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Psychiatric Disorders

Psychiatric Disorders . Chapter 13. In this lesson. Anxiety Tourette Syndrome Major Depression Bipolar Schizophrenia. Our essential questions throughout this unit: What is it? How does it affect those afflicted? Can it be treated?. Anxiety. Most widespread mental illness

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Psychiatric Disorders

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  1. Psychiatric Disorders Chapter 13

  2. In this lesson • Anxiety • Tourette Syndrome • Major Depression • Bipolar • Schizophrenia Our essential questions throughout this unit: What is it? How does it affect those afflicted? Can it be treated?

  3. Anxiety • Most widespread mental illness • Many different diseases are included • OCD • Panic • Phobia • PTSD

  4. Obsessive Compulsive Disorder • Repetitive thoughts (obsession) and behaviors (compulsion) • Ex. repeatedly washing hands, checking that doors are locked • Thought that environmental factors and genetics probably play a role in the development of the disorder. • Multiple abnormalities in brain • Positron emission tomography (PET) scans reveal abnormalities in both cortical and deep areas of the brain • Treated with antidepressants and behavioral interventions • OCD- Grey's Anatomy

  5. Panic Disorder • Starts "out of the blue" • Symptoms: Overwhelming sense of impending doom, sweating, weakness, dizziness, shortness of breath • If untreated, may lead to agoraphobia (fear of open spaces) • Treated with antidepressants (including SSRIs) and cognitive behavioral therapy

  6. Phobias • Intense, irrational fear of a particular object or situation. • Broad range of phobias including dogs, dating, blood, snakes, spiders, or driving over bridges. • Exposure to object causes extreme fear reaction that may include: • a pounding heart, shortness of breath, and sweating. • Treatment • Cognitive behavioral therapy • Likely that panic disorders and phobias have similar neurochemical mechanisms.

  7. Guess the phobia: • Ablutophobia- Fear of washing or bathing.Acarophobia-Fear of itching or of the insects that cause itching.Acerophobia- Fear of sourness.Achluophobia- Fear of darkness.Acousticophobia- Fear of noise.Acrophobia-Fear of heights.Aerophobia-Fear of drafts, air swallowing, or airbourne noxious substances.Aeroacrophobia- Fear of open high places.Aeronausiphobia- Fear of vomiting due to airsickness.Agateophobia- Fear of insanity.Agliophobia- Fear of pain.Agoraphobia- • Fear of open spaces or of being in crowded, public places like markets. Fear of leaving a safe place.

  8. Post-Traumatic Stress Disorder • Due to extreme stressors (ex.combat- Video, rape victim, witnessing a crime) • Intense fear, helplessness, flashbacks, avoidance, numbing, hyperarousal • Dysregulation of fight or flight response • Disordered sleep • Major depressive disorder • Elevated levels of adrenaline released during stress -> Strengthens amygdala (emotion, fear) while weakening prefrontal cortex

  9. PTSD-Treatment • alpha-1 blocker,prazosin, a drug used to lower blood pressure is now used to treat nightmares experienced with PTSD. • People treated with prazosin include those with a very long-standing illness, such as Holocaust survivors. • Beta-blockers such as propranolol also are being tested in individuals exposed to trauma • must be administered shortly after the trauma, before PTSD has been established • Antidepressant & atypicalantipsychotic medications • Psychotherapies, such as cognitive behavioral therapyor eye movement desensitization & reprocessing (EMDR) therapy. • EMDR therapy remains controversial due to questions about its methods, theoretical foundations

  10. Case 1 A patient goes to the emergency room because all of a sudden he started perspiring, and feeling shaky and feeble.  He also said that he felt like he was short of breath, and felt like the world was going to end. What do you think this person has? Later, he begins to experience intense fear whenever he leaves his house to go somewhere.What is this called? Panic Disorder Agoraphobia-

  11. Case 2 A man coming back from fighting in a war complains of not sleeping well due to nightmares.  Also, he states that when he is awake he has been experiencing intense fear, and flashbacks of the war.  He feels like he is always in a state of anxiety. If you could look in his brain, you would see that his amygdala (the fear/emotion center) is extra active, while the prefrontal cortex that should be controlling it is not. What does this patient have? If a blood test were to be taken, levels of what hormone/neurotransmitter are elevated? Which structure would a PET scan reveal abnormally high activity in? PTSD adrenaline amygdala

  12. Anxiety Treatment • Brain receptors for the benzodiazepineantianxiety drugs has sparked research to identify the brain’s own antianxiety chemical messengers. • Enhance responsiveness to endogenous GABA • Recent studies have revealed alterations in certain GABA receptors in the CNS of patients with PTSD, effectively providing an additional neurochemical link between anxiety disorders. • Could lead to new ways to modulate anxiety disorders. What do you know about benzodiazepine?

