Neuro - aggression, ADHD, developmental disorders, psychosis

91 terms by jimhsu 

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18-24

This age group is most susceptible to violence AND most likely to commit violent acts

Friends/Acquaintances

Most common cause of violent acts when perpetrator is known

Argument

Most common circumstance of murder when cause is known

Gun

Most commonly used murder weapon

Male

Gender more likely to commit murder, and be murdered

Premeditated (cold-blooded)

Aggression that is calculated, predatory, instrumental

Impulsive (warm-blooded)

Aggression that is reactive, defensive, autonomic arousal

L orbitofrontal, R Ant Cingulate, B Ant Temporal

Regions of brain associated with anger in normal individuals

PFC, S Parietal, L angular, Corpus callosum

Regions of decreased glucose metabolism in murderers

Amygdala, Thalamus, R Medial Temporal

Regions of asymmetric activity in murderers

Head injuries, EEG, Seizure, Neurological soft signs

Possible neurological findings in aggression

Serotonin

Low levels of this neurotransmitter can cause impulsive aggression, in the most widely accepted theory

Acetylcholine

High levels of this neurotransmitter may cause predatory aggression

GABA

High levels of this neurotransmitter have an inhibitory effect on aggression

Norepinephrine

Low levels of this neurotransmitter can cause both impulsive and episodic aggression

Dopamine

High levels of this neurotransmitter cause aggression in animals, but not in humans

Testosterone

High levels of this hormone are associated with aggression in men, but not women

MAOA-L

Genotype that predicts increased violence in males, but not females

MAOA-H

Genotype that predicts no increase in violence in both males and females

MAOA-H

Genotype that predicts normal amygdala and cingulate volume

MAOA-L

Genotype that predicts decreased amygdala and cingulate volume

Go / Nogo

Experiment designed to test information processing differences in inhibition of behavior in normal vs aggressive subjects

Alcohol

CNS depressant that increased risk of violence by 12 times

Stimulants, hallucinogens, sedative hypnotics,m opiates, anticholinergics, steroids

Other drugs that increase the risk of aggression

Rejection

Primary parental contribution (or lack thereof) that leads to aggressive behavior

Abuse

Parental contribution that increases risk of kids with low MAOA to developing violence

Social skills training

Treatment intended to improve communication and teaches alternative behaviors to violence

Cognitive therapy

Treatment involving problem solving, recognition of feelings, anger management, and understanding

Behavior therapy

Treatment that rewards desirable actions to reinforce the good

Neuroleptics

Drug class to decrease limbic activation and increase prefrontal control

Benzodiazepines

Drug class to calm patients in acute aggression

Lithium

Drug used for managing not just bipolar aggression, but normal aggression as well

Anticonvulsants

Drug class that works to reduce aggression whether or not the patient has a seizure

Stimulants

Drug class that improves behavior in ADHD patients

7

Critical age of onset of ADHD (where symptoms must occur before)

3

Typical age of onset in ADHD

7

Prevalence of ADHD in typical population (percentage)

Hyperactivity, impulsive, inattention

The critical components that make up a diagnosis of ADHD

Tourette's disorder

DDx for ADHD that features motor and vocal tics

Oppositional Defiant Disorder

Similar disorder to ADHD, but characterized by impulsive, inattentive behavior with authority challenge

Pervasive Developmental Disorder

Deficits in learning and social skills that is confused with ADHD

Oppositional Defiant Disorder

The most common co-morbid condition with ADHD

Stimulants

The use of this substance in the treatment of ADHD may reduce substance abuse

(Maternal) smoking, alcohol

Pre/perinatal risk factors that dramatically increase the risk for ADHD

Diet, allergy

"Risk factors" that are NOT implicated in ADHD

Frontostriatal

Key brain region (collection) that is responsible for ADHD

Norepinephrine

Neurotransmitter responsible for inhibitory activity on striatal structures implicated in ADHD

Dopamine

Neurotransmitter responsible for striatal output, excess of which is implicated in ADHD

Alpha-2 agonists

Drug class that can be useful for impulsivity and inattention, but has risk of sedation and hypotension

Antidepressants

Current drug class under FDA review for ADHD

Otitis media (Ear infection)

Important differential to rule out for a diagnosis of ADHD; commonly performed by school nurses

Autism

A 6-year old male presents with poor language development and lack of symbolic play, occuring before the age of 3. Physical exam revealed lack of eye contact, peer relationships, or social reciprocity; failure to sustain conversation; and repetitive nonfunctional motor movements. What is the most likely diagnosis?

