Ch 19-Neurobiology of Schizophrenia, Mood Disorders & Anxiety Disorders

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Questions and Answers

Which brain structure's size reduction may disrupt neurotransmission between the cortex and primary sensory and motor areas in individuals with schizophrenia?

  • Hippocampus
  • Parahippocampal gyrus
  • Thalamus (correct)
  • Amygdala

What is the primary characteristic described by Eugen Bleuler in 1911 to define schizophrenia?

  • Thought disorders reflecting a break in reality (correct)
  • Extreme emotional reactivity
  • Auditory and visual hallucinations
  • Motor skill deficits

In individuals with schizophrenia, enlargement of the lateral and third ventricles is often associated with what?

  • Improved cognitive function
  • Reduced negative symptoms
  • Enhanced response to treatment
  • Cognitive impairments and poor treatment response (correct)

Reduced dopaminergic neurotransmission in the mesocortical dopamine pathway is proposed to result in which type of symptoms in schizophrenia?

<p>Negative symptoms and cognitive alterations (B)</p> Signup and view all the answers

Which of the following prenatal factors is believed to contribute to brain abnormalities in schizophrenia?

<p>Maternal viral infections (C)</p> Signup and view all the answers

What is the estimated percentage of the world’s population affected by schizophrenia?

<p>1% (A)</p> Signup and view all the answers

Reduced levels of glutamic acid decarboxylase, an enzyme involved in GABA biosynthesis, are believed to impair which functions in schizophrenia?

<p>Cognitive and emotional functions (D)</p> Signup and view all the answers

Besides dopamine, which neurotransmitter system is implicated in the pathogenesis of schizophrenia, particularly through its action on NMDA receptors?

<p>Glutamate (A)</p> Signup and view all the answers

What is the role of Reelin in the context of schizophrenia?

<p>It plays a role in neuronal migration during development and synaptic function during adulthood. (D)</p> Signup and view all the answers

Which brain region is most closely associated with impaired initiation and maintenance of goal-oriented activities and cognitive problem-solving in schizophrenia?

<p>Dorsolateral prefrontal cortex (DLPFC) (C)</p> Signup and view all the answers

Progressive loss of cortical gray matter in adolescents with early onset schizophrenia is observed in which of the following regions?

<p>Temporal lobes, somatosensory and motor cortices, and dorsolateral cortex (A)</p> Signup and view all the answers

Which neurotransmitter imbalance is primarily associated with the positive symptoms of schizophrenia?

<p>Increased dopamine levels (B)</p> Signup and view all the answers

Which of the following is classified as a negative symptom of schizophrenia?

<p>Alogia (A)</p> Signup and view all the answers

Which of the following best describes 'anhedonia' as a negative symptom of schizophrenia?

<p>Inability to experience pleasure (D)</p> Signup and view all the answers

Alterations in which of the following systems are related to depression symptoms?

<p>Hypothalamic-pituitary-adrenal (HPA) system (A)</p> Signup and view all the answers

Which of the following is NOT one of the typical alterations associated with depression?

<p>Increased GABA (A)</p> Signup and view all the answers

Which of the following factors is believed to contribute to the development of depression?

<p>A complex interaction between susceptible genes and environmental influences. (A)</p> Signup and view all the answers

According to the monoamine hypothesis, what neurochemical imbalance is associated with depression?

<p>Deficit in the concentration of brain norepinephrine, dopamine, and/or serotonin. (B)</p> Signup and view all the answers

Which neuroanatomic abnormality has been observed in the frontal cortex of some suicide victims?

<p>Norepinephrine receptor alterations. (B)</p> Signup and view all the answers

What changes in serotonin receptors have been found in individuals with depression?

<p>Widespread decrease in serotonin 5-HT1A receptor subtype binding in the frontal, temporal, and limbic cortex. (A)</p> Signup and view all the answers

Which criterion is essential for diagnosing major depression according to the DSM criteria??

<p>Exhibiting five or more symptoms from a specific list within a two-week period, with at least one symptom being either depressed mood or loss of interest in pleasure. (A)</p> Signup and view all the answers

Which of the following is NOT typically associated with major depressive disorder?

<p>Increased interest in pleasurable activities and interpersonal relationships. (C)</p> Signup and view all the answers

What is the global impact of major depression concerning disability?

