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PSYCH 275 > Chapter 14: Psychological Disorders > Flashcards

Chapter 14: Psychological Disorders Flashcards

1
Q

What is the name of the DSM-5?

A

Diagnostic and Statistical Manual of Mental Disorders, 5th edition

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2
Q

What is the difference between incidence and prevalence?

A

Incidence is the amount of people diagnosed with a psych disorder in a certain period of time (one year usually), and prevalence is the total amount of people with a specific psych disorder at a point in time.

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3
Q

What is schizophrenia?

A

A debilitating disorder characterized by perceptual, emotional and intellectual deficits, it is the most severe psych disorder, all social classes are equally vulnerable BUT once diagnosed people tend to drift towards lower SES. It involves a loss of contact with reality and an inability to function in life

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4
Q

What does it mean that schizo is a psychosis?

A

It means that the individual has severe disturbances in reality, orientation and thinking.

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5
Q

What are the positive symptoms of schizo?

A

Hallucination and delusions, anything that it added to normal cognition that it not usually there. Also includes thought disorders and movement disorders. These symptoms are usually acute and can be treated because they are caught early.

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6
Q

What are the negative symptoms of schizo?

A

Negative symptoms are deficits in normal cognition. These include the 5 A’s:
Anhedonia: no pleasure
Apathy/avolition: no motivation to complete tasks
Asociality: no motivation to partake in socializing
Alogia: no speaking
Affective flattening: no emotional expression
These symptoms are usually chronic as they are caught later than positive symptoms so they are harder to treat

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7
Q

What is the difference between acute and chronic symptoms?

A

Acute: develop suddenly and are more responsive to treatment (+)
Chronic: gradually develop and persist, more resistant to treatment (-)

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8
Q

What age range is at the highest risk for developing schizophrenia?

A

20-29

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9
Q

Is schizo heritable?

A

Incidence of schizo is higher in among relative of people who have schizo, however this could be due to genes or environment, Concordance rates are higher in identical twins than fraternal twins as well, could be a familial disorder.
Heritability is about 0.8, and studies show environment provides little protection over genetics

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10
Q

Are there “schizo genes”? What are the three categories of genes that are thought to be related to schizo? How much do genes account for schizo overall?

A

No, it is likely the cumulative effects of multiple genes that have modest individual effects. Three categories of genes includes:
Neurotransmission, neurodevelopment and plasticity of forebrain, and also immune/stress responses.
5%

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11
Q

What is the vulnerability model of schizo?

A

Asserts that some threshold of causal factors must be exceeded in order for the illness to occur (could include job loss, grief, or internal changes like infection, toxicity, poor nutrition, etc)

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11
Q

What is the diathesis-stress model for schizo?

A

Asserts that genetics make you more vulnerable to getting schizo but need environmental factors as well. Genetics make you more vulnerable to the stressors and will cause schizo much easier

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11
Q

What is the dopamine hypothesis of schizo? What is the issue with it? What drugs help schizo patients based on this hypothesis?

A

Theory that schizo results from high dopamine activity, and blockage of D2 receptors in the brain. The issue is that some schizo patients show normal or deficient levels of DA so this hypothesis does not work.
Based on this hypothesis anti-psychotics which decrease DA levels help lots of people.

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12
Q

What is the aberrant salience hypothesis?

A

Suggests that the heightened levels of DA increase attentional and motivational circuits such that ordinary environmental stimuli seems significant. It hypothesizes that the increased levels of DA in the mesolimbic reward system cause it to interpret normally meaningless stimuli as important, maybe even when there is no stimuli present.

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13
Q

Some schizo patients show a DA deficiency and so they are treated with DA drugs that are not always effective. What is a common side effect of these dopaminergic drugs?

