Chapter 14 - Psychological Disorders Flashcards
What is major depressive disorder?
Person feels sad and helpless for days at a time. Changes in the synapse at the nucleus accumbens make it less responsive to reward. There is a moderate heritability for depression.
What is the relationship between happiness and activity in the left PFC for normal people?
Normal people have a strong relationship between happiness and increased activity in the left PFC.
What area of the brain do people with depression have decreased activity?
People with depression often have decreased activity in the left PFC.
What are the three types of antidepressant drugs?
Tricyclics, Selective serotonin reuptake inhibitors (SSRI’s) and monoamine oxidase inhibitors (MAOI’s)
How do tricyclics work?
They block proteins that reabsorb serotonin, dopamine and norepinephrine into the presynaptic neuron after their release. Tricyclic drugs block the protein so that it can’t reuptake. The result is to prolong the presence of the neurotransmitters in the synaptic cleft, where they continue to stimulate the postsynaptic cell.
What are the side effects of tricyclics?
Tricyclics also block histamine receptors, acetylcholine receptors and certain sodium channels. Histamine produces drowsiness, acetylcholine leads to dry mouth and difficulty urinating and sodium causes heart irregularities.
How do SSRIs work?
They are similar to tricyclics but they only work on serotonin. They produce similar results as tricyclics but with less side effects. Serotonin norepinephrine reuptake inhibitiors block the reuptake of serotonin and norepinephrine.
How do MAOI’s work?
MAOI’s block monoamine oxidase (MAO) a presynaptic enzyme that metabolises catecholamines and serotonin into inactive forms. When MAOI’s block MAO there is more transmitter available for release at the presynaptic terminal.
What do physicians prescribe patients?
They prescribe tricyclics and SSRI’s before MAOI’s.
What food must people taking MAOI’s avoid?
People taking MAOI’s must avoid foods containing tyramine (cheese and raisin’s). Tyramine and MAOI’s together can cause an increase in BP.
What are the levels of neurotransmitters and neurotrophins in people with depression?
People with depression often have normal or increased levels of neurotransmitters. Most people with depression have decreased levels of neuotrophins.
What role do neurotrophins play in depression?
Neurotrophins aid in the survival and growth and connections of neurons. People with depression have a decreased levels of a neurotrophin called brain-derived neurotropic factor (BDNF) that is important for synaptic plasticity, learning and proliferation of new neurons in the hippocampus.
What neurotrophin is linked to depression?
brain-derived neurotropic factor (BDNF)
What role does the hippocampus play?
People with depression have a smaller hippocampus, impaired learning and reduced production of hippocampal neurons.
What alternatives to drugs are there to treat depression?
CBT - psychotherapy is more likely to prevent relapses than drugs.
Exercise is an effective treatment when used with other methods.
What is the most effective treatment plan for people with depression?
Patients receiving psychotherapy and antidepressants show greater improvement than people receiving only one.
What is ECT?
Electroconvulsive therapy. Causes a person to have a seizure.
How is ECT used in treatment of depression?
ECT relieves depression in many cases. Usually given to patients with severe depression. Applied every second day for 2 weeks. Patients given muscle relaxants or anaesthetics to minimise discomfort. Side effects can include memory impairment.
How is sleep impacted by depression?
People with depression usually struggle to go to sleep and awaken early. They usually enter REM sleep within 45 minutes of going to sleep.
How does sleep deprivation improve symptoms?
Sleep deprivation can relieve symptoms for one day.
How can sleep patterns help with depression?
Altering the sleep schedule (i.e. going to bed earlier and awakening earlier) can have similar effects of sleep deprivation and last for a while.
What is the symptoms of bipolar disorder?
Variation between two poles - depression and mania.
What is mania?
Mania is characterised by restless activity, excitement, laughter and excessive self-confidence, rambling speech and loss of inhibitions. Usually onsets in teens or early 20s.
What is Bipolar I disorder?
Full manic episodes.
What is Bipolar II disorder?
mild or hypomanic episodes.
What are the gender differences with bipolar disorder?
Men are more likely to have severe (bipolar I). Women are more likely to get treatment.
What are treatments of bipolar disorder?
Lithium salts. They stabilise mood, preventing a relapse into mania or depression. Dose must be regulated carefully - a low dose is ineffective. High dose is toxic. Other drugs are valproate and carbamazepine. If ineffective, physicians can combine with antidepressants or antipsychotics.
How does lithium, valproate and carbamazepine work?
They decrease the number of AMPA type glutamate receptors in the hippocampus. Excessive glutamate activity is responsible for some aspects of mania. They also block the synthesis of arachidonic acid - produced during brain inflammation. Effects of arachidonic acid are counteracted by omega-3 fatty acids (found in seafood). consistent sleep patterns also helps.
What is seasonal affective disorder?
SAD is depression that reoccurs during a particular season (i.e. winter) especially near the poles where winter nights are long.
How is sleep impacted by SAD?
People with SAD have phase-delayed sleep and temperature rhythms - they become sleepy and wakeful later than normal.
How can SAD be treated?
