Psychology 250 Lecture 14 Kevin R Smith. Hemorrhages Result From: Aneurysms Aneurysms Hypertension...

Psychology 250Psychology 250

Lecture 14Lecture 14

Kevin R SmithKevin R Smith

Hemorrhages Result From:Hemorrhages Result From:

AneurysmsAneurysms HypertensionHypertension Structural defects in blood vesselsStructural defects in blood vessels Blood diseasesBlood diseases Exposure to toxinsExposure to toxins

John Olney and “Excitotoxicity”John Olney and “Excitotoxicity”

Observed damage following stroke is Observed damage following stroke is not consistent with the idea that cells not consistent with the idea that cells die due to oxygen and glucose die due to oxygen and glucose deprivationdeprivation• One would expect that a deprived brain One would expect that a deprived brain

would uniformly have damagewould uniformly have damage• Damage more often found in certain Damage more often found in certain

areas, typically in the middle of the areas, typically in the middle of the cortexcortex

New Theory of Brain DamageNew Theory of Brain Damage

Olney suggested that excess Olney suggested that excess glutamate following stroke is glutamate following stroke is responsible for damageresponsible for damage• Neurons may swell and burstNeurons may swell and burst• Calcium moves into neuron, possibly Calcium moves into neuron, possibly

initiating apoptosisinitiating apoptosis• Interactions with NO may damage Interactions with NO may damage

neuronsneurons

Chronic Traumatic Brain Injury Chronic Traumatic Brain Injury (CTBI)(CTBI)

Repeated concussions may produce:Repeated concussions may produce: • slurred speechslurred speech• memory and personality changesmemory and personality changes• Parkinson’s DiseaseParkinson’s Disease

The APOE4 gene, The APOE4 gene, implicated in implicated in Alzheimer’s, may Alzheimer’s, may influence CTBIinfluence CTBI

© Szenes Jason/CORBIS SYGMA

Brain TumorsBrain Tumors

Tumors do not arise from mature neurons, Tumors do not arise from mature neurons, which do not typically replicatewhich do not typically replicate

Tumors do arise from glia and the tissues Tumors do arise from glia and the tissues of the meningesof the meninges

Infiltrating (malignant) tumors lack defined Infiltrating (malignant) tumors lack defined boundariesboundaries• usually return after surgical removalusually return after surgical removal• often shed cells or metastasizeoften shed cells or metastasize

Encapsulated (benign) tumors rarely Encapsulated (benign) tumors rarely reoccur after surgery or metastasizereoccur after surgery or metastasize

Symptoms of TumorsSymptoms of Tumors

General symptoms occur due to General symptoms occur due to displacement and pressuredisplacement and pressure• headache, vomiting, seizures, double headache, vomiting, seizures, double

vision, reduced heart rate, reduced vision, reduced heart rate, reduced alertnessalertness

Specific symptoms relate to the Specific symptoms relate to the location of the tumor (e g occipital location of the tumor (e g occipital tumors affect vision)tumors affect vision)

Types of TumorsTypes of Tumors

Gliomas (from Glial cells) range in Gliomas (from Glial cells) range in severityseverity• AstrocytomasAstrocytomas• Medulloblastomas Medulloblastomas

Meningiomas (from meninges) are Meningiomas (from meninges) are usually benignusually benign

Treatment for TumorsTreatment for Tumors

Surgical RemovalSurgical Removal ChemotherapyChemotherapy ThalidomideThalidomide

• Reduces the blood vessels that serve Reduces the blood vessels that serve the tumorthe tumor

• Kills the tumor by starving it of nutrientsKills the tumor by starving it of nutrients

EpilepsyEpilepsy Partial seizures Partial seizures

originate in an originate in an identifiable part of identifiable part of the brain and then the brain and then spread outwardspread outward

Generalized seizures Generalized seizures symmetrically affect symmetrically affect both sides of the both sides of the brain and do not brain and do not appear to have a appear to have a focus or clear point of focus or clear point of originorigin

