Final Flashcards

Question

Social interactions ASD

Answer 1

- Affective social competence ○ Ability to experience , send motional messages and read others' emotional signals § Lower functioning kids often are on the lower end of recognizing emotions of other people § Higher functioning kids lack actual sense or feeling of emotion, robotic § Males have less compared to females 3. Restricted Behaviour a. Exhibit repetitive, pointless behaviours (stereotypies) i. Stimming - rocking, hand flapping, yelling, self injurious b. Associated with intense preference for status quo, routines i. Liking things to stay the same c. Ritualistic behaviours are apparent, lining up blocks in specific order

Answer 2

- 1 in 50 youth age 1-17 diagnosed - 1 in 32 males - 1 in 125 females - 53.7% diagnosed by age 5 - Some geographic differences, ability to diagnose Male to female ratio is always the same ## Footnote 2%

Answer 3

- Not correlated - Time bound observational affect ○ Parents want to know why their kids are showing symptoms shortly after getting vaccinated

Answer 4

- No correlated - Pregnant women are told to take Tylenol ○ Infections, fevers

Answer 5

- Genetic susceptibility ○ Epigenetics ○ Environment (smoking, drugs) ○ Gene mutations Sex-linked modifiers

Answer 6

- Concordance rates (having the same condition), monozygotic - 36-91%, dizygotic - 0-5% Genes involved in intellectual disability,..

Answer 7

Maternal Diet: - Loss of fatty acids (fish), affects microbiome, immune response ○ Gilal cells ○ Gut bacteria Folic Acid Status: - Low levels can cause risk Maternal Smoking: - Exposure to alcohol or other drugs during pregnancy Maternal Infection: - Immune activation Maternal Education Level: - Relates to life environment (poverty), etc ○ Exposure to heavy metals, pollutants Advanced Maternal and Paternal Age: Older parents

Answer 8

a. No longer views as a focal impairment, whole brain affected b. Resulting as brain reorganization belonging in early development i. Early brain overgrowth 1) Brain is bigger, failure of synaptic pruning (killing off unneeded brain cells ) a) underconnectivity in frontal and occipital regions c. Morphological abnormalities

Answer 9

ut microbiota: i. Microorganisms, bacteria, viruses, protozoa, fungi, that are present in gastrointestinal tract a. Gut-brain axis: i. Microbiome can influence brain function, potentially affecting behaviours and symptoms associated with autism 1) Signals to brain directly and indirectly (immune system) ii. People with autism have a disrupted axis 1) Dysregulation, disturbances a) Increased microglia activation, elevated proinflammatory cytokines b) Increased prevalence of gastrointestinal disorders iii. Microbiota seem to be the intersection between genes and the environment 1) Depends on genetics, and shaped by environment

Answer 10

imon Baron-Cohen i. Autism is an exaggerated male phenotype(traits) 1) Rules, patterns Prenatal Testosterone: - Psychological traits are correlated with prenatal testosterone. ○ Eye contact Young boys make less eye contact than females

Answer 11

Biological mechanism may be elevated prenatal androgen exposure especially testosterone during brain development.

Answer 12

- Discovered while looking at motor cells (within cortex) - May provide neurobiological basis for social cognition. ○ Knowledge of perceptions, ideas, and intention of others - absent for people on autism spectrum. Mirror Neurons: - Fire when individual performs a certain action, or when they observe the action being performed by someone else. ○ Could represent observational learning - Can be found in variety of places, throughout the cortex. - Respond to the understanding of an action. - Found inside the cingulate cortex, and insula ○ Motivation, emotion, empathy

Answer 13

- Kids with ASD show reduced activity (less firing) in frontal MNS. Correlated with severity of disorder.

Answer 14

- Pharmacotherapy available - Behavioural-based therapies - Applied Behaviour Analysis (ABA) ○ Emphasize play, social interaction, and communication initiation - 'natural consequences' are the reward § Controversial: teaches kids to go against their natural brain functioning.

Answer 15

- Psychotic disorder ○ Psychosis - means a loss of contact with reality. - Schizophrenia impacts 1/100 across North America

Answer 16

1. People who have Schizophrenia are violent and dangerous: a. Those being treated are not more violent that others. b. They are a greater risk to themselves. 2. People who have schizophrenia have multiple personalities: a. Not the same as DID 3. People who have schizophrenia have multiple personalities: a. Schizophrenia is characterized mostly by auditory hallucinations.

