Case 12 Flashcards
1
Q
In the resting membrane, which area is more negative; the inside or outside of the neuron ?
A
Inside is more negative
2
Q
In the resting membrane, what is the relative permeabilities to Na, K and potassium?
A
Na, poorly permeable
Proteins, yes
K, moderately in regulating balance
3
Q
What values in mV are recorded if the membrane is said to be; polarised, at threshold, required for opening of K gates?
A
polarised = -70
Threshood = -55
K channels = 30
4
Q
What is the difference between ion channels and G proteins ?
A
Ion channels = fast transmission
G proteins = slow
5
Q
What do excitatory and inhibitory NTs induce in terms of polarisation ?
A
Excitatory = Depolarisation Inhibitory = Hyperpolarisation
6
Q
What is a major function of the choroid plexus ?
A
Produce CSF
7
Q
What structure aids the formation of the basement membrane around the tight junctions between capillaries endothelial cells ?
A
Pericytes , secrete proteins
8
Q
Apart from tight junctions, what other structures allow plasma to leave the cell but prevents larger structures from moving ?
A
Fenestrations between cells of the BVs
9
Q
What is the HPA axis hypothesis ?
A
Hypothalamic pituitary adrenal axis. Elevated cortisol levels/non suppression in DST leads to degenerative changes/neuroplasticity abnormalities.
10
Q
What is the glutamate hypothesis ?
A
Decreased levels of glutamate causes depression. Active at NMDA receptors.
11
Q
What is neuroplasticity ?
A
Altered gene transcription
12
Q
How can ketamine be used as treatment and what are its negative features ?
A
NMDA receptor antagonist. increases mood but only has short lived effects.
13
Q
What is the monoamine hypothesis ?
A
All the monoamines show decreased levels in depression.
NA/DA show ^ in mania.
14
Q
Where is serotonin produced ?
A
Raphe nuclei in the brain
15
Q
How many receptors does Serotonin have?
A
13
12 are GPCR
5HT3 is inotropic
16
Q
What causes the degrading of serotonin?
A
MAO (pref MAO-A) or reuptake.
17
Q
What main characteristics does 5HT influence ? (4)
A
mood/emotion
sleep/wakefullness
feeding/sexual behaviour
Cognition
18
Q
Which serotonin platelet binding sites show an increase in depression ?
A
5HT2 platelet and brain binding sites
19
Q
What NT is produced in the Locus caerulus, pons and adrenal glands ?
A
Noradrenaline
20
Q
What times during the day would NA be at it’s highest and lowest ?
A
Highest during stress/danger
Lowest during sleep
21
Q
What colour would the Locus caerulus be under a microscope and why ?
A
Blue due to the melanin pigmentation
22
Q
What behaviour is dopamine said to influence ?
A
Reward motivation behaviour
23
Q
Where is dopamine produced ?
A
Adrenal medulla
24
Q
What changes in seen for depression in relation to dopamine ?
A
Increase in D2 receptors, euphoriant effects of methamphatiamine (DA release)
25
What are SSRIs ?
Selective serotonin reuptake inhibitors.
| First line of defence for depression or anxiety.
26
List some SSRIs ....
Sertraline, fluoxetine, Citalopram, paroxetine (prozac)
27
SSRIs...
| Rate of absorption, where are they metabolised, by what ?
Rapid absorption, in the liver using CYP450.
28
How does the half life of an SSRI change its issue ? Which drugs have the shortest and longest half lives respectively ?
Shorter half life causes increases discontinuation.
Shortest = Paroxetine (prozac)
Longest = Fluoxetine
29
What type of drug are Venlafaxine and Duloxetine and when are they used ?
SNRIs - Serotonin noradrenaline reuptake inhibitors.
| used in depressed px not responding to SSRIs
30
Where are SNRIs metabolised, what are they excreted by ?
CYP2D6 , excreted by the kidneys
31
A depressed px is on medication, starts experiencing does dependant ^ in BP, seizures and constant sweating. What type of medication are they on ?
SNRIs
| Venlafaxine and Duloxetine
32
Apart from SNRIs, what other drug does CYP2D6 metabolise ?
TCAs, tricyclic antidepressants.
33
Why are TCAs difficult to issue and what severe SEs may be experienced ?
Thin therapeutic index, varied differential dose response.
| Cardiac toxicity is the major con.
34
A px has just been switched from MAOIs to SSRIs. What changes are you likely to see in the first two weeks ?
None relating to SSRIs
| there is a 2 week switching period of MAOI receptors so the new drug would take time to have an effect.
35
What is discontinuation syndrome ? What symptoms will be seen (5)
3-5 days after abrupt stop to a drug treatment.
| Sleep disturbance, sense problems, GI upset, mood swings (mania) , psychosis (rare)
36
Serotonin syndrome is an ^ activity of 5HT in CNS. what are the two main causes ?
2 5HT enhancing drugs interacting with each other
| Idiosyncratic to specific drug.
37
What does serotonin syndrome result in?
Autonomic instability, increased HR RR BP temp. altered conscious level, ^ tone.
