Week 1 Flashcards
Stimulation of _________ due to _______ burst leads to addiction. (STAR)
Nucelus Accubens via dopamine burst (example of maladaptive to reward system)
Shut down of __________ leads to anxiety or depression
Hippocampus
- hippocampus and surrounding limbic structures are critical for both learning and regulating emotion/mood.
Concept of mental function: Continuum
level of mental function varies in individuals along a continuum, each individual is able to adapt to their mental functional levels in different ways.
3 main aspects when evaluating mental disorders
Cognition, Emotion, and Motivation.
Functional Division of the Cortex: Occipital Lobe
Visual Cortex - exclusively for visual processing.
- Note: From birth, needs visual info/input to help wire the occipital lobe to become visual cortex.
Functional Division of the Cortex: Temporal Lobe
- Integration (“what” pathway): Integrating the auditory, visual and olfactory information
- Critically involved in acquiring and retaining knowledge (learning)
Functional Division of the Cortex: Parietal Lobe
- Spatial Processing (“where” pathway): involving visual, auditory, and somatosensory input.
- Cognitive Function: Math operation, spatial orientation, etc.
Functional Division of the Cortex: Frontal Lobe
- Motor Cortex, involved in planning and executing motor behavior => More in prefrontal cortex
Functional Division of the Cortex: Prefrontal Cortex
- Executive Functions: regulates thoughts, motor behavior and emotional responses
- Social Cognition (medial esp.) = sense of self.
Function of Corpus Striatum + brain components
Initiation and Termination of Motor Movements: Mediated by Dopamine
- Caudate, Putamen, Globus Pallidus
Function of (Neo) Striatum + brain components
- Maintain/Switch Attentional Focus: Associated with PFC as well as Habit Formation
- Caudate and Putamen
Function of Limbic Structures: Amygdala (opposite of hippocampus)
- Detects biological significance of incoming information (Friend or Foe)
- Autonomic nervous system: fast and subconscious reaction.
- Provides the emotional information associated with experiences encoded in memory.
Function of Limbic Structures: Hippocampus (opposite of amygdala)
- “Calculated” responses to environment in contrast to more instinctive response.
- Encodes experiences into long term memory
- Associated with Alzheimer disease or amnesia.
Hebbian Principle:
Coordination of neural networks: Simultaneous activation of neurons creates a connection so it will be activated together again in the future.
What is the main differences between ADHD vs Disruptive Disorder?
- ADHD shows up early in childhood (sounds like
Definition of Autism in terms of terminology
“Focus back to oneself”
- Core failure of recognizing the “alternative” perspective or possibility
Hallmark of ASD
Deficient Social Cognition
- Deficients in the Theory of Mind abilities.
ASD: Theory of Mind abilities are developed through __________
Imitation!
Therefore be worried with 2-3 yo that don’t use imagination or pretend play, look at you and point, or look when you point at something.
ASD: What is the Mirror Neuron System
Foundation of our social cognition and skills (ToM related): Potential neural basis of “imitation,” action observation, and intention understanding.
ASD: Major Components of Mirror Neuron System
Inferior Parietal Lobe = (parietal lobe) Charge of many sensory motor and spatial processing/perception.
Posterior Superior temporal gyrus = (temporal lobe) houses primary auditory cortex
- Inferior Frontal Gyrus + pars opercularis = prepares the motor program to be carried out by the primary motor cortex.
ASD: Mirror Neuron System: Language areas
Wernicke Area = Temporal/Parietal Lobe
Broca’s Area = Frontal lobe
a 10 month old is shown to have increased growth of whole brain volume. What dx are you suspicious of?
Autism Spectrum disorder: First year head circumference is larger.
ASD: Genetics
High Heritability
ASD Common Signs and Symptoms (3)
- Head circumference measurements during 1st year
- Social development delay during 2nd year
- Language development delay in 2nd and 3rd year.
Which of the following symptom(s) are/is associated with Learning Disabilities? Memory problems, attention problems, overt physical impairment, average/above average intellectual ability.
Average/above average intellectual ability. The problem is unexpected failure of an individual to acquire, retrieve, or use information adequately. Matter of processing, not their intelligence.