Answer 17

1. Positive Symptoms: go beyond normally occurring experiences. a. Hallucinations (most common) b. Delusions (irrational beliefs or paranoia, misrepresenting reality). 2. Negative Symptoms: characterized by a deficit or absence of normal behaviour. a. Apathy, limited thought/speech, emotional and social withdrawal 3. Cognitive Symptoms: erratic changed in speech, motor behaviour, and emotions. a. Disorganized speech, inappropriate emotional reactions.

Answer 18

- Must have one of: ○ Delusions ○ Hallucinations ○ Disorganized speech - Diminished level of function - Long-lasting symptoms - Not due to drugs or other medical conditions.

Answer 19

- Schizophrenia is usually diagnosed in late adolescence or early childhood. ○ Often when people are about to gain experience(epigenetics). ○ Lag of 1-2 years between onset of symptoms and diagnosis. - 85% of people experience experience subdued symptoms for about 1-2 years. *idea of reference: everything is out to get you*

Answer 20

- 78% of people go through a pattern of relapse and recovery. - Remission can be possible ○ Good social adjustment prior to onset (family, peer groups) ○ Low proportion of negative symptoms ○ Good social support for patients. - Symptoms mat decrease with age

Answer 21

- Clear evidence for genetic link ○ Risk changes depending on who has a diagnosis in the family. - If it was 100% caused by genetics, you'd expect 50% of fraternal twins have schizophrenia.

Answer 22

- Evidence that problems before and shortly after birth can increase risk. ○ Two hit hypothesis - genetics, environment - Fetal exposure to influenza and other viruses can cause damage to the fetuses brain causes symptoms later in life. ○ Toxoplasmosis gondii - Pregnancy and delivery complications are correlated to development. ○ Loss of oxygen during delivery, maternal nutrition (first 3 months)

Answer 23

- People with schizophrenia have enlarged lateral ventricles ○ Ventricles are empty space, indication of loss of cells § Atrophy or miss-development □ Cause and consequence § Empty space is filled with CSF - Enlarged ventricles are in inherited risk factor, present in those with schizophrenia and those without. - Several subtle microscopic pathologies have been found. - Post-mortem brains from people with schizophrenia have less dendritic spine density in the PFC. ○ Reduced surface area and density ○ Dendritic spines are located on dendrites, each have post synaptic terminals § Gliosis - glial cell - PFC, striatum and hippocampus are most impacted.

Answer 24

- Those with SZ how reduced hippocampus size. ○ Due to degradation, decreases over time due to a loss in hippocampus cells. - Degree of degradation is correlated with illness severity ○ Worse symptoms - smaller volume. Disorganized neurons in hippocampus in SZ brains, leading to cell loss.

Answer 25

- Chlorpromazine / Thorazine discovery 1950s. ○ First generation antipsychotic - Was used as an anesthetic prior but had very good success given to psychotic patients. ○ Could return to normal life. - People began to have increased tolerances which led to higher doses and health issues. - Drugs could reduce psychotic symptoms without excessive sedation ○ Allowed patients to resume normal life and to find understand the root cause of psychosis

Answer 26

- Block D2 dopamine receptors ○ D2 antagonists - competes with dopamine to occupy binding sites. Creates elevated dopamine in the synapse. ## Footnote if psychosis is from too much DA, antipsychotics would lower it aka blocking receptors ;)

Answer 27

- Detects changes in blood flow by measuring changes in uptake of compounds such as oxygen or glucose. ○ Radioactive molecules are injected into bloodstream. ○ Used to analyze metabolic activity of neurons. ○ Used to see quick changes.

Answer 28

- Part of basal ganglia Dorsal Striatum: - Involved in habit learning, motor and action planning. Ventral Striatum: - Involved in reward learning, motivation

Answer 29

- Most importantly location for SZ is striatum. ○ Positive symptoms need to be caused by excessive stimulation of dopamine in D2 receptors. ○ Blocking the receptors relive positive psychotic symptoms - First generation antipsychotics are not good at relieving cognitive symptoms.

Answer 30

- SZ could also involve under-stimulation of dopamine D1 receptors in PFC ○ Relating to cognitive impairment and disorganized nature. ○ Called hypofrontality § Explains why people with SZ struggle with planning, problem solving and high level reasoning.

Answer 31

SZ could involve reduced activity of glutamate neurons, linked to cognitive and negative symptoms.

Answer 32

- GABA balances excitatory activity from glutamate Disruptions can contribute to disorganized thinking and behaviours.

Answer 33

- Removal of extra synapses in adolescences can cause underlying SZ neurodevelopmental aspects. *Balance of exhibition and inhibition via NMDA receptor, lose inhibitory control of GABA

Answer 34

- Stimulant drugs (cocaine, amphetamines, etc) can produces psychotic symptoms in high dosages. Drugs that decrease dopamine signalling reduce psychosis.

