Lecture 10 Flashcards

(81 cards)

1
Q

What are the myths surrounding mental illness ?

A
  • People with mental illness are violent and dangerous
  • People with metal illness are poor or less intelligent
  • Mental illness is caused by a personal weakeness
  • Mental illnes is a single, rare disorder
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2
Q

How is mental illness complicated ?

A
  • Comorbidities are common
  • Many people who fit a diagnosis for one mental disorder may partially fit the diagnosis for another as well
  • People may not completely match any specific diagnosis
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3
Q

What is schizophrenia ?

A

a split between the emotional and intellectual aspects of experience

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4
Q

What was schizophrenia previously called ?

A

Dementia Praecoz (“premature dementia”)

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5
Q

What are the positive symptoms of schizophrenia ?

A
  • Disorganized speech
  • Disorganized behaviour
  • Hallucination
  • Delusions
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6
Q

What are the negative symptoms of schizophrenia ?

A
  • Flattened affect and or anhedonia
  • Speech minimized
  • Lack of motivation
  • Social withdrawl
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7
Q

What are the cognitive symptoms of schizophrenia ?

A
  • Poor sustained attention
  • Low psychomotor speed/catatonia
  • Poor learning and memory
  • Poor abstract thinking/problem solving
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8
Q

What symptoms fall under complex syndrome ?

A
  • Psychosis
  • Emotional/Affective symptoms
  • Motivtional impairment
  • Cognitive impairment
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8
Q

What are the types of schizophrenia ?

A
  • Paranoid
  • Catatonic
  • Disorganized
  • Residual
  • Undifferientiated
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9
Q

What is paranoid schizophrenia ?

A

Frequent visual and auditory hallucinations/delusions, disprganized speech, trouble concentrating, and significant behavioural impairment

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10
Q

What is catatonic schizophrenia ?

A

Excessive movement (catatonic excitement), or decreased movement (catatonic stupor)
* inability to speak (mutism). mimicking owrds (echolalia) and mimicking actions (echopraxia)
* Rarest

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11
Q

What is disorganized schizophrenia ?

A

Disorganized behaviours and nonsencial speeach in the absence of delusions and hallucinations
* Most common

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12
Q

What is residual schizophrenia?

A

Previously diagnosed - no longer experiencing prominent symptoms
* still exhibited symtoms including a flattened affect, psychomotor difficulties, and disturbed speech

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13
Q

What is undifferentiated schizpphrenia ?

A

Symptoms fit into more than one subtype of schizophrenia

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14
Q

What is the prevalence of schizophrenia ?

A
  • Prevelance higher in men than women (7:5 ratio)
  • More prevenlent in prosperous countries than 3rd world
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15
Q

How is genetics tied to schizophrenia ?

A
  • People with closer genetic relationships have higher concordance for schizophrenia
  • Adopted children studies suggest a genetic role (Prenatal environment of the biological mother cannot be discontinued)
  • Environmental influence, such as family environment, shown to have a role
  • No common genetic variant produces more than small increase in the probability of schizophrenia
  • A few rare genes are known to greatly increase the risk of schizophrenia, mostly by disrupting the development of glutamate synapses or by interfering with the immune system
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15
Q

What does DISC1 control ?

A

Disrupted in schizophernia 1 controls differentiation and migration of neurons in brain development

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16
Q

What is the DISC1 protein important for ?

A

The DSC1 protein is important for neurodevelopment

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17
Q

What has human studies shown regarding gene mutations ?

A
  • High prevalence of “broken copy” in Large Scottish family over 5 generations - development of schizophrenia, bipolar & other mood disorders
  • Meta-analysis confirmed overall association and found strongest estimate in Chinese population
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18
Q

What has animal studies shown on gene mutations ?

A

Mutant mice with no DISC1 in brain stem stem cells show behaviours that mimic schizophrenia

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19
Q

What is NRG1 important for ?

A

Neuregulin 1 protein is important for neurodevelopment

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20
Q

What do association studies show regarding gene mutations ?

A
  • Iceland population - NRG1 risk allele doubles the risk of schizophrenia
  • Extended to Scottish, Swedish and Chinese populations
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21
Q

What is NRG1 associated with ?

A

Associated with bipolar disorder and creativity, independent of schizotypal traits

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22
Q

What is the recent popular hypothesis ?

