Neuropsych Flashcards
Dysarthria
Disorder of speech, usually occurring secondary to stroke that causes a loss of control over the muscles of face and mouth. Pts. may drool, speak slowly, slur words, and display limited mouth and jaw movement.
Pure Alexia
A disorder of reading (AKA alexia without agraphia). Can spell and recognize words spelled to them but have great difficulty reading. Caused by damage to the connection between the visual cortex and the angular gyrus
Ataxia
A neurological disorder characterized by clumsy movements and poor coordination of musles.
Apraxia
Inability to move despite the urge and physical fitness necessary to do so. Can be very specific, ex. constructional apraxia, which only involves difficulty with drawing objects or constructing simple models.
Kluver-Bucy Sndrome
Neurological disorder thought to be caused by brain damage due to trauma or herpes encephalitis. Pts behave in sexually inappropriate ways, tend to put objects in mouth. May suffer from visual agnosia.
Ganser Syndrome
Factitious disorder where pts mimic behaviors they believe are characteristic of psychosis. May respond with nonsensical words when asked questions, engage in echolalia and echopraxia (rpting mvmts).
Angular Gyrsu
Located in the parietal lobe, just behind Wernickes area. Located on the margin of the occipital and temporal lobes. SErves to coordinate visual, spatial, and language-related information.
Causes of Gerstmann’s Syndrome
Thought to be due to damage to the left parietal lobe in the area of angular gyrys
Gertsmann’s Syndrome
Finger agnosia, right-left confusion, acalculia or dyscalculia, and agraphia. This is different from motor agraphia (find motor probe; poor muscle tone)
Occipital Lobe Damage
Results in visual-perceptual deficits, such as devpmt of scotomas; in addition visual hallucinations or illusions, (objects abnormally sized or colored), may become unable to read (alexia) or write (agraphia)
Parietal lobe damage
Causes abnormalities in body image and spatial perception; damage to the right parietal lobe can lead to contralateral neglect, construction apraxia, and anosognosia. Damage to the left results in Gertsmann’s Syndrome.
Temporal Lobe damage
Causes auditory disturbances including auditory hallucinations, probs with visual perception, difficulty with language comprehension (Wernicke’s aphasia), and impaired long term memory (anterograde amnesia)
Anterior Cingulate Cortex Damage
ACC allows for communication between cortex and limbic system. Also helps focus attention on tasks. ACC damage associated with inability to detect errors, difficulty resolving contradictory stimuli, emotional instability, poor attention, control, and loss of voluntary movement and speech.
Primary Motor Cortex
Executes movements. Damage here associated w/difficulties w/fine finger movement and a loss of speed and strength in the hands/limbs
Motor Association Cortex
Involved in the planning of movement. Damage here may cause difficulties coordinating the muscle movements required for speech
Broca’s Area
Located in the left inferior frontal cortex and involved in word retrieval. Damage may cause Broca’s aphasia (an inability to retrieve words)
Orbitofrontal Cortex
OFC - Associated with judgment, self-monitoring, and processing emotionally arousing stimuli. Damage here associated with poor or heightened response to threatening stimuli, poor decision making and judgment, and poor risk assessment (also disinhibited bx)
Dorsolateral prefrontal cortex
DLPFC - Associated with short term memory and top-down attentional control. Damage to this region associated with difficulties with concentration/attn., and poor recall of recently learned info
Prefrontal Cortex subdivisions
Dorsolateral prefrontal cortex, orbitofrontal cortex,, Broca’s area, motor association cortex, and primary motor cortex
Damage to prefrontal cortex
Personality changes, and disturbances in planning, initiation, judgment,a nd goal-oriented behavior
Prefrontal cortex responsible for
Involved in executive function, planning, decision-making, attentional control, updating working memory
Caudate nucleus
Located within basal ganglia, may be involved in learning and memory and generating feelings of love; abnormalities in caudate nucleus linked to OCD
Cingulate Gyrus
Locate in the medial brain; receives input from the thalamus, somatosensory cortex, and other cortical areas; helps focus attn on tasks, and relay info between limbic system and higher cortical areas
Precocious puberty
A condition from premature activity of the hypothalamic-pituitary-gonadotropic axis. Leads to early sexual maturation
FSH and LH
In females, LH and FSH stimulate ovarian devpmt. In males, FSH essential for spermatogenesis and LH promotes testosterone synthesis
Gonadotropins
Regulate the gonads and the release of hormones necessary for sexual maturation; FSH and LH
Adrenocortitropin
Produced in stressful situations and stimulate release of hormones by the adrenal gland
Thyrotropin
Thyroid stimulating hormones that modulate metabolism in the thyroid gland
Anterior Pituitary Lobe
Controls the release of various hormones from endocrine organs
Disorders associated with the midbrain
Parkinson’s - Degeneration of dopaminergic neurons in substantia nigra. Drug addiction - pleasurable effects of drug as well as addictive qualities are associated with functions of the VTA.
