Week 2 Flashcards
Panic attack is not a _________ and cannot be coded. Panic Disorder however can because it is ___________.
Mental Disorder
Repetitive
Sx of Panic attack
Difficulty Breathing, chest pain, hyperventilation, parasthesis, etc.
Panic/Anxiety: Role of Amygdala in the 3 part emotional processing of the brain
Stage 1, Evaluation: Amygdala is the evaluator = provides primary unconscious response to danger. Very “danger or no danger” based.
Stage 2, Expression: Stress Response via direct pathway (hypothalamus tract, cortisol) or indirect pathway (adrenal glands, cortisol + NE).
Stage 3: Subjective Emotion: Fear or Anxiety.
Which two portions of the Brain control the amygdala?
Medial PFC (Anterior Cingulate Cortex) + Hippocampus help inhibit amygdala to limit the stress response.
Describe the Degenerative Cascade
When excessive cortisol shuts down the hippocampus so it cannot inhibit the amygdala. As a result the amygdala becomes further activated => increased cortisol and therefore continuous shut down of the hippocampus = continuous stress.
F(x) of amygdala
Control center of emotional processing. Especially in response to potential threats.
Effects of GABA, Serotonin, and NE on stress.
GABA = inhibitory function in general, including the amygdala.
Serotonin and NE effects = not exactly known but Sertonin may modulate NE release from the Locus Coeruleus which would increase the action of the hippocampus.
PTSD: DSM-5, 6 symptoms
TRAUMA
- T = Traumatic event
- R = Re-experiences
- A = Avoidance and Emotional Numbing (detachment from others, loss of motion)
- M = One month duration or longer
- A = Arousal Increased (startle reaction, irritable, poor concentration, etc.)
PTSD: Details on Traumatic Events
- Unexpected death of family or close friend due to NATURAL causes is no longer included.
- Exposure Type 1 = PERSONAL INVOLVEMENT in an event that has definite potential for serious injury or death to oneself. Potential loss of life or limb is key here.
- Exposure Type 2 = WITNESSING first hand an event that has definite potential for serious injury or death to someone else.
- Exposure Type 3 = LEARNING OF AN EVENT that has definite potential for serious injury or death of another person.
PTSD: Differential Diagnosis (Many)
- Specific Phobias (no re-experience)
- Panic Disorder (not triggered by recall of trauma)
- Generalized Anxiety Disorder (Did not occur due to traumatic event)
- Dissociative Disorder (Absence of re-experiencing and hyper arousal symptoms)
- Obsessive Compulsive Disorder (not related to traumatic event)
- Malingering (RED)
PTSD: First Line Therapy
SSRIs. Cognitive Behavioral Therapy is also good.
PTSD: Main Brain components involved and overall dysfunction
Amygdala and Hippocampus. From the lecture it sounds like dysfunction of the hippocampus to inhibit the Amygdala. Similar to the anxiety disorders…?
Case of Multiple Memory System
- What happened during the case
- What are the different “multiple memory systems” and which parts of the brain control them?
- What happened: a patient could not retain any new information and never remembered the doctor. However, doctor once shook her hand with a tack in his hand and from then on, she hesitated to shake the doctor’s hand but she didn’t know WHY.
- Implicit Memory system => Subconscious learning to avoid hand, registers any emotional response. via AMYGDALA
- Explicit Memory System => conscious learning, knowing the WHY reasons. via Hippocampus and Medial Temporal Lobe.
OCD Related: Dysfunction in the following areas of the brain (3)
- Striatum (caudate and putamen) => controlling center for motor center
- Orbital Frontal Cortex => Inhibitory function controlling behavior
- Anterior Cingulate Cortex => Monitors what the rest of the brain is doing.
