Chapters 14 & 15 Transcript

So our next lecture is chapter 14, discusses diseases of the eye and the ear. The book does a
decent job discussing anatomy and physiology of the eye. Just to point out a couple of things, so,
when you look at this diagram, just notice, this is the pupil. So this is the dark spot when you
look at your eyes. Then around here, you have the iris. This gives you the color.

Now right behind is the lens. The lens is very significant. The lens has the suspensory ligament.
And these ligaments adjust the thickness of the lens. And by adjusting the thickness of the lens, it
enables you to see close and also far away.

When you go to the back of the eye, you see the optic disk. The optic disk is where the optic
nerve comes in, and also the artery and brings blood in to the eye, the retina. And the retinal vein
brings it out.

And when you've gone to the doctor, if you've had an eye exam, they dilate your pupils. They
make them wider. And by making them wider, it enables the ophthalmologist to look through the
lens into the back of the eye and take a look at the optic disk. And also, we'll take a look at the
small capillary arterials that are in the eye there. You'll see them as red little branches. And
sometimes, you can make a diagnosis of diabetes or hypertension if you are skilled in looking at
these vessels.

So the two basic common diseases and disorders of the eye, two of the most common are going
to be myopic and hyperopic. These are refractive disorders. This refers to the lens and being able
to see close and also see far away. And myopic-- or myopia-- people cannot focus on distant
objects. So myopics are near-sighted. Hyperopics are far-sighted.

And whether you're normal vision, if you're myopic or hyperopia, very often, this can be affected
by the diameter of the eyeball. For example, if you can see near things, if you're able to focus on
close objects but not far, that's because the eyeball diameter is increased. With hyperopia, the
eyeball diameter is too short. And as a result, the objects are focused in behind the retina.

So here we have someone who is hyperopic. And as a result, the image is focused behind the
eyeball. And the eyeball diameter is too short. Myopic is focused in front. The eyeball there is a
little too long.

Here is astigmatism. You see the irregularity. And that usually can result from some type of
abrasion or scar on the cornea. Presbyopia is the term used for hardening of the lens. It doesn't
bend as much. There is more of a firmness to it. And as a result, images get focused behind the
retina and reading glasses are necessary. And once again, here's the same thing with presbyopia
and the focal point being behind this astigmatism is also discussed.

Diseases and disorders of the eye-- there's retinal image defects. Diabetic retinopathy, it's the
leading cause of blindness. It's due to poorly-controlled diabetes mellitus. When I say poorly-
controlled, what I'm referring to is the fact that their sugar levels have fluctuated up and down,
usually high for too long a time period, too many times. And as a result, there can be retinal
hemorrhages, weakening of the vessels, and the resulting effect of the retinal hemmorrhages can
be blindness.

Macular degeneration is also very significant. And it's a progressive eye disease, kills the light-
sensitive cells in the retinal layer, and is the leading cause of vision loss for people over 50. I
tweeted the article on it because I think it's very significant. And one of the things that's
interesting is that the retinas of people with AMD have deposits of the same type of protein that
is found in the brains of people with Alzheimer's.

And as the AMD progresses, the increase in the number and size of fatty deposits also increase.
Increase of deposits are called drusens. And it's a progressive disease. And some people have
early AMD, only they get developed late.

Also, they found out in the study that the amyloid proteins are retained inside the retinal cells and
where they gradually pair a molecular mechanism which is reliant on a protein encoded by the
MAP-2 gene, which this may help us understand some of the important structures inside cells
called microtubules. And maybe this will help us understand better about AMD, but also
possibly Alzheimer's.

Diabetic retinopathy is a leading cause of blindness among adults-- as I mentioned-- damages the
small blood vessels. So small blood vessels are going to be in the retina. They're also going to be
in the kidney. So organs that have small blood vessels are at risk.

So in this diagram here on the right, you see where the red vessels coalesce and meet. That's
where the optic nerve and the vessels come into the eye. And then the white patches that you see
are hemorrhages with scarring.

