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NR507 - Advanced Pathophysiology > Week 7 - Brain and Mood disorders > Flashcards

Week 7 - Brain and Mood disorders Flashcards

1
Q

Major Depressive Disorder

A

Characterized by

-Depressed moods
-loss of interest/pleasure
- changes in activity
- guilt
- worthlessness
- death/suicide,
- fatigue/loss of energy
- decreased concentration,
-changes in sleep, appetite and weight

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2
Q

Treatment for major depressive disorders

A

SSRIs. Initial selection of medication should include consideration of:
- Assessment of symptoms
- Age
- Side effects
- Safety
- Cost

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3
Q

Social anxiety disorder

A

aka. Social phobia – fear and avoidance of social situations

May feel uncomfortable interacting or having a conversation with others and very conscious of being scrutinized and humiliated or rejected by others

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4
Q

Treatment for social anxiety disorders

A
  1. SSRIs (fluoxetine, paroxetine)
  2. Cognitive behavior therapy
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5
Q

Panic Disorder

A

i. Multiple disabling panic attacks with symptoms including
1. Lightheadedness
2. Tachycardia
3. Difficulty breathing
4. Chest discomfort
5. Sweating
6. Generalized weakness
7. Trembling
8. Abdominal stress
9. Chills
10. Hot flashes
11. Agoraphobia - avoiding public places where help is not available during a panic attack

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6
Q

Agoraphobia

A

fear of public places

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7
Q

Treatment for panic disorders

A
  1. SSRIs
  2. Cognitive behavioral therapy
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8
Q

Bipolar 1 Disorder

A

Manic followed by depressive episodes

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9
Q

Bipolar 2 disorder

A

Depression for at least 2 weeks followed by manic episode for at least 4 days

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10
Q

Generalized Anxiety Disorder

A

Worries about life events, relationships, job performance, health, money, social status

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11
Q

Symptoms of Generalized Anxiety Disorders

A
  1. Restlessness
  2. Muscle tension
  3. Irritability
  4. Easily fatigued
  5. Difficulty concentration
  6. Difficulty sleeping
  7. Depression
  8. Panic attacks
  9. Symptoms lessen with age
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12
Q

Treatment for Generalized Anxiety Disorder

A
  1. Diagnosed when the person has experience 6 months of worrying excessively and has 3 of the six major symptoms
  2. Antidepressants
    a. Norepinephrine reuptake inhibitors
    b. SSRIs
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13
Q

Positive symptoms of Schizophrenia

A
  • Hallucinations
  • Delusions
  • Formal thought disorder
  • Bizarre behavior
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14
Q

Negative symptoms of schizophrenia

A
  • Flattened affect
  • Alogia (not talking much)
  • Anhedonia (inability to feel pleasure)
  • Attention deficits
  • Apathy (lack of interest)
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15
Q

Cognitive symptoms of Schizophrenia

A
  • Inability to perform daily tasks requiring attention and planning
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16
Q

Diagnosis for Schizophrenia

A

Neuroimaging reveals

** Enlargement of the lateral and third ventricles and widening of frontocortical fissure and sulci **

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17
Q

Schizophrenia

A

Disorganized thought in schizophrenia is characterized by positive and negative symptoms including auditory hallucinations, paranoid delusions, and cognitive deficits that have devastating effects on the individual and the individual’s family.

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18
Q

Alzheimer’s Disease

A

Alterations in the brain – accumulation of extracellular plaques containing a core of beta and tau proteins, intraneuronal tangles, loss of acetylcholine.

Decreased short term memory occurs with mild cognitive decline as a result of a reduced hippocampus size.

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19
Q

Symptoms of Alzheimer’s Disease

A

a. Individual becomes progressively more forgetful especially with recent events
b. Memory loss increases leading to confusion, disorientation, loss of ability to concentrate.
c. Abstraction, problem solving, judgement gradually deteriorate
d. Mood changes including anxiety, depression, hostile, mood swings

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20
Q

Parkinson’s Disease

A

Complex motor disorder accompanied by systemic nonmotor and neurologic symptoms.

