PSCH 262 Final Exam

3 Stages of Clinical Trials

3 Stages of Clinical Trials

Pre-Clinical, Clinical & Review/Approval Process

3 Phases for Clinical Trial

Phase I - III

Which phases for clinical trials test for efficacy?

II & III

How are clinical trials performed?

Randomized Trials

What are the positive symptoms of Schizophrenia?

Hallucinations & Delusions

What are some negative symptoms of Schizophrenia?

• Flat Affect

• Alogia

• Poor Attention

• Avolition

• Anhedonia

How can one’s environment affect their risk of schizophrenia?

Dysfunctional Family

What are the chances of identical twins both having schizophrenia?

48%

What are the chances of fraternal twins both having schizophrenia?

10%

Sensory Gating Deficits

Difficulties filtering sensory input in the brain

How are Sensory Gating Deficits tested?

Pre-Pulse Inhibition Tests

Aberrant synaptic pruning during development can cause what?

Aberrant Grey Matter

What are some structural abnormalities with Schizophrenia?

• Disorganization of Hippocampal cells

• Atrophying of cortical layers

• Enlarged Cerebral Ventricles

What are the 4 Pathways of Dopamine in the brain?

• Mesolimbic

• Mesocortical

• Nigrostriatal

• Tuberhypophyseal

Which dopamine pathway deals with increase in positive symptoms?

Mesolimbic

Which dopamine pathway deals with increase in negative & cognitive symptoms?

Mesocortical

What effect can amphetamines have on schizophrenia?

Development of schizophrenic symptoms

What medication is used to block dopamine receptors?

Chlorpromazine

What are some symptoms of depression?

• Depressed Mood

• Fatigue

• Decreased interest/pleasure

• Change in Weight/Appetite

Major Depressive Disorder

Feeling 5 or more symptoms of Depression for a period longer than 2 weeks

What is the heritability of MDD?

40%

Epigenetics

A potential mechanism for by which adverse stimuli (e.g., abuse) can result in persistent changes in the expression of inherited genes

What is used to research psychiatric disorders?

Research Domain Criteria (RDOC)

What are the components of RDOC?

• 6 domains of function

• 7 levels of analyses

• Context of development & environment

Negative Valence Systems

Responses to adverse situations such as anxiety, fear and loss

Loss Valence System

Response to a state of deprivation of a motivationally significant con-specific, object, or situation (e.g., shelter, behavioral control, status, loved ones, or relationships)

Connectomics

Brain areas that fire together are functionally connected

Resting State Functional Connectivity

Measure of baseline brain activity

Default Mode can affect what types of networks?

Task-positive networks

How can the resting state affect MDD?

• Increased connectivity in Default Mode

• Decreased connectivity in Task-Positive Networks

Why are Coritsol levels high with MDD?

Corticotrophin is high, leading to an increase in cortisol. Negative Feedback is decreased with MDD

What are the 2 components of CBT?

• Cognitive Restructuring/Reappraisal

• Behavioral Activation

Cognitive Restructuring/Reappraisal

Identifying and correcting inaccurate thoughts associated with negative emotion

Behavioral Activation

Helping patients engage with pleasurable activities

How does Cognitive Reappraisal work with Depression?

• Increases activation of lateral and medial pre-frontal cortex

• Decreases activation of the amygdala and medial-orbito frontal cortex

What 2 medications are used to treat Depression?

• Selective Serotonin-Reuptake Inhibitors

• Selective Norepinephrine- reuptake inhibitors

Which sex is more prevalent to anxiety disorders?

Females

Generalized Anxiety Disorder

Excessive anxiety or worry, most days for at least 6 months

What are some symptoms of Generalized Anxiety Disorder?

• Feeling restless

• Easily Fatigued

• Difficulty Concentrating

• Irritability

What percentage of adults experience GAD in their lifetime?

21%

Does GAD have high comorbidity?

Yes

Can we use RDOC for Diagnosis?

No

Potential Threat Valence System

Response to Potential Threats

Which disorder is most prevalent with Potential Threat Valence System?

Generalized Anxiety Disorder

Bed Nucleus of the Stria Terminals

Center of integration for limbic information and valence monitoring

Enhanced BNST activity is correlated with which Disorder?

Generalized Anxiety Disorder

Acute Threat Valence System

Activation of the brain to engage in behaviors that protect you from perceived danger

Which test is used to assess stress levels?

Trier Social Stress Test

Amygdala response is highest with what?

Social Phobia

What is the amygdala’s role in ‘bottom up’?

Detects relevant negative signals in environment

What is the anterior insula’s role in ‘bottom up’?

Interoception (subjective feeling state)

What are the top-down regions for emotion?