Characteristics of Partial Characteristics of Partial SeizuresSeizures

Simple partial seizures cause Simple partial seizures cause movements or sensations appropriate movements or sensations appropriate to the location of the starting point, or to the location of the starting point, or focus, of the seizure activityfocus, of the seizure activity• little change in consciousnesslittle change in consciousness• Jacksonian seizure: starts in one place, Jacksonian seizure: starts in one place,

and gradually can spread to close areasand gradually can spread to close areas Starts in finger and spreads throughout the Starts in finger and spreads throughout the

handhand

Characteristics of Partial SeizuresCharacteristics of Partial Seizures

Complex partial seizures normally Complex partial seizures normally begin in the temporal lobes and are begin in the temporal lobes and are associated with alterations in associated with alterations in consciousnessconsciousness• memory loss and confusionmemory loss and confusion• sense that environment is either very sense that environment is either very

familiar or foreignfamiliar or foreign

Characteristics of Generalized Characteristics of Generalized SeizuresSeizures

Grand mal seizuresGrand mal seizures• Cycling of tonic and Cycling of tonic and

clonic phases clonic phases followed by comafollowed by coma

Petit mal seizuresPetit mal seizures• Loss of Loss of

consciousness, but consciousness, but patient doesn’t fall patient doesn’t fall overover

• 3/sec spike and 3/sec spike and wave patternwave pattern

Causes of EpilepsyCauses of Epilepsy Partial Seizures:Partial Seizures:

• Paroxysmal depolarizing shift (PDS)Paroxysmal depolarizing shift (PDS) Large abrupt depolarization of affected Large abrupt depolarization of affected

neuronsneurons Triggers a train of action potentialsTriggers a train of action potentials Followed by a period of hyperpolarizationFollowed by a period of hyperpolarization Excitatory activity overwhelms the GABA-Excitatory activity overwhelms the GABA-

inhibitory system and high frequency inhibitory system and high frequency action potentials begin to occuraction potentials begin to occur

Causes of EpilepsyCauses of Epilepsy

Generalized Seizures:Generalized Seizures:• Rhythmic activation connection between Rhythmic activation connection between

the thalamus and the cortexthe thalamus and the cortex

Treatments for EpilepsyTreatments for Epilepsy

Effective medications are usually Effective medications are usually GABA agonistsGABA agonists

Surgery may be used to remove Surgery may be used to remove seizure focus or restrict seizures to seizure focus or restrict seizures to one hemisphereone hemisphere

In children, ketogenic (heavy in fat, In children, ketogenic (heavy in fat, low in sugar) diets may be usefullow in sugar) diets may be useful

Neurocysticercosis (Brain Neurocysticercosis (Brain Worms)Worms)

Infection with the pork tapewormInfection with the pork tapeworm When encysted worm dies, the immune When encysted worm dies, the immune

response initiates focal seizuresresponse initiates focal seizures Treatments include seizure medication, Treatments include seizure medication,

surgery and antiworm medicationsurgery and antiworm medication

Brain InfectionsBrain Infections Encephalitis (e g West Nile virus) is an inflammation of Encephalitis (e g West Nile virus) is an inflammation of

the brain caused by viral infectionthe brain caused by viral infection Meningitis is inflammation of the meninges, resulting from Meningitis is inflammation of the meninges, resulting from

infection by bacteria, viruses or fungiinfection by bacteria, viruses or fungi

Lyme disease is caused by Lyme disease is caused by viruses transmitted by ticksviruses transmitted by ticks

AIDS Dementia Complex (ADC)AIDS Dementia Complex (ADC)

Causes:Causes:• Direct action of HIV virusDirect action of HIV virus• Indirect results of opportunistic Indirect results of opportunistic

infectionsinfections Affects mood, cognition and Affects mood, cognition and

movementmovement Treated with antiretroviral Treated with antiretroviral

medicationsmedications

Transmissible Spongiform Transmissible Spongiform Encephalopathies (TSEs)Encephalopathies (TSEs)

Psychological disturbances:Psychological disturbances:• ParanoiaParanoia• AnxietyAnxiety• DepressionDepression

Progressive loss of cognitionProgressive loss of cognition Motor disturbancesMotor disturbances DeathDeath

Types of TSEsTypes of TSEs Scrapie (sheep)Scrapie (sheep) Bovine spongiform Bovine spongiform

encephalopathy (BSE or “mad encephalopathy (BSE or “mad cow”; cattle)cow”; cattle)

Creutzfeldt-Jakob disease Creutzfeldt-Jakob disease (humans)(humans)

Kuru (humans)Kuru (humans) New variant Creutzfeldt-Jakob New variant Creutzfeldt-Jakob

disease (vCJD; humans)disease (vCJD; humans)

What Causes TSEs?What Causes TSEs?