Reticular formation
Network of neurons that extends from the spinal cord, through the hindbrain and midbrain. Plays a role in the sleep/wake cycle, arousal, attention, pain, and touch.
Ventral Tegmental Area (VTA)
Group of neurons in the base of the midbrain, which are involved in the reward system of the brain
Red Nucleus
Involved in movements such as arm swinging while walking and crawling in babies.
Substantia Nigra
Contains a large number of dopamine-producing neurons, associated with voluntary movement and motor planning
Inferior colliculus
Receives sensory info fromt he ear and relays auditory stimuli
Superior colliculus
Process info related to visual stimuli and is associated with eye movements
Tritanopia
Equally prevalent in males and females; difficulty perceiving short wave lengths (blue and yellow) because retina lacks blue cones; sees reds and greens normally, however sky is green and yellow objects look pink
Deuteranopia
AKA second color deficit; confuse green and red; remainder of color cision normal. More common in males. (Green cones are filled with red spin).
Protanopia
AKA first color deficit; they have good acuity in short wavelengths (blue and yellow) but lose color perception at higher wave lengths; confuse reds and greens as they look yellowish; more common in males
Color agnosia
Condition in which one is unable to associate a color with a particular object; a person with this condition may not know what the color of an elephant is
Color anomia
Inability to name colors one sees. Not a visual problem, but a problem with verbalization and word-finding
Damage to V5
Loss of ability to see movement. Can see still objects, but object will disappear if it begins to move
Damage to both V3 and V4
Complete loss of form perception
Damage to V4
Loss of ability to perceive color, known as cerebral achromatopsia. See the world in shades of gray. Dyschromatopsia refers to partial loss in color perception and is more common
Damage to V3
Partial loss of form perception
Damage to V2
Global disruptions in vision, with impairments in ability to distinguish form, movement, color, and spatial orientation of patterns
Damage to V1
Most serious of visual impairments. Partial blindness in both eyes. Blindsight: a condition in which patients report seeing nothing, but respond to change in visual field, such as movement, due to visual processing still occurring at lower levels.
Homonymous hemianopia
Damage to the optic chasm will affect input from one half of our visual field from both eyes, thereby causing bilateral heminaopia that affects one medial and one lateral input
Heminaopia
Blindness in part fo the visual field caused by damage to either optic nerve. Damage to the medial optic nerve at optic chasm leads to loss of vision in temporal half of both eyes, or bilateral hemianopia.
V5 area
Critical for the detection of form while in motion
V4 area
Function is primarily color processing, although some cells within V4 respond to both form and color
V3 area
Predominantly devoted to form perception
V2 area
Sends visual projections to lower visual areas. Heterogenous with V1 in function, performs some color, form, and mvmt processing and processing spatial info
Primary visual cortex
AKA - V1 and striate cortex. Largest most important visual area. All visual input comes here first then projected to the other occipital areas. responsible for perception of sight.
Vision and occipital lobe
Lateral inputs are projected to the anterior portion of the occipital lobe. Medial inputs are directed to posterior portions of the occipital lobe
Implicit memory
Basal ganglia (caudate nucleus and putamen), globus pallidus, thalamus, substantia nigra, and cerebellum
Explicit memory
Located in the temporal lobe and include: hippocampus, amygdala, temporal cortex. These structures connected through the thalamus to the prefontal cortex
Occipital lobe
Involved with the brain’s ability to recognize objects. Responsible for vision.
Temporal Lobe
Responsible for hearing, memory, meaning, and language. Plays a role in emotion and learning. Concerned with interpreting and processing auditory stimuli.
Parietal lobe
Connected with processing of nerve impulses related to the senses; touch, pain, taste, pressure, and temperature. Also have a language function.
