1 Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 11: Altered Mood, Attention, and Behavior
2 Regulation of Mood Mood: internal psychological state; emotionsStructures that regulate mood Hypothalamus: autonomic control in emotions Prefrontal cortex: judgment, decision-making Amygdala: emotionally charged memories Hippocampus: long-term memory Anterior cingulate cortex: empathy, impulse Cingulate gyrus: emotional memories
3 Key Brain Regions Involved in Mood Regulation
4 Regulation of AttentionCulturally influenced process of selectively concentrating on information Both a cognitive process and a behavior Involves different areas of the brain Reflexive attention (“bottom up”; RAS control) Executive processing (“top down”; frontal lobe) Visual attention
5 Regulation of Attention (cont’d)Types (simple to complex) Focused Sustained Selective Alternating Divided
6 Regulation of BehaviorHow people respond and act in a given situation Frontal lobe control Personality Perception Planning Self-awareness Judgment Mood Attention Memory Motivation Sexuality Expressive language
7 Alterations in Brain Structure and FunctionTraumatic brain injury Prefrontal cortex (social responsibility, concentration, abstract thinking, problem solving, emotional response) Amygdala (fear, aggression, social intelligence) Neurotransmission impairments Neurotransmitters (apathy, inattentiveness, motor deficits, agitation, restlessness, psychosis, anxiety, depression, obsessions, compulsions)
8 Recognizing Alterations in Mood, Attention, and BehaviorPatient history Reported observations of others Screening tools Mood Disorder Questionnaire American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) World Health Organization’s ICD-10
9 Categorical Traits (DSM-5)
10 Treatment Options Psychotherapy Pharmacotherapy CounselingAlternative/complementary therapies Individual or family support group
11 Application of Concepts of Altered Mood, Attention, and BehaviorGeneralized anxiety disorder Posttraumatic stress disorder Major depressive disorder Bipolar affective disorder Attention-deficit hyperactivity disorder Autism spectrum disorders Schizophrenia
12 Generalized Anxiety DisorderPathophysiology Clinical manifestations Diagnostic criteria Treatment
13 Generalized Anxiety Disorder OverviewAnxiety disorders A group of chronic psychiatric conditions characterized by overwhelming and irrational feelings of fear or worry Can cause physical symptoms Types Obsessive-compulsive disorders Trauma/stress-related disorders
14 Generalized Anxiety Disorder Overview (cont’d)Types of anxiety Panic disorder Generalized anxiety Social anxiety Phobias Separation anxiety Medication/illness-induced anxiety
15 Generalized Anxiety Disorder PathophysiologyIncreased response in amygdala to anxiety- provoking events Central nervous system mediators Norepinephrine, serotonin, dopamine, GABA Genetic factors Environmental factors
16 Generalized Anxiety Disorder Clinical ManifestationsWorry that is: Excessive Uncontrolled Irrational Lasting >6 months Includes at least 3: Restlessness Fatigue Difficulty concentrating Irritability Tension Sleep disturbance
17 Generalized Anxiety Disorder Diagnostic CriteriaHistory and physical examination Rule out medical or substance-abuse problem Standardized rating scales
18 Generalized Anxiety Disorder TreatmentCognitive-behavioral therapy Pharmacotherapy Selective serotonin reuptake inhibitors (SSRIs) Benzodiazepines Relaxation techniques (abdominal breathing)
19 Posttraumatic Stress Disorder (PTSD)Pathophysiology Clinical manifestations Diagnostic criteria Treatment
20 PTSD Pathophysiology An anxiety disorder caused by extreme traumatic events Military combat Concentration camp Violent crime Rape Abuse Risk factors Prior trauma Proximity, duration, severity Anxiety/depression Alcohol/drug abuse Family history Impaired support
21 Brain Regions Associated with PTSD
22 PTSD Clinical ManifestationsAdults Avoidance and suppression of thoughts/emotions Nightmares Flashbacks Children Separation anxiety Crying, screaming Trembling Regression Withdrawal Disruptive behavior Inattentiveness
23 PTSD Diagnostic CriteriaSymptoms present for at least 1 month Impaired functioning No other underlying medical condition Experiencing or witnessing traumatic event Persistently reexperiencing event Avoiding stimuli associated with event Exaggerated or impaired response
24 PTSD Treatment Psychotherapy PharmacologyTrauma-focused cognitive-behavioral therapy Eye movement desensitization and reprocessing Play therapy (for children) Pharmacology Antidepressants, benzodiazepines (anxiety), glucocorticoids (neurocellular homeostasis), anticonvulsants (impulsivity), clonidine (nightmares)
25 Major Depressive DisorderPathophysiology Clinical manifestations Diagnostic criteria Treatment
26 Major Depressive Disorder SubtypesSeasonal affective Postpartum Melancholic Catatonic Atypical
