Modules
- Year 1
- Year 2
- Introduction to Year 2 and Year Outcomes
- Cardiorespiratory 2
- Metabolism 2
- Brain and Behaviour 2
- Human Development 2
- Human Sciences and Public Health 2
- Locomotor 2
- Cancer Week
- Moving and Handling Training
- Year 2 Lifesaver Programme
- Clinical Communication Skills
- Medicine in Society 2
- Extended Patient Contact
- Student Selected Component (SSC)
- Year 3
- Introduction to Year 3 and Year Outcomes
- Clinical Science and Professionalism (Weeks 1-3)
- Cardiovascular, Respiratory and Haematology (CR3)
- Gastroenterology and Cancer (MET3A)
- Public Health
- Endocrinology and Renal Medicine (MET3B)
- General Practice and Community Care
- Student Selected Component (SSC)
- Clinical and Communication Skills
- Year 4
- Introduction and Year 4 Outcomes
- Obstetrics and Gynaecology
- Child Health
- HIV & Sexual Health
- Musculoskeletal
- Health Care of the Elderly
- Neuroscience
- Dermatology
- General Practice and Community Care
- Psychiatry
- Ear, Nose and Throat
- Global Health and Ethics
- Ophthalmology
- Clinical & Communication Skills
- Student Selected Component (SSC)
- Year 5
- Introduction to Year 5 and Year Outcomes
- Teaching Week 1
- Teaching Week 2
- Anaesthesia & ITU (AN & ITU)
- Breaking Bad News
- Clinical Pharmacology & Therapeutics
- Community Care
- Doctors as Teachers and Educators (DATE)
- Emergency Medicine (EMERG MED)
- General (Internal) Medicine (G(I)M)
- Immediate Life Support (ILS)
- Student Assistantship
- Simulation
- Surgery
- Student Selected Component (SSC)
- Year GEP 1
Year GEP 1 GEP/BB: Brain and Behaviour
- Dr Greg Michael
- g.j.michael@qmul.ac.uk
Teaching Material for this Module
Introduction
The aim of Brain and Behaviour is to develop an understanding of the structure and function in the nervous system and appreciate ways in which this understanding and knowledge is applied and relevant to clinical practice.
At the end of this course you should be able to:
- Describe the major functional structures of the human central nervous system (CNS) and their main interconnections. This should include all major structures in the forebrain, midbrain and hindbrain and spinal cord.
- Describe the main pathways by which the sensory modalities of low threshold cutaneous sensation (touch, pressure and vibration), pain and proprioception are transmitted from the periphery to the brain. The location of where these pathways crossover (decussate) in the nervous system, the basic tests used to assess their integrity and the clinical signs associated with damage to them.
- To outline the main components of the motor system with particular emphasis on the monosynaptic reflex and the corticospinal (pyramidal) tract, how to test reflexes, their clinical significance, and how to recognise damage to the motor system.
- Describe the vascular anatomy of the CNS, the ventricular system of the brain, the meninges and the circulation of cerebrospinal fluid.
- Understand the structure and function of the different cranial nerves, the principles of examination of the cranial nerves and how this examination can reveal pathologies in brain function.
- Examine a person’s special senses with particular emphasis on appreciating the anatomy and physiology relevant to the understanding of such examinations.
- Have a broad understanding of the parts of the brain involved in and the management of common neurological conditions such as Parkinson’s disease, stroke, dementia, psychosis and depression.
- To appreciate the main neurotransmitters in the CNS, the receptors at which they act and how specific drug classes can be used in the pharmacological management of PNS and CNS disorders.
- Describe the physiology and pharmacology of movement disorders.
- Describe the different pathways by which pain is transmitted to the brain and how it can be physiologically and pharmacologically modulated.
- Understand the psychological principles relating to health and health-related behaviours.
- Describe the mental state examination, the major signs and symptoms of psychiatric illness and the main principles underlying treatment.
- Appreciate the effects on the conscious level of brain disease.
