Chapter 22: Mental Illness Flashcards
Branch of medicine concerned with the diagnosis and treatment of nervous system disorders
neurology
neurological disorders Help illustrate the role of () in normal brain function
physiological processes
Branch of medicine concerned with the diagnosis and treatment of disorders that affect the mind or psyche
psychiatry
an individual is said to me “mentally ill” at the point when the person has a diagnosable disorder of (3) that causes distress or impaired functioning
thought (e.g. schizo), mood (affective), or behavior (e.g. anxiety)
human behavior is ultimately the product of ()
brain activity
the brain is the product of 2 mutually interacting factors:
heredity, environment
earlier belief regarding illness (in context of body and mind)
illness in body -> for doctors
illness in mind -> for religion
current belief on mental illness
Most disorders of mood, thought, and behavior have biological explanations.
psychosocial approaches to mental illness
- Sigmund Freud -> ()
- B.F. Skinner -> ()
- psychoanalysis
- behaviorism
2 assumptions that form the basis for Freud’s psychoanalysis
- much of mental life is unconscious
- past experiences, particularly in childhood, shape how a person will feel and respond throughout life
accdg. to Freud’s psychoanalysis, mental illness arises when ()
unconscious and conscious elements of psyche come into conflict
accdg. to Freud’s psychoanalysis, treatment for mental illness involves ()
unearthing hidden secrets of unconscious
accdg. to behaviorism, Many behaviors are () -> basis of mental illness
learned maladaptive responses to the environment
accdg. to behaviorism, mental illness is treated by ()
“unlearning” maladaptive behaviors through behavior modification
The use of verbal communication to help patient
* Only tools available until the revolution of biological
psychiatry
Psychotherapy
Former major disorder: () ->10-15% of institutionalized patients
Symptoms: mania, cognitive deterioration
general paresis of the insane
general paresis of the insane is caused by ()
infection with Treponema pallidum (syphilis)
aside from infections, () can also cause or confer risk for psychiatric disease
psychiatric disorders also occur in infection-free indivs
gene mutations
approach of using genetic info to develop treatment
new approach for treating psychiatric diseases)
molecular medicine
discovery of an abnormal physiological condition
pathophysiology
Challenges of Psychiatric Diseases
Mental disorders are diagnosed by clinicians based on (1), not by (2) -> Same diagnosis may arise from many causes
- how the appear or are described by the patient (signs and symptoms)
- knowledge of their underlying cause (etiology)
Challenges of Psychiatric Diseases
(): not all mental illnesses have a clear genetic basis, and for those that do, a large number of genes have been implicated
Genetic complexity
a radical new approach to overcoming the challenges od psych. diseases is to study the () from individual patients
pathophysiology of neurons
neurons from individual patients using skin cells that are transformed into induced pluripotent stem cells (iPSCs)
– Caused by inappropriate expression of fear
– Most common of psychiatri cdisorders (>15% of Americans in a given year)
fear: adaptive response to threatening situations
anxiety disorder
(): sudden feelings of intense terror that occur without warning
Panic attacks
(): reoccurring unexpected panic attacks
Panic disorder
Severe anxiety about being in situations where escape might be difficult or embarrassing; leads to avoidance of situations irrationally perceivd as threatening
agoraphobia
Overwhelming and unreasonable fear of objects or situations that pose little real danger but provoke anxiety and avoidance
specific phobias
Several disorders that are no longer classified as “anxiety disorders” are nevertheless characterized by increased anxiety. Two of the most common are ()
PTSD, OCD
long-lasting consequence of psychological trauma
Post-traumatic stress disorder (PTSD)
(): repetitive behaviors or mental acts to reduce the anxiety associated with obsessions (e.g., repeated hand-washing, checking to make sure that something is not out of place …)
Compulsions
(): recurrent, intrusive thoughts, images, ideas, or impulses (e.g., contamination with germs …)
Obsessions
Biological Bases of Anxiety Disorders
2 major causes for anxiety disorders
genetic predisposition, occurence of stressful life events
Anxiety disorders: occurrence of an inappropriate stress response when a () is absent or when it is not immediately threatening
() - threatening stimulus
stressor
coordinated reaction to threatening stimuli
stress response
() orchestrates humoral, visceromotor, and somatic motor responses in stress response
Hypothalamus
the stress response is characterized by (4)
- avoidance behavior
- increased vigilance and arousal
- activation of symapthetic ANS
- cortisol release from adrenal glands
humoral component of the stress response is mediated by ()
Hypothalamic-Pituitary-Adrenal Axis
() may degenerate hippocampus -> less inhibition of HPA axis -> less reguation of stress response
Chronic stress
decreased hippocampal volume in some PTSD patients
Treatments for Anxiety Disorders
– gradually increase the exposure to threatening
stimuli
– learning that the stimuli are not dangerous
Psychotherapy
Treatments for Anxiety Disorders
act by altering chemical synaptic transmission in brain
Anxiolytic medications