And the concern is that when someone has a hemorrhage, they need to be lasered because when
they start to bleed, a laser will stop the bleeding because if you don't laser it, and it bleeds for a
while, when it stops bleeding, the blood that was lost will contract and it can detach the retina
and cause blindness. So they will lose visual acuity and decrease night vision.

Macular degeneration, as I said, is one of the leading causes of blindness in people over 50. And
there's two types. There's atrophic or dry, which is 90%, and then 10% is exudative. And we
don't know why people get it. And sadly, there's no cure for it. And here you see a simulation of
macular degeneration, where the macula at the center is basically, the receptors are lost.

Glaucoma is increased pressure in the eye. It's painless. And it commonly occurs in people older
than 60. There's no warning signs and the vision loss is gradual. And once it happens, it can't be
reversed. The only preventive measures is routine eye exams. If it's diagnosed, the routine eye
exam looks for intraocular pressure.

If the ophthalmologist detects intraocular pressure, then most commonly, it can be treated with
eye drops. And if that doesn't work, there are laser surgical procedures that are used to promote
fluid drainage.
So in contrast to macular degeneration, the peripheral vision is lost, but the central vision is
maintained. That's why when you see this picture, you see the boys in the center of the picture,
but you lose the background of the fence.

Half of Americans over 65 have cataracts. And what cataracts is, a calcification or clouding of
the lens. So you have simulated vision here for someone with a cataract. The vision cloudiness is
usually caused by the calcification that occurs within a small part of the lens. And gradually, the
cataract grows larger. It can become visible. And the only treatment is outpatient cataract surgery
where the clouded lens is removed and is replaced with a clear artificial lens.

Conjunctivitis is inflammation of the conjunctiva which is the thin membrane that lies over the
eye in the sclera, and sometimes referred to as pink eye. It can be caused by bacteria, viruses,
allergies, or chemical irritants. Symptoms include itching, light sensitivity, and red eyes. The
bacterial and viral conjunctivitis are very infectious. Children are advised to stay home.

Conjunctivitis will resolve by itself without antibiotics. However, it's recommended that
antibiotic eyedrops be given because it can hasten the recovery, especially if it's caused by
bacteria. There's really no adequate treatment for viral conjunctivitis.

Styes and chalazions are common eyelid infections. A stye is a bacterial infection near the base
of your eyelash. Chalazion is a blockage when the oil lands at the edge of the eyelid. Treatment
is usually application of warm compresses. Occasionally, antibiotics may be prescribed. After
several days, they resolve on their own.

Color vision is determined by the cones. There can be inherited deficiency, as the books
discussed, so that there's going to be impaired color vision. Concerning color vision, there are
three types of cones that see color-- red, green, and blue. And its input from these three different
types of cones, color cones, that we have color vision. Most genes responsible for color blindness
are on the X chromosome.

A retinoblastoma is a rare tumor of the retina. And it's inherited. And I know that the book says
recessively, but most literature says it's a dominant inheritance. Blastoma, once again, meaning
young, immature, occurs in young children. Treatment is going to depend on the size and
location of the tumor. Chemotherapy is sometimes given initially to help shrink the tumor, and
then cryotherapy or laser therapy cab be used later to treat the remaining cancer, and therefore
avoiding surgery and loss of vision.

I'm sorry, we will go over the anatomy of the ear in this lecture now. In this diagram, you have
the pinna, the outer ear. And notice, this is the auditory canal. This is the external ear. Then here,
you have what you commonly call the ear drum. It's called the tympanic membrane.

Within the tympanic membrane, that starts the middle ear. And so there's three bones-- the
malleus, which looks like a hammer, the incus, which is an anvil, and the stapes, which is a
stirrup. And what happens is sound waves enter the auditory canal, hit the tympanic membrane,
then the vibration is transmitted through the three bones to the cochlear nerve. And the cochlear
nerve transmits the sounds to the brain.
At the bottom of the middle ear is this canal called the Eustachian tubes, which empties into the
nasal pharynx. So when you say it feels like your ears are clogged, you're talking about this tube
being clogged. When we fly, chew gum, eat, chew, whatever, will help open these as pressure
changes occur in the airplane cabin.

