Chapter 16: Psychopathlogy Flashcards
(183 cards)
1
Q
Psychiatric Disorders are…..
A
Highly prevalent in society
2
Q
What fraction of the US will experience a psychiatric disorder at some point in their life?
A
1/3
3
Q
What did 25% of patients in mental hospitals during the early 20th century suffer from?
A
Paralytic Dementia
4
Q
Paralytic Dementia
A
Psychiatric disorder includes delusions, grandiosity, euphoria, and impulsiveness
5
Q
What had caused paralytic dementia in the early 20th century?
A
Syphilis
6
Q
What was paralytic dementia renamed to?
A
Syphilitic Psychosis
7
Q
What did the case of paralytic dementia in the early 20th century prove about psychiatric disorders?
A
Psychiatric disorders have “organic” or biological orgins
8
Q
What plays a large role in psychiatric disorders?
A
Genetics
8
Q
How can disorders be organized?
A
In clusters based on genetics
9
Q
What is the prevalence of scizophrenia?
A
Affects 1% of the population
10
Q
When does schizophrenia usually emerge?
A
Adolescence / early adulthood
11
Q
What are the 3 types of symptoms in schizoprhenia?
A
- Positive
- Negative
- Cognitive
12
Q
What aspect in schizophrenia do positive symptoms relate to?
A
Psychosis (loss of reality)
13
Q
What aspect in schizophrenia do negative symptoms relate to?
A
- Emotional dysregulation
- Impaired movement
14
Q
What aspect in schizophrenia do cognitive symptoms relate to?
A
- Neuro cognitive impairment
15
Q
Is schizophrenia heritable?
A
Yes but multiple genes must be involved
16
Q
What has confirmed the importance of genetics in schizophrenia?
A
Adoption studies
17
Q
What role do twin studies play in schizophrenia?
A
Genetics are not everything
18
Q
What % do dizygotic twins have for obtaining the same trait related to schizophrenia?
A
17% rate
19
Q
What % do monozygotic twins have for obtaining the same trait related to schizophrenia?
A
50% rate
20
Q
What do studies of discordant twins indicate in schizophrenia?
A
A child who develops schizophrenia tends to be abnormal throughout their whole life.
21
Q
What is a main feature of children who go on to develop schizophrenia?
A
Differences in eye tracking
22
Q
Discordant Twins
A
Twins with a significant difference in weight or other characteristics
23
Q
What individual genes are involved in schizophrenia cases?
A
- Neuregulin 1
- Dysbindin
- COMT
24
Neuregulin 1
- Schizophrenia
Regulates NMDA, GABA, and ACh receptors
25
Dysbindin
- Schizophrenia
Regulates synaptic plasticity
26
COMT
- Schizophrenia
Metabolizes Dopamine
27
What happens to many schizophrenics?
They end up homeless
28
What is schizophrenia considered?
A chronic and overwhelming disorder
29
What does "schizophrenia" mean?
"Split Mind"
30
What increases the chance of having a child with schizophrenia?
Older fathers having kids
31
What happens to the ventricles in schizophrenics?
They enlarge
32
Ventricular enlargement is a...
stable trait
33
What do patients with ventricular enlargement show a poorer response to?
Antipsychotics
34
What causes ventricular enlargement?
Buildup of cerebrospinal fluid in the brains ventricles
35
Gene DISC1 Protein
Regulates dendritic spines at glutamatergic synapses
36
Where is the Gene DISC1 Protein found?
In family with schizophrenia
37
What happens to mice that have a mutant DISC1 gene?
They obtain enlarged ventricles
38
What forms of limbic system abnormalities are found in schizophrenics?
1. The walls of ventricles are smaller
2. There is cellular disorganization (hippocampus and other limbic structures)
39
What do the walls of the ventricles make up in the brain?
The hippocampus and amygdala
40
What does cellular disorganization in the brain affect?
Pyramidal cells
41
What happens to the brain cortex in schizophrenics?
Thicker corpus callosum
42
What causes thicker corpus callosum in schizophrenics?
Abnormal neuronal migration in the frontal cortex.
43
What happens to gray matter during adolescence with schizophrenics?
There is a loss of cortical gray matter
44
What does evidence regarding the cortex suggest in schizophrenics?
Alterations in the frontal cortex results in impairments on tasks that depend on the frontal cortical area.
45
What did discovering a thicker cortex in schizophrenics lead to?
The Hypo Frontality Hypothesis
46
Hypo Frontality Hypothesis
Insufficient activity of the frontal cortex
47
What role to antipsychotics play in the hypo frontality hypothesis?
