Psychopathology Flashcards
What does psychiatry use to diagnose patients
Solely behavior
What % of the population fit the criteria of a psychological disorder
almost 50% (46.4% to be exact)
Positive symptoms of schizophrenia
Symptoms not present in neurotypicals
Give an example of positive symptoms
- Hallucinations
- Delusions
- Disorganized thoughts and speech
- Bizarre behaviors
Negative symptoms
Characteristics that should be present but are absent
Give an example of a negative symptom of schizophrenia
- Flat affect
- Anhedonia
- Lack of emotional expression
- Reduced conversation
- Social withdrawal
Give an example of cognitive symptoms of schizophrenia
- Memory problems
- Poor attention span
- Difficulty making plans
- Reduced decision making capacity
- Abnormal movement patterns
How do people with schizophrenia have differing eye movements
- Difficulty smoothly tracking a moving object
- “Jagged” eye movements when looking at something stationary
What is the degree of heritability of schizophrenia
The more related you are to a person with schizophrenia, the more likely you are to develop schizophrenia yourself
What role do DISC proteins play in schizophrenia
If you a have a certain version of the DISC protein/gene, you are more likely to develop schizophrenia
Explain the interaction between environmental stress and gene influence on schizophrenia
The fewer genes you have that favor schizophrenia, the more environmental stress you can take before you develop schizophrenia.
The more genes you have that favor schizophrenia, it takes less stress to develop schizophrenia.
What change occurs in the ventricles when affected with schizophrenia
Ventricles become enlarged
What change occurs in the hippocampus in people with schizophrenia
The pyramidal cells in the hippocampus are disorganized, which lead to a disrupted circuitry
What change occurs in grey matter in adolescents with schizophrenia
Adolescents have an accelerated loss of gray matter
Hypofrontality in schizophrenia
When presented with a card sorting task (which uses the frontal lobe), people with schizophrenia exhibit less activity than they should
Dopamine hypothesis of schizophrenia
People with schizophrenia have an excess of dopamine release or dopamine receptors
Correlation between antipsychotic dose and its affinity for D2 receptors
The more affinity an antipsychotic has for D2 receptors, the lower dose you need
What effect does PCP have on NMDA receptors
It’s a non competitive antagonist. When PCP is bound, no other ligand can activate the NMDA receptor
Psychomimetic
A drug that induces a state resembling schizophrenia, such as PCP
What is observed when amphetamines are taken for a long time
When taken in high doses for a long time, positive symptoms like the ones seen in schizophrenia are exhibited
What causes the emergence of positive symptoms when taking amphetamines
Vesicles containing dopamine leak, increasing the concentration of dopamine leading to positive symptoms
How do major tranquilizers such as Haloperidol affect schizophrenia symptoms
They decrease positive symptoms by antagonizing dopamine receptors
What side effects do dopamine antagonists cause
Tardive dyskinesia (involuntary facial tics) and Parkinsons.
Too low dopamine levels lead to tremors seen in these disorders.
What is the glutamate hypothesis of schizophrenia
Schizophrenia results from an underactivation of glutamate receptors, which may be what causes hypofrontality
Explain the side effects of antipsychotics
- People not on drugs went longer without a relapse
- People never on antipsychotics worked more than people always prescribed antipsychotics
Second-generation antipsychotics
Antipsychotics that act on other receptors as well as dopamine receptors
Name 2 symptoms of depression
- Feelings of sadness, tearfulness, emptiness or hopelessness
- Angry outbursts, irritability or frustration, even over small matters
- Loss of interest or pleasure in most or all normal activities, such as sex, hobbies
or sports - Sleep disturbances, including insomnia or sleeping too much
- Tiredness and lack of energy, so even small tasks take extra effort
- Reduced appetite and weight loss or increased cravings for food and weight gain
- Anxiety, agitation or restlessness
- Slowed thinking, speaking or body movements
- Feelings of worthlessness or guilt, fixating on past failures or self-blame
- Trouble thinking, concentrating, making decisions and remembering things
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or
suicide - Unexplained physical problems, such as back pain or headaches
What is the cognitive cycle of depression
Negative thoughts -> Low mood (feeling worthless and discouraged) -> reduced behavior
What changes occur in nREM sleep in people with depression
- They have difficulty falling asleep and staying asleep
- Reduction in SWS
- Increase in Stage 1 and 2 sleep
What changes occur in REM sleep in people with depression
- Enter REM sleep after sleep onset much earlier
- ## Have unusually vigorous REM sleep
Depriving depressed people of _______ sleep is an effective treatment
REM
Functional polymorphisms in depression
Depression is associated with DNA sequence variations linked to the metabolism or synthesis of serotonin and dopamine
Where is hyperactivity seen in people with depression
The amygdala and prefrontal cortex
Monoamine oxidase (MAO) inhibitors
Inhibit the breakdown of serotonin, norepinephrine, and dopamine
- Marplan, Nardil, Parnate
Tricyclics and heterocyclics
Inhibits the reuptake of serotonin, norepinephrine, and dopamine
- Wellbutrin, Elavil, Norpramin
Selective serotonin reuptake inhibitors (SSRIs)
Block the reuptake of only serotonin
- Prozac, Paxil, Zoloft
Relationship between cortisol and depression
People with high levels of cortisol often have depression
Hypothalamic-pituitary-adrenal axis
The anterior pituitary causes the adrenal gland to release cortisol, which is sensed by the hypothalamus
Dexamethasone
A potent synthetic glucocorticoid that suppresses the early morning rise of adrenocorticotropic hormone (ACTH, a cortisol)
Dexamethasone suppression test
Dexamethasone given late at night fools the hypothalamus into believing there’s a high level of circulating cortisol. In people with depression, dexamethasone fails to suppress cortisol release the next day
What changes in brain activity occur during a manic episode
More brain activity is seen
What structural changes are seen in the brain in bipolar disorder
Enlarged ventricles, and probable changes in subcortical limbic structures
What gene affects the probability of developing bipolar disorder
BDNF, which deals with regulation of synapse connectivity
Cyclothymia
Cycling of mania and depression
How does mania manifest in Type 2 bipolar disorder
Hypomania with a less impaired manic phase is seen
What jobs do people with schizophrenia or bipolar disorder usually have?