TSE infectious agents differed from viruses:TSE infectious agents differed from viruses:• long incubation periodlong incubation period• lack of inflammationlack of inflammation• immunity to hospital sterilization techniquesimmunity to hospital sterilization techniques

Prusiner isolated abnormal proteins called Prusiner isolated abnormal proteins called “prions”“prions”

PrionsPrions

Proteins encoded by genesProteins encoded by genes Uninfected animals encode the Uninfected animals encode the

protein, but if they have the TSE, the protein, but if they have the TSE, the protein is folded differentlyprotein is folded differently

Can be genetically inherited or Can be genetically inherited or incorporated through the digestion of incorporated through the digestion of the abnormal proteinthe abnormal protein

Migraine HeadachesMigraine Headaches

Symptoms include excruciating pain, an Symptoms include excruciating pain, an aura, nausea and vomitingaura, nausea and vomiting

Brainstem “migraine generator” may be Brainstem “migraine generator” may be responsible:responsible:• Possibly the Raphe nucleiPossibly the Raphe nuclei• Serotonin levels are low at the onset of a Serotonin levels are low at the onset of a

headacheheadache• CGRP is released by the trigeminal nerve (V), CGRP is released by the trigeminal nerve (V),

leading to dilation of blood vesselsleading to dilation of blood vessels• Triptans (serotonin agonists) may be helpfulTriptans (serotonin agonists) may be helpful

Psychological DisordersPsychological Disorders

SchizophreniaSchizophrenia Positive SymptomsPositive Symptoms

• DelusionsDelusions• HallucinationsHallucinations• Disorganized speechDisorganized speech• Disorganized Disorganized

behaviorbehavior Negative SymptomsNegative Symptoms

• Social withdrawalSocial withdrawal• Mood disturbanceMood disturbance

John Nash

© N

ajla

h F

ea

nn

y/C

OR

BIS

Schizophrenia May Have Schizophrenia May Have Several OutcomesSeveral Outcomes

Prevalence of SchizophreniaPrevalence of Schizophrenia

Affects 0 5–1% of the world’s population Affects 0 5–1% of the world’s population 2 5 million Americans have schizophrenia 2 5 million Americans have schizophrenia Men and women are equally likely to be Men and women are equally likely to be

diagnosed to schizophrenia diagnosed to schizophrenia Age at diagnosis:Age at diagnosis:

• Very rarely diagnosed in children as young as 6 Very rarely diagnosed in children as young as 6 years of ageyears of age

• Mode: 18–25Mode: 18–25• Diagnoses may occur as late as a person’s 40sDiagnoses may occur as late as a person’s 40s

Disruptions in functioningDisruptions in functioning

Thought and LanguageThought and Language Attention and Perception Attention and Perception Motor Skills and Life FunctioningMotor Skills and Life Functioning

Example of Disruptions of LanguageExample of Disruptions of Language

“Don’t touch me! Especially don’t touch my shoes! I like my shoes They have special powers The movie can’t start until I remove my shoes Choose…Choose… Juice… Do you like juice?”

Disruptions of Thought and Disruptions of Thought and LanguageLanguage

Incoherence Incoherence Poverty of speech Poverty of speech Loosening of associations Loosening of associations Clang associations Clang associations

•Linking rhyming wordsLinking rhyming words Lack of insightLack of insight


Thought and LanguageThought and Language Attention and PerceptionAttention and Perception Motor Skills and Life FunctioningMotor Skills and Life Functioning

Female: The body was buried on Moll Female: The body was buried on Moll Legg Island beside the ahead listen Legg Island beside the ahead listen aim somebody North Carolinaaim somebody North Carolina

Male: We point veiled their many Male: We point veiled their many wife he tussles last other grave and a wife he tussles last other grave and a cross put at its head cross put at its head

numbers nonfiltered filtered

Disruptions of Attention and Disruptions of Attention and PerceptionPerception

Problems directing their own Problems directing their own focus and attentionfocus and attention

Breakdown of attentional filterBreakdown of attentional filter Noises louder & colors more Noises louder & colors more

intenseintense

Disruptions of Attention and Disruptions of Attention and PerceptionPerception

Hallucinations (auditory, & Hallucinations (auditory, & visual)visual)• false sensory experience that false sensory experience that

has a compelling sense of has a compelling sense of realityreality


Thought and LanguageThought and Language Attention and Perception Attention and Perception Motor Skills and Life FunctioningMotor Skills and Life Functioning

