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patho ch 11
altered mood/behavior
| Question | Answer |
|---|---|
| mood | internal psychological state |
| emotions | feelings most fluid, change minute by minute |
| temperament | personality stable representation of outlook less likely to change over time |
| nood | inbetween temperament and emotions |
| hypothalamus | homeostasis autonomic nervous control in emotional expression |
| prefrontal cortex | judgement, decision making and problem solving involvement in emotional response left vs right prefrontal cortex lateral/orbitofrontal/ventromedial prefrontal cortex |
| left/right prefrontal cortex | left = positive feelings right = negative feelings |
| lateral prefrontal cortex | control consideration of alternatives and choosing course of action |
| orbitofrontal prefrontal cortex | delayed gratification |
| ventromedial | connects emotion with meaning |
| amygdala anatomy | 2 almond shaped nuclei clusters (amygdalae) close to hippocampus |
| amygdala function | emotionally charged memories, danger recognition, control negative thoughts (fear/aggression) |
| hippocampus | long term memory |
| anterior cingulate cortex | autonomic functions like BP/HR regulation cognitive functions/emotion (empathy/impulse control/decision making) |
| cingulate gyrus | emotional memories |
| cingulate cortex | BP/HR, emotion, cognitive function (impulse control/empathy/decision making) |
| anterior cingulate cortex | autonomic functions BP/HR regulation |
| limbic system | circuits connecting emotional expression, behavior and cognitive activity --> complex mood/attention/behavior connection hypothalamus, thalamus, hippocampus, anterior cingulate cortex, cingulate gyrus, amygdala, mammillary body, prefrontal cortex |
| dopamine | INHIBITORY voluntary movements of the body mood pleasurable emotions |
| norepinephrine | EXCITATORY physical/mental arousal (fight/flight) mood HR/BP |
| serotonin | INHIBITORY mood perception appetite sleep body temp |
| glutamate | EXCITATORY attention learning memory |
| GABA | INHIBITORY mood muscle activity visual sensory input |
| ACh | EXCITATORY attention arousal learning memory muscle activity |
| inhibitory neurotransmitters | dopamine serotonin GABA |
| excitatory neurotransmitters | norepinephrine glutamate ACh |
| reticular activating system | network of neurons in the brainstem acting as a filter for sensory information, controlling wakefulness, attention, and consciousness |
| bottom up processing | reflexive attention takes in environmental stimulus and tells us to act |
| top down processing | aka executive processing attention mediated by frontal lobe + basal ganglia --> thinking influence environment filter out distractions |
| visual attention | visual attention and executive processing utilized on a focus attention is blurry outside the visual cue |
| focused attention | notice and responding to one specific stimulus |
| sustained attention | prolonged concentration with vigilance over time |
| selective attention | noticing and responding to stimulus while filtering distractions |
| alternating attention | moving between tasks having different cognitive requirements |
| divided attention | responding simultaneously to multiple tasks/demands |
| what is behavior | how people respond and act in given situation |
| frontal lobe controls | personality/self-awareness/mood perception/planning judgement attention/memory motivation sexuality expressive language |
| how doe TBI affect the brain function | prefrontal cortex - lose sense of social responsibility, concentration, abstract thinking, problem solving, emotional response amygdala - reduction of fear/aggression, loss of social intelligence |
| how does decreased serotonin affect brain function | anxiety, obsession, compulsions |
| how does increased dopamine affect brain function | restlessness, psychosis, agitation |
| major cause of mood/behavior/attention disorder | TBI -> damage to frontal lobe and/or limbic system |
| flat affect | observed emotional response shows no emotions |
| impaired amygdala results in | impaired connection to social intelligence and memory |
| screening tool for mood/attention/behavior disorder | mood disorder questionnaire DSM-5 |
