Physio/Psychopharm

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Neurons: Nerve cells = cell body, axon, and dendrites.
We lose 10,000 brain neurons per day. Less than 2 % are lost by age 70.
Action Potentials: Cell depolarized = action potential occurs (either IPSP or EPSP).
Conduction within a cell is electrical while synaptic transmission is chemical.
All or none governs AP's - meaning either cell receives enought stimulation to fire completely or it doesn't fire. Intensity only causes AP's to fire faster, strength stays the same.
Structural Techniques: have you lost cells in the brain: Computed Tomography (CT)= x-rays of horizontal slices of the brain.
Magnetic Resonance Imaging (MRI)- magnetic fields/radiowaves to produce cross sectional images of the brain
Functional Techniques: how active/inactive are areas of the brain: 1. Positron-Emission Tomography (PET)-radioactive sub. taking up by active parts in brain.
2. Single Proton Emission Computed Tomography (SPECT)-similar to PET, less expensive and less detailed.
3. Functional MRI-metabolic activity produced about brain.
Neurotransmitters: ACh
Catecholamines (3)
Serotonin
GABA
Glutamate
Endorphins
ACh-has to do with?: Cholinergic neurons secrete ACh (3)
1.-voluntary movement
(Myasthenia gravis-results
in weakness of skeletal
muscles-ACh attacked)
2.-sleep-wake cycles
3.-memory

Low ACh = Memory loss/Alzheimer's Dementia

Nicotine mimicks ACH in the brain (alertness and memory)
Catecholamines 1. (Norepinephrine- nonadrenaline) 2. Epinephrine (adrenaline) 3. Dopamine *catecholamine hypothesis * dopamine hypothesis: Involved w/(4): Personality/Mood/Memory/Sleep

1.)Norepinephrine-
-Fight or Flight
-High NE =
Mania/schizophrenia
-Low NE = depression
Catecholamine hypothesis links depression w/ low NE.

2. Dopamine- Vol. mov. & mood
-Low DA = depression & Parkinson's (degeneration of substantia nigra neurons).
-High DA = schizophrenia/Tourette's/SAD
Dopamine hypothesis links schizophrenia w/ high DA.
Serotonin (5-HT)-has to do with?: Involved with (5):
Hunger/thirst
sex
sleep
mood (aggression)
migraine headache

High 5-HT = schizophrenia/autism/anorexia
Low 5-HT = depression/suicide/OCD/PTSD/ bulimia
GABA-has to do with?: Gamma-aminobutyric acid
Low GABA results in: seizure/anxiety/Huntington's disease.
Low GABA = anxiety & Huntington's Chorea (invol. basal ganlia/jerky mov.).
Glutamate-has to do with?: Learning and memory/(Long-term potentiation)
High Gluamate = "excitotoxicity" seizures, stroke-related damage.
High gluamate in Huntington's & Alzheimer's
Endorphins-have to do with?: Analgesic effects
-pain relief "acupuncture"
-plearsureable experiences "runner's high"
-control of emotions
-sexual beh.
Paraplegia (thoracic level): Legs paralyzed only
Spinal cord severed at T1 or below.
Quadriplegia (cervical level): All four limbs paralyzed
Spinal cord severed between C1 and C5.
Sensory and motor function lost.
Hemiplegia: Right or left side paralyzed.
Paresis: Slight or parital paralysis
Paresthesia Hyperesthesia: Ab sensations -(numbness, tingling, or burning.)
Hyperesthesia- ab. sensitivity to sensation
What happens if spinal cord severed at C6 or C7?: paraplegia- (legs paralyzed) & partial paralysis of arms (Paresis).
Spinal Cord involves?: 31 pairs of spinal nerves/ 5 types:
12 thoracic
8 cervical
5 lumbar
5 sacral
1 coccygeal
1.Brain: Hindbrain Midbrain Forebrain 2.Spinal Cord: Make up the CNS.
PNS made up of?: 1.Somatic Nervous System (SNS)-Info from senses & vol. movements.
2. Autonomic Nervous System (ANS)-automatic bodily functions..smooth muscles and glands.
A. Sympathetic Branch- fight or flight response
B. Parasympathetic Branch-energy conservation & "house keeping" bodily functions/ (Rest/relaxation).
CNS Hindbrain & Midbrain: Hindbrain (2):
1. Medulla-controls important reflexes (e.g., coughing/swallowing), & breathing/heart rate/bld. pressure. Damage to medulla is fatal!
* Pons connet two halves of the cerebellum.
2. Cerebellum- posture/balance & plays role in motor learning (walking, riding bikes). Damage to cerebellum causes Ataxia-tremors, slurred speech, loss of balance (drunk-like).

