Lecture 13 - Psychatric Disorders Flashcards
What distinguishes psychiatric and mental disorders from other medical conditions ?
- Dramatic abnormalities in cognitive functions without an obvious lesion to the brain
How does the DSM-5 contribute to the understanding and treatment of psychiatric disorders ?
- Categorizes psychiatric conditions
- Leading to better treatment approaches
What does RDoC stand for and how does it contribute to treatment approaches ?
- Research Dominant Criteria
- Understand basic biological functions underlying mental disorders to enhance treatment strategies
Name two major mood disorders
- Major depressive disorder
- Bipolar disorder
What are the different types of psychiatric disorders ?
- Schizophrenia
- Mood disorders
- Dementia
- Anxiety disorders
- Sleep disorders
- Psychosurgery
What are the 3 categories of symptoms in schizophrenia ?
- Positive symptoms
- Negative symptoms
- Cognitive symptoms
According to the dopamine theory, which symptoms of schizophrenia are primarily influenced ?
- Positive symptoms
How does cognitive behavioral therapy (CBT) contribute to the treatment of schizophrenia ?
- Helps improve coping strategies
- Change dysfunctional beliefs
- Enhance social skills
What are some of the major neurochemical changes associated with schizophrenia ?
- Decreased dopamine metabolites in CSF
- Increased striatal receptors
- Decreased cortical glutamate
- Altered GABA function
What was the initial biochemical abnormality identified in schizophrenia ?
- Elevated dopamine activity in frontal lobe (dopamine theory)
What are the five symptoms listed in the DSM-5 for diagnosing schizophrenia ?
- Delusion
- Hallucinations
- Disorganized speech
- Disorganized or excessively agitated behavior
- Other symptoms causing social or occupational dysfunction
What structural abnormalities are commonly observed in the brains of individuals with schizophrenia ?
- Enlargement of lateral & third ventricles
- Decreased in brain volume
- Reduction in GM volume in various brain regions (frontal lobe, PFC, temporal lobe, hippocampus)
What role does the prefrontal cortex play in the cognitive symptoms of schizophrenia ?
- Abnormalities in dopamine, GABA & glutamate inputs
How does pharmacological intervention contribute to the treatment of schizophrenia ?
- Restore monoamine function
- Restore GABA/Glutamate function
Which symptoms of schizophrenia are primarily influenced by serotonin & adrenaline ?
- Negative symptoms
What effect do dopamine agonists (cocaine, amphetamine) have on schizophrenia symptoms ?
- Induce psychotic symptoms similar to paranoid schizophrenia
- Worsen symptoms in individuals with schizophrenia
What are some mood symptoms associated with depression ?
- Sad mood
- Reduced motivation
- Indecisiveness
- Prolonged feelings of worthlessness & guilt
- Disruption of normal eating habits
- Sleep disturbances
- Motor slowing
- Suicidal thoughts
According to the monoamine hypothesis, what neurotransmitters are implicated in depression ?
Serotonin, Dopamine & Norepinephrine
What is the hypothalamic-pituitary-adrenal (HPA) axis hypothesis in depression ?
Suggests that prolonged high level of cortisol, due to impaired feedback regulation, play a role in the pathophysiology of depression
How does the immuno-metabolic depression hypothesis differentiate from typical depression ?
Links depression with inflammation & metabolic changes (often seen in conjunction with physical illnesses like cardiovascular disease)
To what can lead prolonged high cortisol levels ?
- Change in monoamine (serotonin)
- Brain derived neurotrophic factor BDNF (neurogenesis)
What is the role of fluoxetine (SSRI) in treating depression ?
- Enhances serotonin levels
- Stimulates brain-derived neurotrophic factors
- Stimulates neurogenesis in hippocampus
What are some proposed treatments for depression besides pharmacological options ?
- Cognitive behavioral therapy (CBT)
- Lifestyle changes
- Light therapy (for seasonal affective disorder)
- Electroconvulsive therapy
- DBS
Which brain regions show neuropathological changes in depression ?
- Reduced GM in OFC, posterior cingulate & hippocampus
- Decreased connectivity in DMN
- Altered blood flow metabolism in regions like ACC & vmPFC
How do dopamine, serotonin, and glutamate interact with cortisol and inflammation in the context of depression ?
