Exam 1 Flashcards
Define Biological Psychiatry
Understand metnal disorder in terms of biological function. Everything psych is bio, BUT lifestyle/environment alters biology
What does DSM tell us? What does it not?
What tries to fix this problem?
Tells symptoms of disorders.
Doesn’t tell you APPROACHES. Also HETEROGENEITY: disorder can look different in different people.
RDoC
To diagnose depression, you need / sumptoms including at least 1 of depressed mood and loss of interest/pleasure
5/9
3 causes of mental illness throughout time
- Supernatural
- Somatogenic (bio)
- Psychogenic
Who declared mental disorders disorders of the brain?
Wilhelm Griesinger (1817-1868)
German neurologist/psychiatrist
In first half 20th century, was emphasis more on bio?
No, psych with Freud
What brought back bio interest in 2nd half 20th century?
genetics development. Schizoprenia had genetic component.
Thorazine (Chlorpromazine) marketed in 1954
NEUROCHEMICAL INBALANCE became big explanatory model thanks to drug development
When did 1st edition of DSM come out?
1952
What did the gov declare 90’s to enhance public awareness of brain research?
What journal founded in 1997?
Decade of the brain
Molecular psychiatry
New findings: effects of psychiatric drugs not primarily exerted via NT in synaptic cleft, BUT
Up and down regulation of receptors, effects on intracellular cascades
DSM 5 on may 18th 2013, but what was Thomas Insel’s problem 3 weeks earlier?
Lacks validity
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If DSM doesn’t have validity, then what is it good for?
Clinical utility
DSM 5 (2013) to DSM-5-TR (2022)
Updated sections. New diagnosis of prolonged grief disorder, 70 modified crieria set, intro and use of manual guides, considers racism/discrimination, New ICD-10_CM codes to monitor suicidal behavior and suicidal self-injury, updated old codes 50 coding updates for substance intoxication and withdrawal and other disorders
People only diagnosed with disorder IF
Harm to other or self and significant impariment
When was homosexuality taken out of the DSM
DSM 3
The DSM-5, more than other versions, tries to what?
Incorporate research findings in classifications
Why is DSM 4 anxiety split into 4 categories?
Data from neuroscience, imaging, and genetic studies suggests differences in heritability, risk, course, and treatment.
Fear based (phobias)
OCD
trauma (PTSD)
dissociative disorders
What is RDoC?
Research framework for investigating mental health disorders.
Integration of many levels of information.
Dimensional apporach involving multiple analysis levels
Framework to study mechanisms that cut across traditional diagnostic categories
What is required for RDoC to pass for group in internal NIHM workshop?
- Persuasive evidence for validity
- Evidence for neural circuit or system that implements the psychological function described
Implicit: linkable to psychiatric clinical phenomenon
Similarities and differences of RDoC and HiTOP
Similarities: both move away from diagnostic categories. Both work-in-progress approaches.
Differences: how they define dimensions, content and units of analysis, current gaps and limitations.
RDoC reserach framework
HiTop is a dimensional classification system (general p factor)
Who made the RDoC? Why?
NIMH
Neuroscience has not made major breakthroughs towards prevention and treatment. NO satisfacotry theory of pathophysiology, biology doesn’t map onto DSM
Why use the RDoC? How has neuroscience failed?
- Heterogeneity (more than 1 way for a symptom)
- measuring biology on different levels is very expensive
- Comorbidity
- Only enroll subjects based on diagnosis
- to understand mental health and illness adopt dimensional conceptualization
- DSM diagnosis aren’t great constructs to begin with
Why is PTSD not an anxiety disorder in DSM5?
fear/anxiety not central to PTSD
Fear- alarm to present/imminent danger real or perceived
Flashbacks specific to PTSD, low base-rate symptom
What symptoms does PTSD share with depression?
Anhedonia, difficulty sleeping, irritaiblity, difficulty concentrating
Give an example of an experiment using two units of analysis
from the RDoC Matrix (make sure to answer the following
questions in your response): What is your construct of
interest? Who would you recruit into your study? How would
you measure those two units?
Cognitive systems: Congitive control or attention
Populations: ADHD, Autism, NT
Genes, fMRI for circuits, behavior, you can do attention or cognitive control task
DSM good for clinical use, increase reliability since DSM 3, good for legal and social systems, clinical phenotypes, but why is it bad for research?