A

Not just one gene, but new mutations in any one of hundreds of genes

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23
What was found regarding **microdeletions and microduplications** ?
* Found in 15% schizophrenia patients; 20% if onset before 18 years. Compared to 5% in control group * Not random, but selective for genes that are important for production of proteins involved in neurodevelopment and nognitive function
24
What is the **neurodevelopmental hypothesis** ?
Suggests abnormailities in the neonatal development of the nervous system leads to mild abnormalities of brain anatomy and major abnormalities in behaviour * abnormalities could result from genetics or other influences * Environmental influences later in life aggravate the symptoms
25
What is the **season-of-birth-effect** ?
Babies born in late winter and early spring motnhs are at higher risk of "positive" schizophrenia
26
What are some **viral infections** that a mother can get ?
* Increase cytokines in the mother that impair brain development of fetus * Cause fever that damages the fetal brain
27
What is the **research evidence** found on **viral infections and schizphrenia** ?
* Babies born from mother who contracted flu in 1st trimester 7x more likely to develop schizophrenia * Increased schizophrenia rates among people born 2-3 months after major influenza epidemics
28
What are the **risk factors** falling under the **neurodevelopmental hypothesis** ?
* Poor nutrition of the mother during pregnancy * Premature birth * Low birth weight * Complications during delivery * Extreme stress of mother during pregnancy * Immunological rejection * Other infections during pregnancy * Postnatal stressors
29
What is the **two-hit hypothesis** ?
Schizophrenia is the result of a combination of a **genetic predisposition and impacts from the environement** in prenatal/neonatal development, later in life, or both
30
What are the **brain abnormalities** tied to schizophrenia ?
* Enlarged lateral ventricle and prominent sulci * Decreased tissue cerebral gray matter * Smaller PFC and hippocampus * Less gray matter and white matter * Reduced cortical connectivity and activity * Glial reductions (glial theory): oligodentrocytes and mylein integrity (DISC1); altererd microglia in temporal and frontal lobes; astrocyte glutamate transporters in PFC
31
What is the **dopamine hypothesis** ?
Positive symptoms are caused by over-activity of synapses between DA neurons of then VTA and nucleus accumbems and aymygdala (Mesolimbic)
32
What do **antipsychotic drugs (chlorpromazine) do** ?
Antipsychotic drugs block DA receptors * Block D2 receptors, preventing receptor activation (antagonist)
33
What **resembles** shizophrenia ?
Amephetamine psychosis resembles schizophrenia * amphetamines (and cocaine) block DA reuptake thus increase DA levels (agonist) * Amphetamines exacerbate symptoms
34
What is the **glutamate** hypothesis ?
Schizpohrenia due to excessive glutamate
35
Whay **occurs** regarding the **glutamate** hypothesis ?
* Mesolimbic pathway overactivated * Glutamate neurons fail excite GABA neurons (GABA=Inhibitory) * Glutamate neurons fail to excite DA neurons (negative symptoms)
36
What **blocks NMDA receptors** ?
PCP (angel dust) and ketamine (date rape drug) block N-methyl-D-asparate receptors * they create all symptoms * this effect is not observed in preadolesence
37
How were schizophrenic patients **treated before the mid 1950's** ?
Most people with schizophrenia were idenfinitely confined to mental hospitals
38
How are schizophreniz patients **treated today** ?
Effective drugs and outpatient treatment
39
What does **Glycine or D-serine do** ?
Stimulate NMDA receptors and reduce schizophrenic symptoms * effective in reducing negative symptoms
40
What does **Clozapine do** ?
Atypical antipsychotic -Clozapine- increases release of DA in PFC and decreases DA in nucleus accumbens - addresses all symptoms
41
What is a **partial agonist** ?
Serves as an agonist in regions of low concentration of the normal ligand and as an antagonist in regions of high concentrations
42
What **disorders** are included in **Major Affective Disorders** ?
Includes Major Depressive Disorder (MDD) and Bipolar Disorder
43
What is **MDD** ?
* Unipolar * Unremetting depression
44
What is **Bipolar Disorder** ?
Cyclical periods of mania and depression * BP1: full-blown mania * BP2: hypomania * Cyclothymic
45
What are the **symptoms** of **MDD** ?
* Hopelessness and helplessness * Worthlessness. self-hate, guilt * Agitation/irritability * Weight loss * Concentration * Fatigue/lack of energy * Isolation/withdrawl * Anhedonia * Sleep * Suicidal thoughts
46
What is the **concordance** b/w **MZ and DZ twins** regarding **MDD** ?
Concordance in MZ twin is ~65% vs 13% in DZ twins
47
What is the **monoamine hypothesis** ?
Depression is caused by low level of activity of one or more monoaminergic synapses * Dpamine (DA) - anhedonia * Nonrepinephrine (NE) - (psychomotor symptoms) * Serotonin (5HT) - (rumination, impulsive thoughts)
48
What is the **evidence** for the **monoamine hypothesis** ?
Introduction of monoamine oxidase (mao) inhibitors * Block degradation of monoamines
48
What is the **neurology** of **MDD** ?
Decreased activity in left and increased activity in right PFC Amygdala * 50-70% increased blood flow and metabolism in amygdala * activity correlated with severity of symptoms * faulty amygdala - PFC coupling
49
What is **ACC** ?
