1
Q
Lateralization Issues
A
- Left: Language in most persons (95%)
- Right: Narrative speech, map-reading, prosody, ALSO language
2
Q
Left Handedness
A
- 10% of population
- Excel in visual spatial analysis
- higher levels of education
- overly represented in criminals
- Less lateralization than right handers
3
Q
Future of Language
A
- 6000 languages exist (80% not documented, 90% doomed to extinction in the coming century)
- one language dies every 14 days
4
Q
Broca’s Aphasia
A
- Anterior to motor cortex = impaired speech production
- expressive aphasia
- worsens with anxiety or pressure demands
- generally aware
5
Q
Wernicke’s Aphasia
A
- Posterior portion of temporal lobe and by the primary auditory cortex = impaired comprehension
- Receptive aphasia
- Impaired language comprehension
- Often unaware
6
Q
Learning
A
- Acquisition of new information
- Refers to the process by which experiences change our nervous system and our behavior
7
Q
Learning Stage 1: Sensory Information
A
- Information is first processed through our senses e.g., echoic memory
- < 1 second
8
Q
Learning Stage 2: Short-term Memory
A
- Meaningful/salient information
- < 1 minute
- Can support via repetition or chunking (7+/- 2 Rule)
9
Q
Learning Stage 3: Long term Memory
A
- Short term memories are converted into long term memories = CONSOLIDATION i.e., made solid
- Can be retrieved across a lifetime
- Increased retrieval i.e., rehearsal = strengthening of memory
- Involves the hippocampus
10
Q
Types of Learning
A
- Stimulus-Response Learning
- Motor Learning
- Perceptual Learning
- Observational Learning
11
Q
Stimulus-Response Learning
A
- Perform behavior when stimulus is present
- Classical conditioning
- Involves the amygdala, hippocampus, and thalamus
- Operant conditioning
- Involves the positive/negative reinforcement/punishment
- Mesolimbic and mesocortical system support learning
- Basal ganglia = takes over actions as “over learned motor behaviors”
12
Q
Motor Learning
A
- Learning a skilled task and then practicing with a goal in mind until the skill is executed automatically
- Moving an action from the conscious to unconscious –> Basal Ganglia
13
Q
Perceptual Learning
A
- When repeated exposure enhances the ability to discriminate between two (or more) otherwise confusable stimuli
- Allows us to identify and categorize objects
- Prior experience influence your perception of stimuli (attribution bias, confirmation bias)
14
Q
Observation Learning
A
- Social Learning Theory
- Process of learning by watching the behaviors of models
- occurs via operant and vicarious conditioning
15
Q
Prosocial Modeling
A
- Prompts engagement in helpful and healthy behavior
16
Q
Antisocial Modeling
A
- Prompt others to engage in aggressive/unhealthy behaviors
- Bandura BoBo Doll - physical aggression
17
Q
Likely Models to Mimic
A
- Positive perception (liked, high status)
- Shared (perceived) traits
- Stand out
- Familiarity
- Self-efficacy in mimicry
18
Q
Mirror Neurons
A
- Type of brain cell that respond equally when we perform an action and when we witness someone else perform the same action
- Brain responds the same way to performing, witnessing, and hearing an action
believed to enable: empathy/intention, skill building through mimicry, vicarious experience - Essential brain cells for social interactions
- Lower numbers in psychopathy and ASD
19
Q
Learning: Things with no evidence
A
- Learning styles exist
- Mozart Effect
20
Q
Learning: Things with Evidence
A
- Interleaving/spaced learning
- Writing rather than typing
- studying in natural light
- power nap (caffeine hack)
- context-dependent learning
21
Q
Procedural Memory
A
- Unconscious recall of how to perform an action or skill
- e.g., remembering to ride a bike
22
Q
Episodic Memories
A
- Involve context
- Must be learned all at once
- e.g., where you parked your car
23
Q
Semantic Memories
A
- Involve facts without context
- Facts for which the context does not matter
- e.g., the sun is a star
- Can be acquired gradually over time
24
Q
HM Prior to surgery
A
- Suffered from severe. intractable epilepsy
- Seemed to have epileptic foci in both medial temporal lobes
- Bilateral medial temporal lobectomy prescribed for HM (included removal of hippocampus an amygdala)
25
HM Successful Aspects of Surgery
- Convulsion reduced in severity and frequency
- IQ increased from 104 to 118
