Mental illness Flashcards
What are the two major assumptions underlying Freud’s theory of psychoanalysis? According to Freud, when does mental illness occur, and what causes it?
- Much of mental life is unconscious.
- Past experiences, especially in childhood, shape a person’s feelings and responses throughout life.
-Mental illness occurs when the unconscious and conscious elements of the psyche come into conflict. It is caused by unresolved conflicts related to hidden secrets of the unconscious, often tied to childhood incidents.
What is the key assumption of B. F. Skinner’s theory of personality?
The assumption that many behaviors are learned responses to the environment. –> behaviourism
What does behaviorism focus on in contrast to other theories of personality? According to behaviorism, what factors influence the probability of a type of behavior increasing or decreasing? How does behaviorism view mental disorders?
-Behaviorism focuses on observable behaviors and their control by the environment, rejecting notions of underlying conflicts and the unconscious.
-The probability of behavior increases when it satisfies a craving or produces a pleasurable sensation (positive reinforcement), and it decreases when the consequences are deemed unpleasant or unsatisfactory (negative reinforcement).
-Behaviorism views mental disorders as maladaptive behaviors that are learned
What does treatment for mental disorders in behaviorism involve?
Treatment consists of active attempts to “unlearn” through behavior modification, either by introducing new types of behavioral reinforcement or by providing an opportunity to observe and recognize appropriate behavioral responses.
What is psychotherapy, and how does it relate to treating mental illness? What was one of the shortcomings of psychotherapy, according to Freud?
-Psychotherapy is the use of verbal communication to help the patient, and it plays a role in treating mental illness by addressing variations in behavior and early childhood experiences. However, it is not suitable for all mental disorders.
-Freud recognized the shortcomings of psychotherapy and stated that these deficiencies could be resolved by replacing psychological terms with physiological or chemical ones.
What were the initial symptoms of general paresis of the insane? What was the ultimate cause of general paresis of the insane, and how was it traced? how is general paresis treated? What antibiotic was found to be highly effective in treating brain infections caused by Treponema pallidum?
-Symptoms included mania, excitement, euphoria, and grandiose delusions
-It was caused by brain infection with Treponema pallidum, the microorganism that causes syphilis. Its cause was traced through research.
-the drug arsphenamine could effectively treat general paresis of the insane
-penicillin
Describe the path from gene discovery to treatment development in the context of psychiatric diseases.
Discovering gene mutations in individuals with psychiatric diseases, reproducing these mutations in genetically engineered mice, and studying the differences in brain function can lead to insights into pathophysiology and potential drug targets. If successful, these drugs can be used for treatment.
What are the unique challenges in diagnosing and treating brain diseases?
- Mental disorders are diagnosed based on signs and symptoms, not underlying causes. 2. The same diagnosis may have many causes, complicating treatment approaches. 3. Not all mental illnesses have a clear genetic basis, and some result from multiple small mutations in various genes. 4. Genetic complexity makes it difficult to develop broadly useful animal models.
How does the complexity of genetic causes affect mental illnesses?
Mental illnesses can result from the inheritance of numerous small mutations in many different genes or from gene copy number variants, where duplication or deletion of a gene or gene segment can be the single cause of a diagnosis. This genetic complexity hinders the development of animal models for research.
What is a radical new approach for studying brain diseases in molecular medicine in psychiatry for studying pathophysiology of neurons
A radical approach involves studying the pathophysiology of neurons from individual patients. Skin cells can be transformed into induced pluripotent stem cells (iPSCs), which can then be differentiated into neurons for study. However, the complexity of the brain, with its various cell types and rich interconnections, presents a challenge in understanding the pathophysiology of brain diseases.
What is fear, and how is it expressed in the body? Are all fears innate and species-specific? Why is fear considered adaptive, and what is its adaptive value? What happens when fear is expressed inappropriately, and what does this characterize?