Answer 35

- 40% genetic heritability (strong) - Risk genes affecting neurodevelopment, immune responses, and neurotransmitter systems.

Answer 36

- Excess dopamine in subcortical regions (Striatum) is linked to positive symptoms (ie. Hallucinations, delusions). - reduced dopamine in FC contributes to cognitive deficits.

Answer 37

Insufficient Glutamate activity and disrupted GABA regulation is linked to cognitive and negative symptoms. ○ Reduced motivation, emotional suppression.

Answer 38

Excessive synaptic pruning during adolescence can lead to SZ. Environmental factors can lead to a 'two-hit' theory.

Answer 39

- General emotional state or mood is distorted or inconsistent with circumstances, changed of normal - Interferes with ability to function. Types such as SAD, Bipolar Disorder, and PMDD - must be inconsistent with things happening in your life.

Answer 40

- Most common mood disorder - Persistent feeling of sadness, hopelessness and a lost of interest in activities they once enjoyed. ○ Doesn't go away no matter what is happening in life. ○ No feeling of pleasure - Physical symptoms such as chronic pain, and digestive issues. Affects 1 in 6 individuals

Answer 41

- Must have 5 or more symptoms within a 2 week period with a change of functioning. 1. Persistent feelings of sadness (must be present, only one) 2. Lost of interest in activities (must be present, only one) 3. Diminished ability to think or concentrate or indecisiveness 4. Appetite or weight changes (more than 5%) 5. Fatigue or decreased energy 6. Feelings or worthlessness or excessive inappropriate guilt 7. Slowing down thoughts & physical movements 8. Recurrent thoughts of death and suicide - Symptoms cannot be due to direct physiological effects of a substance or medical condition Twice as many in females

Answer 42

- First degree relatives of people with depression are 2-3 times more likely to get depression as well. - Concordance rate between identical twins is 45.6% - Concordance rates between fraternal twins is 20.2% Large genetic component

Answer 43

- Thought to be caused by deficit in monoamine signaling ○ Monoamine NT contain one amino group and an aromatic chain with two carbons. - Deficit in signalling: ○ Limited release of NTs ○ inability to clear NTs in the synapse ○ limited receptors to bind to ○ Low affinity ○ Desensitization of NT, too much in the synapse. § Dopamine, serotonin Focus on Serotonin: - Plays role in sleep, sexual behaviour, sleeping, mood/cognition. Most nuclei is in brainstem, relays info through serotonin Evidence: - Monoamine oxidase (MAO) is an enzyme which inactivated monoamines ○ First antidepressant, had bad effects - Selective noradrenergic reuptake inhibitors (SNRI) ○ Antidepressants that block the reuptake of noradrenaline at synapse. - Selective serotonin reuptake inhibitors (SSRI) ○ Antidepressants that block the reuptake of serotonin at synapse. Bring transmitter back to normal (both)

Answer 44

- Blocks serotonin reuptake transporters ○ More activation of neuron, brain structurally adapts ○ Leads to an increase in serotonin in the synapse

Answer 45

- Little evidence that low levels of NTs cause depression. ○ Lowering levels in normal people doesn't cause it - Long lag time between treatment and reduction of symptoms ○ Takes weeks for drug to relive depression. - Doesn't work for everyone SSRIs increases risk of suicide in children and adolescents.

Answer 46

- Stressful life events play a role in etiology in depression. ○ Life events + genetics -> depression ○ Stressors and genetics may interact to make things even worse § Stress makes us more susceptible for MDD in the future - Cortisol is the main stress hormone of the HPA axis, part of the glucocorticoid hormone family. - Suggests dysfunctional regulation of the HPA axis. Disfunction can lead to depression

Answer 47

- Abnormal regulation of HPA axis. Most common clinical findings within depression.

Answer 48

- Elevated levels or cortisol in the blood, even during non stressful times, at any time - Chronic stress can lead to over secretion of cortisol (repeated life stress overtime) ○ 45% of adults with depression lasting more than 2 years. - Impaired negative feedback of HPA axis Brain is not able to respond to elevated blood cortisol by shutting down CRH,ATCH and cortisol.

Answer 49

- Normally: - Cortisol binds to glucocorticoid receptors in the hippocampus to activate the NFL and shuts down the stress response. ○ Shuts down by sending signals to the brain Depression: - People with depression cannot shut down their stress response as easily. - Keep releasing cortisol ○ Increased threats, increased cortisol, disrupted glucocorticoid receptors(internalized) ○ Continued exposure to high level of cortisol further damages the hippocampus Longer someone is exposed to stress, the worse things are.