They increase activation of the frontal cortex
48
Amphetamines
Stimulant drugs (BAD) that can produce psychosis
- Found in schizophrenia
49
What can block amphetamines?
Chlorpromazine
50
Chlorpromazine
A dopamine antagonist used against amhetamines
51
What were the 1st antipsychotics?
Chlorpromazine and its relatives
52
What do typical antipsychotics block?
D2 (dopamine) receptors
53
What is the recommended dose of antispychotics to treat schizophrenia correlated with?
The dopamine D2 receptor binding affinity of the specific drug.
54
Drugs with a higher binding affinity for D2 receptors....
can treat schizophrenia with lower doses
55
What is the relationship between Parkinson's and Schizophrenia?
L Dopa (Parkinson's treatment) can produce schizophrenia like symptoms.
56
What are the 2 Neurotransmitter Hypothesis for schizophrenia?
1. Dopamine Hypothesis
2. Glutamate Hypothesis
57
Dopamine Hypothesis
Schizophrenia results from either...
- excessive level of synaptic dopamine
or
-excessive postsynaptic sensitivity to dopamine
58
What are the 4 problems with the Dopamine Hypothesis?
1. There are no consistent results that look at dopamine metabolization.
2. The DA blockers take too long to affect schizophrenia (compared to their normal speed).
3. Some people with schizophrenia are not helped by typical antipsychotics (dopamine based).
4. The atypical antipsychotics have less affinity for DA receptors.
59
Glutamate Hypothesis
Schizophrenia is caused by under stimulation of glutamate receptors.
60
What drug plays a major role in the glutamate hypothesis?
Phencyclidine (PCP)
61
How does Phencyclidine (PCP) induce schizophrenia?
PCP blocks gutamatergic actions, resulting in psychosis sympptoms
62
What type of effect is PCP?
Non competitive NMDA receptor antagonist
63
What happens when PCP binds to a receptor?
No other ligand can bind and activate the NMDA receptor?
= No glutamate production
64
What does Schizophrenia most likely develop from?
The interaction between genetics, development, and environment.
65
How does your location of living relate to Schizophrenia?
Living in a city increases your risk for Schizophrenia
- Increased stress levels
66
What are the 4 risk factors of Schizophrenia?
1. City vs Rural living
2. Having the flu during 1st trimester
3. Birth complications/lack of oxygen
4. Incompatible blood types
67
What is the gender ratio of mood disorders?
Women are 2x more affected than men
68
When do the highest rates of mood disorders occur?
Around age 40
69
What is the twin coordinance for mood disorders?
Monozygotic: 60%
Dizygotic: 20%
70
What is the most common mood disorder?
Depression
71
What are the chacaterictics of depression?
- Unhappy mood
-Loss of interest
- Difficulty in concentration
- Restless agitation
72
Unipolar Depression
Depression that alternates with normal emotional states
73
How long can depression last?
Can last up to several months continuously
74
What plays a large factor in depression?
Inheritance
75
What are the 3 brain changes that occur with depression?
1. Increased blood flow to the frontal cortex and amygdala
2. Decreased blood flow to areas involving attention and language
3. The cortex of the right hemisphere is thinner
76
What are the 3 treatments for depression?
1. ECT
2. TMS
3. Antidepressants
77
Electroconvulsive Shock Therapy (ECT)
Causes a seizure by passing an electrical current through the brain.
78
What was ECT originally used for?
Patients with Schizophrenia
79
What is the go to treatment for individuals who suffer from resistant depression?
ECT
80
Transcranial Magnetic Stimulation (TMS)
Brain stimulation technique that uses magnetic fields to stimulate nerve cells in the brain.
81
Is TMS proven to be efficient in treating depression?
No, it is still under investigation.
82
What are the 4 kinds of antidepressants used to treat depression?
1. MAO Inhibitors
2. Tricyclics/Heterocyclics
3. Selective Serotonin Reuptake Inhibitors (SSRIs)
4. Second Generation Antidepressants
83
Monoamine Oxidase (MAO)
A class of enzymes that break down and thereby inactivate monoamine transmitters.
84
What do monoamines include?
- Norepinephrine
- Dopamine
- Serotonin
85
MAO Inhibitors
Raises the level of monoamines at the synapse.
86
What was an early pharmaceutical treatment for depression?
MAO Inhibitors
87
What helped lead to the monoamine hypothesis?
MAO Inhibitors
88
Monoamine Hypothesis
Depression is caused by decreased monoamines at the synapse
89
What are examples of MAO Inhibitors used to treat depression?
- Marplan
- Nardil
- Parnate
90
Tricyclics
Inhibits the reuptake of monoamines to increase their synaptic accumulation.
91
What are examples of tricyclics used to treat depression?
