulate gyrus and orbitofrontal cortex.
OCD is related to Tourettes and huntington so works through similar pathways
PANDAS?
pediatric autoimmune neuropsychiatric disorders with strep
-caused by streptococcal infection and the body attacks the basal ganglia. You get tourettes like behaviors and these children are more vulnerable to OCD
What is neuronal activity of panic disorder
they have fewer GABA receptors, less inhibition leads to increased activity in amygdala and frontal cortex
Describe the HPA and Neurotrophin pathway
Stress activates hypothalamus > CRH > pituitary > ACTH > adrenal cortex > glucocorticoids > depression.
Defective feedback. Toxic levels of glucocorticoids compromise hippocampal neuronal survival and reduce BDNF
With antidepressants you increase BDNF, rebirth of the hippocampal neurons, all of which will repair hippocampal function. Antidepressants also increase glucocorticoid receptor expression on the mainly hippocampus, hypothalamus, pituitary) for feedback inhibition
Which mental disorders are heritable
- ADHD
- conduct disorder
Nigrostriatal
Mesolimbic/Mesocortical
Tuberoinfundibular
Nigrostriatal pathway aka mesostriatal (control of movement and parkinson’s disease)
- synthesizes most of the CNS dopamine, cell bodies found in SN, projects to D2 receptors of the striatum,
- increased dopamine activity in the striatum is thought to be realted to the neurocognitive deficits in schizo
______________________________________
Mesolimbic pathway: reward pathway, schizophrenia, depression
- Cell bodies found in the VTA of midbrain
- projects to D4 receptors of the limbic system
- hyperactivity results in positive symptoms
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Mesocortical pathway: working memory, schizophrenia (negative symptoms)
-cell bodies also found in VTA of midbrain, project to the frontal cortex and cingulate and prefrontal gyri
-largely hypoactivity (D2 receptor antagonism) worsens negative symptoms, mood and cognition) which is why typical antipsychotics don’t help with negative symptoms
Describe the interview for dissociative symptoms
Any?
Blackouts/time loss
- Disremembered behavior (collateral information)
- Fugues
- Unexplained possessions
- Changes in relationships (may have abrupt changes in interactions due to laters)
- Fluctuations in skills/habits/knowledge
- Fragmentary recall of personal history
- Passive influence (have you ever felt that someone was controlling you or propelling you to do something?)
- Negative hallucinations (seeing something that isn’t there)
- Analgesia
- Depersonalization/derealization
Then questions about trauma history (who made the rules how were they enforced, any family violence, any unwanted sexual contact, flashbacks, nightmares)
How would you treat dissociative disorders?
many symptoms remit quickly but if no remission:
> behavioral (stress management, positive reward)
> cognitive therapy
> psychodynamic psychotherapy
> psycho education (how our past experiences affect us today)
psychopharm
- hypnosis
- higher level of care
Typicals or atypicals , you need to talk about about expected benefits and expected harms, improvements in the positive symptoms.
Risk of typicals: think of in 3s, EPS, INcrease in serum prolactin, 3 Other.
typicals STOMAS - sedating, torsods (life threatening arythmia, orthostatic hypotension, metabolic abnormalities (diabetes), anticholinergic side effects, and lowering seizure threshold.
Atypicals - exact same side effects but reverse order - relatively rare EPS, relatively rare prolactin and think STOMAS, risperidone due to tissue specificity does tend to induce elevated serum prolactin levels
What is selective mutism
Consistent failure to speak in specific social
situations
¨ At least 1 month
¨ Clinically significant
¨ Not better explained by lack of knowledge with spoken language or another mental d/o
What is the tetrad of narcolepsy?
Narcoleptic tetrad includes:
Excessive daytime sleepiness
Sleep paralysis (waking and feeling unable to move)
Cataplexy (loss of muscle tone, usually occurs with strong
emotion),
Hypnagogic & hypnapompic hallucinations when going off to
sleep or waking
Neuroleptic malignant syndrome
Neuroleptic malignant syndrome
- muscle rigidity
- excessive sweating
- hyperpyrexia
- autonomic instability which may be life threatening (10% mortality)
