Module 41 - Mental Health Flashcards
(78 cards)
1
Q
True or false: Of all the leading causes of the burden of disease, based on the WHO, you can see that it is projected that mental health will be the #1 leading cause of disease in the next 10 years.
A
TRUE
2
Q
What are the 6 common themes across mental health conditions?
A
- Conditions are often poorly defined.
- Need better classification, diagnostic tests, and useful biological markers.
- Some genetic links but rarely the only cause.
- For example, depression/mania occurs in both identical twins only 50% of the time.
- Environmental factors
- Depression more common during winter, mania during summer/fall?
- Often triggered by stressful life events
- Limbic structures are often affected
- The limbic system, prefrontal cortex, hippocampus, amygdala, etc.
- Neuromodulatory projection systems and the hypothalamic-pituitary axis (HPA) also often affected.
- Therapeutic control is often slow and progressive
- For example, 2-6 weeks for SSRIs to start reducing anxiety
3
Q
True or false: there are some genetic links for mental health conditions and it is often the only cause.
A
False, Some genetic links but rarely the only cause.
4
Q
Neuromodulatory projection systems and the _________________________ is also often affected in mental health conditions.
A
Neuromodulatory projection systems and the hypothalamic-pituitary axis (HPA) is also often affected in mental health conditions.
5
Q
What are the stress effects mediated by?
A
- Stress effects are mediated by the hypothalamic-pituitary-adrenal (HPA) axis
- It is composed of the following:
- The hypothalamus Glands (limbic system)
- Anterior pituitary
- Adrenal axis
6
Q
Which structure is responsible for the homeostasis of the body?
A
Hypothalamus
7
Q
How does the hypothalamus control homeostasis?
A
(1) it is attached to autonomic nuclei
Exerts control over sympathetic and parasympathetic nervous systems
The hypothalamus is connected to target structures that produce behaviors associated with anger.
(2) influence pituitary to control blood hormones
Cortisol and the HPA axis
8
Q
What is the hypothalamic-pituitary-adrenal axis? What is a typical response effects.
A
- The hypothalamic-pituitary-adrenal axis is a primary neural circuit associated with the hypothalamus, in responses to traumatic stress the hypothalamus control endocrine function by releasing corticotropin-releasing hormone (CRH)
- The CRH then stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH)
- This then affects the adrenal glans which will release cortisol.
- Cortisol has this negative feedback loop that will inhibit the release of CRH/ACTH
- Cortisol has negative metabolic effects (e.g. increases blood sugar)
9
Q
The hypothalamic-pituitary-adrenal axis → explains how each of these structures is connected. (important question)
A
- The hypothalamic-pituitary-adrenal axis is a primary neural circuit associated with the hypothalamus, in responses to traumatic stress the hypothalamus control endocrine function by releasing corticotropin-releasing hormone (CRH)
- The CRH then stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH)
- This then affects the adrenal glans which will release cortisol.
10
Q
What are the two effects of the release of cortisol? (important question)
A
- Cortisol has this negative feedback loop that will inhibit the release of CRH/ACTH
- Cortisol has negative metabolic effects (e.g. increases blood sugar)
11
Q
Which structure in the brain is ultimately the drive to the hypothalamus to start the chain of events and release CRH?
A
The amygdala
12
Q
________________________are involved in the regulation of stress response, through connections with the hypothalamus.
A
Amygdala and other limbic regions are involved in the regulation of stress response, through connections with the hypothalamus.
13
Q
What activates the HPA axis stress response? (important question)
A
Amygdala activates the response
14
Q
What structures in the brain inactivates the HPA axis stress response?
A
The prefrontal cortex and hippocampus inactivate stress response.
15
Q
What are the 3 things that can inactivate our stress response? (important question)
A
The prefrontal cortex
The hippocampus
Negative feedback from increased cortisol = reduced HPA stress response
16
Q
What hormone has a negative feedback loop that can reduce the HPA stress response?
A
Cortisol
17
Q
What happens if we have chronic stress and there is lots of cortisol floating around?
A
- Reduces hippocampal function, including suppression of HPA → overtime the hippocampus is unable to turn off this stress response
- Decreased dendritic length, branching, number of contacts → these are things that are involved in neuroplasticity
- Can inhibit the ability of pre-frontal cortex to regulate the amygdala and HPA stress response.
- In the process, affects cognitive function, including memory.
18
Q
Why is it true that one of the health effects of chronic stress is decreased neuroplasticity?
A
Excess Cortisol = Decreased dendritic length, branching, number of contacts → these are things that are involved in neuroplasticity
19
Q
Can chronic stress inhibit the ability of the pre-frontal cortex?
A
Yes, it can inhibit the ability of the pre-frontal cortex to regulate the amygdala and HPA stress response.
