Neuropsychiatric Disorders Flashcards
What is schizophrenia?
A chronic mental health disorder with a biological basis in the brain. No specific cause has been identified, but a combination of genetic and environmental factors are thought to contribute. Symptoms tend to appear in early adulthood.
What are the three categories of symptoms in schizophrenia?
Positive, negative, and disorganized.
- Positive symptoms: things that are there but shouldn’t be (hallucinations)
- Negative symptoms: things that should be there but are not (lack of motivation, social withdrawal)
- Disorganized symptoms: things that are odd or bizarre
Positive symptoms are the most easily identified. Negative symptoms are harder to identify and are associated with high morbidity and disturb the patients emotions and behaviour
Schizophrenia gender differences
- Men experience it in late teens early 20s
- Women experience it in 20s early 30s
- Females vs Males: estrogen fights off the disorder better
What are the five symptoms of schizophrenia listed in the DSM-5
- Delusions: Beliefs that distort reality.
- Hallucinations: Altered perceptions for which there are no appropriate external stimuli (e.g., hearing voices).
- Disorganized Speech: Incoherent statements or senseless speech that are jumbled and do not make sense.
- Disorganized or excessively agitated behavior: Behavior is not focused on a goal and can be childlike silliness or unpredictable agitation.
- Other symptoms that cause social or occupational dysfunction: Reduced or lack of ability to function normally.
What are some cognitive problems associated with schizophrenia?
Deficits in working memory, episodic memory, language, executive functions, attention, and sensory processing. These deficits are related to abnormalities in the prefrontal cortex, parietal, and temporal regions, as well as in neurotransmitters (dopamine, GABA) and brain circuitry. Cognitive symptoms can be present from the early stages of the illness and are relatively stable over time. They impair educational and vocational performance.
Schizophrenia is not progressive: symptoms may come and go, but it is a constant disorder
What are some brain abnormalities observed in schizophrenia?
● Lower overall brain weight (smaller brains).
● Smaller prefrontal cortex.
● Larger ventricles.
● Disorganized neurons in the hippocampus.
● Less activation in the prefrontal cortex when completing tasks.
What are some neurotransmitter abnormalities associated with schizophrenia?
Imbalances in dopamine, serotonin, and glutamate.
● Abnormal dopamine is associated with four pathways in schizophrenia:
○ Mesocortical Pathway: Low dopamine levels are associated with negative symptoms and cognitive problems.
○ Nigrostriatal Pathway: Low dopamine levels are associated with motor symptoms.
○ Mesolimbic Pathway: Increased dopamine levels are associated with positive symptoms.
○ Tuberoinfundibular Pathway: Low dopamine levels are associated with other symptoms.
● Serotonin imbalance is related to altered perception, aggression, motor behavior, and mood.
● Imbalance in glutamate receptors contributes to cognitive deficits, and both positive and negative symptoms.
● Other neurotransmitters like GABA have also been implicated in schizophrenia.
What are mood disorders?
A category of mental disorders characterized by significant disturbances in a person’s emotional state or mood. They are broken up into depressive or bipolar disorders.
What are some examples of depressive disorders?
Major depressive disorder
What are some examples of bipolar disorders?
Bipolar I and II
What is Major Depressive Disorder?
A mood disorder characterized by a persistent feeling of sadness and loss of interest. It may be caused by a chemical imbalance in the brain, with contributing factors including biological, genetic, environmental, and psychosocial factors. It affects how we feel, think, and behave and can lead to both emotional and physical problems.
What are the symptoms of Major Depressive Disorder?
Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks, with at least five of the following nine symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day:
1. Depressed mood most of the day.
2. Diminished interest or pleasure in all or most activities.
3. Significant unintentional weight loss or gain.
4. Insomnia or hypersomnia.
5. Agitation or psychomotor retardation noticed by others.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive guilt.
8. Diminished ability to think or concentrate, or indecisiveness.
9. Recurrent thoughts of death.
What are some brain abnormalities observed in Major Depressive Disorder (MDD)?
● The more persistent the MDD, the greater the impact on brain volume.
● Volumetric reductions in the hippocampus, basal ganglia, amygdala, orbitofrontal cortex, and prefrontal cortex.
● Reduced connectivity in many areas, including the prefrontal cortex.
● Overactivity in the amygdala, associated with heightened sensitivity to negative emotional stimuli.
**It is possible for people with depression to have underactivity in the amygdala associated to positive stimuli
What are some neurotransmitter abnormalities associated with Major Depressive Disorder?
● Hypothalamus-pituitary axis hyperactivity is a core feature of MDD, leading to volume reductions in areas with high glucocorticoid receptors.
● Over secretion of hydrocortisone (cortisol).
- Stress activates the production of ACTH which triggers the release of cortisol.
- Cortisol keeps producing and binding to receptors without shutting down which then affects our day-to-day function
● Low levels of serotonin, norepinephrine, and dopamine
What is Bipolar Disorder?
A group of mood disorders caused by brain changes that can be chronic or episodic. The exact cause is unknown, but is thought to be related to environmental, genetic, and biological factors.
What are the characteristics of Bipolar I Disorder?
Characterized by at least one manic episode that is followed or preceded by a hypomanic or depressive episode. Symptoms typically last a week or two, but can be longer. Manic episodes are characterized by a period of elevated, expansive, or irritable mood, along with increased energy or activity. Depressive episodes include five or more symptoms of Major Depressive Disorder.
What are some symptoms of a manic episode in Bipolar I Disorder?
At least one manic episode preceded by and may be followed by hypomanic or major depressive episodes. The manic episode will include three or more of the following symptoms (or four if mood is only irritable):
1. Increased self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli).
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
What are some brain abnormalities observed in Bipolar Disorder?
● A relationship between the number of episodes and the amount of gray matter loss.
● Reductions in gray matter and cortical thickness in the anterior cingulate cortex, orbitofrontal cortex, nucleus accumbens, and hippocampus.
● Loss of synapses in the anterior cingulate cortex, dorsolateral prefrontal cortex, and amygdala.
What are some neurotransmitter abnormalities associated with Bipolar Disorder?
● Irregularities in dopamine, serotonin, and norepinephrine.
● Low serotonin and norepinephrine levels contribute to depressive episodes.
● High norepinephrine and dopamine levels contribute to manic episodes.
● Glutamate and GABA dysfunction may also play a role in mood instability and cognitive symptoms
What are some cognitive symptoms associated with mood disorders?
● Increased cognitive dysfunction is often associated with greater symptom severity.
● Changes in thinking processes, perception, memory, and concentration.
● Most common changes observed are impaired performance in tests of attention, executive function, memory, and decision-making.