- Describe the neurobiological, psychological and clinical basis of addictive behaviour.
- Describe the anxiety and mood disorders and explain the rationale underlying their treatment.
Sessions
- Lecture: Overview of the Nervous system
- Lecture: Introduction to the ANS
Teaching Material for this Session
- Compare and contrast the somatic and autonomic divisions of the nervous system.
- Name the divisions of the ANS, and describe the segmental organisation of the sympathetic and parasympathetic nervous systems.
- Draw a series of labelled diagrams to show the arrangement of nerve fibres in the divisions of the ANS at the anatomical and neurochemical and receptor levels.
- Describe how the adrenal medulla acts as a modified post-ganglionic cell.
- Briefly describe how the enteric nervous system can control gut function.
- Lecture: Introduction to Brainstem Histology
Teaching Material for this Session
- Define the main sub-regions of the brainstem, their functions and state which cranial nerves are associated with each region.
- Briefly describe the organisation of the cranial nerve nuclei and main ascending and descending pathways in the brainstem
- Briefly describe functions of the reticular formation
- Describe the blood supply to the brainstem
- List the symptoms associated with damage to cranial nerves
- Explain the consequences of vascular or physical lesions to different areas of the brainstem in terms of clinical signs.
- Explain the consequences of raised pressure in the posterior cranial fossa.
- Lecture: Peripheral Nerves
- Lecture: for Introduction to Ligands & Neuropharmacology
- Lecture: Cerebral Meninges and the CSF
- Lecture: Neurotransmitters of the Nervous System
Teaching Material for this Session
- Review how action potentials are generated, propagated along axons and explain reasons for failure.
- Briefly describe how nerve conduction studies and electromyography are performed and how they can detect peripheral nerve abnormalities.
- Review synaptic transmission and explain the importance of termination of transmitter action, and give two different examples of how this is achieved.
- Describe how epsps and ipsps are generated at excitatory and inhibitory synapses within the CNS.
- State the main neurotransmitters employed by sensory afferents and in CNS neurons and their associated receptors.
- Define the term neuromodulator and give examples of such
- Lecture: Organisation of the spinal cord
- Lecture: Spinal Reflexes
Teaching Material for this Session
- Define the terms: motor unit, upper and lower motoneurons.
- Describe how the force of muscle contraction is controlled by impulse frequency and by recruitment of motor units.
- Draw a reflex arc for control of muscle contraction including tendon organs and muscle spindles.
- Define muscle tone, spasticity and flaccidity.
- Describe the effects on muscles and reflexes of upper and lower motoneuron damage.
- Lecture: Basic Pharmacology
- Lecture: Somatosensory pathways
Teaching Material for this Session
- Describe the pathways to the brain for touch receptors; describe the clinical manifestations of lesions in these pathways
- Describe the pathways to the brain for proprioceptive receptors; describe the clinical manifestations of lesions in these pathways
- Describe the pathways to the brain for pain receptors; describe the clinical manifestations of lesions in these pathways
- Describe the organisation of somatosensory (VP) thalamus
- List the differences that may be encountered when a lesion is located at the peripheral, spinal, posterior fossa (brainstem), or supra-tentorial (thalamus/cortex) levels
- Lecture: Overview of the forebrain
Teaching Material for this Session
- Discuss the evidence that different areas of the cerebral cortex are involved in the production and perception of speech and language, and name these areas
- Discuss the differences in function between the right and left hemispheres
- Describe the functions of the inferotemporal and fusiform cortices, and how these functions may differ in the left and right hemispheres
- Lecture: Cranial Nerves (I) - cranial nerves VIII - XII
Teaching Material for this Session
- List the foramina that cranial nerves VIII-XII pass through as they exit the skull
- Describe the location of the motor nuclei of CN XII & spinal XI, describe the trajectory of these nerves and the muscles innervated, and describe typical signs of damage to these nerves
- Give the names and explain the function of the two motor nuclei of CN X. Give an overview of the function of CN X
- Describe the function of CN IX, and explain how it co-operates with CN X in various functions. Explain how lesions of CN X & CN IX may be differentiated
- Describe the trajectory and function of CN VIII
- Lecture: Cranial Nerves (II) - cranial nerves VII - I
Teaching Material for this Session
- List the foramina that cranial nerves VII-I pass through as they exit the skull
- List the different functions of CN VII, and how the trajectory of its different branches varies depending on destination
- Explain how CN III, CN IV & VI act as a functional unit to control eye movement; include a description of the pathways linking these nuclei
- Describe the signs of CN III palsy and CN VI palsy
- Describe the pathways involved in the pupillary light reflex
- Describe the pathways from retina to cerebral cortex, and explain how information in one visual field projects to the contralateral visual cortex
- Describe the signs of common lesions in the visual pathways to the cortex
- Explain the function of subcortical visual pathways
- Describe the trajectory of CN I
- Lecture: Drug absorption
- Lecture: Drug Mechanisms
Teaching Material for this Session
- Discuss the binding of drugs to cells.
