Lecture 13. Physiology of Psychiatric Disorder Flashcards
These are disorders of psychological function sufficiently severe to require treatment.
Psychiatric Disorders
The diagnosis is guided by the ________
DSM5
2 main difficulties in diagnosing particular psychiatric disorders:
- Patients suffering from the same disorder often display different symptoms
- Patients suffering from different disorders often display many of the same symptoms
5 sorts of Psychiatric Disorders:
- Schizophrenia
- Depressive disorders
- Bipolar disorder
- Anxiety disorders
- Tourette’s disorder
A disorder that means “the splitting of psychic functions.”
Schizophrenia
This is considered to be a severe psychiatric disorder; attacks 1 % of individuals of all races and cultural groups; begins in adolescence or early adulthood
Schizophrenia
What is the assumed primary symptom of schizophrenia in the 20th century?
the breakdown of integration among emotion, thought, and action
The DSM-5 prefers to use the label schizophrenia____________ to refer to schizophrenia and related disorders.
spectrum disorders
Positive symptoms of schizophrenia are symptoms that seem to represent an _____ of typical function
excess
5 Positive Symptoms of Schizophrenia
- Delusions
- Hallucinations
- Inappropriate affect
- Disorganized speech or thought
- Odd behavior
Positive symptom of schizophrenia includes Delusions of being ________, delusions of ________, delusions of _________.
- controlled
- persecution
- grandeur
Positive symptom of schizophrenia that includes imaginary voices making critical comments or telling patients what to do.
Hallucinations
Positive symptom of schizophrenia that includes reacting with an inappropriate emotional response to positive or negative events.
Inappropriate affect
Positive symptom of schizophrenia that includes illogical thinking, peculiar associations among ideas, belief in supernatural forces.
Disorganized speech or thought
Positive symptom of schizophrenia that includes talking in rhymes, difficulty performing everyday tasks.
Odd behavior
Negative symptom of schizophrenia are symptoms that seem to represent a ___________ of typical function
reduction or loss
3 Negative Symptoms of Schizophrenia
- Affective flattening
- Avolition
- Catatonia
Negative symptom of schizophrenia that includes diminished emotional expression
Affective flattening
Negative symptom of schizophrenia that includes reduction or absence of motivation.
Avolition
Negative symptom of schizophrenia that includes remaining motionless, often in awkward positions for long periods.
Catatonia
Frequent recurrence of any two of these symptoms for __________ is currently sufficient for the diagnosis of schizophrenia. Provided that one of the symptoms is _________, _________, or_________.
- 1 month
- delusions
- hallucinations
- disorganized speech
A drug that is meant to treat certain symptoms of schizophrenia and bipolar disorder.
Antipsychotic Drugs
First two widely prescribed antipsychotic drugs:
Chlorpromazine and Reserpine
A drug that has a calming effect on patients with psychosis. It does not cure schizophrenia, but it often reduces the severity of symptoms enough to allow institutionalized patients to be discharged.
Chlorpromazine
A drug no longer used in the treatment of schizophrenia as it produces a dangerous
decline in blood pressure at the doses needed for successful treatment.
Reserpine
In 1960, it was reported that the striatums
(caudates plus putamens) of persons with Parkinson’s disease had been ___________
depleted of dopamine
The dopamine theory of schizophrenia states that schizophrenia is caused
by _______________ and, conversely, that antipsychotic drugs
exert their effects by __________ dopamine levels.
- too much dopamine
- decreasing
Parkinson’s disease ____ dopamine; Schizophrenia ____ dopamine
- low/depleted
- high/too much
Two well-established facts supporting the dopamine theory:
- Antipsychotic drug reserpine was known to deplete the brain of dopamine and other monoamines by breaking down the synaptic vesicles in which these neurotransmitters are stored.
- Drugs such as amphetamine and cocaine, which can trigger episodes that resemble schizophrenia in healthy users, were known to increase the extracellular levels of dopamine and other monoamines in the brain.
substances that are created by the breakdown of another substance in cells
Metabolites
Both chlorpromazine and reserpine antagonize transmission at dopamine synapses, but they do it in different ways. Reserpine by ________ the brain of dopamine and chlorpromazine by ________ to dopamine receptors.
