Neuro Flashcards
What is classical conditioning and operant conditioning
1) conditioned response is paired with specific stimuli
2) positive or negative reinforcement (praising good behaviour, removing something unpleasant)
Difference between fear and anxiety
1) abnormal worry to a perceived threat. Anticipation of something in the future. Urge to avoid, sense of dread
2) sense of danger. Urge to escape. Refers to here and now
-Body sensation: high HR, hot, trembling, fast breath, tense, nausea, dry mouth
-Thoughts: want to escape, something bad will happen, why am I like this
-Feelings: scared, overwhelmed, nervous
Symptoms of Alzeimer’s and when is best to treat them
-Cerebral atrophy: Reduced, Social function, intellect, speech, memory and concentration
-Dental treatment often best first thing in morning
What is Korsakoff’s psychosis. What deficiency is it
Memory deficits, confusion, and behavioral changes
-associated with chronic alcoholism
-B1/thiamine deficiency
Medical and dental complications of bulimia nervosa
[binge-eating then self-induced vomiting or exercise. Fear of becoming fat]
-Russel’s sign - calluses on the back of their fingers and traumatic lesions on their palate as a result of self induced vomiting
-Dehydration/weight fluctuations
-Low potassium and muscle cramps
-Acidosis/alkalosis
-Oesophagitis
-Poor muscular tone in the colon from laxative abuse
-Dental erosion
-Parotid enlargement
-Caution during GA due to low BMI
Positive and negative symptoms of schizophrenia
-Psychosis=Delusion, hallucination, disorganised thoughts, lack of insight
Positive
-Hallucinations: imagined inner voices. See things others don’t
-Extreme disordered thinking
-False beliefs
-Delusions, bizarre thoughts
-Unable to concentrate
Negative
-social withdrawal
-lack of drive
-low mood
-apathy
-lack of cognitive function
Cognitive deficits = disturbances of memory, attention, executive function
Specific dental aspects of schizophrenia
-Delusional beliefs (aliens controlling me through silver fillings)
-Hallucinations may be somatic/pain
-Poor general health and hygiene
-Drug, alcohol and smoking
-Medication effects – haloperidol and clozapine cause hyposalivation
-Struggle following OHI
Drug mechanisms for antipsychotics (1st and 2nd generation)
-Psychosis= increased dopamine in the mesocortical/ mesolimbic pathway (involved in mood, reward, addiction).
-1st=D2 receptor antagonists will inhibit the other pathways causing side effects of increased prolactin and tremors. Also affinity for H1, M1, a1 (sedation, dry mouth, postural hypotension etc.)
-2nd= fewer side effects as dissociate faster from the D2 receptor, and they are better at treating negative symptoms (blunted emotions, loss of energy, social withdrawal). And no affinity for H1, M1, a1
What are affective disorders. Give examples
-marked disruptions in emotions (severe lows or highs)
-depression, dysthymia, bipolar disorder, generalised anxiety, Seasonal Affective Disorder
Difference in symptoms for panic attack and myocardial infarction
-Panic= chest pain in sharp, stabbing, localised in middle chest. Occurs due to extreme stress. Usually lasts shorter. Symptoms get better over time
-MI= squeezing or pressure pain, can radiate to arm, occurs due to physical exertionor at rest, lasts longer with worsening symptoms
What is OCD and its symptoms
-repeated unwanted thoughts of sensations/ urge to do something over again
eg. Checking switches, fear of contamination, lining things up, intrusive thoughts
-Obsessions (intrusive thoughts, impulses)
-Compulsions (rituals) Eg. repetitive brushing causing bleeding/lesions/wear. Nail biting causing TMD
Explain generalised anxiety disorder, depression and bipolar disorder
1) >6 months of anxiety not confined to a specific situation affecting daily life
2) Persistent low mood and loss of interest for >2 weeks. eg. reduced motivation for OH
3) alternating high moods (mania) and low moods (depression)
What is hypochondriasis
-excessive worry about having or developing a serious undiagnosed medical condition
eg. transient dry mouth is proof of oral cancer
Somatization disorder
significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning
-concerned they have serious disease (eg. headache as sign of brain cancer)
What is psychogenic pain. List some syndrome in dentistry
pain with no pathology
evidence of psychological cause (anxiety, depression).
