Mental Health: Depressive Disorders PDF

19/11/2024 1 Depressive Disorders 2 Major Depressive Disorder 3 “Depression is a normal reaction to grievous loss such as the loss of a loved one, the loss of self-esteem, or the loss of health.” 4 “When you are clinically depressed, you feel very sad or hopeless for no e...

19/11/2024 1 Depressive Disorders 2 Major Depressive Disorder 3 “Depression is a normal reaction to grievous loss such as the loss of a loved one, the loss of self-esteem, or the loss of health.” 4 “When you are clinically depressed, you feel very sad or hopeless for no external reason. Depression can be more of a low-grade chronic unhappiness with life, or it can be intense feelings of hopelessness and negative thoughts about yourself and your life.” 5 DEPRESSION ▣ Reactive depression ▣ Endogenous depression 6 DEPRESSION ▣ Five(or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure (anhedonia) 7 8 9 10 DEPRESSION ▣ feel sad and helpless most of the day every day for weeks at a time ▣ can hardly even imagine enjoying anything ▣ clinical depressions attack children, adolescents, and adults ▣ comorbid (the tendency for two health conditions to occur together in the same individual) with one or more other health conditions—for example, anxiety disorders, coronary heart disease, and diabetes 11 DEPRESSION ▣  19/11/2024 ▣ absence of happiness is a more reliable symptom than increased sadness ▣ almost impossible for them to meet the essential requirements of their daily lives ▣ sleep disturbances and thoughts of suicide are common 12 DYSTHYMIA ▣ persistent depressive disorder ▣ a chronic form of depression that lasts for at least two years. It involves a low-grade, persistent depressed mood that does not meet the criteria for major depressive disorder 13 DEPRESSION: PREVALENCE ▣ probability of suffering from a clinical depression during one’s lifetime is about 10 percent ▣ more common in women than in men during the reproductive era, but about equal before puberty and after menopause ▣ lifetime risk of completed suicide in an individual diagnosed with clinical depression has been found to range between 4 and 15 percent in various studies 14 DEPRESSION: PREVALENCE ▣ early episodes tend to be longer, whereas later episodes tend to be briefer but more frequent ▣ some people have shorter episodes, and possibly more of them, than other people do 15 CAUSAL FACTOR: GENETICS ▣ heritability; not the only cause of depression ▣ one or more genes linked to depression (ex: Chinese vs Europeans) ▣ not one gene due to a combining of separate syndromes ▣ effect of a gene varies with the environment (serotonin transport) 16 BRAIN & DEPRESSION 17 BRAIN DIFFERENCES IN DEPRESSION ▣ loss of gray matter in the medial prefrontal cortex and the amygdala ▣ white matter reductions have also been noted in several brain regions— most reliably in the frontal cortex ▣ atypical activity in frontal, cingulate, and insular cortices as well as in the amygdala, thalamus, and striatum 18 BRAIN DIFFERENCES IN DEPRESSION ▣ elevated amygdala activity (Drevets, Bogers, & Raichle, 2002), especially when presented with negative emotional stimuli, such  19/11/2024 ▣ as photos of sad faces ▣ depressed persons are more prone to react to emotionally negative stimuli, yet have greater difficulty controlling these reactions 19 THEORIES 20 MONOAMINE THEORY OF DEPRESSION ▣ depression is associated with underactivity at serotonergic and noradrenergic synapses ▣ norepinephrine and serotonin receptors have been found to be more numerous in the brains of deceased depressed individuals who had not received pharmacological treatment 21 MONOAMINE THEORY OF DEPRESSION ▣ 1: excessive reuptake ▣ depressive symptoms are ushered in by a malfunction of norepinephrine (NE), serotonin (5-HT), and/or dopamine (DA) neurons, which play critical roles in the functioning of the limbic system and the adjacent hypothalamus ▣ neurotransmitter depletion leads to depression only in the presence of a genetic predisposition to mood disorders 22 MONOAMINE THEORY OF DEPRESSION ▣ 2: decreased release of neurotransmitters into