Week 11

• Mental health


  Refers to a person's cognitive, behavioural, and emotional well-being, and how this affects how they react to stressors, engage with others and make choices
• Mental health


  • Covers a range of functions including emotions, moods, thoughts and behaviours
  • Normally responses to cues from our environment which comes from experiences and interactions that develop our perceptions
  • Impacts on a person's ability to manage existing health conditions while maintaining ongoing wellness and happiness
  • Describes our status at any point in regarding effective functioning in daily activities leading to productive activities, healthy relationships, and the ability to adapt to change and cope with adversity
• Mental health disorder


  Describes the presence of a health condition that is characterised by changes in emotion, mood, thinking or behaviour that are persistent, associated with distress and/or disablement, and interfere with functioning in social, work or family activities/life
• Mental health disorder


  • Helps us to distinguish what are normal responses and processes in regulating mental health versus what is a dysfunctional process as part of a mental health disorder
  • Sometimes people talk about being worried or stressed - these terms may be used interchangeably with anxiety, so it is important to clarify if it is specific or general concern, based on something that has actually happened, is about to happen or may potentially happen in future, what the patient is actually feeling and thinking, if it is persistent, and if it is interfering with daily life
• Psychology


  The study of the mind, emotions and behaviours, examining the cognitive and social factors that influence people's actions and reactions
• Psychology


  • Psychologists employ a variety of therapeutic techniques to help patients heal from trauma and improve their mental health
  • Psychologists must earn a bachelors degree, a masters degree and a doctoral degree in psychology
• Psychiatry


  A branch of medicine focused in diagnosing and treating mental health disorders, using psychotherapy and medication
• Psychiatry


  • The term literally means the medical treatment of the soul
  • Psychiatrists use psychotherapy to help clients, and also understand how biological factors into a person's mental health and how to treat mental illness with medication
  • To become a psychiatrist, candidates must first complete a medical degree - all psychiatrists are trained doctors, and therefore are able to formally diagnose and prescribe treatment
  • Prospective psychiatrists study pharmacology, anatomy, biology, neurology and disease, acquiring the knowledge necessary to prescribe medication
• Therapist


  A credentialled counsellor - someone who has been trained to talk with people who need mental health support, may be trained/credentialed to provide general or more specific types of support, most clinical psychologists are also regarded to be counsellors/therapists, although they are much more specialised in the types of support and therapy they provide, pharmacists may also be credentialled as counsellors
• CNS structures and function

  • The hypothalamus, hippocampus and amygdala are the regions of the brain most commonly associated with mood
  • Dopamine, serotonin and noradrenaline are all involved in mood, motivation and movement
• Synaptic features


  • One key feature is how these synapses are cleared of neurotransmitter
  • DAT, NET and SERT are proteins which bind to their specific neurotransmitter and reinternalize it for either reuse or enzymatic degradation
  • Each synapse also has an auto-receptor
• Psychosis


  Term used to describe conditions that affect the mind where there has been some loss of contact with reality
• Psychosis


  • Hallucinations: sensing things that are not present, like hearing voices or seeing things that others do not
  • Delusions: strong beliefs that are not based in reality, like thinking one has extraordinary powers or is being persecuted
  • Disordered thinking: trouble organising thoughts or connecting them logically
• Hallucinations can affect any of the senses, even touch
• Causes of psychosis


  Complex interactions between genetic, biological and environmental factors
• Underlying conditions that can lead to psychosis

  • Genetic conditions
  • Neurotransmitter imbalances
  • Environmental factors
  • Physical conditions and illnesses
• The dopamine hypothesis suggests that psychosis may arise from an overactivity of dopamine in certain brain regions
• Transient psychosis


  Usually triggered by extreme stress, substance use or medical conditions. These episodes are typically brief and may resolve with treatment of the underlying cause or spontaneously without intervention
• Persistent psychosis


  Typically accompany conditions like schizophrenia. Persistent psychosis is a more enduring symptom and requires ongoing management
• Schizophrenia


