Lecture 17- Mental disease I Flashcards
What is the burden of mental disease?
-in terms of years of life lost it is not only 6.8% so not as much -in terms of years lived with disability it is a substantial burden around 20% and increase with age
What is the largest health burden?
-brain and mind disorder pose the largest health, economic and social capital burden to Australia of any disease group -this arises because these disorders are chronic and disabling
How many people suffer from depression?
-affects approximately 20% of the population at any one time -WHO predicts depression will be the second leading cause of disability by 2020 -~2200 Australians take their own lives every year.
Is depression more common in one sex?
-More common in women
How many people suffer of Schizophrenia?
Affects ~ 1% of population
What is the difference in prevalence of schizophrenia in males vs females?
1.4:1 in males: females -more common in males
When is the onset of schizophrenia?
-Early onset: 16 – 25 yrs (males) 25-30 (females)
Is schizophrenia curable?
-Life-long illness, no cure – No preventative treatment ‒ Current antipsychotic treatments manage symptoms (but have side effects)
What are courses and outcomes of schizophrenia?
Heterogeneous illness ‒ Course and outcome vary ‒ Many possible combinations of symptoms ‒ Different aetiologies? ‒ Single disorder? -maybe a mix of several
Are there famous people with schizophrenia?
There are relatively few famous people with schizophrenia because of young age of onset – People this age are too young to be famous – Schizophrenia is very disabling
What are the types of depression?
•Major depression – a depressed mood that lasts for at least 2 weeks •Psychotic depression – a depressed mood which includes symptoms of psychosis •Dysthymia – a less severe depressed mood that lasts for years •Mixed depression and anxiety – a combination of symptoms of depression and anxiety •Bipolar disorder (formerly known as manic depressive illness) – involves periods of feeling low (depressed) and high (manic). Silver linnings playbook.
What is the definition
-Depression – DSM-IV Diagnostic and Statistical Manual (DSM) For the last 2 weeks have you had: -1. Depressed mood -2. Loss of interest or pleasure -If you answered ‘YES’ to either of these questions, complete the symptom checklist below: -1. Depressed mood most of the day -2. Less interest or pleasure in all activities -3. Weight loss or gain (when not dieting) -4. Sleeping difficulties -5. Slowed or fastened movements -6. Tiredness or loss of energy -7. Feeling worthless -8. Difficulty concentrating -9. Thoughts of death
What is Schizophrenia?
• Mental illness characterised by a breakdown of thought processes, perceptions and emotional responsiveness •Greek origin ‘split’ and ‘mind’, but NOT split personality •Symptom categories –Positive symptoms: ‘add’ to a person’s personality –Negative symptoms: take away from a person’s personality –Cognitive impairment
What are the positive symptoms of Schizophrenia? (1)
• Hallucinations – Patient hears, sees, smells, tastes or feels something that is not there – Brain registers information as if it is real – Voice keeping up a running commentary on the person’s behaviour or thoughts – Two or more voices conversing with each other
What are the positive symptoms of Schizophrenia? (2) and (3)
- Delusions – A mistaken personal belief – Often bizarre – Usually of persecution, being watched, guilt, grandeur or religious – Hidden messages 3.•Disorganised speech – Speech that is disconnected and illogical, frequent derailment
What are the negative symptoms of Schizophrenia?
•Slowness to move, think, react •Avolition - lack of motivation • Lack of insight •Alogia or poor speech •Social withdrawal • Blunted affect - reduced ability to express emotion •Inappropriate responses - e.g. laughing at something distressing •Cognitive impairment –deficits in memory, general intelligence, verbal fluency, processing speed
What are the Schizophrenia subtypes?
•1.Paranoid Type – Preoccupation with one or more delusions or frequent auditory hallucinations •2.Disorganised Type – All of the following are prominent: disorganised speech, disorganised behaviour, flat or inappropriate affect •3.Catatonic Type – Motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor – Excessive motor activity (that is apparently purposeless and not influenced by external stimuli) – Peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing •4.Undifferentiated Type – The criteria are not met for the Paranoid, Disorganised or Catatonic Type •5.Residual Type – Absence of prominent delusions, hallucinations, disorganised speech, and grossly disorganised or catatonic behaviour –6.There is continuing evidence of the disturbance, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences)
What is the definition of Schizophrenia?
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) • Characteristic symptoms (active-phase): 2 or more of the following, each present for a significant portion of time during a 1-month period. At least one of these should include 1-3: 1. Delusions 2. Hallucinations 3. Disorganised speech 4. Grossly abnormal psychomotor behaviour, such as catatonia 5. Negative symptoms • Social/occupational dysfunction: 1 or more major areas of functioning (e.g. work, interpersonal relations, self-care) are markedly below the level achieved prior to the onset. • Duration: Continuous signs of disturbance for >6 months. Must include >1 month of active-phase symptoms and may include periods of prodromal or residual symptoms. – Prodromal periods: only negative symptoms or 2+ active-phase symptoms present in an attenuated form (e.g. odd beliefs, unusual perceptual experiences).
What is the causes of mental illness?
•No single mechanism • Genetics ‒ Increases with proportion of shared genetics ‒ Familyhistory • Environment ‒ Neurodevelopment, psychological and social processes • Neurobiology-Neurotransmitters, molecular changes, neuroanatomical anomalies
What are the genes involved in depression?
• Monoamine dysfunction • Serotonin transporter (5-HT-T) •Serotonin 2A receptor •Tyrosine hyrdoxylase (dopamine synthesis) •Tryptophan hydroxylase 1 (serotonin synthesis) •Catechol-o-methyltransferase (COMT) (dopamine catabolism) •Neurotrophic factors (like growth factors of the brain) • BDNF -genes associated with monoamine dysfunction
Genes vs environment in schizophrenia?
-Twin studies have revealed a strong genetic component (but not 100%) -48% chance if a twin, the more related the higher the chance of getting it -Genainquadruplets- all developed schizophrenia between 22-24 y of age
What are the genes involved in schizophrenia?
•Multitude of genes have been implicated in development of schizophrenia: molecular genetics, preclinical studies •Meta-analysis produced a list of 16 genes -(– APOE – COMT – DAO – DRD1, DRD2, DRD4 –DTNBP1 –GABRB2 –GRIN2B- HP - IL1B - MTHFR - PLXNA2 - SLC6A4 -TP53 - TPH1) -mostly to do with dopamine receptors -if have polymorphism in two or more= higher chance of having the illness -•Gene-gene interactions •Gene-environment interactions
What is the neurodevelopmental influence in mental illness?
•Mental illness is hypothesized to be due to disorders in neural development • Proliferation • Migration • Axon targeting • Synapse formation •Environmental factors interact with genes in utero or during childhood when brain is still developing •Prenatal influenza, obstetric complications, winter birth, malnutrition, stress, vitamin D deficiency (winter birth= higher chance of schizophrenia= mayb edue to vit D deficiency)
What are the later environmental in schizophrenia?
– childhood social difficulties – childhood infections influenza epidemic ␣ schizophrenia – puberty onset (Cycling hormone levels) low estrogen= higher symptoms higher hospitalizations postpartum menstruation – stress: Stress hormones (glucocorticoids) may alter neurodevelopment – illicit drug use Psychostimulants (MDMA /‘ecstacy’ (increase serotonin) amphetamine /‘speed’ (increase dopamine) Hallucinogens (LSD/ ‘acid’, psilocybin/ ‘magic mushrooms’ (serotonin) Marijuana ‘cannabinoid psychosis’
