Psychopatholgy

Chapter 18 Neurobiology of Schizophrenia, Mood Disorders, and Anxiety

Unless otherwise noted, all information is obtained from: McCance, Kathryn L. and Huether, Sue E. (2006). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Fifth Edition; Elsevier Mosby, Philadelphia, PA

It is characterized by “thought disorders” which are defined as a “break in reality or a splitting of the cognitive from the emotional side of one’s personality”.
 * Schizophrenia**

Schizophrenia characteristics: -affects 1% of the world’s population, -behaviors include “incoherent speech, delusions, or hallucinations, -psychotic episode may include positive symptoms: (hallucinations, delusions, positive formal thought disorder or bizarre behavior), -or negative symptoms (affective flattening, alogia, anhedonia-asociality, attention, avolition-apathy), -presents in the late teens or early 20’s, -origin thought to be contributed to neurodevelopmental defects during fetal life.

Neuroanatomic and Functional Abnormalities: -enlarged lateral and third ventricles and the widening of fissures and sulci in the frontal cortex of the brain, -the dorsolateral prefrontal cortex (DLPFC) is hypoactive, with decreased blood flow and decreased glutamic acid decarboxylase (GABA), -positive symptoms are contributed to the hypersecretion of mesolimbic dopamine, -negative symptoms are contributed to an abnormal elevation in dopaminergic transmission, -antipsychotic drugs block dopamine and serotonin receptors; pyschosocial is also used as an adjunctive therapy.

//I don't claim to understand mental illness and the causes and all the details about it. Of course, I don't think anybody does. They are trying to find things. It's very popular nowadays to find chemical explanations and genetic explanations and maybe whatever can be observed by imaging. Imaging studies of the brain and differences in the sizes of particular areas in the brain. So this is the popular area -- but I don't think it's so simple that all cases are necessarily the same. The symptoms are very coordinated, so that you can define schizophrenia or manic depressive illness in terms of symptoms, which are observed in behavior. –John Nash, 1994 Nobel Prize winner in economics////. (//http://www.pbs.org/wgbh/amex/nash/sfeature/sf_nash_08.html)

Mood disorders are defined as “a sustained emotional state as opposed to brief emotional feelings, which are called affective states. When emotional states such as euphoria (mania) and depression are maintained and become predominant, the individual may be diagnosed with a mood disorder.”
 * Mood Disorders**

__Major depression__ (unipolar) characteristics: -most common disorder, -afflicted are unable to experience pleasure and have no outside interests, -females have an x2 risk than males, -25% of those with major depression will have an associated manic episode, -recurrent patterns of manic/depression is called “bipolar disorder”, -genetic basis exist for development of moos disorders, -environmental factors play a role in depression, -depression occurs with a deficit in brain monoamines: norepinephrine, and serotonin, -mania results from elevated concentrations of monoamines, -thyroid and growth hormone abnormalities are found in depression, -structurally smaller frontal lobes and limbic systems, -characterized by “unremitting feelings of sadness and despair, insomnia, loss of appetite and body weight, and reduced interest in sex.” -associated thoughts of suicide and risks thereof are increased.

__Manic depression__ characteristics: -elevated levels of euphoria and self-esteem, -associated feelings of grandiosity, -associated traits of restlessness and irritability, -easily distracted, -hallucinations and delusions may manifest.

Pharmacological treatments: __Unipolar depression__: monoamine oxidase inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors. Manic and bipolar: lithium or mood stabilizers. Electroconvulsive therapy may be used for those not responding to pharmacotherapy.


 * //Mike Wallace: I had done a story about depression on 60 Minutes early on. I didn't know anything about it, really. I found out about a California fellow who ran a large corporation, who had been Secretary of Defense or Assistant Secretary of Defense. He had it all. He talked to me about it and said, "Suddenly, I found myself in a deep depression. What was I depressed about?" Josh Logan was on that, and he too had a manic depression. So we put the piece on the air. Then, when I was on trial for my life effectively, during the Westmoreland trial, when he sued CBS and me and a variety of other employees of CBS for $120 million because we told the truth about the story called "The Uncounted Enemy" of Vietnam deception. I sat in the cold and drafty Federal courtroom in Foley Square in New York for about five months, and the plaintiff puts on his case first in a libel suit. He has sued for $120 million bucks. To be called "liar, cheat, fraud," et cetera, and in a libel case nothing is barred. Little by little by little, I found myself getting spacey, and unable to sleep and unable to eat, and I mean really, what in the dickens is going on? What happened, obviously it took me a little time to find out, was that I was in a classical, clinical depression. I mean it really was a tough one. I was copeless; not just hopeless, but copeless. I tried to keep on working, because I was ashamed of acknowledging the fact that I was depressed. You don't use that word.//** **//(http://www.achievement.org/autodoc/page/wal2int-7)////**