Rett's disorder

This relatively rare autism-like disorder occurs only in females, and is characterized by autistic symptoms including hand wringing.

Prader-Willi syndrome

This disorder is characterized by a chromosome 15q partial deletion, commonly presenting with mental retardation and insatiable appetite.

Angelman syndrome

This disorder is caused by deletion of genes in maternal chromosome 15, characterized by sleep disturbances, seizures, and puppet-like movements.

Down syndrome

This trisomy is commonly associated with mild mental retardation.

Turner's syndrome

This monosomy is typically NOT associated with mental retardation.

Rubella

This disease, causing congenital cataracts and encephalitis, can lead to mental retardation, and is preventable by vaccine.

Hurler's syndrome

This lysosomal storage disease caused by the buildup of glycosaminoglycans can cause progressive deterioration, hepatosplenomegaly, dwarfism, and mental retardation.

Fetal alcohol syndrome

A lifelong disorder that accounts for 5% of all birth defects, leading to a variety of neurodevelopmental disorders, and is completely preventable.

Neuroleptics

A drug class that is sometimes used off-label for the management of autism.

SSRIs

A drug class that is used for mood-related disorders occuring with autism.

Affective flattening, alogia, avolition, anhedonia, attention impairment

The "5 A's" that are negative symptoms of psychosis

Paranoid psychosis

Psychosis occurring with delusions, hostile belligerance, grandiose behavior, and hallucinations

Disorganized psychosis

Psychosis occurring with disorientation and incoherent language, sometimes with excitement

Depressive psychosis

Psychosis occurring with retardation and apathy, and anxious self punishment/blame

Catatonia

Behavior characterized by immobility, resistance to movement, mutism, and stereotypy

Persecutory

Delusions e.x "the government is out to get me"

Grandiose

Delusions e.x "I'm the king of the world"

Religious

Delusions e.x "I'm the Messiah"

Erotomanic

Delusions e.x "Paris Hilton loves me"

Somatic

Delusions e.x "There are worms in my stomach"

(Delusions of) Reference

Delusions e.x "That chair is trying to tell me something"

(Delusions of) Thought Control

Delusions e.x "Someone is trying to read my mind"

Positive

Delusions, hallucinations, and distortions fall into this category of symptoms

Negative

Blunted affect, social withdrawal, passivity, lack of spontaneity fall into this category of symptoms

Schizophreniform disorder

Schizophrenia-like disorder with an onset between 1 and 6 months

Brief psychotic disorder

Schizophrenia-like disorder with an onset that is short term (1 month)

Schizoaffective disorder

Schizophrenia-like disorder co-morbid with something like MDD

Male

This gender typically has an earlier onset of schizophrenia.

Mesolimbic

Positive symptoms are explained by an excess of dopamine acting on this pathway.

Mesolimbic

This pathway connects the ventral tegmental area with the amygdala, hippocampus, and nucleus accumbens

Mesocortical

Negative symptoms are explained by an decrease of dopamine acting on this pathway.

Mesocortical

This pathway connects the ventral tegmental area with the cerebral cortex.

Serotonin

LSD may affect the levels of this neurotransmitter in the brain.

Glutamate

PCP may affect the levels of this neurotransmitter in the brain.

GABA

Benzodiazepines may improve schizophrenia by modulating the levels of this neurotransmitter.

Excitotoxicity

Theory that chronic stimulation of neurons could lead to neuro-degeneration and eventally apoptosis.

Neurodevelopmental

This hypothesis explains the preponderance of schizophrenia in babies born over the winter months.

Neurodegenerative

This hypothesis explains the role of excitotoxicity in the development of schizophrenia.

Tubular infundibulum (pathway)

Removal of dopamine may interfere with inhibition of prolactin release by this pathway, leading to gynecomastia.

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