Chapter 16 - Disorders & Treatments Flashcards
Disorders & Treatments
- (2) perspectives
Neurological
Psychiatric
Neurological Disorders
organic brain/NS disorders
→ symptoms due to brain dysfunction
- stroke, TBI, Alzheimers
Psychiatric Treatments & Disorders
behavioral disorders
- schizophrenia, depression, anxiety
Neurological vs. Psychiatric Disorders → Causes
- difficulties
Neurological disorders: causes = largely known
Psychiatric disorders: causes = less known
difficult to identify cause since most disorders do NOT involve a single genetic abnormality
cognitive, behavioral & social symptoms = observable
→ BUT do not necessarily indicate underlying cause
Brain & Behavior Abnormalities
- result from? (5)
- genetic errors
- epigenetics mechanisms
- rapid cell death
- progressive cell death
- loss of neural connections & functions
Neurobiology of Abnormal Behavior
→extremely difficult to find because of?
complexity of NS
abnormal behavior not always clearly related to brain damage
brain damage doesn’t always produce obvious abnormal behaviors
Diagnosing Behavioral Disorders
- ease/difficulty?
- Explain.
difficult
-
behavioral observations usually from family or individual
- biased
- don’t know what to look for
-
skilled evaluators have own conceptual perspectives
- influences Qs asked & info gathered
Anosognosia
lack of self-awareness about a certain disability/disorder one suffers from
Define: EPIDEMIOLOGY
study of distribution & causes of diseases in human popn
- helps define & assess behavioral disorders
Identifying & Classifying Psychiatric Disorders
- (2) sets of criteria for diagnosis
1) Diagnostic & Statistical Manual of Mental Disorders (DSM-5)
2) International Classification of Diseases (ICD-10)
Diagnosing Psychiatric Disorders
1) Diagnostic & Statistical Manual of Mental Disorders (DSM-5)
- author?
- provides/lists? (2)
- limitations? (2)
American Psychiatric Association (APA)
→ lists symptoms & criteria (inclusion/exclusion) for diagnosis
→ provides statistical info (avg age of onset, prevalence, sex ratio etc.)
- arbitrary
- depends on prevailing cultural views
Diagnosing Psychiatric Disorders
2) International Classification of Diseases (ICD-10)
- author?
World Health Organization
- neurobiological & psychiatric disorders
some psychiatric disorders are to some extent arbitrary & depend on prevailing cultural views
→ based on? NOT?
based on consensus not empirical evidence
Identifying & Classifying Mental/Psychiatric Disorders
→ Role of NEUROIMAGING
- present vs. future
- must be?
- limitation/problem?
brain imaging techniques NOT currently used for diagnosis
→ may be used in future in tandem with behavioral diagnoses to make diagnoses more objective
- must be
- sensitive enough to detect unique features of brain disorders
-
specific enough to rule out similar conditions
- problematic: many behavioral disorders display similar abnormalities
Neurological Disorders → TREATMENTS
→ causes largely known
treatment fairly primitive
- provide relief from symptoms, NOT cure
Psychiatric Disorders → TREATMENTS
causes largely unknown & complex
existing treatments = relatively effective
(4) Main Types of Treatments
a) Neurosurgical
b) Electrophysiological
c) Pharmacological
d) Behavioral
Treatment
a) Neurosurgical
- goal? (4)
- very invasive
-
goal = treat dysfunction by:
- removing abnormal tissue
- repairing abnormality
- damaging dysfunctional area
- implanting stem cells or electrode
Neurosurgical Treatments
- goal = treat dysfunction by:
- removing abnormal tissue
- repairing abnormality
- damaging dysfunctional area
- implanting stem cells or electrode
1) epilepsy, tumor
2) hydrocephalus → shunt
3) Parkinson’s → lesion part of BG (neurons)
4) Stroke, Parkinsons → electrode - disrupts BG functioning
Treatments
b) Electrophysiological (2)
non-invasive
1) Electroconvulsive Therapy (ECT)
* electrical stimulation to treat severe depression
2) Transcranial Magnetic Stimulation (TMS)
* alternative to ECT for depression treatment
Electrophysiological Treatments
- ECT vs. TMS
ECT
- anticonvulsants & muscle relaxants
- memory impairments may follow
TMS
- more focused
- shorter-term effects
Electrophysiological Treatments → ECT & TMS
- significance of BDNF
ECT & TMS
→stimulate production of BDNF (Brain-derived Neurotrophic Factor)
- protein that promotes neural health, neurogenesis & synaptogenesis
c) Pharmacological Treatments
- (4)
- limitations (2)
common drugs for neurological/behavioral disorders:
- neuroleptics (antipsychotics) →schizophrenia
- anxiolytics (antianxiety agents)
- SSRIs → depression
- L-dopa → Parkinson’s
→ alleviate symptoms (NOT a cure)
→ many disorders not reducible to single chemical abnormality
“a pill is not a skill”
Pharmacological Treatments
- “a pill is not a skill”
- implications?
