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Brain & behaviour > Lecture 5 - Psychiatry > Flashcards

Lecture 5 - Psychiatry Flashcards

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1
Q

Define Psychosis

????????*****

A

First Broad Psychiatric Disorder Classifications:

No insight

  • Hallucinations and delusions
  • Can sometimes have insight that hallucinations are different from reality. Cant have insight into delusions
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2
Q

Define Neurosis

A

Insight in maladaptive behaviour

  • Recognise your maladaptive behaviour
  • Depression without psychosis, anxiety disorders
  • doesnt make it easy to stop however
  • E.g. dissociation - despite having insight, cant do much about it
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3
Q

What are the main disorders of Axis 1 in DSM 5?

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A

Axis 1 Mental disorders include

  1. Sz
  2. Mood disorders with or without psychoses
  3. Anxiety disorders
  4. Eating, sleep, sexual, impulse control
  5. Substance disorders etc
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4
Q

What are each of the axis in the DSM 5 about

A

Axis 1 = major mental disorders
Axis 2 = Personality disorders
Axis 3 = Disorders related to medical condition
Axis 4 = Psychosocial contributors (Stressors)
- e.g. whats going on in their life and how is this effecting Axis 1 disorder
Axis 5 = Functioning
- in the DSM not considered a disorder unless it impacts on occupational or social functioning

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5
Q

Whats Axis 3?

A

Disorder related to medical condition

  • e.g. personality change related to disease
  • having cancer might contribute to anxiety
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6
Q

Outline Cluster A personality disorders
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A

Odd or eccentric
- abnormal cognitions or ideas, speak/ act strangely, difficulty relating to others

  1. Paranoid PD (removed in DSM 5)
    - suspicious, resentful, blame avoiding, rigid
  2. Schizoid PD (removed in DSM 5)
    - Avoid interpersonal interactions, lack empathy
  3. Schizotypal PD
    - Depersonalisation, schizotypal cognitions (magical thinking, ideas of reference)
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7
Q

Outline Cluster B personality disorders

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A

Dramatic, Emotional and Erratic

  1. Antisocial PD
    - no sense of right and wrong, enjoys humiliating others
  2. Narcissistic PD
    - grandiosity, need approval, sensitive to criticism
  3. Histrionic PD
    - need centre of attention, vanity demanding
  4. Borderline PD
    - Emotional and interpersonal instability, self-harm, seperation issues
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8
Q

Outline Cluster C personality disorders
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A
  1. Obsessive-Compulsive PD
    - perfectionism, minute detail, no compromise, need for control
  2. Avoidant PD
    - introverted, timid, sensitive to rejection, social awkwardness
  3. Dependent PD
    - need to be taken care off, difficulty with everyday decisions
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9
Q

What are the changes made to DSM 5?

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A
  1. Dropped Asperger as a distinct classification
  2. Loss subtype classifications for various forms of Sz
  3. PTSD and OCD now seperate from anxiety
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10
Q

What do critics say about the DSM 5?

A

X - lacks empirical support
X - lacks inter-rater reliability low for many disorders
X - Confusing and poorely written

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11
Q

What changes were made to Personality Disorders in DSM 5?

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A

Instead of:
pervasive pattern of thinking/ emotionality/ behaving

It now reflects:
adaptive failure, involving:
•Impaired sense of self-identity
•Failure in effective interpersonal functioning

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12
Q

Outline Schizophrenia symptoms

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A

Positive - at least 1 for 1 month

  • Disorganised thoughts
  • hallucinations
  • delusions (Grandeur, control, love, persecution)

Negative - at least 1 for 1 month

  • Flat emotions
  • speech poverty
  • Anhedonia (no pleasure)
  • No motivation
  • Disorganised behaviour
  • Catatonia (too much or little activity, echolalia) - like sit in a chair for hours, or are hyper
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13
Q

If its between 1 and 6 months what might you diagnose sz as? ????????

A

Schizophreniform (milder condition) or schizoaffective disorder (sz + mood disorder)

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14
Q

What are the 5 types of Sz, not in the DSM?
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- removed
******

A

These were removed as they didnt really cluster, main issue is cognitive issues: they are disordered in form and in content

  1. Paranoid Sz
    - delusions of persecution, threatening/ hostile auditory hallucinations
  2. Catatonic Sz
    - Either stuporous or excited (but withdrawn)
  3. Hebephrenic Sz
    - bizzare behaviour/ affect, childlike
  4. Simple: Anhedonia, impoverished thought, flat affect
  5. Unspecified: Mix of all these things
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15
Q

Outline the 2 broad types of Sz
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******

A

People might have a mix, but usually one type is more prevalent than another

Type 1: Positive Symptoms

  • Hallucinations, delusions, bizzare behaviour, confused thinking
  • Supposedly caused by problems in dopamine neurotransmission
  • Anti-psychotics really help

Type 2: Negative Symptoms

  • Speec poverty, flat emotions, seclusiveness, imparied attention
  • Believed to be caused by structural abnormalities - doesnt respond well to anti-psychotics
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16
Q

What are the 2 types of brain abnormalities?

