Block 6 - Psychological Medicine 1 Flashcards
(183 cards)
1
Q
Define psychology
A
The scientific study of the behaviour of individuals and their mental processes
2
Q
Define conciousness
A
The state of being aware ad responsive to sensory surroundings
The ability of memory, language, emotion, abstraction and attention
3
Q
Why is consciousness hard to assess?
A
You need to be alert
4
Q
How are sleep-wake cycles affected when you have a low level of consciousness?
A
You still have sleep-wake cycles until you are classed as ‘brain-dead’
5
Q
What type of behaviour do you have when you are in a vegetative state?
A
Non-purposeful behaviour
6
Q
What type of behaviour do you have when you are in a coma?
A
Reflex behaviour
7
Q
What is a normal and abnormal loss of consciousness?
A
Normal: Sleeping
Abnormal: Loosing consciousness in situations where you shouldn’t (e.g. work)
8
Q
10 pathology’s which cause a lack of consciousness?
A
Cardiovascular, dementia, diabetes, drugs, epilepsy, head injury, increased intracranial pressure, malaria, metabolic disorders, stroke
9
Q
3 things to define brain stem death
A
No reflexes
Heart beat and breathing through machinery only
Clear evidence of brain damage through scans
10
Q
4 examples of when people may not be brain stem dead
A
Drugs, reversible body disturbances, hypothermia, cervical cord injury
11
Q
What 3 things does the Glasgow Coma scale look at?
What is each one scored out of?
A
Eye opening (4) Verbal response (5) Motor response (6)
12
Q
What are the 4 levels of eye opening in the Glasgow Coma scale?
A
Spontaneous
To loud voice
To pain
To nothing
13
Q
What are the 5 levels of verbal response in the Glasgow Coma scale?
A
Orientated Confused/disorientated Inappropriate words Incomprehensible Nothing
14
Q
What are the 6 levels of motor response in the Glasgow Coma scale?
A
Obeys commands Localises pain Withdraws from pain Abnormal flexion Extensor posturing Nothing
15
Q
What score does a fully conscious and comatised patient receive in the Glasgow Coma scale?
A
Fully conscious: 15
Comatised: 3
16
Q
What is the Reticular Activating System?
A
A collection of nuclei and tracts in the midbrain that project to the pons, medulla and spinal cord
17
Q
What 2 structures are needed for conciousness?
A
RAS System
Cerebral cortex
18
Q
What are the 4 neurotransmitters involved in the reticular activating system?
What do they do?
A
Dopamine: Increases the will to do something
Noradrenaline: Increases when anxious/frightened (super conscious)
Acetylcholine: Sleep
Serotonin
19
Q
What does damage to the anterior hypothalamus cause?
A
Decreased sleep
20
Q
What does damage to the posterior hypothalamus cause?
How?
A
Increased sleep
Histamine activity –> drowsiness
21
Q
What happens to acetylcholine levels when you are asleep?
What does this cause?
A
Increase
Activation of sensory thalamus –> Inhibition of reticular nucleus –> Increased thalamocortical neurones
22
Q
What happens to the EEG when you are asleep and awake?
A
Asleep: Low frequency waves
Awake: High frequency waves
23
Q
What is another name for synchronised sleep?
What are the EEG waves like?
A
non-REM sleep
Low frequency waves
24
Q
What is another name for desynchronised sleep?
What are the EEG waves like?
A
REM sleep
High frequency waves
25
How often does REM occur?
Every 90-120 minutes
26
What happens to muscle tone during REM sleep?
It is lost
27
3 long term consequences of little sleep?
Obestiy, diabetes, increased blood pressure
28
What is narcolepsy?
Spontaneous transition from being awake to REM due to a mutation in the orexin receptor gene
29
How is the Circadian Rhythm established?
Light is detected by the retina and processed by the suprachiasmatic nucleus in the hypothalamus
Vasopressin is released to the pineal gland which releases the sleep promoting hormone melatonin
30
What are the EEG waves like for the 7 stages of sleep?
```
Awake: low voltage high frequency BETA waves
Drowsy: ALPHA waves
Stage 1: THETA waves
Stage 2: Mixed EEG with sleep spindles
Stage 3+4: DELTA waves
REM: Low voltage and increased frequency
```
31
How does information get from the sensory stores to the long term memory?
- Sensory stores of memory last milliseconds
- Paying attention moves it to the short term store
- Repeated attention changes the brain synapses causing it to be moved to the long term store
32
How can you decrease the chance of memory interference?
