Download Mood Disorders and Schizophrenia

Mood Disorders and
Schizophrenia
Psychology II
February 17th, 2009
• We all feel sad at one point or another. What
separates normal sadness from depression?
Mood Disorders
• Mood Disorder: prolonged and disturbed
emotional state that affects almost all of a
person’s thoughts, feelings and behaviors
• Three most common: major depressive
disorder, bipolar I disorder, and dysthymic
disorder
Mood Disorders: Major Depression
• Marked By at least 2 weeks time period of:
– Bad mood, no interest in anything, no pleasure
from normal activities
– At least four of the following symptoms:
• Problems with:
– Eating, sleeping, thinking, concentrating, making decisions
• Lacking energy
• Thoughts of suicide
• Feeling worthless or guilty
Mood Disorders: Bipolar I Disorder
• Marked by:
– Fluctuations between episodes of depression and
mania
• Mania: episode that goes on for over a week, during
which a person is unusually euphoric, cheerful, and
has great self esteem, little need for sleep, racing
thoughts, and is easily distracted
Mood Disorders: Dysthymic Disorder
• Less serious than major depression
• Characterized by:
– Chronic but not continuous depression for a
period of two years or more
– Experiences at least two of the following
symptoms:
• Poor appetite, fatigue, insomnia, low self-esteem,
feelings of hopelessness
Mood Disorders: Causes
• Biological factors: genetic, neurological,
chemical, and physiological components that
may predispose or put someone at risk for
developing a mood disorder
– No one single factor
– Abnormal levels of certain neurotransmitters can
interfere with brain functioning and put people at
risk
– Prefrontal cortex sometimes smaller, less active
Mood Disorders: Causes
• Psychosocial Factors: personality traits,
cognitive styles, social supports, and the
ability to deal with stressors all interact with
biological factors to create risks
• Stressful life events, negative cognitive style,
personality factors
– Overreact to negative events
– Socially dependent personality
– Achievement personality
February 18th, 2009
Would you rather suffer from major depression
or lose large parts of your memory?
Mood Disorders: Treatments
• Depending on diagnosis and psychotherapy,
treatment may include psychotherapy,
antidepressants, or both
Mood Disorders: Treatments
• Antidepressant Drugs: increase specific
groups of neurotransmitters (monoamines)
that are involved in the regulations of
emotions and moods
– Serotonin, norepinephrine, and dopamine
– Mostly SSRI’s: selective serotonin reuptake
inhibiters
– Help about 65% of patients; half or more relapse
when taken off drugs
Mood Disorders: Treatments
• Psychotherapy
– For less severe depression, just as effective as
anti-depression medications
– For severe depression: best results come from a
combination of both
– 25-60% of depressed patients may have
significantly reduced symptoms when treated with
only placebos
Are antidepressants prescribed too much?
Mood Disorders: Treatments
• Relapse
– Within 18 months, 70% of patients had relapsed
– 82% of patients relapse within first five years
– Of the remaining that had not relapsed:
• 30% treated with psychotherapy
• 20% with antidepressant drugs
• 20% with placebos
Because of recurrence of relapse, clinicians
conclude that major depression is a long-term or
chronic disorder
Mood Disorders: Treatments
• Bipolar I Disorder
– Treatment
• 50% of patients are greatly helped by a combination of
lithium and other drugs such as anti-depressants and
anti-psychotics
– Relapse
• For both Bipolar I and major depression patients, 10%-30% of patients not helped at all
• 30%--70% initially improve but later relapse
February 19th, 2009
• Consider yesterday’s question. Would you
rather be seriously depressed, or undergo a
treatment that causes you to have a grand mal
seizure and lose parts of your memory– if you
knew that much of it would return eventually?
Mood Disorders: Electroconvulsive
Therapy
• Often called “treatment of last resort”
• Involves placing electrodes on the skull and
administering a mild electric current that
passes through the brain and causes a seizure
• Usual treatments consists of a series of 10-12
ECT sessions, at the rate of about three per
week
Mood Disorders: Electroconvulsive
Therapy
Pros
• Effective in reducing
depressive symptoms in
60%--80% of patients
Cons
• Memory Loss, both for
events experiences during
weeks of treatment and
before and after
• Some memories return, but
about 50% of patients given
ECT reported considerable
memory loss for as long as 3
years after the treatment
Case Study: Michael
Schizophrenia
• Serious mental disorder that:
– Lasts for at least 6 months
– Has at least two of the following symptoms:
•
•
•
•
Delusions
Hallucinations
Disorganized speech\behavior
Decreased emotional expression
Schizophrenia
• No two patients have the same exact set of
symptoms; five categories of symptoms
1. Disorders of thought
2. Disorders of attention
3. Disorders of perception
1. Hallucination: Sensory experiences without any
stimulation from environment
4. Motor Disorders
5. Emotional (affective) disorders
Subcategories of Schizophrenia
• Paranoid: auditory hallucinations or
delusions, such as thoughts of being
persecuted by others or delusions of grandeur
• Disorganized: bizarre ideas, often about one’s
body (i.e. bones melting), confused speech,
childish behavior (giggling for no apparent
reason, making faces, etc), great emotional
swings, and often extreme neglect of
personal appearance and hygiene
Subcategories of Schizophrenia
• Catatonic: periods of wild excitement or
periods of rigid, prolonged immobility;
sometimes, the person assumes the same
frozen posture for hours on ends
February 20th, 2009
• For you, what would be the worst part of
having schizophrenia?
Causes
• Biological
– Genetic predisposition
• Several genes involved
• If identical twin has schizophrenia, likely other twin will
too
• Neurological
– Larger ventricles
– Less activation of prefrontal cortex
Causes
• Environmental
– Stressful events, such as hostile parents, poor
social relations, the death of a parent or loved
one, or career or personal problems can all
contribute to the development and onset of
schizophrenia
– Diathesis stress theory: some people have a
genetic predisposition that interacts with stress
to result in schizophrenia
Chances of Recovery
• Dependent on a number of factors, grouped
under two main types of schizophrenia
– Type I: positive symptoms– hallucinations,
delusions, etc. Distortion of normal functions, no
intellectual impairment, good reaction to
medication
– Type II: negative symptoms – dulled emotions,
etc. Loss of normal functions, intellectual
impairment, poor reaction to medication
Treatment:
• Typical Neuroleptics: decrease dopamine
– Primarily reduce positive symptoms and have little
effect on negative symptoms
– Dopamine Theory: symptoms are caused by
overactive dopamine neurotransmitters
– 20% of schizophrenics not helped
– Serotonin and glutamate also involved
• Atypical Neuroleptics: decrease dopamine and
serotonin
– Reduces positive symptoms, may improve negative
symptoms, and reduce relapse
Side Effects, Effectiveness, Relapse
Typical Neuroleptics
• Side effects
– Unwanted motor movements
• Rapid twitching of mouth
and lips
• Effectiveness
– 2-12 years after treatment,
20%-30% showed good
outcome
• Relapse
– After average of 19 months,
53% experienced relapse
Atypical Neuroleptics
• Side Effects
– Unwanted motor movements
in 5% of patients
– Increased levels of blood
sugar, excessive weight gain,
onset of diabetes
• Effectiveness
– 31%-60% showed significant
improvement
• Relapse
– 16% relapse rate