1
Q
What are the myths surrounding mental illness ?
A
- People with mental illness are violent and dangerous
- People with metal illness are poor or less intelligent
- Mental illness is caused by a personal weakeness
- Mental illnes is a single, rare disorder
2
Q
How is mental illness complicated ?
A
- Comorbidities are common
- Many people who fit a diagnosis for one mental disorder may partially fit the diagnosis for another as well
- People may not completely match any specific diagnosis
3
Q
What is schizophrenia ?
A
a split between the emotional and intellectual aspects of experience
4
Q
What was schizophrenia previously called ?
A
Dementia Praecoz (“premature dementia”)
5
Q
What are the positive symptoms of schizophrenia ?
A
- Disorganized speech
- Disorganized behaviour
- Hallucination
- Delusions
6
Q
What are the negative symptoms of schizophrenia ?
A
- Flattened affect and or anhedonia
- Speech minimized
- Lack of motivation
- Social withdrawl
7
Q
What are the cognitive symptoms of schizophrenia ?
A
- Poor sustained attention
- Low psychomotor speed/catatonia
- Poor learning and memory
- Poor abstract thinking/problem solving
8
Q
What symptoms fall under complex syndrome ?
A
- Psychosis
- Emotional/Affective symptoms
- Motivtional impairment
- Cognitive impairment
8
Q
What are the types of schizophrenia ?
A
- Paranoid
- Catatonic
- Disorganized
- Residual
- Undifferientiated
9
Q
What is paranoid schizophrenia ?
A
Frequent visual and auditory hallucinations/delusions, disprganized speech, trouble concentrating, and significant behavioural impairment
10
Q
What is catatonic schizophrenia ?
A
Excessive movement (catatonic excitement), or decreased movement (catatonic stupor)
* inability to speak (mutism). mimicking owrds (echolalia) and mimicking actions (echopraxia)
* Rarest
11
Q
What is disorganized schizophrenia ?
A
Disorganized behaviours and nonsencial speeach in the absence of delusions and hallucinations
* Most common
12
Q
What is residual schizophrenia?
A
Previously diagnosed - no longer experiencing prominent symptoms
* still exhibited symtoms including a flattened affect, psychomotor difficulties, and disturbed speech
13
Q
What is undifferentiated schizpphrenia ?
A
Symptoms fit into more than one subtype of schizophrenia
14
Q
What is the prevalence of schizophrenia ?
A
- Prevelance higher in men than women (7:5 ratio)
- More prevenlent in prosperous countries than 3rd world
15
Q
How is genetics tied to schizophrenia ?
A
- People with closer genetic relationships have higher concordance for schizophrenia
- Adopted children studies suggest a genetic role (Prenatal environment of the biological mother cannot be discontinued)
- Environmental influence, such as family environment, shown to have a role
- No common genetic variant produces more than small increase in the probability of schizophrenia
- A few rare genes are known to greatly increase the risk of schizophrenia, mostly by disrupting the development of glutamate synapses or by interfering with the immune system
15
Q
What does DISC1 control ?
A
Disrupted in schizophernia 1 controls differentiation and migration of neurons in brain development
16
Q
What is the DISC1 protein important for ?
A
The DSC1 protein is important for neurodevelopment
17
Q
What has human studies shown regarding gene mutations ?
A
- High prevalence of “broken copy” in Large Scottish family over 5 generations - development of schizophrenia, bipolar & other mood disorders
- Meta-analysis confirmed overall association and found strongest estimate in Chinese population
18
Q
What has animal studies shown on gene mutations ?
A
Mutant mice with no DISC1 in brain stem stem cells show behaviours that mimic schizophrenia
19
Q
What is NRG1 important for ?
A
Neuregulin 1 protein is important for neurodevelopment
20
Q
What do association studies show regarding gene mutations ?
A
- Iceland population - NRG1 risk allele doubles the risk of schizophrenia
- Extended to Scottish, Swedish and Chinese populations
21
Q
What is NRG1 associated with ?
A
Associated with bipolar disorder and creativity, independent of schizotypal traits
22
Q
What is the recent popular hypothesis ?
A
Not just one gene, but new mutations in any one of hundreds of genes
23
What was found regarding **microdeletions and microduplications** ?
* Found in 15% schizophrenia patients; 20% if onset before 18 years. Compared to 5% in control group
* Not random, but selective for genes that are important for production of proteins involved in neurodevelopment and nognitive function
24
What is the **neurodevelopmental hypothesis** ?
Suggests abnormailities in the neonatal development of the nervous system leads to mild abnormalities of brain anatomy and major abnormalities in behaviour
* abnormalities could result from genetics or other influences
* Environmental influences later in life aggravate the symptoms
25
What is the **season-of-birth-effect** ?
Babies born in late winter and early spring motnhs are at higher risk of "positive" schizophrenia
26
What are some **viral infections** that a mother can get ?
* Increase cytokines in the mother that impair brain development of fetus
* Cause fever that damages the fetal brain
27
What is the **research evidence** found on **viral infections and schizphrenia** ?
