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94 Cards in this Set

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What is Psychosis caused by?
Dopamine overdrive
How can you tell that Dopamine is in overdrive during psychosis?
HVA (homovanilic acid) can be measured in increased levels immediately following a psychotic episode.
What happens to Dopamine turnover and metabolism in psychosis?
Both are increased
What is the typical receptor that is bound by antipsychotics?
D2 receptor
What happens to D2 receptor availability in psychosis?
It is decreased in availability.
What antipsychotic drugs take advantage of the D2 receptor?
Both typicals and atypicals
What is the result of blockage of D2 receptors?
Movement disorders
What are the 3 common movement disorders in psychosis?
-Dyskinesia
-Tremors
-Rigidity
What 3 dopamine-dependent cognitive functions are disrupted by Psychosis and dopamine overdrive?
-Working memory
-Attention (deficit)
-Motivation (lacking)
What are the 2 most common "Typical" antipsychotics?
-Chlorpromazine (Thorazine)
-Haloperidol
What do the Typicals do?
Almost completely blockade D2 receptors
What are the primary side effects of the Typicals?
-Rigidity and Parkinson like sx
-Due to Induced Dysfunction of the basal ganglia
What do the Typicals treat?
The positive symptoms
What don't the Typicals treat?
The negative symptoms
When do psychotic symptoms appear in males vs females?
earlier in males than females
What are positive symptoms?
Hallucinations
Paranoia
Delusional thinking
What are negative symptoms?
Loss of memory, attention deficit, etc.
What do the atypicals treat?
Positive and negative symptoms
How do the atypicals achieve treatment of negative symptoms?
By using "less sticky" blockade at the D2 receptor
What is good about the atypicals?
They have less negative side effects like movement disorders
What is PANIC associated with?
Norepinephrine
What is Panic caused by?
Triggers and hyperventilation
Where is panic caused in the brain?
Locus ceruleus (NE)
Where is NE released from locus ceruleus?
Throughout the brain - >80% of it is bathed in NE
So what is the "response" that causes the panic?
Sympathetic activation - fight our flight..
What kind of a feeling do you get with sympathetic activation?
Impending doom - panic
How do you treat panic peripherally?
By blocking NE
What is a beta blocker?
Propanolol
How do you treat panic Centrally?
With CBT - cognitive behavioral therapy
What is the basis of CBT?
Repeated exposure to the trigger to desensitize the patient to it.
So if someone's panicking and you just wnat them to settle down what do you give them?
Give 'em a little propanolol.. it works wonders.
How can you stop the SOURCE of panic?
By blocking Locus ceruleus firing
What drugs block Locus ceruleus firing?
-Benzodiazepines
-SSRIs/TCAs/MAOIs
What is the circuit of Papez?
1. Cingulate gyrus
2. Parahippocampus
3. Hippocampus
fornix
4. Mammilary body
5. Anterior thalamus
Back to cingulate gyrus
What is the amygdala involved in?
Conditioning and reward
What is the orbitofrontal cortex involved in?
Reward identification and Satiety
What do lesions of the orbitofrontal cortex result in?
Increased Risk taking - gambling
Poor social performance
What are 3 causes of hypometabolic orbitofrontocortex?
-Abstinence from cocaine
-Use of crystal meth
-Familial major depression
What happens to the Orbitofrontal cortex in Major depression?
It becomes HYPOTROPHIC - decreased in volume.
How do we know that major depression causes low volume in the orbitofrontal cortex?
It is measurably smaller after suicide.
How is the Hippocampus involved in emotion?
It gives emotions with contextual memory.. like if you do really well on an exam, the next one you sit for you'll be more confident.
What is the Anterior Cingulate involvement in emotion?
-Immediate emotional tone
What is the retrosplenium's involvement in emotion? (caudal cingulate)
Retrospective events
What disease is the cingulate hypermetabolic in?
OCD
What is necessary for severe refractory obsessive compulsive disorders?
Cingulotomy - removal of the cingulate gyrus
What is the James-Lange Theory of emotion?
That emotions are cognitive response to information from the periphery - ie you are hurt when you sense disgust at you..
What is Schacter's Theory of emotion?