- Remained emotionally stable with generally superior psychological abilities
26
HM Surgery Negative Aspects
- Surgery produced devastating amnesia
- Repeatedly wrote "Today I woke for the first time"
27
Hippocampal Volume Loss and Mental Health
- Seen in Alzheimer's Dementia, Depression, Childhood stress, ETOH, PTSD, and Bipolar Disorder
28
Long Term Memory/Storage
- Memory peaks at age 8
- Reviewing/rehearsing materials
- Storage is not permanent for a few hours to days
- Once established it is mostly permanent (memories change every time you recall)
29
Anterograde Amnesia
- Failure in EXPLICIT memory (Declarative, Info available to consciousness)
- Capable of perceptual, motor, and Stimulus-Response learning
- Failure of relational learning
- Loss of ability to learn new information/form new memories
- You cannot retain new information/facts i.e., explicit memories
- You can repeat a task until that task becomes a procedural memory (habit) for you
30
Retrograde Amnesia
- Failure in IMPLICIT memory (non-declarative)
- Loss of memory for events that occurred before a specific injury/time
- In extreme cases, you cannot recall prior procedural tasks you used to complete i.e., implicit memories such as how to send an email
31
Stroke
- Occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts
32
Infarcts
- Tissue necrosis due to stroke
33
CVA
- Cardiovascular Accident
34
Risk Factors of CVDs
- Hypertension
- Diabetes
- Dyslipidemia
- Smoking
- Obstructive Sleep Apnea (OSA)
- Obesity
35
Risk Factor for CVD: Hypertension
- 77% of individuals first strokes have BPs higher than 140/90
- 50% have history of hypertension
36
Risk Factor for CVD: Diabetes
- 3x increased risk of ischemic strokes
- heightened risk in African Americans <55 and whites <65
- Hyperglycemia at stroke onset = higher brain damage
37
Risk Factor for CVD: Smoking
- Higher heart rate and blood pressure and lower arterial distensibility
- Secondhand smoke equal risk
38
Risk Factor for CVD: Obstructive Sleep Apea
- Prevalence in stroke patients >60%
- Independently higher risk 4x
- Linked to other risk factors
- CPAP and BiPAP reduce risk
39
Risk Factor for CVD: Obesity
- Abdominal obesity > total body obesity
- Linked to multiple other risk factors
40
Types of Strokes (3)
- Ischemic Strokes
- Hemorrhagic Strokes
- Transient Ischemic Attack (TIA)
41
Ischemic Strokes
- Obstruct the flow of blood
- 88% of strokes
42
Thrombus
- A blood clot in blood vessels
43
Embolus
- A piece of material that breaks off and is carried through the bloodstream until it reaches an artery too small to pass through
44
Hemorrhagic Strokes
- Caused by bleeding in the brain
- 12% of strokes
45
Transient Ischemic Attack (TIA)
- a stroke that lasts only a few minutes
- 1/3 will eventually have a stroke
- 50% within a year
46
Initial Damage in Ischemic Stroke due to Glutamate Ecotoxicity
- Immediate cause of neuron death is the presence of excessive amounts of glutamate
- Decreased O2 leads = neural membranes become depolarized = more glutamate
- NMDA receptors become over-stimulated
- Inflammation attacks microglia
- Microglia attracts WBC that attach to the region
- Cell death
47
Circle of Willis
- Where the internal carotid arteries branch into smaller arteries that supply oxygenated blood to over 80% of the cerebrum
48
Middle Cerebral Artery (MCA) Strokes
- 90% of strokes
- Largest of the brain arteries
- Supplies most of the outer surface of the frontal, parietal, temporal lobes and the basal ganglia (including pre-central gyrus (Sensory) and post-central (motor) gyrus)
49
Middle Cerebral Artery (MCA) Stroke Symptoms
- Contralateral weakness and sensory loss in upper extremities
- Homonymous Hemianopia (loss of visual field)
- Left MCA stroke = speech deficits (Broca's Aphasia and Wernicke's Aphasia)
- Right MCA stroke = neglect and poor motivation (flat prosody)
50
Anterior Cerebral Artery (ACA) Stroke
- less common (L ACA> R ACA)
- feeds deep structures in the brain. frontal, parietal, corpus callosum and bottom of the cerebrum
51
Anterior Cerebral Artery (ACA) Stroke Symptoms
- Contralateral motor and sensory loss in lower extremities- Poor gait and coordination = clumsy
- Slowed inhibition (abulia)
- flat affect
52
Posterior Cerebral Artery PCA Stroke and Symptoms
- 5-10% of strokes
Symptoms:
- Impaired consciousness
- Nausea/vomiting
- Ataxia
- Vision changes
