READINGS! Flashcards
Disorders of Consciousness
Describe the case of Kate
- Kate - fell into a coma after flu-like illness
- Declared vegetative - meaning that she had sleep-wake cycles, but lacked conscious awareness
What was unique about Kate’s case?
- Put into a PET scan - flashed pictures of friends and family to look for response from brain
- Not only did her brain respond to the faces, but the pattern of brain activity was strikingly similar to what we and others had seen when showing the faces of loved ones to healthy, aware individuals
How were Kate’s brain activity scans possible? RESEARCH STUMPS
- Finding results has been difficult across similar patients (legally and medically)
- Unsure if the seemingly normal brain responses reflected an undetected consciousness or if they were more basic, automatic neural signals, largely independent of any higher-level conscious processing.
Describe the functional magnetic resonance imaging (fMRI)-based experiments that Owen and colleagues carried out on individuals who had been deemed to be in a vegetative state
Speech/Nonspeech sounds
- sedated healthy participants and exposed them to the same combination of speech and nonspeech sounds that we had shown could elicit normal patterns of brain activity in some vegetative patients.
- Surprisingly, when these healthy subjects were rendered unconscious with the short-acting anesthetic propofol, the speech-perception areas of the brain were activated just as strongly as when the participants were wide awake.
- This crucial piece of evidence that the brain processes speech automatically, even when we are not conscious and aware that we are doing it.
Describe the functional magnetic resonance imaging (fMRI)-based experiments that Owen and colleagues carried out on individuals who had been deemed to be in a vegetative state
Response to Command
- Patients were too injured to produce physical responses to commands, but could they produce a measurable brain response by just thinking about it?
- Just like the TV doctor who tells the patient to “Squeeze my hand if you can hear me,” we found we could elicit a reliable response to a command, visible by fMRI in the premotor cortex, by asking the volunteers to “Imagine playing tennis if you can hear me.”
Describe three conditions (other than brain death) in which consciousness is compromised
- Coma
- Vegetative state (unconscious wakefulness state)
- Locked-in syndrome (CMD)
- Minimally conscious state
Dysfunction Associated with Psychiatric Disorders
Define stigma
- Stigma: characterized by societal prejudice and discrimination, profoundly influences psychiatric care, creating barriers to the timely recognition and treatment of mental health disorders
- Deeply embedded in societal norms, stigma is a multifaceted issue permeating every level of psychiatric care, leading to delayed treatment, increased morbidity, and a diminished quality of life for patients.
How can stigma impact the individual?
- stigma can lead to fear and avoidance of mental health services, causing delays in seeking help even when a patient is in dire need
How can stigma impact the families?
stigma can lead to shame and isolation, making seeking necessary support and resources more difficult.
How can stigma impact the patient and their provider?
difficulty in establishing trustful and therapeutic relationships, which are essential for effective care
How can stigma impact society?
- stigma can result in the misallocation of resources, with mental health services often being underfunded and overlooked
- social isolation/discrimination
- stereotyping
Provide 2 examples of culturally-specific perceptions around mental health
- Healthcare providers are not immune to these cultural beliefs, and this can influence their practice. In some cultures, mental illnesses are viewed through a supernatural lens rather than a medical one (EX: Ethiopian)
- In many Asian societies, mental health issues are often perceived as a sign of personal weakness or a failure of self-control
Explain 2 potential strategies to address mental health stigma
- Public Awareness Campaigns
- Cultural Competency Training for Healthcare Professionals
Neuroplasticity
List 2 obstacles to developing evidence-based therapies for recovery of function after cerebral injury
- There is no generally accepted definition of what constitutes “recovery”; EX: the three legged cat (not necessarily recovering, but adapting)
- Most animal studies have well-defined injuries that are controlled by the investigators whereas there is far more variance in human conditions
Describe 3 general principles of plasticity in the normal brain, pointing to specific
research or findings for each
- The brain is altered by a surprisingly wide variety of experiences throughout the lifespan
- Different measures of neuronal change independently of each other and sometimes in opposite directions
- Plastic changes are age-dependent
The brain is altered by a surprisingly wide variety of experiences throughout the lifespan
Describe 3 general principles of plasticity in the normal brain, pointing to specific
research or findings for each
- Many of these experiences can be obvious or less inuitive.
- The brain can be changed by virtually any experience, and even a thought
- Some of the biggest changes in brain functioning come from drugs such as psychomotor stimulants or the administration of neurotrophic factors when used in combination with other experiences such as sensorimotor training.
Different measures of neuronal change independently of each other and sometimes in opposite directions
Describe 3 general principles of plasticity in the normal brain, pointing to specific
research or findings for each
- There has been a tendency in the literature to see different neuronal changes as surrogates for one another
- One of the most common is to assume that changes in spine density reflect changes in dendritic length and vice versa.
- This turns out not to be the case as the two measures can vary independently and sometimes in opposite directions
- Furthermore, cells in different cortical layers, but in the same presumptive columns, can show very different responses to the same experiences
Plastic changes are age-dependent
Describe 3 general principles of plasticity in the normal brain, pointing to specific
research or findings for each
- It is generally presumed that the developing brain will be more responsive to experiences than the adult or senescent brain.
- Furthermore, there are qualitatively different changes in the brain in response to what appears to be the same experience at different ages.
- For example, when weanling, adult, or senescent rats were placed in a complex environment, all groups showed large synaptic changes but they were surprisingly different
Social Determinants of Health
Describe, in general terms, Kate’s experience of being diagnosed with dementia
- Diagnosed young with a relatively rare form of dementia called semantic variant primary progressive aphasia
- Once she had her diagnosis, she was surprised by her options. Or really, the lack thereof: told to “give up on her job”, the medical community still see dementia as a death sentence; no grief and loss counseling
- Even some of her friends and family seemed to write her off once she told them about her diagnosis
Describe, in general terms, a challenge Nikki experienced while caring for her mother with dementia.
- No one explained sundowning: could have such a great morning, and all of a sudden she’d be angry, throwing things, getting loud.
- Many people with dementia have trouble in the evening, quite literally when the sun goes down. They often get anxious, and irritated, and can sometimes lash out because they’re feeling afraid and out of control.