Common manifestations include failure to acquire reading, writing or math skills at age/grade expected level. (esp. Reading)
Major types of individual Learning Disorder (3)
- Dyslexia (reading), Dysgraphia(writing), and dyscalculia (math).
- Note that anatomic issues are not causes (bad eyes, ears, etc.), this is a brain issue in processing and interpreting the outside stimuli.
Right hemispheric Developmental LD is a _______ based LD
Non language base. Right hemisphere is known for visual/spatial organization. May have problem comprehending reading and solving math problems but not memorizing math facts.
LD: Dysphasia/Aphasia =
Difficulty with language, therefore can have problem with mathematical WORD problems.
LD is multifactorial, highly affected by personal and environmental factors as well as genetics.
Answer on the front.
ADHD: Manifests in childhood and symptoms include ________, ________, and _________
- Hyperactivity, Inattention, and Impulsivity
Criteria for ADHD Dx: Requirement
- Requires impairment of function in academic, social, or occupational activities.
- be present before the age of 12
- be present in more than one setting.
Pharmacology for treatment of ADHD can be _________ therefore also need ______ history.
Cardiotoxic, cardiac history
DSM-5 Diagnosis of ADHD
- Divided according to ________ + Number of Sx.
Age
if 5 symptoms of inattention.
if > 17 yo = requires > 4 symptoms of … … …
ADHD Subtypes: Combined
- Note: Also predominately inattentive and predominately hyperactive/impulsive
if 5 symptoms in BOTH lists
if > 17 yo = requires 4 symptoms in BOTH lists
ADHD: genetics
High heritability
ADHD: Reduced global activation and _______(part of brain) activation on functional imaging which effects ________ and _______ functions.
reduced Anterior Frontal Activation => areas affecting motor response inhibition and executive functions.
ADHD: Neurochemical abnormalities
Decrease in inhibitory dopamine and an increase in norepinephrine activity.
- dopamine is most deficient in prefrontal cortex.
____________ have the greatest benefit from methylphenidate treatment (know this)
ADHD children with specific genetic traits including genetically altered increase transporters of dopamine.
Medical Condition that can mimic ADULT ADHD: Only one that was bolded (blah?)
Frontotemporal Dementia
Adult ADHD Treatment: stimulating the release of __________ seems to have a greater therapeutic role in adult ADHD
norepinephrine/inhibiting reuptake
ADHD Attention: the Network that helps sustain attentional focus.
Prefrontal-Striatal Network = Core attentional control system
ADHD Attention: Components and Function of the Prefrontal-Striatal Network
- Prefrontal Cortex: holds “spotlight” to direct attention.
- Straitum: serves as “gating” function to help PFC maintain focus
- When more relevant or significant info comes in, Straitum open the “gate” and PFC finds a new focus.
_________ primary communication channel between and within the striatum and PFC in attention control (Prefrontal-Striatal Network)
Dopamine
- Orginates from VTA and substantia nigra
ADHD Attention: Dopamine Functions, the Tonic-Phasic System
- Tonic Release of Dopamine: Results in maintenance of attentive equilibrium = sustained attention.
- Phase Burst of Dopamine: Switched attentional focus.
ADHD Attention: and Tonic-Phasic System: Dysfunction
Inadequate/Lower tonic level (therefore difficult to maintain focus) and indiscriminate signaling of phasic signals (random switches in attentional focus).
ADHD Impulsivity: Two complementery concepts
- Decrease function in behavior inhibition
- Increased tendency in reward-driven behavior.
ADHD Impulsivity:
- Impulsive Immediate Route of Behavior
- Amygdala (emotion) => Nucleus accumbens (behavior reinforcement) => insula (sensory input)
Inadequate Attentional/Impulsivity Control - Looks for immediate reward = Impulsivity seen in ADHD
ADHD Impulsivity:
- Reflective, Slower Route of Behavior
- PFC (supervisory) => Striatum (Behavior control) => Anterior cingulate (conflict monitoring) => hippocampus (memory)
Adaptive Attentional/Impulsivity Control - Able to wait for a larger reward = deficiency in ADHD.
Behavior Disorders: Intermittent Explosive Disorder is the _________ in severity of the three.