Also part of the ear is going to be the vestibular nerve. And the vestibular nerve receives input
from the semicircular canals and the cochlea. And the semicircular canals help determine motion
and sensation of motion and movement and position. For example, if you close your eyes, you're
able to sit up straight. You're able to stand straight. You close your eyes, you're aware of body
movements. If you turn your head, you're aware of that. And so that type of sensation is from this
semicircular canals and the cochlea.

This is the inner ear. Now, the common ear infections that need antibiotics are otitis media. And
that's an infection of the middle ear-- this area right here. Also, I'm sure you've heard of little
children with allergies becoming ear infections. They put tubes in their ears. The tube is placed
in the tympanic membrane. For those of you who've taken medical terminology, it's ostomy. And
that opening of the tympanic membrane, they insert the tubes-- a tympanostomy-- opening the
tympanic membrane. And once again, you have the book's illustration. And here you see the
malleus, the incus, and the stapes attached to the tympanic membrane eustachian tube.

The external ear infections are going to be your earwax is called cerumen. And that can become
impacted, or otitis externa, swimmers ear, which is water in the ear, not drying it well. And you
get a fungal infection.

Middle ear infections are called otitis media. And the concern is that now that you've seen the
anatomy, when you get recurring ear infections-- otitis media-- you get some scarring and you
get damage into the movement of the three bones. As a result, you can have a hearing loss.

Presbycusis just refers to as people age, their hearing may decrease. Meniere's disease, we'll talk
about in a minute. Here's a picture with someone with a nasty otitis externa. This would be easily
treated with, I would think, probably just antibiotic ointment. It's probably fungal, and a fungal
ointment. Typically, it's going to be painful. This can be redness, can be itching, discharge.

Otitis media is infection of the middle ear. The risk factor is age, because pediatric auditory tubes
are horizontal. And they don't really drain well. So as they age, they're not as horizontal. And
symptoms include pain and swelling and pus. Diagnosis can be made by visualization. As I
mentioned earlier, tympanostomy tubes are used.

Our next lecture is on chapter 15, mental illness and cognitive disorders. When it comes to
mental health, there is the Diagnostic and Statistical Manual of Mental Disorders. It's known as
the DSM. And it is what is used to diagnose mental illness and mental disorders. It is the only
real reference manual.

So here we have a list of commonly diagnosed mental disorders, whether it be phobias, panics,
bipolar. And we'll go over some of these to some degree. Risk factors include genes, genetic
history-- which is a huge risk factor-- and environmental factors-- alcohol, illegal drugs, toxic
brain injury, oxygen deprivation at birth, poor nutrition, but also going on external environmental
factors during growth and development-- external factors, including poverty, abuse, watching
abuse, traumatic life events, death of a parent, a tragic accident.

My son has a friend who was in a car accident when he was younger-- he was about 10-- with his
father. And the car was totaled. It was turned over. And the father died. The son survived the
accident. The son was pinned underneath his dead father for two hours before they could get him
out-- a definite tragic, stressful situation. He honestly has talked about it. He seems to be doing
fine, I might add. But there are traumatic life events that people do experience.

Some of the warning signs and symptoms of mental disorder include confused thinking,
prolonged sadness, irritability, moodiness. Table 15 gives us an adequate list. Also, you can have
brain defects and imbalance of neural transmitters. There are so many different causes for mental
disorder.

This is the DSM 5. This is the current edition. This was published in 2013, so it's the fifth
edition. It outlines psychiatric disorders through symptoms and treatments. Table 15-3 discusses
some of the mental status examinations to evaluate someone-- their appearance, their attitude,
their level of consciousness, their orientation. Do they know their full name, where they are,
what's the month, what's the day? All these things are significant.