<p>It is the most common mood disorder and the leading cause of disability worldwide. (C)</p> Signup and view all the answers

Someone says "My mood has been persistently low. My sleep has been disrupted. I also can't seem to derive any enjoyment from my hobbies anymore." What could be some potential symptoms?

<p>Feelings of worthlessness, poor concentration, and decreased appetite. (D)</p> Signup and view all the answers

Which neuroanatomical change has been observed in individuals with depression?

<p>Reduced frontal lobe volume (B)</p> Signup and view all the answers

Chronic activation of the hypothalamic-pituitary-adrenal (HPA) system in major depression leads to which hormonal imbalance?

<p>Elevated glucocorticoid secretion (B)</p> Signup and view all the answers

What effect do proinflammatory cytokines (IL-1α, IL-β, TNF-α, and IL-6) have on the hypothalamic-pituitary-adrenal (HPA) axis during psychosocial stress?

<p>Augmented secretion of HPA hormones (B)</p> Signup and view all the answers

Which neurotrophic factor deficit is associated with stress-induced depression in animal models?

<p>Deficit in hippocampal brain-derived neurotrophic factor (BDNF) levels (A)</p> Signup and view all the answers

What characterizes the hypothalamic-pituitary-thyroid (HPT) system in a subset of individuals with major depressive disorder (MDD)?

<p>Blunted thyroid-stimulating hormone response to TRH challenge (C)</p> Signup and view all the answers

What is a key diagnostic criterion for Bipolar I disorder, according to the text?

<p>Manic episodes and at least one major depressive episode (B)</p> Signup and view all the answers

How does Bipolar II disorder differ from Bipolar I disorder?

<p>Bipolar II features recurrent major depressive episodes with hypomania, while Bipolar I involves manic episodes. (A)</p> Signup and view all the answers

What is the relationship between antidepressant drugs and HPA hormone secretion in individuals with major depression?

<p>Antidepressants are effective when they normalize mechanisms responsible for increased HPA hormone secretion. (B)</p> Signup and view all the answers

Which of the following is NOT typically associated with a manic episode?

<p>Reduced goal-directed activity (A)</p> Signup and view all the answers

What is a primary neurochemical imbalance associated with depression, according to the monoamine hypothesis?

<p>Deficit of norepinephrine, dopamine, and/or serotonin (D)</p> Signup and view all the answers

Elevated levels of cortisol throughout the evening and early morning are MOST indicative of:

<p>Major Depressive disorder (C)</p> Signup and view all the answers

An individual with two copies of the 's' allele is MOST likely to exhibit which response when exposed to stress?

<p>A higher likelihood of developing MDD and suicidal thoughts (D)</p> Signup and view all the answers

Which brain regions are MOST likely to show alterations in blood flow in individuals with depression?

<p>Prefrontal and limbic brain regions (B)</p> Signup and view all the answers

What effect does persistent elevation of cortisol levels have on the immune system function?

<p>Induces immunosuppression, which compromises the body's ability to contain inflammation (B)</p> Signup and view all the answers

MAOIs can induce a hypertensive crisis when combined with foods containing high levels of:

<p>Tyramine (C)</p> Signup and view all the answers

Which medication class poses the MOST dangerous interaction risk when taken with MAOIs?

<p>TCAs (C)</p> Signup and view all the answers

Why are MAOIs used less often compared to other antidepressants?

<p>They have more adverse side effects. (A)</p> Signup and view all the answers

What is the approximate success rate of ECT (electroconvulsive therapy) in alleviating depressive symptoms?

<p>50% to 80% (B)</p> Signup and view all the answers

Which of the following scenarios is NOT a typical situation where ECT might be considered as a treatment option?

<p>When a patient is experiencing mild anxiety symptoms. (B)</p> Signup and view all the answers

What structural change in the brain has been associated with improved clinical responses after ECT?

<p>Increased volume of the hippocampus and amygdala. (C)</p> Signup and view all the answers

What underlying defect is associated with Generalized Anxiety Disorder(GAD)?

<p>Abnormalities in norepinephrine and serotonin systems. (D)</p> Signup and view all the answers

What is the hallmark symptom that defines Generalized Anxiety Disorder (GAD)?