Remembering information in a meaningful way
33
2 things which patients with Amnesia find difficulty doing?
Forming new long-term memories
| Recalling that information
34
5 causes of Alzheimer's
Viral infection (herpes), Alcoholism (korsakoff's), Head injury, Alzheimer's, Anoxia
35
What is Anoxia?
When the hippocampus is deprived of oxygen
36
What is the memory loop that allows encoding and retrieval of memories?
Cortex - Hippocampus - Fornix - Mamillary bodies - Thalamus
37
What is the role of the para-hippocampal cortex
Provides spacial information and talks to the hippocampus
38
What is the temporal gradient?
A timeline of memories
Reterograde: Before the accident
Anterograde: After the accident
39
What happens to the reterograde and anterograde in Alzheimer's patients?
```
Reterograde = spared
Anterograde = lost
```
40
What is semantic memory?
Factual knowledge
41
What is non-declarative memory?
| e.g.
Motor memories
| e.g. if you draw image in a mirror you will improve over time even if you can't remember drawing the previous images
42
Where are old memories stored?
| Why is this possible?
Neocortex
| The neocortex is next to the hippocampus so is able to cooperate with it
43
What two types of memory are spared in patients with amnesia?
Semantic and non-declarative memory
44
What is declarative memory?
Concious
45
What is non-declarative behaviour?
Non-conscious
46
Explain how the hippocampus forms a memory?
| Where does it get its information from?
Combines 3 things:
PLACES: From the parahippocampal place
OBJECTS: From the inferior temporal cortex
PEOPLE: From the anterior temporal lobes
47
How does semantic dementia occur?
Damage to the neocortical store causes loss of conceptual knowledge and old memories
Loss of semantic memories
48
What is another name for semantic dementia?
Frontotemporal dementia (FTD)
49
What can people with semantic dementia still do?
Remember short term events
Non-verbal reasoning and intelligence is spared
Recognise simple animals but not complex ones
Copy an image well but can't remember it as well after a minute
50
What memory is lost in amnesia?
| What area of the brain is damaged?
New episodic memories
| Hippocampus
51
What memory is lost in dementia?
| What area of the brain is damaged?
Old semantic memories
| Anterior temporal lobe
52
Define behavioural genetics
Casual links between genes, behavioural traits and neural mechanisms
53
Who founded behavioural genetics?
Francis Galton
54
What movement is behavioural genetics NOT linked to?
Eugenics
55
Define genome
A combination of alleles at a locus
56
Define behavioural phenotype
Observed trais
57
Define polygenic inheritance
Genes have small effects towards the heritability of a behavioural phenotype
58
Define heritability
The proportion of phenotypic variance that is accounted for by genetics
59
What do genome wide association studies do?
Link SNPs and CNVs to behavioural phenotypes
| Unrelated individuals
60
What type of distribution does a large gene pool have?
A normal distribution
61
Which non-genetic environment has the biggest impact on siblings?
Non-shared
62
Define gene-environment correlation
Life experiences correlated with genetics
63
Define gene-environment interaction
Environmental effects depend on genetics
AND
Genetic effects depend on the environment
64
What type of research is human genetic research?
Observational
65
What is the difference between adoption studies and combination studies?
Adoption studies: Reared together vs apart
| Combination studies: Twins adopted apart
66
What does TEDs stand for?
When did it start?
What did it examine?
```
Twins Early Adoption Study
1994
Language, behaviour and cognition
DNA analysis
Comparison between twins and parent
```
67
What happens to the inheritability of inheritance throughout development?
It increases
68
What type of neurotransmitter is glycine?
An amino acid
69
Neurotransmitters:
- What are the vesicles like?
- Where are they synthesised?
- Where are they packaged?
Vesicle: Small, clear core
Synthesis: In the soma and transported down microtubule tracts in the axon
Packaged: In the presynaptic neurone
70
Neuropeptides:
- What are the vesicles like?
- Where are they synthesised?
- Where are they packaged?
- What happens in the pre-synaptic neurone?
Vesicle: Large, dense core
Synthesis AND packaged: In the soma and transported down microtubule tracts in the axon
Pre-synaptic neurone: Modified
71
What are co-transmitters?
Make, store and release more than one neurotransmitter/peptide?
72
What is the difference between low and high frequency stimulation?