Midbrain:
1. Reticular Formation-sleep/wakefulness, motor mov., pain perception, & some reflexes (cardiac).
*Contains the ASCENDING RETICULAR ACTIVATING SYSTEM (ARAS)- vital to consciousness/3A's:
awareness/arousal/attention. Damage can produce permanent coma-like state of sleep.
CNS Forebrain Diencephalon: Thalamus & Hypothalamus: Thalamus-
-"relay station" for all senses except olfaction which goes directly to amygdala.
-Involved in memory (e.g., Wernicke-Korsakoff syndrome-thiamine deficiency, involves ante/ret-rograde amnesia & confabulation.)
2. Hypothalamus-
-Maintains body's internal HOMEOSTASIS & five f's regulating endocrine system- e.g., fever (temp), feeding (hunger/thrist), fornicating (sex), fighting (aggression-regulate emotional reactions), and falling asleep (sleep/wake cycle/seasonal cycle =suprachiasmatic nucleus (SCN).
-Mammillary bodies= memory
*Damage may result in uncontrollable laughter or rage.
CNS Forebrain Telencephalon: 1.basal ganglia, 2.limbic system, 3.cerebral cortex: 1. Basal ganglia- caudate nucleus/putamen/globus pallidus.
-important in org./coordinating vol. movement & in motor learning.
Abnormalities found in Huntington's/Parkinson/Tourette's D/O.
2. Limbic system -(amygdala/hippocampus)
-amygdala controls emotional reactivity & attaches emotion to memory.
Damage to amygdala results in Kluver-Bucy-reduced aggression/fear, increased docility, hypersexuality, psychic blindiness, & compulsive oral beh.
Hippocampus-Involved in processing only, not storing...(consolidation of declarative memories-STM to LTM). Small hippocampuses linked w/depression & PTSD.
Forebrain Telencephalon: Cerebral Cortex (Frontal Lobe): Frontal lobe-
1.primary motor cortex
2.prefrontal cortex (emotions, self awareness, & EF)
3.Broca's area-speech production.

Damage-motor impairments (reflexes/muscle tone), EF deficits, personality changes (pseudodepression & pseudopsychopathy-neurological damage), & Broca's (expressive) aphasia.
Forebrain Telencephalon: Cerebral Cortex (Parietal Lobe): Parietal Lobe-
1. somatosensory cortex-intergrates tacitle, visual, & auditory stimuli
Damage:
-anosognosia-inability to recognize own D/O.
Right side damage:
dressing apraxia & contralateral neglect of left side of body.
Left side damage:
ideational apraxia (no sequence actions)
ideomotor apraxia (no simple action in response to command)
Gerstmann syndrome-AADA
agraphia-no writing
acalculia-no math
right-left disorientation
finger agnosia (can't recognize).
Forebrain Telencephalon: Cerebral Cortex (Temporal Lobe): Temporal Lobe
1.auditory cortex-auditory sensations and perceptions
2. Wernicke's area-comprehension of lang.
Damage:
-auditory agnosia-(can't recognize familar sounds)
-auditory hallucinations
-impaired declarative memory (ante/ret-rograde amnesia)
-Wernicke's (receptive) aphasia- severe deficits in lang comprehension & ab. lang. production.
Forebrain Telencephalon: Cerebral Cortex (Occipital Lobe): Occipital Lobe-
1. visual cortex-visual sensations and perception. perception/recognition/memory

Damage-
-visual agnosia (can't recognize familar objects)
-visual hallucinations
-cortical blindness
Left side damage:
simultanagnosia- can't see more than one thing at a time)
Lesions at the junction of the Occipital/Temporal/Parietal lobes = prosopagnosia- (can't recognize familiar faces)
Hemispheric Specialization: Left (Dom.) hemisphere- controls written/spoken lang.
verbal memory
logical/rational/abstract thinking
postive emotion

Right (nondom) hemisphere-
facial recognition
nonverbal memory
creative/intuitive
negative emotion
Contralatereral reprensentation: -left hemisphere controls the functions of the right side of the body and vice-versa.
"spilt -brain" patients- corpus callosum cut/
-deficits in ability to verbally identify info presented to RIGHT hemisphere only....
-Right eye/left brain/right body movement (lang.)
-Left eye/right brain/left body movement. (no lang.)
Color Blindness: Trichromats-normal color vision:three visual pigments
Dichromats- lack one of three visual pigments (red/green blind).
Monochromats- no color/rods only.