  13. Tourette Syndrome What do you know about Tourette Syndrome?

  14. Tourette Syndrome • An inherited disorder that causes tics • Tics are repetitive, involuntary movements or utterances that are rapid and sudden and persist for more than one year. • Video of a teenager with Tourette Syndrome: • http://www.youtube.com/watch?v=KgwJZp5SxDo

  15. Tourette Syndrome • How common? • 1 in 200 Americans • Who is affected? • 3-4X more males than females affected • Typical onset between 4-8 yrs • What is the natural history of the disorder? • Tics change frequently and severity of tics fluctuates • 50% have disorder for life • 50% will have more mild symptoms or even have remission as they age

  16. Conditions associated with Tourette Syndrome • Difficulties with learning and attention • Obsessive thoughts • Compulsive rituals

  17. Neurobiological Basis • Not well understood • Probably the result of abnormal activity in the basal ganglia • Excess dopamine may also be involved

  18. Treatment of Tourette Syndrome • Not always required • Medications may be used to control tics, nausea, high blood pressure, seizures, or anxiety if these are significant in a patient • Antipsychotics, SSRIs • The same medications used for ADHD may help if there are attention problems • Stimulant drugs (methylphenidate, dextroamphetamine) • Obsessive-compulsive symptoms treated similarly to obsessive compulsive disorder • SSRIs, antidepressants

  19. Treatment Continued • Side effects of treatments • Weight gain, muscular rigidity, motor restlessness, social withdrawal • Besides medication, psychotherapy and counseling may be beneficial

  20. Review tics • What is defined as repetitive, involuntary movements or utterances that are rapid and sudden and persist for more than one year • Which gender is more likely to be affected by Tourette’s and when is typical onset? • What are common symptoms of Tourette Syndrome • SSRI drugs may be used to treat which symptoms of Tourette’s? Boys, 5-8 Difficulties with learning and attention Obsessive thoughts Compulsive rituals • tics, • nausea, • high blood pressure, • seizures, • anxiety • Obsessive-compulsive symptoms

  21. MAJOR DEPRESSION

  22. What are the symptoms of Major Depression? • Long-lasting feelings of sadness, hopelessness, pessimism, loss of interest in life, and reduced emotional well-being. • Disturbances of sleep and appetite • Decreased energy, • Cognitive disturbances such as difficulty concentrating and remembering. • Depressed individuals are at a significantly elevated risk of suicide.

  23. Causes & Mechanisms: • Combination of genetic & environmental factors • Physical symptoms may reflect disturbances in the hypothalamus, resulting in an excessive production of stress hormones. • In the laboratory: Many patients fail to shut off secretion of the stress hormone cortisol in response to potent synthetic analogs that normally feed back to shut off secretion.

  24. Causes & Mechanisms: • PET imaging implicates involvement of a region of the anterior cingulategyruswithin the prefrontal corte • Anterior cingulategyrus normally integrates aspects of cognition and emotion • Experimental target for deep brain stimulation in severely depressed patients

  25. How common is major depression? • US- Lifetime risk of a depressive episode severe enough to warrant treatment is approximately 18%. • In the past 12 months, 6.7% of U.S. adults experienced a major depression.

  26. Treatments? • Drugs, Psychotherapy, or Combo • Severe cases-electroconvulsive therapy • Deep brain stimulation

  27. Treatments • Antidepressant drugs increase levels of norepinephrine or serotonin in synapses, with a few medications also targeting dopamine. • The well-known selective serotonin reuptake inhibitors, or SSRIs, act on serotonin alone. • The increased levels of neurotransmitters then initiate plastic changes in cells and circuits • Cognitive behavioral psychotherapies

  28. Treatments • Cognitive behavioral psychotherapies have been shown to be effective. • Recently, ketamine, a drug that blocks NMDA glutamate receptors, has been shown to alleviate depressed symptoms rapidly. • Too many side effects • Not likely to be used clinically

  29. BipolarDisorder Depressive Lows and Manic Highs

  30. Bipolar disorder • Thought to affect 1% of population • Manic Highs and depressive lows • Acute periods of normalcy* (still have mild depressive symptoms) • Genetic basis, many genes identified to contribute to the disorder

  31. What are the syptoms of Mania? • Increased energy, decreased need for sleep, a marked interest in goal-directed activities, and poor judgment. • Individuals may spend excessively or engage in uncharacteristic drug abuse or sexual behaviors. • Individuals with mania may be euphoric, but some are predominantly irritable. • Typically, manic individuals are grandiose (believing the are superior to all), and when the mania is particularly severe, they may have delusions or hallucinations. • May believe that they are prophets, deities, or on a special mission. • Mania can be mild. Then it is called hypomania.

