Lecture 10: Psychopathology

Question 1

epidemiology of mental illness in US adults; who is most at risk

Answer 1

21% of adults; 4% have severe impairment
higher in females
higher in younger adults
highest in LGBTQ
racial background results in cultural factor

*drug abuse doesn’t count

Question 2

most common types of mental illness

Answer 2

anxiety is most common = 19%

depression is next = 4%

Question 3

types of mental illness

Answer 3

emotional - related to limbic system
- internalizing = anxiety/depression
- externalizing = drugs/conduct disorder

psychotic - more association areas involved
- i.e. bipolar or schizophrenia

**mental illness is a spectrum

Question 4

examples of primary vs secondary mental illness

Answer 4

autism pt develops mental illness = secondary

cannabis abuse (primary) causes psychosis (secondary)

Question 5

characteristics of mental illness in adolescents

Answer 5

most start to show in adolescence

50% of adolescents have some kind of mental illness; 11% have severe impairment

prevalence peaks at 17-18 years

no obvious difference in prevalence with sex BUT females do have different S&S than males

major increases in substance abuse in those with mental illness

Question 6

how does the cerebral cortex develop/mature

Answer 6

matures from posterior to anterior and right to left

posterior portion of the brain is like the gas pedal (contains limbic system); everything based on emotion

anterior portion (prefrontal lobe) is like the brake; more sound/logic decision; stop impulses

L dorsolateral prefrontal cortex (last to develop) = working memory and executive functions

ratio of gray matter to white matter increases?

Question 7

3 critical stages of synaptogenesis

Answer 7

1st: sensorimotor, 2 months before birth and peaks 1 month after

2nd: frontal, parietal, temporal association cortex; peaks around 8 months of age

3rd: prefrontal cortex develops last, peaks around 2 years of age

Question 8

which critical stage is the fastest

Answer 8

1st/sensorimotor

fastest in utero

Question 9

all 3 critical stages peak by what age

Answer 9

2 years

Question 10

frequency of firing at peak synaptogenesis vs peak pruning

Answer 10

peak synpatogenesis = 4.3 million per min

peak pruning = 0.072 million per minute (lasting longer = maturation)

Question 11

describe the functional connections and myelination of the brain during critical stages

Answer 11

whole brain has less gray matter and more white

prominent in adolescent period

males have 20% more brain mass than females; not necessarily a good thing

Question 12

describe what happens to the brain with marajuana

Answer 12

increase in non functional connections

more connections but they are not useful and inhibit the good connections

Question 13

describe the stages of brain development from 1 month to 9+months

Answer 13

1 month = internal capsule, projection fibers (coordination with different body parts)

2 months = long association fibers (inter regional?)

5-6 months = long association fibers (inter regional?)

7-9 months = commissure and short association fibers (regional functioning and cross talking)

over 9 months = all fibers start to mature

Question 14

pathophysiology of ASD

Answer 14

altered functional connections

decreased long distance/subcortical connections = compromised integration functions

increased short distance association fibers (focus a lot on details but not the context of the whole situation)

Question 15

core diagnostic criteria for ASD

Answer 15

loss of social cognition
increase of repetitive behavior

females - different S&S (more depression like)

Question 16

prevalence of ASD

Answer 16

1-3%

Question 17

prevalence of different mental illnesses secondary to ASD

Answer 17

10-50% = depression
80% = anxiety
30% = bipolar
28-39% = childhood onset schizophrenia

over 75% of ASD pts have one or more mental illness

Question 18

what is a phenotype and what is the implication of this

Answer 18

universal formula

gene(s) + environmental factor(s) = phenotype(s)

some diseases are genetically predisposed; some can be managed (PKU) but some cannot (HD)

environments can promote activation or inhibition of certain genes

genetic component varies from 0-100%; decides how much of it you can manage/control

Question 19

describe the types of onset of ASD

Answer 19

congenital = mainly prenatal and during critical development stage I (genetic/environmental)

postnatal = trauma to amygdala, temporal lobe, cerebellum, etc (environmental)