| treatment for mood/attention/behavior disorder | psychotherapy/counseling pharmacotherapy alternative/complementary therapies individual/family support groups |
| types of altered mood/attention/behavior | generalized anxiety disorder (GAD) PTSD major depressive disorder (MDD) bipolar affective disorder ADHD autism spectrum disorders (ASD) schizophrenia |
| Generalized anxiety disorder | overwhelming/irrational feelings of fear/worry lasting longer than 6 months interfering with daily can cause physical symptoms |
| types of GAD | anxiety disorders (panic, social, separation, phobia, medication/illness induced) OCDs trauma/stress related disorders |
| clinical manifestations of GAD | excessive/uncontrolled/irrational worry lasting >6 months at least 3 physical symptoms restlessness, fatigue, difficulty concentrating, irritability, tension, sleep disturbance |
| diagnostic criteria of GAD | history and physical exam r/o substance/medical problem standardized rating scales (GAD-7) |
| tx for GAD | CBT w/ or w/o pharmacotherapy (SSRI/benzodiazepines) or relaxation therapies |
| SSRI | selective serotonin reuptake inhibitors provides more serotonin @ nerve synapses |
| benzodiazepines | increase action of GABA |
| PTSD pathophysiology | anxiety disorder caused by 1+ extreme traumatic event ( impairment of hypothalamic-pituitary axis (HPA) |
| HPA impairment | hypothalamic-pituitary axis impaired in PTSD suppression of cortisol and elevated catecholamines |
| risk factors for PTSD | prior trauma proximity/duration/severity anxiety/depression substance abuse FHx impaired support |
| high norepinephrine promotes | flashbacks and nightmares |
| high dopamine promotes | anxiety and psychosis |
| cortisol suppression cause | prohibits homeostasis |
| catecholamines | neurotransmitter class epinephrine (adrenaline) norepinephrine (noradrenaline) dopamine |
| prefrontal cortex in PTSD | emotional regulation center decreased gray/white matter density and response to trauma/emotional stimuli in PTSD |
| amygdala and hippocampus in PTSD | conditioned fear and associative learning increased response to traumatic and emotional stimuli in PTSD |
| fear response in PTSD (amygdala) | - stress sensitivity - generalization of fear response - impaired extinction (difficulty in reducing conditioned fear responses) |
| adult PTSD clinical manifestations | avoidance/suppression of thoughts and emotions nightmares/flashbacks within 3 months of traumatic event |
| children PTSD clinical manifestations | separation anxiety crying/screaming/trembling regression withdrawal disruptive behavior inattentiveness |
| dx criteria for PTSD | >1 month symptoms impaired functioning no other medical conditions Hx experiencing traumatic event + reexperiencing event avoiding associated stimuli exaggerated/impaired response |
| PTSD Tx | psychotherapy (trauma CBT + eye movement desensitization) play therapy (children) antidepressant/benzo/glucocorticoids anticonvulsants (impulsivity) clonidine (nightmare) |
| major depressive disorder pathophysiology | pervasive/persistent low mood w/ low self esteem + anhedonia neurotransmitter deficiency norepinephrine/dopamine/serotonin |
| anhedonia | loss of pleasure |
| MDD influences (social/psychological) | isolation/social rejection familial issue unemployment/poverty abuse/substance abuse lack of significant relationships |
| seasonal affective MDD | depressive episodes in fall/winter |
| postpartum depression | disabling depression after birth up to 3 months |
| melancholic depression | pronounced depression typically in t he AM weight loss |
| catatonic depression | rarest type of depression immobility + inability to speak |
| atypical depression | mood reactivity, weight gain excessive sleep social impairment |
| clinical manifestations of depression | persistent low mood + anhedonia worthlessness/guilt/helplessness/hopelessness/self-hatred sleep pattern disruption fatigue altered appetite/weight/sex drive |
| dx criteria for MDD | Hx mental status exam DSM5 (5+ symptoms >2 weeks) + anhedonia beck depression inventory to assess severity |
| psychosomatic issues (depression) | muscle tension chronic pain stomach ache/digestive issue headaches |