  32. Treating Bipolar Disorder • Lithium • When given to manic patients, lithium improved all manic symptoms and stabilized their moods. • This enabled people with the disorder to return to work and live relatively normal lives. • Many patients require additional treatments • Other medications include some drugs, such as valproate, that were first developed as anticonvulsants. • None of the existing drugs are perfect, and they all have side effects.

  33. TedTalk • http://www.youtube.com/watch?v=8Ki9dgG3P5M Long Video Personal Account • http://www.webmd.com/bipolar-disorder/bipolar-tv/ Short Video Biology

  34. Schizophrenia

  35. Schizophrenia-What is it? • Chronic illness marked by disturbances in thinking, cognition, emotionalreactions, and socialbehavior-often results in personalitychange. • Delusions, hallucinations, and thoughtdisorder are common, as are disturbances in attention, memory, and complexthinking. • 1.1 percent of the population, or 2.4 million Americans • Annual costs total about $62.7 billion.

  36. Symptoms may be “Positive” or “Negative” • +Positive: Hallucinations, delusions, confusion • -Negative: Inability to experience pleasure, lack of motivation

  37. Schizophrenia-What causes it? • May be caused by the disruptionofneurodevelopment through a genetic predisposition • May be exacerbated by environmental factors such as maternal infections or direct brain trauma.

  38. Schizophrenia-Can we see it? • Brain scans and postmortem studies show abnormalities in some people with schizophrenia, such as enlarged ventricles (fluid-filled spaces) and reduced size of certain brain regions

  39. Schizophrenia-Can we see it? • PET and fMRI taken while individuals perform cognitive tasks, particularly those involving memory and attention, show abnormal functioning in specific brain areas. • Brain systems using the chemicals dopamine, glutamate, and GABA appear to be particularly involved in the development of the disorder.

  40. Schizophrenia • Mutations in several genes involved in controllingnervecellcommunication have been identified that appear to increase the risk of developing schizophrenia. • Twin Studies

  41. Schizophrenia • Diagnosis between the ages of 15 and 25. • Few patients recover fully • Most continue to have moderate or severe symptoms • Symptoms may be aggravated by stressors. • About 15% of individuals return to a productive life after a single episode, • 60% will have intermittent episodes throughout their lives, • 25% percent will not recover their ability to live as independent adults.

  42. Schizophrenia-1st Gen of Antipsychotic Drugs • 1950s- 1st antipsychotic drug, chlorpromazine, • Led to development of more than 20 effective antipsychotic drugs • The first generation of antipsychotic drugs acts by inhibiting certain dopamine receptors. • Side effects similar to those seen with Parkinson’s. • Risk of developing an irreversible movement disorder, tardivedyskinesia, which results in aimless, uncontrollablemovements, such as grimacing or rapid eye blinking.

  43. Schizophrenia-Gen 2 Drugs • The second generation of antipsychotic medications were developed to be more effective in treating the positive symptoms of schizophrenia. • Reduces Parkinsonian effects • Does have other debilitating side effects: • Large weight gain, • Blood disorders, • Muscle pain and dysfunction • As a result of problems with both generations of antipsychotic medications, safer drugs with fewer side effects are currently being sought.

  44. http://www.youtube.com/watch?v=bWaFqw8XnpA

  45. Review • What was the first antipsychotic drug used for schizophrenia? • Chlorpromazine • How does this drug work? • It blocks dopamine receptors • This leads to symptoms similar to those seen in • Parkinson’s disease • Chlorpromazine use also runs the risk of developing a movement disorder which results in aimless, uncontrollable movements, such as grimacing or rapid eye blinking. What is this disorder? • Tardive dyskinesia • The 2nd gen drugs decrease the Parkinson’s symptoms but often result in… • Weight gain, blood disorders, muscle pain & dysfunction

  46. REVIEW

  47. Name the disorder! • This disorder, whose symptoms include social and communication abnormalities, has a higher prevalence today than in the 1970s due, in part, to changes to diagnostic criteria and greater awareness. Autism (ASD)

  48. Name the Disorder! • The neurobiological basis of this disorder is thought to involve abnormal function of the basal ganglia and excess dopamine. Tourette Syndrome

  49. Name the Disorder! • The neurobiological basis of this disorder involves an expanded triplet repeat of a gene located on chromosome 4, & is thought to involve the breakdown of the basal ganglia. Huntington’s Disease

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