- Discuss the desirability of drugs being selective in their actions and how this may be achieved.
- Explain the molecular basis for rational drug design.
- By using suitable examples, discuss the advantages and disadvantages of the various routes of administration for drugs.
- Using an annotated diagram define the terms: threshold , therapeutic range, lag-time, duration of effect.
- Lecture: Drug Absorption
- Lecture: Drugs and Drug Dependency
Teaching Material for this Session
- Describe addiction, physical dependence and psychological dependence, tolerance and withdrawal syndrome.
- Draw a labelled diagram of the mesocorticolimbic system, showing connections of the nucleus accumbens and the ventral tegmental area with the frontal cortex, hippocampus, thalamus, amygdala and the substantia nigra. Indicate dopaminergic tracts, principal opioid pathways and areas rich in gamma-aminobutyric acid (GABA).
- Define the physiological role of the mesocorticolimbic system.
- Explain, via their proposed effects on the mesocorticolimbic system the actions of amphetamine (including methyl amphetamine), cocaine, ethanol, benzodiazepines and barbiturates.
- List the major classes of drug that are subject to abuse for their CNS effects and which are associated with physical and psychological dependence.
- Describe the major pharmacological effects of certain drugs, emphasising effects which promote abuse and effects that are harmful.
- Lecture: Sedative Hypnotic and Anxiolytic Drugs
Teaching Material for this Session
- Discuss the rational for treating sleep and anxiety.
- Describe the pharmacology of barbiturates.
- Describe the mechanism of action of benzodiazepines.
- Discuss in detail the use of benzodiazepines as anxiolytics, hypnotics and sedatives.
- Compare risks and side effects associated with the use of barbiturates and benzodiazepines.
- Discuss alternative hypnotics and anxiolytics, such as chloral hydrate, buspirone and ß- adrenoceptor antagonists.
- Lecture: Antipsychotic Drugs
- Lecture: Drugs Mechanisms
Teaching Material for this Session
- Define the terms: agonist, antagonist, EC50, efficacy and potency.
- Draw idealised concentration vs response curves to distinguish between drugs of high and low potency and/or high and low efficacy.
- Describe, with a clinical example, the characteristics of competitive antagonism, and distinguish it from non-competitive antagonism.
- Discuss how receptors may be classified according to pA2 or agonist selectivity.
- Lecture: Blood Supply to the Brain
Teaching Material for this Session
- Describe the principal arteries of the brain, thalamus and spinal cord
- Explain the possibilities for collateral circulation through the Circle of Willis
- Describe the relationship of the blood supply to major functional areas of the brain
- Describe the venous drainage of the brain and spinal cord
- Describe the major vascular disorders with regard to the blood supply to the CNS
- Lecture: Visual System I & II
Teaching Material for this Session
- Describe the mechanism for the production of lacrimal secretions and the role of these secretions in vision
- Explain the role of the cornea in vision
- Explain the conditions of glaucoma and cataract and their probable causes
- Describe how photons absorbed by photoreceptor cells (rods and cones) cause changes in the membrane potential of these cells
- Explain what is meant by the retinal âdark currentâ
- Describe the main neuronal cell types in the retinal and their role in transmission of visual information
- Describe the blood supply to the retina and the significance of the choroidal circulation
- Lecture: Peripheral Distribution of Cranial Nerves
- Lecture: Cerebral Meninges & Cerebrospinal Fluid
Teaching Material for this Session
- Describe the arrangement of the dura mater, arachnoid mater and pia mater in the cranial cavity and outline their functions.
