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!