By very bright lights.
What evidence suggests two types of depression influenced by different genes?
Relatives of people with early-onset depression have a high risk of depression and many other psychological disorders. Relatives of people with late-onset disorder have a high probability of circulatory problems.
What did Caspi and colleagues report to be the relationship between depression and the gene controlling the serotonin transporter protein?
People with the short form of the gene are more likely than other people to react to stressful experiences by becoming depressed. However, in the absence of stressful experiences, their probability is not increased.
Some people offer to train you to use the right hemisphere of your brain more strongly and allegedly to increase creativity. If they were successful, can you see any disadvantages?
People with predominant right-hemisphere activity and decreased left-hemisphere activity show an increased tendency toward depression.
What are the effects of tricyclic drugs?
They block the reuptake of serotonin and catecholamines. They also block histamine receptors, acetylcholine receptors and certain sodium channels, thereby producing unpleasant side effects.
What are the effects of SSRIs?
SSRIs selectively inhibit the reuptake of serotonin.
What are the effects of MAOIs?
MAOIs block the enzyme MAO, which breaks down catecholamines and serotonin. The result is the increased availability of these transmitters.
In what way does the time course of antidepressants conflict with the idea that they improve mood by increasing neurotransmitter levels?
Antidepressants produce their effects on serotonin and other neurotransmitters quickly, but their behavioural benefits develop gradually over 2 to 3 weeks.
As opposed to an interpretation in terms of neurotransmitter levels, what is an alternative explanation for the benefits of antidepressant drugs?
Antidepressant drugs increase production of BDNF, which gradually promotes growth of new neurons in the hippocampus and new learning.
As depression becomes more severe, what happens to the percentage of patients showing improvements while taking antidepressant drugs or placebos?
For more severe cases, the percentage of patients who improve remains about the same for patients taking antidepressant drugs but fewer patients taking placebos show improvement.
What is an advantage of psychotherapy over antidepressant drugs?
People who respond well to psychotherapy have a lower risk of later relapse than people who respond to antidepressant drugs. Also, antidepressant drugs produce unpleasant side effects.
How can one decrease the memory loss associated with ECT?
ECT over just the right hemisphere produces less memory loss.
What changes in sleep habits sometimes relieves depression?
Getting people with depression to go to bed earlier sometimes relieves depression.
What are two common treatments for bipolar disorder?
The common treatments for bipolar disorder are lithium salts and certain anticonvulsant drugs - valproate and carbamazepine.
What are the advantages of bright light treatment compared to antidepressant drugs for SAD?
It is cheaper, has no side effects and produces more benefits quickly.
Which of the following is the most typical outcome after someone develops major depression?
a) The person will remain seriously depressed for life.
b) The depression will grow worse over time.
c) The person will alternate between episodes of depression and periods of normal mood.
d) The person will recover without any likelihood of returning to depression.
c) The person will alternate between episodes of depression and periods of normal mood.
Relatives of people with late-onset depression have an increased probability of what type of disorder?
Circulatory problems.
Which of the following is a likely reason why it has been difficult to identify a gene associated with depression?
a) Depression does not have a genetic basis.
b) Only early-onset depression has a genetic basis.
c) Certain genes link to depression only in people who have undergone severe stress.
d) Researchers have studied only animal models, not humans.
c) Certain genes link to depression only in people who have undergone severe stress.
How do tricyclic drugs block the reuptake of serotonin and other neurotransmitters?
They lock the transporter protein into one position.
What is the advantage of SSRIs compared to tricyclic drugs?
They produce milder side effects.
What is the disadvantage of using St. John’s wort as an antidepressant?
St. John’s wort decreases the effectiveness of other drugs someone might be taking.
Which of the following is evidence against the idea that antidepressant drugs relieve depression simply by elevating neurotransmitter levels?
a) The dose of drug necessary for relieving depression is greater than the amount necessary to elevate neurotransmitter levels.
b) The drugs quickly affect levels of serotonin and other neurotransmitters but take weeks to alter mood.
c) The drugs become less and less effective in relieving depression after weeks of use.
d) Several procedures other than antidepressant drugs are also effective in relieving depression.
b) The drugs quickly affect levels of serotonin and other neurotransmitters but take weeks to alter mood.
If you are already in a normal mood, could you make yourself feel even better by taking antidepressant drugs? If not, why not?
No, you could not. Antidepressant drugs promote new learning that competes with depressed thoughts. Someone without depressed thoughts has little to gain.
How does effectiveness of psychotherapy compare to that of antidepressant drugs?
Psychotherapy and antidepressant drugs help about an equal percentage of patients, and mostly the same patients.
One important factor to consider when making judgments about the relative influence of genetics on schizophrenia is:
the mother’s prenatal environment.
