BMS2046_Disorders of CNS_Part 2_v1.0_04 MAR 2024.pdf

BMS2046 Disorders of the Central Nervous System (CNS): Part 2 Dr Vikki Revell [email protected] Office: 03MA00 - Clinical Research Building, Manor Park Campus Part 1: Learning Outcomes Be able to define the most prevalent neurological and psychiatric disorders Have an understanding of the cost o...

BMS2046 Disorders of the Central Nervous System (CNS): Part 2 Dr Vikki Revell [email protected] Office: 03MA00 - Clinical Research Building, Manor Park Campus Part 1: Learning Outcomes Be able to define the most prevalent neurological and psychiatric disorders Have an understanding of the cost of brain disorders Within the Central Nervous System (CNS) be able to describe: The location and function of different brain regions The component cell types and their function Part 2: Learning Outcomes For a range of CNS disorders, both neurological conditions and mental health conditions, be able to describe the: Characteristics Symptoms Causes Treatment(s) if available Migraine Most prevalent diagnosis in the UK: headache Fineberg et al, J Psychopharmacol 2013 Migraine Characteristics Intense throbbing pain or a pulsing sensation Usually on one side of the head 2 – 3 times more common in women than in men Symptoms Migraine with aura – visual disturbance - warning signs e.g. flashing lights Migraine without aura – onset without warning Acute pain Nausea, vomiting and extreme sensitivity to light and sound Triggering factors: Bright or flashing lights, lack of food, certain food or drink, tiredness, stress or menstruation Migraine Causes Exact cause unknown Dilation and constriction of blood vessels Change in serotonin signalling Genetic component Ion channels – impact on nerve activity Trigeminal ganglion Mutations in the TRESK – potassium channel Migraine Treatment(s) Triptan drugs - serotonin receptor agonists Anti-emetics Painkillers Lying in dark room Anxiety, mood & psychoses Anxiety, mood & psychotic disorders Fineberg et al, J Psychopharmacol 2013 Anxiety Disorders: Generalized anxiety disorder Symptoms Excessive anxiety or worry, most days for at least 6 months Personal health, work, social interactions, and everyday life Difficulty controlling feelings of worry Feeling restless, wound-up, or on-edge Easily fatigued Difficulty concentrating Irritable Muscle tension Sleep problems Anxiety Disorders: Panic disorder Symptoms Recurrent & unexpected panic attacks Sudden periods of intense fear Unexpected or triggered Heart palpitations Sweating Trembling Shortness of breath Feelings of impending doom Feelings of being out of control Anxiety Disorders: Phobia related disorder Symptoms Intense fear of specific objects or situations Fear is out of proportion to the actual potential danger Irrational or excessive worry about encountering the feared object or situation Actively avoid the feared object or situation Intense anxiety if encounter feared object or situation If unavoidable endure with intense anxiety https://www.nimh.nih.gov/health/topics/ Anxiety Disorders Causes Genetic and environmental factors Risk factors Shyness or behavioral inhibition in childhood Exposure to stressful and negative life events in early childhood or adulthood Family history of anxiety or other mental illnesses Cardiac or thyroid issues or excessive use of caffeine may aggravate anxiety Anxiety Disorders Treatment(s) Psychotherapy Anxiolytics Benzodiazepines (GABA agonist) Anti-depressants (e.g. SSRI) Depression Categories Major depressive disorder Persistent depressive disorder Bipolar disorder Psychotic depression Postpartum depression Seasonal affective disorder Symptoms Continuous low mood or sadness Feeling hopeless Low self-esteem Feel guilt ridden No motivation Difficult to make decisions Suicidal thoughts Anxiety or worry Changes in weight or appetite Lack of energy Disturbed sleep Depression Causes Genetic predisposition Early life experiences Upsetting or stressful life events e.g., bereavement, relationship breakdown, illness, economic worries Gut microbiome Pathophysiology Alterations in monoaminergic neurotransmitter signalling (serotonin, norepinephrine, dopamine) Depression Treatment(s) Antidepressants Selective serotonin reuptake inhibitors (SSRIs) e.g., fluoxetine (PROZAC), citalopram Serotonin-norepinephrine reuptake inhibitors (SNRIs) Tricyclic antidepressants (TCAs) e.g., amitryptiline Monoamine oxidase inhibitors (MAOIs) Atypical agents Psychotherapy Psychosis Characteristics Psychosis Loss of contact with reality 3 stages of psychotic episode: prodromal, acute, recovery Psychotic illness Schizophrenia (hallucinations, delusions, extremely disordered thinking) Schizoaffective disorder (psychosis and mood) Paraphrenia (paranoid delusions - personality not affected) Symptoms 3 main symptoms: hallucinations, delusions, confused