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Neuro - Introduction to Psychiatry

Terms in this set (52)

Ethical and pragmatic problems are seen as an unwelcome irritant in clinical practice
What is one problem with a biomedical model that embraces only fact-gathering and scientific understanding?
Their consideration in practice distinguishes good physicians

(and, more practically/cynically, decreases litigation)
Why is consideration of ethical and pragmatic problems so important?
Altruism and bedside manner
With certain grave intractable (hard to treat/unstoppable) conditions, what are the important interventions?
a broad view that attributes disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors (mood, personality, behavior, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.).
What is the biopsychosocial model?
General systems theory
Biology
Psychology
Sociology
Anthropology
Other natural/social sciences
Health law
Ethics
Other philosophy
Informatics
Communication theory
Business management
Other disciplines

[do not memorize]
What are the components of the biopsychosocial model?

[do not memorize]
Patients face stigma
What's one issue faced by those with mental illness that isn't faced by those suffering from most other illnesses and which can manifest itself internally?***
A belief that they are defective and undeserving
How can stigma manifest itself internally in a patient?***
Family may marginalize relative with mental illness
How can stigma manifest itself internally in a family?***
society may discriminate and place barriers to the person's full integration into their community
How can stigma manifest itself internally in society?***
Patient whose illness is controlled no longer sees it at necessary to continue following treatment plan and taking medication, falling back into their mental illness.

Family of patient becomes frustrated that patient will not adhere to/comply with treatment plan.

Society becomes frustrated with patient who will not utilize the resources and structures established to help them.

This serves to propagate stigma.
Describe an example of the "vicious cycle" seen in mentally ill patients
Integrating information from multiple levels (i.e. neural systems level, cellular/molecular level, social level, etc.)
What is an important factor in diagnosing/following mental illness?
Using neuroimaging to track neural changes and progression over time

(i.e. we can look at the tracts for gross changes)
What kind of information about mental illness can be gleaned from the neural systems level?
Using genomics to identify genetic mechanisms of neural change
What can be gleaned from the molecular and cellular levels?
Genetic-based treatments for mental illness
What could new research into the molecular and cellular levels of mental illness lead to?
Freud
Who was one of the major founding members of psychiatry?
It was asylum-based; observation was the major tool for evaluation (and still is today, to an extent)
What was unique about the beginning of psychiatry?
Their illnesses have a course and outcome

He postulated that the mental illness was the result of early-onset cognitive decline
What did Kraeplin (1856-1926) notice about patients with mental illness?
"dementia praecox"

This term is largely not in use today
What illness did Kraeplin coin?
Schizophrenia

He postulated that it was not a dementia
What illness did Bleuler (1857-1939) coin?
A disease with key symptoms in cognition and emotion ("negative symptoms")

"Split mind"

Not a dementia
How did Bleuler describe schizophrenia?
Genes

Molecules

Cells

Neural circuits and systems

Cognitive and emotional processes
A disturbance in which entities can lead to a disease process?
disturbance in a system leading to the manifestation of disease process
Define "symptom"
Misconnection Syndrome
When studied at the systems level, what type of syndrome is schizophrenia?**
It involves an abnormality in connections that are widely distributed throughout the brian
Describe schizophrenia as a misconnection syndrome**
Cognitive and emotional impairments, as well as other clinical symptoms

i.e. a misconnection leads the person to misinterpret info; a delusion arises because a perception is linked to the wrong association
What does the misconnection theory explain in schizophrenia?**
An impairment in neuroplasticity that affects the healthy development of synapses, spines, and dendrites in cerebral GM

This is reflected in neuropathology of schizophrenia and major mental illnesses in general
What causes the "misconnection" seen in schizophrenia?***
Examining relationship b/t genes that regulate neuroplasticity (i.e. Brain-Derived Neurotrophic Factor, or BDNF)