-Sex linked recessive trait located on X chromosome (thus males more prone).
Females must inherit trait from both parents/ male inherits color-blind trait if mom is a carrier.
Role of memory in the following brain locations: cerebellum & basal ganglia Hippocampus Amygdala Temporal lobe Prefrontal Cortex: Cerebellum & basal ganglia-responsible in procedural memory (how to).
Hippocampus-Memory consolidation
Amygdala-attaches emotion to memory
Temporal Lobe-long-term storage of declarative memories.
Prefrontal Cortex-short-term memory/episodic memory/ prospective memory.
Long-term potentiation (LTP): LTP_first obs. in hippocampus and involved in formation of long-term memories/depends upon protein synthesis/which depends upon RNA.
-LTP refers to increase in prolonged neural activity following high freq. activity (e.g. learning). What's the consequence of LTP- changes brain structures/existing synapses change/new receptor sites added/increased cell sensitivity.
Damage to language production/comprehension called aphasia.: 1. Broca's (expressive) Aphasia- diff. producing lang. while comprehension remains intact./aware of deficits.
-slow, labories speech, poor articulation, omissions, anomia, probs. repeating phrases.
2. Wernicke's (receptive) aphasia-impaired production and comprehension of lang./unaware speech is meaningless. Paraphasia-substitution words related in sound or meaning)/ speech rapid, effortless & devoid of content.
3. Conduction (associative) aphasia-damage to arcuate fasciculus (connects Wernicke's and Broca's areas).Comprehension stays intact, production problematic (anomia and inabilty to repeat words or simiple phrases.)

What do all 3 have in common: inability to repeat words spoken by somone else and anomia (can't name objects.)
Brain Structures and emotion:: 1.Hypothalamus-strong emotions (rage, uncontrollable laughter).
2.Amygdala-emotional reactivity (fear/rage);attach emotion to memories.
3.Frontal lobe-internal experience of emotion.
Left hemisphere is damaged-emotional consequences catastrophric anxiety reactions.
If damaged in right hemisphere-obs apathy, paranoia, or undue cheerfulness.
Theories of Emotional Experience.: James-Lange Theory-emotions are a result of bodily reactions. (Support from quadriplegics exp. less intense emotion following injury).
Cannon-Bard theory-emotion and bodily reactions occur simultaneously.
Schachter & Singer Two-factor theory-emotion consequence of: physio arousal/cognition/environmental context. Support from Schachter & Singer's epinephrine study.
Selye-General Adaptiation syndrome (GAS)/people respond to stress in the same way.: GAS-adrenal and pituitary glands
1. alarm-epinephrine (adrenaline released)
2. Resistance- stress cont. ACTH activates cortisol.
3.Exhaustion-prolonged stress, ilness sets in.
Neurobehavioral Disorders: Head injury-(most common cause of brain damage in those 40yrs. of less). Post-Concussional D/O Cerebral vascular accident: 1. Head injury=may cause concussion w/ ante/ret-rograde amnesia, motor problems, and personality change.Best predictor-duration of anterograde amnesia/ most recovery occurs w/in 6-9mths.
2. Post-Concussional D/O= must have the following: 1. loss of consciousness/amnesia/ or seizure following head injury 2. persisting deficits w/ attention & memory 3. three of more of symptoms lasting at least 3mths. (irritability, fatigue, depression, headaches, dizziness...)
3. Cerebral Stroke-brain damage resulting from interruption of bld. flow. (50% die immediately or w/in months. Only 10% fully recover). Greatest improvement occurs in first 6mths-physical come back quicker than cog. Risk factors for stroke:
-arteriosclerosis-hardening of arteries
-hypertension.
Symptoms depend on artery and brain location. Often include hemiplegia (paralysis on one side), contralateral sensory loss (opposite side of effected hemisphere), slurred speech, dizziness, and confusion.
Disorders of Movement: Parkinson's/Huntington's Chorea: 1.Parkinson's-degenerative disease (age of onset 50yrs.) Begins in hands & involves tremor, muscle rigidity, akathesia (cruel restlessness), bradykinesia (slow vol. mov/speech), loss of coordination, and cog. impairments (50% will dev. dementia). Caused by degeneration of dopamine/temporarily relieved by L-dopa. Substantia nigra involved, then basal ganglia.
2. Huntington's Chorea-fatal inherited disease (age of onset 30 to 40). Early symptoms include depression and apathy, forgetfulness, fidgeting. Later symptoms = athetosis (slow, writhing mov.) and chorea (-jerky invol. mov). Due to low GABA in basal ganglia and high glutamate. Remember: 1. affective-irritability, depression, apathy (awareness coupled w/poor impulse control=suicidal risk). 2. Cognitive-forgetfulness-progresses to dementia 3.Athetosis & Chroea
Symptoms of brain tumor:: 1. headaches 2. seizures 3. nausea/vomiting 4. change in vision/ hearing 5. focal neurological signs
Child tumor-brainstem and cerebellum.
Adult tumor-cerebral cortex
Seizure D/O:: 1. Tonic-clonic (grand mal) seizures: ab. change of electrical energy in brain. Tonic stage-muscles contract/body stiffens.
Clonic stage-rhythmic shaking of limbs.
Post seizure depression/confusion w/amnesia for seizure.
Bi-lateral
2. Absence (petit mal) seizure-loss of consciousness w/out motor symptoms.
3. Partial seizure-one side of brain/
Simple partial seizures-no loss of consciousness.
Complex partial seizures-(most common type/onest around puberty) some loss of consciouness.
Headaches:: Migraine-Involve severe throbbing unilateral w/nausea, vomiting, and sensitivity to light/noise. Classic begins w/aura (focal neur. symptom) while common begins with gastrointestinal symptoms. Triggered by stress/relaxation after stress, alcohol, certain foods (tyramine) beer, wine, aged cheese, soy sauce, tomatoes, avocadoes.
Cluster headache- excuriating nonthrobbing pain behind one eye (burning) occurs in clusters/bursts one or more days over two to three month period.
Tension headache-nonthrobbing band around head-both sides of head/back of neck.
Sinus headache-fullness, tension, or throbbing ache over eyes. Infection of sinuses/worse in AM/ made worse by bending forward.
Hypo/Hyper thyroidism: Hypothyroidism-hypo/low secretion of thyroxin. Symptoms-bradycardia (slow heart rate), cold intolerance, confusion, impaired attention/memory, depression, fatigue, and weight gain.
Hyperthyroidism-(Graves Disease) hypersecretion of thyroxin. Symptoms-tachycardia (racing heart), heat intolerance, impairmed attention, restlessness, emotional liability/mania, and insomnia, increased appepitite and weight loss
Gonadotropic hormones/ovaries & testes =(gonads) -Pituitary gland and gonads primary source of sex hormones.: estrogen-Ovaries
progesterone-ovaries
testosterone-testes
androstenedion-testes