- Characterized by…
Mildest, characterized by out proportion aggression, not premediated. Outbursts can be caused by marked distress or impairment (stress).
In order to be diagnosed with Intermittent Explosive disorder, must be at least _________ and treatments are ___________
- 6 yo, since outbursts like this are normal in in anyone younger. Tx is SSRI (fluoxetine) + CBT
Behavior Disorders: Oppositional Defiant Disorder is the __________ in severity of the three.
- Characterized by…
middle in severity. Pattern of angry/irritable mood, argumentative/defiant behavior/ or vindictiveness lasting at least 6 months.
Behavior Disorders: Oppositional Defiant Disorder = TX
Pharmacological: Risperidone (used but not approved)
- Anger management, psychotherapy, etc. etc.
Behavior Disorder: Conduct disorder is the __________ in severity of the three
- characterized by…
- MOST severe. Repetitive and persistent behavior that violates the rules and laws. Most criminal (such as destruction of property, theft, use of a weapon and injuring, etc.)
Behavior Disorder: Conduct disorder
- Dx Category
Besides presence of at least 3 characteristics in the past 12 months (+ 1 in the past 6 months)
- Significant impairment in school, academic, or occupational functioning (similar to ADHD)
Schizophrenia in DSM-5: at least one of the 3 following characteristics =
Delusions, Hallucinations, and disorganized speech.
= Primarily a COGNITIVE disorder
Schizophrenia, Hallucination:
Possible Dysfunction #1: When inner speech is generated, an efferent copy is automatically sent to the auditory language area to “dampen” the activation level of “perception” => Involves which parts of the brain?
Note: Not mutually exclusive from Dysfunction #2
Failure of automatic signaling network from INFERIOR FRONTAL GYRUS (Speech production area) to inform SUPERIOR TEMPORAL GYRUS (primary auditory cortex) of the internal nature of speech.
- Dr. Copolla also emphasizes IFG activation during auditory verbal hallucinations.
Schizophrenia, Hallucination: Most fundamental dysfunction.
Possible Dysfunction #2: Dysfunction in self monitoring mechanism in detecting one’s own thoughts and actions => involves which part of the brain? (Same as in Delusion)
Note: Not mutually exclusive from Dysfunction #1
Abnormal activations in ANTERIOR CINGULATE CORTEX and med PRE FRONTAL CORTEX in self monitoring tasks
- Dr. Copolla said that lack of self monitoring was because of IFG to ACC connection.
Schizophrenia:
Definitions of Hallucinations, Delusions, and Disorganized Language
Hallucinations: primarily auditory in nature, often in form of verbal utterances as if someone is talking to you.
- Perceptual in nature, false perceptions.
Delusions: Ideas and beliefs deviating from reality (but based on things in reality). Persecutory in nature. High level distortion of reality.
Schizophrenia, Delusion:
Possible Dysfunction #1: Erroneous attribution of salience (significance) to perceived information => involves which parts of the brain?
Note: Possible Dysfunction #2 is the same as in Hallucinations: Dysfunction in self monitoring
Abnormal functions in the striatum, hippocampus, and dopamine system.
Note: Something that shouldn’t be important to us becomes important (like neighbor working in the backyard) so mistakenly perceived as having to do with their safety, etc.
Schizophrenia, Disorganized Language:
Possible dysfunction in cognitive control => involves which parts of the brain?
Dorsolateral PFC: Fails to coordinate information within conscious awareness to produce meaningful speech output.
- Highly heritable.
Monitoring Internal and External Info:
Function of Anterior Cingulate Cortex, Medial PFC, Orbital Frontal Cortex, and Lateral PFC
Know where it is located in the brain as well (perhaps important?)
- ACC = Detect conflicting info or responses (emphasized in Copolla as well)
- Medial PFC = Self monitoring based on ACC signals (also emphasized in Copolla)
- Orbital Frontal Cortex = inhibit inappropriate responses (regulation of behavior)
- Lateral PFC = Coordinate internal and external input for reasoning and decision making; attentional control.
Neuropathology of Schizophrenia:
- Dorsal Lateral Prefrontal Cortex: Working Memory
Relationship between working memory load and activation.