Disruption in Motor Skills and Disruption in Motor Skills and Life FunctioningLife Functioning

strange facial strange facial expressionsexpressions

peculiar sequence of peculiar sequence of gesturesgestures

agitation or catatonic agitation or catatonic immobilityimmobility

Disruption in Motor Skills and Disruption in Motor Skills and Life FunctioningLife Functioning

limited social skillslimited social skills can't cope with school or can't cope with school or

hold a jobhold a job ignore personal hygieneignore personal hygiene

Development of SchizophreniaDevelopment of Schizophrenia

Prodromal PhaseProdromal Phase•Patients do not show enough Patients do not show enough

symptoms to be categorized as symptoms to be categorized as Schizophrenic, but still show Schizophrenic, but still show some symptomssome symptoms

•Can last for many yearsCan last for many years Psychosis PhasePsychosis Phase Treatment PhaseTreatment Phase

Types of SchizophreniaTypes of Schizophrenia1) Schizophrenic 1) Schizophrenic

ParanoidParanoid systematized systematized

delusions (false delusions (false beliefs)beliefs)

extensive auditory extensive auditory hallucinationshallucinations

think others are think others are conspiring against conspiring against themthem

Four Types of SchizophreniaFour Types of Schizophrenia

2) Schizophrenic Disorganized 2) Schizophrenic Disorganized eat dirt or own body productseat dirt or own body products silliness, incoherence, uncleansilliness, incoherence, unclean

Types of SchizophreniaTypes of Schizophrenia3) Schizophrenic 3) Schizophrenic

CatatonicCatatonic Episodes of being Episodes of being

withdrawn and non withdrawn and non communicativecommunicative

frozen or excited frozen or excited motor behaviormotor behavior

Limb will stay in the Limb will stay in the position you put it position you put it

Four Types of SchizophreniaFour Types of Schizophrenia

4) Schizophrenic 4) Schizophrenic Residual/UndifferentiatedResidual/Undifferentiated

absence of delusions, absence of delusions, hallucinations, & incoherencehallucinations, & incoherence

flat affect, peculiar behaviorflat affect, peculiar behavior

Identify which type of Schizophrenia Identify which type of Schizophrenia is demonstrated belowis demonstrated below

Mickey laughed while a doctor was telling him Mickey laughed while a doctor was telling him about an accident his mother had been inabout an accident his mother had been in

Donald believes he is he King of France and Donald believes he is he King of France and that people around him are plotting to take that people around him are plotting to take him downhim down

Tweety was finally caught by Sylvester when Tweety was finally caught by Sylvester when he was unable to run, because of getting he was unable to run, because of getting stuck in one positionstuck in one position

Bugs lost his job due to poor hygiene and his Bugs lost his job due to poor hygiene and his inability to communicate to customersinability to communicate to customers

Causes of SchizophreniaCauses of Schizophrenia

1) Biological1) Biological Tissue lossTissue loss

Neurological Causes of Neurological Causes of SchizophreniaSchizophrenia

Enlarged ventriclesEnlarged ventricles Shrunken HippocampusShrunken Hippocampus

A Possible Genetic MarkerA Possible Genetic MarkerA majority of patients and 45% of their relatives show abnormal intrusions of saccades in smooth pursuit tasks

Schizophrenia and the Schizophrenia and the HippocampusHippocampus Cell bodies in a control participant are Cell bodies in a control participant are

arranged neatly arranged neatly Cell bodies in a participant diagnosed Cell bodies in a participant diagnosed

with schizophrenia appear relatively with schizophrenia appear relatively disorganized disorganized

Co

urt

esy

Arn

old

B

Sch

eib

el,

Un

ive

rsity

of

Ca

lifo

rnia

, L

os

An

ge

les

A Comparison of Auditory A Comparison of Auditory Hallucinations and Listening to Hallucinations and Listening to

Real VoicesReal Voices

Causes of SchizophreniaCauses of Schizophrenia1) Biological1) Biological dopamine dopamine

hypothesis – hypothesis – overabundance of overabundance of dopaminedopamine• Leads to Leads to

overactivityoveractivity• May be the basis May be the basis

for for hallucinations hallucinations and delusionsand delusions

Support for the Biological Support for the Biological HypothesisHypothesis

Drugs that increase Dopamine Drugs that increase Dopamine activity in Schizophrenics activity in Schizophrenics intensifies symptomsintensifies symptoms

Drugs that block dopamine Drugs that block dopamine receptors lessen symptomsreceptors lessen symptoms

Seems to work for the Seems to work for the hallucinations and delusionshallucinations and delusions

Does not help with social Does not help with social withdrawal symptomswithdrawal symptoms

Problems With a Dopamine Problems With a Dopamine HypothesisHypothesis

25% of patients do not respond to dopamine 25% of patients do not respond to dopamine antagonists antagonists