OCD: Possible Manifestations in Brain Structure(3)
- Decrease in Grey Matter Volume (via structural study, MRI)
- White Matter damage (via structural study, DTI)
- Reduced Frontal-Striatal activation (via functional Study, fMRI)
OCD: Motor functions of the striatum
D2 mediated (INDIRECT PATHWAY) = inhibits thalamus and therefore no excitatory signal to the cortex
D1 mediated (DIRECT PATHWAY) = DISinhibits thalamus and therefore excitatory signal to the cortex
OCD: Neurotransmistters heavily involved + f(x)
- Serotonin and Dopamine => may influence striatum motor functions
OCD: Steps of OCD + areas of Brain involved
- Anxiety over Perceived Threat => Stress Response System (amygdala, HPA axis, and hippocampus
- Obsessions => ACC and mPFC usually serve to terminate the anxiety but feedback system doesn’t work every well
- Compulsion => OFC usually monitors behaviors generated from the striatal motor system but not here.
Definition of Somatic Symptom Disorder
Excessive thoughts, feelings, or behaviors related to somatic symptoms (Sx already present)
Definition of Illness Anxiety Disorder
Preoccupation with having or acquiring a serious illness (Absent or mild Sx present)
Definition of Conversion Disorder + Tx.
A somatoform disorder involving actual loss of bodily functions due to anxiety (blindness, weakness, numbness, etc.)
- Red Flag phrase = La belle indifferencem seems unconcerned about their deficiet.
Tx: Reassurance
Defintion of Factitious disorder
Falsification of physical or psychological symptoms but NO SECONDARY GAINS. Factitious disorder can be imposed on another person (like child)
Definition of Malingering
Falsification of symptoms with secondary gains.
Definition of Body Dysmorphic Disorder
Debilitating preoccupation with physical defect: real or imagined. “Big Ears.”
Definition of hypchondriasis
- Misinterpets/fixates on/exaggerates physical symptoms.
- FEAR despite reassurance to the contrary: Pathognomonic feature.
- Dx made after > 6 months of nondelusional preoccupation with Sx.
Definition of Pain Disorder
Pain associated with underlying psychological stress (headache commences at time of divorce proceedings) = Pain is the focal point.
DX of Somatoform Disorder: Not used in DSM5
Use PHQ. If patient is obthered a lot by at least 3 sx without adequate medical explanation.
- Stomach Pain, Back Pain, headaches, Chest Pain, Pain in arms, legs, joints, dizziness, shortness of breath, etc.
3 Required clinical criteria for each sx of somatoform disorders.
- Cannot be fully explained
- Not a result of Factitious or Malingering!!
- Cause significant impairment of social, occupational, etc.
Best TX for Somatoform Disorders
CBT + Psychiatric Referral (STAR)
Dissociative Disorders: Depersonalization/dereailzation disorder
Feeling unreal, detached from yourself.
- Dissociation = Defense Mechanism
Dissociative Disorders: Dissociative Amnesia
Inability to recall autobiographical information
- Repression = Defense Mechanism
Dissociative Identity Disorder
used to be called “multiple personality disorder”
- Interjection and projection = Defense Mechanism
Dissociative Fugue Feature
Ending up in a new place without remembering anything about the trip, not planned
- Repression = Defense Mechanism
Refusing to accept a diagnosis of cancer and continuing to seek “second opinion” from many different doctors despite repeat confirmation
Denial
Painful memories of seeing a friend die as a child are kept out of conscious awareness even though related cues may still induce emotional response
Repression
A person tells his family about HIS late stage cancer diagnosis in a “matter of fact” fashion without any emotion
Isolation of Affect
A person recounts an abuse in childhood as if he was watching the vent unfold as a bystander
Dissociation
A person convinces himself that oral sex (instead of intercourse) outside of marriage does not count as infidelity
Rationalization
A person seeks to research extensively on the physiological and pharmacological aspects of her newly diagnosed illness
Intellectualization
A person is abused by a parent as a child and then takes on the abuser’s behavior toward her own child
Identification/Introjection
A girl criticizes a classmate’s work as mediocre when the teacher praises it as the best in the class (protects self esteem)
Projection
A man angry at his boss at work goes home and takes out his hanger on his wife and children and then pounds his desk
Displacement
A grown person giggles like a child when the topic of conversation makes her uncomfortable
Regression
A formerly well behaved teenager engages in serious delinquent behavior with others when the real issue was her anxiety over the divorce of her parents
Acting Out
A husband worried about his wife getting upset about him coming home late washes the dishes immediately after he arrives home.
Undoing
