1 / 33

Adult Psychopathology

Adult Psychopathology. Mood Disorders. Depression Major depression Dysthymia Postpartum depression Bipolar disorder Bipolar I Bipolar II Cyclothymia. Major Depression. Marked change in mood Diagnosis entirely behavioural

burkholder
Télécharger la présentation

Adult Psychopathology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Adult Psychopathology

  2. Mood Disorders • Depression • Major depression • Dysthymia • Postpartum depression • Bipolar disorder • Bipolar I • Bipolar II • Cyclothymia

  3. Major Depression • Marked change in mood • Diagnosis entirely behavioural • Persistent sad mood, loss of appetite, insomnia, restlessness, feelings of: worthlessness, guilt, helplessness, pessimism, cognitive difficulties, social withdrawal, decreased energy, etc. • Behaviours must persist at least 2 weeks • Isolated or recurrent, mild, major, or severe

  4. Epidemiology • Affects 8-17% of population at least once • Over 1 million Canadians; over 120 million world wide • Projected to be second-leading cause of disability worldwide by 2020

  5. Comorbid Conditions • Anxiety disorders • Attention-deficit hyperactivity disorder • Suggest roles of serotonin, norepinephrine, and dopamine in depression • (More on this later)

  6. Numbers • Heritable • Family risk about 9% vs. 3% in controls • Concordance of 0.43 for MZ and 0.28 for DZ twins • Adoption studies mixed, but sample sizes quite small • No shared environmental effect to speak of

  7. Dysthymia • Less severe condition than major depression • Chronic • Altered eating patterns, insomnia or hypersomnia, low energy, low self-esteem, poor concentration, feelings of hopelessness • Heritable, 2-3 times more common in females

  8. Postpartum Depression • Form of clinical depression • Can affect men too post-childbirth • 5-25% prevalence rate in women • Typically lasts hours to days • Wide range of symptoms • Sadness, hopelessness, low self-esteem, guilt, sleep disturbance, exhaustion, social withdrawal, etc. • Some interesting correlations

  9. Meta-analyses • Predominately environmental factors have been examined • SES is significant, but even when controlled, higher prevalence in African-American • Heritability and ethnicity PredictorCorrelation Prenatal depression 0.44-0.46 Low self-esteem 0.45-0.47 Childcare stress 0.45-0.46 Life stress 0.38-0.40 Low social support 0.36-0.41 Marital difficulty 0.38-0.39 Single parent 0.21-0.31 Low socioeconomics 0.19-0.22 History of depression 0.38-0.39 <Beck (2001)> EthnicityPrevalence of PPD Overall 15.7% African-American 25.2% Native American 22.9% Caucasian 15.5% Hispanic 15.3% Asian/Pacific 11.5% <Segre et al. (2006)>

  10. Hormones and PPD • Has been suggested that post-childbirth hormonal changes are causative factor • Not supported (e.g., O’Hara, 1995) • Also, fathers can experience PPD… • Diathesis-stress models, gene-environment interaction • Some women are susceptible to stress of childbirth and/or hormonal shifts • Hormones simulating pregnancy and parturition induce PPD-like symptoms, but only in some women

  11. Bipolar Disorder • Not a single disorder; category of mood disorders characterized by abnormally elevated mood (mania), sometimes followed by depressive episodes, generally interspaced with normal periods • Affects about 1% of world’s population; 17% lifetime risk for suicide • Bipolar I • At least one or more manic episodes; may be episodes of major depression as well • Bipolar II • At least one manic and one major depressive episode

  12. Affect • Mania • Euphoria, grandiosity, increased energy, increased irritability, decreased need for sleep, rapid speech, risk taking • Depression • Low mood, low energy and motivation, insomnia, feelings of hopelessness

  13. Cyclothymia • Milder form of bipolar II • Recurrent mood disturbances between hypomania and dysthymic mood • Ranging from mild elation to mild depression • Generally goes through cyclic periods • Typically unrelated to life events (from self-reports), although may be triggered by general stress levels • Lifetime prevalence of 0.4-1% • Equal in sexes, but women seek treatment more

  14. Numbers • Heritable • Family risk of 9% vs. 1% in controls • Concordance of 0.4-0.65 for MZ and 0.05-0.07 for DZ twins • Adoption study (Mendlewicz & Rainer, 1977) found 7% of biological parents vs. 0% of adoptive parents show bipolar disorder

  15. Bipolar Linkage • Early linkage studies inconsistent • Suggestions of autosomal dominant loci largely rejected • Polygenic effect • Possible loci: 4p, 5q, 10q, 12q, 13q, 18p, 21q, 22q, Xq (and more!)