Atypical antipsychotic medications (clozapine) Atypical antipsychotic medications (clozapine) act primarily on neurotransmitters other than act primarily on neurotransmitters other than dopamine dopamine

Drugs change dopamine activity immediately, Drugs change dopamine activity immediately, but patient may not improve for weeks but patient may not improve for weeks

PCP produces symptoms similar to PCP produces symptoms similar to schizophrenia by blocking the NMDA schizophrenia by blocking the NMDA glutamate receptor glutamate receptor

Genetic Causes of SchizophreniaGenetic Causes of Schizophrenia

Heritability Index Heritability Index of 46%of 46%

For fraternal twins For fraternal twins only 14% chanceonly 14% chance

Children of a Children of a Schizophrenic Schizophrenic patient: 14% patient: 14% chancechance

FMRI scans of FMRI scans of Schizophrenics: At restSchizophrenics: At rest

FMRI scans of Schizophrenics: FMRI scans of Schizophrenics: During a Cognitive testDuring a Cognitive test

Patterns found in FMRI scans of Patterns found in FMRI scans of SchizophrenicsSchizophrenics

Lower amounts of blood flowLower amounts of blood flow Lower amount of brain activityLower amount of brain activity


2) Psychological2) Psychological early childhood experiencesearly childhood experiences

•NeglectNeglect•Physical abusePhysical abuse•Sexual abuseSexual abuse


3) Sociocultural3) Sociocultural 8 times more schizophrenics 8 times more schizophrenics

among poor peopleamong poor people poverty or social stress trigger poverty or social stress trigger

schizophrenia or schizophrenics schizophrenia or schizophrenics can't hold jobs which leads to can't hold jobs which leads to poverty statuspoverty status


4) Diathesis-Stress Model4) Diathesis-Stress Model predisposition for schizophreniapredisposition for schizophrenia triggers when person encounters triggers when person encounters

great stressesgreat stresses

Treatments for SchizophreniaTreatments for Schizophrenia

In the pastIn the past•Most schizophrenics locked in Most schizophrenics locked in

asylumsasylums•Given SedativesGiven Sedatives•Mid 1930’s: Insulin Coma Mid 1930’s: Insulin Coma

TherapyTherapy

Insulin Coma TherapyInsulin Coma Therapy

Give patients InsulinGive patients Insulin•Aids in the digestion of glucose Aids in the digestion of glucose

(sugar)(sugar) When enough insulin was given, When enough insulin was given,

patients went into a comapatients went into a coma•1-10% mortality rate1-10% mortality rate

Main treatment used through the Main treatment used through the 60’s60’s


Late 1950’sLate 1950’s•First true drug for treating First true drug for treating SchizophreniaSchizophrenia

•Antihistamines (as now Antihistamines (as now taken for allergies)taken for allergies)

NowNow•Dopamine Blocking DrugsDopamine Blocking Drugs


Magnetic stimulation of the brain Magnetic stimulation of the brain seems to reduce hallucinationsseems to reduce hallucinations

Before Treatment After Treatment

Two Major Categories of Mood Two Major Categories of Mood DisorderDisorder

Major depressive disorder (unipolar): Major depressive disorder (unipolar): Lengthy, uninterrupted periods of Lengthy, uninterrupted periods of depressed mood depressed mood

Manic depressive disorder (bipolar): Manic depressive disorder (bipolar): Cycling between periods of elevated Cycling between periods of elevated mood (mania) and depression mood (mania) and depression

While sharing the common feature of While sharing the common feature of depression, these are unique and depression, these are unique and separate disorders separate disorders

Genetic Contributions to Genetic Contributions to DepressionDepression

Concordance rate between identical Concordance rate between identical twins is about 40% twins is about 40%

Adoption studies support a role for Adoption studies support a role for genetics in depression genetics in depression

Families with depressed members Families with depressed members also have very high rates of anxiety also have very high rates of anxiety disorders disorders

Environmental Influences on Environmental Influences on DepressionDepression

Prenatal events such as the “Dutch Prenatal events such as the “Dutch Hunger Winter” may lead to Hunger Winter” may lead to depression depression

Environmental stress may trigger an Environmental stress may trigger an episode of depression episode of depression

Brain Structure and Function in Brain Structure and Function in DepressionDepression

Happy moods are associated with Happy moods are associated with activity in the left frontal lobes activity in the left frontal lobes

Depression is correlated with Depression is correlated with increased right frontal lobe activity increased right frontal lobe activity and decreased left frontal lobe and decreased left frontal lobe activity activity

