Psychiatry 79 Midterm Study Guide PDF

Brain Regions - Prefrontal Cortex: thinking, planning, impulse control (the rational adult) – the thinking brain - Overall organization (eg. dorsal vs. ventral) - Dorsal (top) = more cognitive - Ventral (bottom) = more emotional (regulating limb...

Brain Regions - Prefrontal Cortex: thinking, planning, impulse control (the rational adult) – the thinking brain - Overall organization (eg. dorsal vs. ventral) - Dorsal (top) = more cognitive - Ventral (bottom) = more emotional (regulating limbic system’s emotions) - Medial (middle) = thinking about self - Lateral (outer) = thinking about world - Orbitofrontal - Medial PFC - Medial = middle = thinking about self - Dorsomedial (top middle) = cognitive self - Ventromedial (bottom middle) = emotional self - Lateral PFC - Lateral = outer = thinking about world - Dorsolateral (top outer) = cognitive world - Ventrolateral (bottom outer) = emotional world  - Automatically regulates amygala’s emotional reactivity - Orbitofrontal - Damaged in Phineas Gage - Helps modulate goal-directed behavior – so damage increases impulsivity - Related to motivation - Limbic system: emotion and memory (the crying child) – the emotional brain - Hypothalamus - Maintains homeostasis by triggering stress response - Amygdala - Threat detector, anticipates bad situations and reacts ahead of time, related to anxiety and fear or excitement and surprise - Hippocampus - Forms long term memories, comparing present moment to previous experiences so we know how to act - Anterior cingulate cortex - Attention - Striatum: impulses, routines, and reward (the dog – “can’t teach an old dog new tricks”) – the action circuit of the brain - Dorsal striatum: where the deepest most engrained habits are - Nucleus accumbens: impulsive part of the brain – releases dopamine in response to reward and in anticipation of reward, which motivates actions to achieve that reward - Insula - Processes fear signals and make them into bodily signals Chemicals - Dopamine - Released in response to reward in nucleus accumbens - Motivation, reward, and habits - Targeted by antidepressants  - Norepinephrine - Responding to stress - Targeted by antidepressants - Serotonin - Willpower and mood - Targeted by antidepressants - Endorphins - “Feel good”, pain reducing - Endocannabinoids - Psychoactive ingredient in marijuana - Increases feelings of peacefulness and well being - Glutamate - Most common neurotransmitter - GABA - Primary inhibitory neurotransmitter - Target of anti-anxiety meds - Boosts mood and has a calming effect - Melatonin - Sleep aid, important in regulating circadian rhythms - Cortisol - Stress hormone - BDNF - Brain-derived Neurotrophic Factor - Protein that helps to grow and strengthen neurons in the hippocampus - Steroids for neurons Concepts - Neurons - Cell body/gray matter - Cell body interprets info from dendrites and determines whether to send electrical signals down axon - Grey matter is cell bodies – where the processing is going on - Grey matter is largely on the surface of the brain (the cerebral cortex) - Axon/myelin/white matter - Electrical signals travel down axon - Myelin sheath makes it so the electrical signal can travel faster - White matter is axons (white because of fat from myelin) - Dendrites - Listening for info from other neurons (little tree branches attached to cell body) - Neurotransmitters - Chemicals that allow neurons to communicate with each other - Synapses  - The connection between two neurons - Neurons have about 7,000 synapses on average - Where neurotransmitters are transferred (think synaptic cleft) - Working memory - “Short term memory” - The Action Conversation - Actions you take are a result of a convo between PFC, nucleus accumbens, and dorsal striatum - PERMA model of wellbeing (components to flourishment) - Positive Emotions - Engagement: need to be fully immersed in something (eg. reading) - Relationships: need deep relationships - Meaningfulness: need purpose - Accomplishments: need to achieve things, feel progress - Growth mindset - The belief that effort can improve talents (Carol Dweck) - The power of “yet” (cognitive reframing) - Creates greater connectivity between DLPFC and dorsal striatum - Works because of neuroplasticity – “neurons that fire together, wire together” - fMRI - Measures changes in blood flow that occur with brain activity - Looks at a “movie of the brain” to determine what parts of brain are more active during certain tasks - Phineas Gage  - Damage to orbitofrontal cortex which modulates goal-directed behavior - Damage to OFC increases impulsivity - Types of scientific evidence - Observation - Researcher observes subjects and measures variables of interest - No manipulation of IV – cannot determine causation - Experimental - Researcher applies intervention or treatment and measures an outcome variable of interest - Manipulation of IV – can determine causation - Study limitations (eg. confounding variable, correlation vs. causation, etc) - Stress - An organism’s response to an environmental change - Linked with homeostasis, meditated by the hypothalamus - Psychological (feeling of pressure) vs. physiological stress (bodily need) - HPA (hypothalamus, pituitary gland, adrenal) axis: system that regulates body release of cortisol is response to stress - Autonomic nervous system - Sympathetic - Fight or flight response - Parasympathetic - Calms down fight or flight response from sympathetic nervous system - Vagus nerve - Originates in brain stem and goes to bunch of internal organs – sends info down to them from brain - But also from them to