Answer 50

- DGgr thinner - decrease cell density - - Evidence to suggest that the hippocampus is damaged by chronic major depression - Neuroimaging studies have shown reductions in hippocampal volume in patients with depression Successful antidepressant treatment leads to healthier hippocampal volume. - - Antidepressants help by increasing the rate of neurogenesis in hippocampus - Neurogenesis is a process that creates new neurons, cortisol blocked by cortisol and certain cytokines. - Long term decrease in hippocampal neurogenesis could explain hippocampal shrinkage seen in depression. Links Between Estrogen and the HPA Axis: ** What is Psilocybin:** - Compound found in various species of fungi (mushrooms) ○ Different mushrooms have different properties - Inactive, but when ingested/absorbed (liver), its immediately converted to psilocin which has hallucinogenic effect. - Agonist to several serotonergic receptors, similar to serotonin - May reduce the symptoms of depression - Only needs 2 doses to feel decreased depression symptoms ○ Less dose, increased lasting effects, compared to SSRI How Does This Work: - Evidence that some non-hallucinogenic analogs can also alleviate depression. - People report the trip is also beneficial ○ Problematic since 'tripping' can lead to temporary psychosis is costly to administer. § Risk of developing schizophrenia § Expensive - Work different system - Differential effects on the serotonergic system ○ Different receptor activation ○ Different behavioural outcome - Myelin is decreased in brains of MDD patients ○ Fat repels water, less fat = more water ○ Psilocybin has been shown to increase myelin density ○ Possible mechanism to assist in restoring neurotransmission balance. 5 - HT1AR - rich: - Limbic/stress circuitry ○ Emotional processing, lead to a lack of emotions 5 - HT2AR - rich: - Increases environmental sensitivity (internalizing emotions) ○ Why they seem to last longer. Take- Home Message: - Depression is very serious and debilitating illness. - Can be treated with high success by using antidepressants and psychotherapy. - Still don’t know the whole picture. Graph shows clear downward trend - Negative correlation between hippocampal volume and number of days of untreated depression

Answer 51

- Estrogen levels vary over the menstrual cycle - Only possible to understand the stress response in females is by studying different points in the cycle. - Estrogen is protective against stress and depression. - Postpartum depression

Answer 52

- Compound found in various species of fungi (mushrooms) ○ Different mushrooms have different properties - Inactive, but when ingested/absorbed (liver), its immediately converted to psilocin which has hallucinogenic effect. - Agonist to several serotonergic receptors, similar to serotonin - May reduce the symptoms of depression - Only needs 2 doses to feel decreased depression symptoms ○ Less dose, increased lasting effects, compared to SSRI

Answer 53

- Evidence that some non-hallucinogenic analogs can also alleviate depression. - People report the trip is also beneficial ○ Problematic since 'tripping' can lead to temporary psychosis is costly to administer. § Risk of developing schizophrenia § Expensive - Work different system - Differential effects on the serotonergic system ○ Different receptor activation ○ Different behavioural outcome - Myelin is decreased in brains of MDD patients ○ Fat repels water, less fat = more water ○ Psilocybin has been shown to increase myelin density Possible mechanism to assist in restoring neurotransmission balance.

Answer 54

5 - HT1AR - rich: - Limbic/stress circuitry ○ Emotional processing, lead to a lack of emotions 5 - HT2AR - rich: - Increases environmental sensitivity (internalizing emotions) Why they seem to last longer.

Answer 55

- ' A syndrome at the centre of which is loss of control over a reward-seeking behaviour' Compulsive nature

Answer 56

- Stimuli that are desirable or positive in some way impacting behaviour ○ Tendency to enjoy naturally rewarding stimuli. - Humans naturally find specific activities rewarding ○ Usually critical to survival § Eating, sleeping, sex, exercise - Rewarding stimuli varies between people depending on their experience. Learned behaviours - we value more than was we were born liking.

Answer 57

- Discovered intracranial self-stimulation (ICSS) ○ Rat had electrode on brain ○ Electrode controlled by lever in the cage ○ Rat could self-stimulate via pushing lever § Medial forebrain bundle ○ Rats would constantly press lever and ignore everything else § Even eating, water, females. ○ Resembled humans behaviour with drug addiction

Answer 58

- Begins within the midbrain in the ventral tegmental area - Neurons in the VTA project axons to regions in the limbic system and cortex. - Dopamine is main neurotransmitter - Hippocampus ○ DA released, reminds brain of positive feelings - Nucleus Accumbens ○ DA released, pleasure feeling ○ Inhibitory but breaks over time § Impacts set point ○ 'teaching signal' § Expectation and experience of a rewarding stimulus □ Unexpected rewards lead to larger dopamine release - Prefrontal Cortex ○ DA feeling, planning for future - next hit,etc - When on drugs, neuron in VTA become activated, they release dopamine into PFC, NA and Hippo - Addictive drugs lead to supraphysiological dopamine Release is much larger than what would happen naturally

