Chapter Sixteen Psychological Disorders
Prevalence of Psychological Disorders? Approximately 25% of the Adult Population here in the U.S. of A. Higher percentages in areas / countries with high poverty or stress factors (war, famine) Anxiety and Mood disorders are FAR and away the most popular. Severe Disorders Much less common (usually 1% of the population or less)
Schizophrenia! YIKES! Usually includes Positive symptoms like hallucinations and delusions, as well as Negative symptoms = social, communication and mood issues + personality disintegration Long term prognosis poor. Expect repeated and increasingly severe episodes Typically diagnosed in late adolescence and early adulthood (age 18 to 25). Signs earlier?
Figure 16.2 Outcomes of Schizophrenia Takes Several Forms
Genes & Bio-factors in Schizophrenia Concordance rate with Identical twins is 50% Genetic irregularities vary widely, and share some factors with Bipolar Disorder Some structural anomalies like enlarged ventricles, associated with Excessive loss of gray matter after puberty Smaller hippocampus with disorganized or chaotic cell structures Reduced number of glutamate receptors
Figure 16.3 The Influence of Genetics on Schizophrenia
Figure 16.4 A Possible Genetic Marker for Schizophrenia
Figure 16.5 Schizophrenia Is Associated with Enlarged Ventricles
Figure 16.6 Cell Arrangements in the Hippocampus Appear to be Disorganized in Cases of Schizophrenia
Figure 16.8 Schizophrenia is Associated with Larger Losses of Gray Matter in Adolescence
Environmental Factors & Treatment Urban settings; poverty, nutrition, & stress Prenatal stresses on mom? Maternal exposure to famine or viral infection Typical Anti-psychotics (Phenothiazines) act as dopamine antagonists (block d4 receptors) Atypical Anti-psychotics (Clozapine) work on the serotonin system more than dompamine Reduce + symptoms, but nasty side effects! Transcranial Mag Stim offers temporary relief
Figure 16.10 The Introduction of Typical Antipsychotic Medications Reduced the Number of Institutionalized Patients
Figure 16.11 Tardive Dyskinesia Can Occur as a Side Effect of Treatment with Typical Antipsychotic Medications
Figure 16.12 Repeated Transcranial Magnetic Stimulation Reduces Auditory Hallucinations
Shifting Gears to Mood Disorders Major Depression the common cold - 16% 35% recover, most have more episodes Genes affect hormones and circadian rhythms Results in hypersomnia, hyposomnia (?!?) and abnormal patterns of cortisol release Meds up Serotonin levels and promote new cell growth (neurogenesis) in hippocampus Moderate aerobic exercise works really well ECT improves response to dopamine and norepinepherine + neurogenisis in hippocampus Best outcomes with SSRIs and cog-behavior therapy
Figure 16.14 Depression is Associated with Abnormal Patterns of Sleep
Figure 16.16 Electroconvulsive Shock Therapy
What about Bipolar Disorder? All the downsides of MDD, Plus bouts of MANIA! Contrasts are huge / dramatic Hits < 1% of adults, but if we ve got an identical twin, concordance rates at 85% Abnormal activity levels in basal ganglia and an enlarged amygdala are common Medicine of choice is Lithium, but hazardous WIDE mood swings and trouble keeping folks on meds can lead to high suicide rates
Let s talk about Anxiety Disorders Variety! OCD, PTSD, Panic, Phobias, Social etc Popular! Hit about 30% of adults. PTSD alone found in up to 12% of victims of disasters. Concordance rates vary from 63% to 87% Neurotransmitters involved include Serotonin, GABA and norepinepherine Abnormal circuit connections between basal ganglia, hypothalamus, and frontal cortex Used to use tranquilizers, but addiction issues. NOW we use SSRIs and Cog-Behavior Therapy
Autism now a spectrum disorder VERY HIGH concordance rates - 90% in I. twins Affects communication, self image, and range of interests Many with intellectual disability (30% to 60%) and a few with savant behaviors Genes affecting brain development cause abnormal acceleration and then deceleration Environmental factors also a consideration Intense early behavioral interventions and some diet considerations may help some
Attention Deficit/Hyperactivity Disorder Genetic factors in ADHD Significant role 80% concordance rate Brain Structures & Function in ADHD Prefrontal Cortex and Basal Ganglia Biochemistry and Treatment of ADHD Stimulant meds like Ritalin, Adderall or dexedrine are dopamine agonists (reuptake inhibitors) A little behavior therapy may help too
Antisocial Personality Disorder Pervasive pattern of disregard for & violation of the rights of others. Elliot Roger? Genetics of Antisocial Personality Disorder Twin studies: concordance high (up to 67%) but we need to consider environmental factors Child abuse history not uncommon Brain Structure and Function Antisocial Personality Disorder Limbic structures Damage to orbitofrontal cortex