Trauma and the Brain Mid term Flashcards
Six steps of differential diagnosis
- Are the symptoms real? (i.e., rule out malingering and factitious disorder)
- Rule out substance intoxication/withdrawal, including medication
- Rule out medical condition
- Primary diagnosis
- Determine adjustment or other specified or unspecified
- Establish the boundary with no mental disorder
Hierarchy of Evidence
- Systematic reviews published by reputable organization
- Large scale multi-site randomized controlled clinical trials
- Individual randomized controlled clinical trials
- Large scale multi-site quasi-experimental studies
- Replicated pre-experimental outcome studies
- Individual pre-experimental outcome studies
- Single case experimental designs
- Correlational studies
- Narrative case studies
- Expert clinical opinion
- Credible theory
- Opinions of professional colleagues
Steps in Evidence Based Practice
- Convert information needs related to practice decisions into answerable questions
- Track down, with maximum efficiency, the best evidence with which to answer questions
- Critically appraise that evidence for its validity, impact (size of effect), and applicability (usefulness in practice)
Elements of Evidence Based Practice Method
- Best available research evidence
- Client/Population characteristics, state, needs, values & preferences.
- Resources, including practitioner experience
Define Evidence Based Practice Model
EBP is a process used to review, analyze, and translate the latest scientific evidence.
Levels of Evidence (Bonus)
- Level A: Evidence is based on randomized, well controlled clinical trials
- Level B: Evidence is based on well-designed clinical studies, without randomization or placebo comparisons
- Level C: Evidence is based on service and naturalistic clinical studies combined with clinical observations that are sufficiently compelling to warrant use of the treatment technique or follow the specific recommendations
- Level D: Evidence is based on long-standing and widespread clinical practice that has not been subjected to empirical test in PTSD
- Level E: Evidence is based on long-standing practice by circumstances groups of clinicians that as not been subjected to empirical test in PTSD
- Level F: Evidence is based on recently developed treatment that has no been subjected to clinical or empirical test in PTSD
Excretion/Kidneys
The kidney is the main excretion organ less frequently from the lungs, sweat glands, saliva, feces, bile, and breast milk.
Metabolism
Must drugs are broken down in the liver by enzymes, which act to transform chemicals or drugs into more water-soluble or hydrophilic so the drugs can be excreted in the urine.
Antagonist
- Decreasing the production of an NT by blocking the enzyme required for its synthesis
- Blocking storage of NTs in vesicles
- Preventing release of NTs (sometimes substance P) from terminal buttons
- Binding postsynaptic receptors on presynaptic neurons, called autoreceptors, which tell neurons not to release NTs
Agonist
- Being a precursor for an Neurotransmitter (NT), resulting in an increase in NT synthesis increasing release of NTs from terminal buttons
- Acting like endogenous NTs and simulating postsynaptic receptors
- Blocking reuptake by presynaptic neurons, allowing NTs, to remain in synapse longer
- Immobilizing enzymes that breakdown Nts in synapse, this increasing the number of NTs in the synapse available for action
Blood Brain Barrier
o Responsible for restricting the dye from dispersing from the blood into the brain tissues
o Consists of astrocytes (special glial cells) that encapsulate the capillaries in the brain.
o Is selectively permeable meaning some substances cross it into the brain easily and others not
o A substance that is lipophilic (dissolves readily in fats) moves effortlessly through the BBB and is why alcohol can permeate the brain so easy.
o Alcohol actually permeates the cells and nucelli in the brain and acts as a toxin.
o Support cells of the nervous system
o Functions include
Holding the CNS together like glue
Protecting neurons
Cleaning up particles of dead cells
Insulating neurons from other neurons
Producing myelin sheaths
Glial Cells
- Factors that contribute to drug interactions are protein binding and enzyme induction or inhibition
o Protein binding
o Enzyme induction or inhibition
o Contraindications
o Toxicity
Drug interactions
Drug allergy
- Involves histamine action common symptoms are hives and trouble breathing
- Reactions can range from mid to fatal
- If reactions occur medication is usually discontinued
- When a drug binds with any receptor that its chemical structure will allow, this nonselective drug binding capacity explains the origin of drug side effects.
- Generally as the dosage increases symptoms of the disease decrease but side-effects increase.
- Physicians try to adjust drugs so they maximize symptom reduction with the last number of side effects.
- Drug holidays are blocks of times when the drug is not administered
Side effects
Refers to the study of the processes by which drugs affect the body and the brain, and the behavioral, emotional, and cognitive outcomes of drug action and neurotransmitter interaction.
Pharmacodynamics
Pharmacokinetics
Refers to the study of in vivo (occurring inside the body) drug processes and includes administration and absorption, distribution, metabolism, and excretion of drugs.