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A
  1. Biochemical

2. Structural

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17
Q

Outline Biochemical Brain Abnormalities in Schizophrenia
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A

Positive symptoms are linked to biochemical abnormalities

  • Overactivity in Dompaminergic system in VTA
  • Antipsychotics act on this system
  • causes anhedonia as it shuts off dopamine (pleasure/ reward) system
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18
Q

Outline Structural Brain Abnormalities in Schizophrenia
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A

Negative symptoms are linked to Structural abnormalities

  • Atrophy: enlarged ventricles (is sz early dementia?)
  • Can be caused by low dopaminergic activity in frontal areas - dopamine levels fluctuating causing either positive (high levels) or negative symptoms (low levels)
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19
Q

What are the 4 dopamine pathways?????????

and how do they link to Sz

A
  1. Nigro-Striatal system
    •Substantia-nigra -> Putamen/ Caudate
    •Movement
  2. Mesolimbic System
    • VTA -> Limbic structures (Amygdala, NAc)
    • positive symptoms
  3. Mesocortical System
    • VTA -> frontal/ temporal lobes
    •Negative symptoms
  4. Tuberinfundibular Tract????????
    •Arcuate Nucues -> median Eminence
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20
Q

How do Anti-psychotics work?

A

They block the dopamine receptors but dont have an effect themselves
- particularly in pleasure areas, this would cause anhedonia

21
Q

What are the long term motor side effects of anti-psychotics

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A
  • Long term motor side effects are similar to parkinsons disease
  • Old Anti-psychotics used to block ALL DA receptors, so it caused parkinsons symptoms:
  • Slow Movement
  • Lack facial expression
  • Weakness
  • Might be due to too much ACH and too little DA in Basal ganglia
22
Q

Outline Tardive Dyskenisa as a side effect of anti-psychotics
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A

Opposite to parksinsons

1/3 of patients will develop this
•cannot stop movement/ fly-catching tongue, gurning
•Increased D2 receptor in striatum complex (basal ganglia)
• See the same in PD with too much L-Dopa
• Too little dopamine originally, but now got way too much

23
Q

Outline Heritability of Sz

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A

30-50% chance of your offspring also having it to, leads to vulnerability to environmental factors

24
Q

Outline environmental factors of Sz

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A
  • Seasons of birth (late winter/ early spring increases chances)
  • Viral epidemics when born
  • Population density
  • Prenatal malnutrition
  • Maternal stress
  • Parental Age
  • Complications at birth
25
Q

What are the theories about why Sz happens
????????
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A
  1. environment + genes = accelerated synpatic pruning
    - this causes structural deficits
    - in healthy people this starts around 16
  2. Dorsolateral Prefrontal area less active = negative symptoms
  3. Over activity of Dopaminergic system = positive symptoms or mixed symptoms
26
Q

Outline Major Depressive Disorders

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A

•Low mood/ irritability
• Loss interest/ pleasure - anhedonia
- For at least 2 weeks

Reduced energy/ appetite/ sleep/ sex/ activity

27
Q

Whats an adjustment disorder

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A

Response to an event/ stressor, low mood between 3-6 months

28
Q

What are the types of major depressive disorders?
????????
******

A
  1. Melancholic
    - anhedonia, psychomotor retardation, weight loss and guilt
  2. Atypical
    - weight gain, sensitive to rejection, mood reactivity
  3. Catatonic
    - mute/ no or bizzarre movements
  4. Post-Partum depression
    - between 1 and 3 months after birth
  5. Seasonal Affective Disorder
29
Q

What are the suicide % for mood disorders?

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A
  1. Unipolar - 16% risk
    - more likely for women to get this, but men more at risk of suicide
  2. Bipolar - 30%
30
Q

If its less severe, what is Unipolar and Bipolar
????????
*******

A
  1. Unipolar if less severe = dysthymic

2. Bipolar if less severe = Cyclothymic

31
Q

Outline Bipolar Disorder

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A
  1. Major depression
    - little energy/ movement/ speech, restless/ no pleasure
  2. Mania: Too much speech, activity, risk taking, unrealstic projects, delusions
  3. Hypomania
    - less severe
    - self-esteem, need less sleep, talkative, flight ideas, distractable

People fluctuate between short manic episodes and longer depressive episodes

32
Q

How is the manic stage different from positive symptoms of Sz?
????????
******

A

They both:
•onset in adolescence
•Social stress + early emotional alterations
- Might play by self, fantasy games etc

• genetic risk overlap

  • Sz more in cognitive domain
  • Bipolar more in affective domain

• Dopamine may play a role in both

33
Q

What are potential causes of bipolar?