-Atypical facial pain (may be misdiagnosed as trigeminal neuralgia)
-Atypical odontalgia (continuous toothache with no cause)
-Oral dysethesia (recurring burning of oral mucosa)
TMJ dysfunction syndrome
-disturbance of balance of musculoskeletal system where there Is abnormalities in relationship between teeth and muscles
-lack of coordination
-due to muscle hypoxia and/or articular degeneration
-aggrevated by stress, psychological factors, environmental, genetic
Differences and similarities between TMD dysfunction syndrome and trigeminal neuralgia
-Similarities=pain due to activity of facial or masticatory muscles, reduction of patient’s quality of life, radiating pain
-TN= mainly unilateral, acute, stabbing, remission at night, short lasting with long periods of remission
-TMD= bilateral, dull continuous, may still present at night, long-lasting with short intermissions, worse in the morning
Signs and symptoms of syncope (faint)
-due to fear, being too hot, lack of food
-Before loss of consiousness: vessel dilation, drop in BP, dizziness, pale tachycardia >100bpm, unresponsive, light head, sweaty
-After faint: reflex bradycardia <60bpm
What are the 2 origins of a faint. Management of syncope
1) Vaso-vagal origin: autoregulation of BP, a drop in cerebral perfusion causing transient loss of consciousness
2) Carotid sinus- due to pressure put on carotid sinus (turning head, tight collar)
Get them to lie down and raise legs. Glucose drink
Generalised epilepsy affect both sides of brain. Difference between 1) Grand Mal and 2) Peitit Mal epilepsy
=Sudden uncontrolled burst of electrical activity in brain
1) Motor seizures. Tonic clonic seizure. Aura, then loss of consiousness then convulsion (jerky) Incontinence, hypersalivation
2) Absence (non-motor) seizure. Lose awareness of surroundings for a few seconds. Rapid blinking or staring into space. Mainly affects children
What is focal type epilepsy. The different types
Seizure in 1 location of your brain- partial seizures. 4 types:
1. Focal aware – aware of what’s happening
2. Focal impaired awareness – confused, remember some of it
3. Focal motor – twitch, spasm, unconscious movements
4. Focal non-motor – raised HR, goosebumps, heightened emotions
How to manage someone having a seizure
-start timer. During the first 5 mins make sure pt comfortable, remove any danger, reassure patient, do not restrain them
-If >5 mins= status epileptics. Emergency. 10mg buccal midazolam. Repeat if no response after 10 mins.
Mechanism of action for anticonvulsant medications. Give examples of names of drugs
-they inhibit rapid repetitive neurones firing to treat convulsions in epilepsy, can also treat neuralgia and neuropathic pain
-Inhibit ionic channels (Na, Ca)
-enhance GABA (increasing Cl)
-inhibiting glutamate
-Phenytoin, carbamazepine, gabapentin, Benozdiazepine
Oral side effects of 1) phenytoin and 2) carbamezapine
(anticonvulsants)
1) Gingival overgrowth, Root shortening &/or resorption, Hypercementosis, Salivary gland hypertrophy
2) Xerostomia, Glossitis, Oral ulceration, stephen johnson syndrome, liver disorders (so FBC checked every 6 weeks)
Both: Cervical lymphadenopathy, Cleft–lip and palate – avoid in pregnant women unless absolutely necessary
History taking for someone with epilepsy
-Ask what medication they are on, if their medication works
-what triggers a fit (bright lights, hunger, stress, little sleep, alcohol, excitement)
-timing of their last 3 seizures
-If meds recently changed- their previous meds likely didn’t control their symptoms so may want to defer treatment until been on their new meds for a couple months
Febrile convulsions
-epileptic type symptoms, but not epilepsy
-Common in infancy but grow out of them. Brought on by very high temperature secondary to infections
-Treated by bringing down temperature- paracetamol, fans
What is multiple sclerosis. Symptoms.
-autoimmune condition where body attacks brain and spinal cord causing demyelination of nerves
-fatigue, vision problems, numbness, tingling, muscle spasms/stiffness/weakness/atrophy, mobility problems, pain, problems with thinking/learning/planning. Difficulty controlling bladder, coordination/balance issues
What is Parkinson’s. What part of the brain is affected and what abnormal proteins accumulate there. Symptoms
-degeneration and loss of nerve cells in substantia nigra due to Lewy bodies and neurtites, due to ageing, head injury or cerebrovascular disease
-reduced dopamine, which results in increased Ach
-Nigrostriatal pathway affected
-Involuntary shaking (pill-rolling tremor common), rigidity on movement, bradykinesia (slow), restless, expressionless face, stooped posture, fatigue cognitive decline, postural hypotension, hypersalivation
What is parkonsonism
-umbarella term for a group of disorders with symptoms of slow movement, tremor at rest, involuntary movement, stiff, fatigue, drooling, postural instability
-causes: Parkinson’s disease (neurological disorder), toxins, drugs, brain injury, infection
Effects of dopamine. What are the 3 pathways
-Tyrosine enters presynapse and converted to DOPA then DA and then released.
1- Nigrostriatal pathway: controls fine movements. Reduced DA (in Parkinson’s) causes tremors, muscle rigidity and loss of facial expression
2-Mesocortical/ mesolimbic pathway: controls mood and reward so increased DA here causes psychosis
3-Tuberonifundibular: DA also acts as a hormone when released form hypothalamus and acts on ant pituitary. Inhibits prolactin
Dopaminergic medications used in Parkinson’s disease - Different types and their actions. Side effects
Increase dopamine
- Precursor of DA
eg. Levodopa - COMT inhibitors- decrease DA metabolism (entacapone, opicapone)
- Dopamine agonists
- Dopamine release stimulators
Dry mouth (=taste disturbance, stomatitis, ulcers) headache, dyskineasias (involuntary movements)
What is the issue with Levodopa for treating Parkisnon’s
-becomes less effective over time
-Motor fluctuations and dyskinesia develop in the majority of people who take levodopa long term. So only used short term
-causes BMS