For example, what's the person's affect? Are they happy? Do they make eye contact? Are they
excitable? Are they crying? Are they hysterical? The book discusses several ways to treat mental
disorders-- psychotherapy, medications, and even sometimes, to some degree, brain stimulation
treatments.

The major depressive disorder is when people are so depressed, there's a sense of hopelessness
and despair. There's sadness and feelings of worthlessness, irritability, loss of interest in
activities. The major depressive disorder may require long term treatment. We discussed the
depression symptoms before. We don't really know what causes depression. It may be traumatic,
can be stressful events.

Low self-esteem, why does low self-esteem occur? Maybe that's a manifestation of depression,
self-critical or pessimistic outlook. Blood relatives with depression, definitely a huge factor that I
saw in my practice. LGBTQ individuals in unsupportive situations, history of other mental health
disorders, alcohol, drug abuse-- all these can cause a major depressive disorder. Treatment is
usually medication and counseling.

Personality disorders. The book discusses the personality disorders can be clustered into cluster
A, or B, or C. And of course, we have the eating disorders-- the anorexic nervosas, bulimia
nervosas, the binge eating disorders, and of course, the anorexics and bulimics usually occur at a
younger age group. The anorexics have an altered self-image-- I think you guys probably all
know that.

They can look in the mirror and they can see themselves as 50 pounds overweight, even when
they're 20 pounds underweight. Bulimics, sometimes, it stems from lack of control or feeling
they need to get control and they self-induce vomiting. My one son has a good friend who was a
swimmer, a top swimmer-- Ivy league swimmer. And a full scholarship. And she was bulimic in
high school.

And she told him she always carried a bottle of Mylanta or Maalox. So when she was in school
and she would induce vomiting, she then would rinse her mouth out with the Mylanta or Maalox
to neutralize the acid so it didn't destroy her teeth.

Binge eating disorder is a relatively new classification. It occurs in the older age group. And this
just summarizes what we talked about with anorexia with the altered self-image or self-
evaluation. And of course, I think you all know these people can go to extreme measures to try to
control their weight and lose weight. And it can be fatal. It can be fatal.

Anorexics can stop getting a period. We call that amenorrhea. They have low estrogen levels,
and they can even develop osteoporosis because of the low estrogen levels.

Bulimia, recurring episodes of binge eating is done to prevent weight gain and getting control.
And it is something I think that a lot of students have an understanding of or are aware of. It also
can involve the misuse of laxatives and diuretics, fasting, or excessive strenuous exercise.

Binge eating is characterized by recurring episodes of binge eating and a large amount of food
that's larger than most people would eat during a similar period of time, usually is due to a cycle
of lack of control. Binge eaters tend to eat more rapidly until the feeling they're uncomfortably
full. They have to be extremely uncomfortable before they really stop. And they can eat when
they're not physically hungry. And they usually eat alone.

Attention deficit hyperactivity disorder, ADHD, where there's a persistent pattern of inattention
and/or hyperactivity. It's usually evident in preschool or early elementary years. Treatment may
include medications. The concern is that some of these children, if they're diagnosed early with
ADHD, may go on to develop bipolar, being diagnosed with bipolar. And initially, it's diagnosed
as ADHD.

I threw this in there. It's kind of interesting. The CDC claims that possibly 11% of children
between the ages of 14 and 17 have been diagnosed with ADHD. And it shows the state which
has the greatest percentage of children diagnosed with ADHD. Luckily, Florida is not there. And
one of the best states would be over here in the west. And just interesting how there seems to be
a geographic tendency for diagnosing children with ADHD.

So after major depressive disorders, we have anxiety disorders. We have the panic disorder. We
have OCD. We have PTSD, social anxiety disorder, specific phobias, generalized anxiety
disorder, or agoraphobia.

Anxiety disorders are, basically, these people have increased fear, concerns, and of course,
anxiety. And it's probably the most common mental disorder and can affect job performance,
school work, personal relationships.
The next is bipolar. And bipolar basically means there's a change in personality from emotional
highs, to emotional lows. And the emotional highs are, of course, the manic phase. These people
have boundless energy, activity. They may have rapid speech, fleeting thoughts. And then the
other end is going to be the depressive phase. And their treatment is going to be medication to
help stabilize their mood, so that the manic phase is brought down, the depressive phase is
brought up.

