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The Brain’s Inner Workings Complexity of the Brain Imaging the Brain NIMH Research on the Brain and Mental Illness NAMI Ohio/ NIMH Outreach Brain Trivia The average number of neurons in the brain = 100 billion. A newborn baby’s brain is as soft and gooey as tapioca pudding! The adult brain weighs about 3 pounds. The average number of glial cells in the brain = 10-50 times the number of neurons. NAMI Ohio/ NIMH Outreach Complexity of the Brain … one hundred trillion synapses in a single human brain organized into exquisitely complex circuits… responding to experience, drugs, disease, and injury… NAMI Ohio/ NIMH Outreach Complexity of the Brain As befits the 3-pound organ of the mind, the human brain is the most complex structure ever investigated by our science. NAMI Ohio/ NIMH Outreach Complexity of the Brain The brain contains approximately 100 billion nerve cells, or neurons, and 10 – 50 times more supporting cells, or glia. NAMI Ohio/ NIMH Outreach Complexity of the Brain The workings of the brain depend on the ability of nerve cells to communicate with each other. Communication occurs at small, specialized structures called synapses. NAMI Ohio/ NIMH Outreach Nerve Cell Communication Synapse NAMI Ohio/ NIMH Outreach Complexity of the Brain The synapse typically has two parts: A presynaptic structure containing packets of signaling chemicals, or neurotransmitters NAMI Ohio/ NIMH Outreach and a postsynaptic structure on the dendrites of the receiving neuron that has receptors for the neurotransmitter molecules. Complexity of the Brain “…One of the most awe-inspiring mysteries of brain science is how neuronal activity within circuits gives rise to behavior, and even consciousness…” Mental Health: A Report of the Surgeon General NAMI Ohio/ NIMH Outreach The Cerebral Hemispheres The brain consists of two hemispheres. The Left Hemisphere of the Brain: The left hemisphere processes information sequentially and is described as analytical because it specializes in recognizing parts which make a whole. Although it is most efficient at processing verbal information, language should not be considered as being 'in' the left hemisphere. This hemisphere is able to recognize that one stimulus comes before another and verbal perception and generation depends on the awareness of the sequence in which sounds occur. NAMI Ohio/ NIMH Outreach The Cerebral Hemispheres The brain consists of two hemispheres. The Right Hemisphere: While the left hemisphere separates out parts that make a whole, the right hemisphere specializes in combining the parts to produce a whole. Unlike the left, the right hemisphere organizes simultaneously. It specializes in a method that perceives and constructs patterns. It is most efficient at visual and spatial processing and it is thought that non verbal stimuli are processed primarily in the right hemisphere. Research into the operation of the right and left hemispheres shows that the effective processing of information requires access to both as they complement each other. NAMI Ohio/ NIMH Outreach It is useful to think of the brain as containing six or seven component parts. The largest and most advanced part consists of the left and right cerebral hemispheres, which appear to be more or less symmetrical. They are covered with a layer of gray matter called the cerebral cortex. Each of the cerebral hemispheres has traditionally been divided into four "lobes," which are named after the bones of the skull that surround them: frontal, parietal, occipital, and temporal. NAMI Ohio/ NIMH Outreach The entire outer surface of the brain is called the cortex, with the forebrain area called the frontal cortex. Those brain structures lying underneath the cortex are termed “subcortical.” Two sites of great interest in current brain research are the left frontal cortex and the left temporal subcortical areas, both of which are linked to key parts of the basal ganglia and the limbic system within the brain. In research language, these are the “cortico-limbic” and “tempero-limbic” circuits in the brain. NAMI Ohio/ NIMH Outreach The frontal lobe is the largest and least understood, beginning at the front of the brain and reaching back to the central sulcus. The area between the central and precentral sulci helps control body movements and is called the "motor area," while the remainder of the frontal lobe probably modulates various aspects of thinking, feeling, imagining, and making decisions. NAMI Ohio/ NIMH Outreach The Frontal Cortex is the highest and most complex integration center in the human brain; the essential function area for "volition," i.e., planning and carrying out meaningful, goal directed activities. Lesions in the left frontal cortex create deficits in attention, abstract thinking, foresight, mature judgment, integration of thought and perception, reality testing, initiative, and perseverance and induce a state of pseudodepression characterized by apathy, lack of motivation, withdrawal, and loss of sexual interest. Lesions in the right lobe have a disinhibiting effect, revealed in wide mood swings, immature behavior, irresponsibility, inappropriate sexual behavior and/or hypersexuality. NAMI Ohio/ NIMH Outreach The parietal lobe is the region behind the central sulcus. Part of it is called the "somatosensory area," since it receives information about various bodily sensations; the parietal lobe also modulates such activities as spatial orientation. The occipital lobe recieves and sends out visual information. The temporal lobe is perhaps the most conspicuous lobe of the brain since it juts out from the rest and is