Left hemisphere damage due to Left hemisphere damage due to stroke and other medical causes is stroke and other medical causes is associated with depression associated with depression

Depression Is Associated with Depression Is Associated with Abnormal Sleep PatternsAbnormal Sleep Patterns

Depressed people: Depressed people: fall asleep faster fall asleep faster enter REM earlier enter REM earlier spend little time spend little time

in Stage 3 or 4 in Stage 3 or 4 awaken frequently awaken frequently

Biochemistry of DepressionBiochemistry of Depression Possibly due to problems in the HPA Axis, Possibly due to problems in the HPA Axis,

depressed people show elevated:depressed people show elevated:• growth hormone levels growth hormone levels • thyroid hormone levels thyroid hormone levels • cortisol levelscortisol levels

Monoamines and DepressionMonoamines and Depression Reserpine depletes available monoamines and Reserpine depletes available monoamines and

produces profound depression produces profound depression Antidepressant medications act on monoamines Antidepressant medications act on monoamines

• MAO inhibitors suppress MAO, which breaks down MAO inhibitors suppress MAO, which breaks down monoamines monoamines

• Tricyclic antidepressants inhibit the reuptake of Tricyclic antidepressants inhibit the reuptake of serotonin and norepinephrine serotonin and norepinephrine

• Selective serotonin reuptake inhibitors (SSRIs) inhibit Selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin the reuptake of serotonin

• However, cocaine is a monoamine reuptake inhibitor However, cocaine is a monoamine reuptake inhibitor that does not reduce depression that does not reduce depression

People attempting suicide have low serotonin People attempting suicide have low serotonin levels levels

Treatment for DepressionTreatment for Depression

MedicationMedication The role of exerciseThe role of exercise Cognitive-behavioral therapyCognitive-behavioral therapy Medication plus psychotherapyMedication plus psychotherapy Electroconvulsive shock therapy (ECT)Electroconvulsive shock therapy (ECT)

© W

ill &

De

ni M

cIn

tyre

/Ph

oto

R

ese

arc

he

rs,

Inc

Bipolar DisorderBipolar Disorder

Periods of mania alternate with Periods of mania alternate with depression depression

Mania is characterized by:Mania is characterized by:• Inflated self-esteem (grandiosity)Inflated self-esteem (grandiosity)• Reduced need for sleepReduced need for sleep• TalkativenessTalkativeness• Racing thoughtsRacing thoughts• DistractibilityDistractibility• Goal-oriented behaviorGoal-oriented behavior• Excessive involvement in pleasurable Excessive involvement in pleasurable

activitiesactivities

Prevalence of Bipolar DisorderPrevalence of Bipolar Disorder

Affects 0.4–1.2% of the populationAffects 0.4–1.2% of the population Males and females are equally likely Males and females are equally likely

to be diagnosed with bipolar disorder to be diagnosed with bipolar disorder Rare prior to puberty; approaches Rare prior to puberty; approaches

adult prevalence in adolescenceadult prevalence in adolescence May be more prevalent among May be more prevalent among

artistic and creative peopleartistic and creative people

Genetics of Bipolar DisorderGenetics of Bipolar Disorder

Concordance rates between identical Concordance rates between identical twins may be 70% or even higher twins may be 70% or even higher

Adoption studies support a strong role Adoption studies support a strong role for genetics in bipolar disorder for genetics in bipolar disorder

Multiple genes are probably involved Multiple genes are probably involved Bipolar disorder is 3–4 times more Bipolar disorder is 3–4 times more

common in families with members common in families with members diagnosed with major depressive diagnosed with major depressive disorder disorder

Brain Structure and Function in Brain Structure and Function in Bipolar DisorderBipolar Disorder

Little is known about structural and Little is known about structural and functional correlates of bipolar functional correlates of bipolar disorder disorder

Basal ganglia activity may be elevated Basal ganglia activity may be elevated Enlargement of the amygdala may Enlargement of the amygdala may

occur occur

Biochemistry of Bipolar DisorderBiochemistry of Bipolar Disorder

Monoamines may be involved Monoamines may be involved • Bipolar is associated with a decreased Bipolar is associated with a decreased

need for sleep need for sleep • Sleep deprivation may trigger mania Sleep deprivation may trigger mania • Patients have more monoamine binding Patients have more monoamine binding

sites than healthy controls sites than healthy controls Thyroid hormone deficiencies may be Thyroid hormone deficiencies may be

involved involved

Use of Lithium Carbonate to Use of Lithium Carbonate to Treat Bipolar DisorderTreat Bipolar Disorder

