Week 10 Flashcards by Luc King

People with mental illness are violent and dangerous People with mental illness are poor or less intelligent
Mental illness is caused by a personal weakness
Mental illness is a single, rare disorder

Mental Illness myths

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In mental illnesses ________ are common.

Comorbidities are common

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True / False: Many mental illnesses are very complicated as 1.__________________________________ and 2.________________________________________
Because of this mental illnesses should be shown as a 3.__________________

Many people who fit a diagnosis for one
mental disorder may partially fit the
diagnosis for another as well
People may not completely match any
specific diagnosis.
Spectrum (Severity of Symptoms)

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Originally called Dementia Praecox
(“premature dementia”; Emile Kraepein,
1883).

(“splitting of mind”), a split
between the emotional and intellectual
aspects of experience (Eugen Bleuler, 1910)

Disorganized speech
Disorganized behavior
Hallucinations
Delusions
Psychosis
Emotional/Affective Symptoms
Cognitive impairment
etc

Schizophrenia

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Schizophrenia that involves: frequent visual and auditory hallucinations /delusions, disorganized speech, trouble
concentrating, and significant behavioral impairment.

Paranoid

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Schizophrenia that involves: Excessive movement (__________ excitement), or decreased movement ( ________ stupor), Inability to speak (mutism), mimicking words (echolalia), and mimicking actions (echopraxia).

Catatonic
(Excessive movement (catatonic excitement), or decreased movement ( catatonic stupor).)

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Schizophrenia that involves: Disorganized behaviors and nonsensical speech in the absence of delusions and
hallucinations.
– Most common form

Disorganized

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Schizophrenia that involves: Previously diagnosed - no longer experiencing prominent symptoms
– still exhibited symptoms including a flattened affect, psychomotor difficulties, and disturbed
speech

Residual

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Schizophrenia that involves: symptoms fit into more than one subtype of schizophrenia

Undifferentiated

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Schizophrenia’s prevalence is higher in ______ than
______ (_____ratio)

Men than Women (7:5 Ratio)

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True / False: Schizophrenia is more prominent in ________

prosperous
countries than 3rd World

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Schizophrenia: Etiological Theories

n Genetic Theories
n Twin studies
n Adoption studies
n Gene mutation
n Neurodevelopment Hypotheses
n Neurology of Schizophrenia
n Seasonal effects
n Dopamine & Glutamate Hypothesis

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Genetics in Schizophrenia shows that:

■ Adopted children studies
suggest a genetic role.
– Prenatal environment of
the biological mother
cannot be discounted.
■ Environmental influence,
such as family environment,
shown to have a role

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In Schizophrenia Genetics, one major rare gene disruption is known to greatly increase the risk of schizophrenia, mostly by disrupting the development of glutamate synapses or by
interfering with the immune system. This is known as

DISC1 (disrupted in schizophrenia 1) controls differentiation and
migration of neurons in brain development.

Suppported by
§ High prevalence of “broken copy” in large Scottish family over 5
generations - development of schizophrenia, bipolar & other mood
disorders (St. Clair et al, 1990)
§ Meta-analysis confirmed overall association and found strongest
estimate in Chinese population (Wang et al., 2018)
§ Animal studies:
§ Mutant mice with no DICS1 in brain stem cells show behaviors that
mimic schizophrenia

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In Schizophrenia Genetics, one major rare gene disruption occurs because a gene protein important for
neurodevelopment is defective, this is known as

Neuregulin 1 (NRG1 )

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Despite some genes showing correlations to schizophrenia, a new more popular hypothesis (other than DISC1 and NRG1) shows that schizophrenia is

not just one gene, but new mutations in
any one of hundreds of genes

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The neurodevelopmental hypothesis for Schizophrenia suggests

Abnormalities in the neonatal development of the nervous system leads to mild abnormalities of brain anatomy and major abnormalities in behavior
- Abnormalities could result from genetics or other influences (e.g.,
intrauterine environment)
- Environmental influences later in life aggravate the symptoms

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The neurodevelopmental hypothesis for Schizophrenia: research shows that

Research evidence:
- Babies born from mother who contracted flu in 1st trimester 7x more likely to develop schizophrenia
- Increased schizophrenia rates among people born 2-3 months after
major influenza epidemics

Risk factors increasing the likelihood include:
n Poor nutrition of the mother during pregnancy
n Premature birth
n Low birth weight
n Complications during delivery
n Extreme stress of mother during pregnancy
n Immunological rejection e.g., Rhesus factor(Rh) incompatible
n Other infections during pregnancy (Toxoplasma gondii)
n Postnatal stressors
etccccc

