Psychopathology Flashcards
affects 1% of people
schizophrenia
- dissociative thinking
- impaired logical thought
key symptom of schizophrenia
abnormal behaviors that are gained
positive symptoms of schizophrenia
result from lost functions
negative symptoms of schizophrenia
- hallucinations
- delusions
- excited motor behavior
- usually acute
- more likely to respond to antipsychotic medications
postive symptoms
- slow thought and speech
- emotional and social withdrawal
- blunted affect or emotional expression
negative symptoms
- disorganized thoughts
- difficulty concentrating and following instructions
cognitive symptoms of schizophrenia
is partly heritable
schizophrenia
- environmental exposures combine with your genetic vulnerability
- occurs if a threshold is exceeded
schizophrenia causes
__________ __________ upregulate and downregulate gene function
Environmental factors
people with the same genome can have different outcomes
characteristic of epigenetics
some brain defects in schizophrenia apparently stem from environmental exposure during _________
pregnancy
pyramidal neurons in hippocampus are ________ in schizophrenia
disorganized
accelerated loss of _____ _____ in teens with schizophrenia
gray matter
under activity of temporal and frontal lobes
‘hypofrontality’ schizophrenia
accelerated aging and neuron loss
loss of gray matter and less metabolic activity in frontal and temporal lobes
schizophrenia results from _______ synaptic _________ or increased postsynaptic sensitivity to it
excess, dopamine
are DA antagonists
Neuroleptics
use produces a schizophrenia-like syndrome
chronic amphetamine
of Parkinson may produce psychosis
L-dopa treatment
treatment of schizophrenia with _______ _____ can produce Parkinson symptoms
anti dopamine drugs
are higher in schizophrenics
D2 levels in auditory thalamus
all current antipsychotic drugs modulate function of the
dopamine D2 receptor
- schizophrenics have normal DA metabolite levels
- drugs block DA receptors much faster than symptoms are reduced
- positive symptoms respond better to DA blocking drugs
- some patients don’t improve on anti dopamine drugs
Problems with the dopamine (DA) hypothesis
- Risperidone, Abilify
- block serotonin (5HT2) receptors and D2 receptors
- some increase dopamine in frontal cortex
Atypical neuroleptic drugs
schizophrenia is due to ________ of glutamate receptors
under activation
- is an NMDA receptor antagonist
- prevents glutamate from acting normally
PCP
If NMDA receptor under activation is ________, symptoms of acute schizophrenia emerge
prolonged
decrease glutamate repute by down regulating glutamate transporter gene (increasing synaptic glutamate levels)
atypical antipsychotics
overactivity of endocannabinoids
schizophrenia
act on CB1 receptors
Endocannabinoids (EC)
is inhibitory modulator of other neurotransmitters
CB1 receptor
are elevated in CSF of schizophrenics
EC levels
show increased CB1 receptor binding
Post-mortem brains
can precipitate psychosis and schizophrenia in at-risk patients
THC in cannabis
can worsen symptoms and prognosis in diagnosed schizophrenia patients
THC
the most common mood disorder
Depression
- sad mood
- feeling worthless or guilty
- fatigue/ lack of energy
- loss of interest or pleasure in activities
- problems concentrating and thinking
- increased or decreased appetite & weight
- changes in pattern of sleep
- suicidal thoughts or plans
Depression
- normal reaction to life events
- mood described as ‘blue’
- few other symptoms
- short duration (hours/days)
- little if any impairment in functioning
‘Normal’ depression
- mood described as ‘black’
- many symptoms
- long duration (weeks/months)
- significant impairment in functioning (can be debilitating)
Clinical depression
of emotional orbitofrontal cortex and amygdala (brain activity patterns in depression)
Increased activity (blood flow)
of areas involving attention and language (brain activity patterns in depression)
Decreased activity (blood flow)
depression is due to ________ synaptic activity of _______ and _______
reduced, norepinephrine, serotonin
depression is due reduced synaptic activity of norepinephrine serotonin
monoamine hypothesis
inactivates monoamines
MAO
- reduces monoamines
- can cause depression
Reserpine
treatment with MAO inhibitors raises level of monoamines at synapse, and ________ __________
improves depression
inhibiting reuptake of 5-HT, or binding to presynaptic, or inhibiting monoamine oxidase
How all antidepressants work via
5HT or NE autoreceptors, thus enhancing neurotransmitter release
binding to presynaptic
thereby reducing neurotransmitter breakdown
inhibiting monoamine oxidase
