Week 4 Flashcards
genetics
- exact genetic basis of most psychiatric disorders remains unclear
- family members of individuals who have major mental disorders increased risk for the same disorder (ex: schizophrenia, bipolar disorder)
epigenetics
- challenges the ancient ‘nature/nurture’ debate
(it is not either/or but about interactions of genes with an individual’s environment) - cells w identical genetic make-up (genotype) can function in radically different ways
- genotype is influenced by environment and lifestyle prenatally and across the life span
- chemicals that change or mark a genome in a way that directs genetic expression (methyl groups, histones)
- epigenome marks (turns on or off) the genome directly through DNA methylation and indirectly through histone modification
what is the autonomic nervous system
linkage between brain and internal organs that allows for maintenance of homeostasis
2 divisions of ANS
- PSNS - rest + digest
- SNS - fight or flight
occipital lobe
visual area
- sight
- image recognition
- image perception
temporal lobe association area
- short term memory
- equilibrium
- emotion
motor function area
initiation of voluntary muscles
bronca’s area
muscles of speech
somatosensory association area
- evaluation of wt, texture, temperature, etc for object recognition
wernicke’s area
written and spoken language comprehension
describe the frontal cortex
- “guide behaviour” in absence of, or despite discriminative environmental stimuli
- orbitofrontal: contain olfaction, reward value of smell, taste, and other sensations, “personality” or other social-emotional changes
- humour
- judgement
- abstract thinking
- creativity
- maintaining social appropriateness
- contains “motor cortex”
prior to the 1970’s what did neurologists and neurosurgeons think about the frontal cortex
that this area was “silent,” often sacrificing them in surgery
whats the L prefrontal in frontal cortex do
fluency in spontaneous speech
whats the R prefrontal in frontal cortex do
fluency in design
what can happen after frontal lobe damage occurs
personality changes after frontal lobe damage (ventromedial and orbitofrontal regions
- disinhibition
- emotional instability
- aggression
- irritability
- impulsiveness
describe the parietal lobe
- all about understanding the world around you
- coordinates processing of sensory information (including spatial relationships, sensory inputs, interpreting visual and mathematical information)
- proprioception and body awareness
describe the temporal lobe functions
- visual recognition
- auditory
- emotion
- memory
- olfaction
what is the limbic sys
- helps modulate basic emotions and memory
- regulates autonomic and endocrine function in response to emotional stimuli and also is involved in reinforcing behaviour
- compromises several small structures that work in a highly organized way: include hippocampus (storing memories), thalamus (relays sensory info), hypothalamus (basic human activities such as a sleep-rest patterns, body temperature and physical drives), amygdala (primitive center of the brain sense of smell)
what are 2 subcortical temporal lobe limbic structures
1) hippocampus
2) amygdala
what’s the hippocampus
learn and remember thoughts, events, things, places
amygdala
emotions, feelings attached to thoughts, events, things, places
occipital lobe
- visual processing center
- damage to this area causes cortical blindness: retina and optic nerve are intact but the person cannot see
object agnosia
- pt can see (acuity, colour, and motion preserved)
- can not recognize (name, describe, demonstrate use of an object)
- can not copy an object or picture
- may only be able to draw from memory only
prosopagnosia
inability to recognize faces including self in mirror, friends, famous people
pure alexia
inability to read words, in the absence of other language problems
what is aphasia
language disorder
what is broca’s aphasia
(expressive, non-fluent)
- loss of ability to produce language
- comprehension is in intact
wernicke’s aphasia
receptive, fluent
loss of comprehension or understanding of speech
what are 2 types of brain cells
- glia
- neurons
3 types of glia cells (just state)
- astrocytes
- oligodendrocytes
- microglia cells
astrocytes
regulate blood flow, form the BBB
oligodendrocytes
produce the myelin sheath, speeds electrical conduction
microglia cells
immune cells of the brain
what does overactivity of dopamine relate to
related to signaling pathways underlie thought disturbances of schizophrenia
deficiencies in pathways involving NE, serotonin or both…
underlie depression and anxiety
insufficient GABA-related signalling may play a role in…
anxiety
pharmacological treatment is directed at …
suspected neurotransmitter - receptor problems
what do antipsychotic drugs do
improve dopamine signaling
antidepressant drugs alter
neurotransmission by NE, serotonin, or both
antianxiety drugs enhance
the actions of GABA, 5-HT, NE, or all 3
2 types of neuroimaging + describe