thought Psychosis Causes of psychotic episodes Underlying psychotic illness Comorbid illnesses e.g. Alzheimer’s disease, Parkinson’s disease Triggers e.g., depression, stress – if predisposed Early life experience Alcohol and drug misuse Psychosis Pathophysiology Genetic Anatomical Neurotransmitter signalling (glutamate, GABA, dopamine) Environmental Treatment(s) Antipsychotics – inhibit dopaminergic transmission Psychological treatment e.g., CBT Tourette’s syndrome Tourette’s syndrome Characteristics Symptoms usually begin in childhood (2 – 14 years old) Symptoms Tics – repeated, sudden movements, twitches or sound Premonitory sensations (strong urge before a tic) Comorbidities e.g. OCD, ADHD, anxiety Tourette’s syndrome Causes Complex disorder – genetic and environmental factors Abnormalities in basal ganglia, frontal lobes & cortex Changes in serotonin and dopamine signalling Tourette’s syndrome Treatment Behavioural Therapy Habit reversal training Exposure with response prevention Medication E.g. Respiridone (dopamine and histamine receptor antagonist) CNS trauma, injuries & tumours Traumatic brain injury Characteristics Sudden injury / trauma causes damage to the brain Blow, bump or jolt to the brain Closed head injury Symptoms Loss of consciousness Persistent headache Repeated vomiting and nausea Convulsions or seizures Feeling tired Blurred vision Traumatic brain injury Treatment Acute medical care Oxygen supply Blood flow Surgery e.g. to stop bleeding and remove haematomas Medications e.g., anti-convulsants, diuretics, comainducing Rehabilitation Physical therapy Occupational therapy Speech therapy Neuropsychologist Spinal cord injuries Causes Sudden, traumatic blow to the spine Fracture or dislocation or compression of vertebrae Crush, destroy, bruise or tear spinal cord tissue Disrupt communication in the spinal cord Complete Total lack of sensory and motor function below the level of injury Incomplete Potential to regain some function Spinal cord injuries Complications Chronic pain Respiratory infections Bladder and bowel dysfunction Fractures Treatment Rehabilitation programs – physical therapy, occupational therapy, counselling CNS tumours Characteristics Abnormal growths of tissue: benign vs malignant Can place pressure on tissue & impair function Symptoms Brain tumour: Headaches, seizures, nausea, vomiting, vision or hearing problems Behavioural, & cognitive changes Motor and/or balance problems Spinal cord tumour: Pain, sensory alterations, motor problems CNS tumours: treatment Surgery, radiotherapy, chemotherapy Epilepsy & Hydrocephalus Epilepsy Characteristics Excessive, abnormal & synchronised pattern of neuronal activity in the cortex Symptoms Seizures Convulsive (~60%) Non-convulsive e.g., absence Trigger for seizures e.g., lack of sleep, stress, excessive alcohol Causes Genetic - ion channels, GPCR, enzymes, GABA Acquired e.g., stroke, head injury, brain tumour, infection Epilepsy Treatment Antiepileptic drugs Surgery Vagus nerve stimulator Deep brain stimulator implanted Ketogenic diet Diagnosis of Epilepsy Hydrocephalus Characteristics Excessive accumulation of CSF Pressure on brain Causes Congenital Spina bifida or infection during pregnancy X-linked hydrocephalus Arachnoid cysts CSF flow restricted Brain damage when born Hydrocephalus Causes Acquired Head injury Brain tumour Symptoms Vomiting Problems with balance & coordination Sleepiness/lethargy, drowsiness Changes in personality & cognition Treatment Surgery to drain excess fluid Autoimmune conditions Multiple Sclerosis & Narcolepsy Multiple sclerosis Characteristics Demyelinating condition Causes Thought to be an autoimmune disease Immune system attacks the myelin sheath of neurons Genetic & environmental factors Previous infections e.g., Epstein-Barr Multiple sclerosis Symptoms Progressive or relapsing remitting Relatively benign to disabling / devastating Difficulty walking Vision problems Bladder control Numbness or tingling Muscle stiffness and spasms Problems with balance and co-ordination Problems with thinking, learning and planning Multiple sclerosis Treatment Steroids for relapses Disease modifying therapies Narcolepsy Characteristics Neurological disorder First identified in dogs Symptoms Excessive daytime sleepiness Cataplexy (sudden onset of muscle atonia) Direct transition from wakefulness to REM sleep Narcolepsy Causes Loss of hypocretins/orexins Autoimmune disease Cells producing orexin Orexin receptors Triggers – hormonal changes, psychological stress, infection Treatment Stimulants e.g., modafinil SSRIs – suppress REM sleep Sodium oxybate - cataplexy Part 2: Learning Outcomes For a range of CNS disorders, both neurological conditions and mental health conditions, be able to describe the: Characteristics Symptoms Causes Treatment(s) if available