A

Tardive dyskinesia: tremors and involuntary movements due to long-term blocking of DA D2 channels from dopaminergic drugs. Mimics Parkinson’s symptoms, and they may continue for months or years past when you stop taking the drugs because the number of dopamine receptors decreases

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14
Q

What are neuroleptics? When do docs prescribe these meds?

A

Atypical or second generation antipsychotics that block dopamine receptors less strongly and also target other receptors as well (5HT). People prescribe these meds when traditional anti-psychotics do not work.

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15
Q

What is the glutamate hypothesis of schizo?

A

Due to the decreased functionality of NMDA receptors, there is an increase of glutamate (excitatory NT) in the synapse and therefore an increase in dopamine. Explains positive and negative symptoms.

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16
Q

What does the glutamate hypothesis do that the dopamine hypothesis does not?

A

Glutamate hypothesis explains positive and negative symptoms and the dopamine hypothesis only explains the positive symptoms

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17
Q

What are some neurological anomalies we see in people with schizo?

A

Malfunctions in virtually every part of the brain
Decrease in gray and white matter
Enlarges ventricles that take up more space that is available due to tissue death
Most pronounced tissue death in the frontal and temporal regions
Hippocampus and frontal cortex do not work in synchrony
Decrease in myelin sheath therefore harder/slower to communicate
Hypofrontality: decrease in function and volume in the frontal cortex, therefore deficits in planning and decision making

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18
Q

What part of the brain shows increased activity during schizo?

A

Orbitofrontal cortex (part of the hippocampus) which may be related to production of hallucinations

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19
Q

What is the winter birth effect?

A

Some researchers believe that there is a correlation between being born in the winter months and increased risk of getting schizo. May be due to mothers getting an infection (influenza) during the second trimester, and the mothers/fetuses immune response increases schizo risk. One piece of strong evidence is that during peak influenza years there is also a peak in schizo

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20
Q

TRUE OR FALSE: Higher IL-1 beta levels are correlated with developing schizo

A

TRUE

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20
Q

Is schizo a developmental disease?

A

Yes, you have it at or before birth, could be due to failed migration of neurons from the PFC and temporal lobes to other parts of the brain, or neurons not being able to tell the difference between signaling molecules, and you may be able to see enlarged ventricles before diagnosis

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21
Q

What are the three different types of affective disorders?

A

Depression (intense sadness and loss of interest)
Mania (excess energy and confidence)
Bipolar (mania and depression cycles)

22
Q

What are the two different types of depressive disorders?

A

Reactive depression: “normal” depression, occasional intense sadness in response to life’s challenges
Major depressive disorder: also called unipolar, intense sadness for long periods of time, may begin as reactive, do not need a stimulus for this to occur, can even lead to hopelessness for weeks/months, includes cognitive slowing, loss of appetite

23
Q

What is mania and how is it diagnosed?

A

Excess confidence and energy leading to grandiosity. Need to have at least three of the following symptoms and they must not be induced by drugs, and must be debilitating:
- inflated self esteem, decreased sleep, talkativeness, racing thoughts and ideas, easily distracted, increased goal-directed activities, agitation and risky behaviors

24
Q

What are the two types of bipolar disorders? What is the third type?

A

Bipolar I: alternate between periods of depression and full blown mania, often includes psychotic features like hallucinations, delusions, paranoia or bizarre behaviour
Bipolar II: alternate between periods of depression and hypomania (less intense mania), the periods of depression are less severe
Cyclothymic disorder: rapidly cycle between mania and depression, lots of switching

25
Q

What is a potential cause of bipolar like disorders? How are they treated?

A

Possibly due to increased sensitivity to dopamine and either decreased sensitivity to 5HT, or more general dysregulation of the dopaminergic system.
These disorders can be treated with second generation antipsychotics (treats mania), lithium (limits depressive episodes and has normalizing effects) as well as with carbamazepine and valproate (anticonvulsants that mediate electrical stimulation and phase switching)

26
Q

What is the heritability of affective disorders?

