Week 2

Question 1

Panic attack is not a _________ and cannot be coded. Panic Disorder however can because it is ___________.

Answer 1

Mental Disorder

Repetitive

Question 2

Sx of Panic attack

Answer 2

Difficulty Breathing, chest pain, hyperventilation, parasthesis, etc.

Question 3

Panic/Anxiety: Role of Amygdala in the 3 part emotional processing of the brain

Answer 3

Stage 1, Evaluation: Amygdala is the evaluator = provides primary unconscious response to danger. Very “danger or no danger” based.

Stage 2, Expression: Stress Response via direct pathway (hypothalamus tract, cortisol) or indirect pathway (adrenal glands, cortisol + NE).

Stage 3: Subjective Emotion: Fear or Anxiety.

Question 4

Which two portions of the Brain control the amygdala?

Answer 4

Medial PFC (Anterior Cingulate Cortex) + Hippocampus help inhibit amygdala to limit the stress response.

Question 5

Describe the Degenerative Cascade

Answer 5

When excessive cortisol shuts down the hippocampus so it cannot inhibit the amygdala. As a result the amygdala becomes further activated => increased cortisol and therefore continuous shut down of the hippocampus = continuous stress.

Question 6

F(x) of amygdala

Answer 6

Control center of emotional processing. Especially in response to potential threats.

Question 7

Effects of GABA, Serotonin, and NE on stress.

Answer 7

GABA = inhibitory function in general, including the amygdala.

Serotonin and NE effects = not exactly known but Sertonin may modulate NE release from the Locus Coeruleus which would increase the action of the hippocampus.

Question 8

PTSD: DSM-5, 6 symptoms

Answer 8

TRAUMA

• T = Traumatic event
• R = Re-experiences
• A = Avoidance and Emotional Numbing (detachment from others, loss of motion)
• M = One month duration or longer
• A = Arousal Increased (startle reaction, irritable, poor concentration, etc.)

Question 9

PTSD: Details on Traumatic Events

Answer 9

• Unexpected death of family or close friend due to NATURAL causes is no longer included.
• Exposure Type 1 = PERSONAL INVOLVEMENT in an event that has definite potential for serious injury or death to oneself. Potential loss of life or limb is key here.
• Exposure Type 2 = WITNESSING first hand an event that has definite potential for serious injury or death to someone else.
• Exposure Type 3 = LEARNING OF AN EVENT that has definite potential for serious injury or death of another person.

Question 10

PTSD: Differential Diagnosis (Many)

Answer 10

• Specific Phobias (no re-experience)
• Panic Disorder (not triggered by recall of trauma)
• Generalized Anxiety Disorder (Did not occur due to traumatic event)
• Dissociative Disorder (Absence of re-experiencing and hyper arousal symptoms)
• Obsessive Compulsive Disorder (not related to traumatic event)
• Malingering (RED)

Question 11

PTSD: First Line Therapy

Answer 11

SSRIs. Cognitive Behavioral Therapy is also good.

Question 12

PTSD: Main Brain components involved and overall dysfunction

Answer 12

Amygdala and Hippocampus. From the lecture it sounds like dysfunction of the hippocampus to inhibit the Amygdala. Similar to the anxiety disorders…?

Question 13

Case of Multiple Memory System

• What happened during the case
• What are the different “multiple memory systems” and which parts of the brain control them?

Answer 13

• What happened: a patient could not retain any new information and never remembered the doctor. However, doctor once shook her hand with a tack in his hand and from then on, she hesitated to shake the doctor’s hand but she didn’t know WHY.
• Implicit Memory system => Subconscious learning to avoid hand, registers any emotional response. via AMYGDALA
• Explicit Memory System => conscious learning, knowing the WHY reasons. via Hippocampus and Medial Temporal Lobe.

Question 14

OCD Related: Dysfunction in the following areas of the brain (3)

Answer 14

• Striatum (caudate and putamen) => controlling center for motor center
• Orbital Frontal Cortex => Inhibitory function controlling behavior
• Anterior Cingulate Cortex => Monitors what the rest of the brain is doing.

Question 15

OCD: Possible Manifestations in Brain Structure(3)

Answer 15

• Decrease in Grey Matter Volume (via structural study, MRI)
• White Matter damage (via structural study, DTI)
• Reduced Frontal-Striatal activation (via functional Study, fMRI)

Question 16

OCD: Motor functions of the striatum

Answer 16

D2 mediated (INDIRECT PATHWAY) = inhibits thalamus and therefore no excitatory signal to the cortex

D1 mediated (DIRECT PATHWAY) = DISinhibits thalamus and therefore excitatory signal to the cortex

Question 17

OCD: Neurotransmistters heavily involved + f(x)

Answer 17

• Serotonin and Dopamine => may influence striatum motor functions

Question 18

OCD: Steps of OCD + areas of Brain involved

Answer 18

• Anxiety over Perceived Threat => Stress Response System (amygdala, HPA axis, and hippocampus
• Obsessions => ACC and mPFC usually serve to terminate the anxiety but feedback system doesn’t work every well
• Compulsion => OFC usually monitors behaviors generated from the striatal motor system but not here.