Lithium carbonate has little effect on Lithium carbonate has little effect on people who do not have bipolar disorder people who do not have bipolar disorder

Lithium does not affect serotonin levels, Lithium does not affect serotonin levels, but may influence related enzymes and but may influence related enzymes and second messengers second messengers

Lithium enhances norepinephrine Lithium enhances norepinephrine reuptake reuptake

If lithium can’t be tolerated, patients If lithium can’t be tolerated, patients may use SSRIs, benzodiazepines, may use SSRIs, benzodiazepines, neuroleptics and anticonvulsant drugs neuroleptics and anticonvulsant drugs

Anxiety DisordersAnxiety Disorders

Anxiety disorders take many Anxiety disorders take many different forms different forms

Anxiety has two components:Anxiety has two components:• strong negative emotions strong negative emotions • physical reactions due to anticipated physical reactions due to anticipated

danger danger

Common Features of Anxiety Common Features of Anxiety DisordersDisorders

Genetics may predispose a Genetics may predispose a person to an anxiety person to an anxiety disorder, but not to a disorder, but not to a specific type specific type

Norepinephrine, serotonin Norepinephrine, serotonin and GABA systems may be and GABA systems may be involved involved

““High-reactive” infants may High-reactive” infants may be vulnerable to anxiety be vulnerable to anxiety disorders disorders

Anxiety disorders are Anxiety disorders are treated with medication and treated with medication and psychotherapy psychotherapy

Generalized Anxiety DisorderGeneralized Anxiety Disorder

Excessive anxiety for six monthsExcessive anxiety for six months No focused fear object, as in a No focused fear object, as in a

phobiaphobia Autonomic underarousalAutonomic underarousal

Obsessive-Compulsive DisorderObsessive-Compulsive Disorder Repetitive, intrusive Repetitive, intrusive

thoughts accompanied by thoughts accompanied by ritualistic, repetitive ritualistic, repetitive behaviorsbehaviors

Concordance rate of 68%Concordance rate of 68% Birth trauma, infection and Birth trauma, infection and

injury may also cause OCDinjury may also cause OCD Abnormal activity in the Abnormal activity in the

basal ganglia, prefrontal basal ganglia, prefrontal cortex, orbitofrontal cortex cortex, orbitofrontal cortex and cingulate gyrusand cingulate gyrus

Treatment of OCDTreatment of OCD Antidepressant medication, especially Antidepressant medication, especially

clomipramine, a serotonin reuptake clomipramine, a serotonin reuptake inhibitorinhibitor

Behavioral treatmentBehavioral treatment Both are effectiveBoth are effective

Panic DisorderPanic Disorder

Panic attacks involve intense fear and Panic attacks involve intense fear and sympathetic arousal sympathetic arousal

Repeated panic attacks along with Repeated panic attacks along with worrying about attacks characterize panic worrying about attacks characterize panic disorder disorder

.5% experience panic disorder, with more .5% experience panic disorder, with more females than males having the disorder females than males having the disorder

About half have depression or another About half have depression or another anxiety disorder anxiety disorder

Correlates of Panic DisorderCorrelates of Panic Disorder Sodium lactate can initiate an attack in Sodium lactate can initiate an attack in

a patient with panic disorder, probably a patient with panic disorder, probably by stimulating the locus coeruleus by stimulating the locus coeruleus

Antidepressants effective in panic Antidepressants effective in panic disorder reduce activity in the locus disorder reduce activity in the locus coeruleus coeruleus

A circuit connecting the hippocampus, A circuit connecting the hippocampus, orbitofrontal cortex, and cingulate orbitofrontal cortex, and cingulate gyrus may mediate panic attacks gyrus may mediate panic attacks

Posttraumatic Stress Disorder Posttraumatic Stress Disorder (PTSD)(PTSD)

Recurrent dreams of trauma, Recurrent dreams of trauma, flashbacks, hyperarousal and flashbacks, hyperarousal and avoidance of stimuli associated with avoidance of stimuli associated with trauma characterize PTSD trauma characterize PTSD

5–10% experience PTSD 5–10% experience PTSD 2/3 of patients are female 2/3 of patients are female Automobile accidents, combat and Automobile accidents, combat and

natural disasters are common traumas natural disasters are common traumas that result in PTSD that result in PTSD

