Week 6- Emotion and Personality Flashcards
What sensations is the hippocampus informed of?
ALL of them. It has input from the amygdala, sensory association areas (therefore sensations go to the cortex first) and the entorhinal cortex (which is like bc in the parahippocampal gyrus
How many nuclei does the amygdala have and which one regulates social behaviour and which one regulates cortisol
4 nuclei (medial, central, lateral and basolateral)
Central does Cortisol
Medial does social behaviour (the face you present to the media)
Which nuclei in the hypothalamus do diurnal cycles, ADH response, melatonin and the final common pathway for cortisol release?
SCN: diurnal cycles (makes sense, it’s right above the optic chiasm)
SON: ADH response
MB: melatonin
PVN: final common pathway for cortisol release. lies next to the ventricle but is still protected by the BBB
What are the acute and chronic sequelae of the panic response?
This comes back to cortisol
- mobilize energy–> myopathy, DM
- increase vascular tone –> HTN
- suppress digestion —> ulcers
- suppress reproduction–> amenorrhea
- suppress immune system–> increase infection risk
- sharpen cognition–> eventual neuronal cell death
Appearance/ Assessment (Attention, LOC, orientation
Speech
Emotion (mood and affect)
Perception (hallucinations, illusions)
Thought
- content: obsessions, delusions
- form: circumstantiality, tangentiality, perseveration
Insight and Judgement
Cognition (MMSE)
What are the DSM IV axes?
- Major psych conditions
- Personality and intellectual disability
- The medical problems
- Psychosocial and environmental stressors
- Global assessment of function (WHODAS)
SIGECAPS
Sleep
Interest
Guilt
Energy
Cognitive changes
Appetite
Psychomotor changes
Suicide
What are the criteria for major depressive episode, manic episode, hypomania?
What combination of these mood episodes give MDD, bipolar 1 and bipolar 2?
Major depressive episode (lasts 2 wks or more):
- decreased mood OR ahedonia
- AND
- 4 of SIGECAPS
Mania ( lasts 1 wk or greater and causes distress/impairment/hospitalization)
- 1 wk of elevated/expansive/irritable mood AND
- 3 of:
- decreased need for sleep
- racing thoughts
- pressure of speech
- distractability
- grandiosoty
- increased goal-directed activity
- increased involvement in pleasurable but risky activities
Hypomania (lasts less than 4 days and does not cause impairment)
- all of the above
MDD:
- At least one major depressive episode
Bipolar I
- MDD + at least one mania
Bipolar II
- MDD + at least one hypomania
How long does dythymia have to last for to be diagnosed?
2 yrs of chronic low grade depressive sx
What are the 5 factors of personality
- emotional stability/neuroticism
- Extroversion
- Openness to experience
- Agreeableness
- Conscientiousness
What is a personality disorder? When is the usual onset?
An enduring pattern of inner experience that deviates markedly from expectations of a person’s culture. Manifests in (>2) cognition, impulse control, affectivity, interpersonal functioning. It is inflexible and pervasive across situations. Causes functional impairment or distress.
Onset is usually in adolescence/young adulthood.
What are the three clusters of personality disorders?
A: odd & eccentric
- paranoid (Mad-Eye Moody)
- schizoid: detached, does not connect **(arelational) **(Professor Snape)
- schizotypal: relational discomfort, cognitive/perceptual distortions, eccentricities (…Luna Lovegood)
B: dramatic & erractic
- histrionic: excessive emotionality + need for attention (Professor Trelawney)
- boderline: unstable relationships, unpredictable, impulsive (Moaning Myrtle)
- antisocial: disregard for others, superficially charming but hostile when confronted (Voldemort)
- narcissitic: need for attention, lack of empathy (Gilderoy Lockhart)
C: Anxious & fearful (much ADO about nothing…)
- Avoidant: social inhibition, hypersensitive (but has desire to be close to others vs. schizoid)
- Dependant (Merope)
- Obsessive-Compulsive (Percy)
Tx is behavorioural therapy and perhaps antipsychotics for schizotypal
What is anxiety vs. fear? What are the common features of anxiety disorders?
Anxiety: anticipation of future threat
Fear: emotional response to perceived threat
Unwanted emotion, thoughts and actions
Panic attacks are a feature of all anxiety disorders
Lifetime prevalence for GAD, social anxiety and specific phobia?
