Disorders II: Mood Disorders and Schizophrenia

1. Disorders II: Mood Disorders and Schizophrenia Module 23 By Samantha Kops

2. Mood Disorders • A Mood disorder is a prolonged and disturbed emotional state that affects all of a person’s thoughts and behaviors. • The DSM-IV lists 10 different mood disorders • The three most common are Major Depressive Disorder, Bipolar I (or manic-depressive disorder) and Dysthymic Disorder

3. Major Depressive Disorder is characterized by at least 2 weeks of being in a bad mood, having no interest in anything and getting no pleasure in any activities. Victims must also have 4 of the following symptoms: Problems eating Problems sleeping Problems thinking Problems concentrating Problems making decisions Lacking energy Thoughts of suicide Feelings of worthlessness or guilt 17% of surveyed adults reported at least one episode of major depression More common in women than men (21% to 13%) Major Depressive Disorder

4. Bipolar I Disorder • Bipolar I is marked by fluctuations between episodes of depression and mania • A manic episode goes on for about a week during which a person is unusually euphoric, cheerful and high. • Must have at least 3 of the following symptoms • Great self-esteem • Little need for sleep • Speaks rapidly and frequently • Has racing thoughts • Is easily distracted • Pursues pleasurable activities • Less than 1% of the general population has bipolar I disorder

5. Dysthymic Disorder is characterized by being chronically but not continuously depressed for a period of 2 years. While depressed, the person must experience at least 2 of the following symptoms: Poor appetite Insomnia Fatigue Low self-esteem Poor concentration Feelings of hopelessness Afflicts 6% of population Dysthymic Disorder

6. Causes of Mood Disorders • About 15 million Americans develop a mood disorder each year • 2 categories of causes: • Biological Factors • Psychosocial Factors • Is not one or the other, both interact to form causes of development of disorder.

7. Mood DisordersBiological Factors • The Biological Theory of Depression states that there are underlying genetic, neurological and physiological factors that may predispose a person to develop a mood disorder. • Genetic Factors • Studies with twins prove there is a genetic correlation • Study showed that if one twin has bipolar disorder: - In identical twins, the other has an 80% chance of developing the disorder - In fraternal twins, the other has a 16% chance of developing the disorder • Researchers have not yet identified the specific gene or genes contributing the development of mood disorders.

8. Mood DisordersBiological Factors • Neurological Factors • Researchers have identified a certain group of neurotransmitters involved in mood disorders. • Research has also found that the prefrontal cortex area of the brain was 40% smaller in depressed patients.

9. Mood DisordersPsychosocial Factors • Psychosocial factors including personality traits, amount of social support and the ability to deal with stressors are believed to interact with predisposing biological factors, combining to put one at risk to develop a mood disorder. • Self-esteem plays an important role in personality factors. • Those with lower self-esteem create additional stressors on themselves, thereby increasing the chance of developing a mood disorder.

10. Treatment of Mood Disorders • Due to their separate diagnosis, each disorder is treated differently • Most treatment combines drug therapy and Psychotherapy • If that does not work, some patients proceed to Electroconvulsive Therapy

11. Antidepressants increase levels of a specific group of neurotransmitters. They are commonly used on Major Depressive Disorder and Dysthymic Disorder About 80% of prescribed antidepressants are selective serotonin reuptake inhibitors These drugs work by raising serotonin levels Prozac is a popular one due to its lack of major side-effects. Drug TreatmentAntidepressant Drugs

12. Lithium is a naturally occurring mineral salt. Lithium is the most effective treatment for bipolar I disorder because it reduces or prevents manic episodes. 30-60% of bipolar patients were greatly helped by the use of lithium. 30-50% were partially helped Has some serious side effects including weight gain and toxic effects Many bipolar patients stop using lithium on their own because they miss the sense of euphoria caused by their manic episodes Drug TreatmentLithium

13. Electroconvulsive Therapy • Electroconvulsive Therapy or ECT is a last resort effort to treat those with mood disorders • Involves placing electrodes on the skull and administering a mild electric current through the brain, causing a seizure. • Treatment consists of a series of 10-12 ECT sessions, about 3 per week.