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Schizophrenia?: The two-hit hypothesis

Schizophrenia is the result of a combination of a genetic
predisposition and impacts from the environment in
prenatal/neonatal development, later in life, or both

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Brain Area Abornormalities as a result of Schizophrenia

Enlarged lateral ventricle and prominent sulci
Decreased tissue cerebral gray matter
Smaller PFC and hippocampus
Less gray matter and white matter
Reduced cortical connectivity and activity
Glial reductions (glial theory) : oligodendrocytes and myelin integrity (DISC1); altered microglia in temporal and frontal lobes; astrocyte
glutamate transporters in PFC

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Schizophrenia:The Dopamine Hypothesis

Positive symptoms are
caused by over-activity of
synapses between dopamine
neurons of the ventral
tegmental area (VTA) and
nucleus accumbens and
amygdala (Mesolimbic)
(TOO MUCH DOPAMINE)

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The Glutamate Hypothesis

Schizophrenia due to excessive glutamate / under-stimulation of
glutamate receptors.

Glutamate neurons fail
to excite DA neurons
(negative symptoms)

Glutamate neurons fail to excite GABA
neurons (GABA = Inhibitory)

Mesolimbic path
overactivated

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Before antipsychotic drugs became
available in the mid-1950s, most
people with schizophrenia were
indefinitely confined to ______________

mental
hospitals.

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Treatments for Schizophrenia

Antipsychotic drugs (chlorpromazine) block DA receptors
- Effective in reducing positive symptoms

Glycine or D-serine stimulate NMDA receptors and reduce schizophrenic symptoms
- Effective in reducing negative symptoms

Atypical antipsychotic - Clozapine- increases release of DA in PFC and decreases DA in nucleus accumbens – addresses all symptoms
Partial agonist

____________: serves as an agonist in regions of low concentration of the normal ligand and as an antagonist in regions of high concentrations.

Partial agonist

Major Depressive Disorder (MDD) and Bipolar Disorder are labelled as

Major Affective Disorders

A condition in which an individual has "unremitting" depression

Major Depressive Disorder but (unipolar)!!!

A condition in which an individual has cyclical periods of mania and depression

Bipolar

Bipolar Disorder can be 1. ______ 2. ______ 3. ______

BPI: full-blown mania BPII: hypomania Cyclothymic

Hopelessness and helplessness Worthlessness, self-hate, guilt Agitation/ irritability Weight loss Concentration Fatigue/lack of energy Isolation/withdrawal Anhedonia Sleep Suicidal thoughts An individual that has the following symptoms most likely has: _______

Major Depressive Disorder

True / False: Females likely to have Major Depressive Disorder than men

True

Major Depressive Disorder Monoamine Hypothesis

Depression is caused by low level of activity of one or more monoaminergic synapses -Dopamine (DA) - (anhedonia), -Norepinephrine (NE) - (psychomotor symptoms) -Serotonin (5HT) - (rumination, impulsive thoughts) Evidence: Introduction of monoamine oxidase (MAO) inhibitors -Block degradation of monoamines

Major Depressive Disorder Genetic Influence is shown through:

Twin studies: Concordance in MZ twin is ~ 65% vs 13% in DZ twins Gene Mutations Diathesis-Stress Model

Treatment of Major Depressive Disorder involving antidepressant drugs

- SSRIs and NRIs - enhance 5-HT and NE (respectively) by inhibiting reuptake of the neurotransmitters. - Tricyclics (TCAS) - Block transporter proteins that reabsorb serotonin, dopamine, and norepinephrine into the presynaptic neuron after release - Monoamine oxidase inhibitors (MAOIs) - enhance monoamines by inhibiting MAO.

The Role of Neurogenesis in Major Depressive Disorder?

- Hypothesis: Stress exposure decreases neurogenesis in the dentate gyrus of the hippocampus which causes depression. - Evidence: Treatment with anti-depressant meds alleviate symptoms at the same time that they facilitate neurogenesis in the rodent HC - Evidence: Exercise enhances neurogenesis in the HC of both animals and humans and alleviates depressive symptoms

Other treatments of Major Depressive Disorder (not drugs)

Transcranial Magnetic Stimulation Electroconvulsive therapy (ECT)

A treatment of Major Depressive Disorder that: Pulses of magnetic energy focused over a particular surface along the scalp to deactivate neurons