Sympathetic and Parasympathetic are regulated by
Autonomic NS
Peripheral Nervous System is divided into
Autonomic NS and Somatic NS
The brain and the spinal cord are part of
The Central Nervous System
The Nervous System is divided into
Central Nervous System and Peripheral Nervous System
Somatic NS controls
voluntary muscles
Autonomic NS controls
involuntary muscles
Parts of the hindbrain are
The medulla oblongata, pons, and cerebellum
Hindbrain regulates
breathing, pumping of heart, digestion, and motor coordination
Parts of the midbrain
are reticular formation, thalamus, and hypothalamus
Part of the brain that coordinates movement with sensory input of arousal and tension
The Midbrain
The limbic system, hippocampus, cingulated gyrus, septum and amygdala
Base of the forebrain
Forebrain regulates
regulates our emotion experiences and expressions
Frontal Lobe Functions
- Motor function (right)
- Problem solving
- Spontaneity
- Memory
- Language production (left)
- Initiation (motivation)
- Judgment
- Impulse Control
- Social Behavior
- Sexual Behavior
- Voluntary movement
- Executive function
- Comportment
Asymmetrical differences in frontal lobe
Left frontal lobe controls language related abilities and right frontal lobe nonverbal abilities
- How we know what we are doing in our environment (consciousness)
- How we initiate activity in response to our environment (motivation)
- Judgements we make about what occurs in our daily lives
- Controls our emotional response
- Controls our expressive language
- Assigns meaning to the words we choose
- Involves word associations
- Memory for habits and motor activities
Are functions from…
Frontal lobe functions
Functions of Frontal lobe
- How we know what we are doing in our environment (consciousness)
- How we initiate activity in response to our environment (motivation)
- Judgements we make about what occurs in our daily lives
- Controls our emotional response
- Controls our expressive language
- Assigns meaning to the words we choose
- Involves word associations
- Memory for habits and motor activities
Parietal lobe functions
- Location for visual attention
- Location for touch perception
- Goal director voluntary movements
- Manipulation of objects
- Integration of different senses that allows for understanding of a single concept
- Calculation (left)
- Reading (left)
1) Inability to attend to more than one object at time
2) Inability to name an object (Anomia)
3) Inability to locate the words for writing (Agraphia)
4) Problems with reading (Alexia)
5) Difficulty with drawing objects
6) Difficulty in distinguishing left from right
7) Difficulty with doing mathematics (Dyscalculia)
8) Lack of awareness of certain body parts and/or surrounding space that leads to difficulties is self-care
9) Inability to focus visual attention
10) Difficulties with eye and hand coordination
Observed problems due to parietal lobe damage
Occipital lobe function
Vision
1) Defects in vision (Visual field cuts)
2) Difficulty location objects in environment
3) Difficulty identifying colors (Color Agnosia)
4) Production of hallucinations
5) Visual illusions – inaccurately seeing objects
6) Word blindness – inability to recognize words
7) Difficulty in recognizing draw objects
8) Inability to recognize the movement of an object (Movement Agnosia)
9) Difficulties with reading and writing
Problems related to occipital lobe damage
Temporal lobe functions
1) Hearing ability
2) Memory acquisition
3) Some vision perceptions
4) Categorization of objects
5) Emotion
6) Language comprehension (left)
1) Difficulty in recognizing faces (Prosopagnosia)
2) Difficulty in understanding spoken words (Wernicke’s Aphasia)
3) Disturbances with selective attention to what we see and hear
4) Difficulty with identification of, and verbalization about objects
5) Short term memory loss
6) Interference with long-term memory
7) Increased or decreased interest in sexual behavior
8) Inability to categorize objects (Categorization)
9) Right lobe damage can cause persistent talking
10) Increased aggressive behavior
Problems due to Temporal Lobe Damage
1) Breathing
2) Heart Rate
3) Swallowing
4) Reflexes to seeing and hearing
5) Controls sweating, blood pressure, digestion, temperature (Autonomic Nervous System)
6) Affects level of alertness
7) Ability to sleep
8) Sense of balance (Vestibular Function)
Brainstem Functions
Problems due to Brainstem Damage
1) Decreased vital capacity in breathing, important for speech
2) Swallowing food and water (Dysphagia)
3) Difficulty with organization/perception of the environment
4) Problems with balance and movement
5) Dizziness and nauseas (Vertigo)
6) Sleeping difficulties (Insomnia, Sleep Apnea)
Cerebellum Function
1) Coordination of voluntary movement
2) Balance and equilibrium
3) Some memory for reflex motor acts
1) Loss of ability to coordinate fine movements
2) Inability to reach out and grab objects
3) Tremors
4) Dizziness (Vertigo)
5) Slurred Speech (Scanning Speech)
6) Inability to make rapid movements
Problems due to Cerebellum Damage
Hypothalamus function
- Water balance
- Sugar and fat metabolism
- Body temperature
- Release of inhibition hormones that control appetite, rage, blood pressure
Regulation of internal and external stimuli
Amygdala
Memory is regulated by the
Hippocampus
- Hippocampus
- Fornix
- Mamillary bodies
- Anterior nucleus of the thalamus
- Cingulate gyrus
- Amygdala
- Septum
- Basal forebrain
- Nucleus accumbens
- Orbitofrontal cortex
Are the Limbic System
Parts of the Neuron
1) Dendrite
2) Cell Body
3) Axon
4) Axon terminal
Extensions from the neuron cell body that take information to the cell body, the axon, and the axon terminal
Dendrite
Part of cell that contains the nucleus
Cell Body
The extension from the neuron cell body that takes information away from the cell body
Axon
End part of an axon that makes a synaptic contact with another cell
Axon terminal
Both inhibitory and excitatory and plays a role as a “reward center” and many body functions such as memory, movement, motivation, mood, attention etc.