- Wellbutrin
- Elavil
- Aventyl
- Norpramin
92
Selective Serotonin Reuptake Inhibitors (SSRIs)
Antidepressants that block the reuptake of serotonin at synapses.
93
What is different from SSRIs when compared to tricylics or MAOIs?
SSRIs have fewer side effects
94
What are examples of SSRIs used to treat depression?
- Prozac
- Paxil
- Zoloft
95
Second Generation Antidepressants
Inhibit the reuptake of the monoamines.
96
What are examples of second generation antidepressants used to treat depression?
- NDRI
- SNRI
- NaSSA
- SARI
- Buprenex
97
98
Is the drug or the placebo more effective in patients with mild depression?
They were equally effective
99
Is the drug or the placebo more effective in patients with severe depression?
The drug was more effective .
100
What are 3 treatments for depression that are being developed?
1. Vagal Nerve Stimulation
2. Deep Brain Stimulation
3. Cognitive Behavioral Therapy
101
Vagal Nerve Stimulation
Electrodes are surgically wrapped around the vagus nerve (neck) to provide mild stimulation at intervals.
- Used to treat depression
102
Deep Brain Stimulation (DBS)
Mild electrical stimulation is applied to brain sites through a surgically implanted electrode.
- Used to treat depression
103
Cognitive Behavioral Therapy (CBT)
Psychotherapy aimed at correcting negative thinking and improving interpersonal relationships.
- Used to treat depression
104
What are the problems with Vagal Nerve Stimulation and DBS?
- Expensive
- Little evidence supported
- Hard to get matched controls for studies
105
What is the order of best treatment options for depression?
1. SSRIs alone
2. CBT alone
3. CBT and SSRIs (BEST)
106
Cushing's Syndrome
A condition in which levels of adrenal glucocorticoids are abnormally high.
107
What relation does depression have to Cushing's Syndrome?
Depression may involve dysfunction of the HPA axis
108
What do individuals with depression have higher levels of?
Cortisol Levels (increase your weight)
109
Dexamethasone
A synthetic glucocorticoid that normally suppresses cortisol release by providing negative feedback to the hypothalamus.
110
Does Dexamethasone work on people who suffer from depression?
No
111
What does the functioning of Dexamethasone suggest?
Dysfunction in the HPA axis.
112
Dexamethasone Suppression Test
A test that can show excess cortisol release.
113
What kinds of people display high cortisol levels?
- Depressed patients
- Suicide victims
114
What is the main reason that supports why women are more depressed than men?
Sex differences in endocrine physiology, related to the reproductive cycle.
115
Postpartum Depression
A bout of depression that afflicts a woman around the time she gives birth.
116
How is sleep affected by depression?
- The time in SWS is reduced
- Enter REM sleep quicker
- Longer lengths of REM sleep in 1st half of the night.
117
Seasonal Affective Disorder (SAD)
A type of depression brought on by the shorter days of winter.
118
What does SAD suggest?
Seasonal rhythms can influence depression
119
What is the treatment for SAD?
Phototherapy
120
Phototherapy
Light administered in the treatment of physical/mental illness
121
What does phototherapy reduce?
Melatonin levels
122
Melatonin
A hormone that is aligned with sleep when secreted.
123
What method of study is used to examine depression in animals?
Learned helplessness
124
Learned Helplessness
An animal is exposed to a repetitive stressful stimulus, causing the animal to eventually stop attempting to escape the stimulus.
125
What is learned helplessness linked to?
A decrease in serotonin function
126
Bipolar Disorder
A psychiatric disorder characterized by periods of depression that alternate with excessive, expansive moods.
127
What varies in bipolar disorder?
The rate of cycles (mood changes)
128
What gender is more likely to be affected by bipolar disorder?
Men and women are equally affected
129
What disorder is bipolar disorder most in common with?
Schizophrenia
- Many genes are linked to having both disorders
130
What are the 2 structural changes in bipolar disorder?
1. Larger ventricles
2. Decreased gray matter
(increases with manic episodes)
131
Cyclothymia
A milder form of bipolar disorder
-fewer extreme moods
132
Dysthymia
Poor mood or mild depression
133
Hypomania
A state of increased energy and positive mood that lacks some bizarre aspects of frank mania.
134
What does Cyclothymia cycle between?
Dysthymia and Hypomania
135
What is the main treatment for bipolar disorder?
Lithium
136
Lithium
Mood stabilizing drug used to treat bipolar disorder.
137
What does lithium interact with?
The circadian clock
137
What is unknown about Lithium?
How it is able to treat Bipolar Disorder
138
What does Lithium have?