<p>Excessive and persistent worrying. (D)</p> Signup and view all the answers

Which of the following is NOT an abnormality found in individuals with Generalized Anxiety Disorder (GAD)?

<p>Increased platelet binding of paroxetine. (C)</p> Signup and view all the answers

Which brain region's activity is notably associated with anticipatory anxiety in individuals with Generalized Anxiety Disorder (GAD)?

<p>The cingulate cortex. (A)</p> Signup and view all the answers

Flashcards

Cortical gray matter loss

Progressive reduction of gray matter, especially in temporal lobes, affecting cognition.

Dorsolateral prefrontal cortex (DLPFC)

Brain region involved in goal-directed behavior and cognitive problem-solving.

Negative symptoms

Symptoms like flattened affect and lack of motivation in schizophrenia linked to prefrontal dysfunction.

Positive symptoms

Symptomatic excesses in schizophrenia, including hallucinations and delusions, often linked to dopamine.

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Reelin

An extracellular protein involved in neuron migration and synaptic function; often reduced in schizophrenia.

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Mood disorders

Chronic emotional disturbances such as prolonged sadness or mania, affecting daily functioning.

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Unipolar depression

A type of mood disorder characterized by persistent sadness or lack of interest without manic episodes.

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Schizophrenia

A collection of mental illnesses characterized by thought disorders, revealing a disconnect from reality.

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Bipolar disorder

A mood disorder marked by alternating episodes of mania and depression.

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Heritability of Schizophrenia

Schizophrenia is influenced by genetic factors, not a simple inherited trait.

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Prenatal Vulnerability Factors

Factors during fetal development, such as maternal viral infections, increase schizophrenia risk.

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Glutamate's Role

Underactivation of glutamate receptors is linked to schizophrenia symptoms.

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Dopaminergic Neurotransmission

Reduced dopamine activity in mesocortical pathways contributes to negative symptoms and cognitive impairments.

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Cerebral Ventricles Enlargement

Enlarged lateral and third ventricles are associated with cognitive impairment and negative symptoms in schizophrenia.

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Thalamus Reduction

Smaller thalamus size may disrupt communication between cortical and sensory/motor areas.

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Temporal Lobe Alterations

Changes in the temporal lobe may be linked to positive symptoms of schizophrenia.

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Major Depression

A mood disorder with unremitting sadness, insomnia, and loss of interest.

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Diagnosis Criteria

Five or more symptoms from a list must be present for two weeks.

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Symptoms of Depression

Includes mood changes, appetite changes, fatigue, and feelings of worthlessness.

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Neurochemical Dysregulation

Imbalance of brain chemicals like norepinephrine, dopamine, and serotonin causes depression.

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Genetic Predisposition

The tendency for depression can be influenced by hereditary factors and environment.

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Serotonin's Role

Reduced serotonin receptor activity is linked to depressive symptoms.

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Neuroanatomic Changes

Alterations in brain structure, such as norepinephrine receptor changes, observed in depressed individuals.

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Epidemiological Impact

Depression is the most common mood disorder and top cause of disability worldwide.

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Manic Episode Symptoms

Symptoms include elevated mood, irritability, and increased activity.

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Monoamine Hypothesis of Depression

Depression linked to reduced brain monoamines like norepinephrine and serotonin.

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Cortisol and Depression

Persistently high cortisol levels may trigger depression through immune dysfunction.

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Risk Factors for MDD

Genetic makeup, life stressors, and serotonin dysfunction elevate MDD risk.

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MAOIs Side Effects

Common side effects include sedation, insomnia, and hypertensive crises with tyramine.

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Blood Flow Alterations

Changes in blood flow to prefrontal and limbic areas affect emotional behavior.

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Inflated Self-Esteem

Characteristic of mania; individuals may feel excessively confident and powerful.

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Cytokines and Depression

Stress activates immune system cytokines which may worsen depressive symptoms.

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MAOIs

Monoamine oxidase inhibitors; antidepressants used less often due to side effects.

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ECT

Electroconvulsive therapy, a treatment for severe depression that alters monoamine systems.

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ECT effectiveness

ECT alleviates depressive symptoms in 50% to 80% of patients.

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Hippocampus volume increase

ECT may increase the hippocampus volume, linked to mood and cognition.