the synapse ▣ reduction in the synthesis of the neurotransmitter and an inability to adequately store neurotransmitters in vesicles, and/or abnormalities in the process of vesicle migration and the creation of transmembrane pores 23 MONOAMINE THEORY OF DEPRESSION ▣ 3: NE, DA, and 5-HT cells can shut down is when the naturally occurring enzyme monoamine oxidase (MAO) becomes too active, excessively degrading neurotransmitters 24 MONOAMINE THEORY OF DEPRESSION ▣ 4: disruption of the synthesis of neuroprotective proteins, such as BDNF (brain-derived neurotropic factor) ▣ the production of this important protein is markedly reduced during episodes of severe depression ▣ BDNF reduces the toxic effect of hypercortisolemia (an abnormal elevation in the stress hormone cortisol, seen to occur in 60 percent of people with major depression) ▣ one important mechanism of action of antidepressants is to increase the production of BDNF 25 NEUROPLASTICITY THEORY OF DEPRESSION ▣ depression results from a decrease of neuroplastic processes in various brain structures (e.g., the hippocampus), which leads to neuron loss and other neural pathology ▣ stress and depression are associated with the disruption of various neuroplastic processes ▣  19/11/2024 ▣ stress and depression are associated with the disruption of various neuroplastic processes ▣ antidepressant treatments are associated with an enhancement of neuroplastic processes 26 ANTI-DEPRESSANT DRUGS 27 MONOAMINE OXIDASE INHIBITORS ▣ iproniazid: accidental discovery; TB px less concerned with their disorder ▣ increases the levels of monoamines (serotonin & norepinephrine); inhibiting the activity of monoamine oxidase – enzyme that breaks down monoamine NTs in the neuron ▣ symptom: cheese effect; increases blood pressure ▣ consume tyramine-rich foods run the risk of stroke caused by surges in blood pressure 28 TRICYCLIC ANTIDEPRESSANTS ▣ considered “dirty” drugs in that they react with a number of receptors besides the one responsible for the therapeutic effect, resulting in a host of side effects 29 TRICYCLIC ANTIDEPRESSANTS ▣ side effects: ○ anticholinergic: dry mouth, dry skin, blurred vision, constipation, inability to urinate) ○ adrenergic: sweating, sexual dysfunction, hypotension ○ antihistaminic: sedation and weight gain 30 TRICYCLIC ANTIDEPRESSANTS ▣ antidepressant action and because their chemical structures include three rings of atoms (DA, NE, 5-HT) ▣ imipramine, the first tricyclic antidepressant; originally an antipsychotic drug ▣ block the reuptake of both serotonin and norepinephrine, thus increasing their levels in the brain ▣ safer alternative to MAOIs 31 SELECTIVE SEROTONIN REUPTAKE INHIBITORS ▣ newer class of antidepressants ▣ generally as effective as the tricyclics but have significantly fewer side effects and are safer in overdosage ▣ first SSRI on the market was fluoxetine (Prozac) ▣ newer agents are citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)  19/11/2024 ▣ newer agents are citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) 32 SELECTIVE SEROTONIN REUPTAKE INHIBITORS ▣ they are relatively “clean,” and interact very little with other receptors besides the serotonin 5-HT reuptake receptor 33 SELECTIVE SEROTONIN REUPTAKE INHIBITORS ▣ side effects: ○ related to increased serotonin activity: nausea, gastrointestinal upset, sweating, anxiety, insomnia, headache, restlessness, and sexual dysfunction ○ mild anticholinergic side effects and can cause dry mouth, sedation, and blurred vision 34 ATYPICAL ANTIDEPRESSANTS ▣ a blocker of dopamine and norepinephrine reuptake, and it is also a blocker of nicotinic acetylcholine receptors 35 ATYPICAL ANTIDEPRESSANTS ▣ mechanism of action is not reuptake inhibition ▣ work in a complex way to increase noradrenergic activity ▣ bupropion (Wellbutrin); most common agents used to augment SSRIs and has an additional positive feature in that it has fewer sexual side effects ▣ side effects of anxiety and insomnia ▣ tendency to lower the seizure thresholds in patients with eating disorders 36 ANTIDEPRESSANTS ▣ SSRIs (Selective Serotonin Reuptake Inhibitors): Sertraline (Zoloft): This is a widely available and commonly prescribed SSRI. The price range for a month's supply can vary from PHP 500 to PHP 1,500. Fluoxetine (Prozac): Another popular SSRI, the price range for a month's supply can be similar to Sertraline. ▣ SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): Venlafaxine (Effexor XR): This SNRI is commonly used to treat depression and anxiety. The price range for a month's supply can be around PHP 1,000 to PHP 2,000. ▣ 37 ANTIDEPRESSANTS ▣  19/11/2024 ▣ Atypical Antidepressants: Bupropion (Wellbutrin): This atypical antidepressant is often used for depression and smoking cessation. The price range for a month's supply can be around PHP 800 to PHP 1,500. Mirtazapine (Remeron): This atypical antidepressant is known for its sedative properties. The price range for a month's supply can be around PHP 800 to PHP 1,200. 38 OTHER FORMS OF TREATMENT 39 TREATMENT ▣ Electroconvulsive therapy (ECT) ▣ High-intensity light therapy ▣ Repetitive Transcranial Magnetic Stimulation (rTMS) ▣ Vagus nerve stimulation (invasive) ▣ Exercise ▣ Psychotherapy ▣ Psychosurgery/neurosurgery (rarely used) 40 thanks! Any questions? 41 Bipolar Disorder 42 “People with a bipolar disorder experience both the lows of depression and the highs of mania. Many describe their life as an emotional roller coaster, as they shift back and forth between extreme moods. A number of sufferers eventually become suicidal. Their roller coaster ride also has a dramatic impact on relatives and friends.” 43 1. Bipolar Disorder Bipolar I Bipolar II 44 Bipolar Disorder ✗unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks 45 Bipolar Disorder ✗Bipolar I: Mania ✗Bipolar II: Hypomania  19/11/2024 ✗there is an abnormally, persistently elevated, expansive, or irritable mood and persistently increased activity or energy ✗mood in a manic episode is often described as euphoric, excessively cheerful, high, or "feeling on top of the world." ✗individual may spontaneously start extensive conversations with strangers in public 46 Bipolar Disorder ✗individual may engage in multiple overlapping new projects ✗projects are often initiated with little knowledge of the topic, and nothing seems out of the individual's reach 47 48 49 50 51 Bipolar Disorder 1 ✗Hypomanic Episode ✗people are talkative, energetic, impulsive, positive, and very confident ✗they can be very effective at certain jobs and can be great fun to be with 2 ✗Manic Episode ✗restless activity, excitement, laughter, excessive self-confidence, rambling speech, and loss of inhibitions ✗usually involves psychosis 3 ✗Depressive Episode ✗as is in MDD episode 52 Bipolar Disorders ✗patients are often initially diagnosed with major depressive disorder and only receive the diagnosis of bipolar I disorder after a later manic episode ✗nearly all patients who have one manic episode will have another; the number of manic episodes varies from person to person, but the average number of episodes a patient will have in a lifetime is nine ✗some patients have rapid cycling - with four or more manic or depressive episodes in a year 53 Bipolar Disorders ✗depressive episodes often occur immediately before or after a manic episode ✗some patients have hypomanic symptoms that progress to a manic episode ✗many patients return to normal mood between episodes, although others have residual mood symptoms between episodes,  19/11/2024 ✗many patients return to normal mood between episodes, although others have residual mood symptoms between episodes, and 10% remain chronically ill 54 Bipolar Disorders ✗even when mood symptoms improve, patients often do not return to their previous level of functioning ✗stress is associated with onset of manic episodes and depressive episodes, though less so with episodes later in the course ✗sleep deprivation, drug/alcohol use, and antidepressants can also trigger manic episodes 55 Bipolar Disorders: Prevalence ✗usually has its onset in the teenage years or early 20s ✗equally common for men and women, men are more likely to have severe (bipolar I) cases, but women are more likely to get treatment ✗women