- Explain the functions of the falx cerebri and the tentorium cerebelli in stabilising the brain during movement.
- Define the extradural, subdural and subarachnoid spaces and explain possible ways in which haemorrhage can occur within them.
- Describe the ventricular system of the brain and the formation and drainage of cerebrospinal fluid.
- Describe the structure of the arachnoid granulations and explain their function.
- Explain the function of glia cells and the role of the blood-brain barrier.
- Lecture: Visual Pathways
- Lecture: Stroke
- Lecture: Head injury
Teaching Material for this Session
- Review the anatomical features of the cranium relevant to head injury.
- Explain the physiological principles relating to the intracranial pressure.
- Explain the pathological changes which occur in the brain following head injury.
- To provide an overview of the types of intracranial injury which occur and the basic principles of their management after head injury.
- Lecture: Peripheral Anatomy of Cranial Nerves
- Lecture: Nerve Injury and Repair
Teaching Material for this Session
- Define the term neurotrophic factor and explain the neurotrophic hypothesis
- List the changes that occur after nerve injury - distal to the injury; in the dorsal root ganglion; proximal to the injury
- Describe the process of nerve regeneration and state the criteria for determining its success
- Briefly explain why regeneration in the CNS fails to occur
- Lecture: Migraine & Headache
Teaching Material for this Session
- To understand the difference between primary and secondary headaches.
- To understand the distinguishing symptoms of primary headaches.
- To understand the role of genetic and environmental factors in headache (thresholds and triggering / precipitating factors).
- Review the central structures involved in primary headache.
- Define the following terms: neurogenic inflammation, spreading excitation/depression, peripheral and central sensitization, central generator/modulation.
- Lecture: Mechanisms of Pain and How to Manage Them
Teaching Material for this Session
- Describe the nature of Specificity and Gate-control theories of pain.
- Consider explanations for unusual pain phenomena
- Discuss the psychosocial factors that modulate the perception of pain.
- Introduce various methods and means of measuring pain.
- Describe psychological methods of pain management and therapy and discuss their efficacy.
- Lecture: Overview of Neural Control of Movement
Teaching Material for this Session
- Draw a diagram of the connections of the major components of the motor system (motor cortex, basal ganglia, cerebellum, brainstem, spinal cord and a-motoneurons)
- Outline the main fuction of each part of the motor system
- Define the area of the brain occupied by the motor cortex, its major inputs and outputs and its topographic arrangement (in terms of the distorted motor homunculus representation)
- Define the main functions of the motor association cortex
- Name the pathways that comprise the pyramidal and extra-pyramidal systems and describe their main functions
- Describe the basic neurological sequence involved in executing a voluntary movement
- Lecture: Auditory System
Teaching Material for this Session
- Describe the main functions of the auditory system.
- Give an account of the anatomy of the cochlea, and explain how it enables us to determine the frequency and the loudness of incoming sound.
- Explain how the direction of incoming sound may be determined.
- Define the unit of sound intensity, and draw a typical human hearing curve.
- Describe the auditory pathways.
- Define conduction and nerve deafness, and state tests for these.
- Lecture: Pharmacology of Movement
- Lecture: Motor systems of the brainstem
Teaching Material for this Session
- Be able to describe the functional characteristics of the major motor tracts (pyramidal, reticulospinal and vestibulospinal) and their origins
- Describe the pathophysiologic mechanisms of spasticity, clonus, hyperreflexia and decorticate and decerebrate postures.