- Emphasis on reliability over validity
- Heterogeneity of disorders
- Extensive co-morbidity (Discrete disorders no symptom overlap)
- Antedates current knowledge of brain and behavior
- Difficult to relate diagnoses to genes, particular circuits, or basic behavioral mechanisms
Domains of RDoC
- Negative Valence Systems
- Positive Valence Systems
- Cognitive Control Systems
- Systems for Social Processes
- Arousal/Modulatory Systems
Units of Analysis on the RDoC
Genes, molecules, cells, circuits, physiology, behavior, self-report paradigms
GMCCP B S-R P
Negative Valence Systems Constructs
- Acute threat (fear)
- Potential threat (anxiety)
- Sustained threat
- Loss
- Frustrative nonreward
Positive Valence Systems Constructs
- Approach motivation
- Initial responsiveness to reward
- Sustained responsiveness to reward
- Reward learning
- Habit
Cognitive Systems Constructs
- Attention
- Perception
- Working Memory
- Declarative Memory
- Language Behavior
- Congitive (effortful) control
Systems for Social Processes constructs
- Affiliation/attachment
- Social Communication
- Perception/Understanding of self
- Perception/Understanding of others
Arousal/Modulatory Systems constructs
- Arousal
- Biological Rhythms
- Sleep-wake
RDoC Limits
units called behavior and self-report, but at present these units do not intend to include the majority of signs, symptoms, and behaviors requiring clinical attention
many self-report, behavioral, and task exemplars included in the RDoC matrix have inadequate or unclear psychometric properties and were
not developed to operationalize RDoC constructs
limited application in clinical practice
HiTop Limits
but do not take into account their underlying underpinnings.
Doesn’t include autism or ID
Includes understudied somatoform disorder
Anhedonia
No response to reward
Complexity of nervous system means there are different ways that
neurotransmission can occur
Does RDoC take the 1:1 neuron approach?
No, compels us to understand molecules and
channels within and between two neurons; to assembly of
neurons in circuits; to neural networks; emergent behavior
Motor cell will take ____ or more incoming fibers
10,000
Chemical synapse transmission
Presynaptic release chemical (NT) pick up by postsynaptic cell
Electrical Synaptic Transmission
Gap Junctions
Not synpase, connected with each other.
Direct signal going. Sodium ion, signal that creates AP.
Ions back and forth across neurons
Excitatory Synaptic Transmission
Sodium more likely to release AP
Depolarizing next cell, making it less negative
Inhibitory Synaptic Transmission
Less likely to fire AP
Make next cell more negative
Slow Synaptic Transmission
Metabotropic (postsynaptic cell goes through a lot to open ion channels, time scale difference) Slow.
Fast Synaptic Transmission
Ionotropic (NT bind, communication is quick, ions in)
Modulatory influences mean that it’s not 1:1. Give 1 example.
Dopamine might make it less likely to fire
Make it more negative
Nervous system is not linear
Circular.
Posynaptic cell also influences presynaptic cell. All connected one big system.
What illustrates complexity of synaptic transmission?
- Chemical vs. Electrical
- Excitatory vs. inhibitory
- slow vs. fast
- modulation
- Nervous system not linear
Synaptic basics
Calcium through voltage gated ion channels
Vesicles fuse and release NT
What concepts reflect complexity and non-linearity?
- Multiple receptor subtypes
- Autoreceptors
- Multiple receptors from numerous inputs converge on 1 target and may interact
- Erosion of Dale’s Law
- Neuromodulation of synpases and networks
- INFORMATION PROCESSING BY BRAIN OCCURS ON DIFFERENT TEMPORAL AND SPATIAL
SCALES
7.Feedback loops in the circuit - divergence—cells branch extensively to supply many target cells
How do autoreceptors increase complexity?
Presynaptic cell releases NT, auto receptor puts it back in cell. Auto receptors on PREsynaptic cell. Regulate how much NT released. Can bring NT back. Monitoring system.
SSRIs use autoreceptors. Block autoreceptors so serotonin can’t come back. Stays in synapse for longer period of time.
Mental health meds focus on auto receptors.