Low: Neurotransmitters
High: Neurotransmitters AND neuropeptides
73
What is the difference between inotropic and metabotropic receptors?
Inotropic: Ion channel, agonist causes conformational change, fast
Metabotropic: Trans-membrane receptor, agonist signals through intracellular intermediates, slow
74
4 ways of identifying neurotransmitters?
Immunocytochemistry: Antibody
In-situ hybridisation: Synthetic probe with nucleotides that binds to mRNA in tissue
Microiontophoresis: Inject drug and pass an electric current to stimulate axon and record voltage
Radioactive binding assay: Calculate radiation level
75
7 things ACh is involved in in the brain
Arousal, biorhythms, learning, memory, sexual behaviour, sleep and thermoregulation
76
What 5 areas of the brain is ACh found in?
Basal forebrain, cortex, hippocampus, pons and midbrain
77
Where are nicotinic ACh receptors found? (4)
Autonomic ganglia, adrenal medulla, CNS and NMJ
78
Where are muscarinic ACh receptors found? (2)
CNS and peripheral tissues
79
What are the 2 types of nicotinic receptors and where are they found?
Nn: Postgabglionic neurones, presynaptic cholinergic terminals
Nm: Skeletal motor end plates
80
What are the 5 types of muscarinic ACh receptors and what are their structure?
M1, M2, M5: Stimulatory G protein
| M2, M4: Inhibitory Gi protein and K+ channels
81
Which ACh receptor is blocke by curare?
Nicotinic
82
How is ACh formed? (+ enzyme)
Choline + acetyl CoA --> ACh
Enzyme: Choline acetyl transferase (chAT)
83
How is ACh broken down? (+ enzyme)
ACh --> Choline + Acetate/Acetyl Acid
Enzyme: Acetylcholinesterase (AchE)
84
What is glutamate a reduced form of?
| Name 2 other molecules it can be synthesised by
Glutamic acid
| Glucose and aspartame
85
Which organ's functioning does glutamate regulate?
The brain
86
Explain what happens to glutamate in glial cells
Glutamate --> Glutamine
(Enzyme: Glutamine synthetase)
It is then transported to mitochondria in the synapse where Glutamine --> Glutamate
(Enzyme: Glutaminase)
87
How can glutamate cause neurone death?
If there are too high extraneuronal levels
88
How is glutamate packaged into vesicles?
By the action of a proton pump
89
What are the 3 types of glutamate receptors?
AMPA
NDMA
Kainite
90
Which glutamate receptors are decreased in epilepsy?
AMPA
91
Which glutamate receptors are decreased in strokes and memory problems?
NDMA
92
Explain how the receptors AMPA and NDMA co-exist
Glutamate binds to AMPA and causing partial depolarisation and a confrontational change which removes the Mg ions that are blocking the NDMA receptor
93
How is GABA made? (+ enzyme)
| Name 2 other molecules that GABA can be made from
Glutamine --> Glutamate (Enzyme: Glutaminase)
Glutamate --> GABA (Enzyme: Glutamic acid decarboxylase)
Glucose and pyruvate
94
What 2 ions can GABA neurones activate?
Chloride and calcium
95
What happens in epilepsy?
Increased GABA inhibition causes uncontrolled brain excitation
96
How is glycine produced? (+ enzyme)
| Where is it produced?
Serine --> Glycine
(Enzyme: SHMT)
In the mitochondria
97
Where are glycine receptors found?
Brainstem
| Spinal cord
98
What do glycine receptors do in the spinal cord?
Inhibit skeletal muscle
99
What causes hyperreflexia?
| 4 symptoms
Glycine receptor defects
| Increase in muscle tone, exaggerated startle reflex, rigidity and decreased balance
100
What causes stiff person syndrome?
| 1 symptom
Decreased GABA
| Stiff muscles
101
What 2 groups do all catecholamines have?
Catechol and amine group
102
What is the rate limiting step for catecholamine production?
Tyrosine --> L-DOPA
103
What is the role of MAO-A?
| Where does it occur?
Oxidises serotonin in the liver
104
What is the role of MAO-B?
| Where does it occur?
Oxidises dopamine in the liver
105
What are the four dopamine pathways and what are they involved in?
Mesolimbic: Reinforcement and reward
Mesocortical: Planning, emotions, cognition, motivation
Nigrostriatal: Movement
Tuberoinfundibular: Inhibits prolactin release from pituritary gland
106
Which pathway is disrupted in Parkinson's disease?