  • Loss of dopaminergic pigmented neurons in the substantia nigra pars compacta with dopaminergic deficiency in the putamen of the striatum
  • Degeneration of the basal ganglia
  • Formation of Lewy bodies
  • Loss of dopaminergic neurons
  • Dopamine loss in other parts of the brain
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21
Q

Symptoms associated with Parkinson’s Disease

A
  • Bradykinesia/shuffling gait
  • Resting tremor
  • Rigidity
  • Postural disturbance
  • Dysarthria (difficulty speaking)
  • Dysphagia (difficulty swallowing)
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22
Q

Multiple Sclerosis

A

Chronic inflammatory disease involving degeneration of the CNS myelin, scarring (sclerosis or plaque formation) and loss of axons)

Caused by autoimmune response to self or microbial antigens in genetically susceptible individuals

T & B cell mediated to cross the blood-brain barrier

Loss of myelin disrupts nerve transmission which leads to symptoms

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23
Q

Risk factors for MS

A
  • Smoking
  • Vitamin D deficiency
  • Epstein-Barr virus infection
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24
Q

Clinical manifestations of MS

A
  • Paresthesia of face, trunk or limbs
  • Weakness
  • Impaired gait
  • Visual disturbances
  • Vertigo
  • Double vision
  • Tremor
  • Memory/attention problems
25
Q

Four types of MS

A
  1. Relapsing/remitting
  2. Primary Progressive
  3. Secondary Progressive
  4. Progressive relapsing
26
Q

Relapsing/remitting MS

A

Most common, periods of flares and recovery periods

27
Q

Primary Progressive MS

A

Least common – gradual progression of the disease without periods of remission

28
Q

Secondary Progressive MS

A

Comes after relapsing/remitting, gradual worsening of symptoms between flares, short intervals of remission followed by more severe symptoms

29
Q

Progressive relapsing MS

A

Steadily worsening symptoms from the onset with clear relapses and more severe symptoms during relapses

30
Q

Febrile seizures

A

Seizures associated with fever in the absence of CNS infection. i. Most common from age 6 months to 5 years

31
Q

Simple febrile seizure

A
  • Occur between 3 months and 5 years
  • Convulsion occurs with temp over 39
  • Usually respiratory tract or ear infection present
  • Only one seizure per illness
  • Occurs in first 24 hours
  • Convulsion is short – 15 min or less
32
Q

Complex febrile seizure

A
  • Convulsion lasts more than 15 min
  • symptoms may be confined to one side of the body
  • Occur more than once in 24 hours
33
Q

Possible causes of febrile seizures

A
  1. Fever raises the core body temperature which makes neurons more excitable. Action potentials are more likely to occur.
  2. Fever causes hyperventilation that leads to respiratory alkalosis with increase in blood pH that seems to excite the neurons.
  3. Fevers are caused by cytokines which may also enhance the activity of the NMDA receptors.
34
Q

Cluster headache

A

Severe pain with ipsilateral autonomic manifestations including
- Tearing on affected side
- Ptosis (drooping) of the ipsilateral eye
- Congestion of the nasal mucosa
- Occurs on one side of the head primarily in men between 20-50 years old
- Pain may alternate sides with each headache episode and is severe, stabbing and throbbing
- Occur in clusters (up to 8 attacks per day) and last for minutes to hours followed by a period of remission
- Often referred to as midface or teeth

35
Q

Migraine headache

A

Episodic neurological disorder whose marker is lasting 4-72 hours.

Migraine is broadly classified as:
- Migraine with aura, visual, sensory, or motor symptoms
- Migraine without aura (most common)
- Chronic migraine – begin as episodic and increase in frequency over time, diagnosed with 15 occurrences in a month

36
Q

Symptoms and diagnosis of Migraine headache

A

Diagnosed with 2+ of the following symptoms
- Unilateral head pain
- Throbbing pain
- Pain worsens with activity
- Moderate or severe pain intensity

And at least one of the following
- N &V
- Photophobia and phonophobia

37
Q

Tension headache

A

Most prevalent type of recurrent headache
- Onset during 20s
- Mild to moderate bilateral headache with a sensation of a tight band or pressure around the head
- Gradual onset of pain

38
Q

Sinus headache

A

Associated with sinusitis or a disorder outside the CNS of the nasal mucosa, turbinate or septum

Should be evidence of hypertrophic or inflammatory process within the nasal cavity – evidenced by clinical signs or nasal endoscopy

39
Q

Symptoms/Diagnosis of sinus headache

A

Must have two of the following:
- Headache developed in temporal relationship to the onset of intranasal lesion
- Headache significantly improved/worsened in parallel with improvement/worsening of lesion
- Significant improvement with local anesthesia of the mucosa near the lesion
-
Headache is ipsilateral to site of lesion

40
Q

Bell’s Palsy

A

Associated with cranial nerve VII paralysis and results in facial asymmetry, inability to close eye, frown or smile on the affected side.

Associated with bacterial or viral infection.

Bell’s palsy involves a lower motor neuron lesion where the facial nerve is damaged. Information from the contralateral and ipsilateral motor cortex is lost for the upper face as well as the contralateral motor cortex involving the lower face (see diagram below). This results in paralysis of all the muscles on the side of the affected nerve.