drugs = “bandaids”
→ NOT a fix
→ must also address sources of distress
d) Behavioral Treatments
* (4)
- “brain alters behavior & behavior alters brain”*
1) Behavioral Modification
2) Cognitive Therapy
3) Neuropsychological Therapy
4) Psychotherapy
Behavioral Treatments
1) Behavioral Modification
→ mostly for psychiatric disorders
change maladaptive behaviors to more constructive behavior
- therapists apply principles of operant/classical conditioning
- systematic desensitization
Behavioral Treatments
2) Cognitive Therapy
change maladaptive thoughts
→ depression, brain injury
- perspective that thoughts intervene b/w events & emotions*
- challenge self-defeating attitudes/assumptions*
Behavioral Treatments
3) Neuropsychological Therapy
retraining cognitive & behavioral processes lost after injury
→ ABIs, stroke
restraint therapy, relearning in novel ways
Behavioral Treatments
4) Psychotherapy
Emotional Therapy
talking about emotional problems
- provides insight into & helps overcome causes
Neurological Disorders → Traumatic Brain Injury
- cause
- factors that damage brain
result from blow to head
- bleeding
- disrupt blood supply
- swelling
- infection
- scar tissue
Neurological Disorders → Traumatic Brain Injury (TBI)
- (2) types of damage
MOVEMENT OF BRAIN CAN CAUSE:
(1) widespread damage → generalized impairments
- throughout brain
(2) focal damage → discrete impairments
- specific region
Neurological Disorders → Traumatic Brain Injury (TBI)
1) Focal Damage
- location
- most susceptible areas
- impairment(s)
at coup (site of impact) or countercoup (opposite side)
- anterior temporal
- inferior prefrontal
impairment of specific functions
- personality
- social functioning
Neurological Disorders → Traumatic Brain Injury (TBI)
1) Widespread Damage
- location
- impairment(s)
→ minute lesions throughout brain
loss of complex cognitive functions:
- reduced mental speed
- poor concentration
- memory difficulties
Traumatic Brain Injury (TBI)
- diagnosis
Diagnosis of chronic behavioral problems resulting from TBI can be difficult
- often NO obvious damage visible on CT/MRI scans
Traumatic Brain Injury (TBI)
→ Widespread vs. Focal Damage
- recovery
most cognitive recovery occurs within fist 6-9 months
widespread damage → cognitive abilities have good prognosis
focal damage→ social skills/personality do not
- quality of life more challenging to recover
Psychiatric Disorders → Symptoms (3)
lose touch with reality
irrational ideas (delusions)
distorted perceptions (hallucinations)
Psychiatric Disorders → SCHIZOPHRENIA
- diagnostic symptoms (5)
positive symptoms → more responsive to drugs
- delusions (distorted thoughts)
- hallucinations (altered sensory/perceptual experiences)
- disorganized speech
- disorganized/catatonic behavior
negative symptoms → poor response to neuroleptics
- blunted affect (apathy) → lack of emotion
Psychiatric Disorders → SCHIZOPHRENIA
- NEURAL CORRELATES
- abnormalities (2)
family history, 5 abnormal xsomes
thin frontal & medial temporal cortices
Abnormal dendritic fields in:
- dorsolateral prefrontal cortex
- hippocampus
- entorhinal cortex
Abnormalities in NT systems:
- DA, glutamate, GABA, seratonin
Psychiatric Disorders → SCHIZOPHRENIA
- NEURAL CORRELATES
- relation to symptoms (3)
medial temporal cortices → auditory hallucinations & disorganized speech
dorsolateral prefrontal cortex → negative symptoms
hippocampus → memory impairments
Psychiatric Disorders → Mood & Anxiety Disorders
- causes? (2)
genetics
early life experiences (negative)
Psychiatric Disorders → Mood Disorders (2)
Depression
Bipolar Disorder
- mania & depression
Psychiatric Disorders → Mood Disorders
- neural correlates
- Depression
imaging studies show ↑ activity in:
– orbitofrontal cortex → conscious experience/emotion regulation
– Anterior cingulate cortex → “ “
– Amygdala → primal threat detector
→ all 3 involved in rumination
Psychiatric Disorders → Anxiety Disorders (3)
Generalized Anxiety Disorder (GAD)
Panic Disorder
Specific Phobias
Psychiatric Disorders → Anxiety Disorder
- neural correlates
imaging studies show ↑ activity in:
At Rest:
- Cingulate cortex
- parahippocampal gyrus → role in turning off stress response
Anxiety-provoked:
- Amygdala
- prefrontal cortex
Psychiatric Disorders → Treatments (3)
- Depression
Antidepressants
- SSRIs (mainly)
Cognitive-Behavioral Therapy
Electrophysiological (ECT/TMS)
Psychiatric Disorders → Treatments (3)
- Anxiety Disorders
Benzodiazepines → acute
SSRIs → long-term
Cognitive-Behavioral Therapy
Mood & Anxiety Disorders → Antidepressants
- Drug Mechanism
Similar to ECT
↑ BDNF & stimulate neurogenesis in hippocampus
→ presumably result in:
- ↑ brain health
- ↑ ability to turn off stress response