Dopamine
Both Inhibitory and excitatory and plays a key role in such body functions as mood, sleep, digestion, nausea, wound healing, bone health, blood clotting and sexual desire.
Serotonin
Excitatory. It is released into the bloodstream to prepare your body for dangerous situations by increasing your heart rate, blood pressure, and glucose production.
Epinephrine
Excitatory. Increases heart rate and blood pumping from the heart. It also increases blood pressure and helps break down fat and increase blood sugar levels to provide more energy to the body.
Norepinephrine
Excitatory. used at the neuromuscular junctions, triggering the firing of motor neurons and affecting voluntary movements.
Acetylcholine
Inhibitory. Is an amino acid that functions as the primary inhibitory neurotransmitter for the central nervous system (CNS). It functions to reduce neuronal excitability by inhibiting nerve transmission.
GABA
Excitatory. several types of receptors found throughout the central nervous system, and its metabolism is important to maintaining optimal levels within the extracellular space. As such, it is important to memory, cognition, and mood regulation.
Glutamate
Inhibitory. Hormones that are released when your body feels pain or stress. They are produced in your brain and act as messengers in your body. Endorphins are produced to help relieve pain, reduce stress and improve mood.
Endorphins
Responsible for consciousness, motivation, judgment, memory for habits and movements, expressive language and emotional response, impulse control, social and sexual behavior, executive functioning.
Prefrontal Cortex (PFC)
HPA Axis
Mediates the effects of stress by releasing stress hormones, affects the autonomic nervous system, and affects other physiological processes.
Caudate Nucleus
Modulation of motor function, allows the motor system to perform goal directed behavior.
Insula
Controls autonomic functions, regulates sympathetic and parasympathetic systems, role in regulating immune systems
Thalamus
Learning Memory, relay center for all senses except smell. Sleep, wakefulness, consciousness.
Routes of Drug/ Medication Administration
Intravenous Injection - Into the vein
Intramuscular Injection - Into the muscle
Subcutaneous Injection - Under a layer of the skin
Oral - Liquids, tablets, and capsules (Liquids are the fastest absorption rate)
Sublingual - Tablet under the tongue
Buccal - medication placed between the gum and cheek
How are drugs distributed through the body
by the circulatory system
Dopamine Hypothesis of Schizophrenia
Hyperactivity of Dopamine in the Brain
Making room for the role of Serotonin
Low levels of Dopamine are being implicated in
depression and high levels in mania
Biogenic Amine Hypothesis of mood disorders
Hypoactivity of serotonin and norepinephrine in the
brain cause depression or mania
Permissive Hypothesis
Abnormally low Levels of serotonin permit abnormal
levels of norepinephrine to cause depression
*Role of Serotonin is being considered with anxiety disorders
Antagonistic Drug Effects (Slide 44 Neuroanatomy)
Drug blocks the synthesis of NT molecules (by destroying synthesizing enzymes)
Drug causes the NT molecules to leak from the vesicles and be destroyed by degrading enzymes
Drug blocks the release of the NT molecules form terminal buttons
Drug activates autoreceptors and inhibits NT release
Drug is a receptor blocker; it binds to the postsynaptic receptors and blocks the effect of the NT
Agonistic Drug Effects (Slide 44 Neuroanatomy)
Drug increases synthesis of NT molecules (increasing the amount of precursor)
Drug increases number of NT molecules by destroying degrading enzymes
Drug increases the release of NT molecules from terminal buttons
Drug binds to autoreceptors and blocks their inhibitory effect on NT release
Drug binds to postsynaptic receptors and either activates or increases the effect on them of NT molecules
Drug blocks the deactivation of NT molecules by blocking degradation or reuptake