overactive serotonin autoreceptors impair serotonin release
Depression
autoreceptor activation decreases ____ release
5HT
depressed patients have overactive _______
autoreceptors
autoreceptor function & number ______ over weeks of SSRI use, increasing neuronal firing and serotonin release
declines
a ____ _____ _____ between treatment onset and reduction of symptoms
long lag time
antidepressants have roughly ____ response in primary care setting
60%
is an imbalance of the immune system, stress system, and gut microbiota
depression
drug-induced seizures alleviated depression
Early finding
ECT
Electroconvulsive shock therapy
ECT raises _______ levels
monoamine
ECT increases ______ of postsynaptic serotonin receptors
sensitivity
sensitivity of presynaptic autoreceptors is _______, which ______ norepinephrine & dopamine release
reduced, increases
suicidal ideation that requires immediate alleviation
ECT now used in severe depression
short-term remission rate of ECT is _____
87%
long-term remission rate of ECT is _____
43%
produces effects similar to traditional ECT
Fast TMS (transcranial magnetic stimulation)
of the anterior cingulate gyrus & median forebrain bundle also produces immediate effects
deep brain stimulation
gradually relieves depression
stimulation of the vagus nerve
- SSRI
- SNRI
- TCA (tricyclics)
- MAO inhibitors
Antidepressants (equal efficiency)
glutamate and ketamine
stress and depression
- is due to impaired serotonin release
- due to autoreceptor over-expression
Depression
ketamine causes upsurge in __________
glutamate
- causes upsurge in glutamate
- restoring synaptic function
- likely replace ECT for treatment of severe acute depression
ketamine
______ is disturbed in depression
sleep
_____ _____-_____ sleep is reduced, fragmented
deep slow-wave
patients enter ____ sleep quickly, with ______ REM sleep in first half of night
REM, increased
individuals alternate (cycle) between depression and mania
bipolar disorder
- delusions
- hallucinations
- paranoia
- bizarre behavior
- similar to schizophrenia
Bipolar psychotic symptoms
- excess energy
- confidence
- grandiose thinking
- little need to sleep
- hypersexual drive
- drug abuse
Mania symptoms
one gene affected in bipolar disorder is _____
clock
______ is regular in some and unpredictable in others
cycling
_____ ______ varies from days to months
cycle length
activity varies with mood state
ventral prefrontal cortex (box)
is up to 40% smaller in people who are depressed
ventromedial cortex
neuron number is normal, but ____ ____ are much reduced
glial cells
activity increases in _______ _______ ______ at start of manic period, so it may be a ‘bipolar switch’
subgenual prefrontal cortex
a mild form of bipolar disorder
cyclothymia
mild depression
dysthymia
increased energy
hypomania
intense irrational fears centered on an object, activity, or situation
phobic disorders
recurrent attacks of intense fearfulness
panic disorder
persistent, excessive worry
generalized anxiety disorder
recurrent uncontrollable (irrational) thoughts (germs)
obsessions
- uncontrollable need to perform certain acts over and over (hand-washing, counting rituals, checking doors)
- peak onset is 25 to 44 years of age
compulsions
an ______ is a recurring thought: an annoying tune or wishing harm to another person
obsession
a ______ individual is compelled to do repetitive behaviors
compulsive
antidepressants help by, reducing _____ _______ sensitivity
serotonin autorectopr
______ and ______ blockers help other patients
antipsychotics, glutamate
_______ activate DLPFC more than normal during stroop test
OCD
OCD patients have _______ _______ in orbital frontal cortex and caudate nuclei (basal ganglia)
increased activity
surgery to _______ orbitofrontal cortex from anterior cingulate cortex produces long-lasting improvement
disconnect
supported by efficacy of SSRIs
serotonin
- MRN
- DRN
Raphe is site of 2 major nuclei
- limbic/ prefrontal cortex
- mediates fear/anxiety
MRN
- prefrontal cortex
- basal ganglia
- thalamus
- PAG
- modulates cognitive/ behavioral components
DRN
_____ also treats anxiety
Benzodiazepines
bind to GABA receptors to enhance _____ _____ actions
GABA inhibitory
_____ ________ therapy works best for specific phobia
behavioral desensitization
_______-________ with alcohol is common
self-medication
_______ ______ is related to OCD
Tourette’s syndrome
a disorder of motor and phonic tics and behavioral/ cognitive deficits
Tourette’s syndrome
activation of ______ ______ during tics
basal ganglia
- Walter freeman
- done to people with all sorts of psychiatric disorders
- remission of symptoms in many patients but personality is severely affected
- now rarely performed
Frontal lobotomy