Psychopathology

Question 1

Schizophrenia

Answer 1

> Generally thought to be a disease of the brain, much to be understood

> Considered a: chronic condition (cannot be cured)
> But can be managed

> Schizophrenia amounts to half of all admissions to psychiatric hospitals

> Often manifests in late adolescence/ early adulthood

> Requires clinical management after manifestation

> 1 in 200 people affected in any given time

Question 2

Symptoms and features of schizophrenia (diagnosis)

Answer 2

• Hallucinations
• Delusions
• Disorganized speech
  (one of these must be present for diagnosis)
  > Grossly disorganized/ Catatonic behaviour
  > Negative symptoms (absence of normal behaviour)

Diagnosis based on observable behaviour and psychological features. At least 2 of the above symptoms must be present for at least one month in duration.

Question 3

Positive vs. Negative Symptoms

Answer 3

Positive: something is being added, excess or distortion of normal behaviour, presence of symptoms that aren’t normally there

Negative: something is being removed, absence of normal behaviour.
»> apathy, flattened affect, failures of volition or self-directed behaviour
»> associated with a poorer prognosis, less easily treated

Question 4

Psychopathology

Answer 4

“Mental illness”

• Schizophrenia
• Depression
• Anxiety disorders
• Substance use disorders

Question 5

Schizophrenia and ventricles

Answer 5

• Enlargement of the lateral and third ventricles is a well-noted piece of evidence for schizophrenia
• Larger ventricles reflect brain atrophy
• Brain atrophy can continue up to 20 years after diagnosis

Question 6

Approaches in studying schizophrenia

Answer 6

Two main cognitive neuroscience approaches:
1. Comparing cognitive deficits in schizophrenia to deficits in patients with known brain damage
2. Using neuroimaging and brain functioning measurements to identify areas of difference between schizophrenics and control groups

Both demonstrate involvement of the frontal and temporal lobes

Question 7

Frontal lobe disruption

Answer 7

Affected:
> Working memory
> Self monitoring
> Attention
> Cognitive control
> Behavioural flexibility
___________
Working memory
E.g. Activity is abnormal in the dorsolateral prefrontal cortex when manipulating held information, the ventrolateral prefrontal cortex is underactive during the encoding phase of working memory
Self-monitoring
E.g. Abnormalities in structure and function of medial regions of the frontal lobe including ACC, Abnormal ERN responses to errors
Attention
E.g. Deficient smooth-pursuit eye-movements, fail to activate the frontal eye fields as much as controls
Cognitive control
E.g. frontal lobe mechanisms involved in inhibiting behavior are disrupted
Behavioral flexibility
E.g. impaired on tests of planning and tests of mental flexibility

Question 8

Hypofrontality

Answer 8

Frontal hypoactivation is evident in schizophrenia when the person is resting and when engaged in tasks that normally activate the frontal lobe

Question 9

Temporal lobe disruption

Answer 9

Reduced volume of grey matter in the left and right middle temporal gyrus, left posterior superior temporal gyrus, and left angular gyrus

Sensory gating effect for auditory stimuli is absent or substantially reduced

Abnormalities in semantic priming (linked to temporal lobe processing):
»»> ERP component sensitive to the degree of semantic relatedness between items (reduced when the target word is semantically related to the prime) do not differentiate as well between concepts that are highly related versus unrelated.

Question 10

Genetic link to schizophrenia

Answer 10

Risk depends on relation to someone with the disorder

Linked to schizophrenia
»> Genes relate to synaptic pruning during development, immune function, dopaminergic transmission or glutamate function, and more

Question 11

Treatment of Schizophrenia

Answer 11

Most common form: antipsychotic drugs that affect the dopamine symptoms of the brain (especially D2 dopamine receptor)
» Effective in reducing positive symptoms
> relatively ineffective at reducing negative symptoms
> can have unwanted side effects

Question 12

Depression

Answer 12

• One of the most common mental illnesses
  » 1 in 10 adults withing any 12-month period
  » Twice as common in women than in men
• Timing in relation to life stressors
  » First episode is often tied to a severe life stress, subsequent episodes may appear to be decoupled from discrete life stressors