A

They are at least partially heritable (high concordance rate in identical twins versus fraternal twins) BUT there are many prominent environmental antecedents of depression involving stress such as poverty and hardships as well as disruption in circadian rhythms

27
Q

Are depression and bipolar disorder genetically independent?

A

YES, there is not a lot of crossover between the genes responsible

28
Q

What is the monoamine hypothesis of depression? How does this relate to the drugs used to treat depression?

A

Idea that depression results from reduced activity at the NE and 5HT synapses.
Effective antidepressants will increase the activity of NE or 5HT (or both) at their synapses
MAO inhibitors (prevents degradation of NE/5HT at their synapses therefore prolonging their effects)
Tricyclic antidepressants
Atypical antidepressants: most successful, SSRI, SNRI

29
Q

What is the issue with antidepressants?

A

They change your brain chemistry as soon as you take them, however we do not see behavioral effects until 2-3 weeks afterwards and we do not know why. They can also worsen symptoms before making them better as it messes with NE and 5HT levels in all parts of brain, not just the ones involves in depression

30
Q

What is ECT?

A

Electroconvulsive therapy, apply 70-130 volts of electricity to an anesthetized patient to induce seizures and convulsions in the head and neck that lasts for about 30s-1 min. You can use both bilateral and unilateral (RT), but bilateral is quicker and used for more important matters (suicidal thoughts) and unilateral is more gradual for less important symptoms

31
Q

When is ECT used? Why not all the time?

A

This is used when patients are not responding to traditional medications and not used a lot because the ethics of it are controversial

32
Q

What is a circadian rhythm and what does it have to do with affective disorders?

A

Circadian rhythm is your bodies daily rhythms (day/night) and in affective disorders the circadian rhythms tend to be phase advanced as they will feel sleepy earlier in the evening and will wake up early in the morning

33
Q

What is REM sleep and what does it have to do with affective disorders?

A

Rapid eye movement, stage of sleep where the most dreaming occurs, brainwaves here are similar to if you were awake, therefore if you spend too much time here then you do not feel rested (need stage 3/4). People with affective disorders lose out on other stages of sleep in favor of REM sleep, therefore become sleep deprived

34
Q

How do you reset your body when you are sleep deprived?

A

You induce extreme sleep deprivation by staying awake for long period of time, therefore when you go to sleep you go straight into stage 3/4 sleep, and when you wake up you are well rested for at least a few days.

34
Q

What is seasonal affective disorder? What is one proposed method to fix winter induced depression?

A

Pattern of depression that rises and falls with the seasons, most commonly see depression in the winter months. May be due to less light in the winter, and if depressed in summer then you probably enjoy cooler temps.
Leads to excessive sleep and increased appetite
Phototherapy: sit in front of a high intensity light for a couple of hours a day to increase 5HT and offset winter induced depression

35
Q

What are some neurological anomalies seen in depression?

A

We see prefrontal deficits, as well as reduced total brain activity in unipolar and depressed bipolar patients, we also see reduced activity in dorsolateral cortex, ACC, and hippocampus (and reduced brain volume)

36
Q

What brain regions are more active in depressed patients?

A

Areas responsible for attention and filtering information (impaired decision making) as well as amygdala and PFC (ventral) become enlarged and also get enlarged hypothalamus

37
Q

What are some neurological anomalies in bipolar?

A

Decreased thickness and glial density in ACC, reduced density of neurons in the amygdala, decreased in subset of neurons in the PFC.
Connectivity reduced in the cortex, corpus callosum, and the thalamus
Increased brain metabolism during manic episodes

38
Q

What part of the brain is responsible for the mania and depression switch?

A

Subgenual PFC

39
Q

Is suicidal ideations/ thoughts genetic?

A

Genes can give you a predisposition to suicide but also largely environmental

40
Q

What is the heredity of anxiety, trauma and stress-related disorders?