with bipolar I disorder are at very high risk for postpartum mania and psychosis ✗women are also more likely to have rapid cycling, which is defined as having four or more manic or depressive episodes per year 56 Biological Causes Bipolar Disorders 57 Causal & Risk Factors in Bipolar Disorders ✗highly heritable; linked to many genes, but apparently none of them are specific to bipolar disorder ✗not one gene responsible for the condition ✗same genes also increase the risk of unipolar depression, schizophrenia, and other disorders ✗brain’s increase in glucose use during mania and its decrease during depression 58 Causal & Risk Factors in Bipolar Disorders ✗neurotransmitter dysregulation ✗mania: increased dopamine and norepinephrine activity; increased glutamate; lowered GABA ✗depressive episodes: decreased dopamine and norepinephrine ✗ ✗ ✗ 59 Causal & Risk Factors in Bipolar Disorders ✗HPA Axis Dysregulation: The hypothalamic-pituitary-adrenal (HPA) axis, which regulates stress response, may be dysregulated in individuals with bipolar disorder, leading to heightened sensitivity to stress. ✗risk factors for impaired functioning include substance abuse, earlier age at onset of disease, and family history of mood  19/11/2024 ✗risk factors for impaired functioning include substance abuse, earlier age at onset of disease, and family history of mood disorder ✗another risk factor is childhood emotional abuse 60 Treatment Lithium 61 Lithium ✗first successful treatment for bipolar disorder ✗the most common one ✗accidental discovery by J.F. Cade, who believed uric acid might relieve mania and depression ✗mixed uric acid (a component of urine) with a lithium salt to help it dissolve ✗it was indeed helpful, but investigators soon discovered that lithium was the effective agent, not uric acid 62 Lithium ✗stabilizes mood, preventing a relapse into either mania or depression ✗reducing the intensity and duration of both manic and depressive episodes ✗dose must be regulated carefully, as a low dose is ineffective and a high dose is toxic ✗hippocampus forms new neurons throughout life, and some of those that form in bipolar patients are hyperexcitable 63 Lithium ✗reducing the symptoms of mania, such as elevated mood, racing thoughts, and impulsive behavior ✗significantly reduce the risk of suicide in individuals with bipolar disorder 64 Lithium: Side Effects ✗gastrointestinal: nausea, vomiting, and diarrhea (lithium toxicity) ✗nervous system: headache, lethargy, and muscle weakness, hand tremor ✗severe lithium toxicity can result in seizures, cns depression, irregular heartbeat, decreased kidney function, coma, or death ✗endocrine: clinical hypothyroidism, goiter ✗renal: increased thirst (polydipsia) and increased urination (polyuria) 65 Treatment  19/11/2024 Anticonvulsants 66 Anticonvulsants ✗carbamazepine (tegretol), valproic acid (depakote), and lamotrigine (lamictal) ✗valproic acid: first-line for mania & rapid cycling ✗carbamazepine: second-line for mania; first-line for mixed episodes ✗lamotrigine is approved for acute and maintenance therapy and is generally considered a first-line agent for the treatment of bipolar depression ✗second-line agent for rapid cycling 67 Anticonvulsants: Side Effects ✗CNS: common and they include sedation, dizziness, drowsiness, blurred vision, and incoordination ✗Gastrointestinal: nausea, vomiting, diarrhea, and abdominal pain, all of which may be alleviated by taking the medication with food or milk ✗Dermatological: red, itching rash or hives ✗administered with caution to patients with a history of cardiac problems and liver disease 68 Other Treatments 69 Other Treatments: ✗if anticonvulsant drugs are not fully effective, physicians sometimes supplement them with antidepressant drugs or antipsychotic drugs ✗diet and sleep ✗getting consistent, adequate sleep helps stabilize mood and decrease the risk of a new episode ✗ECT ✗psychotherapy/psychoeducation 70 Thanks! Any questions? 71 Anxiety Disorders  19/11/2024 72 Oh! Hi there! Agoraphobia Generalized Anxiety Disorder Panic Disorder Selective Mutism Separation Anxiety Disorder Social Anxiety Disorder Specific Phobia 73 “Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.” 