20
Q
Can chronic stress affect memory?
A
Yes, in the process, with increased cortisol, suppression of the hippocampus, and less neuroplasticity = affect our memory.
21
Q
True or false: Increased levels of cortisol after exposure to psychological stress tests impair memory retrieval.
A
True
22
Q
How does cortisol affect learning?
A
Cortisol administered after learning and before retrieval negatively affects hippocampal depending on declarative learning.
23
Q
Is HPA dysregulation observed in Alzheimer’s disease (AD)?
A
YES, HPA dysregulation is observed in Alzheimer’s disease (AD)
24
Q
What is the HPA-axis reaction to depression?
A
- HPA-axis is often hyperactive!!!
- Possibly due to genetic factors or aversive stimuli that may occur during early development or adult life.
25
How does long term stress affect the hippocampus volume?
* Long term stress, which is caused by an increase in cortisol levels, negatively affects the hippocampus volume
* Low self-esteem has higher stress responses
* Retraction of dendritic processes, inhibition of neurogenesis, and loss of pre-existing neurons (neurotoxicity)
26
RECALL → what are the main functions of our projection system of brainstem and forebrain? What are the 2 general functions of neurotransmitters?
* Projections system of brainstem and forebrain:
* Consciousness
* Attention
* Other functions
* Neurotransmitters have 2 general functions:
* Excitation and inhibition (glutamate and GABA)
* Neuro-modulation
* Signaling cascades that regulate synaptic transmission
* Can be excitatory or inhibitory
27
Which brain regions provide input to the parts of the reticular formation mediating alertness?
* Ascending sensory inputs
* For example, anterolateral pathways
* Pain can increase alertness
* Frontoparietal association and limbic cortices
* Cognitive and emotional processes can modulate alertness
* Hypothalamus
* Fight or flight
28
What are the four neurotransmitters that are involved in mediating alertness and important for mental health?
* Acetylcholine
* Dopamine
* Norepinephrine
* Serotonin
29
What are the four structures in the brain that make up the consciousness system networks? Which neurotransmitters do they use?
* Structures of consciousness system networks
* Upper brainstem
* Thalamus
* Hypothalamus
* Basal forebrain
* Neurotransmitters
* Cholinergic → Acetylcholine
* Dopaminergic → Dopamine
* Noradrenergic → Norepinephrine
* Serotonergic → Serotonin
30
What are the general roles of each of the neurotransmitters that are involved in mediating alertness and important for mental health?
* Acetylcholine
* Alertness
* Memory
* Dopamine
* Alertness
* Memory
* Movements
* Initiative
* Norepinephrine
* Alertness
* Mood elevation
* Serotonin
* Alertness
* Mood elevation
* Breathing
31
What are the cell bodies, targets, and functions of acetylcholine?
* Cell bodies → basal forebrain
* Targets → cerebral cortex, including hippocampus; thalamus, cerebellum, pons, and medulla
* Functions → alertness, memory
32
What is the link between Alzheimer’s disease and acetylcholine?
* Degeneration of cholinergic neurons in basal forebrain may account for memory loss in Alzheimer’s disease.
* This is likely due to the fact that there is not as much of an impact on the hippocampus.
33
True or false: There is a gradual reduction of acetylcholine with normal aging which can cause memory deficits.
TRUE
34
What are the cell bodies, targets, and functions of dopamine?
* Cell bodies → Midbrain - substantia nigra, pars compacta & VTA
* Targets → Striatum, limbic cortex, amygdala, nucleus accumbens, prefrontal cortex
* Functions → movements, initiative, working memory
35
What is the relationship between dopamine and psychosis?
* “Negative” symptoms in schizophrenia may result from dysregulation of dopaminergic pathways
* Some antipsychotic meds that prevent the binding of dopamine to certain receptor sites decrease hallucinations, delusions, and disorganized thinking.
* HOWEVER, because the drugs prevent the binding of dopamine, side effects can include motor difficulties, like tardive dyskinesia.
36
What type of drugs are used to decrease hallucinations, delusions, and disorganized thinking? What are some possible important side effects?
* Some antipsychotic meds that prevent the binding of dopamine to certain receptor sites decrease hallucinations, delusions, and disorganized thinking.
* HOWEVER, because the drugs prevent the binding of dopamine, side effects can include motor difficulties, like tardive dyskinesia.
37
What are the cell bodies, targets, and functions of norepinephrine?
* Cell bodies → Pons (and medulla)
* Targets → entire CNS
* Functions → alertness, mood elevation
38
How are norepinephrine and stress connected/linked?
Associated with fight or flight reaction to stress
High levels associated with vigilance, low levels associated with sleep.
