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202 Neuroscience & Behaviour > Theme 3 - Modulatory systems in Psychiatry > Flashcards

Theme 3 - Modulatory systems in Psychiatry Flashcards

1
Q

What is the pathway for reward in the brain?

A

mesocorticolimbic

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2
Q

What is tolerance?

A

Diminished response to the effects of a given amount of drug following repeated exposures to the drug.

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3
Q

In what brain system does addiction?

A

Mesolimbic dopaminergic system

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4
Q

What structure releases what substance in addiction?

A

Dopamine released from nucleus accumbens

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5
Q

What effect does alcohol have on the DAergic system?

A

disinhibition of ventral tegmental DA neurons

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6
Q

What effect do opiates have of on the DAergic system?

A

inhibit GABAergic neurons in VTA which disinhibits VTA DA neurons

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7
Q

What effect do psychostimulants have of on the DAergic system?

A

direct effect on DA neurons in nucleus accumbens

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8
Q

What effect do nicotine have of on the DAergic system?

A

increases nuclesus accumbens DA directly and indirectly

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9
Q

How does cocaine affect dopamine levels in nucleus accumbens?

A

Blocks reuptake transporters

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10
Q

How do amphetamines affect dopamine in the nucleus accumbens?

A

DA transporters run in reverse

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11
Q

What receptors does alcohol affect?

A

GABAa - agonist

NMDA - anatgonist

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12
Q

What brain structure is linked to the physical dependance upon opiates?

A

Locus coereolus

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13
Q

What receptors are linked to alcohol dependence?

A

GABAa - downregulated
NMDA - upregulated
SO when you stop pissing up get excitation symptoms such as tremors, agitation, seizures

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14
Q

6 examples of disorders associated with neurosis?

A 
Anxeity
Depressive
Obsessive
Compulsive
Adjustment
Somatisation
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15
Q

4 disorders associated with psychosis

A

Organic
Bipolar
Schizophrenia
Depressive

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16
Q

What is defined as
An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions and hallucinations?

A

Psychosis

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17
Q

What is the time limit for a psychotic episode?

A

1 week

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18
Q

What is defined as Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background

A

delusion

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19
Q

What is defined as a perception experienced in the absence of external stimulus?

A

Hallucination

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20
Q

Schizophrenia is a minimum of 1 of these symptoms

A

a Thought echo, insertion, withdrawal or broadcast

b Delusion of passivity or delusional perception
(e.g. the toilet flushed and then I knew)

c Running commentary hallucination or 2 voices discussing the patient

d Persistent delusions of other kinds

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21
Q

Schizophrenia it at least 2 of these symptoms for at least one month

A

e Persistent hallucinations in any modality with accompanying brief delusions

f Breaks in thought resulting in abnormal speech (eg. incoherent, neologisms)

g Catatonic behaviour eg. Excitement, posturing, waxy flexibility, negativism

h Negative symptoms not due to depression or medication

In the absence of an organic disorder

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22
Q

At least 5 causes of organic psychosis

A

Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Cerebral trauma
Cerebrovascular disease
Demyelination: Multiple sclerosis etc
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Immunological: SLE
Acute drug intoxication: eg. Ketamine, Cannabis, LSD, PCP, Amphetamine,
Toxins eg. lead
Dementias

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23
Q

What are the 2 types of schizophrenia and types of symptoms associated with each?

A

Acute - positive symptoms

Chronic - negative symptoms

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24
Q

Percentage prognosis of schizophrenia?

A

20% - complete recovery and off treatment
25% - perisitant symptoms after first episode
+50% - relapsing remitting