Question 13

Symptoms of Depression

Answer 13

In general, depression is a mood disorder characterized by:
> Chronic feelings of sadness and hopelessness
> Loss of interest or pleasure in once pleasurable activities
Other common symptoms include:
> Change in appetite and/or sleeping patterns
> Low energy
> Low self-esteem
> Poor concentration and difficulty making decisions
> Suicidal thoughts

Question 14

Subtypes and variations of depression

Answer 14

Major Depression

Dysthymia

Seasonal Depression

Bipolar Disorder

Question 15

Cognitive characteristics of Depression

Answer 15

Memory and attention are biased toward negative events and interpretations (creating a self-perpetuating cycle)
Poor performance on standard tasks of executive functions
Trouble shifting mental sets (reduced activity in the DLPFC and dorsal anterior cingulate cortex)
Inability to respond adaptively to performance errors or negative feedback (disruption in functional connectivity between cingulate and DLPFC regions)
Poor performance on spatial tasks that depend on the right hemisphere

Question 16

Subcortical regions in depression

Answer 16

Overactive amygdala, especially in response to negative information

Subcortical reward pathways are underactive
> Apathy, lack of motivation, anhedonia
> Related to dopaminergic motor symptoms, such as the basal ganglia, may also be implicated in psychomotor slowing

Hippocampus affected by elevated stress hormones
» Smaller and less active in depression

Question 17

Disruptions during emotional regulation in depression

Answer 17

Highly interconnected with other regions involved in emotion

May be especially related to the somatic and vegetative symptoms of depression

Shows increased activity in depressed compared to non-depressed people

Activity decreases when therapeutic interventions (e.g., antidepressant drugs or electroconvulsive therapy) are effective

Question 18

Therapeutic interventions

Answer 18

Both cognitive therapy and antidepressant medication are relatively effective for many people.
> Cognitive therapy: client works to identify and alter self-defeating and pessimistic thoughts
> Antidepressant Drug treatment: affects the monoamines (serotonin, norepinephrine, or dopamine)
»> Antidepressants reduce the amygdala’s response to negative information, while increasing PFC’s responses

Question 19

Novel treatments for depression:

Answer 19

A. Repetitive transcranial magnetic stimulation, magnetic coil of DLPFC alters activity of the brain below the coil

B. Deep brain stimulation: subgenual anterior cingulate cortex is stimulated by electrodes withing the brain (invasive process)

C. Vagus nerve stimulation: device places in the chest cavity stimulate the vagus nerve as it enters the brain

Question 20

Anxiety Disorders

Answer 20

• 5-20% of the population affected at any given time
  > Anxiety disorders more common among women
  > Depression and anxiety are often comorbid
  > Many types of anxiety disorders

Question 21

Diagnostic categories of anxiety disorders

Answer 21

Phobias
Panic disorders
PTSD (technically a separate category)
GAD
OCD

Differ in the object, cause, and manifestation of the fear

Question 22

Phobias

Answer 22

Fears centred on specific objects and/ or situations
-> Irrational, interferes with normal function

Panic disorder
-> Repeated panic attacks
-> Sensations of extreme bodily hyperarousal, dizziness, shortness of breath, elevated heart rate, and a sense of losing control

Question 23

PTSD

Answer 23

Clear origin of a deeply traumatic experience such as combat, assault, torture, a natural disorder, or other life-altering experience

Symptoms include vivid and intrusive recollections of the traumatic situation, avoidance of the situations related to that group, chronically elevated bodily arousal, feelings of survival guilt and suicidal thoughts

Question 24

GAD

Answer 24

Generalized Anxiety Disorder

Free-floating and chronic experience of anxiety, not tied to specific triggering event or object

Question 25

OCD

Answer 25

Obsessive thoughts Engages in repeated, compulsive actions intended to ward off a negative outcome

Question 26

Anxiety and Attention

Answer 26

Individuals with anxiety have exaggerated attentional bias to threatening information in the world **Emotional Stroop task**: > Identify the ink colour of the words > Anxious people slower naming in colour of emotionally threatening words because attention automatically captured by the word's meaning **Dot Probe Task** > Indivate the presence of a dot flashed on the screen > Anxious people respond faster when dot appear in a location where a threatening word appeared, indicating attention shifted to the threatening word

