Clinical Neuroscience Flashcards by Jade Kiersten

mental disorders

abnormal thoughts, emotions behaviour and relationships

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prevalence of mental disorders

depression - 17.5% lifetime
17% AD - women >65
3% ADHD, 1% autism
20% at one time

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2 types of diagnoses/approaches

nomothetic

idiographic

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Nomothetic

General laws eg long term course, risk factors, genetics, epidemiological data
feighner criteria
Kahlbaum and Hecker

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Idiographic

individuals, single case

Freud and Jung

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Manuals of criteria

ICD-10 and DSM-5

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Some ICD-11 categories

neurodevelopmental 
schizophrenia 
anxiety
mood
personality 
food related

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Depression diagnostic criteria

5 + symptoms for 2 weeks
low energy, anhedonia, low mood
apettite, guilt, suicidal, concentration

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Phenomenology

study structures of consciousness as experienced from first-person point of view

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history of psychoses

Kahlbaum and Hecker
tertiary syphilis
delirium vs psychoses

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Kraeplinian dichotomy

1890s - bipolar and schizophrenia

also dementia praecox

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delirium vs psychoses

delirium - disorientation in time, place, person
poor short term memory, visual hallucinations
psychoses = oriented, auditory hallucination, delusions

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schizophrenia

negative symptoms 
schneiders 1st rank sx
1. auditory hallucinations
2. delusional beliefs 
3. control - thoughts and body

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bipolar disorder

altered affect
2nd order hallucinations
disturb sleep/appetite

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schizophrenia vs bipolar

course of illness important
bipolar - earlier onset, cyclical, recovery between episodes
schizophrenia - recovery from +ve
schizoaffective disorder
dichotomy not so neat

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Treatments for schizoaffective

antipsychotics 
antidepressants 
mood stabilisers 
hallucinogens
ECT, TMS, DBS
cognitive therapy

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Reserpine

invented to treat hypertension
caused depression in some
block monoamine transporter

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monoamine hypothesis

monoamines eg serotonin, norepinephrine and dopamine

decrease in these cause depression

problems with monoamine hypothesis

long time to have effect

no baseline deficit in serotonin or noradenaline function in depression

Neuroplasticity theory of depression

too much stress - cortisol
hippocampal degradation
dendritic spines and densities - glutamate
neuroplasticity

Non-pharmacological treatments depression

ECT
hallucinogens
psychosurgery
insulin coma therapy

How do ECT, psychosurgery and hallucinogens work?

decreasing frontal over-connectivity

drugs which increase dopamine - examples and what do they induce?

psychosis
L-dopa
cocaine
dexamphetamines

what drugs reduce psychotic symptoms?

those which block dopamine receptors

schizophrenia and dopamine

increased binding at D2 receptor

Problems with dopamine theory of schizophrenia

most predictive is negative symptoms - motivation, cognition, blunted affect abnormal hippocampus smaller brains ketamine and PCP - antagonise NMDAR

variable manifestation of depression and anxiety

negative eg depression, anger, anxiety depression - psychoses no symptoms eg just somatic psychosis in adolescence --> bipolar

Huntingtons disease

1 triple repeat | accumulation of huntingtons protein in caudate and putamen kills cells

huntingtons symptoms

``` motor control apathy OCD balance impulsive ```

GWAS - mental illness

SNPs large overlaps for mental illnesses neurotic personality and smoking genes involved in regulation of DNA transcription

Simple inaccurate bullet model

disease - abnormal brain - psychopathology | abnormal brain - treat - normal

More complicated model

correlation not causation genes, gestation, life events, inflammation, nutrition treatments and prevention abnormal brain development

RDOC

diagnoses map poorly into psychiatry | dimensional measures of agreed constructs more useful for research eg effectiveness of treatments

temporal aspects of brain function and malfunction

``` synpase transmission = 0.5ms conversation = minutes mood = hours personality = years mental illness, days, weeks or years ```

intra-individual variation

High levels differences week to week eg circadian rhythm, fatigue

psychometry

underpin clinical psychology tools to measure presence and degree of abnormality of one or more behaviours quantitative

medical model

clinical observatoins - signs and symptoms pattern recognition qualitative

What is developmental psychopathology

processes go wrong during development | genes, biological processes and life experiences interact

Genetic factors

twin studies autism and ADHD polymorphisms innate temperament

intra-uterine and perinatal factors

maternal health, substance misuse, premature, twin, epigenetics, androgens

Epigenetic regulation of HPA axis

transcription (cpg) methylation

Inflammation

stress impairs immune response - cortisol inflammation activates HPA axis altered reward circuitry

early environment

attachment, PND, marital harmony, nutrition, discipline

Later experiences

peers, school, abuse | childhood maltreatment and ASBO