Nigrostriatal
107
How is dopamine broken down?
Dopamine --> DOPAC --> Homovanillic Acid
108
What are the 2 classes of dopamine receptors?
Which receptors do they include?
What are they coupled to?
D1-like receptors: positively coupled to adenylate cyclase via Gs proteins (D1+D5)
D2-like receptors: negatively coupled to adenylate cyclase via Gi proteins (D2,D3+D4)
109
Where is noradrenaline released from in the brain?
Locus Coeruleus in the brainstem
110
What do decreased and increased levels of noradrenaline lead to?
Decreased: Depression
Increaded: Mania
111
2 pathways by which noradrenaline is broken down
Nordrenaline --> Normetanephrine (Enzyme: COMT)
Noradrenaline --> VMA/MHPG (Enzyme: MAO)
112
How is serotonin produced? (+enzyme)
Tryprophan --> 5HTP (Enzyme: Tryptophan hydroxylase)
| 5HTP --> Serotonin (Enzyme: 5HTP decarboxylase)
113
What is another name for serotonin?
5HT
114
Where do serotenergic neurones project from?
The Raphe Nuclei in the brainstem
115
What do decreased levels of serotonin lead to?
Depression
116
How is serotonin taken up by neurones?
SERT transporters
117
How is serotonin taken up into vesicles?
VMAT
| A monoamine transporter
118
How many classes of serotonin receptors are there?
What word describes them all?
Which is the odd one out?
7 receptor classes: metabotropic
| 5-HT3 = inotropic
119
2 ways that serotonin is degraded
MAO oxidises it to 5-HIAA
| Pineal gland converts it to melatonin
120
What family is Substance P in?
Tachykinin family
121
What does substance P bind to and what are its two effects?
Neurokinin 1,2,3
| Smooth muscle contraction and pain transmission
122
What 7 brain regions is substance P involved in?
Amygdala, Cerebral Cortex, Dorsal horn, Hypothalamus, Medulla, Striatum, Substantia Nigra
123
Define stress
An imbalance between demands, and personal resources to deal with these demands
124
How can life events trigger stress through appraisals?
Life event --> Primary appraisal --> Secondary appraisal --> Stress
125
Define primary appraisal
Assessment of event
126
Define secondary appraisal
Assessment of coping abilities
127
Give an example of a physiological response to stress
Fight or flight
128
Give 4 examples of emotional responses to stress
Sad, irritable, tearful, over-reacting
129
Give 5 examples of behavioural responses to stress
Activity changes, diet changes, decreased sleep, increased smoking and drinking
130
Give 5 examples of cognitive responses to stress
Difficulty concentrating, hard to make decisions, self-critical, sensitive to criticism, switching off
131
What does the individual illness response depend on?
Appraisal and coping style, childhood factors, mental illness, previous illness experience, worrying
132
What can stress cause to happen to existing illnesses?
Relapses
133
How does stress increase levels of cortisol?
Activates the hypothalamic-pituritary adrenocorticol axis
134
How does stress increase levels of catecholamines?
Activates the sympathetic-adrenal medullary system
135
3 changes that bereavement causes in the heart?
ECG changes
Increased vascular resistance
Ventricular dysfunction
136
What does the disease illness response depend on?
Is the disease life-threatening or controllable
Is the disease ambiguous?
Does the disease have undesirable treatment?
137
What is emotional discharge?
When you talk to other people about how you are feeling
138
What are illness cognition's?
| What does it influence?
The patient's own common sense beliefs about their illness
| It influences their response
139
What 6 things affect illness cognition?
- How the patient identifies the disease
- The perceived duration of the disease
- The expected outcome for the disease
- Whether the disease can be controlled or cured
- The personal ideas about what may have caused the disease
- How the patient appraises the pain
140
Define pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
141
How long does pain have to occur for before it is classed as chronic?
6 months
142
6 impacts of chronic pain on patients
Negative attitude, fear avoidance, decreased activity levels, depressive symptoms, social issues, unrealistic expectations
143
What is central sensitisation?
| How does it occur?
When the pain threshold is decreased so sensitivity to pain is increased
Changes to the receptors in the dorsal horn
144
5 reasons why pain gates open?
