Week 6: Psychopathology

Question 1

Affective Disorders

Answer 1

Disorders of the mood; profound alternation of mood

Mania or depression

Question 2

Depressed Mood

Answer 2

Increase or decrease in activity
changes in sleep (insomnia or hypersomnia)
suicidal ideation or thoughts of death

Question 3

Mania

Answer 3

Feelings of gradiosity
Periods of excessive talking
Decreased need for sleep
Risky behavior

Question 4

Area 25

Answer 4

Prefrontal cortex just below the genu of the corpus callosum

Activity (positive or negative) is mostly in this area

Question 5

VTA to Nucleus Accumbens

Answer 5

A major player in reinforcement - changes in reinforcement (bad things seeming worse, good things seeming not as good) is characteristic of affective disorders

Question 6

Iproniazid

Answer 6

Euphoria in TB patients - then used an antidepressant

Enhances MA functioning

Question 7

Reserprine

Answer 7

Depression in hypertensive patients

Affects the vesicles and their ability to package NT to decrease MA functioning

Question 8

Amphetamines CNS Actions

Answer 8

1. Hampers reuptake of MA’s
2. Enhances the release of MA’s
3. Directly stimulates the postsynaptic receptors

Question 9

Raphe Nuclei

Answer 9

huge arousal system

NE increases arousal

Question 10

Locus Ceoruleus

Answer 10

5HT decreases arousal

Question 11

Medications for Affective Disorders

Answer 11

1. TCA’s
2. MAO-I’s
3. SSRI’s
4. NSRI’s
5. SNRI’s
6. Other

Question 12

TCA’s

Answer 12

Hamper reuptake of NE and 5HT, some do one better than the other

desipramine - blocks reuptake of NE better than 5HT

imipriamine - blocks reuptake of 5HT better than NE

Question 13

MAO-I’s

Answer 13

global effect of MA’s

parnate

Question 14

SSRI’s

Answer 14

Zoloft, Prozac

Question 15

SNRI’s

Answer 15

Effexor = Pristiq

Question 16

NSRI

Answer 16

Strattera

Question 17

Others

Answer 17

Wellbutrin(Anti-depressant)/Zyban(quit smoking) - blocks reuptake of DA and NE

Remeron - Histamine receptor antagonist

Question 18

Monoamine theory of Affective Disorders

Answer 18

affective disorders are the result of either underactive monoamine system in the brain or the levels of monoamine NT molecules in the brain are too low

Question 19

Shortcomings of the MA Theory of Affective Disorders

Answer 19

Failst o explain why there is a 10-14 day delay of the onset of taking medication to the onset of clinical improvement

Question 20

Beta Andrenergic Theory of Affective Disorders

Answer 20

Beta Andrenergic receptors are too active and the down regulation of these receptors (which takes 10 - 14 days) helps to treat depression

The down regulation comes with medication that block the reuptake of NE, and also with a variety that do not directly alter NE

Question 21

Hypericum / St. John’s Wort

Answer 21

Helps mild-moderate depression

Inhibits MA’s
Inhibits the reuptake of 5HT, NE

Question 22

Alternatives to Drug Intervention

Answer 22

1. Electro-shock therapy
2. Transcortical Magnetic Stimulation (TMS)
3. Deep Brain Stimulation
4. Vagus Nerve Stimulation

Question 23

ETC

Answer 23

Current is sent through the patient’s brain

immediately down regulation beta andrenergic receptors
enhances 5HT sensitivity

95% response rate, but also a high relapse rate if nothing else is used.

Question 24

TMS

Answer 24

Generates a strong magnetic field over the brain to change behavior, typically depression

data is not entirely convincing

Question 25

Deep Brain Stimulation (DBS)

Answer 25

Drop electrodes into area 25 to down regulate activity and depression can be relieved Some show improvement, some show none

Question 26

Vagus Nerve

Answer 26

The relief may be due to its upstream pathway - including the locus ceoruleus, which deals with reward and pleasure

Question 27

Treatment for Mania

Answer 27

Lithium

Question 28

Side effects of Lithium

Answer 28

``` relief of manic symptoms mental dullness decreased memory and concentration headache fatigue ```

Question 29

Effects of Lithium on brain functioning

Answer 29

``` decrease brain calcium levels enhances reuptake of NE and 5HT reduces release of NE Alters Na+K+ATPase Pump Prevents recycling of IP3 in G-protein system ```

