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Brain and Behaviour > Week 9- Psychosis and Movement Disorders > Flashcards

Week 9- Psychosis and Movement Disorders Flashcards

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The Brain flashcards
1
Q

What is the pattern in AD

A

Memory impairment , possible with expressive defects and deficits in complex executive function with preserved attention and visuospatial

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2
Q

What is the difference between pyramidal and extra-pyramidal symptoms

A

Pyramidal: spasticity and weakness

Extrapyramidal: no overt weakness, rigidity, hypo/hyperkinesia

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3
Q

rule of thumb: more dopa –>

A

direct pathway, more movement

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4
Q

anxiety makes all tremors….

A

worse…adrenalin sensitizes the muscle spindle

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5
Q

Differentiate essential tremor and parkinson’s tremor

A

Essential: PD

  • head voice can be affected: uncommon for head to be affected
  • symmetric: assymmetric
  • maybe cogwheeling: rigidity
  • large writing: micrographia
  • better when walking: worse when walking
  • better with EtOH: no change with EtOH
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6
Q

Parkinson’s tremor is a ____________

A

rest tremor, disappears with intention!!

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7
Q

early signs of PD

A

anosmia, depression, sleep disturbance, masked facies, stiffness, decreased arm swing, constipation

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8
Q

Sinemet is:

What does the therapeutic window do as disease progresses?

A

carbadopa + levodopa (carbadopa reduces the peripheral breakdown of levodopa)

narrows

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9
Q

Treatment of essential tremor

A

propranolol or primidone (anticonvulsant)

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10
Q

Treatment of chorea, tics and ballism?

A

An antidopaminergic drug (e.g. tetrabenzine or haloperidol

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11
Q

What are the four dopamine pathways and which are responsible for psychotic symptoms?

A
  1. Mesocortical ( less dopa here …negative symptoms like flat affect, ahedonia)
  2. Mesolimbic (more dopa here…positive symptoms)
  3. Nigrostriatal (basal ganglia communication)
  4. Tubuloinfundibular (inhibits prolactin)
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12
Q

antipsychotics….how they work, and broad side effect profiles

A

Variable blockade of:

  • D2
  • H1
  • alpha1
  • M1
  • 5HT2a (for atypical)

S/E can be grouped into metabolic (from blocking H1…) and extrapyramidal-ish (EPS symptoms

Atypicals are “better” because they antagonize 5-HT2a. 5-HT2a physiologically slows dopa release. Blocking 5-HT2a then will increase dopa release, but the trick is that there are more of the receptors in the mesocortex so they treat the negative symptoms well without exacerbating the negative symptoms.

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13
Q

APs treat and AAPs treat

A

positive symptoms, negative symptoms

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14
Q

All APs are ______efficacious except _______

A

equally…sort of…it doesn’t appear that one is better than the next…. except clozapine, but this one is associated with agranulcytosis

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15
Q

treatment of neuroleptic side-effects

  • acute dystonia
  • pseudo-parkinsonism
  • akathisia
  • tardive dyskinesia
  • neuroleptic malignant syndrome
  • agitation
  • insomnia
  • persistent aggression
A

acute dystonia: anticholinergic

pseudo-parkinsonism: anticholinergic

akathisia: beta-blocker

tardive dyskinesia: STOP anticholinergic

neuroleptic malignant syndrome:

agitation

insomnia: benzos

persistent aggression: mood stablizer

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16
Q

Contrast actions of dopa and serotonin

A

Dopa: reward, pleasure, motor fine tuning, compulsion, perseveration

5-HT: mood, memory, sleep, cognition…akathisia is too much 5-HT?

17
Q

S/S of the serotonin syndrome!

A

rigidity, myoclonic, hyper-reflexic, vasomotor instability, confusion, disorientation

18
Q

What is catatonia?

A

marked decrease in reactivity to environment

19
Q

To know:

  • delusion disorder (1 month)
  • brief psychotic disorder (1 day- 1 month)
  • schizophreniform (1 month-6 months)
  • schizophrenia (>6 months)
  • Schizoaffective (at least 2 weeks of schizophrenic symptoms alone + mixed/manic/depressed episode)
  • due to another condition
  • Substance use disorder psychosis
  • attenuated psychotic
A
20
Q

What are the negative symptoms

A
  • alogia (poverty of speech)
  • Anhedonia
  • Asociality
  • Avolition (decreased purposeful behavior)
  • Affective blunting
21
Q

The neurotransmitter psychosis hypotheses

A

dopa

5-HT (increased activity…5-HT regulates dopamine tone)

glutamate (decreased transmission or NMDA function)

ACh-Da imbalance

22
Q

What is the neurodevelopmental hypothesis?

A

neuronal changes occur while the brain is developing. Limited evidence for continued degeneration

23
Q

Monozygotic concordance with schizophrenia, bipolar, MDD, panic

A

Schizo: 50

Bipolar: 70

MDD: 35

Panic: 25

24
Q

All of the following are associated with basal ganglia lesions except…. intention tremor ( but abnormal postures is ass. with basal ganglia)

A
25
Q

The cerebellar hemispheres are involved in learned and skilled motor activities, with the major output originating in the dentate nucleus and projecting to the VL/VA nuclei of the thalamus via the dentatorubrothalamic tract.

lateral hemispheres…

A
26
Q

Most prominent imaging based finding in schizophrenia

A

ventricular dilatation (not decreased hippocampal volume, although this also happens)

27
Q

The A in TRAP stands for….

A

Akinesia…not ataxia. people with PDs don’t usually get ataxia

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