Treatments for Anxiety Disorders: Anxiolytic medications
– (1) (binds to site in GABA receptor to make GABA more effective if producing inhibition)
– (2) (effective for OCD; effect develops slowly)
*virtually all drugs enhancing GABA
actions are anxiolytic
- Benzodiazepines
- Serotonin-selective reuptake inhibitors (SSRIs)
Treatments for Anxiety Disorders
- Target for new drugs: () -> if inactive, can’t activate cortisol release
CRH receptors
Repeated episodes of mania, or mixed episodes of mania and depression
Bipolar (Manic-Depressive) Disorder
– A distinct period of abnormally and persistently
elevated, expansive, or irritable mood
– Symptoms: inflated self-esteem or grandiosity; a decreased need for sleep; increased talkativeness; impaired judgement
Mania
Bipolar Disorder
- Type I: () (1%)
- Type II: () (0.6%)
- mania
- hypomania
– a milder form of mania
– often associated with increased productivity or creativity
– always associated with episodes of major depression
hypomania
() can enhance cognitive processes, creative thinking, and linguistic skills
Hypomania
() states reduce the need for sleep, foster intense concentration, create unmitigated self-confidence, and eliminate concern for social norms
Manic
Biological Bases of Affective Disorders
Deficit in central diffuse modulatory systems (NE, 5-HT)
monoamine hypothesis
The Monoamine Hypothesis
(): for high blood pressure; causes severe depression (20%); depletes central DA, NE and 5-HT
Reserpine
The Monoamine Hypothesis
(): for tuberculosis; causes mood elevation
Monoamine oxidase (MAO) inhibitors
The Monoamine Hypothesis
(): antidepressant; inhibits reuptake of 5-HT and NE
Imipramine
treatment of depression based on monoamine hypothesis: focus on ()
central 5-HT and/or NE synapses
Biological Bases of Affective Disorders
Genetic predisposition + other stress factors (especially during early childhood)
The Diathesis-Stress Hypothesis
Genetic predisposition = diathesis
accdg. to the Diathesis-Stress Hypothesis, () is the main site where genetic and environmental factors converge to cause mood disorders
HPA axis
Brain () injection in animals induces depression symptoms (insomnia, low appetite, high anxiety …)
CRH
Biological Bases of Affective Disorders
Resting-state metabolic activity in anterior cingulate cortex increased in depression; decreased by treatment
Anterior Cingulate Cortex Dysfunction
activity in the Anterior Cingulate Cortex is increased by (1) and decreased by (2)
- sad memory recall
- depression treatment
(): localized electrical stimulation
– Unknown mechanism in relieving depression
– Affects temporal lobe
– Advantage: quick relief of depression, mania
– Adverse effect: loss of prior memories, impaired storage of new information
Electroconvulsive therapy (ECT)
(): Help patients overcome negative views.
– Effective for mild to moderate depression
– Helps patients overcome negative view
– Neural basis of the treatment unknown
Psychotherapy
examples of antidepressants
MAO inhibitors, tricyclics, and SSRIs
The nature of adaptive changes unknown, but antidepressants dampen hyperactivity of the () in humans
HPA system and ACC
Antidepressants: animal studies
long-term () → glucocorticoid receptor elevation in
the hippocampus → suppression of HPA and ACC
serotonin
SSRIs increase () in the hippocampus
neurogenesis
Antidepressants: new drug target
(): rapid action; for suicidal patients; psychotic side effects
Ketamine
act on CRH receptors
basis of lithium treatment for bipolar disorder
Mechanisms unknown, but lithium enters neurons and inhibits PIP2 turnover and adenylate cyclase activity
basis of deep brain stimulation as treatment for severe depression
used only when patient fails to respond to other treatments
implanted electrode delivers electrical stim.; decreases activity in brain circuits that are chronically active
technically kind of brain surgery -> last resort
Severe mental disorder—loss of contact with reality
schizophrenia
Schizophrenia () in ways that healthy people find difficult to understand
distorts thoughts and perceptions
3 possible biological bases of schizophrenia
- Genes and the Environment
- The Dopamine Hypothesis
- The Glutamate Hypothesis
describe how genes and the environment explain onset of schizophrenia
faulty genes (roles in synaptic transmission) -> vulnerability to environmental factors (viral infection; poor maternal nutrition; marijuana)
explains physical changes in schizophrenia patient brains
describe how the dopamine hypothesis explains onset of schizophrenia
psychotic episodes triggered by activation of dopamine receptors
() overdose can lead to psychotic episodes with positive symptoms indistinguishable from those of schizophrenia
Amphetamine
Neuroleptic drugs (antipsychotic drugs)—potent blockers of dopamine D2 receptors
describe how the glutamate hypothesis explains the onset of schizophrenia
Schizophrenia reflects diminished activation of NMDA receptors in the brain
NMDA recpetor inhibitors (ketaine, phenylcyclidine) -> don’t affect dopaminergic transmission
involuntary lips and jaw
movements
Tardive dyskinesia
basic treatment for schizophrenia
Drug therapy combined with psychosocial support
(1) neuroleptics, such as chlorpromazine and haloperidol, act at (2) -> Reduce the positive symptoms of schizophrenia
- Conventional
- D2 receptors
c.f. conventional neuroleptics, () have less side effects when used for schizophrenia treatment
atypical neurleptics
newest focus for schizophrenia drug research
NMDA receptors
