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; emotions
Structures 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 Attention
Culturally 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 Behavior
How 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 Function
Traumatic 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 Behavior
Patient 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 Counseling
Alternative/complementary therapies
Individual or family support group

11. Application of Concepts of Altered Mood, Attention, and Behavior
Generalized anxiety disorder
Posttraumatic stress disorder
Major depressive disorder
Bipolar affective disorder
Attention-deficit hyperactivity disorder
Autism spectrum disorders
Schizophrenia

12. Generalized Anxiety Disorder
Pathophysiology
Clinical manifestations
Diagnostic criteria
Treatment

13. Generalized Anxiety Disorder Overview
Anxiety 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 Pathophysiology
Increased response in amygdala to anxiety- provoking events
Central nervous system mediators
Norepinephrine, serotonin, dopamine, GABA
Genetic factors
Environmental factors

16. Generalized Anxiety Disorder Clinical Manifestations
Worry 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 Criteria
History and physical examination
Rule out medical or substance-abuse problem
Standardized rating scales

18. Generalized Anxiety Disorder Treatment
Cognitive-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 Manifestations
Adults
Avoidance and suppression of thoughts/emotions
Nightmares
Flashbacks
Children
Separation anxiety
Crying, screaming
Trembling
Regression
Withdrawal
Disruptive behavior
Inattentiveness

23. PTSD Diagnostic Criteria
Symptoms 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 Pharmacology
Trauma-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 Disorder
Pathophysiology
Clinical manifestations
Diagnostic criteria
Treatment

26. Major Depressive Disorder Subtypes
Seasonal affective
Postpartum
Melancholic
Catatonic
Atypical

27. Major Depressive Disorder Pathophysiology
Pervasive 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 Manifestations
Persistent 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 Criteria
History
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 Treatment
Psychotherapy/counseling
Antidepressant medications
Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants (TCSs)
Monoamine oxidase inhibitors (MAOIs)
Electroconvulsive therapy
Alternate therapies

33. Bipolar Affective Disorder
Pathophysiology
Clinical manifestations
Diagnostic criteria
Treatment

34. Bipolar Affective Disorder Pathophysiology
Periods 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 Manifestations
Periods 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 Criteria
Patient history
Reported observations by friends and family
Mental status examination
Ruling out physical conditions
DSM-5 diagnostic criteria
Seven subtypes

37. Bipolar Affective Disorder Treatment
Psychotherapy
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 Manifestations
Inattention
Hyperactivity
Restlessness
Impulsivity
Disruptive behavior
Difficulties in school oar work
Difficulties in social situations

41. ADHD Diagnostic Criteria
Patient 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 exercise
Cognitive-behavioral therapy
Behavioral therapy
Pharmacology
Stimulants
Physical exercise

43. Autism Spectrum Disorders
Pathophysiology
Clinical manifestations
Diagnostic criteria
Treatment

44. Autism Spectrum Disorders Pathophysiology
Neurodevelopmental disorder with onset in early childhood
Environmental and genetic factors
Changes in brain structure and function

45. Autism Spectrum Disorders Clinical Manifestations
Impaired 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 Criteria
Clinical manifestations
Screening tools
DSM-5 criteria

47. Autism Spectrum Disorders Treatment
Therapies
Speech
Occupational
Physical
Cognitive-behavioral
Language training

48. Schizophrenia Pathophysiology Clinical manifestations
Diagnostic criteria
Treatment

49. Schizophrenia Pathophysiology
A 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 Manifestations
Hallucinations
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 Criteria
Patient 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 Treatment
Pharmacology
Antipsychotics
Psychological and social support