Question 27

Anxiety and the amygdala

Answer 27

Functions relevant to anxiety > Curcial for the acquisition of learned fears > Provokes the body's fight-or-flight response to stimuli > Directs attention to emotionally salient or urgent stimuli Activity in the amygdala increases when anxious people are confronted with fear-inducing triggers and in times of uncertainty

Question 28

Anxiety and the frontal lobe

Answer 28

Emotional Regulation: regions exert top-down control over subcortical emotion structures (like the amygdala) Fear extinction: reduced activation of the vmPFC in anxious people leads to difficulty remembering that feared situations are actually safe Self-monitoring: overactive ACC reflects increased emotional salience of actions

Question 29

Cingulotomy

Answer 29

Controversial therapy for Anxiety

Question 30

Verbalization and Worry

Answer 30

> Anxious apprehension (worry) is typically a verbal process, implicating the left frontal region (which generates speech) > Appears inconsistent with approach-withdrawal model of frontal lobe asymmetry (left frontal involvement in approach emotions) > fMRI data resolve this inconsistency: >>>> A region in left inferior frontal gyrus is more activated in worriers. >>>> A left dorsolateral frontal region is more active for positive vs. negative words, consistent with approach-withdrawal model.

Question 31

Posterior Regions and Anxious Arousal

Answer 31

Anxious arousal associated with right-hemi systems governing attentional vigilance and autonomic arousal Experiences of heightened panic activate the posterior right hemi

Question 32

Action Systems in OCD

Answer 32

> Circuits that initiate and inhibit actions may be disrupted in obsessive-compulsive disorder (OCD). > Disruptions in control loops that link orbitofrontal cortex with the basal ganglia > Basal ganglia appear to have increased activity > Orbitofrontal cortex also shows abnormalities > Imbalance between systems supporting habitual action (basal ganglia), and those supporting goal-directed action (frontal)

Question 33

Substance Abuse and Addiction

Answer 33

In any 12-month period, 5-10% of Americans grappling with substance use disorders Defining feature of abuse: unable to control drug-seeking behaviour even when consequences are severe, desire for drug outweighs consequence Two main brain systems have been related to drug abuse: > Dopaminergic reward pathways > orbitofrontal cortex

Question 34

Addiction and Reward Pathways

Answer 34

Most drugs of abuse appear to activate the reward pathways that stretch from the midbrain to the nucleus accumbens in the basal forebrain Long-term changes in neurons within the reward system in response to the ongoing attention of the drugs

Question 35

Addiction and Orbitofrontal cortex

Answer 35

OFC is important in generating expectancies about the outcomes of behaviour which guide decision making Research shows that OFC region is dysfunctional in addicts Substance-dependent individuals perform poorly on gambling tasks that involve learning consequences of choices

Question 36

Addiction changes in the brain

Answer 36

Changes in dendritic spine density following chronic exposure to amphetamines Insula, amygdala, ACC, DLPFC also implicated > reinforced major cognitive neuroscience theme: >>>> Pathology may be best understood as disrupted relationships among interacting brain areas, rather than simple under-activations or over-activations in certain areas

Question 37

Psychopathy

Answer 37

**Not an official diagnosis** > ASPD > Shallow emotional responses, lack of emptathy, disregard for others, impulsivity, increased likelihood for antisocial behaviour (behaviour which conflicts with social norms) > ASPD more common in men than women

Question 38

Diagnosis of Psychopathy

Answer 38

**In order to receive a diagnosis of ASPD, a person must show a pattern of disregard for and violation of the rights of others. This is indicated by three or more of the following criteria, according to the DSM-5:** failure to conform to social norms concerning lawful behaviours, such as performing acts that are grounds for arrest deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit impulsivity or failure to plan irritability and aggressiveness, often with physical fights or assaults reckless disregard for the safety of self or others consistent irresponsibility, failure to sustain consistent work behaviour, or honour monetary obligations lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person

Question 39

Psychopathy and brain dysfunction

Answer 39

Dysfunction in both amygdala and prefrontal cortex regions including orbitofrontal cortex (OFC) Studies have shown reduced brain volume in these areas Reasons for this dysfunction remain unknown Some genetic contribution: research estimates that between 38 and 69 percent of cases may be hereditary Environmental contribution: triggers may include childhood neglect, abuse, and/or other adverse experiences Psychopathy is notoriously resistant to treatment, therapeutic intervention and rehabilitation strategies often prove to be ineffective