Question 20

diagnosis of schizophrenia

Answer 20

2 of the following:
- delusion (thoughts)
- hallucinations (perception)
- disorganized speech

Question 21

pathology implications of those with schizophrenia

Answer 21

enlarged lateral and 3rd ventricles

atrophy of frontal lobe association cortex
- frontal eye field problems; can’t smooth track
-delusion
- disinhibition function
- trouble with working memory (LDLPFC)

Question 22

what S&S of schizophrenia are caused by temporal lobe atrophy

Answer 22

auditory hallucinations

disorganized speech; fluent aphasia/talking to the hallucination

loss of frontal temporal synchrony

loss of sensory gating (reactions are not decreased after 1st sensory stimuli is perceived)

Question 23

how much of schizophrenia is genetic vs environmental

Answer 23

50% for both

Question 24

congenital vs postnatal

Answer 24

congenital
- lacking nutrition
- drug abuse
- viral/bacterial infection of embryo/fetus

postnatal
- drug abuse (i.e. MJ)
- trauma to frontal/temporal lobe

Question 25

types of mental illness with critical stage III

Answer 25

control of emotion internalizing = depression and anxiety externalizing = drug abuse and behavior antisocial personality disorder = 3.5% in US adolescents highly vulnerable to drug abuse due to brains not being fully developed yet

Question 26

describe the mechanism of drug abuse and addiction

Answer 26

2 dopaminergic pathways initiated in middle brain - substantia nigra/caudate and putamen = motor/cognition/emotion - ventral tegmental/nucleus accumbens = reward seeking path almost all addictive drugs affect the reward seeking path

Question 27

what happens in the brain with binge drinking

Answer 27

decreases corona radiata contents (all axonal bundles of brain) affects cognition, emotion, and behavior compromises temporal lobe functions; 10% volume decrease in gray AND white matter

Question 28

describe the negative effects of cannabis on the brain

Answer 28

compromises frontal lobe development - decision making - increases connections = false memory (emotional and psychotic mental illness)

Question 29

describe the negative circuit of marajuana use

Answer 29

abuse = delay in prefrontal development = controls emotional development = decides future orientation = leads to more future abuse

Question 30

features of depression and clinical presentation

Answer 30

chronic feelings of sadness and hopelessness; loss of interest in activities clinical presentation: - can't accept negative feedback - ruminating on negative results

Question 31

describe the loss of functional connections with depression/ areas of the brain affected

Answer 31

cingulate gyrus - negative emotions L dorsolateral prefrontal cortex - decreased inhibition function Amygdala - decreased aversion to neg stimulus

Question 32

medication management for depression

Answer 32

SSRIs incidental findings tryptophan metabolism

Question 33

purpose of cognitive behavior therapy for depression

Answer 33

reconnection of ACC and L DLPRC

Question 34

non-invasive vs invasive treatment for depression

Answer 34

repetitive transcranial stimulation: rTMS activates L DLPFC deep brain stim: DBS inhibits neg circuitry vagus n stim: balance HPA axis stress and improve alertness/arousal

Question 35

what can PT do for depression pts

Answer 35

30 min daily high intensity exercise is better than meds and cognitive behavior therapy

Question 36

describe the longitudinal impairment from early life stress and how it relates to depression

Answer 36

through hypothalamus pituitary gland pathway (HPA axis) "double crush theory" increased cortisol and sympathetic nervous system activates: sensitization recall SNS and sleep cycle; depression is worse in winter due to decreased sunlight exposure

Question 37

describe pathophysiology of HD and the implications

Answer 37

100% genetic predisposition degeneration of basal nuclei and cortex (caudate is worst) = subcortical dementia impairments of cognitive, sensorimotor, and emotional functions

Question 38

prefrontal lobe injury results in what

Answer 38

psychopathological presentation i.e. Phileus gage L DLPFC; compromised with psychopathology but still functional can happen with stroke, viral infections, etc

Question 39

effects fo physical activity/PT on mental illness

Answer 39

large effects on depression and schizophrenia moderate effects on aerobic capacities small effects on anthropometry