GAD: 55%!!!!
Social anxiety disorder: 5-15%
Specific phobia: 7-10%
How long does a panic attack usually last for?
less than 20, peaks at 10
How long do you have to have unexpected recurrent panic attacks to have Panic Disorder? How to differentiate from agoraphobia, specific phobia, GAD
At least one month, with persistent concern of further attacks or maladaptive behaviour.
Agoraphobia duration is 6 months, there is a fear of a particular situation AND there is avoidant behaviour. Agoraphobia the fear is loss of control.
Specific phobia can be to an object or situation, the person recognizes the fear is unreasonable.
GAD: excessive anxiety and worry with restlessness, fatigue, difficulty concentrating, muscle tension etc… for 6 months
PTSD features
reexperiencing
avoidance
negative changes in mood and cognition
hyperarousal
What brain circuits are dysregulated in OCD
frontal striatal: there is dysregulation in the circuit that does error monitoring (the person gets a persistent error message)
What is the cognitive model of panic attacks?
trigger–> perceived threat–> apprehension–> body sensation–> body sensation perceived as catastrophic–> percieved threat –>apprehension etc…..
What are the monoamines? What terminates the action of monoamines? What is the monoamine hypothesis and what does it pertain to?
5-HT, NE, Dopa
- MOA (all), COMT (NE and dopa), SERT (5-HT)
Monoamine hypothesis: depressed state due to upregulation of monoamine receptors
Bipolar disorder is more like dopaminergic dysregulation
Which symptoms are 5-HT, NE and dopa involved in the pathopathysiology of depression?
All three: Sleep, mood, apathy, psychomotor
NE/dopa: concentration and fatigue
5-HT: guilt, weight, suicidal ideation
What are the different classes of anti-depressants and what do they block? What are mood stabilizers and what are anxiolytics?
SSRIs: block SERT
- fluoxetine, escitalopram, paroxetine
SNRIs (5-HT, NE): block SERT and NERT
- venlafaxine, duloxetine
NDRI (NE, dopa): weakly blockes dopa and Ne reuptake. doesn’t block SERT or MAO
- bupropion only
NaSSA (NE and serotonin specific antidepressant)
- antagonizes alpha-2 (presynaptic) causing more NE and 5-HT release.
- blocks 5-HT 2A and 2C…thought to increase 5-HT1 transmission
- mirtazapine
SARI’s (5-HT antagonist, reuptake inhibitor):
- blocks 5-HT 2A, 2C
- trazadone
TCA’s
- based on chemical structure, not mechanism SNRI, SRI, NRI
Mood stabilizers are some AED + lithium and are used in bipolar disorder
Anxiolytics are 1st line SSRI/SNRI at lower dose +/- short term benzos and are used in anxiety disorder
What are the various blockades possible with TCAs
Histamine: weight gain, fatigue
anti-cholinergic: blurred vision, dry membranes, urinary retention
alpha-adrenergic blockade: orthostatic hypotension
Na channel blockade: arrhythmia in overdose
What are mood stabilizers?
Most of them are ALSO anticonvulsants:
- carbamazepine
- valproate
- lamotrigine
And lithium, which is not an AED
What are the important/memorable side effects of:
SSRIs
NDRI
SARI
SSRIs:
- wt gain
- sexual DFx
- bleeding (5-HT is a platelet activator…don’t use with warfarin!)
NDRI (bupropion):
- can cause insomnia if dosed too close to bed
- less sexual effects
SARI (trazadone)
- priapism
TCAs can have a blockade of
- histamine
- ACh
- alpha adrenergic
- sodium channels
MAO
- hypertensive crisis…have to watch tyramine in diet
What is the reason for the time to clinical effect gap with SSRIs? (autoreceptors and stuff)
SSRIs block SERT. This increases 5-HT concentrations. This tells the presynaptic neuron to downregulate the number of 5-HT1A receptors in the presynaptic terminal. Normally these receptors (like most auto-receptors) DECREASE the amount of sertonin release. So if you decrease the number of 5-HT1A receptors, you increase the amount of serotonin released
In CBT, automatic thoughts are….
thoughts on the periphery of awareness…
Does the presence of GAD increases the risk of other mood disorders or anxiety disorders? Or both?
Both.