14. Personality Disorders • Personality Disorders are inflexible, long-standing, maladaptive traits that cause significantly impaired functioning or great distress in one’s personal and social life, • Found in 12% of the adult population in the United States • Common in serial killers • 10 different types described in DSM-IV

15. Types of Personality Disorders • Paranoid Personality Disorder: a pattern of distrust and suspiciousness, often perceiving others as having evil motives.( 0.5-2.5% of population) • Schizotypical PD: an acute discomfort in close relationships, distortions in thinking, and eccentric behavior.(3-5% of population) • Histrionic PD: excessive emotionality and attention-seeking. (2% of population) • Obsessive- Compulsive PD: an intense interest in being orderly, achieving perfection, and having control. (4% of population)

16. More Types of Personality Disorders • Dependent PD: A pattern of being submissive and clingy because of an excessive need to be taken care of. (2% of population) • Antisocial PD: A pattern of disregarding or violating the rights of others without feeling guilt or remorse. (3% of population, predominantly males)

17. Troubled childhoods Childhood problems continuing to adulthood Maladaptive or poor personal relationships Extreme abnormal behaviors People with Personality Disorders • Individuals with Personality Disorders often have one or more of the following: • Antisocial Personality Disorder is most commonly associated with serial killers and is often covered in the media.

18. Antisocial Personality Disorder • Those diagnosed with antisocial personality disorder are more commonly referred to as psychopaths or sociopaths. • Their symptoms form a continuum at which one end are the chronic delinquents, bullies and lawbreakers; at the other are the serial killers. • Psychopaths have two common characteristics: • A Consistent pattern of disregard for the violation of the rights and/or properties of others where they might steal, harass or beat others, destroy property, kidnap or kill. • Their dishonesty, lying or deceitful manipulation of others • Psychopaths are more likely to be men (2-4.5%) than women (0.5-1%)

19. Psychopaths • Becoming a psychopath is caused by both biological and psychological factors • Psychopaths are notoriously hard to treat due to the fact that they usually are convincing liars, have no guilt or remorse, impulsive and reckless and fail to learn from experience. • Common treatment for psychopaths comes in the form of serotonin-raising antidepressants. • Psychotherapy usually has little or no effect

20. Schizophrenia is a serious disorder lasting for at least six months and including at lest 2 of the following symptoms: Delusions Hallucinations Disorganized speech Disorganized behavior Decreased emotional expression No two cases are exactly alike The DSM-IV describes 5 different subcategories of schizophrenia. The three most common are paranoid, disorganized and catatonic. Schizophrenia

21. Types of Schizophrenia • Paranoid schizophrenia: Having auditory hallucinations or delusions, such as thoughts of being persecuted by others or thoughts of grandeur. • Disorganized schizophrenia: marked by bizarre ideas, often about one’s body (Ex: bones melting), confused speech, childish behavior (giggling uncontrollably, making faces at people), mood swings (fits or laughing or crying), and extreme neglect of personal appearance and hygiene. • Catatonic schizophrenia: characterized by periods of wild excitement or periods of rigid, prolonged immobility; sometimes the person assumes the same frozen posture for hours on end. • Disordered thought processes and delusions are common among all types or schizophrenics.

22. Classifying Schizophrenics • The chances of recovery differ depending on the patient’s symptoms. • Schizophrenics classified into two general categories according to the connotations of their symptoms. • Type I schizophrenia includes having positive symptoms, such as hallucinations and delusions which are distortions of normal functions. This group has no intellectual impairment, a good reaction to most medication, thus a good chance of recovery. • Type II schizophrenia includes having negative symptoms including dulled emotions and little inclination to speak, which are a loss of normal functions. In addition, this group has intellectual impairments, poor reactions to medication, thus a poor chance of recovery.