Most people recover within 6 hours of onset. Some develop permanent facial weakness/paralysis

41
Q

Symptoms of Bell’s Palsy

A
  • Absence of nasolabial fold
  • Drooping eyelid
  • Drooping mouth
  • Dryness of affected eye/mouth
  • Hypersensitivity to loud noises
  • Loss of taste in anterior 2/3 of tongue
42
Q

Symptoms of Bell’s Palsy

A

i. Absence of nasolabial fold
ii. Drooping eyelid
iii. Drooping mouth
iv. Dryness of affected eye/mouth
v. Hypersensitivity to loud noises
vi. Loss of taste in anterior 2/3 of tongue

43
Q

Bell’s Palsy treatment

A

Some people need no treatment. Corticosteroids reduce nerve inflammation and speed recovery

44
Q

Trigeminal neuralgia

A

Associated with compression of cranial nerve V and results in severe and sharp stabbing pain that can worsen with chewing.

Diagnosed based on history and clinical presentation.

Treated with anticonvulsants like carbamazepine

45
Q

Bacterial meningitis

A

Infection of the pia mater and arachnoid villi, subarachnoid space, ventricular system and CSF. Bacteria are inhaled or spread through droplets.

46
Q

Clinical manifestations of systemic bacterial meningitis infection

A
  • Fever
  • Tachycardia
  • Chills
47
Q

Clinical manifestations of meningeal irritation

A
  • Severe throbbing headache
  • Severe photophobia
  • Nuchal rigidity
  • Positive Kerning and Brudzinski signs
48
Q

Kerning sign

A

Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. Sign of meningeal irritation.

49
Q

Brudzinski’s sign

A

Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed. Sign of meningeal irritation.

50
Q

Neurological signs of bacterial meningitis.

A
  • Decreased consciousness
  • Hemiplegia and ataxia
  • Seizures
51
Q

Clinical signs and symptoms of bacterial meningitis

A
  • Neck stiffness and pain
  • Vomiting
  • Confusion
  • Petechial or purpuric rash
    o papilledema (Swelling around the optic disk)
52
Q

Ischemic stroke

A

due to decreased blood flow to the brain due to an embolus

53
Q

CVA @ internal carotid

A
  • low arterial pressure in the retina
  • bruits over internal carotid
  • possible retinal emboli
  • history of TIAs
  • Positive non-invasive studies
54
Q

CVA @ middle cerebral artery

A

Motor
- Contralateral hemiparesis or hemiplegia, greater in the face and arm than leg
- Mirror movements
Speech
- Nonfluent aphasia
- Comprehension deficits
- Dysarthria (difficulty speaking)
Sensation
- Contralateral loss (greater in face and arm than leg)
Vision
- Contralateral or bilateral blindness
Respiration
- Cheyne-stokes respirations
- Contralateral hyperhidrosis (excessive sweating)
- Occasional mydriasis (pupil dilation)

55
Q

CVA @ Anterior Cerebral Artery

A

Motor
- Contralateral paresis greater in foot and thigh
- Mild upper extremity weakness
Sensory
- Mild contralateral lower extremity deficiency with loss of vibratory or position sense
- Loss of 2 point discrimination (ability to feel skin touch at two points – feels like one)

56
Q

CVA @ Vertebral Artery

A

Motor
- Contralateral hemiparesis (face spared)
- Impaired contralateral proprioception (ability to sense movement, action, location)
- Weakness or paralysis of tongue
- Dysarthria (difficulty speaking)

57
Q

CVA @ Basillar Artery

A

Motor
- Contralateral hemiplegia
- Paralysis involving the tongue, throat, extremities
- Dysphagia
- Facial weakness
- Ataxia
- Weak mastication muscles
Sensation
- Impaired sensation (vibratory, two-point, position sense, pain, temp)
- Facial hypesthesia
- Impaired rapid alternating movements
Visual
- Inferior pontine
- Diplopia (double vision)
- Impaired abduction of ipsilateral eye
- Internuclear ophthalmoplegia (inability to perform conjugate lateral gaze)
- Medial superior
- Skewed deviation (eye misalignment)

58
Q

CVA @ Posterior cerebral artery

A

Motor
- Contralateral hemiplegia
- Dyskinesia
- Ataxia
- Tremor
- Contralateral upper motor neuron palsy
- Weber syndrome – cranial nerve 3 palsy and contralateral hemiplegia
- Claude syndrome – superior crossed cerebellar ataxia or inferior crosse cerebellar ataxia with cranial nerve 3 palsy
- Decerebrate attacks
Sensory
- Contralateral sensory loss without agraphia (impairment or loss of previous ability to write)
Function
- Prosopagnosia (inability to recognize familiar faces)
- Topographic disorientation
- Memory deficits
- Inability to read
* Color anomia
Level of consciousness
- Coma with absent doll’s eyes reflex
- Loss of alertness
- Akinetic mutism

NR507 - Advanced Pathophysiology (9 decks)

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