Chapter 22: Mental Health Flashcards
Mental illness
What is mental illeness and what are some interacting factors?
A diagnosable disorder of thought, mood, or behavior.
* Genes can predispose or protect against psychiatric illness; a single gene isn’t responsible for a disorder.
* Environment such as stress, drugs, can change how genes are expressed.
Mental illness
Describe Freud vs. Skinner’s view
Freud: Most of mental life is unconscious. Past experiences shape feelings for life.
Skinner: Pleasureable behaviors produce reinforcement. Negative behaviors produce aversion, mental illness is an inappropriate learned response and can be overcome by willpower.
Anxiety Disorder, OCD, PTSD
What are the 4 types of Anxiety disorders?
- Panic disorder
- Generalized Anxiety Disorder (GAD)
- chronic worry accompanied by increased sympathetic arousal. - Social Anxiety Disorder
- Fear of social situations - Phobias
Anxiety Disorder, OCD, PTSD
What is the HPA axis
- Hypothalamus- In response to stress, periventricular zone secretes corticotropin releasing homorone (CRH)
- **Pituitary **- In response to CRH, releases adrenocorticotropic hormone (ACTH)
- **Adrenal **- In response to ACTH, releases stress hormone cortisol (a glucocorticoid)
Anxiety Disorder, OCD, PTSD
How are hypothalamic secretions of CRH regulated?
Regulated by the Hippocampus and the Amygdala
* Hippocampus
- Glucocorticoid receptors which respond to cortisol
- Suppresses CRH release in response to cortisal
- Negative feedback response
- Amygdala
- Dysregulation of amygdala is associated with anxitey-like bahviors
- Sends output to BNST (Activates HPA axis)
Anxiety disorders are associated with hypoactivity of the hippocampus and hyperactivity of the amygdala
Anxiety Disorder, OCD, PTSD
What are Benzodiazepines?
Anxiety reducing drugs
* They are sedative-hypnotic class of CNS depressants that causes sedation and decrease cognitive function.
* Xanax, Valium
* They act on GABA-A receptors as positive allosteric modulators (PAMs)
- Cl- enters cell»> hyperpolarization
- Suppresses activity in brain circuits used in stress response
Xanax and alcohol can lead to overdose
Anxiety Disorder, OCD, PTSD
What are the downsides of Benzodiazepines
People will go through withdrawal and can’t function without them.
Anxiety Disorder, OCD, PTSD
What are SSRIs?
Another anxiety reducing drugs known as selective serotonin reuptake inhibitors.
* Prolongs actions of serotonin (5-HT) by blocking reuptake at SERT. (Ex. Prozac)
* Takes several weeks to become effective: do not work for acute anxiety episodes.
Anxiety Disorder, OCD, PTSD
What is OCD?
- Obsession (thoughts): Recurring, persistent, intrusive thoughts of contamination, violence, sex or religion.
- Compulsions (actions): Repetitive rituals to relieve anxiety generated by obsessive thoughts.
- Some compulsions are unrelated to obessions
inappropriate or irrational and consume most of their waking hours.
Patients feel forces to do them against their will
Anxiety Disorder, OCD, PTSD
What is PTSD?
After witnessing severly traumatic events, an individual feels not only fear but also a sense of hopelessness and horror.
* Nightmares & flashbacks
* Increased physiological reactivity to reminders of the trauma, sleep disturbances, avoidance of stimuli associated with trauma, and anumbing of emotional responses for many years.
* Outbursts of irritability
* Increase in suicide
* increase in depression, substance abuse, marital problems, feelings of guilt and anger.
Affective Disorders and Bipolar Disorder
Give some info about major depressive disorder
- Recurring episodes of dysphoria and negative thinkinh
- World’s leading cause of disability
- people could have different symptoms but still be treated the same so more research is needed.
Affective Disorders and Bipolar Disorder
What is the difference between Bipolar 1 & 2?
- Bipolar 1: manic episodes with or without MDD episodes
- Bipolar 2: Always associated with MDD and there is hypomania: increase in efficiency, accomplshment, & creativity.