23. Biological Causes of Schizophrenia • A recent study with identical twins showed that if one twin was diagnosed with schizophrenia, then there was an 83% chance that the other also had it. • This proved that some people inherit a predisposition for the disease. • For the past 10 years, scientists have been searching for genetic markers that might trigger the disease. • A newer theory is that a specific part of chromosome 6 could be associated with the disease. • Researchers believe that genetic factors act primarily during the 20th-30th week of fetal development • Most scientists agree that a predisposition for schizophrenia is often the result of faulty development of certain structures of the brain; they develop it.

24. Neurological Causes of Schizophrenia • One study found that out of a pair of identical twins (one with schizophrenia, one without) the diagnosed one had larger ventricles. • Many schizophrenics have a significantly smaller thalamus, which may result in a defect in neural circuitry. • Some schizophrenics also a less active prefrontal cortex than most healthy people. ♥♥The Diathesis Stress Theory of schizophrenia states that some people have a genetic predisposition that interacts with life stressors to result in the onset and development of schizophrenia.

25. Treatment of Schizophrenia • Neuroleptic drugs are the most common form of treatment for schizophrenia • Neuroleptic drugs (or antipsychotic drugs) are used to treat serious mental disorders, like schizophrenia, by changing the levels of neurotransmitters in the brain. • There are two types: typical and atypical.

26. Typical neuroleptic drugs reduce the levels of the neurotransmitter dopamine. Two of the most common are phenothiazines and butrophenones. These drugs reduce positive symptoms and have no effect on negative symptoms. The dopamine theory states that in schizophrenia the dopamine neurotransmitter is overactive and results in a wide range of symptoms. Atypical neuroleptic drugs also lower dopamine levels, but more importantly lower levels of other neurotransmitters, especially serotonin. One common group are benzamides such as clozapine. These drugs primarily reduce positive symptoms and may slightly improve negative symptoms. Neuroleptic Drugs

27. Problems with Neuroleptic Drugs • Typical neuroleptics, specifically phenothiazines, can produce unwanted motor movements or tardive dyskinesia. • Tardive dyskinesia is the appearance of slow, involuntary, and uncontrollable rhythmic movements and rapid twitching of the mouth and lips as well as unusual movement of the limbs. Usually associated with the usage of typical neuroleptics. • Atypical neuroleptics have a less chance in the development of tardive dyskinesia, but a greater increase of side-effects including: - fatigue - emotional indifference to one’s surroundings - loss of white blood cells

28. Dissociative Disorders • A Dissociative Disorder is characterized by a person having a disruption, split, or breakdown is his or her normal integrated self, consciousness, memory, or sense or identity. • The DSM-IV lists 5 dissociative disorders however the 3 most common are dissociative amnesia, dissociative fugue and dissociative identity disorder. • Dissociative Amnesia: is the inability to recall important personal information or events and is usually associated with stressful or traumatic events. • The importance or the extent of information forgotten is too great to be explained by normal forgetfulness. • Dissociative Fugue: is a disturbance marked by suddenly and unexpectedly traveling away from home or place of work and being unable to recall one’s past or may be confused about his or her new, assumed identity.

29. Dissociative Identity Disorder • Dissociative Identity Disorder: (formerly multiple personality disorder) is the presence of two or more distinct identities or personality states, each with its own pattern or perceiving, thinking about, and relating to the world. • Different personalities might take control of the individual’s thoughts and behaviors at different times. • The personalities are often very different and complex and the original personality is usually unaware of their existence. • Two theories why: 1) A traumatic childhood episode split the identities as a defense mechanism. 2)People are using it as an excuse to manipulate others for personal gain. (Ex: in a court of law) • Majority of cases are women. (89%)

30. Depression • Mild depression is generally has less of an impact on a person’s functioning than Major Depression. • According to Beck’s theory of depression, we have automatic negative thoughts that we rarely notice throughout the day. These thoughts distort how we perceive and interpret the world and influences our behaviors and feelings, resulting in depression. • Depression can be more easily avoided through improving social skills and increasing social support.