“Characterized by intense autonomic arousal that involves a wide variety of symptoms”
 * Panic disorder**

Symptoms: lightheadedness, racing heart, difficulty breathing, chest discomfort, sweating, weakness, chills and hot flashes.

Treatments: -behavioral therapy and antidepressant medication, -breathing and biofeedback techniques are learned, -benzodiazepines prescribed as adjunctive therapy.

Characterized by “excessive and persistent worries… about life, marital relationships, job performance, health, money, or social status.”
 * Generalized Anxiety Disorder**

Treatment: -serotonin/norepinephrine reuptake inhibitors, -behavioral therapy, -relaxation thechniques.

Panic disorder with agoraphobia. For a time, Kim Basinger's fears left her homebound. "I stayed in my house and literally cried every day. I didn't know what it was. I didn't know how to define it," Basinger states in Panic, an HBO American Undercover documentary. Basinger describes herself as a shy child but experienced her first panic attack in her mid-twenties, when her career was taking off. The panic became bad once again during the media attention prior to her Oscar win. (http://panicdisorder.about.com/od/famouspeople/p/kimbasinger.htm)//

Disorders produced by “ exposure to terrifying or life-threatening events”.
 * Posttraumitic stress disorders**

Characteristics: -most susceptible are those with a history of mental illness, depression, or weak social skills, -traumatic event is re-experienced in thoughts and dreams, -triggered by cues, -individuals may avoid associated stimuli, -results in difficulty sleeping, decreased concentration, and hypervigilance, -brain regions involved prefrontal cortex, hippocampus, and amygdale.

Treatment: -pschycotherapy, -selective serotonin reuptake inhibitors, -antidepressants.

By Kevin G. Hall and David Montgomery
 * Official Iraq war costs don't tell the whole story**

More than 73,000 soldiers returning from Iraq and Afghanistan have been diagnosed with post-traumatic stress disorder (PTSD) and with problems such as drug abuse and depression. That's enough people to fill a typical NFL stadium. Internet blogs written by soldiers or their wives tell of suicide attempts by soldiers haunted by the horror of combat, civilian careers of reservists who've been harmed by deployment and redeployment, and marriages broken by distance and the trauma of war. "Back-to-back war deployments has changed both of us - to where it's as if a marriage does not exist anymore," wrote a woman calling herself Blackhawk wife on an Iraq war vets Web site. "We just go through the daily steps of life and raising children as best we can." A mother of a returning soldier posted this: "Since he has been back, he has had 3 DUIs, wrecked his truck, attempted suicide, been diagnosed with PTSD" and is being kicked out of the Army. (http://www.mercurynews.com/mld/mercurynews/news/politics/16178928.htm)

“Repetivitve, intrusive thoughts and/or compulsions…that are irrational, impair normal functioning, and may cause marked distress. Obsessions may involve a preoccupation with contamination, doubting, religious or sexual themes, or a belief that a negative outcome will occur if a specific act is not performed.”
 * Obsessive-compulsive disorder**

Characteristics: -thoughts contributed to orbitofrontal and anterior cortical hyperactivity, -serotonin agonists exacerbate symptoms.

Treatments: -cognitive-behavioral therapy, -selective serotonin reuptake inhibitors,

//Howie Mandel has [|obsessive-compulsive disorder] (OCD) and [|mysophobia] (fear of [|germs]) to the point that he does not shake hands with anyone, including enthusiastic contestants on Deal or No Deal, unless he is wearing latex gloves. Instead of shaking contestants' hands when they offer them, he will give the contestants congratulatory gestures such as: tapping another's fist with his own fist, hugging them, and putting his hands on their shoulders. Howie now takes medicine to control his condition and even pokes fun at himself for it. (http://en.wikipedia.org/wiki/Howie_Mandel)//