1) structural
- visualization of brain structures
- types: CT, MRI
2) functional
- shows how the brain is working
- observe metabolic functioning
ex: cerebral blood flow, neuro receptor location and function and distribution of specific chemicals
- types: PET, SPECT
how does computed tomography (CT) or computed axial tomography (CAT)
- uses an x-ray bean passed through the head in serial slices
- high speed computers measure the decreased strength in the x-ray beam that results from absorption (degree of energy absorbed by a tissue is proportionally related to its density)
- computer assigns a shade of grey that reflects that change then develops a 3D x-ray image (CSF absorbs the least so it appears the darkest, whereas bone absorbs the most and appears light
describe magnetic resonance imaging (MRI)
0 magnetic field causes hydrogen-containing molecules to line up and move in symmetric ways around their axes
- magnetic field is then interrupted in pulses, causing the molecules to turn 90 or 180 degrees
- electromagnetic energy is released when molecules return to their original position
- energy released is related to the density of the tissue and is detected
what is single photon emission computed tomography (SPECT) and positron emission tomography (PET)
- functional scan
- uses gamma rays
- both procedures require administering radioactive tracers that bind to sugar substances that emit charged particles which are measured by scanning equipment
describe to me depressive disorders
- common feature of all depressive disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function
- differences characterized by duration, timing, or presumed etiology
- somatic symptoms: changes in appetite, lack of energy, sleep disturbance, aches and pains
for major depressive disorder diagnostic criteria how much of the symptoms do you have to have
5+
diagnostic criteria for major depressive disorder
- depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
- markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- significant wt loss when not dieting or wt gain, or decrease/increase in appetite nearly every day
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly every day
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive or inappropriate guilt nearly every day
persistent depressive disorder (dysthymia) diagnostic criteria
(chronic major depressive disorder)
A) depressed mood for most of the day, for more days then not, as indicated by either subjective account or observation by others, for at least 2 years
(in children and adolescents, mood can be irritable and duration must be at least 1 yr)
B) presence, while depressed, of 2+
1) poor eating or overeating
2) insomnia or hypersomnia
3) low energy or fatigue
4) low self esteem
5) poor concentration or difficulty making decisions
6) feelings of hopelessness
C) during 2 yr period (1 yr for children/adolescents) of the disturbance, the individual has never been w/o the symptoms in Criteria A and B for more than 2 mo at a time
D) criteria for a major depressive disorder may be continuously present for 2 yrs
E) there has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder
monozygotic (identical) twins show concordance rate of ______ _____ _____
50% for MDD
studies show that the influence of genetic factors and MDD is around ______. non-genetic factors explain the remaining _______
30-40%.
60-70%.
(individual-specific environment effects (ex: adverse childhood events, ongoing recent stress, trauma, low social support
describe stress
- corticotropin-releasing hormone (CRH) is released from hypothalamus in response to perception of psychological stress
- this induces the release of cortisol, which when prolonged can have neurotoxic effects on the hypothalamus, resulting in an altered stress response (exaggerated stress response)
- altered stress hormone secretion appears most prominent in depressed pts w a history of childhood trauma
- elevated cortisol may act as a mediator between major depression and physical long-term consequences such as CAD, T1D, T2D, and osteoporosis
describe monoamine-deficiency theory
(serotonergic, dopaminergic and norepinephrine)
- monoamines are involved in regulation mood, attention, reward processing, sleep, appetite, cognition
- almost every compound that inhibits monoamine reuptake, has been shown to be a clinically effective antidepressant
- this theory posits that the underlying pathophysiology of depression is a depletion of the neurotransmitters serotonin, NE, or dopamine
quick summary of depression
1) concept description
2) mnemonic for diagnosis + how much do you need to be diagnosed
- depression is a concept that can be both a symptom and a disorder
- in additional to depressed mood must have 5 symptoms
a) Sleep disturbances
b) loss of Interest (anhedoniaa - which is a pervasive lack of pleasure)
c) increased Guilt (or persistent worthlessness)
d) low Energy ( or high in cases of atypical depression)
e) loss of Concentration