* Babies born from mother who contracted flu in 1st trimester 7x more likely to develop schizophrenia
* Increased schizophrenia rates among people born 2-3 months after major influenza epidemics
28
What are the **risk factors** falling under the **neurodevelopmental hypothesis** ?
* Poor nutrition of the mother during pregnancy
* Premature birth
* Low birth weight
* Complications during delivery
* Extreme stress of mother during pregnancy
* Immunological rejection
* Other infections during pregnancy
* Postnatal stressors
29
What is the **two-hit hypothesis** ?
Schizophrenia is the result of a combination of a **genetic predisposition and impacts from the environement** in prenatal/neonatal development, later in life, or both
30
What are the **brain abnormalities** tied to schizophrenia ?
* Enlarged lateral ventricle and prominent sulci
* Decreased tissue cerebral gray matter
* Smaller PFC and hippocampus
* Less gray matter and white matter
* Reduced cortical connectivity and activity
* Glial reductions (glial theory): oligodentrocytes and mylein integrity (DISC1); altererd microglia in temporal and frontal lobes; astrocyte glutamate transporters in PFC
31
What is the **dopamine hypothesis** ?
Positive symptoms are caused by over-activity of synapses between DA neurons of then VTA and nucleus accumbems and aymygdala (Mesolimbic)
32
What do **antipsychotic drugs (chlorpromazine) do** ?
Antipsychotic drugs block DA receptors
* Block D2 receptors, preventing receptor activation (antagonist)
33
What **resembles** shizophrenia ?
Amephetamine psychosis resembles schizophrenia
* amphetamines (and cocaine) block DA reuptake thus increase DA levels (agonist)
* Amphetamines exacerbate symptoms
34
What is the **glutamate** hypothesis ?
Schizpohrenia due to excessive glutamate
35
Whay **occurs** regarding the **glutamate** hypothesis ?
* Mesolimbic pathway overactivated
* Glutamate neurons fail excite GABA neurons (GABA=Inhibitory)
* Glutamate neurons fail to excite DA neurons (negative symptoms)
36
What **blocks NMDA receptors** ?
PCP (angel dust) and ketamine (date rape drug) block N-methyl-D-asparate receptors
* they create all symptoms
* this effect is not observed in preadolesence
37
How were schizophrenic patients **treated before the mid 1950's** ?
Most people with schizophrenia were idenfinitely confined to mental hospitals
38
How are schizophreniz patients **treated today** ?
Effective drugs and outpatient treatment
39
What does **Glycine or D-serine do** ?
Stimulate NMDA receptors and reduce schizophrenic symptoms
* effective in reducing negative symptoms
40
What does **Clozapine do** ?
Atypical antipsychotic -Clozapine- increases release of DA in PFC and decreases DA in nucleus accumbens - addresses all symptoms
41
What is a **partial agonist** ?
Serves as an agonist in regions of low concentration of the normal ligand and as an antagonist in regions of high concentrations
42
What **disorders** are included in **Major Affective Disorders** ?
Includes Major Depressive Disorder (MDD) and Bipolar Disorder
43
What is **MDD** ?
* Unipolar
* Unremetting depression
44
What is **Bipolar Disorder** ?
Cyclical periods of mania and depression
* BP1: full-blown mania
* BP2: hypomania
* Cyclothymic
45
What are the **symptoms** of **MDD** ?
* Hopelessness and helplessness
* Worthlessness. self-hate, guilt
* Agitation/irritability
* Weight loss
* Concentration
* Fatigue/lack of energy
* Isolation/withdrawl
* Anhedonia
* Sleep
* Suicidal thoughts
46
What is the **concordance** b/w **MZ and DZ twins** regarding **MDD** ?
Concordance in MZ twin is ~65% vs 13% in DZ twins
47
What is the **monoamine hypothesis** ?
Depression is caused by low level of activity of one or more monoaminergic synapses
* Dpamine (DA) - anhedonia
* Nonrepinephrine (NE) - (psychomotor symptoms)
* Serotonin (5HT) - (rumination, impulsive thoughts)
48
What is the **evidence** for the **monoamine hypothesis** ?
Introduction of monoamine oxidase (mao) inhibitors
* Block degradation of monoamines
48
What is the **neurology** of **MDD** ?
Decreased activity in left and increased activity in right PFC
Amygdala
* 50-70% increased blood flow and metabolism in amygdala
* activity correlated with severity of symptoms
* faulty amygdala - PFC coupling
49
What is **ACC** ?
Attentional processes that regulate cognition and emotion
50
What is the **role of neurogenesis** in **MDD** ?
* **Hypothesis**: Stress exposure decreases neurogenesis in the dentate gyrus of the hippocampus which causes depression
* **Evidence**: Treatment with anti0depressant meds alleviate symtpoms at the same time that they facilitate neurogenesis in the rodent HC
* **Evidence**: Exercise enhances neurogenesis in the HC of both animals and humans and alleviates deprresive symptoms
51
What do **antidepressant drugs** do ?