38
At what age do antidepressants not result in an ^ in suicidal thoughts. Which drug doesn't cause suicidal tendancies to ^ ?
Up to age 25
| Fluoxetine
39
What effect do anxiety disorders have on these particular areas of the CNS ?
PAG , Medial hypothalamus, amygdala
PAG, brainstem hard wired fight or flight. Can induce pain attacks
Medial hypothalamus, autonomic/endocrine components of anxiety. HR changes, sweating
Amygdala, classical conditions chemoreceptors for CO2.
40
What system is responsible for feelings of avoidance/anticipatory anxiety and memory?
Hippocampal system
41
What do Yohimbine and Clonidime cause respectively ?
Yohimbine , ^ NA release - pain
| Clonidime, decrease NA and sedation.
42
How is GABA formed ?
Decarboxylation of glutamate
43
What are the two types of receptor for GABA? Which one is coupled with Cl channels ?
GABA-A (ligand gated) and -B (G protein linked)
| -A is coupled to Cl channels
44
Barbiturates can bind to GABA, causing what effect ?
Sleep inducing, ^ likelihood of channel opening creating inhibitory effect.
45
What is the difference between anxiolytic and anxiogenic effects ?
Anxiolytic, inhibits anxiety (NMDA, AMPA receptor antagonists are anxiolytic)
Anxiogenic, causes anxiety
46
Name two benzodiazepines
Diazepam or lorazepam
47
Lorazepam can produce active metabolites. What effect does this have ?
Longer half life, prolonged effect of drug action. May cause confusion in older px.
48
What is the effect of a Ca influx into presynaptic nerve terminal ?
Vesicles filled with NTs migrate to pre and release contents into cleft through exocytosis.
49
Which dopamine receptors are linked to depression ?
D1 and D2, D2 ^ in depression
50
How does transmission terminate in synapses?
active reuptake by pre/post terminals
| enzymatic breakdown in synaptic cleft
51
For monoamines, what is the enzyme that breaks them down in the synaptic cleft ?
Monoamine oxidase
52
Why are DA, NA and 5HT sometimes referred to as 'modulatory NTs' ?
They have the potential to influence GABA and glutamate
53
Describe the process of DA synthesis ?
Tryosine across bbb. Hydroxylated (tyrosine hydroxylase) into L-DOPA
L-DOPA -> DA using L- amino acid decarboxylase (AADC)
54
What is required for the synthesis of DA other than Tyrosine ?
Fe, O2 and hydrogen donor for rate limiting step
| Then Vit B6.
55
How is DA -> NA ?
Dopamine-B-hydroxylase inside synaptic vesicles using Vit C and Cu.
56
What is given in Parkinson's treatment and why ?
L-DOPA is given because it avoids the rate limiting step of the reaction
57
What is serotonin converted to in the pineal gland ? What is this substance involved in?
Melatonin
| Circadian rhythms and sleep
58
What is St John's Wort and why does it have dangerous potentials ?
Herbel remedy intended for mild depression
| Induces drug metabolising enzymes
59
What structures secrete proteins that contribute to the basement membrane ?
Pericytes, believed to be involved in production and maintenance of tight junctions between cerebral epithelial cells
60
Which area of the brain lacks the bbb?
Postrema
61
What effect does Fluoxetine have on 5HT regulation ?
Short term ^ in synaptic serotonin, long term down reg of postsynaptic 5HT receptors
62
What drug acts on GABA-A receptors in anxiety and sleep disorders ?
Lorazepam
63
What is Moclobemide ?
Selective (reversible) monoamine oxidase inhibitor. Used for depressive and anxiety disorders and psychosis
64
Name a TCA antidepressant that limits 5HT and NA reuptake but also blocks voltage gated cation channels in the CNS ?
Amitriptyline
65
What is personality ?
Combination of characteristics or qualities that form an individual's distinctive character, patterns of thinking feeling and behaving.
66
What is the biological trait theory ?
Traits are heritable and can be described biologically. Personality is made of a number of distinct traits.
67
What is the behavioural theory?
Personality is result of interactions between the individuals and environment. Px responds to external stimulus
68
What theory is this; cognitive expectations about the world shape personality. Cognitive processes work in environmental influences
Social learning
69
What is the psychodynamic theory ?
Unconscious mind and childhood experience in development eg. motivations, sex, aggression, conflicts
70
What is the humanistic theory ?
Importance of freewill and individual experience on the development of personality
71
What are the 5 factors of the 5 factor model ?
```
Openness
Conscientiousness
Extraversion
Agreeableness
Neuroticism
```
72
What traits would somebody have if they scored highly on the conscientiousness scale ? Where is the brain activity related to ?
Organised, thoughtful, meticulous, disciplined, dependable.
| Dorsolateral PFC
73
What volume change is seen in the brain with a high score in agreeableness ?
Increased volume in the posterior cingulate cortex
74
For neuroticism; what traits would be common , what brain activity has changed, what disorders is it common in ?
Anxiety, emotional instability, tension, moodiness
5HT activity in thalamus and insular cortex
Anxiety/depressive disorders
75
What is the personality inventory measure and why is it limited ?