| MDD tx | psychotherapy electroconvulsive therapy SSRI/TCA/MAOIs |
| TCA | tricyclic antidepressants |
| MAOIs | monoamine oxidase inhibitors |
| BP affective disorder pathophysiology | periods of mania/depression! high dopamine = mania low dopamine = depressive high glutamate in prefrontal cortex = mania |
| what genetic inheritance is associated with BPD | major affective disorder (MAFD) loci needs multiple changes in the alleles |
| risk factors for bipolar disorder | psychological/environmental/social childhood abuse harsh home environment relationship disruption |
| what can occur in severe BPD | psychosis develops and patients fully dissociate from reality |
| BPD clinical manifestations | MANIA PERIODS >1+ WEEK/periods of depression hypersexuality impulsivity/impaired judgement moody/irritable distractibility decrease need for sleep |
| dx criteria for BPD | Hx (observation by F&F) mental status exam r/o physical conditions DSM-5 criteria w/ 7 subtypes |
| BPD treatment | psychotherapy mood stabilizers (lithium carbonate/sodium valproate) atypical antipsychotic drugs medication compliance is very important, will feel great and self D/C |
| ADHD pathophysiology | genetic (75%) environmental factor (smoking in pregnancy/lead/insecticide) thinning of posterior parietal cortex reduced volume of left prefrontal cortex dopamine/NE impairment + lack of executive fn in prefrontal cortex |
| ADHD definition | neurodevelopmental disorder of attention deficit/hyperactivity/impulsiveness |
| ADHD classifications | inattentive vs hyperactive-impulsive vs combined |
| predominantly inattentive ADHD clinical manifestations | easily distracted/missing detail forgetful difficulty focusing losing items daydreaming confused easily difficulty processing info missing social cue struggling to follow instruction |
| predominantly hyperactive-impulsive ADHD clinical manifestations | unable to sit still continuous talking touch/play with everything constantly in motion impatient/interruptive anger management acting without care for consequence |
| ADHD diagnostic criteria | Hx (observations by F &F) mental status exam r/o physical conditions DSM-5 dx criteria (3 subtypes) |
| ADHD onset age | typically before age 12 in multiple settings for at least 6 months |
| ADHD tx | psychotherapy (CBT + behavioral therapy) stimulants physical exercise |
| how do stimulants treat ADHD | affects dopamine + NE mechanism to improve concentration and reduce impulsivity |
| autism spectrum disorder (ASD) | neurodevelopmental disorder with onset in early childhood |
| ASD pathophysiology | teratogen exposure or valproic acid during pregnancy environmental/genetic reduced GABA-beta receptors in limbic cortex thinning of corpus callosum reduce neuroanatomical connection to frontal lobe |
| ASD triad (clinical manifestations) | impaired social interaction impaired verbal/nonverbal communication repetitive pattern of movement/interest/behavior |
| ASD other clinical manifestations | poor muscle tone incoordination toe walking developmental regression |
| dx criteria for ASD | clinical manifestations screening tools DSM-5 |
| ASD tx | speech therapy occupational therapy physical therapy CBT language learning therapy |
| schizophrenia pathophysiology | psychotic mental disorder affecting how one perceives world ENLARGED VENTRICLES decreased temporal/prefrontal brain volume reduced glutamate receptor/glutamate levels |
| schizophrenia risk factors | FHx/Genetics perinatal risk (viral infection/fetal hypoxia/malnourishment) socioenvironmental triggers |
| familial risk for schizophrenia | first degree relative w/ schizo = 10% higher risk parents = 40% risk |
| schizo clinical manifestations | hallucinations (hearing voices) delusion social withdrawal/paranoia poor hygiene poor judgement memory/attention/cognitive impairment disorganized thought/speech |
| dx criteria for schizophrenia | Hx (F&F observations) comprehensive clinical assessment r/o physical conditions at least 2 indicators of delusion/hallucination/disorganized speech for 1+ month w/ significant impact to life for 6+ months |
| tx for schizophrenia | antipsychotics psych/social support possible need for hospitalization |
Created by:
sleepingbear