NEUROPSYCHIATRIC DISORDERS

Submitted to- Submitted by-Department of Zoology Bhavya VashishtKurukshetra University M.Sc. Zoology(F)Kuruksherta Semester IV Roll No.4

Contents• Introduction• Causes• Types1. Anxiety and attention deficit hyperactivity disorder2. Borderline Personality Disorder3. Multiple Sclerosis4. Guillain–Barre syndrome5. Parkinson’s Disease6. Alzheimer’s Disease7. Progeria8. Ischemia• Conclusion

Introduction• Neuropsychiatry is a field of scientific medicine that concerns itself with the

complex relationship between human behavior and brain function, and endeavors to understand abnormal behavior and behavioral disorders on the basis of an interaction of neurobiological and psychological–social factors.

• These disorders studied under this are called Neuropsychiatric Disorders. These are-

Related to dopamine transport (as in Anxiety and attention deficit hyperactivity disorder)

Due to brain abnormalities, Adverse childhood experiences,( as in BPD) Due to damage in Myelin Sheath (as in Multiple Sclerosis and Guillain–Barre

syndrome) Oxidation of molecules such as iron and environmental toxins (as in Parkinson’s

disease) Abnormalities in Parts of Brain (as in Alzheimer’s disease) Point mutation (as in Progeria)

Anxiety and attention deficit hyperactivity disorder

• Most frequently diagnosed of all neuropsychiatric disorders.• It can continue through adolescence and childhood• Symptoms include difficulty staying focused and paying attention,

difficulty in controlling behaviour etc• ADHD patients has less active frontal lobes of brain which control motor

function, reasoning, judgement, memory etc.

Symptoms• Inattention ( 6 or more)

Often fails to give close attention to details

Often has trouble holding attention on tasks or play activities.

Often does not seem to listen when spoken to directly.

Often does not follow through on instructions and fails to finish schoolwork,

chores, or duties in the workplace

Often has trouble organizing tasks and activities.

Often avoids, dislikes, or is reluctant to do tasks that require mental effort over

a long period of time

Often loses things necessary for tasks and activities

Is often easily distracted

• Hyperactivity and Impulsivity (6 or more)

Often leaves seat in situations when remaining seated is expected.

Often runs about or climbs in situations where it is not appropriate

(adolescents or adults may be limited to feeling restless).

Often unable to play or take part in leisure activities quietly.

Often talks excessively.

Often blurts out an answer before a question has been completed.

Often has trouble waiting his/her turn.

Often interrupts or intrudes on others

Causes• The dopamine transporter pumps dopamine out of the synapse back

into cytosol. Dopamine reuptake via DAT provides the primary mechanism through which dopamine is cleared from synapses.

• The rate at which dopamine transporter(DAT) removes dopamine from the synapse can have a profound effect on the amount of dopamine in the cell. The amount of dopamine is reduced that cause ADHD

Treatment

• Benzodiazepines are the most widely prescribed drugs for the treatment of anxiety

• They have side effects like sedation, memory impairment, and dependence.

Borderline Personality Disorder (BPD)

According to I.C.D. by WHO:

Emotionally Unstable Personality Disorder: Personality disorder whose essential features are a pattern of marked impulsivity and instability of interpersonal relationships, and self image.

According to D.S.M. by (APA):

Borderline Personality Disorder: Pervasive pattern of instability in interpersonal relationship, self image and affects, as well as marked impulsive behavior.

BPD Symptoms• Emotions • Self-harm and suicidal behavior• Interpersonal relationships• Sense of self• Cognitions

BPD Causes• Brain abnormalities – less active Prefrontal cortex (regulate emotional

arousal), smaller Amygdala (generation of negative emotions), smaller Hippocampus (memory)

• Adverse childhood experiences• Family environment

DiagnosisAccording to DSM (5 should be present)

Frantic efforts to avoid real or imagined abandonment. A pattern of unstable and intense interpersonal relationships

characterized by alternating between extremes of idealization and devaluation.