They are more likely to work in a creative field
Name 2 symptoms of generalized anxiety disorder
- Restlessness or feeling wound-up or on edge
- Being easily fatigued
- Difficulty concentrating or having their minds go blank
- Irritability
- Muscle tension
- Difficulty controlling the worry
- Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)
What is panic disorder?
Recurrent, unexpected panics which are sudden periods of intense fear
Name one symptom of panic disorder
- Sudden and repeated attacks of intense fear
- Feelings of being out of control during a panic attack
- Intense worries about when the next attack will happen
- Fear or avoidance of places where panic attacks have occurred in the past
Name 2 symptoms of social anxiety disorder
- Feeling highly anxious about being with other people and having a hard time talking to them
- Feeling very self-conscious in front of other people and worried about feeling humiliated,
embarrassed, or rejected, or fearful of offending others - Being very afraid that other people will judge them
- Worrying for days or weeks before an event where other people will be
- Staying away from places where there are other people
- Having a hard time making friends and keeping friends
- Blushing, sweating, or trembling around other people
- Feeling nauseous or sick to your stomach when other people are around
What effect does the projection to the periaqueductal gray from the amygdala have on stress response
Avoidance behavior
What effect does the diffusion from the amygdala have on stress response
Increased vigilance
Explain the push-pull regulation of the HPA by the amygdala and hippocampus
- Activation of the amygdala increase HPA activity which increases cortisol
- Increase in cortisol activates the hippocampus which decreases HPA activity
What effect does chronic stress have on the HPA axis?
Chronic stress damages hippocampal neurons, which dampens the ability of the hippocampus to decrease cortisol output via the HPA
How do benzodiazepines work?
They bind to GABAa receptors as agonists to upregulate inhibitory neurotransmitter systems
What is the distribution of benzos in the brain?
The effect of benzos happen in a wide distribution all over the cortex
What is obsessive-compulsive disorder?
Recurring, repetitive acts carried out without reason while recognizing the behaviors are abnormal
What areas of the brain do OCD patients have increased metabolic rates?
Orbitofrontal cortex, cingulate cortex, and caudate (disinhibition of these areas)
What role does the caudate play in OCD
The caudate which deals with motor and cognitive habits is disinhibited, which could be a reason for repetitive acts
What drug does OCD respond to and what does this show?
OCD responds to SSRIs in most cases, which suggests a serotonin dysfunction plays a role
Overactivity in what circuit might underlie OCD?
Prefrontal cortex to striatum to thalamus
Name 2 obsessive symptoms of OCD
- Dirt, germs, or environmental toxins
- Something terrible happening
- Symmetry, order, or exactness
- Religious obsession
- Body waste or secretions
-Lucky or unlucky numbers - Fear of harming self or others
Name 2 compulsive symptoms of OCD
- Performing excessive or ritualized cleaning routines
- Repeating rituals
- Checking things
- Engaging in miscellaneous rituals
- Removing contaminants from contacts
- Touching
- Counting
What can be lesioned as an intervention for OCD?
A lesion of the cingulum
Name 2 motor tics of Tourette’s
- Eyes, face, head
- Shoulder, neck
- Arms, hands
- Trunk
- Legs
Name 2 vocal tics of Tourette’s
- Low noises
- Loud noises
- Stuttering
- Obscenities
- Syllables
- Words out of context
- Repeating others
Name 2 compulsive actions of Tourettes’s
- Head banging
- Kissing
- Touching objects
- Kicking
- Tapping
- Touching self or others
- Biting self
- Touching sexual organs
- Mimicking others
What structural change can be seen in people affected with Tourette’s?
D2 receptors in the caudate are denser, which may be due to differences in the dopaminergic system
What drug can be used to treat Tourette’s?
Haloperidol, a dopamine antagonist
What is posttraumatic stress disorder?
When memories of a traumatic (whether acute or chronic) event repeatedly plague a person, and can be easily reactivated by stressful circumstances
What structural change is seen in people with PTSD?
Decreased volume in the right hippocampus
How does the brainstem sensitize people with PTSD?
Norepinephrine, dopamine, endogenous opioids, and corticotropin releases hormones are released as a result of the original trauma, and subsequent stressors lead to a sensitization
What role does the amygdala play in in PTSD?
Sensory and cognitive associations to the original trauma lead to fear conditioning and a lack of an extinction response.