Damage to frontal lobes
Difficulty interpreting feedback from the environment, perseverating on a response, risk taking, and non-compliance with rules, and impaired associated learning (external cues to guide behavior). Change in social behavior.
Left vs. right frontal lobe
Left - controlling language related movement. Right - non-verbal abilities. Not an absolute; both sides influence verbal and non-verbal movement.
Frontal lobes
Emotional control and home to our personality. Involved in motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual behavior. Most common region of injury in mild-mod brain injury.
Medulla oblongata
This structure is the caudal most part of the brain stem, between pons and spinal cord. Responsible for maintaining vital body functions, such as breathing and heart rate.
Pons
Part of met encephalon in hindbrain. Involved in motor control and sensory analysis. Info enters here first. Has parts that are important for levels of consciousness and sleep. Some of pons linked to cerebellum (mvmt and posture)
Cerebral peduncle
Anterior part of midbrain, huge bundles of axons traveling from cerebral cortex through brain stem. These fibers (along with other structures) are important for voluntary motor function.
Midbrain
AKA mesencephalon, rostral part of brain stem. Includes tectum and tegmentum. Involved in vision, hearing, eye mvmt, and body mvmt.
Hippocampus
Portion of cerebral hemispheres in basal medial part of temporal lobe. Important for learning and memory (short term–>long-term) and recalling spatial relationships.
Amygdala
Part of telencephalon, located in temporal lobe; involved in memory, emotion, and fear. Beneath surface of the front, medial part of temporal lobe; causes bulge called the uncus
Hypthalamus
Part of diencephalon, ventral to thalamus. Involved in homeostasis, emotion, thirst, hunger, circadian rhythms, and control of autonomic nervous system. Also controls pituitary.
Thalamus
Deep in the forebrain at the topmost portion of diencephalon. Sensory and motor functions. Almost all sensory info enters it where neurons send info to cortex. All senses except olfaction synapses here. Last relay site before info reaches cerebral cortex.
Components of the brain stem
Midbrain, pons, and medulla
Limbic System
“Emotional brain:. Buried within cerebrum. Contains the thalamus, hypothalamus, amygdala, and hippocampus.
What is the “little brain”
The cerebellum. 2 hemispheres. Associated with regulation and coordination of movement, posture, and balance.
What is the neocortex?
Bulk fo the cerebrum: nerve cells that make up the gray surface of the brain. White nerve cells underneath carry signals between nerve cells and other areas of the brain and body.
Pharmacokinetics
What the body does to the drug
Pharmacodynamics
What the drug does to the body
EEG
Measure brain waved during sleep; monitor anesthesia; contributes to the dx of epilepsy; poor spatial resolution/localization
MEG
Better spatial resolution than EEG; contributes dx of epilepsy; pre-surgical planning
CT
Uses x-rays to generate structural brain image; relatively low resolution; detects large brain tumor
PET
Measures metabolic brain activity; used to study cognitive processes; detects brain legions via the detection of abnormal functional activity
MRI
Higher structural resolution than CT; detection of brain tumors and other brain abnormalities
fMRI
variant of MRI; measures BOLD signal; provides poor temporal resolution relative to EEG measures
Poor performance on Stroop
Associated with frontal lobe lesions, including those locacted in the inferior frontal gyrus and anterior cingulate cortex
Adrenal glands
On top of kidneys; consist of adrenal cortex and adrenal medulla; synthesizes corticosteroids, including cortisol. Testosterone, androgen, and aldosterone secreted by adrenal cortex. Responds to HPA.
Adrenal medulla
Contains chromaffin cellls; synthesizes catecholamine hormones, adrenalin, noradrenalin; involved in fight or flight
HPA Axis
Stress manifested by activation of HPA; System is modulated by corticotropin releasing factor (CRF). CRF released by hypothalamus. CRF travels to anterior pituitary gland where it activated production of adrenal corticotropin hormone
ACTH
Travels thru blood stream to adrenal cortex; stimulates adrenal cortex ro release cortisol
Cortisol
Predominant hormone involved in stress. Hypercortisolemia (chronically inflated cortisol levels) associated with structural and functional brain damage and lower resistance to infections
Pineal gland
regulates the circadian rhythm thru production of melatonin
Pancreas
has both exocrine and endocrine functions
Alpha waves
8-12 Hz; most observable during resting (awake) with eyes closed
Beta waves
13-30 Hz; occur when individual is awake and attentive
Theta
4-7 Hz; occur during transition from wakefulness to sleep
Delta
less than 4 hz; present during stage three sleep during transition from light to deep sleep
Explicit memory
Located in temporal lobe and include: hippocampus, amygdala, and prefrontal cortex
Implicit memory
Basal ganglia (caudate nucleus and putamen), globus padillus, thalamus, substantia nigra, and cerebellum
Alexithymia
Inability to express emotions, despite feeling them; persons with Kluver-Bucy syndrome are unable to feel emotions.