depleting
binding
They argued that chlorpromazine is the first identified ________ __________ at dopamine
synapses
receptor blocker
Rather than high dopamine levels, the main factor in schizophrenia was presumed to be high levels of _____ __ __________ ________
activity at dopamine receptors (D2)
One of the most potent antipsychotic drugs of its day. And had a relatively low affinity for dopamine receptors
Haloperidol
Current drugs of choice for the treatment of schizophrenia. Also known as second-generation antipsychotics. Drugs that are effective against schizophrenia but yet do not bind strongly to D2 receptors
ATYPICAL ANTIPSYCHOTICS
the first atypical antipsychotic to be approved for clinical use
Clozapine
Drugs whose primary action is to alter perception, emotion, and cognition
hallucinogens / psychedelic drugs
The psychedelic effects of classical hallucinogens such as LSD, mimic the
________________ of schizophrenia by acting
as an agonist of the serotonin type-2a receptor.
positive symptoms
Dissociative hallucinogens (e.g., ketamine) mimic the ___________________ of schizophrenia by acting as antagonists of glutamate receptors
negative symptoms
Several _________________ play important roles in development of the disorder
physiological changes
A variety of _______________ have been implicated in the development of
schizophrenia
early experiential factors
Schizophrenia and ____________ disorders share many of the same causal factors (e.g., genetic risk factors, environmental triggers)
Autism spectrum
Recent research has identified many __________ that contribute to the emergence and persistence of schizophrenia.
epigenetic mechanisms
Recent research used modern functional
_____________ to study functional connectivity in the brains of their daily lives.
brain-imaging techniques
Used to refer to a reaction to grievous loss; also used to refer to a psychiatric disorder.
Depressive Disorders
loss of the capacity to experience pleasure
anhedonia
Depression can be so extreme that it can
impair _______ and _________.
cognition contacts
personal hygiene.
When this condition lasts for 2 weeks or longer, these people are said to be suffering from a ________, also known as major depressive disorder.
clinical depression
________ are about twice as likely to a receive a diagnosis of depression during their lifetime
Females
The lifetime risk of completed suicide in an individual diagnosed with clinical depression ranges between ____ percent.
4 and 15 %
2 Categories of Depression
Reactive Depression
Endogenous Depression
depression triggered by an obvious negative experience
Reactive Depression
depression with no apparent cause
Endogenous Depression
the tendency for two health conditions to occur together in the same individual
comorbid
In, ________clinical depression is often comorbid with one or more other health conditions.
Adults
2 Subtypes of Major Depressive Disorder
Seasonal Affective Disorder (SAD)
Peripartum Depression
A subtype of major depressive disorder which states: Episodes of depression and lethargy typically recur during particular seasons—usually during the winter months.
Seasonal Affective Disorder (SAD)
Depressive Episodes are triggered by the _____________.
reduction in sunlight
A subtype of major depressive disorder where it is the intense, sustained depression experienced by some women during pregnancy, after they give birth, or both.
Peripartum Depression
Drugs that have been used for the treatment of depressive disorders:
Anti-depressant Drugs
5 major classes of Anti-depressant Drugs
- Monoamine Oxidase Inhibitors
- Tricyclic Antidepressants
- Selective Monoamine-reuptake Inhibitors
- Atypical Antidepressants
- NMDA-receptor antagonists
The first antidepressant drug. A monoamine agonist; it increases the levels of monoamines (e.g., norepinephrine and serotonin) by inhibiting the activity of monoamine oxidase (MAO)
Iproniazid
Antidepressants that block the reuptake of both serotonin and norepinephrine, thus
increasing their levels in the brain. They are a safer alternative to MAO inhibitors.
Tricyclic Antidepressants
What is the first tricyclic antidepressant that was initially thought to be an antipsychotic drug?
Imipramine
A Selective Monoamine-reuptake Inhibitors that are serotonin agonists that exert their agonistic effects by blocking the reuptake of serotonin from synapses?
Selective serotonin-reuptake inhibitors
(SSRIs)
Was the first
SSRI to be developed.
Fluoxetine
A Selective Monoamine-reuptake Inhibitors that is proven to be just as effective as the SSRIs in the treatment of depression.
Selective norepinephrine reuptake inhibitors
(SNRIs)
A catch-all class comprising drugs that have many different modes of action
Atypical Antidepressants
An Atypical Antidepressant that has several effects on neurotransmission; A blocker of dopamine and norepinephrine reuptake
Bupropion
An Atypical Antidepressant that is a melatonin receptor agonist.
Agomelatine
A NMDA-receptor antagonist that a single low dose can rapidly reduces depression, even in patients who had been experiencing a severe episode.
ketamine.
Only about ____ of depressed individuals are actually helped by the antidepressants.
