BIO-322 Mood & Neurocognitive Disorders PDF

Emotional Regulation & Mood Disorders • Anxiety Disorders BIO-322 Topic 5a Ch: 29.2-29.3 Ch: 30.1, 30.3-30.5 • • • • • Panic Disorder Generalized Anxiety Disorder Social Phobia OCD PTSD • Depression Neurocognitive / Neurodevelopmental Disorders • Schizophrenia • ADHD • ASD • Alzheimer’s Dementi...

Emotional Regulation & Mood Disorders • Anxiety Disorders BIO-322 Topic 5a Ch: 29.2-29.3 Ch: 30.1, 30.3-30.5 • • • • • Panic Disorder Generalized Anxiety Disorder Social Phobia OCD PTSD • Depression Neurocognitive / Neurodevelopmental Disorders • Schizophrenia • ADHD • ASD • Alzheimer’s Dementia Epinephrine & Norepinephrine • Catecholamines Anxiety • “A state of being uneasy, apprehensive, or worried about what may happen.” • Anxiety is a normal emotion • Anxiety will set off an alarm reaction in our body • “Fight or flight” • Adrenalin released • Typically symptom subsides • When anxiety interferes with day-to-day activities and relationships, then it may be classified as a disorder. • 40 million people (age 18-54) in the USA have excessive anxiety Panic Disorder Generalized Anxiety Disorder Obsessive Compulsive Disorder PTSD Social Anxiety Disorder / Social Phobia Agoraphobia Specific Phobia Anxiety Disorders • Anxiety is normal reaction to stress, we all get it occasionally • Before a test, making an important decision, asking someone on a date • Anxiety disorders are the most common of mental disorders and affect nearly 30 percent of adults at some point in their lives • With an anxiety disorder, the anxiety is out of proportion to the situation or age inappropriate • They get anxiety about having future anxiety, which leads to an avoidance of situations that could make their anxiety worse • These feelings can interfere with daily activities such as job performance, school work, and relationships Anxiety Disorders • Risk Factors • Combination of FHx/genetics, Environmental, psychological and developmental • Treatment • Psychotherapy AND pharmacotherapy • Cognitive behavior therapy (CBT), a type of talk therapy, can help a person learn a different way of thinking, reacting and behaving to help feel less anxious. • Medications will not cure anxiety disorders, but can give significant relief from symptoms. • Most commonly used medications are anti-anxiety medications (generally prescribed only for a short period of time) and antidepressants. • Beta-blockers are sometimes used to control physical symptoms of anxiety. Panic Attack • A Symptom, NOT A DISORDER • Sudden intense fear • • • • Fear of loosing self control Fear of dying Fear of going mad Fear of impending doom • Accompanies by physical symptoms • • • • Chest pain, palpitations Shortness of breath, hyperventilation Numbness & tingling Abdominal distress • Seen w/ many disorders • • • • • • • Generalized Anxiety Disorder (GAD) Post Traumatic Stress Disorder (PTSD) Panic Disorder Agoraphobia Specific Phobias Social Phobias Substance abuse 6 million, 2.7% Panic Disorder • Recurrent panic attacks • Panic attacks may be expected, such as a response to a feared object (phobia) • May be unexpected, apparently occurring for no reason • 1+ months of persistent concern about having another panic attack • Causes physical symptoms and psychological distress • S/S  Fight and Flight Response • Palpitations, diaphoresis, tremors • Chest Pain, Hyperventilation, SoB • Light headed, dizzy, syncope • Many go to the hospital believing they are having a heart attack, dying F>M (2:1) Age of onset: 20-25 6.8 million, 3.1% Generalized Anxiety Disorder (GAD) • Chronic Anxiety for 6+ months, that interferes with daily activities • The worries focus on everyday things such as: • • • • Job responsibilities Health, Finances Relationships, Family minor matters such as chores, car repairs, or appointments. • S/S (fight/flight) • • • • “can’t stop worrying” restlessness, feeling on edge easily fatigued, difficulty concentrating, problems sleeping muscle tension, teeth grinding (bruxism) tachycardia, palpitations, SoB F>M (2:1) Generalized Anxiety Disorder (GAD) Phobias The American Psychiatric Association identifies three types of phobias: • Specific Phobia: Going to extreme lengths to avoid an activity or object because of fear of danger or harm. • Examples: Fear of heights, snakes, spiders • Social Phobia: A fear of being humiliated or underperforming in social situations. Also known as social anxiety disorder. • Examples: Fear of public speaking, public restrooms, eating in front of others • Agoraphobia: Feeling discomfort in situations where escape is difficult or help is not readily available. • Examples: Fear of leaving the house, public transportation, small spaces 19 million, 8.7% F>M (2:1) Specific Phobias • An irrational excessive and persistent