So mania is a distinct period of abnormally persistently elevated, expansive, or irritable mood. It

Hypomania is a distinct period of abnormally persistently elevated mood, but it only lasts for
several days. And it usually is not as extreme as the mania. And for both a manic and a
hypomanic episode, they can form the symptoms that can be present. And as I mentioned, they
have a lot of energy. They have decreased need for sleep. They have an inflated self-esteem or
grandiose, racing thoughts, rapid speech, distractability, and agitated, risky behaviors, buying
sprees, foolish investments, sexual behavior.

And they breakdown bipolar into bipolar 1 and bipolar 2. And you can see the definitions there.
The cyclothymic means sort of more that they have numerous periods of hypomania and then
depression. So it just happens one after the other after the other. And they can have it for quite a
while.

Schizophrenia distorts the way a person thinks, acts, expresses emotion, or perceives reality. The
really big one is people may think in different ways, but their perception of reality is totally,
totally altered. And that's why you hear about people and they can see pink elephants flying, or
they think they're some type of deity. That's distorted reality. And sometimes, that goes with
bipolar, but it also goes along with schizophrenia.

And this is my favorite slide in the chapter. This is a slide that shows the artist's work of Louis
Wain. And he painted a cat. And he was a schizophrenic. And as you go along to the right, the
cat begins to look more artistic and less like a cat. And then you go to the bottom row, and you
go from left to right where as the last cat on the bottom right is so abstractly interpreted, that to
us, it doesn't look like a cat. And this illustrates the progression of the distortion of thought,
distortion of reality with schizophrenia.

And they may have hallucinations, as mentioned, delusions, disordered-thinking behavior.

The autism spectrum disorders-- a range of complex developmental disorders, usually diagnosed
in children. It's much more common in boys with a great range of abilities and characteristics. So
that's why they use the term spectrum. They don't classify it's a spectrum. You have a wide
spectrum of the disorder. So autism spectrum disorder is a serious neural development disorder
that impairs the child's ability to communicate and interact with others.
And as I said, the word spectrum refers to the wide range of symptoms and severity. And the
number of children diagnosed being on the spectrum is increasing. And each child's unique.
They have a unique pattern of behavior, level of severity. And sometimes, they can be slow to
gain knowledge or skills.

Intellectual disability, they have significant limitations in intellectual functions and adaptive
behavior. Intellectual disability, basically, they have IQ between 70 or 75. And issues for them
are going to be adaptive behavior, conceptual skills, also social skills, practical life support skills.
I have a niece who is intellectually disabled. And she is a great speller, but she has dyscalculus.
She cannot do math. She cannot do math. She cannot make change. And so these people, their
adaptive behavior, conceptual skills are going to be challenged.

The causes for intellectual disability can be genetic, maybe problems during pregnancy,
problems at birth, maybe infections during childhood, injury during childhood. Most of the time,
we do not know. For my niece, there's no obvious cause. She was an uncomplicated pregnancy,
uncomplicated birth, no obvious infections. But by one year of age, it was obvious that she was
going to be labeled intellectually disabled. She was way behind on her motor skills and verbal
skills.

So the article that I tweeted today for you students was on PTSD and PTSD complex. And it
basically discusses PTSD in greater depth than the book, and also, the idea of complex-- whereas
with PTSD as an anxiety disorder and develops after a person experiences a traumatic event.
However, in our society, there are people that have recurring traumatic events. And these people
have the symptoms of a complex PTSD. And it's going to be repetitive, such as childhood
neglect, domestic abuse, human trafficking is becoming more in the news. And all these issues
contribute to the diagnosis of PTSD being complex. So I really thought it was an excellent
article. And that's why I tweeted it for you guys to read and have a better understanding. Thank
you.