A

Ranges from 30-50% depending on disorder, but hard to determine because comorbidity is high. BUT antidepressants can treat mood disorders and anxiety disorders which suggests some neurochemical overlap

41
Q

What are the three clusters of gene types believed to be involved in A/T/SRD?

A
  1. Generalized anxiety, panic, agoraphobia
  2. Animal and situational phobias
  3. Social phobias (overlaps with both groups)
    Most genes involved here are involved with 5HT production/reuptake or receptors
42
Q

What is anxiety? What is generalized anxiety?

A

Anxiety is an anticipatory state or inappropriate reaction to the environment. Generalized anxiety is feelings of stress and unease most of the time and overreacting to stressful conditions (most common)

43
Q

What is a panic disorder? What was previously used to treat them and why are they not really used anymore?

A

Sudden and intense anxiety attacks, rapid breathing, increases HR, sense of impending doom and disaster, can use benzos to treat this but they have a high addiction potential and make people sleepy

44
Q

What is a phobia?

A

Fear or stress when confronted with a particular situation, INTENSE, may trigger a panic attack, use SSRI to treat them mostly

45
Q

What is PTSD? How is it treated?

A

Used to be classified as an anxiety disorder, it is a prolonged stress reaction to a traumatic event. It is characterized by recurrent images/thoughts of the event (flashbacks), avoiding reminders of the event, feelings of emptiness and detachment, lack of concentration, overreactivity to environmental stimuli
Most psychotherapy is not good for treating symptoms but good for emotional numbing
Exposure therapy effective in treating recurring thoughts/images but NOT cure them
Fear erasure: combo of reconciliation and exposure theory, eliminates more resistant symptoms, expensive,

46
Q

What are some anomalies in brain functioning in anxiety?

A

They amygdala is hyperresponsive
ACC hyperactive in generalized anxiety, panic disorder, and phobias
Insular cortex is overly responsive in phobias and PTSD
PTSD: decreased activity in the medioprefrontal cortex and hippocampus, and the amygdala/hippocampus are smaller
The smaller the ACC the higher risk for developing PTSD

47
Q

What are some behavioral patterns in personality disorders?

A

Distrust and suspicion, unstable social relationships, problems with control and attention, emotional dysfunctions

48
Q

What is OCD?

A

Obsession: recurring, uncontrollable thought
Compulsion: a ritualistic behavior done to remove the anxiety of an obsession
They show increased activity in the orbitofrontal cortex (especially LT gyrus) and in the caudate nuclei, and research shows that they are also high in serotonergic activity

49
Q

What is OCPD?

A

do not have distress over compulsions and obsessions, obsessively clean and organize, feelings of perfection seem reasonable and logical, UNAWARE their compulsions are unreasonable, RARE, hard to treat because they think nothings wrong.

50
Q

What are two treatment methods for OCD?

A

Cingulotomy, removes ACC, not used very often but very effective and DBS is a safer option

51
Q

What is overgrooming? What is Hoarding?

A

Overgrooming: may manifest as nail biting, hair pulling or skin picking, treat w SSRI
Hoarding: dedicated collectors, more activity in ACC and insula and the rest of the salience network compared to OCD patients

52
Q

What is tourettes?

A

disorder where people produce a variety of motor/phonic tics, symptoms usually arise between 2-15 years, and tics progress from simple to complex, to ritualistic/compulsive
They can be suppressed for short period of time, but then released in a wave.
See increased basal ganglia activity, and treat with DBS, previously with benzos

53
Q

What is borderline personality disorder?

A

Characterized by: unstable relationships, poor self-image, impulsivity, intense fear of abandonment and rejection, strong desire to be loved, cycling between feelings of hate and love, risky behaviours, high risk of suicide and suicidal thoughts

54
Q

Is BPD heritable?

A

It is about 40% heritable and 60% environment, thought to be in genes that are involved in production/fxn of 5Ht/DA

PSYCH 275 (9 decks)

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