Most common personality measure, px does a questionnaire.
| Response bias issues, px gives socially desirable answers
76
What is the dif between temperament and personality ?
Temperament is a set of narrowing defined characteristics that appear early in infancy whereas personality takes time to develop
77
What 4 temperaments are commonly assessed in an TCI ?
```
Temperament and character inventory
Novelty seeking
Harm avoidance
Reward dependance
Persistence
```
78
What are the characters assessed in TCI ?
Self directness, cooperativeness, self transcendence
79
Why might having a low conscientiousness score be bad for treatment ?
More likely to have poor adherence
80
What trait is emotional instability most linked to ?
Neuroticism. Vulnerable to stress, anger, depression.
81
What would high score on neuroticism and low on extraversion indicate ?
Harm avoidance tendencies.
82
What is 'felt' stigma ?
shame/fear that interferes with person seeking help. Px may avoid confronting their condition so that they're not -ve viewed
83
What are the 5 dimensions of adherence ?
```
Social/economic
Health care system
Condition related
Therapy related
Patient related
```
84
What is the difference between compliance and adherence ?
Compliance, passive role of the px
| Adherence, active/voluntary collaborative involvement of the px.
85
What is the word used to describe a shared agreement between HCP and a px of therapeutic goals.
Concordance
86
What is enacted stigma ?
First hand experience of stigma eg. health condition.
87
What are the 9 protected characteristics ?
```
Sexual orientation
Religious beliefs
Sex equality
Pregnancy/maternity
Gender reassignment
Age
Disability
Marriage/civil partnership
Race
```
88
When is a mental impairment considered long term? (3)
Lasted over 12 months
Will last over 12 months
Likely to last for rest of px life
89
What is indirect discrimination ?
Practice that appears neutral but puts a person at disadvantage
90
What is the difference between associative and perceptive discrimination ?
Association, connection with a disabled person
| Perception, belief they're disabled even when they're not.
91
What is the major +ve of diagnostic labelling ?
Px receives care from a specialist in that field. Helps manage condition now and I the future.
92
What are the potential -ve of diagnostic labelling.
Removes uniqueness of illness may affect self worth.
In mental health may be part of 'self fulfilling prophecy'
Others perceive the px differently
93
What is labelling theory ?
Assertion that deviance and conformity result not from what people do but from how others respond to those actions
94
What is inverse care law ?
Good medical/social care tends to vary inversely with the need of the population served
95
How does risk taking behaviour vary throughout puberty ?
^ throughout puberty compared with infancy then decrease post pubertal
96
When does adrenarche take place in girls and boys ?
```
Girls = 6-9 years onset
Boys = roughly 7-10
```
97
What is adrenarche ?
Deviation of HPA axis for adrenal production (zona reticularis)
98
Name the two adrenal androgens involved in adrenarche ?
DHEA and DHEA-S.
99
A girl is 11 yo , what development stage of puberty is she likely to be going through ?
Gonadarche.
100
What is the age range in boys for gonadarche ?
9-15 mean 12.
101
How is gonadarche initiated and what key hormone is involved ?
Reactivation of the HPA axis
| Pulsatile release of GnRH from hypothalamus during sleep
102
What is the effect of GnRH during gonadarche ?
Stimulates APG production of FSH/LH -> gonadal maturational changes -> ^ in oestrogen and testosterone
103
What are the '4Fs' of the hypothalamus ?
Fight or flight
Feeding
Fucking
104
What effect does a hyperactive environment have on a person development ?
Prolonged HPA activation which leads to less GH. Causes a smaller growth spurt and can also lead to mental consequences
105
What effect does GH have on the liver ?
Produces IGF-1
| Acts on pituitary and hypothalamus in a +ve feedback loop.
106
What are 4 major effects on the brain during adolescence ?
Amygdala and hippocampus volume increase
Synapse elimination
Axonal growth and myelination
Prefrontal activity increases.
107
What are the 3 main affects of sex steroid hormones ?
^ reproductive behaviours (via hypothalamus)
Reorganisation of sensory and association regions (visual cortex, amygdala, hippocampus) , motivation and reward based behaviour (NA, DA pathways to PFC)
108
What 3 substances are released during anxiety triggered by an early stress repose
Cortisol, CRH, ACTH
109
How can a poor antigenic environment pre and post natally hinder growth ?
Pre, placental transfer of antibodies
| Post, antibodies in breast milk and ^ exposure to allergens
110
How do white and grey matter growth vary in adolescence ?
White shows steady linear growth
| Grey is region specific non linear growth.
111
Why does grey matter volume decrease post pubertal ?
Synaptic overproduction results in pruning
112
What is synaptic pruning ?
when rarely used connections are eliminated making the brain more efficient. Allows greater change in response to environmental demand
113
What is neuroplasticity ?
Structural changes from exposure to environmental stimuli, both +ve and -ve.
114
What are the 3 main areas of cognitive development during adolescence ?
Cognition; attention, goal setting, info processing
Behaviour, less inappropriate
Emotionally, more impulse control
115
What two structures form the ventral striatum ?