the brain (this info is processed in the insula) - Key part of parasympathetic NS - Important for heart rate variability - Some functions: constricts bronchi, slows heartbeat, stimulates peristalsis and secretion, and stimulates bile release - Effects of exercise and sleep - Exercise - Helps with stress and depression - Reduces cortisol and improves mood - Reduces activity in dorsal stratium when looking at cigarettes - Releases endorphins and endocannabinoids - Increases brain-deprived neurotrophic factor (BDNF) – helps grow new neurons in the hippocampus - Increased in voluntary and forced exercise, but more strong increase for voluntary exercise - Shows interaction between actions we take and the thoughts we have about them in our wellbeing - Increases PFC activity & grey matter in the PFC (for older adults) - Boosts serotonin  - Yoga releases GABA - Exercise improves sleep - Sleep - Improves mood - Reduces pain and stress - Reduces reward response to unhealthy behaviors - Improves learning and cognitive performance - Boosts immune system - Reciprocal relationship between sleep and stress - Inadequate sleep increases stress - Increased stress disrupts sleep - Important for memory consolidation - Communication between hippocampus and PFC during slow-wave sleep - Reduces amygdala reactivity - Disrupted sleep increases pain (sleep likely releases endorphins) - Important for prefrontal activity - Biofeedback - The body’s impact on the brain – mind body technique used to control some body functions - Breathing helps to modulate activity in the vagus nerve - Increased heart rate variability (HRV) means less stress - Relaxing muscles (facial muscles or stretching) & posture - Moderators of stress - Certainty, controllability, consequences - Controllability - Perceiving control is essential to feeling less stressed (perception of control, don’t need real control) - Study where panic disorders patients were given air with CO2 – either told they could adjust knob (control) or not – knobs didn’t actually work - Greater control = greater activity in vmPFC and greater communication between vmPFC and amygdala - Certainty - Increased uncertainty = increased stress - Study where the same baseline stress response was activated when people were certain they were getting or avoiding a shock - Shock itself is irrelevant, it’s about the uncertainty - Consequences - Interaction between certainty and consequences - Consequential + uncertainty = increased amygdala activation - Inconsequential + uncertainty = no activation in amygdala  - Shown in study showing people certain/uncertain neutral and aversive pics - Effects of Gratitude - Nucleus accumbens only alerts us to things that are unexpectedly good not expectedly good (the things we should be grateful for) - Why expressing gratitude has these positive effects - Reduces stress/anxiety/symptoms of depression - Improves sleep quality and reduces anxiety in college students - Improves physical health and perception of pain/discomfort - Better immune system - Feel more social support and closer to others - Expressing appreciation for people in our lives increases anterior cingulate cortex response to positive events - Placebo - Fake intervention - Study where people were given placebo or control pain reliever with electric shocks - Found that placebo cream reduced pain - But blocking endorphins reduced placebo’s effect - Placebo activates the endorphin system & increases DLPFC activity - Even in studies where participants were told it was a placebo, it produced “significant mind-body self healing processes” - Worry - Different from fear and anxiety - Anxiety is the engagement of fear circuitry in response to the possibility of danger (often subconscious), while worry is consciously thinking about the possibility of danger - Worry is a coping mechanism used to cope with anxiety - Mediated by medial PFC and anterior cingulate - Worry examples: thinking about the chances of failing an exam or losing a loved one - Circadian rhythms - Circadian process is driven by your internal clock and it’s cyclical - The hypothalamus controls the internal clock and it’s reset by light - Daily fluctuations in melatonin, cortisol, body temperature can impact circadian rhythms - Cortisol increases during day & decreases at night - Melatonin decreases during day & increases at night - Sleep hygiene - Different practices/habits that are necessary for good nightime sleep quality and full daytime alertness - Some practices: - Uninterrupted sleep - Bright light during the day, and not at night  - Quiet and dark sleep environment - Calming routine - Reduce stress - Avoid caffeine - No naps - Use your bedroom only for sleep - Don’t use alcohol as regular sleep aid - Exercise - Sleep debt - If you only get 4 hours of sleep monday-friday, then on saturday and sunday you might need to sleep for 10 hours - You are accumulating sleep debt monday-friday that you need to pay off over the weekend - There is more lapses in attention for those getting less sleep, but the differences are small - Differences get worse over time since sleep debt is accumulating - Sleep architecture - Stage 1-4 - Stage 1 = light sleep - Stage 2, 3, 4 = slow wave sleep - We progress from stage 1 to 2 to 3 to 4 to REM (and cycle repeats throughout the night) - REM - Last stage of sleep - Rapid eye movement - Cerebrospinal fluid (CSF) - The brain sits in this fluid - This is why sleep is restorative - Sleep cleans away metabolic waste via CSF - Yerkes-Dodson Law - Relationship between arousal and performance for complex tasks - For complex tasks, there’s an inverted