Kapitel 16 Psykopatologi

Question 1

Hvad er en lobotomy?

Answer 1

Det hvide snit - Slår hul i øverste del af øjenhulen og graver noget af frontallapperne ud. Man brugte det på skizofrene.

Question 2

Hvornår udvikler skizofreni sig oftest?

Answer 2

Appear in adolescence or young adulthood.

Question 3

Hvornår udvikler depression og antisocial personality disorder sig oftest?

Answer 3

25-44 år.

Question 4

Hvad menes der med positive og negative symptomer af skizofreni?

Answer 4

Positive symptomer er ting man “får” af lidelsen - Hallucinationer, delusions of grandeur og paranoide følelser.
Negative symptomer er ting du mister af lidelsen - Social withdrawal, blundet emotional responses, anhedonia (Loss of pleasureable feeling) mm. (p. 494).

Question 5

Er skizofreni arveligt?

Answer 5

I nogen grad. Det er bevist at det er arveligt, men der er ikke kun enkelte gener, der forårsager lidelsen. Det er flere.

Question 6

Hvilke neurostrukturelle- og funktionelle forandringer kan man se ved skizofrene?

Answer 6

Ventricular abnormalities - Man får større ventrikler. (eller har større ventrikler).
Hippocampus og amygdala er umiddelbart mindre ved tvillingen der har skizofreni ifht. den anden tvilling (p. 498).
Funktionelt er skizofrene dårligere til tests, der er sensitive over for frontal cortical lesions. - Der er mindre metabolisering i frontal lobes ved skizofrene.

Question 7

Hvilken kategori af medicin bruges til at afhjælpe nogle symptomer af skizofreni? Og hvilke symptomer er dette?

Answer 7

Antipsychotic medicine. Afhjælper kun de positive symptomer.

Question 8

To typer af stoffer hypotiseres at være den primære faktor for, hvorfor antipsykotisk medicin virker. Hvilke?

Hint. Den ene er en neurotransmitter den anden er en endogen ligand.

Answer 8

Dopamin - (Dopamin hypotesen p. 500). Ifht. denne hypotese bruges typical neuroleptics, der er d2 receptor antagonister.
Glutamat - (The glutamate hypothesis p. 503). Da PCP og ketamin fungerer begge som en NMDA receptor antagonist, hvilket hæmmer den endogene ligand, glutamat fra at have sin effekt.

Question 9

Hov.. Det skal sgu da være på engelsk..

What is the most prevalent mood disorder?

Answer 9

Depression.

13-20% of the population at all times. p. 506

Question 10

Is inheritance an important determinant of depression?

Answer 10

Yes.. There is higher concordance rate for monzygotic twins (about 60%) than concordance rate for dizygotic twins (20%). Genes does matter. (p. 506)

Question 11

Which neuro-functional changes are seen in depressed individuals?

Answer 11

Increased blood flow in prefrontal cortex, suggesting greater activity in prefrontal cortex and the amygdala. (p. 506).
Also decreased blood flow in parietal and posterior temporal cortex and in the anterior cingulate, systems that has been implicated in attention. (p. 506)

Question 12

Which structural changes are seen in depressed people?

Answer 12

Many studies report reduction of the hippocampal volume, and there is reduced activation of the hippocampal region in depressed people durin gmemory tasks. (We don’t know wether this change comes before or as a result of depression) (p. 507)
Depressed peoples descendants have a thinner cortex across large swaths of the right hemisphere. (p. 506)

Question 13

name some treatments that are available for depression.

Answer 13

Electroconvulsive shock therapy (ECT)

Drugs that affect monoamine transmitters. Either inhibitors of monoamines inhibitors (like monoamine oxidase), or inhibitors of reuptake of monoamines which boosts the synaptic activity.
Patients need more monoamines! - Serotonin seems to be the most important one (p. 507).

Deep brain stimulation (DBS) is also used.

Cognitive behavioral therapy.

Question 14

Name some monoamine transmitters.

Answer 14

Norepinephrine, dopamine and serotonin.

Question 15

How does the HPA-axis and depression link?

Bonus question: What is the HPA-axis?

Answer 15

People who have very high levels of circulating glucocorticoids such as cortisol are prone to depression.
Hypothalamus –> Pituitary glands –> Adrenal Gland.

Question 16

Does animal models of depression exist? If yes, which?

Answer 16

Scientest are still searching for a compatible animal model. One model that resembles depression is “learned helplessness”, in which the animal is exposed to a repetitive stressful stimulus.
Removing the olfactory bulb also creates a model of depression. Irritability, preferences for alchohol and elevated levels of corticosteroids.

Question 17

What is bipolar disorder?

Answer 17

Bipolar disorder is characterized by periods of depression alternating with periods of excessively expansive mood (mania), that includes sustained overactivity and so on. (p. 512)

Question 18

How does bipolar disorder show neurostructurally?

Answer 18

Patients exhibit enlarged ventricles - like depressive and skizophrenic people.
The more manic episodes the person experiences, the greater the entricular enlargement, suggesting a worsening of brain loss over time.

Question 19

Which substance is often in the medication, prescribed to people with bipolar disorder?

Answer 19

Lithium. Boosting BDNF, which combats the neuronal cell death underlying shrinking gray matter. (p. 512)

Question 20

Name some anxiety disorders.

Answer 20

Phobic disorders.
Panic disorder
General anxiety disorder.
Posttraumatic stress disorder
Obsessive-compulsive disorder.

Question 21

Using your knowledge of neurotransmitters. Which transmitter receptor, do you believe that medicine against anxiety is binding noncompetetively agonistic to?

Answer 21

GABA.

GABA is the most common inhibitory transmitter in the brain. p 513

Question 22

What is the prevalence of OCD? And when does it onset?

Answer 22

1% of adults in USA will suffer from “severe” OCD in any given year. It is hard to know the exact number of people with lower levels of OCD.
Peak age group for onset of OCD is 25-44 years.

Question 23

How does OCD show in the brain?

Answer 23

Patients with OCD display increased metabolic rates in the orbitofrontal cortex, cingulate cortex and caudate nuclei. (p. 516).

Question 24

Which neurotransmitter is especially involved in OCD?

Answer 24

Serotonin.
Most medication that works against OCD, share the ability to inhibit the reuptake of serotonin, at serotonergic synapses, thereby increasing the synaptic availability of serotonin.

Question 25

Is the heritable genetic components involved in OCD?

Answer 25

Yes several genes may contribute to susceptibility to this disorder. - BDNF fx. (p. 517).

Question 26

Is lobotomy still performed today?

Answer 26

No.
lobotomy was the beginning of psychosurgery.
Today only much more modest psychosurgeries are performed and only as a last resort. Fx. cingulotomy (lesions that interrupt pathways in the cingulate cortex) is effectful in the treatment of depressions and anxiety disorders.
Surgery is also used on epilepsy patients. - surgically remove the part of the brain where the discharge begins.

Question 27

What is prions?

Answer 27

Abnormally folded proteins that can destroy the brain. (mad cows disease).
The folded proteins folds more protein. p. 518f.