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