Study Guides (248,605)
Canada (121,634)
Psychology (1,882)
PSYD35H3 (3)
Final

Final exam notes (Chapters + lectures)

7 Pages
171 Views

Department
Psychology
Course Code
PSYD35H3
Professor
Nussbaum D

This preview shows pages 1 and half of page 2. Sign up to view the full 7 pages of the document.
Description
Lecture 9- Bipolar Mood Disorder:  1 or more manic/mixed episodes  1 or more episodes of MDD  Episodes don’t occur concurrently with substance, medication somatic treatments  Not due to a general medical condition  Episodes aren’t better accounted for by schizoaffective, schizophreniform, delusion, psychotic, schizo, NOS  Bipolar I: at least one episode of mania  Bipolar II: and hypomanic episodes  Cyclothymia: less severe  Bipolar NOS: only hypomania  Mania symptoms: irritability, excessive high-risk activities, inflated self-esteem, distractibility, less need for sleep  BP depression can look like MDD and schizo, BPD, ADHD, substance abuse, medical conditions  BP may be comorbid with another axis I disorder  Poorer outcome if comorbid with ADHD, anciety, OCD, panic, impulse control  Suicide high in BP and BP is stable  BP have lower life expectancy, health, 60% have comorbid substance, only 1/3 seek treatment  Usually male, psychotic features, history of alchy, poor occupational status  BP associated with: reduction of PFC volume, decreased glial and neurons in PFC, lower levels of NNA marker for neuronal health  Mood stabilizers: reverse impairment in brain structure and BDNF levels  Lithium in rats: promote neuron growth, protect neurons against toxic agents 1  Lithium in humans: increase NAA (marker for health) and gray matter volume nd rd  2 and 3 messenger system most studied mood stabilizers  ^processes produced by G-coupled protein receptors  Lithum, valproeate, carbamazepine interact with enzymes involved in the system  4 classes of mood stabilizers: lithium, anticonvulsants, atypical antipsychotics, omega 3  Lithium  Anti-manic Anticonvulsants:Carbamazepine (Tegretol) ,Valproic Acid (Depakene) Gabapentin (Neurontin), Lamotrigine (Lamictal) ,Gabapentin (Neurontin) ,Topiramate (Topamax) ,Oxcarbazepine (Trileptal)  Atypical Antipsychotics:Olanzapine (Zyprexa), Risperidone, and others  Omega-3 Fatty Acids  Putative Mechanisms: 1)membrane stabilizers( Lithium),  2)inhibition of intracellular enzyme Glycogen Synthase Kinase-3 (GSK-3, lithium, valproate, laomotringie)  Inhibition of GSK-3 increases b catenin( b catenin increases cell survival and promotes axon growth (but increases amyloid b)  3) Protection from Oxidative Stress due to reduction of excessive metabolic activity (e.g., excitotoxicity due to hyper-stimulation by Glutamate  4) Protein Synthesis Induction (DNA stimulation) to increase cellular protective proteins such as cAMP Response Element Binding Protein (CREB) -> increase in BDNF & bcl-2 (Valproate)  Treatment focus: diminish excitatory activity via GLU metabolism, or through GABA/ 5HT inbihition; use neuroprotectants; counter effects of stress to brain  Lithium: effective in 60-80% of acute episodes---used less now because of safety, compliance is poor, side effects intolerable, patients miss the high with the mood swings  Lithium’s excreted unchanged by the kidneys, not metabolized, thou less effected by liver disease---but may cause kidney damage over log use (decades)  Lithium used in: acute mania, hypomania, maintenance of bp or cyclothymia, mixed states, depression, schizophrenia/affective, or aggressive outburst  Anti manic effects: decreases #, frequency, duration, and intensity of episode, decreases subtle mood changes, tkes 5-10 days for response, 2/3 show great response,  Lithiumfor mania: not as good for mixed, atypical, secondary mania---better for acute mania st  Lithium for depression: 1 choice for acute BP depression  People who respond poorly: mixed states, depressive-manic, personality disorder, mania secondary to general condition  Side effects: no specific antidote