Psych Vivas · Foundations — basic neuroscience for psychiatry
Basic neuroscience for psychiatry — structured clinical viva
Fellowship viva on psychosis and depression neuroscience, methods limits, patient communication, and landmark models.
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Target exams
Interpretation
Reveal interpretation
Multilevel answer. Genes, development, substance hits, and stress can converge on synaptic and circuit dysfunction expressed as a clinical syndrome — not a single litre of wrong chemical. [1][5]
Psychosis model. Dopamine hypothesis version III: final common pathway of striatal dopamine dysregulation and aberrant salience; imaging supports increased dopaminergic occupancy/tone in samples. Cannabis is an upstream risk, not proof of one mechanism alone. [1][2]
Pathways. Teach mesolimbic (positive symptoms), mesocortical (cognition/negatives), nigrostriatal (EPS), tuberoinfundibular (prolactin). [1]
Scans. MRI if red flags; normal MRI does not exclude primary psychosis. fMRI BOLD is research haemodynamics, not a diagnostic photo of 'the imbalance.' [6] EEG if seizure/encephalopathy concerns.
Ketamine dual lesson. Psychotomimetic NMDA antagonism supports glutamate models; separate literature shows rapid antidepressant effects in treatment-resistant depression protocols — different clinical contexts. [3][4]
Depression contrast. Multilevel circuit and molecular dysfunction, stress–neurotrophic themes; reject pure serotonin deficiency monologue. [5]
Communication. 'Brain systems involved in meaning, motivation and perception are disrupted; medicines that modulate dopamine can reduce positive symptoms; recovery also needs psychosocial care; we do not diagnose this with a routine colour brain scan.' [1][6]
Key points
References
- [1]Howes OD, Kapur S The dopamine hypothesis of schizophrenia: version III--the final common pathway Schizophr Bull, 2009.PMID 19325164
- [2]Abi-Dargham A, Rodenhiser J, Printz D, et al. Increased baseline occupancy of D2 receptors by dopamine in schizophrenia Proc Natl Acad Sci U S A, 2000.PMID 10884434
- [3]Krystal JH, Karper LP, Seibyl JP, et al. Subanesthetic effects of the noncompetitive NMDA antagonist, ketamine, in humans. Psychotomimetic, perceptual, cognitive, and neuroendocrine responses Arch Gen Psychiatry, 1994.PMID 8122957
- [4]Zarate CA Jr, Singh JB, Carlson PJ, et al. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression Arch Gen Psychiatry, 2006.PMID 16894061
- [5]Nestler EJ, Barrot M, DiLeone RJ, et al. Neurobiology of depression Neuron, 2002.PMID 11931738
- [6]Logothetis NK, Pauls J, Augath M, et al. Neurophysiological investigation of the basis of the fMRI signal Nature, 2001.PMID 11449264