- Describe the vestibule-ocular reflexes and how they are tested. Define nystagmus and vertigo.
- Describe the normal pupillary and accommodation reflexes and their clinical significance
- Describe the functional neuro-anatomy underlying eye movement defects; oculomotor, trochlear and abducens palsies and internuclear ophthalmoplegia
- Briefly describe the brainstem structures involved in the production of breathing, and list the inputs to the brainstem which influence breathing. Describe the types of pathological respiratory patterns that can occur.
- Lecture: Cerebellum
Teaching Material for this Session
- Describe the main gross anatomical features of the cerebellum, including its input and output pathways and its lobular arrangement.
- Describe the microanatomical arrangement of the cerebellum including the cortical morphology and connections of the deep nuclei.
- Describe the functional subdivisions of the cerebellum and the effect of injury in different regions.
- Describe the functional significance of the cerebellar connections to the vestibular system
- Lecture: Cortical and Subcortical Control of Movement
Teaching Material for this Session
- Diagram the connections of the major components of the motor systems (motor cortex, basal ganglia, cerebellum, brainstem, spinal cord and motoneurons)
- Outline the main function of each part of the motor system
- Define the area of the brain occupied by the motor cortex, its major inputs and outputs and its topographic arrangement (- the distorted motor homunculus representation)
- Define the main functions of motor association cortex
- Name the pathways that comprise the pyramidal & extra-pyramidal systems and describe their main functions
- Describe the basic neurological sequence involved in executing a voluntary movement
- Lecture: Vestibular System
Teaching Material for this Session
- List the functional roles of the vestibular system.
- Describe how the vestibular system detects angular and linear acceleration.
- Describe the vestibulo-ocular reflex and explain how nystagmus can occur.
- Describe the central pathways of the vestibular system.
- List the clinical signs of vestibular system dysfunction.
- Describe tests for balance disorders.
- Lecture: Mind & Brain
Teaching Material for this Session
- The complexity of 'the mind' and the origins of the concept from different disciplines
- Concepts of dualism and monism and the principle of physicalism
- The strengths and weaknesses of analytical models
- How dysfunction of the mind reflects dysfunction of the brain
- The importance of behavioural investigation, cognitive neuroscience and drug studies in eliciting the mind
- Biopsychosocial neuroscience as a model of the mind
- Lecture: Anatomy and Physiology of Pain
Teaching Material for this Session
- Review terms associated with pain systems
- Explain transduction, transmission, perception and modulation in the nociceptive system
- Describe the heterogeneity of nociceptors and its functional significance
- Define in detail pain pathways and their functional roles
- Explain the concepts of peripheral and central sensitization and their importance to medicine
- Lecture: Basal Ganglia
Teaching Material for this Session
- Describe the morphology and blood supply of the caudate and lentiform nuclei and the associated internal capsule
- Describe the principal afferent and efferent connections of the caudate nucleus and putamen (striatum).
- Describe the connections of the globus pallidus & subthalamic nucleus.
- Describe the motor deficits seen in Parkinsonâs disease and explain the theory of direct and indirect pathways used to explain the motor deficits
- Describe Huntingtonâs chorea, ballismus and athetosis, and explain the deficits in basal ganglia function that lead to these syndromes.
- Lecture: Limbic System
Teaching Material for this Session
- Describe the morphology of the main limbic structures - the hippocampus, the amygdaloid and the septal nuclei.
- Explain the principal connections between the foregoing limbic structures and the hypothalamus, anterior and dorso-medial thalamic nuclei, prefrontal cortex and midbrain reticular formation.
- Describe the effects of lesions in the amygdala and fornix.
- Describe the Kluver Bucy syndrome, temporal lobe epilepsy and Wernicke-Korsakoff syndrome.
- Discuss the theories of prefrontal cortex and temporal lobe function based on clinical evidence.
- Lecture: Dementia
- Lecture: Sleep and Consciousness
- Lecture: Epilepsy
- Lecture: Spinal Cord and Brainstem
- Lecture: Abnormal psychology
Teaching Material for this Session
- To appreciate the link between behavioural and medical problems.
