Pathology

Question 1

Panic Attacks

Answer 1

Amygdala highly activated

Question 2

Schizophrenia

Answer 2

Increased DA (positive symptoms) & decreased DA (negative symptoms)

Question 3

Panic Disorder

Answer 3

Deficit in coordination of information to amygdala, misinterpretation of sensory information, heightened activation of fear response

Question 4

Alzheimer’s, PTSD

Answer 4

Hippocampus - integrates info by forming new declarative memories

Question 5

OCD, Schizophrenia, BD

Answer 5

Cingulate - cognitive, pain response, motor response to emotion, visuospatial

Question 6

Anxiety, Sleep d/o’s

Answer 6

Hypothalamus - homeostasis (circadian, appetite, temperature), neuroendocrine

Question 7

Addiction

Answer 7

Nucleus accumbens - reward pathways (DA + GLU)
- part of the striatum that mediates the reward pathway in the brain

Also decreased activity in OFC & cingulate gyrus (loss of inhibitoyr control over reward pathways)

Question 8

OCD

Answer 8

Lateral Orbitofrontal (“Alexander”) Loop

OFC –> caudate –> globus pallidus / substantia nigra –> thalamus –> OFC –> …

Obsessions: PFC/OFC

Compulsions: striatum

Anterior cingulate cortex: way-station b/n cortex & striatum

Question 9

PTSD

Answer 9

Trauma is “etched” into amygadala via long-term potentiation or interactions w/ hippocampus

HPA Axis

Chronic stress is neurotoxic

Glucocorticoid receptors appear to be more responsive to negative feedback

Question 10

BD

Answer 10

Suprachiasmatic Nucleus (masterclock of the circadian system)

Question 11

Alcohol Addiction

Answer 11

Naltrexone
Disulfiram
Acamprosate

Question 12

Opiate Use Disorder

Answer 12

Opiate agonists (methadone, buprenorphine)

Question 13

Smoking

Answer 13

Bupropion

Question 14

Substance Use Disorders

Answer 14

Alcohol
- Naltrexone
- Disulfiram
- Acamprosate
Opiate
- Methadone
- Buprenorphine
MI
CBT
Relapse Prevention
Contingency management (incentives reward patient for positive outcomes)
Self-help groups (AA, NA)
Family involvement

Question 15

SCZ

Answer 15

Enlarged lateral ventricles
Reduced whole brain volume
Decreased cortical gray matter in frontal & temporal lobes
Smaller volume of excitatory pyramidal neurons
Reduced synapse density
Increased neuronal packing density
Alterations in synaptic pruning
Too much or too little DA
Too much 5HT

Question 16

Suicide

Answer 16

Low 5-HIAA in CSF
high 5HT transporter gene promotor 5-HTTLPR
Low 5HT levels in pts w/ depression, impulsive disorders, & history of suicide attempts

Question 17

Delirium

Answer 17

Decrease Ach function

Increase DA activity

Question 18

Panic Disorder

Answer 18

Prefrontal cortex is underactive & unable to regulate the hyperactive amygdala

Also involves HPA axis, ANS, etc.

Question 19

GAD

Answer 19

Not amygdala

Question 20

Violence

Answer 20

Increase NE, DA, & limbic structures

Decrease 5HT, ACh, & prefrontal structures

Question 21

Temperament

Answer 21

Limbic structures

Striatum

Question 22

Character

Answer 22

Neocortex (frontal)

Hippocampus