39
High levels of norepinephrine are associated with \_\_\_\_\_\_\_\_\_, and low levels of NE associated with \_\_\_\_\_\_\_\_\_\_.
High levels associated with vigilance, low levels associated with sleep
40
What would abnormal norepinephrine signaling are related to which mental health disorders?
* PTSD: involves excessive norepinephrine
* Depression -\> lower levels of norepinephrine
* Mania
41
What type of mediations are typically used to treat depression?
SNRI → Selective norepinephrine reuptake inhibitors OR
SSRI → Selective serotonin reuptake inhibitors
42
What are the cell bodies, targets, and functions of serotonin?
Cell bodies → midbrain, pons, and medulla
Targets → entire CNS
Functions → alertness, mood elevation, breathing control
43
What is the connection between serotonin and the general arousal level?
* Serotonin adjusts the general arousal level and suppresses sensory information (e.g. plays a role in descending pain control system)
* High levels = alertness
* Low levels = associated with NON-REM sleep, depression, and suicidal behavior.
44
High levels of serotonin are associated with \_\_\_\_\_\_\_\_\_, and low levels of serotonin associated with \_\_\_\_\_\_\_\_\_\_.
High levels of serotonin are associated with alertness, and low levels of serotonin associated with NON-REM sleep, depression, and suicidal behavior.
45
What is the definition of depression?
Depression - A major depressive disorder - usually just called “depression” - is different than the “blues”. Someone experiencing depression is grappling with feeling of severe despair over an extended period of time. Almost every aspect of their life can be affected, including their emotions, physical health, relationships and work. For people with depression, it does not feel like there is a “light at the end of the tunnel” - there is just a long, dark tunnel.
46
Does depression affect more women or men?
10-25 % of women
5-12 % of men in a lifetime
47
Depression is often accompanied by what kind of disorders?
Often accompanied by an eating disorder, sleeping disorder, feelings of guilt, etc.
48
What is unipolar depression?
Depression alone
49
What is bipolar depression?
Depression with manic episodes
50
True or false: Depression has a blunted affect.
True
51
Is there a genetic component for depression?
Increased incidence in identical twins and close relatives
Gene unknown, and not the only cause
52
What are some neurological correlates with depression?
* Smaller hippocampal volume in depressed individuals
* Increased HPA activity
* Deficiency in noradrenergic and serotonergic neurotransmission
* SSRI and SNRI treatment
53
The severity of depression is correlated with increased blood flow in which regions of the brain?
* Amygdala
* Medial dorsal nucleus of the thalamus
* Prefrontal cortex
We know that this circuit and the amygdala plays an important role in a lot of negative emotions.
54
What is the basal-lateral amygdala in charge of?
* It is in charge of interpreting and evaluating the significance of stimuli and as you go to the prefrontal cortex there is a lot of the integration happens, we know that both the connections both to and from the amygdala provide the concept of what is necessary to express emotions such as fear.
* SO again it makes sense that with a high level of negative emotions → depression → we see a high level of blood flow to these regions.
55
What is the link between exercise and depression
* “...assuming the relationship is causal, 12% of future cases of depression could have been prevented if all participants had engaged in at least 1 hour of physical activity each week…”
* “Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.”
56
What are the different subtypes of anxiety?
* Phobias
* Panic disorder
* Agoraphobia
* Social anxiety disorder
* Generalized anxiety disorder
* Obsessive-compulsive disorder (OCD)
* Post-traumatic stress disorder (PTSD)
57
What are the four general characteristics of people that suffer from anxiety?
* Excessive fear and avoidance of anxiety triggers (for example, someone who has the anxiety to go over a bridge will avoid getting into situations where they need to)
* Increased activity in the amygdala is most common
* In response to stimuli, not necessarily at rest
* Increases in cortisol levels (it makes sense because high cortisol levels mean that the amygdala is telling the hypothalamus to start the chain of events in response to something that is causing fear or anxiety)
* Dysregulation of the noradrenergic and serotonergic transmitter systems
58
What is the definition of a generalized anxiety disorder?
“Generalized anxiety disorder is excessive worry around a number of everyday problems for more than six months. This anxiety is often far greater than expected - for example, intense anxiety over a minor concern. Many people experience physical symptoms too, including muscle tension and sleep problem.”
59
What are some of the treatments for generalized anxiety disorder?
* Psychotherapy - CBT
* Antidepressants
* Selective serotonin reuptake inhibitors (SSRI)
* Serotonin and norepinephrine reuptake inhibitors (SNRI)
60
True or false: Increase cortisol from a generalized anxiety disorder in late life does not have an effect of cognitive decline.
FALSE → Increase cortisol from a generalized anxiety disorder in late life may increase the rate of cognitive decline
61
What are the positive and negative/cognitive symptoms of schizophrenia?