Nucleus accumbens and olfactory tubercle
116
What part of the brain is responsible for reward anticipation ?
Nucleus accumbens
117
What are the two systems responsible for adolescent risk taking ?
Prefrontal cognitive control
| Subcortical motivational drive network
118
How does the development of the 'dual system' influence risk taking behaviours ?
Prefrontal cognitive control develops linearly and slowly whereas subcortical motivation is rapid. Therefore in the period in between risk taking behaviour is not inhibited.
119
Why is adolescence a key developmental period for mental health issues ?
Suboptimal trajections have ^ chance of developing before executive function matures
120
What are 3 key factors for depression onset ?
Familial/genetic risk
Environmental (acute stress life events)
Gene environment (high risk groups at ^ sensitivity)
121
Which circuit shows ^ activity during depression ?
Circuit connecting amygdala, hippocampus and PFC
| Linked to HPA (^ Cortisol)
122
What changes are seen during depression in the circuit connecting the striatum to PFC and ventral dopamine reward system ?
Decreased activity of the circuit
123
From a psychological basis what is Schizophrenia ?
Decrease in attention and general impairment of executive functions possibly due to abnormal brain development
124
What 3 responses indicate why sleep is important ?
Emotional ; feeling, stress, overt behaviour
Cognitive; attention, memory, executive
Somatic; drowsiness, pain/cold, CV disease, cancer risk, metabolic problems etc.
125
What are the common negative effects of sleep deprivation ? (7)
Circadian rhythm disruptions; body temp, RR, hormonal production
Brain effect; REM sleep down, fatigue
GI disorders; dyspepsia, heartburn
Cancer risk; breast and colorectal ^
CV disorders; angina pectoris, hypertension, MI
Mental health; stress, anxiety, depression etc.
126
What happens when the brain 'wakes' ?
Neurons in the pons produce ACh which go and activate the thalamus (channels signals to cerebral cortex - consciousness)
127
What NTs are produced in the pons and hypothalamus to prime the cerebral cortex during the 'woke' state ?
NA, 5HT, DA and histamine.
128
What are orexins and what is their effect on the arousal system ?
Peptides produced in lateral hypothalamus to reinforce and increase the arousal system
129
Why does the brain 'tire' ?
^ adenosine triggers neutron activity in ventrolateral preoptic nucleus
130
What is circadian control influenced by ?
Retinal signals throughout the day and melatonin from pineal gland at night
131
In the brain 'sleeps' stage, VLPO neurons are activated. What happens next ?
They release GABA and galanin which binds to hypothalamus and pons to inhibit arousal system and sleep.
132
What is the MOA of sleep tablets?
Tablets increase binding of GABA to decrease arousal
133
How do the stages of sleep vary from a newborn to an adult ?
Newborn; ^ REM to allow for ^ development
| Adult; N3 down as grey matter down from medial prefrontal cortex.
134
Why do adenosine levels effect sleep ?
Adenosine binds to receptors in brain -> tiredness. ^ due to ATP breakdown throughout the day.
135
How does coffee effect wakefulness ?
Blocks the binding of adenosine so stops the tiredness feelings from being induced
136
What are the common triggers of the SCN? (4)
Suprachiasmatic nucleus
| Melatonin, stress hormones, core body temp, alertness
137
What is the term given to environmental agents or events that act as stimuli to reset the biological clock of an organism?
Zeitgebers
138
What is the primary Zeitgeber ? list some others ...
Light
| food, stress, travel, sport, temp
139
Why does jet lag effect the body ?
Takes time for the peripheral clocks to re-sync.
140
Why shouldn't you remove the eyes of a blind px ?
Removing the eyes takes away the SCN so no melanopsin is produced -> depression etc.
Retinal ganglion still work even though eyes don't
141
When is the urge to sleep the largest ?
When the gap between the homeostatic sleep drive and circadian arousal drive is largest.
142
What type of condition is narcolepsy and what are the common sx (4)
Hypersomnolence disorder
| Sleep attacks, Cataplexy, sleep paralysis, hypnagogic.
143
Name two sleep related breathing disorders
Central sleep apnea; lack of resp drive causes resp movement down.
Obstructive sleep apnea; upper airway blockage during sleep
144
How would you treat CSA ?
CPAP, continuous positive airway pressure
145
What is the Diff between delayed and advanced sleep phase disorder ?
Delayed; rarely sleepy until 6am, awake by 12
| Advanced; can't sleep past 7pm.
146
What condition is involuntary hypnic jerk seen in ?
Periodic limb movement disorder
| Repetitive movements, common in limbs every 20-40 seconds.
147
When is insomnia classed as chronic ?
3 nights a week for 3 months.
148
What are the causes of insomnia according to the 3P model ?
Predisposing fx; hyperactivity, NT abnormalities
Precipitating fx; lifes stress, illness
Perpetuating fx; not sleeping in bed, staying in bed whilst awake
149
What are two common methods of treatment for acute insomnia ?
Sleeping tablets, BZD receptor agonist
| Sleep hygiene, 10 lifestyle points
150
Name a BZD receptor agonist used as a hypnotic
Sleeping tablet - Zolpidem
151
When asking screening Q's for insomnia, if px shows a circadian phase disorder, what would be your next step ?