- To understand problems in defining psychological abnormality.
- To discuss general approaches to understanding psychological illness.
- To appreciate how paradigms influence the choice of assessment and treatment.
- To explain the main concepts of biological, psychodynamic, behavioural, cognitive and evolutionary paradigms of mental illness.
- A video of an unusual psychological disorder will be used to illustrate the main points of the lecture, i.e. problems with definitions of psychological abnormality, and paradigms in abnormal psychology.
- Lecture: Addiction
- Lecture: Symptoms of the Mind
- Lecture: Cortical Assymmetry
Teaching Material for this Session
- Discuss the evidence that different areas of the cerebral cortex are involved in the production and perception of speech and language, and name these areas.
- Discuss the differences in function between the right and left hemispheres.
- Describe the functions of the inferotemporal and fusiform cortices, and how these functions may differ in the left and right hemispheres.
- Lecture: Schizophrenia
- Lecture: Learning and Conditioning
- Lecture: Higher Mental Functions
Teaching Material for this Session
- Lecture: ANS Anatomy and Physiology
- Lecture: Learning & Memory
Teaching Material for this Session
- Define learning, and describe the conditions under which it occurs.
- State the differences between classical conditioning and operant conditioning.
- Define short- and long-term memory, and consolidation
- Define anterograde and retrograde amnesia, and state some of the major causes of these.
- Describe the possible synaptic mechanisms underlying memory formation.
- State the role of the hippocampus and the amygdala in memory.
- Briefly outline the effects of frontal and temporal lobe lesions on memory.
- Course Review
- B&B- PBL 1: ALTERED SENSATIONS
- B&B- PBL 2: A BROKEN MAN
- B&B- PBL 3: A SUDDEN LOSS OF FUNCTION
- B&B- PBL 4: A PROBLEM WITH THE FACE
- BB1 -PBL 5: ACHES AND PAINS
- Lecture: Pharmacology of ANS:
Teaching Material for this Session
- Describe the different types of acetylcholine receptors and list their contribution to the effects produced by the parasympathetic nervous system
- List the different agonists and antagonist which bind to acetylcholine receptors and describe their therapeutic uses
- Describe the effects of drugs which act indirectly to modulate cholinergic transmission
- Describe the different types of adrenoceptors and list their contribution to the effects produced by the sympathetic nervous system
- List the different agonists and antagonist which bind to adrenoceptors and describe their therapeutic uses
- Describe the effects of drugs which act indirectly to modulate noradrenergic transmission
- Lecture: Basic Pharmacology
Teaching Material for this Session
- Discuss the binding of drugs to cells.
- Discuss the desirability of drugs being selective in their actions and how this may be achieved.
- Explain the molecular basis for rational drug design.
- By using suitable examples, discuss the advantages and disadvantages of the various routes of administration for drugs
- Using an annotated diagram define the terms: threshold , therapeutic range, lag-time, duration of effect
- Lecture: Pharmacology of Depression
Teaching Material for this Session
- Discuss the hypotheses on the neurochemical substrate of depression.
- Describe bipolar and unipolar affective disorders.
- Describe in detail the pharmacology of tricyclic antidepressants.
- Describe in detail the pharmacology of serotonin selective uptake inhibitors.
- Describe in detail the pharmacology of monoamine oxidase inhibitors.
- Discuss the drug interactions associated with the above classes.
- Discuss the use of mood stabiliser in mania (lithium, valproate, and carbamazepine).
- Lecture: Pharmacology Review
- Lecture: Pharmacology of pain
Teaching Material for this Session
- Describe opioid and non-opioid analgesic drugs, including specific examples
- Explain what is meant by the concept of âanalgesic ladderâ and how it works
- Describe local and general anaesthetics
- Describe the management of trigeminal neuralgia, as an example of treatment of a neuropathic pain condition
- Lecture: From Movement and Posture to Brain and Behaviour