Chapter #16: Psychiatric Disorders Flashcards
What are psychiatric disorders?
-Disturbance in thought, mood and/or behavior that impairs function or causes distress
-Diagnosed by behavioral symptoms vs. lab test
-Diagnostic & Statistical Manual of Mental Disorders
-biological underpinnings
Prevalence of Psychiatric Disorders
-More than 1/3 of US population reported at some point symptoms matching psychiatric disorders
-Sex differences
-Age of onset
Social Behavioral Dysfunction in mental Illness
-Hypo- or a-sociality (reduced, or lack of, healthy social function)
-Impaired motivation to elicit social interactions
-Social avoidance
-Impaired social cognition
Impaired motivation to elicit social interactions
Schizoid personality disorder – cold, detached, aloof
Social Avoidance
Social anxiety disorder – find social interactions aversive
Impaired social cognition
Autism spectrum disorders – difficulty understanding others’ emotions and thoughts
Pattern of antisocial behavior and/or attitudes
-Disregard for and violation of the rights and feelings of others
-Deviates noticeably from expectations of individual’s culture
-Pervasive and inflexible
-Leads to personal distress or impairment
Sociopathy
having a sense of morality and a well-developed conscience, but the sense of right and wrong is not that of the parent culture – can show remorse for actions
Psychopathy
no empathy or sense of morality, dishonesty, manipulativeness – shows no remorse
Cluster B personality disorders
- Antisocial personality disorder
- Borderline personality disorder
- Narcissistic personality disorder
- Histrionic personality disorder
In some studies, 9 out of 10 people with antisocial personality disorder…
have been found to have some other major psychiatric illness
What psychiatric illnesses are common with antisocial personality disorder?
-Substance use disorder is most common
-Other impulse control problems
-Mood disorders
Theoretical Psychological Basis
-Part 1: Callousness/unemotionality
-Part 2: Impulsive/impaired learning
-Consequence: Antisocial behaviors
Neuroscience Basis
- Amygdala dysfunction causes reduced emotional empathy and sets the stage of psychopathy
- Reward/reinforcement system (striatum) dysfunction causes impaired action-outcome (instrumental learning), particularly for punishment
- Frontal lobe dysfunction and impulsive crime
Amygdala & Emotional Empathy
-Viewing people experiencing fear, sadness or pain evokes emotional empathy in healthy people (we experience their emotions)
-Activates:
1. Amygdala
2. Anterior Cingulate
3. Insula
4 facets - Amygdala & Emotional Empathy
- Interpersonal – superficial charm, manipulative
- Affective – shallow affect, lack of remorse
- Lifestyle – impulsivity, irresponsibility
- Antisocial – poor behavioral control, criminal versatility
Ventral Frontal Lobe & Self Control
-fitful, irreverent, indulging at times in the grossest profanity (not previously custom)
-little deference for his friends
-impatient of restraint or advice when it conflicts with desires
What is schizophrenia?
-Schizo = to split
-Phren = mind, not personality
→ Thought, mood, affect and behavior are splintered
What spectrum of disorders is schizophrenia?
Psychosis = disconnection from reality
Prevalence of schizophrenia
-Age of onset is typically 18-24
-1 to 3% of US population
-more common in males
DSM V Criteria for Schizophrenia
-2 or more of the following present for a significant portion of time in a 1 month period, at least one of these must be 1,2, or 3
1. delusions
2. hallucionations
3. disorganized speech
4. grossly disorganized or catatonic behavior
5. negative symptoms (ex. diminished emotional expression or avolition)
-for a significant portion of time since onset, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is below the level achieved prior to onset
-continuous signs of persistence for at least 6 months
-schizoaffective disorder and depressive or bipolar disorder with psychotic features have been rules out
-the disturbance is not due to a substance
-if autistic spectrum disorder or communication disorder of childhood onset, schizophrenia is only diagnosed if prominent delusions and hallucinations are present and required symptoms are present for at least 1 month
DSM V Criteria for Alcohol Use Disorder
In the past year you must have 2 symptoms to have AUD, 2-3 for mild, 4-5 for moderate, and 6 for severe
1. drank more than intended
2. more than once wanted to stop but could not
3. spent a lot of time drinking
4. wanted to drink so badly you couldn’t think about anything else
5. drinking or being sick from it interfered with your home or family or job or school
6. continued drinking despite home or job problems
7. given up activities
8. continued to drink regardless of depression or anxiety
9. built a tolerance
10. more than once gotten into situations while drinking that increased your chances of getting hurt
11. had withdrawal symptoms
Positive symptoms
refers to symptoms that are present but should not be
negative symptoms
refers to characteristics of the individual that are absent but should be present
cognitive symptoms
refers to problems with processing and acting on external information
examples of positive symptoms - psychosis
-hallucinations
-delusions
-disorganized thought and speech
-bizarre behaviors
2 types of negative symptoms
- Emotional Dysregulation
- Impaired Motivation
examples of negative symptoms - emotional dysregulation
-lack of emotional expression
-reduced facial expression (flat affect)
-inability to experience pleasure in everyday activities (anhedonia)
examples of negative symptoms - impaired motivation
-reduced conversation (alogia)
-diminished ability to begin or sustain activities
-social withdrawal
examples of cognitive symptoms - Neurocognitive impairment
-memory problems
-poor attention span
-difficulty making plans
-reduced decision-making capacity
-poor social cognition
-abnormal movement patterns
What may promote psychosis?