Target sleep schedule, melatonin and light therapy
152
What are 3 major groups of health problems that can arise with Insomnia ?
Sleep apnoeas eg. restless leg
Mental health eg. depression
Kids with neudevelopmental disorders eg. ADHD.
153
What are the 'stimulus control' components of CBT? (5)
```
Only sleep (or sex) in bed
15 min rule for sleep
Sleep schedule
No naps
only go to bed when physically sleepy
```
154
What is the equation for sleep efficiency?
Total hours slept / total hours in bed (x100)
155
What is the expected value for sleep efficiency in a normal person ?
>90%
156
Where is dopamine synthesised ?
Substantia nigra, adrenal medulla
157
How do dopamine levels change during psychosis ? What other NTs are thought to be linked as a cause ?
^ DA in the nigrostriatal (indirect) pathway.
| Glutamate/GABA imbalance thought to be more of an issue
158
What receptor is commonly blocked in antipsychotic medication ?
D2 antagonism
159
Drug use ^ DA in nucleus accumbens, what does this mediate ? Which group of drugs is the only one not to show an ^ ?
Mediates positive reinforcement
| BZD only drug not to show ^
160
What sedative effects do antipsychotics induce ?
Anti histamine, alpha adrenergic antagonism.
161
What does the mesolimbic pathway transport ?
Transports DA from mental segmental (midbrain) to the nucleus accumbens
162
What are the major negative effects of D2 blockage in the mesolimbic pathway ?
Blunting affect, poverty of speech, limited +ve emotion.
163
Which pathway connects the substantia nigra to the striatum?
Nigrostriatal pathway
164
What are the components of the striatum ?
caudate and putamen
165
D2 antagonism produces some EPSEs, given the 4 common ones
Extra pyramidal side effects
| Dystonia, Parkinsons, Akathasia, Tardive dsykinesia
166
What is the pathway of the tuberofundibular gland ?
Hypothalamus to the pituitary gland
167
What effect does blockage of D2 receptors have on the tuberofundibular pathway ?
Causes the pituitary to ^ prolactin. Leads to;
| Amenorrhea, gynaecomastia, glactorrhoea, sexual dysfunction, hypogonadism.
168
Name 3 of the atypical antipsychotic drugs
Clozapine, olanzapine, risperidione
169
What are the advantages of the 2nd generation antipsychotics over Haolperidal ? (3)
^ efficacy for +/- sx. lower tendency to cause EPSE. Less likely to ^ prolactin
170
What condition shows; central obesity, HTN, DM, hyperlipidaemia, ^ serum triglycerides
Metabolic syndrome
171
What are the suggested methods of tx of metabolic syndrome ? (4)
5HT2C antagonism, H1 antagonism, hyperprolactinemia, ^ serum leptin (leads to leptin desensitisation).
172
What are the 3 main antipsychotics associated with weight gain, which have the highest and lowest risk ?
Clozapine (high), Olanzapine, Aripiprazole (low)
173
Antipsychotics block repolarisation of K channels in myocardium. What effect does this have?
Prolongs QT interval, ^ risk of sudden cardiac death
174
Dystonia is caused by reciprocal actions of DA and MACh systems in the basal ganglia. When is dystonia more likely ?
More likely with antipsychotics with no intrinsic antagonism of MACh receptors.
175
What is the normal Tx of Parkinsons ?
Decrease dosage of antiepsychatrics. Change to an atypical. Add MACh antagonist
176
What is a common MACh antagonist used in Dystonia treatment ?
Procyclidine
177
What is Akathasia ?
Unpleasant subjective inner restlessness, unknown cause. Difficult to treat
178
What is the tx for Akathasia? why must the px be monitored whilst being treated ?
Decrease dosage. Use BDZ/beta blockers. Can cause depression/suicidal thoughts
179
What drugs might be used in neuroleptic malignant syndrome and why ?
Dantrolene (reduce muscle spasm)
| Bromocriptine (DA receptor antagonist)
180
How are endothelial cells connected in the bbb, what structures are present in the surrounding spaces ?
Tight junctions
| Pericytes, secrete proteins which contribute to the basement membrane
181
How do CNS drugs cross the bbb ?
Transcellular route, go through vascular endothelial cells rather than between (paracellular) due to the complex tight junctions.
182
What structures are present that are able to rapidly transport drugs out of the CNS ?
Transmembrane pumps, even if the drugs have penetrated the BBB.
183
How do certain drugs affect brain function ?
Utilise transporters decreasing protein uptake.
184
What are the 3 main causes of weight loss ?
Malignancy, GI conditions, psychiatric causes
185
What are the two main areas of the hypothalamus that ^ food intake ?
Lateral nuclei
| Dorsomedial nuclei
186
What effect does the Paraventricular nuclei have on food intake ?
Decreases food intake, lesions lead to excessive eating
187
What is the proper name for the 'satiety centre', what is the effect when it is stimulated ?
Ventromedial nuclei. Stimulation leads to satiety even with highly appetising food. Destruction causes continued eating.