Anxiety, decreased activity (e.g. stiff joints), depression, focusing on pain, stress
145
Explain how persistent pain can be made worse
Persistent pain decreases activity causing muscle and joint weakness. This causes fatigue and frustration causing social issues and depression --> more pain
146
5 examples of social treatments for pain
Communication, goal setting, pacing, relaxing, return to work
147
5 examples of psychological treatment for pain
Acceptance, CBT, fear-avoidance, mindfulness, psychoeducation
148
3 examples of physical treatment for pain
Exercise, pain education, homeopathy
149
What 5 categories are in the 'Holistic model of pain'?
Give 2 examples for each category
```
Behaviour: Work, hobbies, resting
Environment: Relationships, home
Mood: Depressed etc.
Physical: Weight increase, medication side effects
Thoughts: Isolated, useless
```
150
What 2 things does CBT develop?
New behaviours and thoughts
151
What is mindfulness?
Meditative techniques that soothe brain patterns
152
Three examples of third wave cognitive therapies
Compassion therapy
Acceptance and commitment therapy
Mindfulness
153
Define somatisation
Physical expression of psychological pain
154
Define stress
Condition that challenges the maintenance of homeostatsis
155
Give examples of external, internal, psychological and physiological stressors
External: Physical environment, society, life events,
Internal: Lifestyle, self-appraisal, personality
Psychological: Unemployment, relationships, work, money, health
Physiological: Health
156
What is the general adaptation syndrome?
The physiological response to stress to regain homeostasis
157
What are the 4 phases of the stress response?
Alarm phase: ST - fight or flight
Resistance phase: LT - adapting
Exhaustion phase: Body depletes resources
Recovery
158
What does the short term stress response activate?
Sympathetic nervous system
| Catecholamine release
159
How is stress activated in the brain?
Cerebral cortex --> Hypothalamus --> ST/LT
160
What does the long term stress response activate?
Hypothalamic-Pituritary-Adrenal Axis
161
Give an example of a glucocorticoid
When is it secreted
6 roles
Cortisol
Secreted during stress
Activates CNS, anti inflammatory, decreases B and T cells, increase glucose, increases memory, maintains blood pressure
162
Give an exmaple of a mineralocoritocoid
Where is it released
3 roles
Aldoesterone
Released by the adrenal cortex
Sodium and water retention, increases blood pressure and immune supression
163
13 symptoms of excessive stress
Ageing, anxiety, asthma, blood pressure increase, cancer, depression, diabetes, GI issues, immune dysfucntion, migraine, muscle breakdown, psychosis, sex hormone decrease
164
What can persist after the stress response?
Pathological changes
165
What does acute and chronic stress do to the immune system?
```
Acute = Increases the immune system
Chronic = Decreases the immune system
```
166
Define psychoneuroimmunology
Nervous and immune system interactions
167
4 methods to decrease stress
Counselling, exercise, meditation, relaxation
168
What does activation of the Periaqqueductal grey matter lead to? (in regards to stress)
Avoidance behaviour
169
What does activation of the diffuse modulatory systems lead to? (in regards to stress)
Increased vigilance
170
What does cortisol enhance?
Memory
171
What are relaxation and exercise examples of?
Psychological treatments
172
Define anxiety
Inappropriate expression of fear in unrealistic situations
| It is anticipated and affects ADL
173
Define fear response
Realistic response to a known and threatening stimulus
174
Define anxiety disorder
Psychological disorder with unrealistic fear
175
4 symptoms of anxiety disorder
Tension, stimulation of the nervous system, GI issues, insomnia
176
Give 5 examples of anxiety disorders
```
Generalised anxiety disorder
Panic Disorder
Phobias
Obsessive Compulsive disorder
Post Traumatic Stress disorder
```
177
What is Generalised anxiety disorder?
6+ months of anxiety, panic or worry
178
What is Panic Disorder
Panic attacks - brief periods of intense fear
| Increased blood pressure, hyperventilation, heart palpitations, tight chest, dizzy, tingling
179
What are Phobias?
Strong fears of specific things/situations
180
What is Obsessive Compulsive disorder?
```
Intrusive thoughts (obsessions) that cause anxiety
People have specific compulsions (repetitive behaviours) to decrease their anxiety
```
181
What is Post Traumatic Stress disorder?
| 2 brain changes during this condition?
Anxiety triggered by recall of past/stressful life events
Re-lived through flashbacks and nightmares
Causes avoidance, detachment and insomnia
Decreased size of the hippocampus and abnormal amydala activation
182
4 actions of noradrenaline in the brain?
Attention, behaviour, feeding and sleep
183
3 actions of serotonin in the brain?
Emotion, mood and sleep
