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49 Cards in this Set
- Front
- Back
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Major Depression |
- Most Common Mood Disorder - affects 5% of the population every year - symptoms must persist for at least 2 weeks - Occurs in discrete episodes - twice as many females than males - High Suicide Risk - Age of Onset: 30s |
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Major Depression - Symptoms |
- Depressed Mood - Loss of pleasure and interest in things - Weight Change - Sleep Disturbances - Fatigue - Feelings of worthlessness - Decreased ability to concentrate - Thoughts of Suicide |
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Bipolar Disorder |
- Bouts of Depression followed by periods of mania - Effects 1% of pop - recurrent, 7-9 episodes of mania in a lifetime - Age of Onset 20s or 40s |
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Bipolar Disorder - Manic Symptoms |
- Abnormally Elevated Mood - Increased Energy - Inflated Self-Esteem - Decreased Need for sleep - Increased speed of thoughts - involvement in risky pleasure seeking behavior |
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Hypomania |
- Bipolar II - Milder with less severe symptoms - not associated with marked impairments in judgment or performance |
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Monoamine Hypothesis |
- Depression is a consequence of a deficit in 5-HT and serotonin systems - changes observed in adrenergic & 5-HT receptors in depressed people - Levels of 5-HT correlate with depression - Suicide patients have decreased 5-HT and 5-HT metabolite - MAOI helps depression, reserpine causes symptoms |
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Reserpine |
- depletes vesicular stores of monoamines (5-HT and Serotonin) - produced symptoms similar to depression |
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Diathesis-Stress Hypothesis |
- Emphasis on HPA-axis dysfunction - combination of genetic predisposition and early childhood stress |
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HPA Axis Dysfunction |
- Exaggerated activity associated with Anxiety & Depression - Blood Cortisol levels and CSF concentration of CRH are elevated - decreased number of glucocorticoid receptors in hippocampus (caused by childhood neglect in rats) |
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Tricyclic Antidepressants (TCA) |
- First used to treat schizophrenia, improvement of depressive symptoms was observed - blocks reuptake of NE or NE & 5-HT into presynaptic terminals - takes several weeks for symptoms to improve |
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MAOIs |
- first used to treat TB, and observed elevation of mood in subjects - inactivation of MAO, which metabolizes 5-HT & NE - cannot consume foods containing tyramine, which is metabolized by MAO, can cause increase in BP |
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SSRIs |
- Comparable effectiveness of treatment of depression with TCA & MAOI with fewer side effects - inhibits reuptake of 5-HT into presynaptic terminals - several weeks of therapy required |
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Lithium (LI+) |
- Treatment of Bipolar - decreases length, severity, recurrence of mania - also acts as anti-depressant - must be given chronically to be effective - Toxic levels only slightly higher than therapeutic levels |
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Schizophrenia |
- Onset of symptoms late teens- early twenties - Heterogeneity of symptoms among patients - loss of contact with reality, and a disruption of though, perception, mood, and movement - catatonic, paranoid, disorganized types |
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Catatonic Schizophrenia |
- immobility or stupor - bizarre posturing or grimacing - senseless parrot-like repetition of words or phrases |
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Paranoid Schizophrenia |
- preoccupation with delusions organized around a theme - often accompanied by auditory hallucinations - best chance at rehabilitation |
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Disorganized Schizophrenia |
- lack of emotional expression - disorganized behavior and incoherent speech - poor outlook |
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Positive Symptoms (Schizophrenia) |
- Delusions, hallucinations, disorganized speech - grossly disorganized catatonic behavior - typical acute onset due to neurochemical, rather than structural abnormalities in the brain - respond to anti-psychotic drugs that block dopamine receptors |
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Negative Symptoms (Schizophrenia) |
- Reduced expression of emotion - Poverty of speech - loss of energy - memory impairment - resistant to anti-psychotic drugs - progressive deterioration - structural brain abnormalities (ventricular enlargement) |
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Family Studies (Schizophrenia) |
- more common among relatives - but 60% have no family history |
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Twin & Adoption Studies (Schizophrenia) |