Answer 59

- Addiction is not a diagnostic term - DSM - 5 uses 'Substance Use Disorder' - Under the DSM patient must have 2+ criteria within the past year ○ Using in spite of adverse consequences ○ Preoccupation with obtaining the drug ○ Great deal of time spent getting the drug ○ Craving ○ Use result in failure to fulfill major role obligations ○ Tolerance ○ Withdrawal Mild, moderate, or severe spectrum

Answer 60

- Increased amount of a drug needed to become intoxicated, or decreased effects while using the same amount of drug. ○ Can have high blood levels of drug and not seem intoxicated - Can become tolerant to some aspects of a drug but not others ○ Tolerant to different aspects at different speeds Increased HR, decreased balance

Answer 61

- Acute or long term drug use can lead to withdrawal - Behavioural and physiological symptoms when someone stops taking drug ○ Opposite to drug effects ○ Severity varies based on the person and their history of drug use § Hangover § Muscle aches, cramps, anxiety, sweating, nausea, convolution, death

Answer 62

1. Brain is in normal drug-free homeostasis 2. Taking drug leads to imbalance 3. Compensatory adaptations to try and restore homeostasis 4. Quitting drug leads to imbalance in opposite direction - withdrawal

Answer 63

- Varies across countries, 4% of population will receive diagnosis of a substance use disorder - 87% of Canadians use substances ○ Treatment gap, people will not seek help or only those on extreme end will actually be helps by medical professionals

Answer 64

- Addictive behaviour + vulnerable person + stress - Addiction is not the disease, it is a coping mechanism for stress / PTSD - Early life trauma is a very big predictor for later life addiction 5 times more likely to have a SUD after childhood sexual assault

Answer 65

- Questions about how life was as a kid, most people have two of the possible answers checked off ○ Higher amount = higher likelihood - Scale assesses negative childhood experiences (ACE) ○ ACE's are linked too § Risky health behaviours § Chronic health conditions □ Increased major mental health disorders § Increased morbidity and mortality

Answer 66

- Most used illegal drug in the world - Has medicinal properties, associated with some harm - 80 cannabionids ○ Most common tetrahydrocannabinol (THC) ○ Cannabidiol (CBD) Psychoactive not intoxicating

Answer 67

- Inhalation ○ 50% enters lungs, almost all enters body ○ Reaches brain in 30 seconds ○ 30-60 minute peak, lasts 3-4 hours - Vaping: ○ Peak 10 minutes after - Distributed everywhere, likes fatty tissue - Oral(eating) 'edibles' ○ Absorbed from gut slowly ○ Absorption improved by adding oil ○ Onset - 1h ○ Peak - 2-3h Larger dose needed

Answer 68

- Cognitive ○ Decreased attention, concentration (easily distracted), learning ○ Short term and long term memory impaired - Behavioural/emotional ○ Decreased movement, increased talkativeness ○ Increase anxiety, psychosis - Perceptual ○ Decreased visual, pain, and time perception

Answer 69

- Endocannabinoid system ○ Activated in times of stress, helps regulate / return to baseline § Sense of calm, nervous system regulation ○ Endogenous ligands: § AEA - anandamide § 2-AG ○ Main receptors: § CB 1 (brain) □ AEA and TCH bind to CB 1 □ Localized across many areas of the brain □ Almost impossible to overdose as there is no receptors in breathing or HR areas of the brain § CB2 (immune system) □ 2 - AG and CBD bind to CB 1 and CB2

Answer 70

- Binding to receptor creates production of AEA ○ Presynapse is super activated due to stress ○ Does not need to bind to membrane, acts as a retrograde inhibition ○ Acts as a breaking system - - Cb1 receptor located pre-synaptically on axon terminals - AEA and 2-AG carry information in the opposite direction - Helps calm down all the activity of stress - NFL

Answer 71

- THC mimics shape of AEA(binds to CB1 receptor), exploiting mechanism - THC binds to CB 1 receptor pre-synaptically, inhibiting release of neurotransmitters - THC is agonist to CB1 receptor - Doesn't require an active synapse to bind

Answer 72

- Less harmful than alcohol - Very strong links between cannabis and psychotic disorders (SZ, etc) ○ Frequent use of high-THC cannabis ○ especially young men before 16 yrs old who have variation of COMT gene § Enhanced or reduced breakdown of dopamine § Val/Vak variant Increased enzyme activity