demarcated by the very deep Sylvan fissure. The temporal lobe receives auditory information and controls memory and language. NAMI Ohio/ NIMH Outreach Complexity of the Brain The specific connectivity of circuits is, to some degree, set in expected patterns within the brain, leading to the notion that certain places in the brain are specialized for certain functions. NAMI Ohio/ NIMH Outreach Frontal Lobe: Motor Behavior Prefrontal Cortex: Ability to plan & integrate cognitive and emotional information NAMI Ohio/ NIMH Outreach Parietal Lobe: Processing of Tactile Information Occipital Lobe: Visual Processing Mapping the Mind Personality traits from shyness to impulsiveness, scientists believe, are produced by particular brain molecules acting on specific brain structures. Through brain mapping and biochemistry, researchers have identified some of them. NAMI Ohio/ NIMH Outreach NAMI Ohio/ NIMH Outreach Subcortical Structures of the Limbic System These brain areas are closely connected in structure and function. Pathology in schizophrenia and other major mental illnesses is thought to lie somewhere in the complex interconnections in the limbic system. NAMI Ohio/ NIMH Outreach Mental Disorders Mental disorders are characterized by abnormalities in cognition, emotion (or mood), or behavior, such as social interactions or planning of future activities. Symptoms related to behavior or our mental lives clearly reflect abnormalities in brain function. NAMI Ohio/ NIMH Outreach NAMI Ohio/ NIMH Outreach Viewing Disorders in Action One of the major areas in which molecular genetics will play an important role in the future is in complex disorders like schizophrenia and depression. The figure shows areas of increased blood flow (red hotspots) in the left amygdala and the medial orbital cortex of a person with familial (inherited tendencies to) major depressive disorder. NAMI Ohio/ NIMH Outreach MRI Magnetic resonance imaging provides a high resolution image of the brain's internal structure. The scanner contains a large magnet that induces different chemical elements to emit distinctive radio signals. The signal data is translated into 2-D pictures of the brain, slice by slice. These data can also be combined to create 3-D views. MRI is an important tool in studies of mental illnesses that may involve structural changes, such as schizophrenia and ADHD. NAMI Ohio/ NIMH Outreach Functional Magnetic resonance imaging (fMRI) is a powerful tool for studying the ever-changing activity of the brain on a moment to moment basis. Once limited to visualizing structures, MRI has become the leading technology for examining the living brain at work. PET Positron Emission Tomography is a brain imaging technique that uses a radioactive tracer to show chemical activity of the brain. The PET scanner pinpoints the destination of radioactively tagged glucose, oxygen, or drugs to reveal the parts of the brain involved in performing an experimental task. PET allows us to look at brain functions by measuring levels of energy - or activity - in specific areas of the brain. PET scans generate pictures of the working brain, providing maps of emotions, learning, vision, and memory. Identifying these brain functions is key in developing new ways to diagnose and treat schizophrenia and other mental disorders. NAMI Ohio/ NIMH Outreach This image shows different PET scans of a forty-five-yearold woman with recurrent depression. The scan on the left was taken when she was on no medications and very depressed. The scan on the right was taken several months later when she was well, after medication had treated her depression. Note that her entire brain is more active when well, particularly the left prefrontal cortex. Identifying brain activity associated with depression and the changes that result from treatment and the patient's improved mood will help to destigmatize the illness, a disease of the brain. NAMI Ohio/ NIMH Outreach The Invisible Disease Depression One man in ten and one woman in five will have a serious depression in their lives, usually before they are 40 years old. Bipolar disorder (manic-depression) occurs in 1.2% of the population. The majority of individuals with this illness report having symptoms during their adolescence. Suicide is a very high risk for this population. Tragically, 15% of those individuals suffering from recurrent depressive disorders kill themselves. This is a suicide rate 30 times greater than that of the general population. Most people with depression can be helped with treatment. But a majority of depressed people never get the help they need. And when depression isn’t treated, it can get worse, last longer, and prevent you from getting the most out of life. NAMI Ohio/ NIMH Outreach Depression Depression is believed to result from a chemical imbalance in the brain. NAMI Ohio/ NIMH Outreach Antidepressant drug therapy may help restore that chemical balance and relieve depression . Depression You should get evaluated by a professional if you’ve had five or more of the following symptoms for more than 2 weeks or if any of these symptoms cause such a big change that you can’t keep up your usual routine… 1. You feel sad or cry a lot and it doesn’t go away. 2. You feel guilty for no reason; you feel like you’re no good; you’ve lost your confidence. 3. Life seems meaningless or like nothing good is ever going to happen again. You have a negative attitude a lot of the time, or it seems like you have no feelings. 