ACC
Invovled with processing cognitive information, emotion regulation,a nd autonomic control
dACC
superior to genu of corpus callosum; plays a role in cognitive function, including; executive function, response selection, negotiating conflict, and autonomic control; sensitive to task difficulty and novelty
rACC
located inferior to genu of corpus callosum; associated with emotional function; implicated in processing emotional information and regulating emotional response
Medial Prefrontal Cortex (mPFCA
Interfaces with both cognitive and emotional systems. Thought to be involved w/distinguishing task-relevant info from task-irrelevant info.
Posterior Cingulate Cortex
pCC has been showns to relate to inhibition processes as well as engagement level during a task. Abnormal activity in subgenual cingulate cortex observed in depressed individuals
Basal Ganglia
Functions to inhibit actions that would interfere with smooth motor output of the intended action. Primary neurotransmitters are GABA and dopamine, but receive noradrenergic and serotenergic inputs as well.
Dysfunction of Basal Ganglia
Parkinson’s, Huntington’s, OCD, Tourette’s, ADHD, and Cerebral Palsey
Reticular Activating System
Involved in regulating states of arousal and activity, and helps maintain circadian rhythm
Prosencephalon
Forebrain; becomes the telencephalon and diencephalon
Mesencephalon
Midbrain
Rhombencephalon
hindbrain; becomes the met encephalon and the myencephalon
Cerebral cortex
Outer most layer of the brain
Left hemisphere of brain
Dominant in most people; location of language functions; associated with analytical and rational thought; calculates, communicates, abstract cognitions, and makes exective decisions; processes info in right visual field; associated w/processing of positive emotions
Right hemisphere of brain
Associated with visual-spatial skills, creativity, nonverbal memory, and intuitive thought; allows us to perceive stimuli as a whole, facilitating out ability to read maps or draw sketches of 3D objects; negative emotions, particularly fear, anger, and pessimism; processes info in left visual field
Implication of lateralization of function after stroke
Depends on hemisphere affeccted; in left hemisphere more likely to affect language than right. In right occipital lobe, may result in disturbances in visual processing of info in left visual field.
Hemispatial neglect
AKA contralateral neglect; individual is unaware of info on one die of his or her body or environment; occurs most commonly after stroke to right parietal lobe (neglect is for left side). Most often associated with visual processing
Anosognosia
Unawareness of one’s neurological symptoms
Corpus callosum
Bundle of axons that connects the hemispheres and allows for communication
Split Brain
the severing of corpus callosum; May be done to attempt to control epilepsy; Pts are only able to verbalize what they see in the right visual field (info in left field sent to right hemisphere where language is processed). If presented to left visual field, pt would not be able to verbalize but could point to what they saw.
Roger Sperry
Pioneer of split brain research. Nobel prize in 1981.
Anterior commisure
bundle of fibers that connects to the limbic systems in both hemispheres. Remains intact in split-brain pts. Allows for communication of rudimentary emotional stimuli (if violent movie presented to left visual field, pt would not be able to verbalize what was seen but may verbalize feeling afraid)
Ipsilateral
On the same side of the body. Smell and hearing are processed ipsilaterally.
