Lecture 22 - Autism, Depression, Anxiety

Question 1

How is Autistic spectrum disorder defined?

Answer 1

It is described as a wide range of developmental disorders that are characterized by troubles with social interaction and communication, and by restricted and repetitive behaviour.

Question 2

What is autistic spectrum disorder characterized by?

Answer 2

Troubles with social interaction and communication
Restricted and repetitive behaviour

Question 3

How is autistic spectrum disorder comorbidity with other disorders?

Answer 3

1/3 have intellectual disabilities
1/3 have seizure disorders
50% have sensory processing issues

These are not enough to say you have autism, it just means you have autism comorbid with intellectual disabilities for example.

Question 4

When do parents usually get concerned with children with autistic spectrum disorder?

Answer 4

The first two or three years of a child’s life.

Question 5

What are the initial symptoms of autistic spectrum disorder in children?

Answer 5

Social impairments
- Parents will call the child’s name and he/she will not turn their head around at all or even immediately. If they do turn their head, they will not look the parent in the eyes.
- Being held. Some will have no problem with being held, but will not seem to crave being held like other children. They will seem indifferent.
- Being held. Some will arch their backs when picked up, as if they do not want to be held.

Question 6

What is autistic spectrum disorder associated with in terms of causes ?

Answer 6

Associated with a combination of genetic and environmental factors that affect the early brain development.

OR

Many cases have been linked to spontaneous rare gene mutations that have severe effects
- Chromosomal abnormalities involving deletions, duplications or inversions of genetic material.

OR

Other cases are associated with rare multi gene interactions involving common gene variants.

OR

Maternal viral infections during pregnancy

Question 7

What is the heritability of autism and autism spectrum disorder?

Answer 7

Austism —> 70%

Autism spectrum disorder —> 90%

Question 8

How is language affected in autism spectrum disorder?

Answer 8

1/3 of people with autism do not develop enough natural speech to meet their daily communication needs.
- May echo what is said to them or they may refer to themselves as others do — second or third person

Question 9

What are some of the symptoms of autism spectrum disorder?

Answer 9

1) atypical interests and behaviours
- Interests are very specific and they will become obsessed about these interests.

2) stereotyped movements
- Flapping their hand back and forth or rocking back and forth

2) Compulsive or ritualistic behaviour

Question 10

How do people with autism sometimes describe sensory stimulation?

Answer 10

People with autism might have sensory stimulation issues. They describe it as being too loud, too bright, too overwhelming, or on the contrary, not loud enough, not bright enough, not stimulating enough.

• The behaviours and stereotyped movements are anxiety reducing behaviours in an attempt to relieve the sensory stimulation issues

Question 11

What is the possible explanation for why autistic people have sensory issues?

Answer 11

It’s harder for their brain to integrate all the sensory information together. Some parts of the brain are too active or not active enough.

Question 12

How do mild forms of autism spectrum disorder present?

Answer 12

• Often do not include a delay in language development or the presence of important cognitive deficits
• Mostly just involve deficient or absent social interactions and repetitive and stereotyped behaviours along with obsessional interest in narrow subjects

Question 13

What is the sex difference in autism disorder?

Answer 13

• Disorder is 4x more common in males than females
• If intellectual disability cases only, the ratio falls to 2:1
• If cases of high-functioning autism are considered, the ratio rises to 7:1 (males:females)

Question 14

What could be the cause of the sex difference in autism spectrum disorder?

Answer 14

Mammals and most insects
XX - females
XY - males

When you have two copies of a gene, you have a better chance to get a working copy. Males only have one copy of each, which means that they only have one chance of getting it right. If one copy is defective, it will present itself as autism or other deficits and disorders.

It’s really not beneficial to have only one copy of the gene.

Question 15

What are the abnormalities in the development of the brains of autistic children?

Answer 15

• Slightly small brain at birth, but it grows abnormally fast and by 2-3 years of age is often about 10% larger than a normal brain.
• Growth of brain slows down and by adolescence, it is only about 1-2% larger than normal.

Question 16

What are the hypotheses for the cellular and molecular bases of early brain overgrowth seen in autistic children?

Answer 16

1) Altered neuronal migration during early gestation
2) Abnormal formation of synapses and dendritic spines
3) Over-connectivity in key brain regions
4) Unbalanced excitatory-inhibitory neural networks

Question 17

Where is there little to no activity in the brain of autistic adults looking at pictures of human faces?