  16. Kelsoe et al. (2000) • 443 microsatellite markers • 20 families (San Diego and Vancouver) • Have proband and at least two additional affected members (either bipolar I or II)

  17. Loci • 12 yielded LODs greater than 2.0 across genome • Highest scores for 22q13 (GRK3 gene) • Also high LODs at 5p15 (dopamine transporter gene), 10q, and 13q • Some overlap with loci reported for schizophrenia on these chromosomes • Suggests many susceptibility genes are common for the two disorders • Could be nonspecific susceptibility or different mutations in the same gene may predispose to different disorders

  18. GRK3 Gene • GRK3 widely expressed in brain • Regulation of G protein-coupled receptor signaling • Brain neurotransmission effects, including dopamine and corticotropin-releasing factor receptors (and others) • GRK3 expression induced by amphetamine in rats (animal model of mania) • Unclear if GRK3 is a candidate gene in non-Northern European descended Caucasians

  19. Selling bipolar genetic tests to public over the internet for $399 as of March 2008 • Receive cup, spit in cup, mail cup to Psynomics • Psynomics mails results to client’s doctor indicating likelihood of developing bipolar disorder • Two mutations on GRK3 gene • Kelsoe argues that this moves away from behavioural diagnosis • However, only usable for whites of Northern European ancestry who show some behavioural symptoms and have at least one other bipolar family member • As of yet, APA has no policy on genetic testing • Currently not taking new patients

  20. Bipolar Disorder and Schizophrenia • Similar clinical features • Mood disturbance, cognitive impairment, psychosis • Both about 1% prevalence rate • Both have about 10% risk in first-degree relatives • Some evidence that schizophrenia occurs at increased frequency in relatives of probands with bipolar disorder and vise versa • Loci on chromosomes overlap for disorders • Problem has been identifying specific genes and/or biochemical pathways

  21. Chotai, Serretti & Lorenzi (2005) • 114 schizophrenics and 416 bipolar disorder • Interaction between tryptophan hydroxulase (TPH; involved in serotonin synthesis), serotonin transporter (5-HTTLPR), and dopamine receptor (DRD4) genes • Interaction between alleles of TPH and 5-HTTLPR genes constitute susceptibility to schizophrenia but not to bipolar disorder

  22. Silberschmidt & Sponheim (2008) • COMT gene, 22q11 • Enzyme degrading dopamine, epinephrine, norepinephrine • Valine for methionine SNP affects cognitive tasks by reducing dopamine at four times the regular rate • Differentiated relatives of schizophrenic and bipolar disorder patients on various personality dimensions • Valine allele linked to low narcissism, rejectionability, and stimulus seeking; seen in relatives of schizophrenics, but not relatives of bipolar disorder patients • COMT associated with schizophrenia, but not bipolar disorder

  23. Anxiety Disorders • Wide range of types • Panic disorder, generalized anxiety disorder, phobias, obsessive-compulsive disorder • Either involve anxiety or attempt to reduce anxiety • Most common form of mental illness; lifetime prevalence of 29% • May lead to other disorders, like depression

  24. Panic Disorder • Fear of specific situation that can cause more panic attacks • Lifetime risk of 5% • Morbidity risk in first-degree relatives of 13%; concordance of 31% for MZ and 10% for DZ twins

  25. Generalized Anxiety Disorder • Chronic state of diffuse anxiety; excessive and uncontrollable worrying • Runs in families; 10% for first-degree relatives • Contrasting twin studies • Two show no heritability • Three show about 20% • Little shared environment

  26. Phobias • Fear related to specific stimulus • Predisposition to fear something; specific stimulus from learning • 30% familial risk for general phobias (vs. 10% controls), 20% for social phobias (vs. 5% controls) • Somewhere around 30% heritability

  27. OCD • Different diagnostic criteria; gives different results in studies • On average, 7% risk for family members (vs. 3% controls) • Early onset OCD more familial • Two of three twin studies failed to find heritability

  28. Co-Occurrence of Disorders • Diagnostic criteria behaviourally based • Overlap • Should we separate mood disorders? • Relatives of (unipolar) depressives are not at increased risk for bipolar depression, but relatives of bipolar depressives are at a 14% risk (vs. 1% controls) • Individuals with one disorder have close to 50% chance of having 1+ other disorders in the same year

  29. Bipolar & Schizophrenia • Badner & Gershon (2002) find overlapping linkage for bipolar depression and schizophrenia in 13q and 22q • Under DSM-IV, bipolar can only be diagnosed if patient is not schizophrenic • So clinically, can’t be comorbid • But…

  30. Anxiety Disorder Co-occurrence • Hettema et al. (2005) • Significant overlap between generalized anxiety disorder, panic disorder, agoraphobia, and social phobia • Non-shared environmental effects primarily responsible for differences • Should we have some sort of overarching anxiety measure (e.g., a?), like g for cognitive ability?

  31. Anxiety and Depression • Genetically speaking, anxiety and depression are largely the same thing • Kendler et al. (1992) • Major depression and generalized anxiety disorder • No significant shared environment effects ra = 1.0 ru = 0.51 Additive Unique Unique Additive 31% 42% 58% 69% Major Depression Generalized Anxiety

  32. A New Model • Internalizing disorders • Depression and anxiety disorders • Externalizing disorders • Alcohol and drug abuse, and antisocial adult behaviour • Based on behavioural genetics, not traditional clinical behavioural diagnostics

  33. Internalizing Externalizing Anxious/misery Fear Alcohol dependence Other drug abuse or dependence Adult antisocial behaviour Conduct disorder • Genes associated with an internalized disorder will be associated with other internalized disorders; genes associated with externalized disorders will be associated with other externalized disorders • Genetic effects may be broad in their effects on psychopathology • “Generalist genes” Major depression Generalized Anxiety disorder Panic disorder Animal phobia Situational phobias Disorder- Specific factors Disorder- Specific factors

More Related