* SSRI and NRIs - enhance 5-HT and NE (respectively) by inhibiting reuptake of the neurotransmitter
* Tricyclics (TCAS) - Block tranporter proteins that reabsorb serotonin, dopamine, and norepinephrine into the presynaptic neuron after release
* MAOIs - enhance monoamines by inhibiting MAO
52
What is **Trancranial Magnetic Stimulation** ?
Pulses of magnetic energy focused over a particular surface along the scalp to deactivate neurons
53
What is **Electroconvulsive Therapy (ECT)** ?
An electrically induced seizure used for treatment of severe depression
* Non-responders or suicidal patients
* Applied every other day for a period of two weeks
* Side effects include memory loss - can be minimized if shock is localized to the right hemisphere
54
What are the **simplest and least expensive treatments** for **MDD** ?
* Moderate-intensity exercise
* Alter the sleep scheduele
Periodic sleep deprevation sometimes helpful
* Seasonal affective disorder (SAD)
55
What are the **symptoms** of **bipolar disorder** ?
Depressive symptoms
Manic episodes
* Elevated moof: hyperactive, increased energy, high self-esteem (false), grandoise/delusions
* Racing thoughts
* loud-rapid speech
* Reckless behaviour: binging, poor judgement, promiscuity, spending sprees
* Agitated or irritated
56
What is the **concordance** among **MZ twins** for **Bipolar Disorder** ?
Concordance in MZ twins is 80%
57
What is used to **treat Bipolar Disorder** ?
Lithium
* Stabilizes mood and prevents relaspe in mania or depression
* Exact mechanism is unknown, but shows neurotropic effects
* Works by decreasing glutamate activity and inflammation in the brain
58
What is **anxiety** ?
Unfoundded, unrealistic, chronic fear
59
What are the **common types** of **anxiety disorders** ?
* Generalized anxiety disorder
* panic disorder
* specific phobias
* OCD
* PTSD
60
What is **GAD** ?
Excessive uncontrollable anxiety and worry
* Common co-morbity with depression
* Women > Men
61
What are the **symptoms** of **GAD** ?
* Fatigue
* muscle tension
* restlessness
* irritability
* sleep distrubances
* concentration problems
62
What is **Panic Disorder** ?
Characterized by repeated and unpexcted panic attacks along with worry about future attacks
63
What are the **symptoms** of a **panic attack** ?
* chest pains
* rapid heartbeat
* shortness of breath
64
What is a **phobia** ?
An unreasonable or excessive fear of an object, situation, or activity
65
What are the **three categories of phobia's** ?
* Agoraphobia
* Social phobia
* Specific phobias
66
What is **agoraphobia** ?
Fearful of a public place or being outside of the home to the extent that panic attack or extreme embarassment is possible
67
What is **social phobia** ?
A fear of social activity, especially of being scruntinized and embarassed
68
What are **specfic phobias** "?
Exaggerated fear of specific object/situations not covered by the other two
69
What are the **risk factors** of **anxiety** ?
Genetics
* heratibility of 31.6%
* 2x more likely to develop GAD if parents has a diagnosis
* Candidate geens that code for the monoaminergic system
Personality trait neuroticism, high stress sensitivity
Childhood maltreatment
Chronic or Traumatic Stress
70
How does **anxiety** look like in the **brain** ?
* Increased activation of amygdala and decreased activation of PFC while looking at angry faces
* In helathy controls, vmPFC decreases activation of amygdala, but not in persons with anxiety
* High levels of anxiety correlates with increased activation of amygdala, insular cortex and anterior cingulate cortex
71
What are **obsessions** ?
Thoughts, images, or impulses that are intrusice enough to cause marked rise in anxiety
72
What are **compulsions** ?
Ritualistic behaviours or mental acts that are designed to lower anxiety
73
When do obsessions and compulsions **begin** ?
Usually begins at ages 6-15 for females and 20-29 for males
74
How does **OCD** look like in the **brain** ?
Hyperactivity in
* Caudate nucleus (Basal Gnaglia): compulsivity and impulsivity
* Orbitofrontal cortex (OFC): obsessive thoughts
* Anterios cingulate cortex (ACC): emotion regulation
Dysregulation of cortico-basal ganglia-thalamo-cortical (CBGTC) loop
* System of neural circuits
Dysfuntion in 5HT and DA systems
75
What is **PTSD** ?
Occurs in some people after terrifying expeinces
76
What are some **symptoms** of **PTSD** ?
* Frequent distressing recollections
* Nightmares
* Avoidance of reminders of the event
* Exaggerated arousal in response to noises and other stimulu
77
How does **PTSD** look like in the **brain** ?
* The amygdala is esstential for the extreme emotional impact that produces PTSD
* Dysregulation of HPA-axis: Lower than normal cortisol levels and blunted cortisol response to acute stressor
* Smaller than average hippocampus
78
How is **mental health** tied to **intelligence** ?
Higher rates of mental illness in individuals with
* High IQ
* Artists
* Scientists
* "Geniuses"
Biopsychology
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