f) Appetite changes (increase or decrease)
g) Psychomotor disturbances
h) Suicidal ideation
3 phases of treatment and recovery for depression
- acute phase (6-12 wks) - directed at reduction of depressive symptoms and restoration of psychosocial and work function *hospitalization may be required
- continuation phase (4-9 mo) - directed at prevention of relapse through pharmacotherapy, education, and depression specific psychotherapy
- maintenance phase (1 yr or more) - treatment is directed and prevention of recurrences of depression
depression pharmacological interventions (7)
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
- norepinephrine reuptake inhibitors (NRIs)
- norepinephrine-dopamine reuptake inhibitors (NDRIs)
- serotonin-norepinephrine disinhibitors (SNDIs)
- tricyclic antidepressants (TCAs)
- monoamine oxidase inhibitors (MOAIs)
electroconvulsive therapy (ECT)
- electrical current passed through the brain, intentionally triggering a brief seizure
- causes changes in biochemistry (neurotransmitters), neurogenesis in the hippocampus, blood flow, changes in BBB, etc
ECT indicators
- treatment resistant depression
- when a pt is experiencing intense suicidal ideation, and there is a rapid, definitive response
- when a pt is severely malnourished, exhausted, dehydrated
- when there is marked agitation
- catatonia
- major depression w psychotic features
- for ppl w rapid cycling mood swings
transcranial magnetic stimulation (TMS)
- non-invasive treatment that uses magnetic resonance imaging (MRI) - strength magnetic pulses to stimulate focal areas of the cerebral cortex. biochemical response
- approx. 50-60% w medication resistant depression experience clinically meaningful response, and about 1/3 experience a full remission
- not permanent, high recurrence rate, but effects can last months (avg just over a yr)
postpartum blues
- first 2 wks postpartum
- s/s: irritability, anxiety, fluctuating mood, increased emotional reactivity
- mild and spontaneously remits, not considered psychiatric disorder
postpartum depression s/s
s/s: excessive guilt, anxiety, anhedonia, depressed mood, insomnia/hypersomnia, suicidal ideation, fatigue
- moderate to severe symptoms, prolonged course
postpartum psychosis
- in first 3 months postpartum
- s/s: mixed or rapid cycling, agitation, delusions, hallucinations, disorganized behaviour, cognitive impairment and low insight
- severe, considered psychiatric emergency: often necessitates hospitalization
psychosis def
used to describe conditions that affect the mind, in which ppl have trouble distinguishing btwn what is real and what is not
def of postpartum depression (PPD)
- non-psychotic depression experienced shortly after childbirth
- diff from “baby blues”
- DSM-5 does not recognize PPD as a separate diagnosis: must meet criteria for major depressive episode, use perinatal-onset specifier
- linked to hormonal shifts
postpartum depression (PPD) diagnosis
- starts within the 1st month after childbirth and can last wks to mo’s
- major depressive episode w … an onset in pregnancy or within 4 wks of delivery
postpartum depression (PPD) common s/s
focus on motherhood or infant care
- depressed mood or depression w anxiety
- anhedonia: loss of interest in things that would normally bring pleasure, including the baby
- changes in wt or appetite
- sleep disturbance and fatigue
- physical feelings of being slowed down or restlessness, jumpiness and edginess
- excessive feelings of guilt or worthlessness
- diminished concentration, inability to think clearly
- recurrent thoughts of death or suicide
postpartum depression (PPD) treatment
- same as for depression
- antidepressants: fluoxetine (prozac) and paroxetine associated w a small increase in birth defects
- cognitive behavioural counseling (CBT)
- supportive counseling
- increased social support
strong predictors risk factors for postpartum depression (PPD)
depression or anxiety during pregnancy, stressful recent life events previous history of depression
moderate predictors risk factors for postpartum depression (PPD)
- childcare stress, low self-esteem, maternal neuroticism (negative emotional state) and difficult infant temperament (ex: colic)
small predictors risk factors for postpartum depression (PPD)
obstetric and pregnancy complications, single marital status, poor relationship w partner, lower socioeconomic status
can men experience postpartum depression
yes
DSM5 diagnosis
- major depressive episode within 4 wks of delivery
- symptoms are the same
- lack of terminology to describe the phenomenon
4 types of restraint
1) physical
- restraining limbs
- moving a person to another location against their will
2) mechanical
- limb, waist, and trunk
- back-fastening seat belt
- full bed side rails
- chair w locking table
- broda/geri
3) environmental
- seclusion room
- half door, barricades
- wanderguard
- secure units
4) pharmacologic
- antipsychotics
- antidepressants
- sedatives
- benzodiazepines
- may be scheduled or prn