U-shaped function of optimal performance - Mediated by prefrontal dopamine and norepinephrine - A little stress is good (increases interest and attention), but too much stress impairs performance - Optimal performance and arousal is at the top of the inverted U-shape  - Shown in study of test-taking & athletics - Influence of expectations - Anterior cingulate cortex is more active when you make a mistake vs. when you do not - Brain knows what are mistakes because it knows our expectations - Anterior cingulate notices differences between what we expect to happen and what actually happens - Happy = reality - expectations - Study where people are told the probability of a reward and then either receive it or not - Biggest activation in accumbens when low probability of winning and you win (low expectations, good reality) - Biggest decrease in accumbens when high probability of winning and you lose (high expectations, bad reality) - No change in accumbens when 0% probability of winning and same with 100% probability (expectations = reality) - Excitement is entirely modulated by what you expect - Cognitive reappraisal - CBT strategy - Reframing thoughts and identifying incorrect beliefs - Goal is to train brain to work for you, not against you - Cognitive reappraisal by the DLPFC can help mediate amygdala response to uncertainty - Mindfulness - Paying attention to present moment, nonjudgmentally - Benefits: anxiety/stress/depression reduction, increased wellbeing, improved test taking - Mindful people have smaller amygdalas - Reduces anxiety - Increases activity in several parts of the mPFC, ACC, and insula - Goal-directed vs. stimulus-driven actions - Goal-directed: - Motivated by desirability of the goal; flexible  - Behaviors: intentional, willful actions (PFC) and impulses (nucleus accumbens) - Stimulus-driven: - Motivated by stimulus or environment; inflexible - Behaviors: routines/habits (dorsal striatum) - Habits can be emotional, behavioral, cognitive, or social - Habits - Cue/trigger, action, reward - This is the habit loop - Cue → routine → reward → cue —> routine → reward etc. etc. - Routine is mediated by dorsal stratum and reward activates nucleus accumbens - Impulses, routines - Impulses: - Dopamine release in response to novelty or reward, or in anticipation of reward - This motivates actions to achieve that reward - Stress biases toward impulses (shown in ice water healthy food study) - Nucleus accumbens & amygdala activated more in stress condition - Also less likely to involve PFC goal-directed behaviors and more likely to do dorsal striatum stimuli-directed ones when stressed - Routines: - Includes coping habits and rituals (both very challenging to change) - Stress causes release in dorsal straitum – so more likely to get pulled into these habits - Light vs. Heavy Drinker Study - Light drinkers = increased activity in nucleus accumbens (reward, drinking is a fun thing) - Heavy drinkers = increased activity in dorsal stratium (drinking is a habit) - Fixed vs. variable reinforcement - Fixed ratio rewards - Animals know what to do to get reward; predictable - Eg. told you will get $100 every 5 boxes - Variable ratio rewards - Animals don’t know what to do to get reward; based on probability - Eg. gambling - This gets emotions more involved - Cognitive behavioral therapy: development of personal coping strategies for dealing with unhelpful cognitions or behaviors in emotion regulation (behavior, feelings, thoughts triangle — change one to fix the rest)  - Behavioral activation therapy - Context/environment is more important than internal factors - Targets negative behaviors - Eg. struggling to go to the gym? Just go to the building and sit there - Habit Loop - Change cues - Understand triggers, change your environment, reduce stress - Understand rewards - Habits only occur because they benefit you some how, so figure out how new (healthier) habits will benefit you - Replacing routines - Mindfulness-based cognitive therapy - Concentration - Non-judgemental awareness - Acceptance and commitment therapy - Instead of controlling thoughts and feelings, accept them - Choose valued actions (emphasis on choice) - Self-affirmation - Focusing on one’s own positive qualities - Leads to habit change because you are focusing on strengths and focusing on what you can control - Getting Things Done basics - Capture all things you need to get done into a logical and trusted system outside of your head and off your mind - Discipline yourself to make front-end decisions about the inputs you let into your life - If it’s on your mind, your mind isn’t clear - Clarify exactly what your commitment is and decide what you have to do, if anything, to make progress toward fulfilling it - Once you’ve decided on all the actions you need to take, you must keep reminders of them organized in a system you review regularly - Goals and Intentions - They enhance attention and perception and enjoyment - You will see different things (changes visual cortex response) based on your intentions (eg. if you are looking for solutions vs. problems) - Decisions enhance enjoyment – increases nucleus accumbens and insula activity If you can define each term on this list, and understand how the brain regions and chemicals relate to the concepts, then you'll definitely do well on the midterm. A few of the questions on the midterm require that you understand the main point from some of the readings (not the details, just the primary takeaway), though even those can probably be answered by a deeper understanding of the material. Some questions require that you interpret a graph.