- Dopamine : effects reward processing, motivation, energy allocation, mood & cognition
- Serotonin& glutamate : interact with cortisol & inflammation
What are the primary symptoms associated with bipolar disorder ?
- Episode of depression & mania
What is the sensitization hypothesis in bipolar disorder ?
- Repeated exposure to stress & drugs sensitizes brain regions responsible for affect regulation, potentially contributing to the cycling between depressive & maniac episodes
Which brain regions show decreased gray matter in bipolar disorder ?
- Fusiform gyrus
- Hippocampus
- Cerebellum
How does epigenetics contribute to bipolar disorder ?
- Genetic predispositions
- Stress events
What relationship exists between bipolar disorder and dopaminergic drug use ?
- Heightened risk for drug abuse
- Cocaine : induce mania
What are the primary symptoms associated with anxiety disorders ?
- Intense fear or anxiety that is inappropriate to the circumstances
Name the categories of anxiety disorders
- Panic disorders
- PTSD
- Generalized anxiety disorder (GAD)
- OCD
- Phobias
What neuropathological dysregulations are associated with anxiety disorders ?
- Dysregulations of fear & emotional circuits : vmPFC-Amygdala-Hippocampus & hippocampus-DLPFC
- Dysregulations of autonomic circuits : anterior insula-Amygdala-OFC
What are some treatments for anxiety disorders ?
- Benzodiazepines (medication)
- Cognitive-behavioral therapy (CBT)
- Exposure therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
What’s dementia ?
- Substantial cognitive decline from previous level of performance
- Decline in cognitive performance
- Interfering with independent functioning
What are the different types of dementia ?
- Tauopathiesor Synucleinopathies
- Vascular dementias
- Mixed dementias
- Alzheimer’s disease
- Other dementias
What are the primary neuropathological features of Alzheimer’s disease ?
- Aggregation of neuritic plaques (amyloid plaques) & neurofibrillary tangles
- Lead by infection & neuro-inflammation
What are the neuropathological changes in the brain associated with Alzheimer’s disease ?
- Cortical shrinkage, apoptosis, cell death
- Degeneration of cholinergic projections from basal forebrain to neocortex
- Reductions in monoamines (dopamine, serotonin, noradrenaline)
- General decrease in cerebral blood perfusion & glucose consumption
Outline the stages of Alzheimer’s disease progression
- Early stage : involves olfactory dysfunction, retrograde amnesia (most recent memories affected first), difficulty acquiring new information & orientation problems
- Mild stage : extends to frontal lobe involvement, leading to loss of fluency, executive dysfunction, apathy & further loss of episodic memory
- Moderate to severe stages : progress to severe cognitive impairment, including profound memory loss, problems with complex motor tasks, emotional disturbances & spatial disorientation
What is Capgras delusion, and how is it related to Alzheimer’s disease ?
- Psychiatric disorder where a person believes that a close family member or friend has been replaced by an identical imposter
- Occur in Alzheimer’s due to impairments in recognition & memory
What are the areas of the brain affected for each stages of Alzheimer’s disease ?
- Early stage : medial temporal lobe & enthorinal cortex
- Mild stage : extends to frontal & temporal lobe
- Moderate to severe stages : extends to temporal, frontal & parietal lobe
Name & define 2 sleep disorders
- Narcolepsy : condition of excessive sleep or sudden brief sleep episodes during the day
- Insomnia : inadequate sleep (difficulty falling asleep or waking up frequently)
What is the neuropathology associated with narcolepsy ?
- Loss of hypothalamic neurons that produce peptide neurotransmitter hypocretin (orexin)
- Allele of HLA-DBQB1 gene on chromosome 6 involved ( = important for immune system functioning)
What does orexin has an influence on ?
- Regulates monoamines & cholinergic nuclei to regulates sleep/wakefulness
What are the symptoms of narcolepsy ?
- Sleep attacks
- Cataplexy : complete loss of muscle tone & paralysis triggered by emotional excitement (remains conscious/awake)
- Sleep paralysis
- Hynagogic hallucinations
What are the EEG findings associated with insomnia ?
- Takes longer to fall asleep
- Decreased periods of dream (REM) sleep
- More transitions between sleep stages
- More movement
- Do not benefit from restorative properties
What are some symptoms of insomnia ?
- Nightmares
- Restless leg syndrome
- Sleep apnea
