Question

Mary-Lou is a 75-year-old widow, who lost her husband to cancer over a year ago. Her family and friends have noticed that she has been very teary, has low self-esteem and has lost interest in the things she used to love such as going to bingo with her friends and gardening. Her family initially put this down to the loss of her husband and thought it would pass with time. However, they are now getting really concerned as they have noticed that her mood is not improving still. When asked by her daughter if she is sleeping well, she says she has been drinking wine every night to help her go to sleep. It makes her feel happy and relaxed. What started as one glass a night has now increased to two or three glasses a night, and she has also started drinking during the day. Her daughter has noticed that her mum’s face always appears flushed and that she has had quite a few colds lately. Mary-Lou is also losing her balance and experiencing mood swings. Her daughter is worried that she is relying too heavily on alcohol and fears that she is starting to get short-term memory loss from the alcohol consumption. She has been forgetting things such as where she put her keys, whether she turned on the washing machine, why she opened the fridge and forgetting the topic of conversation when talking with her daughter on the phone. Mary-Lou has also been getting disorientated and getting lost when she goes out on her daily walks. A neighbor rang her daughter one day to tell her that she found Mary-Lou wandering around aimlessly, and when questioned what she was doing Mary-Lou snapped and said she was trying to get home. Her daughter decided it was time to take Mary-Lou to the local GP to work out what was going on with her. After listening to the signs and symptoms Mary-Lou was experiencing, the GP diagnosed her with depression and prescribed 50 mg of Fluoxetine/Prozac daily. Based on the results of clinical and radiological assessments, the GP determined that she had early onset Alzheimer’s disease. He prescribed a cholinesterase inhibitor and gave them information on support groups and tips on what to do from here on in. He also prescribed 10 mg of Diazepam daily to help with the withdrawals from alcohol abuse.

Question 1 Based on the clinical picture presented above, you should have identified three diseases/conditions we have covered in BIOL122.

• Name two of the diseases/conditions you identified, and

• List two characteristic signs or symptoms (per disease) that you noted in Mary-Lou’s history

• Finally, explain the pathophysiology of both diseases/conditions you named (i.e., explain the changes that cause the disease and relate the typical signs and symptoms of the disease).

Answer 1

• The diseases identified from the given clinical picture are - 1) Depression 2) Alcoholism
• Characteristic Signs/ symptoms - 1) Depression :- ​​​​​​ Insomnia ( loss of sleep), Very teary , Low self esteem , loss of interest in things once pleasurable 2) Alcoholism :- Memory impairment, loss of coordination (losing balance), Mood swings, facial redness (flushed face), disoriented to place.
• Pathophysiology - 1)Depression :- In order to explain the pathophysiology of depression, some hypothesis are present. Psychosocial stress like stressful life events leads to stress sensitivity cause depressogenic effects. Womens are more sensitive to stressful events such as difficulty getting along with death or serious illness. Stress hormones such as Corticotropin releasing hormones (CRH) released from hypothalamus forms cortisol is another factor. Women show more cortisol responses to social rejection challenges. CRH produces some physiological and behavioural changes like disrupted sleep, decreased appetite etc. Monoamine deficiency mainly serotonin and noradrenaline, seen in Depression.If serotonin and noradrenaline falls to low levels leads to depression because they control the emotional behaviour in balance. Altered endocrine functions lead to pathological mood states. 2) Alcoholism :- Increase in frequency and quantity of Alcohol consumption is pathologically related cause for physical and psychological problems. Genetics also have an important role in development of alcohol abuse. Alcohol alters neuronal activities which is alcohol potentiates GABA-ergic and inhibits Glutamatergic neurotransmission. Alcohol slow down the communication of nerves with each other in a part of brain called hippocampus leads to short term memory loss.