15 percent
Relative efficacy of antidepressant drugs is a function of the ____ and _____ of the depressed individual.
sex
age
2 treatments of depression involving brain stimulation:
- Repetitive transcranial magnetic stimulation
(rTMS) - Deep brain stimulation
2 theories of Depression
- Monoamine theory
- Neuroplasticity theory
This theory holds that depression is associated with underactivity at serotonergic and noradrenergic synapses.
Monoamine theory
This theory holds that depression results from a decrease of neuroplastic processes in various brain structures which leads to neuron loss and other neural pathology
Neuroplasticity theory
Defined as Periods of clinical depression and periods of hypomania or mania. It is a serious psychiatric disorder with one of the highest rates of attempted and completed suicide.
Bipolar Disorder
2 Types of Bipolar Disorder
- hypomania
- mania
Characterized by a reduced need for sleep, high energy, and positive affect. During periods of , people are talkative, energetic, impulsive, positive, and very confident
hypomania
Has the same features as hypomania, but taken to an extreme. Additional symptoms: delusions of grandeur, overconfidence, impulsivity, and distractibility. It usually involves psychosis.
Mania
Type of bipolar disorder which are those persons who experience bouts of mania, or only experience mania.
Type I
Type of bipolar disorder which are those persons who only experience bouts of depression and hypomania.
Type II
These are drugs that effectively treat depression or mania without increasing the risk of mania or depression, respectively.
Mood Stabilizers
A simple metallic ion; the first drug found to act as a mood stabilizer.
Lithium
Theory of Bipolar Disorder
Reward Hypersensitivity Theory of Bipolar Disorder
Proposes that bipolar disorder results from a dysfunctional brain reward system that overreacts to rewards or the lack thereof.
Reward Hypersensitivity Theory of Bipolar Disorder
Based on early observation of individuals with bipolar disorder have a very high likelihood of developing bipolar disorder.
family members
____________ are common in bipolar disorder and such deficits are associated with a variety of changes in brain function. Consistent overall reductions in _____________ volume have been reported.
Cognitive deficits
gray matter
The chronic fear that persists in the absence of any direct threat—is a common psychological correlate of stress.
Anxiety
It happens when anxiety becomes so severe that it disrupts functioning. It is the most prevalent of all psychiatric disorders (almost twice as great in females as in males ).
Anxiety disorder
4 Anxiety Disorders
- Generalized Anxiety Disorder
- Specific Phobias
- Agoraphobia
- Panic disorder
These are haracterized by extreme feelings of anxiety and worry about a large number of different activities or events.
Generalized Anxiety Disorder
A strong fear or anxiety about particular objects or situations.
Specific Phobias
Pathological fear of public places and open spaces.
Agoraphobia
Characterized by recurrent rapid onset attacks of extreme fear and severe symptoms of stress (e.g., choking, heart
palpitations, shortness of breath).
Panic disorder
3 Pharmacological Treatment of Anxiety Disorder
- Benzodiazepines
- Antidepressant Drugs
- Pregabalin
Most widely prescribed psychoactive drugs for the treatment of anxiety disorders
Benzodiazepines
Consistent with the comorbidity of anxiety disorders and clinical depression is the observation that antidepressants, such as monoamine agonists and tricyclics, are often effective against anxiety disorders.
Antidepressant Drugs
One of the newest drugs being prescribed for anxiety disorders. Particularly effective for generalized anxiety disorder. Its effects are believed to be due to its ability to modulate voltage-gated calcium channels, thus affecting calcium levels inside nervous system cells.
Pregabalin
3 Animal Models of Anxiety Disorder
- Elevated-plus-maze Test
- Defensive-burying Test
- ## Risk-assessment Test
A disorder of tics (involuntary, repetitive,
stereotyped movements or vocalizations)
Tourette’s Disorder
Tourette’s Disorder four times more frequent in ____ children than in ________ children.
male
female
4 Common complex motor tics:
- Hitting
- Touching Objects
- Squatting
- Twirling
- Making lewd gesture
4 Common verbal tics:
- Inarticulate sounds (e.g., barking,
coughing, grunting) - Coprolalia (uttering obscenties)
- Echolalia (repetition of another’s words)
- Palilalia (repetition of one’s own words)
The treatment of Tourette focuses on the __________ problems (e.g., anxiety and depression).
ancillary emotional
The tics of Tourette’s disorder are usually treated with ____________
antipsychotics
These are control drugs that have no therapeutic effect but produce side effects similar to those produced by
the drug under evaluation
Active placebos
These are drugs for which the market is too small for them to be profitable
Orphan Drugs