- Nystagmus
53
Arteriovenous Malformations (AVMs)
- Tangle of arteries and veins without connecting capillaries
- Acquired through inborn genetic mutation followed by secondary mutation (1-2% of all strokes)
- Variable size (2mm to several cm)
54
Arteriovenous Malformations (AVMs) Damage
- Compression of neighboring structures
- "Stealing" of blood flow from surrounding regions
55
Arteriovenous Malformations (AVMs) Presentation
- Symptom onset between ages 10-40
- Intracranial Hemorrhage most common presentation
56
Stroke and Depression
- Post stroke depression = 1/3 of survivors
- 6x higher risk of depression 2-3 years post stroke
- more common in L frontal and basal ganglia strokes
- Adversely effects functional recovery
- Higher risk factors = premorbid depression and social isolation post stroke
- EARLY PSYCHOPHARMACOLOGIC TREATMENT IS KEY
57
Stroke and Anxiety
- 1/4 meet GAD criteria post stroke
- Less common
58
Stroke and Psychosis
- More common in right-temporo-parietal-occipto area lesions, seizures, and subcortical atrophy
- Pseudobulbar Affect = 10-15% post stroke patients
- Hypomanic symptoms = 1%
59
BE FAST
B: Balance (Does the person have a loss of balance?)
E: Eyes (Has the person lost vision in one or both eyes?)
F: Face (Does the person's face look uneven?)
A: Arms (Can the person raise both arms for 10 seconds?)
S: Speech (Is the person's speech slurred?)
T: Time (Time is brain, call 911 if you suspect a stroke)
60
Tissue Plasminogen (tPA)
- Can be administered within 4.5 hours
- Helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment
- After that time, has hemorrhagic effect
61
Ingestive Behavior
- Correctional mechanisms that replenish the body's depleted stores of water or nutrients
62
Intracellular Fluid
- 2/3 volume
63
Extracellular Fluid
- 1/3 volume
- 2 types: intravascular (blood plasma), interstitial (fluid that bathes the cell)
- Tiny bit of CSF
64
Tonicity
- The ability of a surrounding solution to cause a cell to gain or lose water via osmosis
- Relationship between interstitial and intracellular
- Solute concentration determines movements
65
Isotonic
- Equal concentration on both sides (no movement)
66
Hypertonic
- More solute
- Water moves out of cells
67
Hypotonic
- Less solute
- Water moves into cells
68
Negative Feedback Loops
- Essential characteristic of all regulatory mechanisms
69
Satiety Mechanisms
- Empty stomach --> triggers hunger --> eating --> triggers satiation (the opposite response)
- Stop behavior in anticipation of replenishment
- Hunger negative feedback loops take time to reach the brain
- 20-minute delay
70
Osmometric Thirst
- Occurs when the fluid content INSIDE (aka intracellular fluid) the cell decreases - usually because not enough water has been consumed to compensate for food intake i.e., salty food
- As a result, water is drawn from the OUTSIDE surrounding fluid (aka extracellular fluid) into the cell
- water moves from extracellular to intracellular
- Thirst triggered by cell dehydration
71
Volumetric Thirst
- Occurs when the blood volume drops due to a loss of extracellular fluid (the outside surrounding fluid)
- As a result, water is drawn from inside the cell to the outside
- Can be caused by sweating, vomiting, diarrhea, and blood loss
- Hypovolemia
72
Osmoreceptors
- A neuron that detects changes in solute concentration of interstitial fluid
- Located in the Lamina Terminalis (anterior wall of the third ventricle)
73
Anterior Cingulate Cortex (ACC)
- Activated by thirst
- ACC responsible for emotional expression, attention allocation, and mood regulation
- May underlie the affective motivation of drinking behavior demanded by thirst
74
Natural Dying
- Dehydration of cells is part of body's natural dying process
- IV fluids do not remain in the vascular system instead cause: edema, swelling, eventual respiratory distress
- Reduction in eating = ketosis which results in: reduction in appetite and thirst, pain relief, euphoria
75
Ghrelin
- Hormone released by the stomach when individuals are fasting or the digestive system is empty
- Binds to receptors in the hypothalamus
- Activates Orexin producing neurons
- Increases BEFORE eating; decreases AFTER eating
76
LOW Ghrelin
- Higher cortisol
- Stress and anxiety
77
HIGH Ghrelin
- Lower cortisol
- Reduced stress and anxiety
78
Prader-Willi Syndrome
- Genetic multi-system d.o.