-Fear is an adaptive response to threatening situations, and it is expressed in the body through the autonomic fight-or-flight response, which is mediated by the sympathetic division of the autonomic nervous system (ANS).
-No, not all fears are innate and species-specific. While many fears are innate (such as a mouse’s fear of a cat), fear can also be learned through experiences.
-Fear is considered adaptive because it helps individuals respond to threats appropriately. Its adaptive value lies in ensuring survival and safety in dangerous situations.
-When fear is expressed inappropriately, it characterizes anxiety disorders, which are the most common of psychiatric disorders.
What are panic attacks, and how do they manifest? How long do panic attacks typically last?
-Panic attacks are sudden episodes of intense terror that occur without warning. They manifest with symptoms such as palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, tingling sensations, and chills or blushing. People often report an overwhelming fear of dying or going crazy during a panic attack.
-Panic attacks are usually short-lived, lasting less than 30 minutes.
Can panic attacks be triggered by specific stimuli?
Yes, panic attacks can occur in response to specific stimuli, but they can also happen spontaneously.
What is panic disorder, and how is it characterized? What percentage of the population suffers from panic disorder, and is there a gender difference in its prevalence? When is the onset of panic disorder most common? What are some common comorbidities associated with panic disorder?
-Panic disorder is characterized by recurring, seemingly unprovoked panic attacks and persistent worry about having further attacks.
-About 2% of the population suffers from panic disorder, which is twice as common in women as in men.
-The onset of panic disorder is most common after adolescence but before the age of 50 years.
-Half of the individuals with panic disorder will also suffer from major depression, and 25% of them will develop alcoholism or substance-abuse problems. and may lead to agoraphobia
What is agoraphobia, and what are some of its characteristics?
Agoraphobia is characterized by severe anxiety in situations where escape might be difficult or embarrassing, leading to avoidance of situations such as being alone outside the home, in crowds, cars, airplanes, or on bridges or elevators. It often occurs as an adverse outcome of panic disorder and affects about 5% of the population, with a higher incidence among women than men.
What is the long-lasting consequence of trauma, and what are its symptoms? What percentage of the adult population in the United States is affected by PTSD?
-The long-lasting consequence of trauma can be post-traumatic stress disorder (PTSD), which includes symptoms such as increased anxiety, intrusive memories, dreams or flashbacks of traumatic experiences, irritability, and emotional numbness.
-PTSD affects 3.5% of the adult population in the United States.
What are obsessions in obsessive-compulsive disorder (OCD), and how are they characterized? What are compulsions in OCD, and why are they performed? What percentage of the population is affected by OCD, and when does it usually appear?
-Obsessions in OCD are recurrent, intrusive thoughts, images, ideas, or impulses that the individual perceives as inappropriate, grotesque, or forbidden.
-Compulsions in OCD are repetitive behaviors or mental acts performed to reduce the anxiety associated with obsessions. Examples include repeated hand-washing, counting, and checking.
-OCD affects over 2% of the population, with an equal incidence among men and women. It typically appears in young adulthood, and symptoms can fluctuate in response to stress levels.
What is the stress response? How does a healthy person regulate the stress response?
-The stress response is the coordinated reaction to threatening stimuli, characterized by avoidance behavior, increased vigilance and arousal, activation of the sympathetic division of the ANS (autonomic nervous system), and the release of cortisol from the adrenal glands.
-A healthy person regulates the stress response through learning, which allows them to appropriately respond to threatening stimuli.
What is the hallmark of anxiety disorders?
The hallmark of anxiety disorders is the occurrence of an inappropriate stress response, either when a stressor is not present or when it is not immediately threatening.
What part of the brain is centrally involved in orchestrating the stress response?
the hypothalamus is centrally involved in orchestrating appropriate humoral, visceromotor, and somatic motor responses related to the stress response.
What is the role of the hypothalamic-pituitary-adrenal (HPA) axis in the stress response?