Answer 73

- Using cannabis products is associated with an increase risk of developing depression, ○ People who have depression are more likely to self medicate with cannabis ○ Bilateral relationship - People use cannabis to relieve their anxiety, however high dose THC can increase anxiety and paranoia - Frequent cannabis use in younger populations may be linked to suicidal thoughts and behaviours

Answer 74

- Older adults, adults, general population, youth, young adults - Post legalization ○ Older adults use more, youth is still the most - 16-24 2X more likely to use cannabis - Average age of initiation is 18.7 but starting to see it around 16 - 18% use daily - Problematic cannabis use: ○ Being male ○ Being alone ○ Using dried flower products Primary motivation being boredom, or to reduce stress

Answer 75

- Euphoric ○ Very cheerful, 'feeling on top of the world' - People do not think there ill or need treatment because they feel so good - May change the way they dress, makeup, person appearance, etc - May have changes in perception ○ Heightened senses (smell, hearing, vision)

Answer 76

- Ancient Greeks use the term 'mania' and 'melancholia' to describe both mania and depression. ○ Used lithium salts in a bath to calm people (mood stabilizer) - In 1851, Jean-Pierre Falret published an article about what he called ' la folie circulaire' - circular insanity ○ Talks about people going from mania to depression, first documented diagnosis on bipolar disorder (1859) - Early 1900s: ○ Emil Kraepelin studied those who have periodic mania and depression. ○ Coined the term 'manic depressive psychosis' § In early editions of the DSM 'Manic Depression' ○ DSM 5: Bipolar Disorder

Answer 77

- A manic episode ○ Period of elevated, expansive or irritable mood ○ Abnormally and persistently increased goal-directed activity or energy § Lasting at least 1 week and present most of the day almost every day. - Three or more: ○ Decreased need for sleep ○ Inflated self-esteem ○ More talkative ○ Flight of ideas - racing thoughts ○ Distractibility ○ Increased in goal-directed activity ○ Excessive involvement in activities that have painful consequences (financial) - Causes impairment in social and occupational functioning ○ Cannot go to school, work, etc - Major depressive episode after manic period

Answer 78

- Period of elevated, expansive or irritable mood ○ Abnormally and persistently increased goal-directed activity or energy ○ Lasting at least 4 days in a row, most of the day, almost every day - 3 + criteria from B1 - Unequivocal change in functioning (can still go to work, class, etc) ○ Change in mood is noticeable by others Major depressive episode later 2+ weeks

Answer 79

- 0.6% B1 - 0.3% for B2 - Male : Female 1:1 - B1: Age onset 18 ○ 90% have other episodes - B2: age onset mid 20s ○ Begins with depressive episode Can be triggered by childbirth Rate of Cycling: - Four or more cycles in a year People can cycle multiple times a day

Answer 80

- Figuring out what genes are causing the issue - People with a diagnosis of bipolar are compared to a control group ○ Looks through genomes for variations

Answer 81

- Risk of BPD with SYNE1 gene ○ Encodes for nesprin - 1 § Links nucleoskeleton to cytoskeleton Regulates chromatin organization Nesprin - 1: Makes sure nucleus is in the proper position, prevents migration

Answer 82

- Largely unknown - Any theory must explain the cyclical nature of disease ○ Giving antidepressants can provoke mania - First drug to treat BPD is Lithium ○ Mood stabilizer - BPD is muli-system dysregulation ○ Neurotransmiter systems (DA theory) ○ Cellular signaling and survival (BNDF theory) Energy regulation (mitochondrial theory)

Answer 83

- Mania can be provokes in individuals who consume moderate - high doses of amphetamines ○ Elevate synaptic levels of dopamine ○ Agonist to DA system Lithium and Valproate do have action on D2/3 receptors Failure of dopamine receptor and transporter homeostasis could show underlie of BPD elevated D2/3 receptor availablity -> increased dopamine signal -> compensatory increase in dopamine transporter levels -> decreased dopamine signal ->

Answer 84

- Protein involved in plasticity of the brain ○ Supports new circuits and cell growth Increased BDNF = Increases neural plasticity

Answer 85

Reduced BDNF in mania and depressed states, reduced plasticity ○ BNDF is reduced among patients with BPD. ## Footnote "BDNF gene, acting like a fertilizer for the brain, influencing mood, cognition"