fear of a specific object, situation or activity that is generally not harmful. • Patients know their fear is excessive, but they can’t overcome it. • Panic attack occurs on exposure • These fears cause such distress that some people go to extreme lengths to avoid what they fear or endured with extreme discomfort Phobias • • • • • • • • • • Ophidiophobia: fear of snakes Acrophobia: fear of heights Cynophobia: fear of dogs Astraphobia: fear of thunder and/or lightning Trypophobia: fear of holes Aerophobia: fear of flying Xenophobia: fear of the unknown or unfamiliar (such as foreigners) Claustrophobia: fear of small spaces Glossophobia: fear of public speaking Emetophobia: fear of vomiting 15 million, 6.8% M=F Social Phobia [formerly Social Anxiety Disorder] • They get significant anxiety and discomfort about being embarrassed, humiliated, rejected or judged in social interactions, especially when they perceive themselves to be the center of attention. • People with this disorder will try to avoid these potential situations or endure it with great anxiety • Affects daily functioning and lasts 6+ months • Examples: • • • • Fear of speaking or working in front of others Fear of meeting new people / making small talk Fear of eating/drinking in public Fear of using public restrooms Agoraphobia • A type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed • After their first panic attack – they have a fear of having another panic attack and will avoid places where it happened. • The fear is out of proportion to the actual situation and generally lasts 6 months or more and causes problems in daily functioning • A person with agoraphobia experiences this fear in two or more of the following situations: • • • • • Being outside the home alone Using public transportation Being in open spaces Being in enclosed places Standing in line or being in a crowd • The individual actively avoids the situation, requires a companion or endures with intense fear or anxiety • Untreated agoraphobia can become so serious that a person may be unable to leave the house. 2.2 million, 1.0% M=F Obsessive-Compulsive Disorder (OCD) • Recurrent unwanted thoughts (obsessions) that are only alleviated by repeated behaviors (compulsions) • ‘I might get sick from germs on the door knob so I clean the door knobs in the house 2x/day” • Signs and Symptoms • Unwanted thoughts, images, urges • Seek relief with rituals • Seen in families Post Traumatic Stress Disorder (PTSD) • After occurrence of witnessing or participating in event that caused or threatened harm • Examples: war, rape, natural disaster, car/plane crash • Normal to have anxiety after such events, but symptoms should subside over time • Signs and Symptoms • Recurrence of event  stress response • Remembering the event  stress response • Difficulty with sleeping Depression S/S ◦ Sadness, apathy, weight/appetite changes, decreased energy, suicidal thoughts ◦ Mood swings, insomnia, crying Types of Depression  Major Depressive Disorder ◦ 2+ major depressive episodes that interferes with life (job, family, sleep, eat, study) almost every day for 2+ weeks.  Post- Partum Depression “baby blues” ◦ S/S + intense anger, severe mood swings, thoughts of harming self or baby  Post-Partum Psychosis  confusion, hallucination, paranoia, attempting to harm self or baby  Seasonal Affective Disorder ◦ Onset in fall/winter Testing  Psychological testing - SIGECAPS  Dysthymia  Rule out organic causes/normal grieving ◦ Less severe than major depression > 2yrs Tx  Therapy, Meds Causes ◦ NT deficiency/imbalance, situational, drug induced 5+ = Major Depressive Disorder Schizophrenia • “Chronic, severe and disabling brain disorder” • Causes • Familial, Genetic + Environmental • Pathophysiology • Dopamine imbalance • New research indicates Glutamate, GABA, ACh and 5HT are also involved in the pathophysiology • Signs and Symptoms • Hallucinations – auditory, visual, tactile • Beliefs of others can hear their thoughts – paranoia • Onset 16-30, typically NOT after 45 • Rarely starts in childhood, but can happen • Testing • Clinical • R/O other “physical” causes – drug abuse • Tx: • Antipsychotic medications (Dopamine Receptor blockers) Autism Spectrum Disorder • Autism is a spectrum. Each person is different. • Some conditions included in ASD: • Autism Disorder • Asperger’s Syndrome • Pervasive Developmental Disorder - Not Otherwise Specified • Some people with autism have an excellent vocabulary and high IQ, but limited conversational and social skills, and restricted interests. Others may be nonverbal with a very low IQ. • Some need a lot of help with everyday life, others need less. Major difficulties in ASD • Social Interaction • may have reduced interest in other people, poor eye contact • Difficult to form and maintain relationships • Communicating • Delayed or no speech • May repeat words or expressions • Restricted or repetitive behavior or interests • unusual interests, rituals, handflapping, spinning, rocking, humming Common Behavioral and Social Behaviors in ASD • Does not respond when name is called (may seem deaf) • Poor eye contact • Difficulty expressing language or non-verbal • Difficulty following direction • Has difficulty shifting from one activity to another • Gets upset with a change in routine • Overreacts to things • Acts unexpectedly • Often impatient • Many prefer isolation and are unwilling to join in social activities ASD Facts • Not all people with autism act the same way. Each person has unique strengths and challenges. • People with autism have feelings. Each person displays them differently. • Because of rigid thinking, they may be less likely to lie. • Do not ask them if your outfit makes you look fat, you won’t like the answer • Due to difficulty recognizing social cues, they may not recognize when they are interrupting or monopolizing conversations or being overly blunt. • Most people with autism are not savants. While many have focused interests, skill level may not be high. • People with autism are able to learn. Methods and pace of instruction may need to be modified. Attention Deficit Hyperactivity Disorder (ADHD) • Causes/RF • • • • Genetics, Brain injury, Alcohol/tobacco use in pregnancy Advanced paternal age Low birth weight / premature delivery • Not a cause/RF • • • • Too much sugar Too much TV Poverty Bad parenting • S/S • Trouble Paying Attention • Frequent daydreaming • Trouble controlling impulsive behaviors • • • • • • • Taking unnecessary risks • Having a hard time resisting temptation Fidgeting, squirming Losing/forgetting things Talking too much Making careless mistakes Having trouble taking turns Having difficulty getting along with others Dementia • In 2015, an estimated 47.47 million had dementia, and it is estimated to grow to 135.46 million by 2050 • The majority of cases are found in low- and middle-income countries • The incidences of dementia double with every 5.9 year increase in age • The estimated worldwide cost of dementia was $604 billion in 2010 • Age is leading risk factor Normal Aging Dementia ADL’s preserved ADL’s affected Complains of memory loss, but can provide details about incidents of forgetfulness Pt concerned about memory loss Doesn’t complain of memory loss, Unable to remember specific instances where memory loss was noticed by others Close family members are more concerned about memory loss Notable decline in memory for recent important events and conversations Frequent word-finding difficulty Recent memory for important events and conversations intact Expressive aphasia (difficulty finding words) Does not get lost in familiar territory, may have to pause to reorient Able to operate common appliances Maintains previous interpersonal social skills Normal performance on mental status exam Can get lost for hours in familiar territory while walking or driving Becomes unable to operate common appliances Shows loss of interest in social activities and inappropriate behavior Abnormal MMSE • • • • Alzheimer’s Disease Progressive destruction / neurodegeneration of the brain Main cause of dementia in elderly Cause – unknown, multifactorial Risk Factors: • Age • Genetic (chr 21), Apoprotein A-4, -Amyloid, presenillin • ↑incidence w/ head trauma, low education, Down’s Syndrome • Pathophysiology • Atrophy of the brain – thin gyri, wide sulci, dilated ventricles • Neuritic (senile) -Amyloid Plaques  disrupts AP’s • Neurofibrillary tangles  tau protein (microtubule binding protein) become insoluble  neuronal death • Degeneration of cholinergic neurons  ↓ACh levels • Prevention: • healthy aging, intellectual stimulation, social activity • Signs/Symptoms • Cognitive Decline: • • • • • Alzheimer’s Disease Amnesia – memory loss (FIRST SIGN) Anomia – can’t remember names of objects Apraxia – misidentifying objects Agnosia – can’t identify sensations/senses to recall memories Aphasia – can’t find the words to express themselves • Behavioral Symptoms: • mood swings, agitation • impaired judgement, reasoning • Depression, confusion • Functional Impairment : • ADLs & IADLs affected • Testing: • mental status exams & CT/MRI + R/O other causes • Complications  Death • • • • • Inhaling food or liquid into the lungs (aspiration) Pneumonia / infections Falls / Fractures Decubitus Ulcers (bedsores) Malnutrition or dehydration Alzheimer’s Disease Alzheimer tissue has fewer synapses and neurons • Beta Amyloid plaques between cells • Neurofibrillary Tangles of twisted strands of protein Alzheimer’s Disease In Alzheimer’s • Cortex shrinks • Small gyrus • Large sulcus • Hippocampus shrinks • Ventricles enlarge