A

Heritability increases the risks

34
Q

What are treatments for Bipolar and positive sz

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A

•MAO inhibiters (2-3 weeks) for unipolar
•Drugs that block norepinephrine and serotonin reuptake (Tricyclics, SSRI, Prozac)
• Sleep deprivation - start clock over
- exercise too
• Bipolar treatment: medication - lithuim, anticonvulsants, antipsychotic. Wont get manic periods and wont get very low, just like luke warm sad

Lifestyle changes:
•reducing expressed emotion in family (how are you, how did you sleep…)
•Take away smoking, coffee, sleep resetting
- get a sleep routine

35
Q

Outline sleep problems in depression

A
  • Early wake up
  • Problems falling asleep
  • Fragmented sleep
  • REM Sleep is early
  • SAD: light therapy
36
Q

How do antidepressants help sleep?

A

SSRI’s inhibit REM sleep, might be why they work so well - stop the period where you are likely to wake up

37
Q

Which Neurotransmitters are in Monamines?

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A
  1. Dopamine
  2. Norepinephrine
  3. Serotonin
38
Q

How do MAO inhibitors work?

A

MAO is an enzyme that mops up excess Neurotransmitters in the cell and in the synapse
- If you inhibit MAO, more of the NT will be available

39
Q

Which receptor does SSRI block?

A

5-HT

  • serotonin receptors
  • blocks the feed-back mechanism is reduced
40
Q

Outline Anxiety Disorders

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A
  • Characterised by insight in irrational fear
  • Easy to treat if fear is irrational
  • Usually avoid exposure to feared stimulus
41
Q

Give examples of Anxiety disorders

A
  1. Panic Disorder
    - often comorbid with depression or agoraphobia
  2. Agoraphobia (cant go outside)
  3. GAD
  4. Social Phobia
  5. Animal Phobia
  6. Obsessive compulsive disorder
  7. PTSD
    - these two are no longer included under anxiety
42
Q

What are the biological theories about panic disorder
????????
******

A
  1. Frontal Lobes enhaned in those who do not panic - do these suppress panics?
  2. Serotonin? - because Prozac helps
  3. Fewer GABA receptors - because Benzo’s help

X - But CBT helps, either focus on thoughts or behaviours, whilst relaxation
- shows links between Frontal lobes and GABA can be overuled

43
Q

What are the 2 biological theories about OCD
????????
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A
  1. Dopamine
    - Dopamine involved in Tourettes syndrome - compulsions / tics
    - OCD has similar tics
    - Haldol (dopamine antagonist) helps Tourrettes, but its very strong and not recommended
  2. Structural Problems
    - Damage to Basal Ganglia, Cingulate Gyrus, Frontal lobes
    - Cingulotomy (cut through cingulate gyrus) helps
    - Serotonin inhibits Basal Ganglia/ PFC -> prozac helps
    - CBT can also help!
44
Q

Outline ADHD

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A
  • Inattention/ lack of focus
  • hyperactivity, impulsivity (linked to other disorders)
  • 4-16% of children, more boys
45
Q

Whats the heritability of ADHD

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A

10-35% if you have a first degree relative

46
Q

What are common coexisting disorders for those with ADHD?

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A
  • Oppositional Defiant Disorder
  • Conduct disorder
  • MDD
  • Anxiety disorders
  • OCD
  • Bipolar
  • Learning Disorders
  • Substance abuse disorder
47
Q

Whats a biological theory behind ADHD?

A
  • Dopamine/ D2 deficiency in VTA

- Individual seeks rewards with risks but cannot focus/ organise to get these rewards

48
Q

What drug can help with ADHD

A

Ritalin - A dopamine Agonist - helps

- Helps Reward deficiency, can now concentrate and focus

49
Q

What are the 6 disorder groups that overlap?

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A
  1. Medical/ Somatoform (make yourself ill, think you are ill - hypochondriac), sexual/ eating/ sleep
  2. Anxiety
  3. ADHD/ Autism
  4. Mood Disorder
  5. Schizophrenia
  6. Substance related disorders, Impulse control, Adjustment disorder

Brain & behaviour (11 decks)

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