Golgi Apparatus
Responsible for processing, sorting, packaging, and delivering proteins, lipids, and other materials manufactured by RER and SER
Mitochondria
Cell’s “powerhouse”; where ATP, the cell’s energy is manufactured. Only cell organelles that can self-replicate - contain their own DNA
Limbic System
AKA paleomammalian brain. Involved in basic mammalian bx and instinct. Related to regulation of fear and aggression; associated with bx related to motivation (hunger, sex); related to formation and storage of memories; AKA emotion center of brain (pleasure and fear)
Limbic System includes:
Amygdala, septum, hypothalamus; hippocampus; thalamus; olfactory cortex
Septum
Along with amygdala, involved in fear and aggression
Lesions of amygdala
Docility in animals
Stimulation of amygdala
Increased rage and predatory bx
Septal lesions in rats
“Septal rage” in which rat becomes extremely aggressive
Removal of amygdala in monkeys
Bilateral temporal lobectomy - mouthing of objects, increased tameness, hypersexuality, visual agnosia
Lesions in limbic system in humans
decrease in motivation, ability to focus on a task, decision making, startle response, and emotional reaction to both aversive and positive emotional stimuli; lack fight-or-flight
Areas in midbrain
Tectum (roof of midbrain); tegmentum (floor), cerebral penduncles (everything except tectum)
Superior colliculus
In midbrain; processes info related to visual stimuli and associated with eye mvmts
Inferior Colliculus
Midbrain; recvs sensory info from ear and relays auditory stimuli
Substantia nigra
Midbrain; contains large number of DA=producing neurons, associated with voluntary mvmt and motor planning
Ventral Tegmental Area
Midbrain; involved with reward system of brain
Diseases associated with midbrain
Parkinsons and drug addiction
Mammilary Bodies
Located in diencephalon and thought to be involved in processing recognition memory. Sometimes categorized as part of hypothalamus
Posterior pituitary lobe
Antidiuretic hormone (ADH, concentrates urine) and oxytocin (uterine and prostate gland contractions)
Lateral geniculate nucleus
Rcvs input from eyes; projects to primary visual cortex
Medial geniculate nucleus
Rcvs info from inner ear
Cerebellum’s role in learning and memory
Contains memory cells that allow for learning new skills thru trial and error.
Characteristics of Huntington’s
Progressive and fatal; caused by mutation of huntingtin gene (4h chromosome); autosomal (non sex-linked) and dominant. Life expectancy 10-25 yrs after onset of sx
Symptoms of huntington’s
Rapid irregular jerky mvmts (known as chorea), “dancing” gait, facial grimacing; dementia, disorientation and confusion, personality changes, memory probs, agitation. Depression and irritability usually first sx seen.
PKU symptoms
Mental retardation, seizures, microcephaly, jerky mvmts in arms and legs, hyperactivity, stunted growth, unusual odor of urine and skin
Von Wildebrand Disease
Most common inherited bleeding disorder; autosomal; dominant
Symptoms of Von Wildebrand
Difficulty clotting after surgery or dental procedure; bruising; bleeding of the gums; frequent nose bleeds; extended bleeding times despite normal platelet counts.
Cerebral Palsey
Non-infectious and non-progressive, includes lifeling impairments in body mvmt and muscular coordination, present in infancy or early childhood
Symptoms of Cerebral Palsey
can be mild to severe; ataxia; muscle stiffness; increased muscle tone (spasticity); awkward gait; in severe cases, may be associtaed with increased drooling, LD, seizures, urinary and bowel probe, and hearing deficits
Treatment for CP
Physical therapy, occupational therapy, assistive devices (braces, walking aids, wheelchairs); medicines (to control seizures when present, decrease muscle tone, and improve constipation)
Four stages of HIV
Acute, asymptomatic, symptomatic, and crisis or late stage
Acute stage of HIV
few weeks after initial infection, flu like symptoms, virus multiplies and infects CD4+T cells
Seroconversion
Dvpmt of antibodies in response to HIV infection
Symptomatic HIV infection
Toward end of chronic phase, individuals become symptomatic and have opportunistic infections
Crisis stage of HIV
Opportunistic infections more sevre. May have ADC (Aids dementia complex); unable to fight simple infections.
Myelogenous Leukemia
Forms in bone marrow cells that are precursors of red blood cells, platelets, and white blood cells
Lymphocytic Leukemia
Forms in bone marrow cells that are designed to mature into lymphocytes
Acute leukemia
fast-growing, aggressive cancers that form blasts
Chronic leukemia
Doesn’t occur in blast cells, threfore is slow-growing and less aggressive.
Four stages to migraine
Prodrone, aura, headache, and resolution
Migraine treatments
Antiemetics (for nausea and vomiting), anti-inflamatory meds/opiates for pain, bx therapy, relaxation therapy, biofeedback
Tension headaches
Most common headaches, feel like tightening of neck and scalp muscles. Exacberated by noise of uncomfortable environments; more common in women, feels like tight band around head.