Answer 86

- Mitochondria is responsible for multiple cellular functions ○ Energy production, cellular growth, cell resilience - If mitochondria fails, so will cell - Mitochondrial dysfunction ○ impairs brains energy supply ○ Neurons become less resilient to stress and prone to malfunction. ○ Amplify neurotransmitter imbalances ○ Impaired neural plasticity ○ Produces too much ROS § Reactive oxygen species - Nesprin 1 should hold the mitochondria in place, but is altered. - Lithium can protect the cell and prevents damage Apoptosis: Programmed cell death

Answer 87

- Immediate reaction to danger ○ Strong motivation to escape - activations SAM pathway ○ Fight or flight § HR increase § Shaking § Pupil dilation - Intake something fearful via our senses ○ Amygdala - limbic system § Threat detection § If activated it is signally that something is a threat, downstream circuit response § Learning about fearful information □ Classical conditioning - Underlays panic disorder

Answer 88

- Worry about something bad happening ○ Real or perceive future threats - Active amygdala - Generalized anxiety disorder - Often comorbid with depression and other mental illnesses. - Around 50% of people with one anxiety disorder also have a second one

Answer 89

Input - visual thalamus - visual cortex - amygdala - SAM pathway 1 Fear and anxiety overlap, hard to tell them apart

Answer 90

- Doesn't have a specific trigger but triggered by a specific stimulus. ○ Can be more than just visual, depending on stimuli the signal will go to the correct cortex. - Surges of intense fear that reaches peak in a very short time - Less than 4% of Canadians 1:2 - male, female

Answer 91

- Increased HR - Sweating - Trembling/Shaking - Shortness of breath - Nausea / Vomiting - Dizzy - Chills/heat - Numbness/tingling - Fear of dying - Must be present at least once a month for no obvious reasons

Answer 92

- Massive amygdala reaction ○ Overactivation, doesn't shut off. - Resembles a normal fear response but escalates, cannot shut down ○ Absence of trigger - nothing to escape - Highly heritable 48 concordance rate - COMPT gene ○ Breakdown of amines, dysregulation of dopamine in PFC ○ Too much dopamine Heightened paying attention, executive control, etc

Answer 93

- Worry about everything , free-floating anxiety Most common diagnoses at university

Answer 94

- 3 or more - Experiences on more days than not 6 months - Restlessness - Easily fatigued - Mind going black - Muscle tension - Sleep disturbance Only one is needed in children

Answer 95

- People with GAD are often consumed by worry, their mind is dominated by intrusive thoughts. Hard to overcome as people often thing that worrying will help with the future danger - control

Answer 96

- Not associated with sympathetic nervous system over-activity - 'autonomic restrictors', SNS is less responsive to stress ○ Produces less cortisol and dopamine - Increased activation of frontal lobe when responding to stressful stimuli ○ People are often more frantic, intense thought processing - constantly worrying Reduced amygdala size and function

Answer 97

- PD is primarily fear based. ○ During panic attacks people § Decrease PFC activity § Increased limbic and SNS activity - GAD primary anxiety-based Increased PFC activity and reduced SNS activity

Answer 98

- Many drugs are effective in treatment, dating back thousands of years - Alcohol has been a long time favourite for stress and anxiety - High rate of comorbidity between anxiety and alcohol use disorders. - Alcohol -> Increase GABA ○ Alcohol increases anxiety baseline - Drugs that treat anxiety are called anxiolytics ○ Fast or slow acting § Fast acting is given for PD § Low acting given for GAD - Benzodiaxepines are agonists of GABA receptors ○ Increase inhibitory signalling in the brain - leading to relaxation § Xanax (alprazolam), Valium(diazepam), Ativan(lorazepam) □ High addiction potential - SSRI are also very effective for treating anxiety - Beta blockers can treat short term anxiety ○ Block B-adrenergic receptor in CNS Good for performance anxiety as they do not pass the blood brain barrier

Answer 99

- Cognitive Behavioural Therapy ○ Focuses on challenging distorted cognitions (thoughts) and behaviours - For PD: Interoceptive Exposure ○ Patients get exposure to trigger to evoke physical sensation to learn that they are safe - Eye Movement Desensitization and Reprocessing (EMDR): ○ For people with a history of trauma. § Asked to recall memory while making eye movements. § Makes memory susceptible to change, reactivating emotions and confusing brain resulting in the separation of semantic and emotional components.

Answer 100

- Had different names throughout history - Included a formal diagnostic entity in 1980 ○ Diagnostic Entity: specific symptoms, signs, criteria Included as 'Anxiety Disorder' until DSM 5.