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25
At least 5 things that give a good prognosis of schizophrenia
``` Female Married Family history of affective disorder Good premorbid function Acute onset Life event at onset Early treatment Affective symptoms Good treatment response ```
26
At least 5 things for a poor prognosis of schizophrenia
``` Male Single Family history of schizophrenia Premorbidly schizoid Slow onset Long duration untreated Negative symptoms Obsessions High Expressed Emotion in the family Substance misuse ```
27
Two structural changes to brain associated with schizophrenia
Ventricular enlargement | reduced brain volume
28
What 3 neurophysiological phenomina are associated whith schizophrenia?
Hypofrontality Hyper-excitable sensory cortex Abnormal neural oscillations
29
What are 4 neurocognitive effects associated with schizophrenia?
``` Lower IQ Attentional deficits (e.g. Stroop Test) Working memory (e.g. Wisconsin Card Sorting Test) Planning and information processing deficits ```
30
What are the 4 affective episodes?
Major Depressive Episode Manic Episode Hypomanic Episode Mixed affective episode
31
give 9 symptoms of depression
``` Depression of mood Anhedonia Psychomotor retardation Agitation / restlessness Anxiety / preoccupation Diurnal variation of mood Insomnia Feelings of guilt , self-reproach worthlessness Somatic symptoms Hypochondriasis Weight loss Suicidal thoughts ```
32
What are the DSM V criteria of a major depressive episode?
5 or more of the following symptoms for 1 week Depressed mood most of the day, nearly every day Diminished interest or pleasure Weight loss / weight gain or appetite decrease / increase Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate, or indecisiveness Recurrent suicidal ideation or a suicide attempt/plan
33
5 features of atypical depression
``` Mood reactivity Significant weight gain Hypersomnia leaden paralysis interpersonal rejection sensitivity ```
34
3 criteria for manic episode
abnormally and persistently elevated, expansive, or irritable mood For a period lasting at least one week and present most of the day, nearly every day: abnormally and persistently increased activity or energy
35
7 possible symptoms of a manic episode
Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas or racing thoughts Distractibility Increase in goal-directed activity or psychomotor agitation Excessive involvement in high risk activities
36
2 Differences between a manic and hypomanic episode?
Same symptoms but hypomanic episode is for 4 days rather than 1 week The episode is not severe enough to cause marked functional impairment or to necessitate hospitalization
37
What 3 features can be associated with both depression and mania?
Anxiety Hallucinations/delusions Catatonia
38
4 epidemiology features of major depressive disorder
onset 25-35 1 in 5 more females than males 8-19% suicide
39
Difference between the two types of bipolar disorder
Bipolar Disorder I At least one manic episode Bipolar Disorder II At least one hypomanic episode At least one major depressive episode
40
4 epidemiology features of bipolar disorder
15-24 onset delayed diagnosis familial aggregation men and women affected equally BP I
41
7 typical symptoms of acute stress
``` Feelings of being numb or dazed Insomnia Restlessness Poor concentration Autonomic arousal Anger/anxiety/depression Withdrawal ```
42
2 abnormal response to stress
PTSD | Adjustment disorder
43
What is the difference between a normal response and an adjustment disorder, how long can the latter last?
Adjustment is out of proportion to stressor | Up to 6 months
44
6 symptoms of PTSD
``` Re-experiencing flashbacks/nightmares Numbness/detachment Avoidance Hypervigilance/startle Insomnia Anxiety/depression ```
45
What is the average course of PTSD?
Usually immediate onset | Most recover within one year
46
6 physical symptoms of general anxiety disorder?
``` sweating palpitations dry mouth epigastric discomfort dizziness trembling ```
47
6 psychological symptoms of GAD
``` Fearful anticipation Irritability Sensitivity to noise Restlessness Poor concentration Worrying thoughts ```
48
Aietology of GAD in relation to parenting
Overprotective Lack of warmth & encouragement more critical and intrusive
49
5 Psychological symptoms of panic disorder
``` fear of losing control dying going mad fainting derealisation ```
50
As many physical symptoms of panic disorder as you can think of
Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes
51
What would be 4 differential diagnosis associated with panic disorder?
Endocrine - hypoglycaemia Respiratory - asthma Cardio - Arrythmia Drugs
52
6 points on aetiology of panic disorders?
Precipitating events in 60-96% of cases - Separation / loss - Relationship difficulties - New responsibilities Traumatic early life events - Early parental separation - Traumatic childhood event – 3 fold increase - Early sexual abuse (<5 years of age)
53
Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction what is this?
Initial short-lived sympathetic arousal Followed by parasympathetic arousal May result in vasovagal syncope The subjective experience tends to disgust and repulsion rather than pure apprehension
54
4 aetiology points on phobias
unresolved unconscious conflict classical conditioning historically threatened species observational
55
In appropriate anxiety in Situations where the person is observed Situations where there is potential for criticism refers to what type of phobia
Social
56
5 symptoms of social phobia
Anticipatory anxiety Feeling anxious Blushing Trembling (observed writing is a problem) Relieved by alcohol (potential for abuse)
57
What brain structure is associated with fear and eliciting a stress a response?
Amygdala
58
What 2 other structures are excited by the amygdala in a stress response and what do they do?
Hypothalamus - HPA axis | Locus coeruleus - NE
59
What is the HPA axis?
Hypothalamus - releases CRH Pituitary - releases ACTH Adrenal cortex - releases cortisol
60
If the amygdala excited the HPA axis, what brain structure inhibits it?
Hippocampus
61
What brain structure is affected by chronic stress and how?
Too much glucocorticoid leads to cell death in hippocampus | Hippocampus cannot feedback to amygdala to limit cortisol production
62
Give 5 anxiety disorders
``` OCD Phobias GAD PTSD Panic disorder ```

202 Neuroscience & Behaviour (5 decks)

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