Correlates of PTSDCorrelates of PTSD

A smaller than normal hippocampus A smaller than normal hippocampus Reduced benzodiazepine activity Reduced benzodiazepine activity Propanolol blocks glucocorticoids in Propanolol blocks glucocorticoids in

the brain and may prevent PTSD if the brain and may prevent PTSD if administered immediately following a administered immediately following a traumatic experiencetraumatic experience

Treatment consists of medication Treatment consists of medication and/or cognitive-behavior treatmentand/or cognitive-behavior treatment

AutismAutism Diagnosed before the age of 3 years Diagnosed before the age of 3 years Criteria focus on:Criteria focus on:

• communication abnormalities communication abnormalities • social abnormalities social abnormalities • ritualistic behavior ritualistic behavior

Approximately 2/3 of patients are mentally Approximately 2/3 of patients are mentally retarded retarded

A small number may exhibit savant behavior A small number may exhibit savant behavior 1–2 people out of 1000 have autism, but rates 1–2 people out of 1000 have autism, but rates

are increasing are increasing Males outnumber females by about 4:1 Males outnumber females by about 4:1

Correlates of AutismCorrelates of Autism Identical twin concordance rates may be 90% Identical twin concordance rates may be 90% Childhood immunizations, parenting style do Childhood immunizations, parenting style do

NOT produce autism!NOT produce autism! Brains are large, possibly due to high levels of Brains are large, possibly due to high levels of

neurotrophins neurotrophins Structural abnormalities are found in the Structural abnormalities are found in the

cerebellum, amygdala, hippocampus and cerebellum, amygdala, hippocampus and entorhinal cortex entorhinal cortex

Serotonin levels may be high Serotonin levels may be high Treatment usually consists of intensive Treatment usually consists of intensive

behavior training, but this is a lifetime condition behavior training, but this is a lifetime condition

Attention Deficit Hyperactivity Attention Deficit Hyperactivity Disorder (ADHD)Disorder (ADHD)

May affect 3–5% of population May affect 3–5% of population Characterized by difficulties with Characterized by difficulties with

sustained attention, impulsivity and sustained attention, impulsivity and hyperactivity hyperactivity

May be overdiagnosed or improperly May be overdiagnosed or improperly diagnosed diagnosed

Correlates of ADHDCorrelates of ADHD Genetics probably have a strong role Genetics probably have a strong role Behavior is similar to people with known Behavior is similar to people with known

frontal lobe damage, leading to frontal lobe damage, leading to hypothesis that frontal lobes may be hypothesis that frontal lobes may be underactive underactive

Smaller volumes of the caudate nucleus, Smaller volumes of the caudate nucleus, the cerebrum and the cerebellum are the cerebrum and the cerebellum are correlated with more severe symptoms correlated with more severe symptoms

Dopamine activity may be low Dopamine activity may be low

Treatment of ADHDTreatment of ADHD

Stimulant medications, including Stimulant medications, including methylphenidate (Ritalin) and methylphenidate (Ritalin) and dextroamphetamine, are commonly dextroamphetamine, are commonly prescribed prescribed • 70–80% benefit from medications 70–80% benefit from medications • Medications do not have different effects in people Medications do not have different effects in people

with ADHD than in healthy controls with ADHD than in healthy controls • Side effects include low appetite, sleep Side effects include low appetite, sleep

disturbance and possible suppression of growth disturbance and possible suppression of growth Medications do not improve long-term Medications do not improve long-term

academic performance academic performance Extent of medication use is controversial Extent of medication use is controversial

Antisocial Personality Disorder Antisocial Personality Disorder (APD)(APD)

Antisocial behavior is characterized by a Antisocial behavior is characterized by a lack of guilt or empathy lack of guilt or empathy

Juvenile offenders probably respond to Juvenile offenders probably respond to environmental factors; genetics probably environmental factors; genetics probably predispose some to continue antisocial predispose some to continue antisocial behaviors in adulthood behaviors in adulthood

Limbic structures may be underactive Limbic structures may be underactive Damage to the orbitofrontal cortex is Damage to the orbitofrontal cortex is

correlated with antisocial behavior correlated with antisocial behavior Treatment is generally ineffective Treatment is generally ineffective

Brain Activity in MurderersBrain Activity in MurderersMurderer with history of abuse and neglect Privileged murdererControl

Courtesy Dr Adrian Raine, University of Southern California

Psychology 250 Lecture 14 Kevin R Smith. Hemorrhages Result From: Aneurysms Aneurysms Hypertension...

Documents

Transcript of Psychology 250 Lecture 14 Kevin R Smith. Hemorrhages Result From: Aneurysms Aneurysms Hypertension...