- 48% concordance in identical twins - 17% concordance in fraternal twins - 58% concordance in identical twins raised apart |
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Developmental Causes of Schizophrenia? |
- Pathological Processes during dev and delivery (infections, hypoxia, influenza during second trimester of pregnancy) - Little gliosis suggests abnormalities occur during dev rather than mature brain - unclear if changes are genetic, environmental - unclear what accounts for delayed onset |
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Schizophrenia Structural Abnormalities |
- Cerebral Atrophy due to cell loss - ventricular enlargement due to cell loss (not a specific sign for schizophrenia) - Reduced brain volume in many regions - disorganization of pyramidal layer of hippocampus - atrophy of cortical layers - unknown if cause or consequence
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Reduced Brain Volume (Schizophrenia) |
- basal ganglia - temporal lobe - limbic structures |
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Schizophrenia Functional Abnormalities |
- Reduced ratio of frontal lobe blood flow to whole brain blood flow - less of an increase in blood flow to frontal lobes during cognitive tasks compared to normal subjects - reduced metabolic activity in frontal lobes |
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Anti-Psychotic Drugs |
- Calms agitated patients & modifies positive symptoms - require weeks of treatment for alleviation - most classes are equally effective |
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Atypical Anti-Psychotic Drugs |
- i.e. clozapine - more effective for treating negative symptoms |
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MOA Anti-Psychotic Drugs |
- Anti-dopaminergic - Anti-cholinergic - anti-adrenergic - anti-serotonergic - anti-histaminergic - each drug has range of effects - correlation between alleviating symptoms and blocking dopamine receptors (mainly D2)
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Anti-Psychotic Side Effects |
- Parkinsonism (from blockade of dopamine receptors in striatum) - Tardive Dyskinesias - additional drugs are used to minimize side effects |
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Dopamine Hypothesis |
- schizophrenia - psychotic episodes are triggered specifically by activation of dopamine receptors - amphetamine causes psychosis and stereotyped behavior that is alleviated by dopamine antagonists - correlation between effectiveness of anti-psychotic drug and blockage of D2 and D4 dopamine receptors |
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Glutamate Hypothesis |
- Decreased glutamate level/activity in brain causes schizophrenic symptoms - many anti-psychotic drugs affect NMDA receptors |
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Amphetamine |
- increases release of dopamine |
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D2 Dopamine Receptors |
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D1 Dopamine Receptors |
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PCP |
- Blocks NMDA glutamate receptors - Symptoms similar to positive and negative schizophrenic symptoms |
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psychosis |
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stereotypy |
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Rapid Cycling Disorder |
- bipolar type - several episodes of mania a year |
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Corticotropin-releasing hormone (CRH) |
- released by hypothalamus - causes release of ACTH - mice display anxiety behaviors when overexpressed |
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Adrenocorticotropic Hormone (ACTH) |
- targets adrenal cortex - released from anterior pituitary in response to CRH - causes release of cortisol, which contributes to the physiological response to stress |
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Hypothalamic-Pituitary-Adrenal (HPA) Axis |
- regulates secretion of cortisol in response to stress
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Glucocorticoid receptors |
- suppresses CRH release - in hippocampus - HPA feedback regulator - continuous exposure to cortisol can cause hippocampal cell death - monoamines regulate glucocorticoid receptor expression |
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Li Side Effects |
- Weight Gain - thyroid abnormalities - impaired cognition - impaired short-term memory |
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Li MOA |
- unclear - Replaces sodium & reduces neuronal excitment - decreases amount of free inositol - dampens response to receptor/ second messenger coupling |
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phosphatidyl inositol |
- precursor for important second messenger molecules that generate in response to G-protein receptors |
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Tardive Diskinesias |
- stereotyped involuntary movements of face and jaw |
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anti-histaminergic |
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Anti-cholinergic |
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anti-adrenergic |
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