Unstable self-image or sense of self. Impulsivity in at least two areas that are potentially self-damaging Recurrent suicidal behavior, gestures, or threats, or self-mutilating

behavior. Affective instability due to a marked reactivity of mood Chronic feelings of emptiness. Inappropriate, intense anger or difficulty controlling anger

Treatment• Psychotherapy– Removing, modifying or retarding existing symptoms. – Medicating disturbed pattern of behavior.– Promoting positive personality growth and development.

• Medications– Haloperidol (reduce anger)– Flupenthixol (reduce suicidal behaviour)– Aripiprazole (reduce depression)

Multiple Sclerosis• Multiple sclerosis is an inflammatory disease in which the

insulating covers of nerve cells in the brain and spinal cord are damaged.

• This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms, including physical, mental and sometimes psychiatric problems.

Symptoms

Causes

• Geography• Genetics• Infectious agents• Pathophysiology (lesions)

Treatment

• methyl prednisolone (intravenous corticosteroid)

• glatiramer acetate (first line treatment)• Natalizumab reduces the relapse rate

Guillain–Barre syndrome (GBS)

• Guillain–Barre syndrome (GBS) is a medical condition in which there is a rapid-onset weakness of the limbs

• The disease is usually triggered by an infection which provokes immune-mediated nerve dysfunction

• Guillain–Barré syndrome is rare, at one to two cases per 100,000 people annually.

Symptoms

Weakness of the legs and arms Muscles of the neck may also be affected Weakness of the muscles of the face Swallowing difficulties Weakness of the eye muscles Respiratory failure

Causes• Infection by Campylobacter jejuni,Varicella zoster , Mycoplasma

pneumoniae

• The nerve dysfunction in Guillain-Barré syndrome is caused by an immune attack on the nerve cells of the peripheral nervous system and their supportive structures

Diagnosis

• A characteristic finding in Guillain-Barré syndrome is an elevated protein level with low numbers of white blood cells.

Parkinson’s Disease

• Neurodegenerative disorder of the central nervous system.

• It was discovered by the scientist James Parkinson in 1817. His birthday is now celebrated as Parkinson’s day i.e. 11th April.

• Parkinson's not only affects humans, but other primates as well.

Symptoms• Motor symptoms

Tremor Bradykinesia (slowness of movement) Rigidity Postural insability

• Neuropsychiatric symptoms

Mood alteration Cognition Behavior alteration Sleep alteration

Causes• 4 theories were given Oxidation of molecules such as iron in the Substantia Nigra by

free radicals kill the dopaminergic neurons Environmental toxins similar to MPTP (a compound related to

the painkiller Demerol), which have been shown to cause Parkinsonism-like symptoms, kill the neurons.

A mysteriously increased rate of dopaminergic neuronal apoptosis in some individuals

Genetic influence, as the penetrance of PD has been observed at higher levels within some families

Treatment• Levodopa- Levodopa has been the most widely used

treatment for over 30 years. L-DOPA is converted into dopamine in the dopaminergic neurons by dopa decarboxylase. Since motor symptoms are produced by a lack of dopamine in the substantia nigra, the administration of L-DOPA temporarily diminishes the motor symptoms.

• DA- Several dopamine agonists that bind to dopaminergic post-synaptic receptors in the brain have similar effects to levodopa.

Alzheimer’s Disease• Alzheimer's disease is a progressive degenerative disease of

the brain. It is first described by the German neuropathologist Alois Alzheimer (1864-1915) in 1905. This disease worsens with advancing age, although there is no evidence that it is cause by the aging process.

• The average life expectancy of a person with the disease is between five and ten years

Causes• When we study the brain of a Alzheimer's victim, we focus on two specific

areas. One is the cortex of the frontal and cerebral lobes. The second is the hippocampus which is located below the cerebral cortex and responsible for short term memory.

• If we study samples of these two section, we would find irregularities

Stages of Alzheimer’s disease1. No clear evidence of memory trouble and deterioration in brain functions.

