Psychopathology

Schizophrenic Disorders:

I. Definition: Schizophrenia means "splitting of the mind,"

II. symptoms.
  1. Schizophrenic disorders are characterized by psychotic symptoms.

  2. Symptoms fall into 2 categories

     A. positive symptoms: reflects the presence of behavior, thinking, &
          emotion that normally is absent.
a. delusions:

        b. Hallucinations:

       c. Disorganized thinking:

       d. Disorganized Behavior:

B . negative symptoms: The loss of behavior, thinking, & emotion that
           should be present.
         a. Flat affect:

b. alogia:

c. avolition:

         d. Social withdrawal:

III. Laboratory findings:
  1. some have enlarged ventricles, decreased cerebral size

  2. Abnormalities in brain structure are associated with negative symptoms.

  3. Neuropsychological signs may include

IV. Onset: usually between the late teens and mid 30s

V. Outcome: A complete remission is uncommon. 

VI. Prevalence: about 1% of the population

VII. Etiology
  1. Genetic vulnerability:

A. born to 2 schizophrenic parents    

B. monozygotic twins vs. dizygotic twins.

     C. Heredity may make us susceptible to schizophrenia.

  2. complications related to childbirth

  3. Stress: this may trigger a schizophrenic episode or a relapse

  4. some have suggested a virus.

  5. some have suggested an autoimmune disease

VIII. Subtypes:
1. Paranoid Type:

2. Disorganized Type (hebephrenic):

3. Catatonic Type:

4. Undifferentiated Type:

IX. Dopamine hypothesis
  1.The dopamine hypothesis proposes that there is too much DA activity

  2. Evidence for DA hypothesis
   A. Drugs that block DA receptors are often an effective  treatment

   B. DA agonist cause or make current symptoms worse

  3. Problems for DA hypothesis:
    A. However, many studies have not found levels of DA to be high

    B. The meds block DA quickly but therepeutic effects take time

X. The Drugs that are used as treatment go by various names:
  1. Different names for the same drugs
    A. antipsychotics:
    B. neuroleptics:
    C. major tranquilizers:

  2. Types of antipsychotics:
    A. typical antipsychotics (first generation):

    B. atypical antipsychotics (new antipsychotics): newer drugs

XI. Problems with DA traditional medications
  1. The medications are not effective in some people (up to 1/3).

  2. Side Effects:
     A. general side effects:

     B. hypothalamus-pituitary side effects

     C. Basal Ganglia side effects

 3. tardive dyskinesia

XII. Newer drugs:
     Newer and apparently better drugs have been introduced more recently

Affective Disorders:

There are two major types of mood disorders: unipolar (major depression) and bipolar (manic depression).

I. unipolar depression: is marked by persistent feelings of sadness

  1. Symptoms:(5 or more of the following) DSM IV

  2. depression is DX more in women

  3. Depression can occur at any time in the lifespan

  4. Dysthymic Disorder: this involves persistent but mild symptoms of depression

II. Bipolar Disorder: (manic depression): Here you see depression but also mania.
  1. Mania involves the following symptoms

  2. Cyclothymic Disorder: persistent but mild symptoms of bipolar depression.

  3. seen equally often in men and women.

III. Etiology:
  1. There appears to be a hereditary predisposition to mood disorders

  2. in some cases left hemisphere brain damage is noticeable

  3. The monoamine hypothesis

   A. problems with the monoamine theory
     a. monoamine levels increase quickly but it takes weeks for therapeutic effects

b. some monoamine agonist are not effective treatments. 

IV, Physiological  Treatment for Unipolar Depression

  1. Drugs:
    A. MAO inhibitors

a. side effects: the cheese effect

    B. tricyclic antidepressants: Prevent reuptake of NE & 5-HT

    C. Second-generation (atypical) antidepressant
      a. e.g., Prozac (fluoxetine)  & Zoloft (sertraline)

  2. Electro Convulsive Therapy (shock treatment)
   A. Electroconvulsive Therapy: Electrical shock is used to produce cortical seizure

V. Treatment of Bipolar Disorder:
  1. Lithium for Manic Depression

VI. Lab Findings:
  1. increased ventricle size in some depressed patients.

  2. Sleep disturbances are commonly seen: slow wave sleep

VII. Seasonal affective disorder:
  1. seen during the winter (days are short & night are long)
  2. carbohydrate craving and wt. gain (not true for ordinary depression)
  3. phototherapy is used for treatment (exposing people to bright light)`

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