Affective Disorders and Bipolar Disorder
Describe more about hypomanic episodes
May interfere to a degree with daily functioning, in patients with mania, day-to-day life is impaired. Hypomania does not include psychotic symptoms.
Affective Disorders and Bipolar Disorder
What are some treatments for bipolar disorders?
- Lithium - Very effective treatment for mania
- Anticonvulsants
- Atypical Antipsychotics ( originally designated to treat Schizophrenia)
Schizophrenia
What is Schizophrenia?
It Is NOT an extreme of a normal brain state
* Loss of contact with reality
* Disruption of thought, perceptions, mood, and movement
* “Divided mind” Patients alternate between normal and abnormal states.
Schizophrenia
What are symptoms?
- Positive: Delusions or Hallucinations
- Negative: Reduced expression of emotion, withdrawal from social interactions, imporverishes thought and speech.
- Cognitive: Impaired working and memory and executive function (most resistant to treatment)
These are not all exhibited by a patient at one time
Schizophrenia
Give descriptons of the genetics of Schizophrenia
- Has one of the highest heritabilities of all the mental illnesses
- 50% concordance in identical twins
- No single gene is responsible
- Symptoms may not appear until twenties but biological changes causing the condition begin early in development.
Schizophrenia
What are other factors of Schizophrenia
Epigenetics
Environmental factors
Schizophrenia
What is the dopamine hypothesis?
Schizophrenia results from too much too dopamine
* High doses of amphetamines in normal individuals produce psychotic symptoms
- Amphetamines enhance dopaminergic release
- Effective treatments for the positive symptoms of Schizophrenia block dopamine receptors
Schizophrenia
What is the dopamine imbalance hypothesis?
Too much DA in mesolimbic DA pathway; to little in mesocortical DA pathway
Schizophrenia
What is the neurodevelopmental hypothesis?
- Schizophrenia is the result of neurodevelopmental alternations
- Early life stresses and in utero problems increase the risk
- Patients show reductions in brain volume, loss of dendrites and dentritic spines
- Loss of gray matter in prefrontal cortex
- Loss of gray matter in temporal lobe, amygdala, hippocampus; integration of cognition & emotion
- Loss of gray matter counterbalanced by enlarged vetricles.
Schizophrenia
What is the Glutamate Hypofunction Hypothesis?
- Hypothesis: Schizophrenia arises from deficits in NMDA receptor function
- Patients with Schizophrenia have reduced levels of NMDA receptors
- PCP and ketamine are NMDA receptor antagonists (they block it) so they produce Schizophrenia like symptoms in normal individuals.
Schizophrenia
What are treatments?
- Antipsychotic (AP) drugs
- Most effective at diminishing positive symptoms
- Don’t really benefit the cognitive symptoms
- 1st Generation or Typical APs
- Chlorpromazine
- D2 receptor antagonists
- side effects: Extrapyramidal Symptoms (EPS)…Dystonia (continuous spasms & muscle contractions), Akathisia (motor restlessness), Parkinsonism (rigidity), Tardive dyskineasia (irregular, jerky movements)
- 2nd generation APs
-Clozapine
5-HT & D2 receptor antagonists
Bettr side effect profile
Effective against negative and positive symptoms - Third Generation
- Aripiprazole
- Partial Agonist of D2 receptor
- Supported by “DA imbalance hypothesis”
Substance Use Disorders
What are the substance Use Disorders?
- Alcohol
- cannabis
- Hallucinogens
- inhalants
- Opioids
- Sedatives
- Stimulants
- Tobacco
Substance Use Disorders
What are the treatments for substance use disorders?
- Alcohol
- Disulfiram (Makes drinking unpleasant)
- Naltrexone (Block the hight that individuals get)
- Acamprostate (Makes withdrawal easier)
- Opioids
- Methadone (ease withdrawal)
- Buprenorphine ( Partial methodone receptor agonist)
- Naltrexone (Patients have to get through the withdrawal process first then this drug prevents relapse)
- Cigarette Smoking
- Nicotine-replacement therapy
- Cocaine, Amphetamines
- None