Answer 17

Fusiform face area

Question 18

What are the treatments for autism?

Answer 18

Goal = to lessen the impact of the associated deficits and family distress, and to increase quality of life and functional independence

• Intensive, sustained special education programs and behaviour therapy early in life
• Medications can help reduce the irritability, inattention and repetitive behaviours

Question 19

What are the medications that can be tried to treat autism spectrum disorder?

Answer 19

-Anticonvuslants (increases GABA receptor activity)
- Antidepressants (increases serotonin receptor activity)
-Antipsychotics (decreases dopamine receptor activity)
- Stimulants (increases dopamine receptor activity

Question 20

What is an affect?

Answer 20

Refers to feelings or emotions

Question 21

What is the primary symptom of affective disorders?

Answer 21

Disordered feelings

Question 22

What is a mood (affective) disorder?

Answer 22

Serious mood disorder
- Bipolar disorder
- Major depressive disorder

Question 23

What is the prevalence of mood disorders in both men and women?

Answer 23

7% in women
3% in men

Question 24

What are the main feelings associated with depressed people?

Answer 24

Feeling unworthy, hopeless
+ strong feelings of guilt

Question 25

What is bipolar disorder?

Answer 25

A serious mood disorder characterized by cyclical periods of mania and depression
- affects 1% of the population
- 80% of the risk attributed to genetics

Question 26

What is a major depressive disorder?

Answer 26

Serious mood disorder that consists of unremitting depression or periods of depression.
- DO NOT alternate with mania
- 40% of the risk attributed to genetics
- More dependent on environmental factors

Question 27

Describe mania.

Answer 27

Episodes of mania are characterized by sense of euphoria that does not seem to be justified by circumstances.
- Exhibit nonstop speech and motor activity
- Unjustified behaviour and thinking
- Can have major consequences on people’s lives. EX; someone decides to sell their house while in a mania episode or gamble a lot of their money away.

Question 28

What is the main biological treatment for bipolar disorder?

Answer 28

Lithium
- Lithium salts are commonly prescribed for bipolar disorder
- Most effective for treating the manic phase of bipolar disorder
- once mania is eliminated, depression usually does not follow
- Therapeutic effect is very fast.

Question 29

What are the several established and experimental biological treatments for major depressive disorder?

Answer 29

Drugs that increase serotonin or norepinephrine signalling by inhibiting their enzymatic breakdown or by blocking their reuptake

• Ketamine (NMDA glutamate receptor blocker) —> pretty rapid lifting of the mood in about a day or two
• Electroconvulsive therapy
• Deere brain stimulation
• Transcranial magnetic stimulation
• Vagus nerve stimulation
• Bright-light therapy
• Sleep deprivation

Question 30

What are tricyclic antidepressant ?

Answer 30

Launched the field of medication to treat depression.
- Inhibits reuptake of serotonin and norepinephrine but also affects other neurotransmitters.

Question 31

What are serotonin specific reuptake inhibitor?

Answer 31

Used to treat depression.

• A class of drugs that specifically inhibit the reuptake of serotonin without affecting the reuptake of other neurotransmitters.
• Prozac, Celexa, Paxil, Zoloft, etc…

Question 32

What are serotonin and norepinephrine reuptake inhibitor?

Answer 32

Used to treat depression.
- Antidepressant drug that specifically inhibits reuptake of norepinephrine and serotonin without affecting the reuptake of other neurotransmitters.

Question 33

What is the monoamine hypothesis of depression?

Answer 33

It’s the idea that depression is caused by insufficient monoamine receptor activity (serotonin, norepinephrine and dopamine.

• Tested cocaine and amphetamine to see if it was the dopamine receptors that were responsible for depression, but the people still had terrible depression after, so they focused more on norepinephrine and serotonin.

Question 34

How did they test whether serotonin was responsible for depression in the monoamine hypothesis?

Answer 34

Tryptophan is the molecular precursor to serotonin. They gave people a low-tryptophan diet and then a tryptophan-free amino acid cocktail that lowered brain tryptophan levels and consequently decreased the synthesis of serotonin.
- This had no effect on most people, but it elicited a depressive episode in people susceptible to depression

Question 35

What are functional imaging scans?

Answer 35

Functional imaging scans have been done on many depressed patients, both before and after a variety of successful treatments.

Question 36

What were the findings of functional imaging scans on people with depression before and after treatment?

