PSYCHOPATHOLOGY Chapter 16 1 Schizophrenia a symptoms b

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

GENERAL SYMPTOMS OF SCHIZOPHRENIA Positive symptoms Hallucinations Delusions Dissociative thought disorders Negative symptoms Impoverished thought and speech Social withdrawal Blunted affect Cognitive symptoms Poor attention Deficits in learning Psychomotor slowing The term schizophrenia was coined by P. Eugen Bleuler (1857 -1939)

DSM-IV-TR SUBTYPES OF SCHIZOPHRENIA 1. Paranoid: delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening are absent. 2. Disorganized: thought disorder and flat affect present together. 3. Catatonic: immobility or agitated, purposeless movement. Symptoms can include catatonic stupor and waxy flexibility. 4. Undifferentiated: Psychotic symptoms present but the criteria for paranoid, disorganized, or catatonic types have not been met. 5. Residual: Positive symptoms are present at low intensity only. Developers of DSM-5 are recommending they be dropped from classification.

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

Gene X Environment Interactions • SERT allele x maternal influence = aggressivity (Soumi and colleagues, 2005). • SERT allele x life stress = depression (Caspi and Moffitt, 2002).

THEORIES OF SCHIZOPHRENIA Hypofrontality hypothesis Schizophrenics have less activity in frontal lobes Supported by PET studies showing less activity in frontal lobes of patients performing on “frontal task” such as Wisconsin Card Sort.

Males Females

THEORIES OF SCHIZOPHRENIA Dopamine hypothesis Schizophrenics have more activity in mesolimbic dopamine system Supported by several lines: 1. Dopamine agonists mimic symptoms 2. PET studies show patients have increased D 2 dopamine receptors 3. With antipsychotic drugs, there is a correlation between affinity of the drug for the D 2 dopamine receptor and clinical potency

THEORIES OF SCHIZOPHRENIA Psychotogen hypothesis Schizophrenics have faulty metabolic process which leads to production of endogenous hallucinogens Supported by evidence of LSD and PCP effects

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

ANTIPSYCHOTIC MEDICATIONS (Pick your “poison”) TRADE NAME GENERIC NAME Abilify Clozaril Geodon Haldol Lidone Loxitane Mellaril Moban Navane Orap (for Tourette's syndrome) Permitil Prolixin Risperdal Serentil Seroquel Stelazine Taractan Thorazine Trilafon Vesprin Zyprexa aripiprazole clozapine ziprasidone haloperidol molindone loxapine thioridazine molindone thiothixene pimozide fluphenazine risperidone mesoridazine quetiapine trifluoperazine chlorprothixene chlorpromazine perphenazine trifluopromazine olanzapine

CLASSES OF ANTIPSYCHOTIC MEDICATIONS 1. Phenothiazines- e. g. , chlorpromazine (Thorazine) 2. Butryophenones- e. g. , haloperidol (Haldol) 3. Thioxanthene derivatives- e. g. , thiothixene (Navane) 4. Dibenzodiazepine derivatives- e. g. , clozapine (Clozaril)

SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS Antipsychotic medications generally have a high therapeutic index, but common side effects include: 1. Anticholinergic effects- dry mouth, constipation. 2. Orthostatic hypotension- dizziness with movement 3. Sexual dysfunction- loss of libido, disrupted cyclicity in females 4. Disrupted thermoregulation- hyperthermia

SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS (con’t) 5. Extrapyramidal motor effects- a. Acute dystonic reaction - facial grimacing, torticollis, oculogyric crisis - most common in young males b. Akathisia - constant movement c. Tardive dyskinesia - stereotyped involuntary movements of lips, tongue and jaw - 10 -20% of old patients 6. Neuroleptic malignant syndrome - fever, confusion - 1% occurrence, but can be fatal due to leukocytosis

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

SYMPTOMS OF DEPRESSION · · · Change in body weight and appetite Change in normal sleep pattern Loss of libido Feelings of hopelessness Thoughts of suicide Internalizing of negative outcomes

SUBTYPES OF DEPRESSION Major Affective Unipolar Bipolar Dysthymia Lower grade, but long-lasting depression Atypical -Specific type of depression characterized by supersensitivity to social rejection and carbohydrate craving -Especially responsive to MAO inhibitors

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

THEORIES OF AFFECTIVE DISORDERS Monoamine hypothesis Depressed patients have less monoamine activity Supported by evidence showing: • Reserpine-induced depletion of monoamine stores leading to depression. • Clinical evidence showing efficacy of SSRIs (e. g. , setraline, Zoloft) and SNRIs (e. g. , venlafaxine, Effexor).

COMORBID DEPRESSION AND ANXIETY

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

TREATMENT OF DEPRESSION · · · Antidepressant medication Electroconvulsive therapy Sleep deprivation Light therapy Psychotherapy

Trade Name Generic Name Adapin Anafranil Asendin Aventyl Desyrel Effexor Elavil Ludiomil Luvox (SSRI) Marplan (MAOI) Nardil (MAOI) Norpramin Pamelor Parnate (MAOI) Paxil (SSRI) Pertofrane Prozac(SSRI) Remeron Serzone Sinequan Surmontin Tofranil Vivactil Wellbutrin Zoloft (SSRI) doxepin clomipramine amoxapine nortriptyline trazodone venlafaxine amitriptyline maprotiline fluvoxamine isocarboxazid phenelzine desipramine nortriptyline tranylcypromine paroxetine desipramine fluoxetine mirtazapine nefazodone doxepin trimipramine protriptyline bupropion sertraline

CLASSES OF ANTIDEPRESSANT MEDICATIONS

SIDE EFFECTS OF ANTIDEPRESSANT MEDICATIONS Antidepressant medications generally have a high therapeutic index and they can be combined safely with other psychotropics (except MAO inhibitors). Some side effects include: 1. Sedation 2. Insomnia 3. Anticholinergic side effects 4. Hypotension 5. Agranulocytosis 6. “Cheese effect” with MAO inhibitors

LITHIUM • First used by John Cade in Australia in 1949 • Complete absorption with no metabolism • Retention enhanced by low sodium diet • Blocks inositol monophosphate phosphatase, thus reducing PI turnover • Low therapeutic index • Side effects include hypothyroidism, weight gain, polydipsia, polyuria, increased leukocytes

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

Anxiety Disorders 1. Phobia a. specific irrational fear b. responsive to behavioral treatment 2. Obsessive-Compulsive disorder a. repetitive intrusive thoughts or actions b. SSRI treatment 3. Panic disorder a. episodes of intense anxiety b. benzodiazepine treatment 4. Generalized anxiety disorder a. free-floating anxiety b. benzodiazepine treatment

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

ANXYOLITICS HYPNOTICS Alprazolam Chlordiazepoxide Buspirone Diazepam Lorazepam Oxazepam Triazolam Phenobarbital Halazepam Prazepam Chloral hydrate Estazolam Flurazepam Pentobarbital Lorazepam Quazepam Triazolam Secobarbital Temazepam Zolpidem