From Brain to Behavior, Part 2. Ali Amirsadri M.D. Chief Medical Officer Department of Psychiatry and Behavioral Neurosciences Wayne State University
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1 From Brain to Behavior, Part 2 Ali Amirsadri M.D. Chief Medical Officer Department of Psychiatry and Behavioral Neurosciences Wayne State University
2 The beginning is The most important part Of the work. Plato
3 Proper, timely, least restrictive, cost effective & individualized Interventions Illness Person Patient in acute crisis Patient in stable condition
4 Protect safety Take down Calm down time After effects? Acute and prolonged development of anger and aggression
5 Individuals with Schizophrenia demonstrate impaired recognition of facial expressions and may misattribute emotional salience to otherwise nonsalient stimuli. An abnormally increased parahippocampal response to neutral faces was positively associated with reality distortion in SZ. Simon S, et al, JBP,V60, N5, Sept 2006
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8 Some Basic Principals 1. Every living creature stays in a natural state of conflict with every other creature in the environment (Hun<ngford and Turner 1987) 2. Certain social signals can increase the likelyhood of aggression on the part of an individual who perceives them.this happens with certain amount of automa<city. (Alcock 1989) 3. Nonspecific, frustra4on induced aggression (Berkowitz 1989), specially in mammals is designed to make the organism to react angrily toward frustra<on. 4. Fear is a fundamental chrachteris4c of the nervous system, and fear of the strange is an extension of this principal. Low level s4mula4on of Amygdala produces alertness and strong s4mula4ons creates fear.
9 Effects & Symptoms Of: 1. DehydraIon/over hydraion 2. Lack of Oxygen 3. AccumulaIon of CO2 4. Excessive or low sugar (Glucose) 5. Electrolyte imbalance (K, Na, Mg, Ca) 6. Excessive or liyle urinaion 7. Irregular bowel movement 8. Temperature dysregulaion (high or low) 9. Sleep disturbance (excessive, liyle) 10. Physical acivity (excessive or minimal) 11. Pain Fa4gued Sleepy Irritable Intolerant Depressed Anxious Angry Agitated Isola4ve Headache Body Pain Not ea4ng Confusion
10 POWER Combined CONTROL Reactive Has a Goal Works Symbolic VIOLENCE Violates Boundaries Proactive STRESS Changes Relationships Changes Relations Inter personal Contingency Plan A Traumatic Experience? Life Events? What about Culture? NO STRESS
11 VIOLENCE EXPRESSION Underlying personality, intelligence, various life stressors, the effect of drugs and alcohol, various illnesses and physiological needs create increased emoional tension. The way this tension is expressed or translated in behavior depends on available repertoire of responses established by the individual. Such tension might cause aggression in predisposed individuals. VIOLENCE is a form of language transmitted through GENERATIONS
12 Unimodal Assoc CTX Primary Sensory CTX Heteromodal CTX GABA ACHLN Thalamus CRF Amygdala Hypothalamus Midbrain ACTH DOPAMINE Medulla Spinal Cord NEPI Neuroendocrine System Autonomic NS Motor Activity Neurobiology of Emotions CRTSL Adrenal G
13 Unimodal Assoc CTX Primary Sensory CTX Heteromodal CTX GABA Thalamus Amygdala APPRAISAL! Hypothalamus Midbrain Medulla Spinal Cord Neuroendocrine System Autonomic NS Motor Activity Neurobiology of Emotions CRTSL Adrenal G
14 CogniIve Impairment Contributors physical comorbidity (sleep apnea, seizure, COPD, DM, CHF. CKD, pain, stroke, anemia, hypothyroidism, etc) medica<ons substance abuse/use sensory deficits depression /grief Anxiety (PTSD, panic disorder, social phobia, etc) Psychosis Delirium Ins4tu4onaliza4on /dependence
15 CONTROL GATING! POWER T H R E A T STRESS FRUSTRATION STAFF FRUSTRATION ANGER PATIENT F E A R
16 Unimodal Assoc CTX Primary Sensory CTX Heteromodal CTX GABA Thalamus CRF Amygdala APPRAISAL REAPPRAISAL Hypothalamus Midbrain Medulla Spinal Cord Neuroendocrine System Autonomic NS Motor Activity Neurobiology of Emotions Adrenal G
17 Biological consideraions & provoking factors Effects or side effects of medicaions Sleepless nights Sleepiness and difficulty awakening Thirst (DehydraIon) Hunger (Low and high blood sugar), diabetes Energy dysregulaion or Iredness and faigue Acute and chronic aches and pains High and low blood pressure Hormonal changes and menstrual cycles, premenopausal and menopausal effects WHAT ABOUT SLEEP APNEA AND SEIZURE DISORDERS
18 Environmental ConsideraIons & Provoking Factors Noise level Noxious odors LighIng / Color / Contrast intensity Temperature / VenIlaIon / Humidity balance Architectural (spacing, equipments, exits, hospitability, etc.) Crowd level Staffing (raio, experience, orientaion.) Time of the day (shif changes) Seasonal effects DISCOMFORT PREVENTION
19 Every living en<ty is looking for tranqulity and persistence in existence Professor Angha in Dawn
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