* Positive symptoms → hallucinations, delusions
* Negative/cognitive symptoms → disordered thinking, tangential speech, withdrawal, flat affect, poor working memory.
62
Which structures of the brain are likely to be pathologic in schizophrenia?
Limbic system
Frontal lobes
Basal ganglia
63
Given that the pathology of schizophrenia is due to problems to the limbic system, frontal lobes, and the basal ganglia; explain the details of what is happening in those pathways.
* Neuroimaging: decreased activation in the dorsolateral prefrontal cortex
* Abnormal \*dopamine levels
* Antipsychotic drugs act on dopaminergic receptors (etc.)
* Given that these pathways modulate cognitive functions known to be affected in schizophrenia, this makes intuitive sense.
64
Compare and contrast schizophrenia to Parkinson’s disease.
IMAGE
65
True or false schizophrenia medications often aim to increase dopamine levels.
False → Parkinson’s medications often aim to increase dopamine levels
Antipsychotic agents for schizophrenia are often dopamine antagonist
66
What is the relationship between exercise and schizophrenia?
Exercise Improves Clinical Symptoms, Quality of Life, Global Functioning, and Depression in Schizophrenia: A systematic REview and Meta-analysis
Conclusion: Physical exercise is a robust add-on treatment for improving clinical symptoms, quality of life, global functioning, and depressive symptoms in patients with schizophrenia. The effect on cognition is not demonstrated but may be present for yoga (mediation).
67
What is dementia?
Dementia is a general term, there are many types, reflecting different patterns of neuronal development
68
Which is the most common form of dementia?
Alzheimer’s disease
69
Dementia is associated with late stages of other degenerative diseases, such as \_\_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Dementia is associated with late stages of other degenerative diseases, such as Huntington’s, Parkinson’s, vascular.
70
True or false: Diffuse neuron loss in the cerebral cortex happens with dementia but the causes are not always obvious.
TRUE
71
What kind of symptoms do people with dementia experience?
Often involves a wide range of cognitive symptoms (including memory, reasoning, etc.) motor symptoms, and emotional symptoms.
72
What is the general progression of Alzheimer’s disease and its stages?
* Amnesia stage - impaired short term memory
* Confusional stage - a decline of cognitive abilities
* Dementia stage - unable to care for oneself
73
What is a typical neuroscience pathology that happens with Alzheimer’s? (important question)
* Neurofibrillary tangs (yellow in figure → Intracellular
* Amyloid plaques (brown in the figure) → Extracellular
* Temporal lobe earliest/most extensive neuronal loss
74
Which lobe in the brain has the earliest/most extensive neuronal loss with Alzheimer’s?
* Temporal lobe earliest/most extensive neuronal loss
* This makes sense because if we have the hippocampus that is important for learning and memory and is sometimes considered to be part of the temporal lobe or it is close by; the hallmark sign of Alzheimer’s is the loss of memory → it would make sense that the temporal lobe earliest/most extensive neuronal loss
75
What is Chronic traumatic encephalopathy (CTE)?
* Chronic traumatic encephalopathy (CTE) is a brain condition associated with repeated blows to the head. It is also associated with the development of dementia. Potential signs of CTE are problems with thinking and memory, personality changes, and behavioral changes including aggression and depression.
* This shows that chronic concussions (even if they are asymptomatic), overtime buildups, and we start to see brain atrophy and a lot of cognitive declines that goes with it.
76
What is the link between acetylcholine and Alzheimer’s?
* The cerebral cortex receives cholinergic input from a group of neurons in the basal forebrain
* So with Alzheimer’s, we see early degeneration of these cholinergic neurons
* Only widely used treatment to slow down the progression of AD: “Cholinergic boosters” like Aricept anticholinesterase that prevents the breakdown of Ach.
77
What is the only widely used treatment to slow down the progression of Alzheimer’s disease? And what does it do?
* Only widely used treatment to slow down the progression of AD: “Cholinergic boosters” like Aricept anticholinesterase that prevents the breakdown of Ach.
* It has to be used quite early because if it is given too late then the cholinergic neurons might have already degenerated so it can’t help anymore.
78
Key concepts
* Specific causes of mental illness are often poorly understood.
* Mental illness has environmental/psychological and genetic causes.
* Limbic system, HPA and neuromodulatory systems (NE, Ach, dopamine, serotonin) often implicated in mental illness.
* Stress response
* Mediated by the hypothalamic-pituitary axis (HPA)
* Involves CHR (hypothalamus), ACTH (anterior pituitary), and cortisol (adrenal glands).
* Understanding stress response, limbic system, and neuromodulatory systems allows for general comprehension of some common disorders.
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