- Experience hyper-phagia due to excessive levels of ghrelin - never feel satiated
79
Lateral Hypothalamus
- Stop eating and drinking when destroyed
- Overeating when activated
- Produces Orexin - motivation to eat
80
Ventromedial Hypothalamus
- Suppression of eating when activated
- Overeating when destroyed
81
Weight Loss
- Reduced for first 8 months of adjustable gastric band - reduced volume = ghrelin levels drop sooner (at 8 months, 53% higher than pre-surgery; not seen in gastric bypass)
- Wegovy (semaglutide)
82
Wegovy (Semaglutide)
- Newly FDA approved 2021
- Augments insulin secretion to inhibit release of glucagon
- Increased risk of problems with gall bladder, kidney, diabetic retinopathy, depression, suicidal thoughts/behaviors
83
Obesity
- AMA = BMA >30 (flawed method)
- 2x in adults; 3x in adolescents
- prevalence went up during pandemic: adults 3% in adults, 9% 5-11 y/o
84
Obesity: Sensory and Social Factors
- Eating high-fat soup > direct tube feed to stomach
- Nutrition value important
- Higher age = Less taste
- More options - increased intake
- Larger plate size = increased intake
- "Pepsi Paradox"
85
Deficiency of Vitamin D
- Depression/negative emotions
- Nearly 40-50% of men and women in the Denver metro area are deficient in vitamin D
- The more melanin you skin has, the harder it is to synthesize vitamin D
- Concurrent use with anti-depressants supportive
86
Magnesium Deficiency
- With stress, can increase agitation, anxiety, sleeplessness, headaches, and apathy
- Can treat restless leg syndrome
- Slow response time to reach steady state via oral supplementation (30+ weeks)
87
Omega-3 Fatty Oils
- Add on treatment for depression (strong evidence)
- For ADHD (some evidence)
88
Anorexia: Twin Studies
- 58-76% heredity
- Risk increases with premature birth or birth trauma
89
Anorexia: Associations
- Loss of gray and white matter in the brain
- Enlarged ventricles and widened sulci (shrinkage of brain tissue)
- Inhibited emotional facial expression despite reporting similar or more intense emotions
- Tissue loss can be reversed with successful treatment of the eating disorder
90
Anorexia: Starvation Study
- 6 months ate at 50% of baseline
- Loss of 25% body weight
- Demonstrated preoccupation with food, ritualistic eating, erratic mood, impaired cognition, slowed eating/lingering
- Post-study = complained of fat on their abdomen and legs
91
Anorexia: Gender Differences
- Women ate less post-fast than men
92
Anorexia: Treatment
- CBT
- Increasing eating speed
- Stimulation of ACC
93
Bulimia Nervosa: Associations
- Less blood flow to the Precuneus (self-perception and memory)
94
Bulimia Nervosa: Amygdala Activation
- Higher activation when eating than control
- Stable when eating post-fasting
95
Bulimia Nervosa: Feedback Loop of DA, 5HTP, and NE
- Anticipation of binge
- Consumption of junk foods
- Anticipation of purging
- Purging - especially vomiting
- Stress = binge-purge cycle = receptor down regulation and repeat
96
Bulimia Nervosa: Vomiting
- Only eliminates approximately 25% of the calories consumed
- Prolonged dehydration and electrolyte depletion = 5x higher risk of heart attack, overall risk of hypovolemic shock, kidney failure, and UTI
97
Microbes (7)
- Bacteria
- Archaea
- Fungi (mycobiome)
- Protists
- Viruses (virome)
- Phages
- Microscopic animals
98
Subarachnoid Hemorrhage
- Sudden onset of a severe headache +/- nausea/vomiting
- Seizure (>25% of patients)
- Ophthalmologic signs: retinal hemorrhage, papilledema
- Meningeal signs seen in over 75% of SAH
- Neck stiffness, low back pain, bilateral leg pain
- May take several hours to develop
- Loss of consciousness
99
Subarachnoid Hemorrhage: Loss of Consciousness
- Transient intracranial circulatory arrest
- the 'percussive' blood pressure impact of the hemorrhage increase ICP (intracranial pressure) and therefore reduces CPP (cerebral perfusion pressure)
100
Hunt and Hess Scale
- Grade I: Asymptomatic or mild headache
- Grade II: Moderate to severe Headache, or occulomotor palsy
- Grade III: Confused, drowsy, or mild focal signs
- Grade IV: Stupor (Localizes pain)
- Grade V: Coma (posturing or no motor response to pain)
101
MCA Syndrome
- Contralateral weakness (face = trunk = arm = leg)