188
How does the arcute nuclei effect food intake ?
Both ^ and decrease. Site of convergence of multiple hormones released by GI tract and adipose tissue.
189
List some inputs that inhibit food intake...
Stretch receptors in stomach via the vagus nerve, chemical signals from circulating macronutrients, hormones released by adipose and GI tract, cerebral cortex (site, smell and taste of food)
190
What macronutrients give off chemical signals to decrease food intake ?
Glucose, amino acids, fatty acids
191
Name two orexigenic substances
Stimulate appetite
Neuropeptide Y
Agouti related protein.
192
What is the action of Neuropeptide Y in ^ appetite ?
Released when energy stores are low to stimulate appetite. Reduces firing of POMC neurons which decreases it's anorexigenic effects.
193
What is Alpha MSH and where is it released from ?
Alpha melanocyte stimulating hormone. Released by POMC neutrons.
194
What receptors does a-MSH act on and what does it stimulate ?
melancortin receptors (MCR) in neutrons of the paraventricular nuclei to decrease appetite.
195
What is the action of MCR subtypes 3 and 4 when stimulated and inhibited ?
```
Stimulated = intake ^
Inhibited = Reduce
```
196
What stimulates CCK release from the duodenum ?
Fat and proteins entering the duodenum.
197
What is the action of CCK once released ?
Stimulates digestion via the gallbladder. Sends inhibitory messages via the vagus to ^ gut motility
198
Where is peptide YY released ?
GIT but especially ileum and colon.
199
What is the effect of GLY, where is it released?
Reduces appetite
Directly - via ^ insulin production
Indirectly via secretion from the pancreas
Released from GIT, nucleus of tracts solitaires.
200
What hormone is released from oxyntic cells of the stomach ?
Ghrelin
201
Where is leptin released ?
Adipocytes, regulates appetite over the long term.
202
What does leptin bind to?
Binds to anorexigenic receptors (POMC neutrons of arcuate nuclei and neurons of paraventricular nuclei.
203
What effect does leptin have when it binds to anorexigneic receptors ?
Decreases hypothalamic production of appetite stimulators. stimulates corticotropin releasing hormone and sympathetic NS.
204
What main domains does the MSE assess ? (7)
```
Appearance and behaviour
Speech
Mood and affect
Thoughts
Perceptions
Cognition
Insight
```
205
What is the required threshold for depression diagnosis ?
Persistant depressed mood for 2 weeks - 1 month
206
What is anhedonia ?
Doesn't find pleasure in activates px used to enjoy
207
What is a persistent and long standing depressed mood that isn't severe enough for depressive disorder ?
Dysthymia
208
What effect does stress have on a physiological level ? (3 up, 3 down)
^ IL-1, IL-6, TNF-a released from cells from macrophage or monocyte lineage. Reduces IL-2, IFN-y and MHC2.
209
Most organ related carcinomas produce a high conc of TNF-a. What does this do ?
Inhibits tyrosine phosphatase so less MHC 1 on cell surface. This means malignant cells escape immune surveillance.
210
What is the cause of persistent activation of HPA ?
Release of stress mediators (NTs - NA, 5HT) , neuroendocrine and stress hormones (cortisol) and cytokines.
211
What inflammatory cytokines compromise effects of the immune system ?
IL-2, IFN-y and TNF-a by Th1 cells
212
Metabolic syndrome is a blanket term that encompasses which 4 conditions ?
Abdomen obesity, insulin resistance, dyslipidemia, elevated BP
213
Why is weight gain common in Clozapine and Olanzapine ?
Antagonism of the histamine H1 and 5HT2C receptors.
214
What are the risk factors for metabolic syndrome ?
Large waistline, high triglyceride levels, low HDL levels, hypertension, high blood sugars
215
Which diagnostic criteria is most commonly used in practice for metabolic syndrome ?
```
International diabetes federation (IDF)
Waist >94 and >80
BP >130/85
HDL <40 <50
Triglycerides >150
Glucose >100
```
216
What is the next course of action if the px doesn't respond to screening/monitoring post a MS diagnosis ?
Prescribe Aripiprazole , reduces Clozapine induced side effects (weight reduction and lowers serum cholesterol)
217
What 3 factors should be considered in schizophrenia px ?
lifestyle fx eg. exercise, diet, smoking
Aspects of psychotic disorder
Antipsychotic medication; 1/2 gen ? risk of MS etc.
218
Once px diagnosed with schizophrenia what 4 areas should you monitor when monitoring MS development ?
BMI
BP
fasting glucose
Fasting plasma lipids
219
How do location and personal isolation factors effect Schizophrenia ?
^ Population density ^ psychosis risk. Greater social cohesion with specific ethnic groups is protective fx.
220
What are the '5As' , negative symptoms in Schizophrenia?
```
Affective flattening
Alogia, poverty of speech
Avolition, lack of motivaiton
Attention
Anhedonia , no pleasure
```
221
Name 4 +ve sx of schizophrenia
Auidotry hallucinations
Persecutory delusions
Referntial element
Disorganised thoughts
222
Why is cig smoking important to monitor in Schizophrenia tx ?