Estrogen and androgen secreted by both sexes, but females produce more estrogen while males produce more androgens.
-Increace of gonads influence dev. of secondary sex characteristics.
Effect of spinal cord injury on sexual functioning: ejaculation affected (esp in complete lesions). Sexual appetite and interest remain unaffected.
Stages of sleep 1-alpha waves-relaxed state 2-theta- 3-delta 4-predominantely delta 5-REM Beta fully alert and awake.: 5 stages: 4-non-rem,
5th stage = REM -stressful nature of REM sleep, heart attacks, acute worsening of ulcers, and other medical ER are more likely to occur here. REM sleep also called paradoxical sleep.
Pass through all five stages every 90 to 100 minutes (4 to 6 times a night)-REM periods increase in length as night progresses.
Total sleep time, stage 4 sleep (deep sleep), and REM sleep all decrease from childhood to adulthood.
infants REM= 50%, adults = 20%.
Alexia vs. Dyslexia: Alexia is word blindness caused by acquired brain lesion.
Dyslexia is a learning disability (not lesion).
Antipsychotics 1. Traditional *neuroleptics -block dopamine /supports dopamine hypothesis: 1. Traditonal include: (faster onset)
chlorpromazine (Thorazine)
thioridazine (Mellaril)
haloperidol (haldol)
Most effective for positive symptoms in schizophrenia.
Side effects:
1.anticholinergic effect (dried up/stopped up w/ tachycardia-racing heart).
extrapyramidal effects (akathesia/restlessness, parkinsonism/mask-like face, hand tremors/rigidity/slow mov., tardive dyskinesia/rep. oral mov./tongue mov./spasms of neck and head/jerky mov. of limbs.)-TS irreversible by slowing of meds.
3.neuroleptic malignant syndrome-rare/deadly, muscle rigidity, tachycardia, hyperthermia, alt. concisounsness. Stop taking med. immediately for NMS.
Antipsychotics 2.Atypical (novel) -act on dopamine, serotonin, and NE.: 2. Atypical include:
clozapine (Clozaril)
risperidone (Risperdal)
Effective for pos. and negative symptoms of schizophrenia.
Less likely to cause Tardive Dyskinesia.
Side Effects:
1.anticholinergic effects (dried up/stopped up w/racing heart)
2.lowered seizure threshold
3.sedation
4.agranulocytosis (bld. disease)
5.neuroloptic malignant syndrome (NMS)-deadly.
6.Akathisia (extreme motor restlessness still common)
Antidepressants: SSRIs TCAs MAOIs: 1. SSRIs- include:
fluoxetine (Prozac)
sertraline (Zoloft)
paroxetine (Paxil)
*Good for melancholic depression, OCD, bulimia, Panic D/O, PTSD.