4. You don’t feel like doing a lot of the things you used to enjoy - and you want to be left alone most of the time. 5. It’s hard to make up your mind. You forget lots of things, and it’s hard to concentrate. NAMI Ohio/ NIMH Outreach Depression You should get evaluated by a professional if you’ve had five or more of the following symptoms for more than 2 weeks or if any of these symptoms cause such a big change that you can’t keep up your usual routine… 6. You get irritated often. Little things make you lose your temper; you over-react. 7. Your sleep pattern changes; you start sleeping a lot more or you have trouble falling asleep at night. Or you wake up really early most mornings and can’t get back to sleep. 8. Your eating pattern changes; you’ve lost your appetite or you eat a lot more. 9. You feel restless and tired most of the time. 10. You think about death, or feel like you’re dying, or have thoughts about committing suicide. NAMI Ohio/ NIMH Outreach If You’re Manic… Some of these sound like you - 1. You’re rebellious or irritable and can’t get along at home, school, work, or with your friends. 2. You feel high as a kite…like you’re on top of the world. 3. You get unreal ideas about the great things you can do. 4. Thoughts go racing through your head, you jump from one subject to another, and you talk a lot. 5. You’re a non-stop party, constantly running around. 6. You do too many wild or risky things; with driving, with spending money, with sex, etc. 7. You’re so “up” that you don’t need much sleep. NAMI Ohio/ NIMH Outreach Schizophrenia These are MRI scans of identical twins. The twin on the right has schizophrenia; the twin on the left is healthy. Even to the unprofessional eye, there are obvious differences, a systematic and consistent variation between the affected and the unaffected twin in the gross anatomy of the brain. (Note enlarged ventricles in the twin affected with schizophrenia) NAMI Ohio/ NIMH Outreach Source: E. Fuller Torrey, M.D., Daniel R. Weinberger, M.D. Schizophrenia Schizophrenia, in many ways, is the most severe of the mental illnesses. One in every one hundred Americans has schizophrenia. This disease, once thought to be psychological, is clearly a brain disease. Throughout the world, whether in Washington or New York City or in rural Kenya, the rate of schizophrenia is still the same: one percent of the population. Schizophrenia is a brain disease in which vulnerability is caused by genes; something happens during brain development that converts this genetic vulnerability into disease. Exactly what happens is the subject of neuroscientific research. NAMI Ohio/ NIMH Outreach Schizophrenia In some ways, schizophrenia is like other diseases. People who develop diabetes or heart disease have a genetic vulnerability, and then external circumstances convert this vulnerability into disease. Rather than being unusual and mysterious entities, mental illnesses are real diseases of an organ - in this case, the brain. NAMI Ohio/ NIMH Outreach Schizophrenia Schizophrenia is particularly tragic because its onset usually occurs in the late teens or early 20s, just when families, society, and educational institutions have already put their full effort into launching a person into the world. Tragically, then, we lose them, often to chronic and persistent hallucinations and delusions, fixed false beliefs about the world, and an inability to live up to their potential; often they withdraw from society and lose their ability to cope with everyday life. NAMI Ohio/ NIMH Outreach Schizophrenia Many of the symptoms of schizophrenia are believed to be caused by excess dopamine. Reduced glutamate transmission which blocks the NMDA restraining action causing limbic structures to release more and more dopamine could be the ultimate cause. NAMI Ohio/ NIMH Outreach Step On A Crack- OCD About 2.3% of the U.S. population ages 18-54 (approximately 3.3 million) has obsessive-compulsive disorder in a given year. People with OCD suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals, such as handwashing, counting, checking, or cleaning are often performed in hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person’s life. OCD is often a chronic, relapsing illness. OCD affects men and women equally. OCD typically begins during adolescence or early childhood; at least one-third of the cases of adult OCD began in childhood. OCD cost the U.S. $8.4 billion in 1990 in social and economic losses, nearly 6% of the total mental health bill of $148 billion. NAMI Ohio/ NIMH Outreach Persons with OCD use different brain circuitry in performing a cognitive task than people without the disorder. Rauch SL, et al. J Neuropsychiatry Clin Neurosci, 1997: 9:568-573. There is growing evidence that OCD has a neurobiological basis. The search for causes now focuses on the interaction of neurobiological factors and environmental influences. Brain imaging studies using PET scans have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. PET scans also show that both behavioral therapy and medication produce changes in the caudate nucleus. This is graphic evidence that both psychotherapy and medication affect the brain. NAMI Ohio/ NIMH Outreach This presentation produced by Velma Beale, Ohio NIMH Outreach Coordinator, NAMI Ohio, with materials from: Mental Health: A Report of the Surgeon General; the NIMH website and publications; and the NAMI Family-to-Family education course. NAMI Ohio/ NIMH Outreach For Further Visit these websites: Information: http://www.nami.org http://www.nimh.nih.gov http://www.namiohio.com E-mail Ohio NIMH Outreach Coordinator: [email protected] NAMI Ohio: [email protected] NIMH: [email protected] Or call the Ohio NIMH Outreach Coordinator: 740-599-5266 NAMI Ohio: 614-444-AMIO NAMI Ohio hotline (in Ohio): 1-800-686-AMIO NAMI Ohio/ NIMH Outreach