A narrow therapeutic window
138
How does experiencing manic episodes affect patients with bipolar disorder?
The lack of manic episodes leads to the desire for patients to stop taking the medication
139
What are the two main connections around bipolar disorder.
- Bipolar Disorder
- Schizophrenia
- Creativity Levels
=
All seem to be related due to similar gene connections
140
Generalized Anxiety Disorder
Any class of psychological disorders that include persistent, excessive anxiety which is experienced for months.
140
Panic Disorder
Recurrent short length attacks of fearfulness
141
What are the symptoms of Panic Disorder?
-Heart palpitations
-Rapid breathing/shortness of breath
-Blurred vision
-Dizziness
-Racing thoughts
142
Phobic Disorders
Intense, irrational fears that become centered on a specific object, activity, or situation that a person feels compelled to avoid.
143
What does the diagnosis of Phobic Disorder consist of?
Symptoms being disruptive to everyday functioning
144
What two brain changes occur with Anxiety?
1. Temporal lobe volume may be reduced/abnormal
- 40% have lesions
2. Amygdala activity could be lowered
145
What is the amygdala involved with?
Fear conditioning and memory
146
What are the 3 treatments for Anxiety?
1. Benzodiazepines
2. SSRIs
3. Exposure Based Therapy
147
Benzodiazepines
A class of anti anxiety drugs that bind with high affinity to receptors molecules in the central nervous system.
148
How do Benzodiazepines work?
- Bind to GABA receptors as non-competitive agonists
- In the presence of GABA, it makes the neuronal membranes more permeable to Cl- ions.
149
What is an example of a benzodiazepine used to treat Anxiety?
Valium
150
Are SSRIs effective to treat anxiety?
Only sometimes
151
When is exposure based therapy used to treat anxiety?
When the anxiety is related to a specific stimulus in the environment.
152
Post Traumatic Stress Disorder (PTSD)
Memories of an unpleasant episode repeatedly plague the victim.
153
What induces PTSD?
Highly stressful, traumatic events
154
What is a structural change caused by PTSD?
Lower volume of the right hippocampus
155
What are the symptoms of PTSD?
- Memory changes (amnesia)
- Flashbacks
- Deficits in short term memory
156
What is the pathway of PTSD similar to?
Fear conditioning
157
What parts of the brain are involved in the pathway of PTSD?
-Amygdala
- Other brainstem pathways
158
Pathway of PTSD
1. The original trauma activates 2 systems (amygdala and other brainstem systems)
2. The brainstem system sensitizes the person to related stimuli in the future
3. The amygdala system conditions a long lasting fearful reaction
159
What has a weaker suppression to the amygdala?
The hippocampus and prefrontal cortex
160
Obsessive Compulsive Disorder (OCD)
A syndrome in which the affected person engages in recurring, repetitive acts that are carried out without rhyme, reason, or the ability to stop.
161
What does the "obsession" part of OCD consist of?
Persistant thoughts
162
What does the "compulsion" part of OCD consist of?
Repetitive thoughts/acts
163
How many people in the world suffer from OCD?
1-2% worldwide
164
When does OCD often begin?
In childhood but peaks young adulthood to middle age
165
What are the 2 treatments of OCD?
1. Cognitive Behavioral Therapy
2. Drugs
166
What is the main drug used to treat OCD?
Prozac
167
Prozac
Inhibits the reuptake of 5HT at the synapse, causing an increase in 5HT available in synapse.
168
What conditions can OCD co-occur with?
Depression and Tourette's
169
How can having OCD lead to Tourette's?
Can be triggered by an infection that causes the immune system to attack the brain
170
What are the 3 brain areas affected in OCD?
1. Orbitofrontal Cortex (prefrontal)
2. Cingulate Cortex (prefrontal)
3. Caudate Nuclei (striatum)
171
What does structural evidence suggest for OCD?
There may be a dysregulate circuit
prefrontal cortex -> striatum
-> thalamus -> back to cortex
172
What are the 5 neurosurgery treatments for psychiatric disorders?
1. Trephination
2. Lobotomy
3. Cingulotomy
4. Remove portions of epileptic brains
5. Deep Brain Stimulation
173
Trephination
Drill holes in the skull
174
When did Trephination commonly occur?
Roman times
175
Lobotomy
Disconnect parts of frontal lobes
176
Why are lobotomys not looked up to?
- The outcomes are not as positive as intended
- HUGE changes in personality
177
Cingulotomy
Lesion pathways in the cingulate cortex
178
What disorders is Cingulotomy used to treat?
Depression and OCD
179
What is the purpose in removing portions of the epileptic brain?
The portions are thought to cause seizures
=
reduce seizures