2. Patient shows very mild memory problems with difficulty in remembering names of friends. He might make a surprising statement such as inquiring about the health of a friend who everyone knows, died years ago.

3. There is definite evidence of memory loss, which might interfere with job performance.

4. Clinical evidence of memory impairment when the mental status is tested by doctors. A sign of this stage is when the patient keeps asking the same question which has already been answered

5. Patient show problems with both recent and past memories, they even forget events that are important.

6. Understanding of languages diminishes and simple commands aren't understood. Victims may go back to their first language if they have one. Eventually languages disappear entirely.

7. Victim becomes bedridden and totally dependent for all functions. Death usually occurs at this stage form aspiration pneumonia, pneumonia caused by breathing in food or other objects because the victim doesn't remember how to swallow food safely, or from urinary infections.

Progeria• Progeria is an extremely rare genetic disorder wherein symptoms

resembling aspects of aging are manifested at a very early age.• The disorder has a very low incidence rate, occurring in an estimated 1 per

8 million live births. • Those born with progeria typically live to their mid teens to early twenties.

Symptoms• Scleroderma-like skin condition (a hardening and tightening of

the skin on trunk and extremities of the body).• Limited growth • full-body alopecia (hair loss)• Small face with a shallow recessed jaw, and a pinched nose) • Atherosclerosis• Kidney failure• Loss of eyesight• Cardiovascular problems. • Prominent scalp veins• Prominent eyes

Cause• LMNA gene codes for a structural protein called prelamin A. There is

a farnesyl functional group attached to the carboxyl-terminus of its structure. The farnesyl group allows prelamin A to attach temporarily to the nuclear rim. Once the protein is attached, the farnesyl group is removed.

• Failure to remove this farnesyl group permanently affixes the protein to the nuclear rim. Without its farnesyl group, prelamin A is referred to as lamin A. Lamin A, along with lamin B and lamin C, makes up the nuclear lamina, which provides structural support to the nucleus

• The cause of progeria was discovered to be a point mutation in position 1824 of the LMNA gene, in which cytosine is replaced with thymine

Treatment• A type of anticancer drug, the farnesyltransferase inhibitors (FTIs),

has been proposed, but their use has been mostly limited to animal models

• Another anti-cancer drug, rapamycin caused removal of progerin from the nuclear membrane

• Pravastatin and zoledronate are effective drugs when it comes to the blocking of farnesyl group production.

• However, it is important to remember that no treatment is able to cure progeria.

Ischemia

• Condition in which there is insufficient blood flow to the brain to meet metabolic demand. This leads to poor oxygen supply and thus to the death of brain tissue.

• Ischemia leads to alterations in brain metabolism, reduction in metabolic rates, and energy crisis.

• An interruption of blood flow to the brain for more than 10 seconds causes unconsciousness, and an interruption in flow for more than a few minutes generally results in irreversible brain damage.

Types• Focal brain ischemia occurs when a blood clot has occluded

a cerebral vessel. Focal brain ischemia reduces blood flow to a specific brain region, increasing the risk of cell death to that particular area.

• Global brain ischemia occurs when blood flow to the brain is halted or drastically reduced. This is commonly caused by cardiac arrest

Symptoms

• Blindness in one eye• Weakness in one arm or leg or weakness in one entire

side of the body. • Dizziness• Vertigo• Slurred speech• Loss of coordination• Multiple cerebral ischemic events may lead to subcortical

ischemic depression, also known as vascular depression. This condition is most commonly seen in elderly depressed patients.

Causes

• Sickle Cell Anaemia• Compression of blood vessels• Blockage of arteries• Heart Attack• Congenital heart defects

Treatment

• Alteplase (tpa) is an effective medication for acute ischemic stroke. When given within 3 hours, treatment with tpa significantly improves the probability of a favourable outcome

Conclusion

There are many types of neuropsychiatric disorders. Some of them can be treated but there is no ultimate cure of them. Treatments can provide relief but they cannot cure it.

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