-psychotropic substances
-inflammation, injury, illness
-stress/trauma susceptibility
-genetic susceptibility
psychotropic substances that promote psychosis
Stimulant drugs of abuse, high potency cannabis & psychedelics (e.g. PCP or Angel dust)
inflammation, injury, illness that promote psychosis
-Meningitis & encephalitis
-Tumors, strokes, Parkinson’s disease & Alzheimer’s disease
Genetic susceptibility
-Twin studies
→ Monozygotic vs. dizygotic
-Discordant monozygotic twins
→ Birth weight
→ Early psychological distress
→ Motor coordination
-Hundreds of genes:
→ Neuregulin 1 – GABA, NMDA, ACh receptors
→ Dysbindin – synaptic plasticity
→ COMT – dopamine metabolism
→ DISC1– brain synapse development
Examples of impairments in people with schizophrenia
-does not have a smooth pursuit of moving cursor
-does not have a free viewing of a photograph
-does not have a fixed gaze on a single point
Impact of stress on SCZ
-SCZ appears in transition from child to adult
→ Physical, emotional, lifestyle changes
-City living
→ Move from one to other
Impact of prenatal stress on SCZ
-Flu (1st trimester = 7x)
-Incompatible blood type
-Gestational diabetes
Ventricle Volume & Schizophrenia
-larger in affected patients
-No relationship to illness length or hospitalization period
-Predicts responsiveness to antipsychotic drugs
-also saw enlarged ventricles in Disc1 transgenic mice
Limbic System & Schizophrenia
-Hippocampus and amygdala smaller in SCZ-discordant twin
-Disorganization of hippocampal pyramidal cells
-Entorhinal cortex, parahippocampal cortex, cingulate cortex abnormalities
Cortex & Schizophrenia
-thinning of grey matter
-hypofrontality (Less cortical activation in SCZ-discordant twin at rest and during task)
How does whole brain volume change with schizophrenia?
as a person with schizophrenia ages, their whole brain volume decreases much more than a healthy individual
Chlorpromazine
-antipsychotic drug
-anesthetic
-lessened psychosis symptoms
-Dramatically impaired/slowed voluntary movement
→D2 antagonist effects in extrapyramidal motor system
→l-DOPA can evoke/worsen psychosis in Parkinson’s patients
-D2 antagonism predicts clinical efficacy
What are first-generation antipsychotics?
dopamine receptor antagonists (also known as typical antipsychotics)
What are second-generation antipsychotics?
serotonin-dopamine antagonists (also known as atypical antypsychotics)
examples of first-generation antipsychotics
-Chlorpromazine
-Thioridazine
-Haloperidol
-Raclopride
examples of second-generation antipsychotics
-Remoxipride
-Clozapine
-Risperidone
Dopamine Hypothesis - Schizophrenia
-Dopamine overactivity in limbic system causes positive symptoms
→ Dopamine release
→ Dopamine receptors
-Dopamine function is too low in the frontal cortex
→ Causes the limbic overactivity
-compared to the normal state, the mesocortical dopamine system is weakened and the mesolimbic dopamine system is overactive in schizophrenia
Limitations of the dopamine hypothesis
-Not all symptoms are treated well by dopamine antagonists
-Not all patients will respond to a dopamine antagonist
-Even if they do respond, their delay to efficacy is prolonged, and the associated adverse effects are substantial