The HPA axis plays a significant role in regulating the humoral response of the stress response, involving the hypothalamus, pituitary gland, and adrenal glands in releasing cortisol to respond to stress.
What is the hormonal response to stress, specifically involving cortisol (glucocorticoid)?
-Cortisol is released from the adrenal cortex in response to an elevation in the blood level of adrenocorticotropic hormone (ACTH), which is released by the anterior pituitary gland in response to corticotropin-releasing hormone (CRH). CRH is released into the blood by parvocellular neurosecretory neurons in the paraventricular nucleus of the hypothalamus
-The hippocampus contains numerous glucocorticoid receptors that respond to the cortisol released from the adrenal gland in response to HPA system activation
-Overexpression of CRH in genetically engineered mice leads to increased anxiety-like behaviors, while genetically eliminating CRH receptors in mice results in reduced anxiety-like behavior compared to normal mice.
What brain structures regulate the HPA axis and the stress response? What is the role of the amygdala in the stress response?
-The amygdala and the hippocampus regulate the HPA axis and the stress response.
-The amygdala processes sensory information related to fear and activates the stress response when the central nucleus of the amygdala becomes active.
How does the bed nucleus of the stria terminalis contribute to the stress response?
The bed nucleus neurons activate the HPA axis and the stress response downstream from the amygdala.
How does the hippocampus regulate the HPA axis?
Hippocampal activation suppresses CRH release, participating in the feedback regulation of the HPA axis by inhibiting CRH release when cortisol levels are high. hippocampus deactivates the HPA axis
What can continuous exposure to cortisol, as seen in chronic stress, lead to?
Continuous exposure to cortisol can cause hippocampal neurons to degenerate, potentially setting off a vicious cycle of increased stress response and more hippocampal damage.
What has been observed in the hippocampus of some people with PTSD?
Human brain imaging studies have shown a decrease in the volume of the hippocampus in some people suffering from PTSD.
How do the amygdala and hippocampus receive information from the neocortex- related to anxiety?
Both the amygdala and hippocampus receive highly processed information from the neocortex, and elevated activity of the prefrontal cortex is a consistent finding in humans with anxiety disorders.
How do the amygdala and hippocampus regulate the HPA axis and the stress response?
The amygdala and hippocampus regulate the HPA axis and the stress response in a push-pull fashion, with the amygdala promoting stress responses, and the hippocampus inhibiting excessive stress responses.
What are the available treatments for anxiety disorders?
Psychotherapy and anxiolytic medications are available treatments for anxiety disorders.
How does psychotherapy typically treat anxiety disorders?
Psychotherapy involves gradually increasing exposure to anxiety-inducing stimuli while reinforcing the idea that these stimuli are not dangerous. It aims to alter brain connections so that stress responses are reduced.
What are anxiolytic medications, and how do they work?
Anxiolytic medications are drugs that reduce anxiety. They work by altering chemical synaptic transmission in the brain. Two major classes of these drugs are benzodiazepines and serotonin-selective reuptake inhibitors.
How do benzodiazepines affect GABA receptors?
Benzodiazepines bind to specific sites on GABA receptors, making GABA more effective in opening chloride channels and producing inhibition in the brain.
What is the role of GABA in the brain, and why is its proper function important?
GABA is a crucial inhibitory neurotransmitter in the brain. Its proper function is essential for maintaining brain stability. Too much inhibition can lead to coma, while too little can result in seizures.
What is the site on GABAA receptors that benzodiazepines bind to, and what effect does this binding have?
Benzodiazepines bind to a specific site on GABAA receptors, enhancing the effectiveness of GABA in opening chloride channels and facilitating inhibition in the brain.
What are benzodiazepines, and why are they commonly used?
Benzodiazepines, including Valium (diazepam), are highly effective treatments for acute anxiety. They are often used to reduce anxiety symptoms.
How does alcohol relate to anxiety and benzodiazepines?
