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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