Cluster headaches
Least common type of headache; felt on one side of head behind eye; more common in men
Multiple Sclerosis
Lesions in brain and spinal cord related to demyelization. Cause unknown. Onset usually in young adults, disproportionally affects women.
Relapse-remitting MS
Most common; relapses followed by months to years of remission w/no new signs of disease activity
Secondary-Progressive MS
(65%), progressive neurological decline between acute attacks without any definite periods of remission
Primary-Progressive MS
(10-15%) Never have remission after initial sx. Progression of disability from onset, with no, or only occasional and minor remissions and improvements
Progressive-Relapsing MS
Steady decline, but also suffer clear imposed attacks. Least common of subtypes.
Simple partial seizure
Focal disruption of brain activity, no loss of consciousness, may have changes in sensory perception, dizziness or tingling, involuntary jerking of body
Complex Partial seizure
Focal disruption in brain, altered level of consciousness adn decreased ability to interact with environment, non-puposeful repetitive mvmts, changed in mood and uncontrollable laughing or fear
Absence seizures
Involves entire brain, staring (w/lack of awareness) and sometimes subtle body mvmts
Myoclonic Seizures
Involved entire brain, jerking or twitching o limbs
Atonic Seizures
Entire brain, associated with loss of muscle tone and results in sudden collapse
Grand Mal (tonic clonic)
Entire brain, loss of consciousness, stiffening, shaking/convulsing of entire body, sometimes loss of bladder control. May be followed by confusion, fatigue, and headache
Vertebrae C1-C7
Cervical/neck and arms
Vertebrae T1-T12
Thoraic/chest and arms
Vertebrae L1-L5
Lumbar/legs
ASIA A
No morot or sensor function preserved in S4-S5
ASIA B
Prserved sensory, but not motor function below injury level and includes S4-S5 (incomplete)
ASIA C
Motor function preserved below level of injury and more than half of key muscles less than grade 3
ASIA D
Motor function preserved blow level of injury and more than half of key muscles are greater than grade 3
ASIA E
Normal neurologica function despite presence of SCI
Hemiplegia
paralysis of one half of the body, most common in victims of stroke
Paresis
weakening in part of body; less severe than overall paralysis
Hemiparesis
half of body is weakened
GCS scores
.13 = mild TBI; 9-12 = moderate TBI, ,8 = severe
Agonist
Medications that enhance synaptic transmission and increase post-synaptic effects
Antagonists
Medications that inhibit synaptic transmission and decrease post-synaptic effects
Competitive Agonists
Increase post-synaptic effects by mimicking the neurotransmitter’s effects
Competitive antagonist
Occupies the binding site and prevents the neurotransmitter from binding, which results in reduced transmission and activity
Noncompetitive agonists and antagonists
Typically do not share structural similarities with neurotransmitter because they bind to different sites; when bound to a receptor site they alter its shape which changes receptor’s affinity for the neurotransmitter
SSRI’s are used for
Serotonergic imbalances, depression, some anxiety disorders, OCD, aggressive behavior, irritable-bowel syndrome, fibromyalgia, and eating disorders (bulimia associated with low serotonin)
Side effects of SSRIs
Dry mouth, vivid dreams, constipation, sexual dysfunction, nausea, drowsiness, dizziness, changes in appetite, weight loss or gain, suicidality, and liver or kidney impairment.
SNRIs used to treat:
Anxiety disorders, ADHD, and nueropathic pain. Side effects similar to SSRIs
Side effects of TCAs
Generally more severe than SSRIs. Dry mouth, blurred vision, constipation, difficulty with urination, and hyperthermia. Other side effects include anxiety, drowsiness (somonlence), confusion, increased appetite, decreased sexual ability, and some cardiovascular effects
Serotonin Syndrome
SSNIs and MAOIs can cause this when taken in combo with SSRIx, tryptophan, illicit substances or some OTC (st. john’s wort). Severe and potentially fatal condition, includes agitation, restlessness, rapid heart rate, dilated pupils, loss of muscle coordination, and cognitive symptoms (hallucination, confusion)
Antipsychotics block which receptors?