Ethanol, the active ingredient in alcoholic beverages, has anxiolytic effects, which can explain the social use of alcohol to reduce anxiety. However, it’s also a reason for the co-occurrence of anxiety disorders and alcohol abuse.
Why might benzodiazepine treatment be necessary for some individuals with anxiety disorders?
The calming actions of benzodiazepines may result from suppressing activity in brain circuits associated with the stress response. In some cases, benzodiazepine treatment might be needed to restore normal function to these circuits.
What did a study using positron emission tomography (PET) imaging reveal about benzodiazepine binding sites in patients with panic disorder?
PET imaging showed a reduction in benzodiazepine binding sites in regions of the frontal cortex that exhibit hyperactive responsiveness during anxiety. This suggests that alterations in GABA receptor regulation could be a cause of anxiety disorders.
What are SSRIs, and how are they used in the treatment of mood disorders? How do SSRIs work in the brain to affect serotonin levels? Apart from mood disorders, what other psychiatric condition can SSRIs effectively treat?
-SSRIs are serotonin-selective reuptake inhibitors, and they are commonly used to treat mood disorders such as depression.
-SSRIs inhibit the reuptake of serotonin in the brain, which prolongs the actions of serotonin at its receptors.
-SSRIs are highly effective in treating obsessive-compulsive disorder (OCD) and have been found to be beneficial in other psychiatric disorders.
How do SSRIs differ from benzodiazepines in terms of the onset of their anxiolytic (anxiety-reducing) effects?
Unlike benzodiazepines, the anxiolytic effects of SSRIs are not immediate and develop slowly over several weeks of regular dosing.
What is one proposed mechanism for the anxiolytic effect of SSRIs related to the hippocampus?
One adaptive response to SSRIs is an increase in glucocorticoid receptors in the hippocampus, which may dampen anxiety by enhancing the feedback regulation of CRH neurons in the hypothalamus.
What novel drug targets are being explored for the treatment of anxiety disorders?
Researchers are exploring CRH receptors as potential drug targets for the treatment of anxiety disorders, as CRH plays a role in the central circuits involved in the stress response and anxiety.
What is the most common mood disorder?
Major depression is the most common mood disorder, affecting 6% of the population every year.
What are the cardinal symptoms of major depression?
The cardinal symptoms of major depression are lowered mood and decreased interest or pleasure in all activities.
How long must the cardinal symptoms of major depression be present for a diagnosis? What are some other symptoms of major depression?
-For a diagnosis of major depression, the cardinal symptoms must be present every day for a period of at least 2 weeks and not be obviously related to bereavement.
-Other symptoms of major depression include loss of appetite (or increased appetite), insomnia (or hypersomnia), fatigue, feelings of worthlessness and guilt, a diminished ability to concentrate, and recurrent thoughts of death.
How long do episodes of major depression usually last?
Episodes of major depression usually don’t last longer than 2 years, although the disease has a chronic, unremitting course in about 17% of patients.
What is dysthymia, and how does it differ from major depression?
Dysthymia is another expression of depression, afflicting 2% of the adult population. It is milder than major depression but has a chronic, “smoldering” course, and it seldom disappears spontaneously.
Is there a gender difference in the prevalence of major depression and dysthymia?
Yes, major depression and dysthymia are twice as common in women as in men.
What is bipolar disorder?
Bipolar disorder is a recurrent mood disorder characterized by episodes of mania or mixed episodes of mania and depression, also known as manic-depressive disorder.
What is mania in the context of bipolar disorder?
Mania is a distinct period of abnormally elevated, expansive, or irritable mood experienced during bipolar disorder.
What are some common symptoms of mania?
Common symptoms of mania include inflated self-esteem, decreased need for sleep, increased talkativeness, flight of ideas, distractibility, and increased goal-directed activity.
How can mania affect judgment in individuals with bipolar disorder?
Mania can lead to impaired judgment, resulting in behaviors like spending sprees, promiscuity, or reckless actions.