Measures of brain structure using sMRI as a research tool
How can misconnections leading to schizophrenia be diagnosed?***
Statistical analysis of % change/year with intracranial volume, gender, and scan type as co-variates
What is the Iowa Longitudinal Study (ILS) of First Episode Schizophrenia)? [begun in 1989]
Progressive gray matter (GM) loss and CSF increase in both patients and controls
What did the ILS find concerning gray matter (GM) and CSF amounts in schizophrenia patients? Controls?
Total cerebral GM

Frontal GM

Parietal GM
Where were the areas of tissue loss in schizophrenia patients?
total sulcal CSF

Frontal CSF

Temporal CSF
Where were the areas of CSF increase in patients?
Progressive Neural Change (PNC, or neuroplasticity) occurs

Since the ILS was the longest and largest longitudinal study examining changes in schizophrenia, its results are powerful
What did the ILS definitively demonstrate?
in a non-linear way
How does PNC proceed?
In the early years after disease onset
When is PNC most severe?
PNC appears to stabilize and to proceed at the same rate as the normal controls (i.e., a normal aging process rather than a disease process)
As the disease advances, how does PNC change?
Pre-emption and prevention
If treatments can be identified that are neuroprotective, what will it have important implications for?
Decreases hippocampal and prefrontal BDNF concentrations
In rats, what effects does the chronic administration of typical antipsychotics (like Haldol) have on BDNF?
dopamine D2 receptor blocade
What is thought to lead to decreased BDNF synthesis?
atypical antipsychotics risperidone and olanzapine
Which drugs are associated with less-marked reductions in BDNF expression?
Clozapine has virtually no D2 receptor activity

It has no effect on (or even up-regulates) hippocampal BDNF mRNA expression
Does the atypical antipsychotic clozapine have an effect on BDNF? Does it have D2 receptor activity?
They don't lean as heavily on the D2 dopamine receptor

They lean on a lot of receptors (i.e. serotonin, histamine, etc.) - note myriad receptors on other side
What's unique about atypical antispychotics?
D2 antagonists
When treating patients with antipsychotics, what method still has to be used?
Group things together and try to define syndromes
What do we do with info/observations from mental illnesses?
ICD
When determining a mental illness diagnosis, is the DSM or ICD used?
Mental illness is abstract and hard-to-understand.

It is difficult to fit something abstract into an artificial structure for diagnostic/billing purposes.
Why is it so difficult to use ICD or DSM codes?
Common clinical definitions often imply something akin to cure:

--symp. remission for 2 years
--no need for maintenance meds
--return to premorbid lvl of functioning

*it is generally assumed this type of recovery is rarely, if ever, possible

per quiz, recovery is a process***
What is recovery in psychiatry?***
Recovery is a process, rather than an end state or outcome***
What's a good way to describe recovery?***
Strengths-based (as opposed to systems-based)

Involves hope, respect, and empowerment (empathic responses)
What is recovery based on? What does it involve?***
A person variable
Recovery is a model that involves the nature of treatment, as well as what?***
From a consumer perspective, Yes

From a Kraepelinian perspective, definitely not

From a research perspective, the answer is probably
Is recovery from schizophrenia possible?
Supported Employment

Family Interventions (for at least 6-9 months, esp. psychoeducation)

Skills Training

Cognitive Behavioral Therapy (for at least 4-9 months)

Token Economy Interventions

Psychosocial Interventions for Weight Management

Psychosocial Interventions for
alcohol and Substance Abuse
What are some evidence-based psychosocial treatment approaches?
Generally, individual treatment

Develop collaborative, trusting relationship with mutual goals

Provide psychoeducation to help patient understand illness, reduce stigma

Teach patient to process information more accurately (e.g., challenge assumptions underlying delusions; place voices inside head)

Teach patient to use more effective coping strategies to reduce frequency or effects of hallucinations and delusions

Problem solving and relapse prevention strategies
What are some psychotherapy approaches?
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