- Contralateral cortical sensory loss
- Homonymous hemianopsia or quadrantanopsia
- Gaze preference
- Dysphagia
102
MCA Syndrome: Non-Dominant
- Contralateral neglect and anosagnosia
- Visuospatial distortions
- Aprosody
- Apraxias
103
MCA Syndrome: Dominant
- Global aphasia
- Apraxia
104
Hemiplegia
- Paralysis affecting one side of the body
105
Hemiparesis
- Implies a lesser degree of weakness than hemiplegia
106
Neglect
- Failure to attend to, respond to, and/or report stimulation that is introduced contralateral to the lesion
- Persistent neglect is a negative functional outcome predictor
107
Apraxia
- Loss of ability to execute skilled or learned movement patterns on command
108
Ideomotor Apraxia
- Plan for the movement is intact, but the execution fails
- Dominant pre-motor area and dominant inferior parietal region implicated in contralateral ideomotor apraxia
- Bilateral apraxia may occur with unilateral lesions of the dominant supplementary motor cortex
109
ACA Syndrome: Unilateral
- Leg > arm motor loss (up to 90% of patients)
- Leg > face = arm cortical sensory loss
- Frontal release signs/inhibition of reflexes
110
Agnosia
- Acquired inability to associate a perceived unimodal stimulus (i.e., visual, auditory, tactile) with meaning
- Disorder of recognition (not naming)
111
Anosagnosia
- denial of deficit
112
Prosopagnosia
- Impaired ability to recognize faces
113
Aphasia
- Impairment of Language
- Associated with damage to the language dominant hemisphere
- Nearly always involves damage to the left fronto- temporal and/or temporo- parietal regions
114
Intraparenchymal Hemorrhage
- Alteration in level of consciousness (~50%)
- Nausea and vomiting (40-50%)
- Headache (~40%)
- Seizures (6-7%)
115
Traumatic Brain Injury (TBI)
- Occurs when a sudden, external, physical assault damages the brain
116
Closed Brain Injury
- Non penetrating injury to the brain with no break in the skull
117
Penetrating Brain Injury
- Penetrating or open head injuries where there is a break in the skull
118
Diffuse Axonal Injury (DAI)
- The tearing of the brain's long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull
- Damage to white matter
- Changes are microscopic
- Can lead to disorders of consciousness
- Difficult to see on CT Scan or MRI
- Can occur without other visible damage
119
Chronic Traumatic Encephalopathy (CTE)
- Produces neurodegeneration due to repeated head trauma
- Prevalence in athletes who participate in contact sports and experience frequent and repeated head trauma
- Seen as: abnormal tau protein accumulation, reduced brain volume, ventricular enlargement
- Mood and cognitive impairment can appear years after the injury occurred
120
Glasgow Coma Scale Limitations
- Substance use
- Administered drugs
- Intubation
- Injury to eye
- Hemiplegia
- Language
121
Post-Traumatic Amnesia
- State of confusion and disorientation that occurs immediately after TBI, is part of the healing process
- do NOT ask them to recall the injury (they cannot do this)
- Brain is unable to form continuous day to day memories
- Memory is the slowest part of the conscious mind to recover
122
Dose-Response Relationship
- Cognitive changes after mild TBI resolve within weeks to about 3 months at most spontaneously without treatment while changes tend to persist greater than or equal to 2 years following moderate to severe TBI
123
Non-Injury Risk Factors that can Influence TBI Outcomes
- Pre-injury psychiatric status and conduct issues/incarceration
- age at injury
- Level of education
- Stable employment 6 months pre-injury
- Marital status
- Other non-neurological injuries sustained
124
TBI: Motor Sensory Impairments
- Paralysis
- Poor coordination
- Changes in sensation (visual, hearing, touch, taste, smell)
- Bowel and bladder control
125
TBI: Communication Impairments
- Dysarthria (motor speech d/o)
- Social communication
126
TBI: Cognitive Impairments
- Slowed processing speeds = most common impairment
- Memory
- Executive functions (need external structures)
127
TBI: Psychosocial Impairments
- Reduced initiation/motivation
- Control challenges
- Emotional control
- Self-centeredness
Physiological Psychology
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