Block reuptake of serotonin
7 to 10 day onset
Side effects:
insomnia, anorexia, sexual dysfunction, gastrointestinal dist.
* less cardiotoxic
* less cognitive problems
* less anticholinergic effects.
* hard to overdose on

2.TCAs (tricyclics) include:
doxepin (Sinequan)
imipramine (Tofranil)
clomipramine (Anafranil)
*good for vegetative, somatic symptoms, OCD, Panic D/O, Bulimia, enuresis in children.

Block reuptake of norepinephrine, serotonin, and/or dopamine. Support catecholamine hypothesis.
21 day onset

Side effet: cariotoxic (tachycardia, plapitations, hypertension, severe hypotension, cardiac arrhythmia. anticholinergic symptoms (dried up/stopped up), gast. dist., confusion/memory problems, sexual dysfunction
*easy to overdose on

3. MAOIs (monoamine oxidase inhibitors)include:
phenelzine (Nardil)
tranylcypromine (Parnate)
*Good for treating non-endogenous and atypical depression w/anxiety, reversed vegetative symptoms (hypersomnia).
Blocks/Inhibits enzyme monamine oxidase which de-activates dopamine, norepinephrine, and serotonin =thus, makes them more available!

Side effects: anticholinergic symptoms, insomnia, headaches, tremor. Most serious side effect called hypertensive crisis-(severe headaches, elevated bld. pressure, possible convulsions)/ MAOI taken w/barbiturates, amphetamines, antihistamines, or foods w/tyramine (aged cheese & meats, beer, red wine, chicken liver, avocadoes, bananas, fava beans.)
Mood Stabilizers: lithium and anticonvulsant drugs: Include:
Lithium
carbamazepine (Tegretol)
valproic acid (Depakote)
clonazepam (Klonopin)
*Good for Bipolar D/O (anticonvulsant (tegretal) good for those who have not responded to lithium.
-Affects reuptake of serotonin and norepinephrine

Side Effects: for lithium-nausea, polydipsia (drink a lot) and polyuria (urinate a lot), cog. impariments and fine hand tremors.
Lithium toxicity-bld. monitoring important/symtoms include vomiting, confusion, seizures, slurred speech, coma, & death.
Side effect for carbamazepine (tegretol)-lethargy, tremor, ataxia (clumisness), and visual dist. Bld. monitorig required/ not good for people with poor Cardiovascular health.
Anxiolytics (minor tranqualizers) include benzodiazepines: Include:
alprazolam (Xanax)
chlordiazepoxide (Librium)
diazepam (Valium)
Good for anxiety, insomnia, tremor.
Addictive-30 day maximum use
Increases GABA levels to slow you down.

Side effects: drowsiness and sedation, confusion/disorientation, paradoxical agitation, rebound excitation, addictive w/chronic use.
Beta-Blockers: Include: propranolol (Inderal)
Good for anxiety, hypertension, angina, migraine, glaucoma.
reduce sympathetic NS activity by by blocking receptor sites for epinephrine and NE.

Side Effects: bradycardia (slow heart), hypotension, sexual dysfunction, depression & memory impariment w/long-term use.
Psychostimulants:: Include:
methylphenidate (Ritalin)
pemoline (Cylert)
Aderall
Good for ADHD
Increase norepinephrine and dopamine-make available

Side effects: dysphoria, insomnia, decreased appetite, tics, obsessive-compulsive syndrome, growth suppression.
Don't use for child w/tic D/O.
If dev. tics while on drug-remove drug. Wellburtin good alt. for side effects.
Drug holidays help w/growth.

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