If working memory load was Low, schizophrenics did fine in Dorsolateral PFC activation
If working memory load high, schizophrenics could not keep up with the activation of Dorsolateral PFC
Neuropathology of Schizophrenia:
- Brain Volume Perspective => 2 examples
1) Enlarged ventricles => reduced whole brain volume
2) Dendritic filed size reduced in schizophrenia.
Neuropathology of Schizophrenia:
- Connectivity Perspective -> 2 examples.
1) White Matter had disrupted connectivity
2) Connection abnormalities between…
IFG-Wernicke => INCREASED connectivity
IFG - Putamen + Putamen-Wernicke => DECREASED connectivity
Neuropathology of Schizophrenia:
- Dopamine Hypothesis
Tonic/Phasic DA system and DA receptor type and distribution in the brain.
Etiology of Schizophrenia: Genetics vs Environmental
Both have an effect but Environmental effects only occur if genetically predisposed first
Neuroimaging Method:
- Post Mortem Study Details + Type of Method
Structural Method
- Post Mortem Study: Offer both macroanatomical and cytoarchitectonic measures. Bridging clinical science and animal models of mental disorders. Complement functional neuroimaging findings.
Neuroimaging Method:
- MRI Details + Type of Method
Structural Method
- MRI: Best for examining GREY MATTER volume. Uses Hydrogen nuclei in H20 align with the magnetic field.
- Ex of Finding: Found anatomical differences in the mirror neuron system and social cognitive network in autism.
Neuroimaging Method:
- DTI (Diffusion Tensor Imaging) Details + Type of Method
Structural Method
- DTI: Best for examining WHITE MATTER tracts => connectivity of neural networks
- Measure characteristics using water diffusion.
Neuroimaging Method:
- fMRI Details + Type of Method
Functional Method
- functional MRI: Best for examining RELATIVE increase or decrease in neural activation
- Uses BOLD (Blood-oxygen-level dependent) signal. More blood supply to neurons => more activity.
Neuroimaging Method:
- PET Details + Type of Method (older method, not the most preferred)
Functional Method
- Positron Emission Tomography: Specific molecules developed for different purposes. Scanner detects radioactivity emitted during the decay of tracer chemical.
Regional Blood blow (oxygen water with oxygen-15) => infer neural activity
Glucose Metabolism (glucose analogue with fluorine-18) => infer neural activity
Neurotransmitter receptor density (ligand labeled with carbon 11 for Dopamine D2) => most significant use of PET.
Continuous Liability Distribution: Def
Genetics: A liability with a continuous distribution that has a critical threshold for disease.
If relative risk of the disease = 1 then….
No increased risk
Total Phenotypic Variance: Low vs High Variance
Low Variance = one gene, one disease. Not multifactorial
High Variance = Multifactorial.
Monozygotic twins with a genetic disease would show low variance.
Copy Number Variation in ASD
15q13, 16p11.2, 22q11.2
q = long arm p = short arm
Microdeletions.
Most common single gene cause of ASD
Fragile X Syndrome: CGG repeats in FMR1
- > 200 is associated with pathology
Schizophrenia vs Schizophreniform vs Schizoaffective
Schizophrenia = > 6 months
Schizophreniform =
ASD
Social Communicative Disorder + Restrictive repetitive behavior
Schizophrenia: Negative Symptoms = the 5 As
- Alogia
Poverty of speech
Schizophrenia: Negative Symptoms = the 5 As
- Affective Blunting
Person’s face appears unresponsive.
Schizophrenia: Negative Symptoms = the 5 As
- Avolition
Apathy, inability to initiate and persist in goal-directed activites
Schizophrenia: Negative Symptoms = the 5 As
- Anhedonia
A-hedonism => can’t achieve pleasure in anything
Schizophrenia: Negative Symptoms = the 5 As
- Attentional impairment
Yes. Impairment in attention.
Sx of Cocaine Intoxication
Tachycardia, hypertension, agitation, Euphoria, Fever and DILATED PUPILS
Sx of Marijuana + psychoactive compounds
Impaired coordination and judgement, euphoria, anxiety, dry mouth, tachycardia, etc.
- Tetrahydrocannabinol (THC) and Cannabidiol (CBD)
Sx of Porphyria
GI Dysfunction (abdominal pain) + Psychosis