According to the dopamine hypothesis, what causes schizophrenia?
excessive activity at dopamine synapses
Lithium is most commonly prescribed for which disorder?
bipolar disorder
Inappropriate emotions, bizarre behaviors, and thought disorders represent the:
disorganised cluster of positive symptoms
On average, those with the short form of the ____ transporter gene and a history of stressful experiences reported more than average symptoms of depression.
serotonin
Prolonged use of antidepressants not only increases the availability of neurotransmitters in the synapse but also:
increases the release of neurotrophins
Which of the following are the most likely side effects of tricyclic antidepressants?
a. cramping and diarrhea
b. nausea and headaches
c. drowsiness and dry mouth
d. increased reaction to eating cheese
c. drowsiness and dry mouth
The main advantage of psychotherapy over drug-therapy in the treatment of depression is that psychotherapy:
produces longer-lasting effects.
Measuring the number of dopamine receptors occupied by a radioactive drug in people with schizophrenia led to the finding that:
excessive dopamine release occupies a greater number of D2 receptors.
One potentially dangerous side effect of St. John’s wort is that it:
decreases the effectiveness of other medications the person may be taking.
The most severe episodes of depression generally occur:
after a traumatic event.
ECT increases the proliferation of new neurons in the:
hippocampus
Bipolar I disorder and bipolar II disorder differ with regard to:
whether they include full-blown manic phases.
All of the following are antipsychotic drugs EXCEPT:
a. Thorazine.
b. L-Dopa.
c. chlorpromazine.
d. Haldol.
b. L-Dopa.
Compared to non-depressed people, which of the following is true regarding depressed individuals?
a. They react more to pleasant experiences.
b. They react worse to unpleasant events.
c. They have greater unpleasant events.
d. They have fewer pleasant experiences.
d. They have fewer pleasant experiences.
Electroconvulsive shock therapy is most likely to be used with patients:
who have not responded to drug therapy
Most depressed people show ____ activity in the ____ prefrontal cortex.
decreased; left
For which of the following is the drug treatment generally only a little better than a placebo?
mild to moderate depression
MAOIs block the activity of the enzyme that:
breaks down catecholamines.
Which is true when considering the role of genetics in depression?
a. Late-onset depression has higher heritability than early-onset depression.
b. Depression in males runs in families, depression in females does not.
c. Adopted children who become depressed are more likely to have depressed biological relatives than depressed adoptive relatives.
d. Adopted children who become depressed are more likely to have depressed adoptive relatives than depressed biological relatives.
c. Adopted children who become depressed are more likely to have depressed biological relatives than depressed adoptive relatives.
An alternative to the dopamine hypothesis of schizophrenia is the proposal that schizophrenia may be due to a deficiency of activity of ____ synapses.
glutamate
Of these treatments for depression–drugs, psychotherapy, and electroshock–which one (if any) usually produces benefits FASTEST?
electroshock
An antidepressant drug operates by blocking reuptake of serotonin and catecholamines, but also blocks histamine receptors, acetylcholine receptors, and certain sodium channels. This drug would most likely be classified as a(n):
Tricyclic
SSRIs work similarly to:
Tricyclics
The cheapest and simplest antidepressant procedure is:
Regular nonstrenuous exercise
Atypical antipsychotic drugs differ from standard neuroleptics like chlorpromazine in terms of:
which set of dopamine synapses they affect.
Of the following treatments for depression - psychotherapy, drug therapy, and ECT - the one with the fastest benefits is ____ and the one with the longest lasting benefits is ____.
ECT; psychotherapy
After ECT has relieved depression, the usual strategy to try to prevent a relapse includes all of the following EXCEPT:
a. periodic ECT treatments.
b. drug therapy.
c. periodic transcranial magnetic stimulation.
d. psychotherapy.
periodic ECT treatments
In contrast to tricyclics, selective serotonin reuptake inhibitors (SSRIs):
block the reuptake of only serotonin.
In certain cases, it is possible to relieve depression by changing a person’s:
Sleeping schedule
If someone has major depression, what is probably true of that person’s relatives?
They have an increased risk of many other disorders.
Long term use of antidepressants increases the proliferation of new neurons in the:
Hippocampus
Prior to the 1950’s, few schizophrenic patients who entered a mental hospital ever left. The discovery most responsible for alleviating that situation was the discovery of:
chlorpromazine.
A first diagnosis of schizophrenia is usually made for a person in which age range?
20s
Antidepressant drugs produce their effects on catecholamine and serotonin synapses within hours, but people need to take the drugs for two or more weeks before they experience any mood elevation. T or F
True
A serious side effect that develops in some people after prolonged use of neuroleptic drugs is:
tardive dyskinesia.
A restless, impulsive person whose speech rambles from one idea to another may fit which of these categories?
a. autistic
b. depressed
c. narcoleptic
d. manic
Manic
Recent research discourages the use of antidepressant drugs, for which reason?
a. The most effective drugs are the most expensive ones.
b. The drugs’ side effects grow worse and worse after repeated use.
c. To get benefits, a person must find exactly the right dose to take.
d. Placebos produce practically the same benefits as the drugs in mild to moderate depression.
d. Placebos produce practically the same benefits as the drugs in mild to moderate depression.
Generally speaking, dopamine and glutamate have opposite effects in the prefrontal cortex. T or F
True
The differences between ordinary and major depression depend on:
Intensity and duration.
