Flashcards in Theme 3 - Modulatory systems in Psychiatry Deck (62)
What is the pathway for reward in the brain?
What is tolerance?
Diminished response to the effects of a given amount of drug following repeated exposures to the drug.
In what brain system does addiction?
Mesolimbic dopaminergic system
What structure releases what substance in addiction?
Dopamine released from nucleus accumbens
What effect does alcohol have on the DAergic system?
disinhibition of ventral tegmental DA neurons
What effect do opiates have of on the DAergic system?
inhibit GABAergic neurons in VTA which disinhibits VTA DA neurons
What effect do psychostimulants have of on the DAergic system?
direct effect on DA neurons in nucleus accumbens
What effect do nicotine have of on the DAergic system?
increases nuclesus accumbens DA directly and indirectly
How does cocaine affect dopamine levels in nucleus accumbens?
Blocks reuptake transporters
How do amphetamines affect dopamine in the nucleus accumbens?
DA transporters run in reverse
What receptors does alcohol affect?
GABAa - agonist
NMDA - anatgonist
What brain structure is linked to the physical dependance upon opiates?
What receptors are linked to alcohol dependence?
GABAa - downregulated
NMDA - upregulated
SO when you stop pissing up get excitation symptoms such as tremors, agitation, seizures
6 examples of disorders associated with neurosis?
4 disorders associated with psychosis
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?
What is the time limit for a psychotic episode?
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
What is defined as a perception experienced in the absence of external stimulus?
Schizophrenia is a minimum of 1 of these symptoms
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
Schizophrenia it at least 2 of these symptoms for at least one month
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
At least 5 causes of organic psychosis
Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Demyelination: Multiple sclerosis etc
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Acute drug intoxication: eg. Ketamine, Cannabis, LSD, PCP, Amphetamine,
Toxins eg. lead
What are the 2 types of schizophrenia and types of symptoms associated with each?
Acute - positive symptoms
Chronic - negative symptoms
Percentage prognosis of schizophrenia?
20% - complete recovery and off treatment
25% - perisitant symptoms after first episode
+50% - relapsing remitting
At least 5 things that give a good prognosis of schizophrenia
Family history of affective disorder
Good premorbid function
Life event at onset
Good treatment response
At least 5 things for a poor prognosis of schizophrenia
Family history of schizophrenia
Long duration untreated
High Expressed Emotion in the family
Two structural changes to brain associated with schizophrenia
reduced brain volume
What 3 neurophysiological phenomina are associated whith schizophrenia?
Hyper-excitable sensory cortex
Abnormal neural oscillations
What are 4 neurocognitive effects associated with schizophrenia?
Attentional deficits (e.g. Stroop Test)
Working memory (e.g. Wisconsin Card Sorting Test)
Planning and information processing deficits
What are the 4 affective episodes?
Major Depressive Episode
Mixed affective episode
give 9 symptoms of depression
Depression of mood
Agitation / restlessness
Anxiety / preoccupation
Diurnal variation of mood
Feelings of guilt , self-reproach worthlessness
What are the DSM V criteria of a major depressive episode?
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
5 features of atypical depression
Significant weight gain
interpersonal rejection sensitivity
3 criteria for manic episode
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
7 possible symptoms of a manic episode
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or racing thoughts
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in high risk activities
2 Differences between a manic and hypomanic episode?
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
What 3 features can be associated with both depression and mania?
4 epidemiology features of major depressive disorder
1 in 5
more females than males
Difference between the two types of bipolar disorder
Bipolar Disorder I
At least one manic episode
Bipolar Disorder II
At least one hypomanic episode
At least one major depressive episode
4 epidemiology features of bipolar disorder
men and women affected equally BP I
7 typical symptoms of acute stress
Feelings of being numb or dazed
2 abnormal response to stress
What is the difference between a normal response and an adjustment disorder, how long can the latter last?
Adjustment is out of proportion to stressor
Up to 6 months
6 symptoms of PTSD
What is the average course of PTSD?
Usually immediate onset
Most recover within one year
6 physical symptoms of general anxiety disorder?
6 psychological symptoms of GAD
Sensitivity to noise
Aietology of GAD in relation to parenting
Lack of warmth & encouragement
more critical and intrusive
5 Psychological symptoms of panic disorder
fear of losing control
As many physical symptoms of panic disorder as you can think of
Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes
What would be 4 differential diagnosis associated with panic disorder?
Endocrine - hypoglycaemia
Respiratory - asthma
Cardio - Arrythmia
6 points on aetiology of panic disorders?
Precipitating events in 60-96% of cases
-Separation / loss
Traumatic early life events
-Early parental separation
-Traumatic childhood event – 3 fold increase
-Early sexual abuse (<5 years of age)
Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction what is this?
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
4 aetiology points on phobias
unresolved unconscious conflict
historically threatened species
In appropriate anxiety in
Situations where the person is observed
Situations where there is potential for criticism
refers to what type of phobia
5 symptoms of social phobia
Trembling (observed writing is a problem)
Relieved by alcohol (potential for abuse)
What brain structure is associated with fear and eliciting a stress a response?
What 2 other structures are excited by the amygdala in a stress response and what do they do?
Hypothalamus - HPA axis
Locus coeruleus - NE
What is the HPA axis?
Hypothalamus - releases CRH
Pituitary - releases ACTH
Adrenal cortex - releases cortisol
If the amygdala excited the HPA axis, what brain structure inhibits it?
What brain structure is affected by chronic stress and how?
Too much glucocorticoid leads to cell death in hippocampus
Hippocampus cannot feedback to amygdala to limit cortisol production