That its due to hypothalamic/thalamic coordination.
What happened to Phineas Gage?
A tamping rod was driven through his orbitofrontal cortex (ventromedial)
What is the result of a Ventromedial Orbitofrontal lesion?
-Inappropriate appreciation of social context cues
-Intact emotion expression
-Poor affect perception
Out of Affective disorders, Heart disease, Cancer, and AIDS, what chronic disease do we spend the most on per year? Rate them:
-Cancer most
-Aids
-Heart disease
-Affective disorders least
What disease is most treatable but least recognized?
Affective disorders
What shows more improvement, treatment of mental disorders, or surgical angioplasty or atherectomy for cardiac disease?
Mental disorder tx! Especially panic and bipolar disordrs.
4 things Depression is NOT:
1. Character defect
2. Personality flaw
3. Grieving
4. Caused by stress
How does stress influence depression?
By worsening it or predisposing one to it, but stress does NOT cause depression.
What is Depression?
A medical illness
What is your chance of getting depression if female?
2X higher than for males
What is the time period that symptoms should be present in order to diagnose major depression?
They should be present for more than 2 weeks.
What are medical illnesses that can have symptoms that mimic depression?
-Hypothyroidism
-Liver/kidney disease
-Diabetes
-Anemia
-Drugs of abuse
-Chronic pain
What molecules are responsible for depression?
Norepinephrine and serotonin
What is 5-hydroxytyrosine?
Serotonin
What is Norepinephrine associated with alone?
Energy and interest
What is Serotonin associated with alone?
Impulse
What are NE and Serotonin together associated with?
Anxiety and irritability
So what is a side effect that serotonin reuptake inhibitor is thought to cause?
Reduced sex drive
What is the major cause of depressio?
Dysregulation of the Hypothalamic Pituitary Adrenal system
What does the HPA axis control?
Stress response (via cortisol)
What do 2 of 3 depressed patients hypersecrete?
Cortisol
What causes the cortisol hypersecretion?
Increased CRH
What are the results of increased CRH?
-Increased eating
-Decreased sex drive
-Behavioral despair
-Increased locus ceruleus FR
Why does it take so long to see improvement of depression symptoms?
Because it involves neurotransmitter receptor alterations being down and upregulated.
Is there one specific receptor that is altered in depression?
No there are many forms; if you target one type of receptor for treatment the polymorphism will get you
What does BDNF stand for?
Brain derived neurotrophic factor
How is BDNF related to depression?
Its expression is decreased by cortisol
What happens when BDNF is decreased?
The brain volume decreases - it atrophies
Why is BDNF assay useful?
It can predict a patient's response to SSRIs based on the subtype
Is depression only caused by HPA disregulation and increased cortisol?
No
What are 2 other causes of depression?
-Low NE in the CNS
-AMPT depletion
What is AMPT?
Alpha methyl-p tyrosine, a drug that blocks the production of NE and Dopamine.
How does AMPT depletion of NE cause depression?
When patients are treated with it, it depletes their NE and causes depressive symptoms.
What are 2 biological causes of depression in primary relatives?
-Low CNS serotonin levels
-Tryptophane depletion
What is Tryptophan a precursor for?
Serotonin
What is used to treat familial depression due to low Serotonin levels?
Selective serotonin reuptake inhibitors
What does a Monoamine oxidase inhibitor do?
Prevents NE breakdown
What is the major problem with SSRIs?
Side effects - if you eat cheese or wine
What is the efficacy rate for most drugs used to treat depression?
About 60%
What is the MOST efficacious treatment for depression?
ECT - electroconvulsive treatment
What are 3 other nondrug therapies for depression?
-Vagal nerve stimulation
-Cortical stimulation
-Deep brain stimulation
What is the cortical stimulation target?
Dorsal medial prefrontal cortex
What is the Deep brain stimulation target?
Subcallosal cortex and the Accumbens nucleus
So panic disorder is most associated with:
Norepinephrine
Depression is most associated with:
5HT (serotonin)
Psychosis is associated with:
Dopamine disregulation
Typicals block ______ and cause _____:
Block D2
Cause extrapyramidal symptoms
Atypicals affect
Negative symptoms