Theme 3 - Modulatory systems in Psychiatry Flashcards Preview

202 Neuroscience & Behaviour > Theme 3 - Modulatory systems in Psychiatry > Flashcards

Flashcards in Theme 3 - Modulatory systems in Psychiatry Deck (62)
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1
Q

What is the pathway for reward in the brain?

A

mesocorticolimbic

2
Q

What is tolerance?

A

Diminished response to the effects of a given amount of drug following repeated exposures to the drug.

3
Q

In what brain system does addiction?

A

Mesolimbic dopaminergic system

4
Q

What structure releases what substance in addiction?

A

Dopamine released from nucleus accumbens

5
Q

What effect does alcohol have on the DAergic system?

A

disinhibition of ventral tegmental DA neurons

6
Q

What effect do opiates have of on the DAergic system?

A

inhibit GABAergic neurons in VTA which disinhibits VTA DA neurons

7
Q

What effect do psychostimulants have of on the DAergic system?

A

direct effect on DA neurons in nucleus accumbens

8
Q

What effect do nicotine have of on the DAergic system?

A

increases nuclesus accumbens DA directly and indirectly

9
Q

How does cocaine affect dopamine levels in nucleus accumbens?

A

Blocks reuptake transporters

10
Q

How do amphetamines affect dopamine in the nucleus accumbens?

A

DA transporters run in reverse

11
Q

What receptors does alcohol affect?

A

GABAa - agonist

NMDA - anatgonist

12
Q

What brain structure is linked to the physical dependance upon opiates?

A

Locus coereolus

13
Q

What receptors are linked to alcohol dependence?

A

GABAa - downregulated
NMDA - upregulated
SO when you stop pissing up get excitation symptoms such as tremors, agitation, seizures

14
Q

6 examples of disorders associated with neurosis?

A
Anxeity
Depressive
Obsessive
Compulsive
Adjustment
Somatisation
15
Q

4 disorders associated with psychosis

A

Organic
Bipolar
Schizophrenia
Depressive

16
Q

What is defined as
An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions and hallucinations?

A

Psychosis

17
Q

What is the time limit for a psychotic episode?

A

1 week

18
Q

What is defined as Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background

A

delusion

19
Q

What is defined as a perception experienced in the absence of external stimulus?

A

Hallucination

20
Q

Schizophrenia is a minimum of 1 of these symptoms

A

a Thought echo, insertion, withdrawal or broadcast

b Delusion of passivity or delusional perception
(e.g. the toilet flushed and then I knew)

c Running commentary hallucination or 2 voices discussing the patient

d Persistent delusions of other kinds

21
Q

Schizophrenia it at least 2 of these symptoms for at least one month

A

e Persistent hallucinations in any modality with accompanying brief delusions

f Breaks in thought resulting in abnormal speech (eg. incoherent, neologisms)

g Catatonic behaviour eg. Excitement, posturing, waxy flexibility, negativism

h Negative symptoms not due to depression or medication

In the absence of an organic disorder

22
Q

At least 5 causes of organic psychosis

A

Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Cerebral trauma
Cerebrovascular disease
Demyelination: Multiple sclerosis etc
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Immunological: SLE
Acute drug intoxication: eg. Ketamine, Cannabis, LSD, PCP, Amphetamine,
Toxins eg. lead
Dementias

23
Q

What are the 2 types of schizophrenia and types of symptoms associated with each?

A

Acute - positive symptoms

Chronic - negative symptoms

24
Q

Percentage prognosis of schizophrenia?

A

20% - complete recovery and off treatment
25% - perisitant symptoms after first episode
+50% - relapsing remitting

25
Q

At least 5 things that give a good prognosis of schizophrenia

A
Female
Married			
Family history of affective disorder
Good premorbid function
Acute onset
Life event at onset
Early treatment
Affective symptoms
Good treatment response
26
Q

At least 5 things for a poor prognosis of schizophrenia

A
Male
Single
Family history of schizophrenia
Premorbidly schizoid
Slow onset
Long duration untreated
Negative symptoms
Obsessions
High Expressed Emotion in the family
Substance misuse
27
Q

Two structural changes to brain associated with schizophrenia

A

Ventricular enlargement

reduced brain volume

28
Q

What 3 neurophysiological phenomina are associated whith schizophrenia?

A

Hypofrontality
Hyper-excitable sensory cortex
Abnormal neural oscillations

29
Q

What are 4 neurocognitive effects associated with schizophrenia?

A
Lower IQ
Attentional deficits (e.g. Stroop Test)
Working memory (e.g. Wisconsin Card Sorting Test)
Planning and information processing deficits
30
Q

What are the 4 affective episodes?

A

Major Depressive Episode
Manic Episode
Hypomanic Episode
Mixed affective episode

31
Q

give 9 symptoms of depression

A
Depression of mood
Anhedonia
Psychomotor retardation
Agitation / restlessness
Anxiety / preoccupation
Diurnal variation of mood
Insomnia
Feelings of guilt , self-reproach worthlessness
Somatic symptoms
Hypochondriasis
Weight loss
Suicidal thoughts
32
Q

What are the DSM V criteria of a major depressive episode?