Question 19

Definition of Somatic Symptom Disorder

Answer 19

Excessive thoughts, feelings, or behaviors related to somatic symptoms (Sx already present)

Question 20

Definition of Illness Anxiety Disorder

Answer 20

Preoccupation with having or acquiring a serious illness (Absent or mild Sx present)

Question 21

Definition of Conversion Disorder + Tx.

Answer 21

A somatoform disorder involving actual loss of bodily functions due to anxiety (blindness, weakness, numbness, etc.)

• Red Flag phrase = La belle indifferencem seems unconcerned about their deficiet.

Tx: Reassurance

Question 22

Defintion of Factitious disorder

Answer 22

Falsification of physical or psychological symptoms but NO SECONDARY GAINS. Factitious disorder can be imposed on another person (like child)

Question 23

Definition of Malingering

Answer 23

Falsification of symptoms with secondary gains.

Question 24

Definition of Body Dysmorphic Disorder

Answer 24

Debilitating preoccupation with physical defect: real or imagined. “Big Ears.”

Question 25

Definition of hypchondriasis

Answer 25

- Misinterpets/fixates on/exaggerates physical symptoms. - FEAR despite reassurance to the contrary: Pathognomonic feature. - Dx made after > 6 months of nondelusional preoccupation with Sx.

Question 26

Definition of Pain Disorder

Answer 26

Pain associated with underlying psychological stress (headache commences at time of divorce proceedings) = Pain is the focal point.

Question 27

DX of Somatoform Disorder: Not used in DSM5

Answer 27

Use PHQ. If patient is obthered a lot by at least 3 sx without adequate medical explanation. - Stomach Pain, Back Pain, headaches, Chest Pain, Pain in arms, legs, joints, dizziness, shortness of breath, etc.

Question 28

3 Required clinical criteria for each sx of somatoform disorders.

Answer 28

- Cannot be fully explained - Not a result of Factitious or Malingering!! - Cause significant impairment of social, occupational, etc.

Question 29

Best TX for Somatoform Disorders

Answer 29

CBT + Psychiatric Referral (STAR)

Question 30

Dissociative Disorders: Depersonalization/dereailzation disorder

Answer 30

Feeling unreal, detached from yourself. | - Dissociation = Defense Mechanism

Question 31

Dissociative Disorders: Dissociative Amnesia

Answer 31

Inability to recall autobiographical information | - Repression = Defense Mechanism

Question 32

Dissociative Identity Disorder

Answer 32

used to be called "multiple personality disorder" | - Interjection and projection = Defense Mechanism

Question 33

Dissociative Fugue Feature

Answer 33

Ending up in a new place without remembering anything about the trip, not planned - Repression = Defense Mechanism

Question 34

Refusing to accept a diagnosis of cancer and continuing to seek "second opinion" from many different doctors despite repeat confirmation

Answer 34

Denial

Question 35

Painful memories of seeing a friend die as a child are kept out of conscious awareness even though related cues may still induce emotional response

Answer 35

Repression

Question 36

A person tells his family about HIS late stage cancer diagnosis in a "matter of fact" fashion without any emotion

Answer 36

Isolation of Affect

Question 37

A person recounts an abuse in childhood as if he was watching the vent unfold as a bystander

Answer 37

Dissociation

Question 38

A person convinces himself that oral sex (instead of intercourse) outside of marriage does not count as infidelity

Answer 38

Rationalization

Question 39

A person seeks to research extensively on the physiological and pharmacological aspects of her newly diagnosed illness

Answer 39

Intellectualization

Question 40

A person is abused by a parent as a child and then takes on the abuser's behavior toward her own child

Answer 40

Identification/Introjection

Question 41

A girl criticizes a classmate's work as mediocre when the teacher praises it as the best in the class (protects self esteem)

Answer 41

Projection

Question 42

A man angry at his boss at work goes home and takes out his hanger on his wife and children and then pounds his desk

Answer 42

Displacement

Question 43

A grown person giggles like a child when the topic of conversation makes her uncomfortable

Answer 43

Regression

Question 44

A formerly well behaved teenager engages in serious delinquent behavior with others when the real issue was her anxiety over the divorce of her parents

Answer 44

Acting Out

Question 45

A husband worried about his wife getting upset about him coming home late washes the dishes immediately after he arrives home.

Answer 45

Undoing