D2
Antipsychotic Side Effects
Anticholinergic side effects, adrenergic, histaminergic, EPS, dystonia, akathisia, Tardive Dyskenisia, neuroleptic malignant syndrome
Anticholinergic Side Effects
Dry mouth, difficulty urinating, constipation, blurry vision
Adrenergic Side Effects
Postural hypotension and sexual dysfunction
Histaminergic side effects
INcreased sedation and gradual weight gain
Extrapyramidal side effects
Due to interference with dopamine system; Parkinsonian-like symptoms, body rigidity
Dystonia
Acute; occurs within a few days of treatment onset, involuntary muscle contractions tha lead to postural abnormalities; difficulty swallowing (dysphagia), uncontrollable eye movements; blank stares (oculogyric crisis)
Akathisia
A sense of distress and restlessness; rocking back and forth, shuffling, pacing, or other repetitive movements.
Tardive Dyskinesia
Results from chronic antipsychotic use; sx include involuntary, uncontrollable, restless movements (facial grimaces, tongue protrusions, eye blinking, and limb movements)
Neuroleptic Malignant Syndrome (NMS)
Potentially fatal syndrome; sx include severe muscle rigidity and hyperthermia, diaphoresis, dysphagia, tremor, incontinence, changes in consciouness, mutism, tachycardia, elevated/labile blood pressure, leucytosis, and muscle injury; onset occurs within 4 weeks of beginning neuroleptic meds
Benzos used for:
GABA agonists results in CNS depression. Used for anxiety disorders (especially panic disorder), agitation, seizures, and muscle spasms
Benzo side effects
Sleepiness, confusion, impaired judgment, unsteadiness, and anterograde amnesia. Paradoxical effects such as increased anxiety or suicidality may occur.
What is the primary site of benzo action?
Amygdala
Opiate withdrawal
Dysphoria, anxiety, watering eyes, runny nose, yawning, sweating, restlessness, irritability, tremor, nausea, vomiting, diarrhea, increased blood pressure and heart rate, chills, cramps, and muscle aches. Can last anywhere from a week to 10 days and are usually not lethal.
Prosopagnosia
Difficulty recognizing faces
Auditory agnosia
Difficulty recognizing sounds
Autopagnosia
Difficulty naming body parts
Simultagnosia
Ability to only recognize one object in a visual field at a time
Form Agnosia
Ability to see details, but not the whole
Apperceptive agnosia
Caused by damage to brain regions involved with early processing of stimuli - stimuli not perceived correctly. Ability to identify perceived object intact, but stimuli sent downstream for identification is jumbled.
Associative agnosia
Brain damage to later stage of ID process. Objects perceived correctly, but have difficulty identifying object. (May be able to copy object, but unable to accurately name it).
Paraprosopia
Face is processed normally at first then takes on image of werewolf
Tachycardia
Rapid hart rate of 100+ BPM.
Bradycardia
BPM of less than 60
Sx of Delirium
Sudden change in cognitive functioning, memory impairments, disruption in language, disorientation and confusion to time and place, reduced alertness, increased distractibility, perceptual disturbances such as hallucinations, changes in mood and personality. Usually associated with underlying disease.
Difference between dementia and delirium?
Delirium is reverseable while dementia is not.
Differences between dementia and pseudodementia
Demential is progressive, pseudodementia can improve by treating underlying psychiatric condition. Dementia is gradual, pseudodementia has more sudden onset. Dementia caused by braindegeneration, pseudodementia related to changes in serotenergic and nonadrenergic activity
ACH effect on CNS
Low levels of ACH found in individuals with Alzheimer’s and associated with confusion/memory loss. ACH agonists my facilitate increased attention, concentration, and memory.
ACH effect on PNS
Found in ganglia. Has inhibitory effect on PNS (relaxed muscle tone, decreased heart rate, normal digestion)
How ACH plays a role in Parkinson’s Disease
Associated with increase in ACh levels and decrease in dopamine. Treatments aim to restore balance via DA agonists and ACh agonists.
DA and schizophrenia
Controversial because research has not been conclusive concerning DA’s role.
Anorexia and serotonin
Serotonin plays a role in appetite regulation. Anorexic brain shows a lower serotonin/dopamine ratio
Brain regions associated with anxiety
Amygdala, medial prefrontal cortex, posterior cingulated cortes, HPA-axis, hippocampus and midbrain.