When taking SGAs eg. Clozapine/Olanzapine, any drastic reductions in smoking can produce toxic effects at previously tolerated doses. Nicotine is an enzyme inhibitor.
223
Px presents with rapid onset muscle rigidity, hypertension and ^ HR. What rare condition does he have ?
Neuroleptic malignant syndrome.
224
What bone lies directly posterior to the cerebellum, medulla and pons ?
Occipital bone
225
What does 'electrochemical' mean in terms of nerve stimulation ?
Electro; involves changes in conductivity of cell membrane
| Chemical; releases Its at a synapse
226
How is ACh used by the spinal cord and brain respectively ?
Spinal cord, to control muscle
| Brain, to regulate memory
227
What do low and high levels of dopamine lead to ?
```
High = Schizophrenia
Low = Parkinsons
```
228
5HT is involved in mood, appetite and sensory perception. What is its action in the spinal cord ?
Inhibits pain pathways -> depression, migraine, ADHD, anxiety
229
What is the function of the spino/paracerebellum ?
Regulate body and limb movements
230
What is the function of the lateral norocerebullum
Regulates planning, sensory movement for action.
231
Where is serotonin produced ?
Serotogenic nuclei in the raphe nuclei
232
Where are dopaminergic nuclei found?
Ventral tegmental and substantia nigra
233
Where is NA synthesised ?
Locus coeruleus
234
What is produced in the tuberomammiliary nucleus ?
Histamine
235
What are the 3 primary divisions of the brain?
Prosencephalon (fore) Mesencephalon (mid) and rhombocephalon (Hind)
236
What is the function of the superior Colliculus ?
Visual processing and eye movement control.
237
What structure is involved in auditory processing ?
Inferior Colliculus
238
How does Parkinsons affect the substantial nigra ?
Decreased DA neurons in substantial nigra
239
The dicephalon contains the lateral and medial geniculate nuclei. What two things do they control ?
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Lat = visual pathway
Med = auditory pathway
```
240
What is secreted from the pineal body ?
Melonatonin
241
What structures are damaged in Wernicke Korsakoff syndrome, due to what vitamin deficiency ?
Mammilary bodies
| B1 (Thiamine)
242
Where is the amygdala located and what is it responsible for ?
Deep in the temporal lobe
| Emotional response
243
What structures do the mammilary bodies connect ?
Part of hypothalamus, receives input from hippocampus via the fornix and projects them onto the thalamus
244
What is the cerebellum responsible for ?
association (intelligence)
245
What sort of memory is the hippocampus involved in, what happens in atrophy ?
Short to long term memory conversion.
| Atrophy leads to Alzeihmers/memory dementia
246
What are the folds and grooves called in the cortex ?
```
Fold = gyrus
Groove = sulcus
```
247
What is the function of the inferior frontal gyrus ?
Language processing. Broca's area, expressive aphasia impedes language processing.
248
What is Pick's disease and where does it occur ?
Accumulation of Tau proteins at frontotemporal regions. Along with associated symptoms give diagnosis
249
Which area of the brain is responsible for planning and executive function ?
Prefrontal cortex
250
What do the temporal lobe and superior temporal gyrus form ?
Auditory cortex, processes sound and apply comprehension
251
What pathologies are associated with posterior superior temporal gyrus ?
(Wernicke's area) aphasia. px knows what to say but words don't come out (gibberish)
252
What is the fusiform gyrus responsible form?
Facial recognition, synaesthesia, dyslexia
253
What tract links Broca's to Wernicke's area ?
Arcuate fasciculus
254
What are the 4 drug free interventions to target abnormal brain function ?
Vagal nerve stimulatin
Deep brain stimulation
Electroconvulsive therapy
Repetitive transcranial magnetic stimulation
255
What is GWAS ?
Genomic wide association studies
| Systemic search fro common alleles.
256
What are CNVs ?
Copy number variants
| Small regions of genome that have been deleted/duplicated. Hinders developing brain/cells
257
What is the difference between mutation and polymorphism ?
Mutation - minor allele is rarer than 1%
Polymorphism - Allele is more common
The same change is involved in both
258
What has Pleiotropy shown relative to Schizophrenia ?
Genetic correlation between Schizophrenia and selected psych disorder, also with autism and ID
259
What is anosognosia ?
Non dominant parietal lobe and motor cortex disfunction in which px is unaware in 'delusional denial'. Occurs in head injury or stroke
260
What are the 7 areas to assess in MSE ?
```
Appearance/behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight
```
261
What are the 4 major abnormal positive sx of schizophrenia ?
Thoughts (delusions)
Perceptions (hallucinations)
Movement/behaviour
Thought process/cognition
262
What are ; low mood, anhedonia and anergia the 3 core sx of ?
Unipolar depression
263
How do you class different types of BPAD?
Bipolar affective disorder
1; one episode must be mania
2; can never have had mania.
264
What is the most inhibitory NT in the CNS ?
GABA
265
Antidepressant tx can reverse abnormal patterns of glucose metabolism in which parts of the brain ?
