Clinical Discussion of Disease A.

Anatomy & Physiology

4 PARTS OF THE BRAIN Cerebrum Cerebellum Brain stem Limbic system CEREBRUM Most high level brain function takes place Divided into 2 hemisphere: right & left hemisphere Right hemisphere is responsible for music & art awareness, insight and controls the left part of the body Left hemisphere is responsible for mathematical skills, language, reading, writing and controls the right part of the body Have 4 lobes: frontal, temporal, parietal and occipital lobe. Covers 85% of the brains weight

CEREBELLUM little brain Located at lower back of brain beneath the occipital lobe Center for coordination of movement and postural adjustment

CEREBELLUM... Receives & integrates information from all areas of body such as: muscles, joints, organs & other components of CNS Inhibited the transmission of dopamine in this area.

BRAIN STEM Connects spinal cord to the rest of the brain Composed of the following: -MEDULLA- located at top of spinal cord, contains vital centers for respirations & cardiovascular function. -PONS- bridges the gap both structurally & functionally serving as primary motor pathway. -MIDBRAIN- connects pons & cerebellum with the cerebrum. -LOCUS CERULEUS- a small group of norepinephrine- producing neurons in brain stem.

LIMBIC SYSTEM Emotional brain- emotional responses such as; anger, fear, anxiety, pleasure, sorrow & sexual feelings generated in limbic system but interpreted in frontal lobe. Parts of the limbic system: -THALAMUS- regulates activity, sensation & emotion. -HYPOTHALAMUS- involved in temperature regulation, appetite control, endocrine function, sexual drive & impulsiveness behavior associated with feelings of anger, rage & excitement. -HIPPOCAMPUS & AMYGDALA- involved in emotional arousal & memory.

STRESS HYPOTHALAMUS- PITUITARY- ADRENAL AXIS

NEUROTRANSMITTERS Neurotransmitters are chemicals which transmit signals from a neuron to a target cell across a synapse. Neurotransmitters are packaged into synaptic vesicles clustered beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to receptors in the membrane on the postsynaptic side of the synapse. ACETYLCHOLINE Found in the brain, spinal cord and PNS. Can be inhibitory and excitatory Synthesized from dietary choline found in red meat and vegetables Affects sleep- wake cycle and to signal muscles to become active

DOPAMINE Essential to the functioning of CNS Excitatory Involved in emotions, moods and regulation of motor control. Dopamine forms from a precursor molecule called dopa- manufactured from liver from amino acid tyrosine.

NOREPINEPHRINE & EPINEPHRINE (ADRENALIN) Most prevalent neurotransmitter in nervous system. Excitatory Has limited distribution in brain but controls fight or flight in PNS Play a role in attention, learning & memory, sleep and wakefulness and mood regulation.

SEROTONIN Its function is mostly inhibitory that includes induction of sleep and wakefulness, pain control, temperature regulation, control of mood, memory, and sexual behavior. Inhibitory Serotonin is produced in brain from amino acid tryptophan- derived from foods high in CHON.

HISTAMINE Involved in emotions, regulation of body temperature and water balance. Neuromodulators

GLUTAMATE GABA Most abundant neurotransmitters within the CNS and in cerebral cortex. Largely responsible for such higher brain functions as thought and interpreting sensations. Major inhibitory neurotransmitter in the brain Excitatory amino acid that at high levels that can have major neurotoxic effects.

Interpretation: In the pathophysiology of Bipolar Disorder there is no known cause. An idiopathic disease where in there is only risk factors. Clients with: Genetic history of Bipolar Disorder Biochemical Malfunction in the brain Neuroanatomic Circuits Problem Childhood Precursors refers to the way the parents raised a child Life Events and Experiences which are traumatic for the client may have higher risk for having Bipolar Disorder. In our interpretation our client had experienced life events and experiences which triggered the onset of Bipolar disorder.

The client would first experience abnormalities in the structure and/or function of a certain brain circuit where in the brain malfunction and would have problems in releasing or controlling the neurotransmitters in the brain. There would be imbalance in neurotransmitters in the brain: Acetylcholine- affects the sleep and wake pattern on the client this happens on the onset of the disorder where in the client experiences difficulty in her sleep. Dopamine- affects the elevation of moods and emotions, during the manic and depressive episodes Dopamine is involved Norepinephrine and Epinephrine (Adrenalin) - play a role in attention, learning & memory, sleep and wakefulness and mood regulation. Serotonin- Its function is mostly inhibitory that includes induction of sleep and wakefulness, pain control, temperature regulation, control of mood, memory, and sexual behavior. The client would also experience shifting to extreme moods during the manic episodes of the client she may experience elevation of moods, irritability, excitability, racing thought and speech and hyperactivity. And in her depressive episodes she may experience extreme sadness, withdrawal, despair and suicidal thoughts. This would lead to the altered functioning of her daily living activities and relationships to others. She may experience violence to others and to herself also may lead to suicide. The complications are just perceived scenarios that may happen if the disorder is not properly managed.

PATHOPHYSIOLOGY of Bipolar Disorder: Neurobiologic Perspective MANIA

Interactive among neurotransmitters (Serotonin, Dopamine, Norepinephrine, GABA) or certain chemicals in the brain that regulate mood Drugs: Cocaine, MAOIs, Trycyclin, Antidepressants, Steroids, Levadopa

DEPRESSION
Interactive among neurotransmitters (Serotonin, Dopamine, Norepinephrine, GABA) or certain chemicals in the brain that regulate mood Alcohol, Drugs: Sedativehypnotics, amphetamine withdrawal, glucocorticoids, propanolol, resperine, & steroidal contraceptives

Increased level of norepinephrine, dopamine & serotonin

Decreased level of norepinephrine, dopamine & serotonin

MANIA

DEPRESSION

Physical Illness: Stroke, Cushings disease & some Endocrine disorders, Traumatic event/s in life

MANIC/ DEPRESSIVE BEHAVIOR

Elevated or irritable mood (1 week): Grandiosity, insomnia, verbosity, flight of ideas, distractibility, increased in goal- directed behavior or psychomotor agitation, excessive involvement in pleasurable activities without regard for consequences Impairment in occupational or social activities & in relationship Extreme activity(requires hospitalization) Impaired functioning

(BIPOLAR)

Prime Symptoms: Depressed mood or loss of interest or pleasure (2 weeks) Change in level of functioning or five or more of the ff: Change in weight, insomnia, psychomotor agitation, fatigue, worthless feelings, inappropriate guilt, concentration difficulties, death thoughts, suicidal ideation, and suicidal attempts Sex drive decreased Constipation and urinary retention