• Anterior cingulate cortex

• Dorsolateral prefrontal cortex

What is a predictor for a positive psychotherapy outcome?

Pre-frontal cortex and Amygdala connectivity

What are the effects of anxiolytics?

• Binds to GABA receptors

• Opens Chloride channels

• Chloride can enter cell

• Hyperpolarization of membrane

Principle of Antithesis

Opposite messages signaled by opposite behaviors

Darwins Six Core Emotions

• Anger

• Fear

• Surprise

• Disgust

• Happiness

• Sadness

Micro-Expressions

Unconsciously displaying a concealed emotion

Emotional Valence

The extent to which an emotion is negative or positive

Arousal

Intensity or strength of the emotional state

Modern Biopsychological View

• Perception of emotion-inducing stimuli

• Autonomic and somatic responses to the stimuli

• Emotional Response

Sham Rage

Removal of the cortex excited aggression

Lesioning in the hypothalamus led to a diminish in rage

Control-Question Technique

Physiological response to a target question compared with a response to a control question

What is the success rate of Control-Question Technique?

80%

Guilty-Knowledge Technique

Ask a question only the culprit would know the answer to

What is the success rate of Guilty-Knowledge Technique?

88%

Fear Conditioning

Pair a neutral stimulus with an aversive stimulus

How can fear conditioning be blocked?

Lesions in the amygdala

What is the amygdala’s role in Fear Conditioning?

• Adding emotional significance to stimulus

• Projects to brain stem regions that control emotional behavior output.

What parts of the amygdala are critical in Fear Conditioning?

Lateral and Central Amygdala

Corticolimbic System

• PFC suppresses conditioned fears

• Hippocampus mediates conditioned fear learning by giving context about event to lateral amygdala

Fear Acquisition

Tone is paired with shock in one environment, but fear/freezing generalizes to a new context

Fear Extinction

Tone given without shock in both environments and fear response is extinguished

What is clinical application of Extinction in humans?

Exposure Therapy

What is the role of the PFC in emotional regulation?

• Regulates emotional responses

• Inhibits inappropriate motor responses

• Regulates attention, thought, and action

• Error monitoring and reality testing

Which area of the brain is responsible for hormonal responses?

Hypothalamic Pituitary Adrenal Axis

Which area of the brain is responsible for neural responses?

Sympathetic Nervous System

What is the hormone released during a hormonal response to stress?

Cortisol

What hormones are released during a neural response to stress?

Norepinephrine & Epinephrine

What section of the brain is responsible for the neural and hormonal responses to stress?

Diencephalon

The Anterior Pituitary Gland

Releases hormones into general circulation and targets other glands and organs

What are the 2 types of Adrenal Glands?

Cortex & Medulla

Cortex Adrenal Gland

Secretes cortisol, androgens, and estrogens

Medulla Adrenal Gland

Secretes norepinephrine and epinephrine

What are the effects of Cortisol?

• Increases blood pressure

• Increases blood sugar level

• Suppresses immune function & inflammation

What are the effects of Epinephrine & Norepinephrine?

• Increase heart rate

• Increase blood pressure

What is the Hypothalamus responsible for the stress response?

Releasing Corticotropin-relasing hormone

What is the Anterior Pituitary responsible for the stress response?

Stimulates the release of the adrenocorticotropic hormone from the Anterior Pituitary Gland

What is the Adrenal Gland responsible for the stress response?

Releasing cortisol as a result of the ACTH

When is cortisol at its peak?

Near Awakening

Cortisol Awakening Response

A period of increased cortisol secretory activity initiated by awakening and peaking between 30 and 45 min after awakening

What is high Cortisol Awakening Response related to?

Job stress and General Life stress

What is low Cortisol Awakening Response related to?

• Fatigue

• Burnout

• Exhaustion

• PTSD

• Positive traits

According to Trier Social Stress Test, which gender shows higher levels of cortisol to the test?

Men

What are some examples of Animal Models of Stressors?

• Cold water restrain stress

• Predatory Stress

• Sleep Deprivation

What are the key dimensions of Stressors?

• Predictability

• Controllability

• Duration

What are the 3 stages of Addiction?

• Binge/Intoxication

• Withdrawal/Negative Affect

• Preoccupation/Intoxication

What are the neurological underpinnings of Binge/Intoxication?

Addictive drugs cause sharp increases in dopamine release

What is the main dopamine system in the brain?

The mesotelencephalic dopamine system

What are the 2 pathways of the mesotelencephalic dopamine system?

Nigrostriatal & Mesocorticolimbic Pathways

Drug Self-Administration Paradigm

Rat presses the lever to self-inject drug into brain