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The Neuroanatomical Basis of Brain Disorders
By Daniel Martinez M.D
Zaid Syed MS4
Medical Model
• George L. Engel – 1977
• Biological, psychological, social, spiritual, cultural factors affect disease and overall wellbeing
• How the cause of the illness stems from functioning of the individuals body
Eitheory.com
Biology
• Very important to stress medical follow up for each patient– Once a year
• Strong connection between body and mind
Biology
• Obtain medical records• Physical Exam– Screening blood test• CBC
– Hematocrit– Hemoglobin
» Rule out anemia • CMP
– Electrolytes– Glucose– Cr/BUN
Biology
• Screening Blood Test (cont)– Liver Function test– Thyroid Function Test
• Hyperthyroidism• Hypothyroidism
– Lipid panel– Drug screen– Pregnancy– Vitamin B12– Folic Acid– Thiamine
http://blog.lib.umn.edu
Neuron in Action
Synthesis and Release of Dopamine
SPECT Scan
Neuroimaging in psychiatry By Tripura Medical College , Slide 23http://www.slideshare.net/shaan_47/neuroimaging-in-psychiatry
Neuroimaging in Psychiatryhttp://www.slideshare.net/shaan_47/neuroimaging-in-psychiatry
Images (c) Dr. Amen
Images (c) Dr. Amen Images (c) Dr. Amen
Images (c) Dr. Amen
http://www.brain-spect.com/SPECTscans/jpg/alz.JPG
OCD
Obsessive-Compulsive Disorder
• Epidemiology – Occurs in 2-3% of US population.– Bimodal distribution – 10 y/o and 21 y/o
• Signs and Symptoms– Obsession - Persistent thoughts, ideas and images
that intrude into conscious awareness.– Compulsion – urges or impulses for repetitive
intentional behavior performed in a stereotyped manner in an attempt to alleviate the anxiety caused by the obsessions.
Obsessive-Compulsive Disorder
• Pathogenesis– Orbitofrontal dysfunction and frontal/parietal
white matter changes.– Prefrontal cortex, cingulate gyrus and basal
ganglia dysfunction are implicated. – By using PET scan, patient after treatment had a
reduction in cerebral metabolism in these areas. – Serotonin is also believed to play an integral role.
active front-on view Heavy increased cingulate activity and right and left anterior lateral prefrontal
cortex activity (together termed hyperfrontality).
http://www.londonneurofeedback.com/uploads/2/2/9/8/2298352/8876880.jpg
Autism
Autism
• Epidemiology • 3 – 2- 1- 1– Before the age of 3– Two social problems (PRNS)– One communication problem (LISP)– One inflexible behavior problem (PIMP)
Autism
• Etiologys– Dr Andrew Wakefield• measles vaccineintestinal inflammation “leaky gut
syndrome”harmful proteins can affect brain Autism
– In 1998, Wakefield & a group of colleagues published a research study in the British medical journal, The Lancet, which linked inflammatory bowel symptoms in 12 autistic children to the Measles-Mumps-Rubella vaccine
Autism
• More than 20 peer-reviewed epidemiologic studies have shown no link between MMR & autism.
• Functional brain-imaging studies show under activation in areas associated with planning & control of complex actions, & in areas linked with processing socioemotional information.
http://www.brain-spect.com/SPECTscans/jpg/normsag.jpg
Autistic patientNormal
Schizophrenia
Schizophrenia
• Pathogenesis– Overall unknown, however many associations are
known. – Genetical component: observed concordance rate is
about 40-50% in monozygotic twins, and 5-10% in dizygotic twins.
– Environmental components• Obstetrical complications• Infections• Inflamation• Cannibus use
http://psycnet.apa.org/journals/szb/13/1/images/szb_13_1_115_fig11a.jpg
Depression
Depression
• Epidemiology – 17% of the US population• 10-14% of medical inpatients1
– linked to social conditions
• Rule out hypothyroidism• Association with Parkinson disease and
dementia1. Katon, W. Epidemiology of Depression in Primary Care. General Hospital Psychiatry 1992. July 14(4). 237-247
Depression
• Pathogenesis- – Deficiency in excitatory neurotransmitters
– Neurotransmitter – • Serotonin
http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/depression_overview_slideshow/mayo_c7_pet_depression.jpg
ADHD
Attention deficit hyperactivity disorder
• Pathogenesis– Genetic Factor
• Concordance as high as 92% in monozygotic twins and 33% in dizygotic twins.
Psychostimulant needed.
http://www.adhd.org.nz/petscan.jpg
Bipolar Disorder
Bipolar disorder
• Episodic mood shifts of mania, major depression, hypomania & mixed states
• Pathophysiology– Altered circadian rhythmicity
http://www.brain-spect.com/SPECTscans/jpg/alz.JPG
Thank You!!
Thank you again!