  • Positive symptoms: additions to one's experience, including symptoms of psychosis
  • Negative symptoms: take away from the individual's ability, characterised by a decrease in normal functions
  • Cognitive symptoms: problems with thought processes
• Negative symptoms are often more persistent than positive symptoms and are harder to treat
• Cognitive symptoms often present in teenage years and can be the most challenging to recognise and measure
• Onset of schizophrenia


  Combination of genetic predispositions and environmental factors. Linked to critical periods of brain development, including synaptic pruning and changes in neurotransmitter systems
• Early stages of schizophrenia

  • Prodromal phase: subtle symptoms start to emerge, such as social withdrawal, unusual behaviour, an increase in vague and abstract thinking, a drop in academic or work performance, and diminished personal hygiene
• Differences between males and females in schizophrenia

  • Males tend to experience earlier onset
  • Females have a somewhat better functional outcome
  • Males are more likely to exhibit negative symptoms
  • Females tend to present more often with affective symptoms
  • Males generally experience a more continuous and disabling course
  • Females tend to have a more episodic course
• There are more than 100 potential susceptibility genes known and many are involved in neuronal development, glutamatergic function and synaptic connectivity
• Chlorpromazine was the first medicine used for the treatment of psychosis
• Dopaminergic action of typical or first-generation antipsychotics

  Primarily block D2 receptors, reducing dopaminergic activity
• Pathways affected by dopamine and associated effects

  • Mesolimbic pathways: positive symptoms of schizophrenia
  • Mesocortical pathway: negative and cognitive symptoms
  • Nigrostriatal pathway: movement disorders
  • Tuberoinfundibular pathway: increased prolactin levels
• Extrapyramidal side effects of first-gen antipsychotics

  • Dystonia: painful and prolonged muscle contractions
  • Akathisia: subjective feeling of restlessness and urge to move
  • Pseudoparkinsonism: Parkinson's-like symptoms
  • Tardive dyskinesia: involuntary, repetitive and purposeless movements
• Second-generation antipsychotics (SGAs)


  Antagonise both dopamine D2 receptors and various serotonin receptors, including 5-HT2A
• SGAs don't bind as tightly to D2 receptors as first-generation antipsychotics
• Receptor binding profiles of antipsychotics


  Contribute to their therapeutic effects and adverse event profiles
• Adverse effects associated with receptor binding

  • Dopamine D2 receptors: extrapyramidal symptoms and hyperprolactinaemia
  • Serotonin 5HT1A receptors: possible role in circadian rhythm and hallucinations
  • Serotonin 5HT2A receptors: metabolic syndrome, gastrointestinal side effects, libido and sexual dysfunction
  • Serotonin 5HT7 receptors: possible role in circadian rhythm, mood, thermoregulation, learning, memory and endocrine regulation
  • Alpha-adrenergic-alpha-1 receptors: sedation, tachycardia, dizziness and orthostatic hypotension
  • Histamine H1 receptors: sedation, weight gain and impaired cognition
  • Muscarinic M1 receptors: anticholinergic side effects
• Metabolic side effects of SGAs

  Antagonism at H1 receptors in combination with 5HT2C blockade leads to increased appetite and weight gain, which exacerbates the cardiometabolic risk. Blockade of muscarinic M1, histaminergic H1 and alpha-1 adrenergic receptors contributes to sedation.
• Goals of treatment in schizophrenia

  Symptom control and prevention of relapse. Improvement of functional capacity.
• D2 receptors, alpha-1 adrenergic receptors

  • Related to arousal pathways in the CNS, contribute to antipsychotic-induced sedation
• Second generation antipsychotics (SGAs)

  • Act upon two or three pathways such as clozapine and quetiapine, are the most sedating
• Sedation during maintenance treatment

  Leads to diminished functions, reduced physical activity and cognitive impairments
• SGAs


  Linked to increased food intake, resulting in weight gain, dyslipidaemia, which increases total cholesterol, hypertriglyceridemia and increased risk of type 2 diabetes