27 Major Depressive Disorder PathophysiologyPervasive and persistent low mood accompanied by low self-esteem and anhedonia (loss of pleasure) Biologic, psychologic, and social factors Genetic heritability (40% women, 30% men) Neurotransmitter deficiency Norepinephrine, dopamine, serotonin
28 Mechanism of Action of Antidepressant Agents
29 Major Depressive Disorder Pathophysiology (cont’d)Social and psychological influences Isolation Social rejection Loss or lack of significant relationships Poor family functioning Unemployment Poverty Abuse Alcohol/drug abuse Poor coping skills Low self-esteem Distorted thinking Low resilience
30 Major Depressive Disorder Clinical ManifestationsPersistent very low mood Anhedonia Feelings of worthlessness, guilt helplessness, hopelessness, and self-hatred Interruption in sleep patterns Unrelenting fatigue Changes in appetite, weight, sex drive
31 Major Depressive Disorder Diagnostic CriteriaHistory Reported observations by friends and family Mental status examination Ruling out physical conditions DSM-5 diagnostic criteria Onset of 5 or more symptoms persisting over a 2-week period
32 Major Depressive Disorder TreatmentPsychotherapy/counseling Antidepressant medications Selective serotonin reuptake inhibitors (SSRIs) Tricyclic antidepressants (TCSs) Monoamine oxidase inhibitors (MAOIs) Electroconvulsive therapy Alternate therapies
33 Bipolar Affective DisorderPathophysiology Clinical manifestations Diagnostic criteria Treatment
34 Bipolar Affective Disorder PathophysiologyPeriods of mania and depression Genetic inheritance Impaired brain functioning Psychological, environmental, social factors Childhood abuse Harsh home environment Disruptions in relationships
35 Bipolar Affective Disorder Clinical ManifestationsPeriods of mania lasting at least 1 week Elevation in mood or irritability Rapid and excessive speech Distractibility Racing thoughts Impaired judgment Impulsivity Periods of depression
36 Bipolar Affective Disorder Diagnostic CriteriaPatient history Reported observations by friends and family Mental status examination Ruling out physical conditions DSM-5 diagnostic criteria Seven subtypes
37 Bipolar Affective Disorder TreatmentPsychotherapy Pharmacology Mood stabilizers Lithium carbonate Sodium valproate Atypical antipsychotic drugs
38 Attention-Deficit Hyperactivity Disorder (ADHD)Pathophysiology Clinical manifestations Diagnostic criteria Treatment
39 ADHD Pathophysiology Neurodevelopmental disorder of cognitive functions, causing attention deficit, hyperactivity, and impulsiveness Genetic inheritance (75%) Environmental factors (brain infection/trauma) Changes in brain structure and function
40 ADHD Clinical ManifestationsInattention Hyperactivity Restlessness Impulsivity Disruptive behavior Difficulties in school oar work Difficulties in social situations
41 ADHD Diagnostic CriteriaPatient history Reported observations by friends and family Mental status examination Ruling out physical conditions DSM-5 diagnostic criteria Three subtypes
42 ADHD Treatment Psychotherapy Pharmacology Physical exerciseCognitive-behavioral therapy Behavioral therapy Pharmacology Stimulants Physical exercise
43 Autism Spectrum DisordersPathophysiology Clinical manifestations Diagnostic criteria Treatment
44 Autism Spectrum Disorders PathophysiologyNeurodevelopmental disorder with onset in early childhood Environmental and genetic factors Changes in brain structure and function
45 Autism Spectrum Disorders Clinical ManifestationsImpaired social interaction Impaired verbal and nonverbal communication Repetitive pattern of movement, interests or behaviors Poor muscle tone, incoordination, or toe walking Developmental regression
46 Autism Spectrum Disorders Diagnostic CriteriaClinical manifestations Screening tools DSM-5 criteria
47 Autism Spectrum Disorders TreatmentTherapies Speech Occupational Physical Cognitive-behavioral Language training
48 Schizophrenia Pathophysiology Clinical manifestationsDiagnostic criteria Treatment
49 Schizophrenia PathophysiologyA psychotic mental health disorder that affects how patients perceive the world Complex interplay among: Genetics (family history) Perinatal risks Socioenvironmental triggers Changes in brain structure and function
50 Familial Nature of Schizophrenia
51 Schizophrenia Clinical ManifestationsHallucinations Hearing voices Delusions Disorganized thoughts and speech Social withdrawal Poor hygiene Poor judgment Loss of motivation Paranoia Impairments of Memory Attention Cognitive processing
52 Schizophrenia Diagnostic CriteriaPatient history Reported observations by friends and family Comprehensive clinical assessment Ruling out physical conditions At least 2 indicators (delusions, hallucinations, or disorganized speech) for at least 1 month, with significant impact on school, work, or home for at least 6 months
53 Schizophrenia TreatmentPharmacology Antipsychotics Psychological and social support