Answer 101

- Development of symptoms following exposure of one or more traumatic events. ○ Exposure to war, threatened or actual physical assault or sexual violence - Clinical presentation varies ○ Fear/anxiety ○ Anhedonic/dysphoric ○ Arousal/reactive Dissociative or combination

Answer 102

- Confirmed experience of trauma, either direct exposure, witness or hearing about event from close family member or friend. - Presence of intrusion symptoms (dissociative state) ○ Recurrent, involuntary, and intrusive distressing memories or dreams. ○ Dissociative reactions (flashbacks) ○ Intense prolonged psychological distress and physiological response to cues and associated with the trauma. - Persistent avoidance of stimuli associated with the event. - Negative alterations in cognitions and mood associated with event (cannot remember what happened) ○ Negative beliefs about slf, expectations ○ Feelings of detachment or estrangement from others. - Alterations in arousal and reactivity associated with traumatic event (at least 2): ○ Irritability, agree outburst ○ Reckless, self-destructive behaviours ○ Hypervigilance (alert) ○ Exaggerated startle response ○ Problems with concentration ○ Sleep disturbance *has to significantly impact psychological well-being for at least a month - Any cluster of symptoms

Answer 103

- Most common forms ○ Transportation accident (35.3%) ○ Physical assault (18.5%) ○ Life-threatening illness or injury (18.4%) - Projected life time risk in Canada for PTSD is 9.2% - PTSD is more prevalent among females than males, across lifespan and length of duration. - High risk of suicidality

Answer 104

- Medial Prefrontal cortex (mPFC) appraises the threat - If it is a threat, mPFC signals to amygdala/hypothalamus Amygdala signals to hippocampus(learn context) and hypothalamus (brainstem response)

Answer 105

- Amygdala hypersensitive, over activates - Prefrontal cortex activity reduced (ineffectively inhibits amygdala), system will not shut down. ○ Contant hypervigilance, intrusion, avoidance of stimuli associated with trauma, cognitive distortions § This is adaptive at the time however it creates an environmental mismatch when the threat is gone - body cannot recognize that there is no threat.

Answer 106

- Reduced volume of hippocampus(ventral medial PFC) ○ Hippocampus cannot use context cues in environment to signal that environment is safe § Reduced cortical capacity to inhibit fear and other negative emotional responses.

Answer 107

Some people naturally have a smaller hippocampus, these people are at a greater risk for developing PTSD

Answer 108

- Exaggerated amygdala activation in response to trauma-related stimuli. - Traumatic event is the unconditioned stimuli which gets paired with stimuli associated with the trauma ○ odors, sounds Sound of battle + war -> combat -> fear response

Answer 109

TSD patients have enhanced activation of SAM and HPA pathways ○ Altered adrenaline, noradrenaline, and cortisol. ○ Dysregulated signaling or noradrenalin is a biomarker for PTSD What caused this: - Excessively strong adrenergic response to event ○ Adaptive short term, memory formation

Answer 110

- Administration of propranolol(beta-receptor antagonist) can prevent the binding or noradrenaline within hours of traumatic event. Can prevent consolidation of memories.

Answer 111

- People with PTSD are more likely to develop cannabis use. ○ Higher number of cannabinoid receptors & lower endocannabinoids - Smoking high levels of THC can worsen PTSD symptoms - CBD is linked to reducing consolidation of fear memory and enhanced fear extinction.

Answer 112

** What is Psilocybin:** - Compound found in various species of fungi (mushrooms) ○ Different mushrooms have different properties - Inactive, but when ingested/absorbed (liver), its immediately converted to psilocin which has hallucinogenic effect. - Agonist to several serotonergic receptors, similar to serotonin - May reduce the symptoms of depression - Only needs 2 doses to feel decreased depression symptoms ○ Less dose, increased lasting effects, compared to SSRI Take- Home Message: - Depression is very serious and debilitating illness. - Can be treated with high success by using antidepressants and psychotherapy. - Still don’t know the whole picture. Graph shows clear downward trend - Negative correlation between hippocampal volume and number of days of untreated depression

Answer 113

How Does This Work: - Evidence that some non-hallucinogenic analogs can also alleviate depression. - People report the trip is also beneficial ○ Problematic since 'tripping' can lead to temporary psychosis is costly to administer. § Risk of developing schizophrenia § Expensive - Work different system - Differential effects on the serotonergic system ○ Different receptor activation ○ Different behavioural outcome - Myelin is decreased in brains of MDD patients ○ Fat repels water, less fat = more water ○ Psilocybin has been shown to increase myelin density ○ Possible mechanism to assist in restoring neurotransmission balance. 5 - HT1AR - rich: - Limbic/stress circuitry ○ Emotional processing, lead to a lack of emotions 5 - HT2AR - rich: - Increases environmental sensitivity (internalizing emotions) ○ Why they seem to last longer.

Final Flashcards

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