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Triad of symptoms for ADHD
inattentiveness, impulsivity, hyperactivity, multimodal regimen needs to
be considered
Dementia characteristics
is an acquired impairment of intellectual function, memory and language
with alteration in behavior and can be caused by trauma, vascular
disease, infection and progressive neurodegeneration. AD is most
common chronic irreversible dementia
Delirium characteristics
acute confusional state, transient disorders of awareness that have
sudden or gradual onset can be caused by alcohol or drugs, withdrawal
from, metabolic disorders, trauma, anesthesia, fever/heatstroke,
electrolyte imbalance, organ failure
Migraine Headaches
a common, multifactorial, disabling, recurrent and hereditary
neurovascular headache disorders. can begin with auras. usually
unilateral and pulsating
,auras
transient focal neurological symptoms whose origin is though to involve
the hypothalamus, brainstem and cortex
Migraines are
an inflammatory process. The MAIN POINTS are that there are likely
alterations in serotonin and other neurotransmitters, neurologic, vascular
(inflammation) and hormonal components (estrogen).
Neurovascular Hypothesis
A trigger alters a specific area of the brain stem called the locus
ceruleus and triggers release of serotonin into the trigeminal vascular
tree. Not all patients are able to identify a trigger. Those commonly
identified include lack of sleep, stress, hormonal changes, physical
exertion, weather changes or certain foods (most commonly wine
caffeine, monosodium glutamate, nitrates, and artificial sweeteners).
Perivascular inflammatory process
Pain sensors in the ophthalmic branch of the trigeminal nerve become
active and release neuropeptides that cause dilation of blood vessels.
This produces even more nerve irritation. The inflammatory response
and distended blood vessels stimulate the trigeminal nerve; producing
pain long after the trigger is gone.
Menstrual migraines are thought to be triggered by changes in estrogen
levels
Estrogen levels rise after ovulation. Falling levels of estrogen during the
premenstrual period may trigger the onset of migraine.
, Process of neurotransmitter transmission between two neurons
1) action potentials arrive at axon terminal
2) Voltage gated Ca+ channels open
3) Ca++ enters cells
4) Ca++ signals to vesicles
5) Vesicles move to the membrane
6) Vesicles release neurotransmitters by exocytosis
7) Neurotransmitter diffuses across synaptic cleft and binds to receptors
The neurotransmitters that could be involved in the different types of
anxiety disorders (i.e., panic)
Major ones are norepinephrine serotonin, and gamma-aminobutyric
acid. Increases would be seen in norepinephrine and serotonin
(opposite in depression).
Dysregulation of the brain GABA
benzodiazepine receptor system may contribute to the development of
panic attacks. Altered in panic disorder related to a reduction in the
benzodiazepine (BZ) receptor binding. BZ plays a role in GABA
producing a neuronal inhibitory effect.