Question 30

Depression and Cortisol

Answer 30

Higher levels of ACTH in depressed patients may raise cortisol levels May be result of hifh CTRH horomone in the hypothalamus The feedback look to decrease cortisol may not be working properly (glucorticoid and dexamethasone)

Question 31

Anxiety Disorders

Answer 31

Panic Disorder Generalized Anxiety Disorder Post-Traumatic Stress Disorder Obsessive Compulsive Disorder

Question 32

Anxiety Disorders

Answer 32

Panic Disorder GAD OCD

Question 33

Drugs for Panic and GAD's

Answer 33

first line: Benzo's -ativan, Xanax SSRI - BuSpar Second line: antipsychotics

Question 34

Drugs for OCD

Answer 34

Antidepressant: clomipramine

Question 35

Motor involvement in OCD

Answer 35

The basal Ganglia (Caudate, Putamen, Globus Pallidus)

Question 36

NT used by Basal Ganglia

Answer 36

1. interneurons in the caudate use ACh 2. Interneruons in putamen use GABA 3. Striatal projections to globus pallidus use enkepahin and GABA 4. pars compacta input to the striatum use DA 5. cerebral cortical input uses glu 6. output from globus pallidus to substantia nigra uses GABA and substance P 7. input from raphe to the striatum uses 5HT

Question 37

Psychoses

Answer 37

1. hallucinations 2. delusions 3. disturbances of thought, languages and communication 4. disturbances of emotion

Question 38

Negative signs of Psychoses

Answer 38

absence of normal social and interpersonal behaviors

Question 39

Positive signs of Psychoses

Answer 39

abnormal behavior

Question 40

Anatomical differences in brains of psychotics

Answer 40

1. reduction in blood flow to the globus pallidus (left side) 2. frontal cortex does not respond vigorously 3. the cortex of the medial temporal lobe is thinner and the antereior portion of the hippocampus is smaller 4. lateral and third ventricles are larger (meaning there is less tissue there)

Question 41

Areas that are prominent in Negative sign of psychoses

Answer 41

hippocampus, prefrontal cortex, basal ganglia

Question 42

Hallocinogenic loop

Answer 42

Cortex -> basal ganglia -> substania nigra -> thalamus -> Cortex

Question 43

Categories of Antipsychotics

Answer 43

1. First generation antipsychotics - typical antipsychotics 2. second generation - atypical antipsychotics 3. third generation - abilify

Question 44

Typical antipsychotics include

Answer 44

Thorazine Prolixin Haldol

Question 45

Actions of antipsychotic drugs

Answer 45

they block DA Typically induce a tranqulized state without loss of consciousness

Question 46

Actions of antipsychotic drugs on the PNS

Answer 46

1. they block ACh receptors | 2. block alpha adrenergic receptors

Question 47

Symptoms of Psychoses that respond well to medication

Answer 47

``` hallucinations acute delusions hostility flat affect general withdrawal ```

Question 48

Effects of blocking Alpha Adrenergic recepotrs

Answer 48

increased heart rate mild decrease in blood pressure postoral hypertension mild hypothermia

Question 49

Effects of blocking muscarinic receptors

Answer 49

memory difficulties, confusion, delirium

Question 50

DA systems

Answer 50

1. Nigro-striatal DA pathway 2. meso-limbic and meso-cortical systems 3. tubero-infundiular sustem

Question 51

DA Theory of Schizophrenia

Answer 51

Overactive or too much DA

Question 52

D2 Receptors

Answer 52

principle site of action for phenothiazines and butyrophenones Located in cerebral cortex, limbic structures, striatum (motor area)

Question 53

D3, D4 receptors

Answer 53

limbic areas and cerebral cortex, NOT motor areas Clozapine - Atypical blocks D3, D4 weakly blocks D2

Question 54

Adverse Behavioral Effects of Antipsychotics

Answer 54

1. Acute Dystonia - sustained muscle contractions 2. Akathesia - compulsion to move 3. Parkinson syndrome - very similar to Parkinson's disease, but will recede with stopping on meds. 4. Tardice Dyskinesia - late-onset motor disorder

Question 55

Challenges to DA Theory

Answer 55

DA may not be causal pathway 5HT - Clozaprine, Risperidone, Zyprexa, Abilify Glu has been suggested - DA may be secondary to Glu, Glu may be secondary to 5HT