A

5 or more of the following symptoms for 1 week
Depressed mood most of the day, nearly every day
Diminished interest or pleasure
Weight loss / weight gain or appetite decrease / increase
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent suicidal ideation or a suicide attempt/plan

33
Q

5 features of atypical depression

A
Mood reactivity
Significant weight gain
Hypersomnia
leaden paralysis
interpersonal rejection sensitivity
34
Q

3 criteria for manic episode

A

abnormally and persistently elevated, expansive, or irritable mood

For a period lasting at least one week and present most of the day, nearly every day:

abnormally and persistently increased activity or energy

35
Q

7 possible symptoms of a manic episode

A

Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or racing thoughts
Distractibility
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in high risk activities

36
Q

2 Differences between a manic and hypomanic episode?

A

Same symptoms but hypomanic episode is for 4 days rather than 1 week
The episode is not severe enough to cause marked functional impairment or to necessitate hospitalization

37
Q

What 3 features can be associated with both depression and mania?

A

Anxiety
Hallucinations/delusions
Catatonia

38
Q

4 epidemiology features of major depressive disorder

A

onset 25-35
1 in 5
more females than males
8-19% suicide

39
Q

Difference between the two types of bipolar disorder

A

Bipolar Disorder I
At least one manic episode

Bipolar Disorder II
At least one hypomanic episode
At least one major depressive episode

40
Q

4 epidemiology features of bipolar disorder

A

15-24 onset
delayed diagnosis
familial aggregation
men and women affected equally BP I

41
Q

7 typical symptoms of acute stress

A
Feelings of being numb or dazed
Insomnia
Restlessness
Poor concentration
Autonomic arousal
Anger/anxiety/depression
Withdrawal
42
Q

2 abnormal response to stress

A

PTSD

Adjustment disorder

43
Q

What is the difference between a normal response and an adjustment disorder, how long can the latter last?

A

Adjustment is out of proportion to stressor

Up to 6 months

44
Q

6 symptoms of PTSD

A
Re-experiencing flashbacks/nightmares
Numbness/detachment
Avoidance
Hypervigilance/startle
Insomnia
Anxiety/depression
45
Q

What is the average course of PTSD?

A

Usually immediate onset

Most recover within one year

46
Q

6 physical symptoms of general anxiety disorder?

A
sweating 
palpitations
dry mouth
epigastric discomfort
dizziness
trembling
47
Q

6 psychological symptoms of GAD

A
Fearful anticipation
Irritability
Sensitivity to noise
Restlessness
Poor concentration
Worrying thoughts
48
Q

Aietology of GAD in relation to parenting

A

Overprotective
Lack of warmth & encouragement
more critical and intrusive

49
Q

5 Psychological symptoms of panic disorder

A
fear of losing control
dying
going mad 
fainting
derealisation
50
Q

As many physical symptoms of panic disorder as you can think of

A

Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes

51
Q

What would be 4 differential diagnosis associated with panic disorder?

A

Endocrine - hypoglycaemia
Respiratory - asthma
Cardio - Arrythmia
Drugs

52
Q

6 points on aetiology of panic disorders?

A

Precipitating events in 60-96% of cases

  • Separation / loss
  • Relationship difficulties
  • New responsibilities

Traumatic early life events

  • Early parental separation
  • Traumatic childhood event – 3 fold increase
  • Early sexual abuse (<5 years of age)
53
Q

Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction what is this?

A

Initial short-lived sympathetic arousal

Followed by parasympathetic arousal

May result in vasovagal syncope

The subjective experience tends to disgust and repulsion rather than pure apprehension

54
Q

4 aetiology points on phobias

A

unresolved unconscious conflict
classical conditioning
historically threatened species
observational

55
Q

In appropriate anxiety in
Situations where the person is observed
Situations where there is potential for criticism
refers to what type of phobia

A

Social

56
Q

5 symptoms of social phobia

A

Anticipatory anxiety
Feeling anxious
Blushing
Trembling (observed writing is a problem)
Relieved by alcohol (potential for abuse)

57
Q

What brain structure is associated with fear and eliciting a stress a response?

A

Amygdala

58
Q

What 2 other structures are excited by the amygdala in a stress response and what do they do?

A

Hypothalamus - HPA axis

Locus coeruleus - NE

59
Q

What is the HPA axis?

A

Hypothalamus - releases CRH
Pituitary - releases ACTH
Adrenal cortex - releases cortisol

60
Q

If the amygdala excited the HPA axis, what brain structure inhibits it?

A

Hippocampus

61
Q

What brain structure is affected by chronic stress and how?

A

Too much glucocorticoid leads to cell death in hippocampus

Hippocampus cannot feedback to amygdala to limit cortisol production

62
Q

Give 5 anxiety disorders

A
OCD
Phobias
GAD
PTSD
Panic disorder