Answer 36

The argument has been made that one area of the anterior cingulate cortex becomes less active after successful treatments.

—> led to the idea that deep brain stimulation of this one area could alleviate depression

Question 37

Where has deep brain stimulation been tried for people with depression?

Answer 37

In the subgenual anterior cingulate cortex as well as in the nucleus accumbens in the striatum.

Question 38

What is transcranial magnetic stimulation and how is it used to treat depression?

Answer 38

It is often targeted to the prefrontal cortex to get it a bit more active, since the prefrontal cortex is thought to regulate emotions. It is stimulated with a magnetic field.

It does not have many side effects, but it’s not proven to work just yet.

Question 39

What is vague nerve stimulation and how is it used to treat depression?

Answer 39

It’s the stimulation of the vagal nerve (vagus). They electrically stimulate it and in some people, there is a rapid change and it lifts up their mood. We do not know how it works and why it works on some people and not others.

Question 40

What is electroconvulsive therapy and how is it used to treat depression?

Answer 40

Electro shocks used therapeutically to alleviate severe depression and bipolar disorder.

Seizures are electrically induced by applying brief electrical shocks to the head.

It’s the most effective treatment, but people hate the experience and complain about the side effects. People will get this if the depression is major enough.

The effects are seen within days.

Question 41

How is sleep affected by depression?

Answer 41

People with depression often have shallow, fragmented sleep. They tend to awaken frequently, especially toward morning.
- They spend more time in stage 1 sleep ad less time in deep, slow-wave sleep.
- They also enter REM sleep soon after falling asleep, much earlier in the night in comparison to other people.

Question 42

What is total sleep deprivation?

Answer 42

One of the most effective antidepressant treatment.
- It has immediate antidepressant effects in some people
- Depression is lifted by staying up overnight, but it returns after a normal night’s sleep.
- It suggests that a chemical builds up during waking hours that has some antidepressant effect and it gets cleared away during sleep.

REM sleep deprivation also works, although more slowly.

Question 43

What is the idea that cam from total sleep deprivation?

Answer 43

The idea that a chemical builds up during waking hours that has some antidepressant effect and it gets cleared away during sleep.

Question 44

What is an anxiety disorder?

Answer 44

A variety of psychological disorders

Characterized by unrealistic and unfounded fear and anxiety.

Includes muscle tension, over activity of the autonomic nervous system,. Expectations of an impending disaster, and continuous vigilance for danger.

Question 45

What is generalized anxiety disorder?

Answer 45

The most common anxiety disorder.

Characterized by excessive anxiety and worry serious enough to cause disruption of their lives

Question 46

What is social anxiety disorder?

Answer 46

Characterized by excessive fear of being exposed to the scrutiny of other people that leads to avoidance of social situations in which person is called on to perform.

Common in teenage years

Question 47

What is panic disorder?

Answer 47

Characterized by episodic periods of severe and unremitting terror. Includes symptoms such as shortness of breath, irregularities in heartbeat and other autonomic symptoms, accompanied by intense fear.

Question 48

What is anticipatory anxiety caused by panic disorder?

Answer 48

Fear of having a panic attack promotes anticipatory anxiety that sometimes leads to the development of agoraphobia.

Question 49

What is agoraphobia?

Answer 49

Fear of being away from home or other protected places.

Question 50

What is the prevalence of anxiety disorders?

Answer 50

12% of people are affected by an anxiety disorder.

2x as much in females than males.

Question 51

What are some of the causes of anxiety disorders?

Answer 51

Combination of genetic and environmental factors

Environmental factors
- history of child abuse
- poverty

Anxiety disorders often occur with other mental disorders, particularly major depressive disorder, personality disorder and substance use disorder.

Older people with dementia, often have problems with anxiety.

Question 52

Which parts of the brain are involved in anxiety disorders?

Answer 52

Amygdala
- Increased activity

Prefrontal cortex
- Decreased activity

Question 53

What lifestyle changes can help with anxiety disorders?

Answer 53

• Exercise
• Regularizing sleep patterns
• Reducing caffeine intake and smoking

Question 54

Which treatments are used for anxiety disorders?

Answer 54

1) Lifestyle changes

2) Cognitive behavioural therapy

3) Medication
- Benzodiazepines are sometimes use, particularly in emergency settings because of their rapid onset
- Selective serotonin reuptake inhibitors are frequently used as a first line treatment