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Generalized Anxiety Disorder (GAD)

A condition marked by excessive and persistent worrying about life events.

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Neurotransmitter abnormalities in GAD

Defects in norepinephrine and serotonin systems contribute to GAD.

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1st line treatments for GAD

Norepinephrine reuptake inhibitors and SSRIs effective in treating GAD.

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Cingulate cortex activity

Elevated activity in this region is linked to anticipatory anxiety in GAD.

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Frontal Lobe Volume Reduction

Reduced size of the frontal lobe found in depressed individuals.

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Temporal Lobe Volume Changes

Decreased or asymmetric volume of the temporal lobe linked to bipolar disorder and depression.

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HPA Axis Activation

Chronic activation leads to increased glucocorticoids in major depression.

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Proinflammatory Cytokines

Cytokines like IL-1α and TNF-α increase with psychosocial stress, affecting HPA hormones.

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Neurogenesis in Depression

Reduction of new hippocampal neuron development identified in stress-induced depression.

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BDNF Levels

Deficit in brain-derived neurotrophic factor (BDNF) levels found in models of depression.

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Hypothalamic-Pituitary-Thyroid System

Altered in 20%-30% of people with major depressive disorder, affecting hormone levels.

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Study Notes

Neurobiology of Schizophrenia

  • Schizophrenia is a disorder characterized by a break between reality and emotion.
  • It affects about 1% of the global population.
  • It's a heritable disorder, but not solely genetic.
  • Brain abnormalities originate in prenatal development.
  • Maternal illnesses during pregnancy can cause neurodevelopmental defects.
  • Reduced glutamate receptor activity and GABA biosynthesis contribute to schizophrenia.
  • Reduced dopamine neurotransmission in the mesocortical pathway affects negative symptoms.
  • Enlarged ventricles and fronto-cortical fissures are associated with cognitive impairments.
  • Temporal lobe areas show reduced volume and may contribute to positive symptoms.
  • Loss of cortical gray matter during adolescence is correlated with severe negative symptoms.
  • Reduced activity in the prefrontal cortex affects cognitive functioning.

Mood Disorders and Anxiety Disorders

  • Mood disorders involve chronic and uncontrollable emotional states like sadness or mania.
  • Hypothalamic-pituitary-adrenal system dysregulation affects mood.
  • Serotonin, norepinephrine and, dopamine imbalances are connected with depression.
  • Unipolar (major depressive disorder) and bipolar disorder are two major mood disorder types.
  • Genetic, environmental, and neurochemical factors contribute to mood disorders' development.
  • Unremitting feelings of sadness, sleep disturbance, appetite/weight change, and reduced interpersonal interest/relationships are symptoms of major depression.
  • Depression is the most common mood disorder globally.

Depression

  • Mood disorders involve mood fluctuations that often disrupt daily life.
  • The cause of mood disorders is complex.
  • Increased HPA system activity and increased glucocorticoid secretion (cortisol) can be seen in major depression.
  • Proinflammatory cytokines may modulate mood and HPA activity.
  • Neurogenesis (neuronal growth) and hippocampal/amygdala volume might be affected by depression.
  • Dysfunction in the hypothalamic-pituitary-thyroid (HPT) system contributes to depression in about 20-30% of cases.

Generalized Anxiety Disorder (GAD)

  • GAD is defined by excessive and persistent worry about various aspects of life (e.g., health, money, relationships).
  • It lasts for at least 6 months.
  • It is associated with decreased a2-adrenergic receptor binding in the brain.
  • Reduced serotonin levels in cerebrospinal fluid and reduced platelet paroxetine binding are seen.
  • Heightened right amygdala activity is linked to the severity of anxiety.
  • Cingulate cortex activity can be reduced via treatment, indicating possible efficacy.

Panic Disorder

  • Panic disorder is characterized by recurrent and intense panic attacks that cause significant fear and avoidance.
  • These attacks involve a wide array of physical symptoms (e.g., rapid heartbeat, difficulty breathing).
  • Increased sensitivity in the amygdala and the temporal lobes might contribute to panic disorder.
  • Reduced GABA-benzodiazepine receptor binding might contribute to the disorder.
  • Agoraphobia (fear of open spaces) or avoidance of places is a frequent complication.

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