Attentional processes that regulate cognition and emotion
50
What is the **role of neurogenesis** in **MDD** ?
* **Hypothesis**: Stress exposure decreases neurogenesis in the dentate gyrus of the hippocampus which causes depression * **Evidence**: Treatment with anti0depressant meds alleviate symtpoms at the same time that they facilitate neurogenesis in the rodent HC * **Evidence**: Exercise enhances neurogenesis in the HC of both animals and humans and alleviates deprresive symptoms
51
What do **antidepressant drugs** do ?
* SSRI and NRIs - enhance 5-HT and NE (respectively) by inhibiting reuptake of the neurotransmitter * Tricyclics (TCAS) - Block tranporter proteins that reabsorb serotonin, dopamine, and norepinephrine into the presynaptic neuron after release * MAOIs - enhance monoamines by inhibiting MAO
52
What is **Trancranial Magnetic Stimulation** ?
Pulses of magnetic energy focused over a particular surface along the scalp to deactivate neurons
53
What is **Electroconvulsive Therapy (ECT)** ?
An electrically induced seizure used for treatment of severe depression * Non-responders or suicidal patients * Applied every other day for a period of two weeks * Side effects include memory loss - can be minimized if shock is localized to the right hemisphere
54
What are the **simplest and least expensive treatments** for **MDD** ?
* Moderate-intensity exercise * Alter the sleep scheduele Periodic sleep deprevation sometimes helpful * Seasonal affective disorder (SAD)
55
What are the **symptoms** of **bipolar disorder** ?
Depressive symptoms Manic episodes * Elevated moof: hyperactive, increased energy, high self-esteem (false), grandoise/delusions * Racing thoughts * loud-rapid speech * Reckless behaviour: binging, poor judgement, promiscuity, spending sprees * Agitated or irritated
56
What is the **concordance** among **MZ twins** for **Bipolar Disorder** ?
Concordance in MZ twins is 80%
57
What is used to **treat Bipolar Disorder** ?
Lithium * Stabilizes mood and prevents relaspe in mania or depression * Exact mechanism is unknown, but shows neurotropic effects * Works by decreasing glutamate activity and inflammation in the brain
58
What is **anxiety** ?
Unfoundded, unrealistic, chronic fear
59
What are the **common types** of **anxiety disorders** ?
* Generalized anxiety disorder * panic disorder * specific phobias * OCD * PTSD
60
What is **GAD** ?
Excessive uncontrollable anxiety and worry * Common co-morbity with depression * Women > Men
61
What are the **symptoms** of **GAD** ?
* Fatigue * muscle tension * restlessness * irritability * sleep distrubances * concentration problems
62
What is **Panic Disorder** ?
Characterized by repeated and unpexcted panic attacks along with worry about future attacks
63
What are the **symptoms** of a **panic attack** ?
* chest pains * rapid heartbeat * shortness of breath
64
What is a **phobia** ?
An unreasonable or excessive fear of an object, situation, or activity
65
What are the **three categories of phobia's** ?
* Agoraphobia * Social phobia * Specific phobias
66
What is **agoraphobia** ?
Fearful of a public place or being outside of the home to the extent that panic attack or extreme embarassment is possible
67
What is **social phobia** ?
A fear of social activity, especially of being scruntinized and embarassed
68
What are **specfic phobias** "?
Exaggerated fear of specific object/situations not covered by the other two
69
What are the **risk factors** of **anxiety** ?
Genetics * heratibility of 31.6% * 2x more likely to develop GAD if parents has a diagnosis * Candidate geens that code for the monoaminergic system Personality trait neuroticism, high stress sensitivity Childhood maltreatment Chronic or Traumatic Stress
70
How does **anxiety** look like in the **brain** ?
* Increased activation of amygdala and decreased activation of PFC while looking at angry faces * In helathy controls, vmPFC decreases activation of amygdala, but not in persons with anxiety * High levels of anxiety correlates with increased activation of amygdala, insular cortex and anterior cingulate cortex
71
What are **obsessions** ?
Thoughts, images, or impulses that are intrusice enough to cause marked rise in anxiety
72
What are **compulsions** ?
Ritualistic behaviours or mental acts that are designed to lower anxiety
73
When do obsessions and compulsions **begin** ?
Usually begins at ages 6-15 for females and 20-29 for males
74
How does **OCD** look like in the **brain** ?
Hyperactivity in * Caudate nucleus (Basal Gnaglia): compulsivity and impulsivity * Orbitofrontal cortex (OFC): obsessive thoughts * Anterios cingulate cortex (ACC): emotion regulation Dysregulation of cortico-basal ganglia-thalamo-cortical (CBGTC) loop * System of neural circuits Dysfuntion in 5HT and DA systems
75
What is **PTSD** ?
Occurs in some people after terrifying expeinces
76
What are some **symptoms** of **PTSD** ?
* Frequent distressing recollections * Nightmares * Avoidance of reminders of the event * Exaggerated arousal in response to noises and other stimulu
77
How does **PTSD** look like in the **brain** ?
* The amygdala is esstential for the extreme emotional impact that produces PTSD * Dysregulation of HPA-axis: Lower than normal cortisol levels and blunted cortisol response to acute stressor * Smaller than average hippocampus
78
How is **mental health** tied to **intelligence** ?
Higher rates of mental illness in individuals with * High IQ * Artists * Scientists * "Geniuses"