Neurotransmitters and hormones associated with anxiety
Increased noradrenergic function, decreased number of GABA receptors or neuromodulator that blocks these sites, elevated levels of cortisol
Brain abnormalities of ADHD
Right anterior cingulate cortex (focuses attn), right prefrontal cortex (impulse control and decision making), D4 and D5 receptors.
Palilalia
Repeating words that have been generated by self
Neural correlates of autism
Abnormal activity in fusiform gyrus (located in ventral temporal lobe and related to face recognition), abnormal activity in amygdala (subcortical bilateral brain region, related to detecting emotional salience of stimuli)
Catecholamine Hypothesis of Depression
Reduced levels of norepinephrin cause depression and higher levels cause elation
Chronic pain and gate control theory proposed by:
Melzack and Wall in 1965
Best drugs for chronic pain?
SNRIs
Lazarus’ three forms of cognitive appraisal
Primary appraisal - evaluation of the salience of an event.
Secondary appraisal - evaluation of one’s ability to cope
Re-appraisal - monitoring of a situation as necessary and modification of one’s primary and secondary appraisals.
toprimate
Topomax; Mood stabilizer
Tiagabine
Garbitril; mood stabilizer
Methylphenidate
Ritalin and concerta; psychostimulants
Dextroamphetamine
Dexedrine; psychostimulant; ADHD
Fluoxetine
Prozac; SSRI
Paroxetine
Paxil; SSRI
Sertaline
Zoloft; SSRI
Citalopram
Celexa; SSRI
Escitralopram
Lexapro; SSRI
Fluvoxamine
Luvox; SSRI
Venlafaxine
Effexor; SNRI
Duloxetine
Cymbalta; SNRI
Imipramine
Tofranil; TCA
Clomipramine
Anafranil; TCA
Isocarboxazid
Marplan; MAOI
Iproniazad
Iprozid; MAOI
Phenelzine
Nardil; NAOI
Tranylcypromine
Parnate; MAOI
Emsam
Selegiline - new patch; MAOI
Carbamazepine
Tegretol; mood stabilizer and anti-convulsant
Oxcarbazepine
Trileptal; Mood-stabiliaer and anti-convulsant
Divalproex
Depakote; mood-stabilizer
Lorazepan
Ativan; Benzo
Buspirone
BuSpar; anti-anxiety
Gabapentin
Neuronitn; anti-anxiety
propanolol
Inderol; beta-blocker/anti-anxiety
Short-acting benzos
Ativan and Xanax
Long acting benzos
Valium and Klonopin
Flurazepam
Dalmane; hypnotic
Quazepam
Doral; hypnotic
Temazepan
Restoril; hypnotic
Zolpidem
Ambien; hypnotic
Zaleplan
Sonata; hypntoic
Eszoplclone
Lunesta; hypnotic
Benadryl
antihistamine and hypnotic
OTC and Herbals
St. John’s Wort - Depression and anxiety
SAM-e - Depression
Omega-3 - Depression and bipolar
Thiothixene
Nauane; High potency anti-psychotic
Opiates
Morphine, oxycodone, methadone
Anti-obsessionals
Mostly SSRIs and the TCA Anafrenil (clomipramine)
Eskalith and Lithonate
Lithium carbonate; mood-stabilizer and anti-convulsant
Trifluoperazine
Stelazine; high potency anti-psychotic
Loxitane
Loxapine; high potency anti-psychotic
Haloperidol
Haldol; neuroloeptic; typical antipsychotic; high potency
Thorazine
Chlopromazine; nueroleptic; typical antipsychotic; low potency
Quietapine
Seroquil; low potency antipsychotic
Clozaril
Clozapine; low potency antipsychotic
Thioridazine
Mellaril; low potency antipsychotic
Benzo (names)
Xanax, Valium, Ativan, Klonopin, Restoril (used for anxiety)
Diazepam
Valium; Benzo
Chlordiazepoxide
Librium; benzo
Clonazepam
Klonopin; benzo
Risperidone
Risperdal; high potency anti-psychotic
Fluphenazine
Prolixin; high potency anti-psychotic
D- and I-amphetamin
Adderall; psychostimulant
Arrpiprazole
Abilify; high potency anti-psychotic
Olanzapine
Zyprexa; high potency anti-psychotic
Symbiax
Syntesis of Olanzapine and Fluoxetine; mood stabilizer and anti-convulsant
Lamotrigine
Lamictal; mood-stabilizer
