Question

Case 2: Anik Anik is a 29-year-old Javanese (Indonesia) woman who was born in a rural area but has lived in the city of Yogyakarta for the past four years. She has been married 1% years, but is very unhappy in her marriage, feeling her husband is lacking in openness and compassion. Anik has been unable to care for her 8-month-old daughter for the past several months, so the daughter was living with Anik's aunt in Jakarta. When her illness began, Anik first became withdrawn and didn't sleep or eat. She developed hallucinations of accusatory voices criticizing her husband, his family, and their landlady. Anik also suffered from jealous delusions that her husband was having an affair. She was taken to the hospital by her brother, where her symptoms included mondar-mandir ("wandering without purpose"), ngamuk ("being irritable"). Being easily offended and suspicious, talking to herself, crying, insomnia, malmun ("daydreaming") and quickly changing emotions. Her sister-in-law reported that she had been chronically fearful and irritable for some time and would frequently slam doors and yell. In Javanese culture, the control of emotions in social situations is of great importance, so Anik's outbursts were seen as clear signs of some sort of pathology. Anik had several explanations for her behavior. First and foremost, she believed that she was in a bad marriage, and this stress was a contributing factor. Shortly before her symptoms began, her landlady said something harsh to her, and Anik believed that her startle reaction to this (goncangan) led to sajit hati, literally "liver sick­ ness:' In addition, Anik's mother had a brief period during Anik's childhood when she "went crazy", becoming loud and violent, and Anik believes she may have inherited this tendency from her mother. Anik initially sought to overcome her symptoms by increasing the frequency with which she repeated Muslim prayers and asking to be taken to a Muslim boarding house. Once she was taken to the hospital, she agreed to take antipsychotic medications, which helped her symptoms somewhat. She was discharged from the hospital after a short time, but was rehospitalized multiple times over the next year. Questions: For each case please answer the following questions: 1. What condition or conditions (there may be more than one possibility) are being described in this case? 3. What brain area or area(s) may be involved? How should they function normally? What could be causing this dysfunction? 4. How would the treatments recommended affect the brain? How might those effects relate to the symptoms? 5. How can you explain all of the symptoms exhibited by this case? Can you relate each symptom to a specific brain area or neurotransmitter? 6. What other interventions may be possible, besides those noted here? Please justify your answers by using the concepts from other scientific resources). Total Posts:

Answer 1

The symptoms of paranoia, unprovoked emotional outbursts, insomnia, hallucinations, delusions and aimless wandering, when combined with the startle response (probably loss of prepulse inhibition), strongly suggest schizophrenia, which is also known to frequently relapse.

The frontal lobe and the hippocampus are affected in schizophrenia, which interferes with episodic memory and long-term memory. There is also reduction in gray matter of the brain (corresponds to neurons), and a reduction in brain connectivity, as seen by reduction in white matter also. However, the exact cause and mechanism of schizophrenia is not clearly understood.

The "default mode network" (DMN) of circuits show activity only during daily tasks that require little attention, allowing us to daydream, plan and reflect on other things. But DMN reduces its activity in order to allow greater attention to detail, cognition and task-related activity when performing specialized tasks, in healthy individuals. However, in schizophrenia, this DMN is always at a heightened functionality, and patients are not able to dedicate enough of their memory resources to pay attention when performing specialized tasks.

This disorder is considered an imbalance in the levels of neurotransmitters dopamine, glutamate, GABA and serotonin. To block dopamine receptors, antagonists of dopamine are provided as medications. These also help to reduce the anxiety-like symptoms seen in schizophrenia. In severe cases that do not respond to medications, electroconvulsive treatment is used. Since schizophrenia is caused by reduced connectivity, this treatment, among other effects, is known to dissolve perineural nets, which may help restore connectivity of neural circuits.