Transcranial Magnetic Stimulation

A treatment of Major Depressive Disorder that: An electrically induced seizure used for the treatment of severe depression. - Non-responders or suicidal patients - Applied every other day for a period of two weeks - Side effects include memory loss ■ Memory loss can be minimized if shock is localized to the right hemisphere

Electroconvulsive therapy (ECT)

The best treatment of minor / temporary / seasonal Major Depressive Disorder that is cheap is 1. __________ or 2.__________________

1. Moderate-intensity exercise 2. Alter the sleep schedule ■ Periodic sleep deprivation sometimes helpful – Seasonal affective disorder (SAD)

- Depressive symptoms - Manic episodes - Elevated mood: hyperactive, increased energy, high self-esteem (false), grandiose/delusions - Racing thoughts - loud-rapid speech -Reckless behavior: binging, poor judgment, promiscuity, spending sprees - Agitated or irritated Someone that has the following symptoms most likely has _____________:

Bipolar Disorder

Bipolar Disorder Genetic Influence is shown through:

- Concordance in MZ twins is 80% - Neurology of Bipolar ■ Overactive Amygdala (see MDD) ■ Overactive ACC (see MDD) ■ Enlarged lateral ventricles (remember DISC1?)

Treatments for Bipolar Disorder:

Lithium - Stabilizes mood and prevents relapse in mania or depression - Exact mechanism is unknown, but shows neurotrophic effects Possibly by - Decreasing glutamate activity - Decreases inflammation in the brain

A person that has unfounded, unrealistic, chronic fear would likely have:

Anxiety

Common Types of Anxiety Disorders

– Generalized anxiety disorder – Panic disorder – Specific phobias – Obsessive compulsive disorder – Post-traumatic stress disorder

Excessive uncontrollable anxiety and worry – Symptoms: fatigue, muscle tension, restlessness, irritability, sleep disturbances, concentration problems ■ Common co-morbidity with depression A person with the following symptoms would most likely have which version of Anxiety Disorder

Generalized Anxiety Disorder (GAD)

- Characterized by repeated and unexpected panic attacks along with worry about future attacks - Anxiety sensitivity ■ Symptoms of panic attack are similar to those of heart attack and include chest pains, rapid heartbeat, shortness of breath A person with the following symptoms would most likely have which version of Anxiety Disorder

Panic Disorder

An unreasonable or excessive fear of an object, situation, or activity is known as a __________

Phobia

In Anxiety / Specific Phobias there are three main broad categories

1. Agoraphobia 2. Social phobia 3. Specific phobias

A person with anxiety that is: fearful of a public place or being outside of the home to the extent that a panic attack or extreme embarrassment is possible. They have __________

Agoraphobia

A person with anxiety that is: a fear of social activity, especially of being scrutinized and embarrassed. They have _________

Social phobia

A person with anxiety that: has exaggerated fear of specific objects/situations not covered by the other two main versions of phobias

Specific phobias

True / False: Genetics Plays a role in MDD, BPD, and Anxiety Disorders overall.

True

Brain differences in individuals with anxiety:

- Increased activation of amygdala and decreased activation of prefrontal cortex (PFC) while looking at angry faces - In healthy controls, vmPFC decreases activation of amygdala, but not in persons with anxiety - High levels of anxiety correlates with increased activation of amygdala, insular cortex and anterior cingulate cortex

thoughts, images, or impulses that are intrusive enough to cause marked rise in anxiety

Obsessions

ritualistic behaviors or mental acts that are designed to lower anxiety

Compulsions

OCD and the brain

Hyperactivity in: – Caudate nucleus (Basal Ganglia): compulsivity and impulsivity – Orbitofrontal cortex (OFC): obsessive thoughts – Anterior cingulate cortex (ACC): emotion regulation ■ Dysregulation of cortico-basal ganglia-thalamo-cortical (CBGTC) loop – System of neural circuits ■ Dysfunction in 5HT and DA systems

occurs in some people after terrifying experiences and includes the following symptoms: – Frequent distressing recollections – Nightmares – Avoidance of reminders of the event – Exaggerated arousal in response to noises and other stimuli

Post-traumatic stress disorder (PTSD)

PTSD and the brain

■ The amygdala is essential for the extreme emotional impact that produces PTSD ■ Dysregulation of HPA-axis: Lower than normal cortisol levels and blunted cortisol response to acute stressor ■ Smaller than average hippocampus – Veteran Twin Study (Gilbertson et al., 2010)

Suprisingly individuals that are – High IQ – Artists – Scientists – “Geniuses” have higher rates of

Mental Illness