for OD, narrow TI, adverse reaction 35-90%, cognitive dysfunction, reduced kidney functioning, vomiting, diarrhea,  Hand tremors, incoordination, nystagmus, muscle weakness, loss if excitement and creativity, weight gain, acne, arrhythmia( rare)  Drug interaction: non-psychotropics may increase plasma levels of lithium  Lithium treatments: take 1-2 weeks, take blood levels every 5 days until stable—then every 6 months, most effective in patients with classic symptoms of mania  Toxicity: early- ataxia, lack of coordination; mid- listlessness, nausea, slurring, diarrhea; moderate- confusion, delirium, ataxia pronounced; severe- changes in consciousness, seizures, coma, death 2  Anticonvulsants: overlap with new atypical antipsychotics  Drugs of both groups are anti-bipolar, treat aggression, violent behaviours, and have affective beneficial actions  Stopped at slide 50/105. Bipolar Chapter notes: Lecture 10- Antipsychotics  Schizophrenia has 5 criteria- A) characteristics B) social and occupational dysfunction C)Duration D) schizoaffective and mood disorder E) substance or general F) relationship/developmental  Criteria A) 2+ for at least a month: delusion, hallucinations, disorganized speech and beh, negative symptoms  Criteria C) duration for at least 6 months  Myth: schizophrenia is rare—uh, no.  Difficult to diagnose because of many symptoms  Downward drift: progressive loss of relationships, inability to maintain ql  Brain changes: Reductions in volume of grey matter in frontal lobe, Alterations in blood flow to certain brain areas  General decreased brain volume & activity, Larger ventricles and basal nuclei, smaller hippocampi and smaller amygdala  Neurobiology: Dopamine Hypothesis version 1 (1959): higher DA= more positive symptoms, antipsych block DA2 receptors  Hypthesis 2 (1991): against increased DA, instead PET show lower cerebral blood flow in frontal area: Prefrontal hypodopamine causes negative symptoms; subcortical hypedopamine causes positive symptoms  Version 3: genes, stress, drug use and frontal- dysfunctional all contribute to psychosis  10-20% d2 and d3 receptors density in straitum  Decreases in d2 and d3 receptors in thalamus and anterior cingulate  Decrease in d1 in PFC (negative + cognitive impairments)   Foussias paper on neuro imaging: compared 12 whitematter tracts: schizo with cog and negative symptoms and schizo without symptoms—deficit patients had higher diffused arcuate fasciculus  Negative symptoms: alogia, affective flattening, avolition  Cognitive symptoms: disorganized thinking, slow thinking, poor concentration and memory, difficulty expression thoughts, words, feelings 3  DA pathway 1: Tuberoinfundibular pathway: hypothalamus Ant pituitary responsible for release of hormone prolactin (lactation)  DA Pathway 2: SNBGresponsible for movement controls (certain types)  DA Pathway 3 mesolimbic: VTANAmediates reward, reinforcement, and positive symptoms  DA Pathway 4 mesocortical: VTAfrontal cortex + cingulate cortex: cognitive impairments, negative symptoms  DA hypothesis testing: Conclusion: the better a drug binds to 2he D receptor and blocks the effect of dopamine there, the better it will be as an antipsychotic.  When DA activity is reduced, psychotic symptoms get better.  Conclusion: psychosis (schizophrenia) is due to some abnormal increase in DA activity, or sensitivity. By bringing that down, you reduce the symptoms, even if you have not cured the actual defect.  Drug attaches to receptorblock DAbut clinical effect isn’t for a few weeksConclusion: the dopamine blockade itself is not the immediate cause of improvement. Bl
More Less
Unlock Document

Only pages 1 and half of page 2 are available for preview. Some parts have been intentionally blurred.

Unlock Document
You're Reading a Preview

Unlock to view full version

Unlock Document

Log In


OR

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


OR

By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.


Submit