Amygdala
266
Schizophrenia is said to link the limbic system and what ?
PFC
267
What region of the brain is associated in processing, reward, motivation and pleasure seeking ?
Nucleus accumbens
268
You prescribe MOAs to a px. What should they avoid eating and drinking ?
Red wine, strong cheese, broad beans
269
What receptor does Citalopram target ?
5HT
270
Which receptor do antipsychotic drugs target to reduce Sx of Schizophrenia ?
D2
271
px gets weight gain after starting antipsychotics meds 3 months ago. What receptor is this side effect responsible for ?
Antagonism of the H1 histamine receptor. Also occurs with antagonism of specific 5HT2 receptor
272
What sx are characteristics of Panic disorder ?
Sudden attacks of palpations, sweating, dizziness, fear of losing control in variety of situations often without cause.
273
Large, rare CNVs shown to ^ risk for which psych disorder?
Schizophrenia
274
What is the difference between Hypnopompic and Hypnogogic
Hypnopompic is hallucinations during or after sleep
| Hypnogogic is hallucinations before or immediately at the start of sleep
275
High scores in which dimension of personality is associated with decreased risk of physical and mental illness ?
Conscientiousness
276
What is the effect of NPY on appetite?
Neuropeptide Y
| Released when energy stores are low ^ appetite.
277
What foods should be avoided whilst on MOAs and why ?
Red wine, strong cheese, broad beans
| Contain tyromine which can cause hypertensive crisis
278
What is the cause of the antidepressant side effect postural hypotension ?
Antiadrenergic
279
What antidepressant side effects are caused by antihistamines ?
Weight gain, drowsiness
280
What is circumstantialily in a schizophrenia px ?
Px goes into unneeded detail and makes irrelevant remarks however in time returns to Q asked.
281
when px speaks goes from one topic to another mid sentence without returning to original stem, what is this ?
Derailment
282
What does the ventromedial PFC control ?
Pain, aggression, libido, appetite moderation
283
What area of the brain controls executive function, attention and working memory ?
Dorsolateral PFC
284
How is the lateral orbital PFC different in depression ?
Hyperactive, enhanced sensitivity to stress, anger, anxiety.
285
What is the monoamine hypothesis ?
Low levels of monoamines cause depression eg. dopamine
286
What hypothesis is linked to cortisol ?
Glucocorticoid receptor. Cortisol -> stress hormone -> damage to neurons in hippocampus
287
What is the neutrophic hypothesis ?
Stress and genetic vulnerability linked to overactive glucocorticoids mediated by glutamate lead to cellular atrophy.
288
How does the neutrophic hypothesis view BDNF?
Rapid ^ in brain derived neurotrophic factor especially in hippocampus.
289
What is the MOSPAD-C ?
cognitive disorders about the self, others and the world
Magnification/minimisation , overgeneralisation, selective abstraction, personalisation, arbitrary interference, dichotomous thinking, catastrophisation
290
Why are changes in appetite typical in depression ?
^ Corticotropin releasing fx causes an aroused stress response
291
What receptor is involved in satiety ?
5HT2c, less 5HT at receptor linked to decreased satiety and carb craving
292
What effect does ketamine/pcp have on healthy volunteers ?
Induces Schizophrenic +/- sx through antagonism of the NMDA receptor.
293
What is the general function of antipsychotics ?
Block dopamine, higher affinity for DA blockade = ^ clinical potency
294
What causes EPSEs and what are a few examples ?
Caused by striatal DA antagonism
| acute dystonia, akathisia (subjective/psychomotor restlessness).
295
How would you use the confidence interval to calculate the mean ?
The CI is the value around the mean eg. +/- 1.04 therefore half the CI is the mean. So in this case the mean is 0.52
296
What is the MHI-5?
Mental health inventory, asks 5 questions:
Have you been ; very nervous ? happy?
Have you felt ; down in the dumps that nothing could cheer you up ? calm and peaceful ? downhearted and depressed ?
297
How is the MHI-5 scored and what does a lower score indicate ?
scored between 0-100 , lower scores indicate poorer mental health
298
What is the P value of a test ? What does a smaller P value show ?
The probability of a difference is greater than the observed difference (chance) if null hypothesis were true. Smaller P value = stronger evidence against hypothesis (shows results not due to chance)
299
If the P < 0.05 for a test, what would this tell you ?
Evidence to reject the hypothesis at 5% level because a difference exists. 5% means 1/20 chance the difference has occurred by chance
300
What is the student's t test , when can it not be used ?
Compares distinct groups in an 'unpaired comparison'. Assumes data is normally distributed with equal SDs in 2 groups. Can't be used if more than 2 groups.
301
If the ANOVA score for a test was F(2,15) = 4.76 ... what would the '(2,15)' section mean?
```
2= group degrees of freedom (so 3 groups in the study)
15 = total observations degrees of freedom (so 18 people total divided into 3 groups of 6)
```
302
How do you calculate the variation between groups in ANOVA ?
'Mean of the group means'. So calculate mean of each group, then the mean of those eg. 3 values. Then calculate sum of squares. Finally times by no in each group and add together.