74 1 Anxiety Sense of apprehension or worry 75 Anxiety ⊙chronic fear that persists in the absence of any direct threat ⊙can be adaptive if it motivates effective coping behaviors ⊙if it disrupts functioning then it becomes a disorder 76 2 Anxiety Disorders 77 Anxiety Disorders ⊙ most prevalent of all psychiatric disorders; more common than depression ⊙ incidence seems to be almost twice as great in females as in males 78 Anxiety Disorders ⊙ disorders that share features of excessive fear and anxiety and related behavioral disturbances  19/11/2024 79 Anxiety Disorders 1 Anxiety ⊙anticipation of future threat ⊙often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors 2 Fear ⊙emotional response to real or perceived imminent threat ⊙often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors 80 Anxiety Disorders ⊙ anxiety disorders differ from one another in the types of objects or situations that induce fear, anxiety, or avoidance behavior, and the associated cognitive ideation 81 Anxiety Disorders ⊙ anxiety disorders tend to be highly comorbid with each other ⊙ can be differentiated by close examination of the types of situations that are feared or avoided and the content of the associated thoughts or beliefs 82 Anxiety Disorders Overview ⊙ separation anxiety disorder: fearful or anxious about separation from attachment figures to a degree that is developmentally inappropriate 83 Anxiety Disorders Overview ⊙ selective mutism: a consistent failure to speak in social situations in which there is an expectation to speak (e.g., school) even though the individual speaks in other situations 84 Anxiety Disorders  19/11/2024 Overview ⊙ specific phobia: fearful or anxious about or avoidant of circumscribed objects or situations ⊙ social phobia: fearful or anxious about or avoidant of social interactions and situations that involve the possibility of being scrutinized 85 Anxiety Disorders Overview ⊙ panic disorder: recurrent unexpected panic attacks and is persistently concerned or worried about having more panic attacks or changes his or her behavior in maladaptive ways because of the panic attacks (e.g., avoidance of exercise or of unfamiliar locations) 86 Anxiety Disorders Overview ⊙ agoraphobia: fearful and anxious about two or more of the following: using public transportation; being in open spaces; being in enclosed places; standing in line or being in a crowd; or being outside of the home alone in other situations 87 Anxiety Disorders Overview ⊙ generalized anxiety disorder: persistent and excessive anxiety and worry about various domains, including work and school performance, that the individual finds difficult to control 88 3 Prevalence 89 Anxiety Disorders Prevalence ⊙ lifetime prevalence rates for anxiety disorders: 25% ⊙ panic disorder patients are eighteen times more likely to make suicide attempts than normal controls ⊙ incidence of anxiety disorders, women to men: 2:1 90 4  19/11/2024 Etiology 91 Anxiety Disorders Etiology ⊙ often triggered by identifiable stressful events and because the anxiety is often focused on particular objects or situations, the role of experience in shaping the disorder is often apparent 92 Anxiety Disorders Etiology ⊙ heritability; 30-50% estimate ⊙ higher for monozygotic twins than dizygotic twins ⊙ no specific genes have been linked to ADs 93 5 Neural Causes 94 Anxiety Disorders Neural Causes ⊙ deficits in GABA and serotonin transmission ⊙ atypical behavior in the prefrontal cortex, hippocampus, amygdala 95 6 Pharmacological Treatment 96 Anxiety Disorders Benzodiazepines ⊙ chlordiazepoxide (marketed as Librium) and diazepam (marketed as Valium) are widely prescribed for the treatment of anxiety disorders ⊙ most widely prescribed psychoactive drugs; should be prescribed for only short-term use 97 Anxiety Disorders  19/11/2024 Anxiety Disorders Benzodiazepines ⊙ often termed minor tranquilizers or anti-anxiety medications ⊙ can be used in severe cases of GAD ⊙ great concern has arisen regarding potential benzodiazepine abuse and dependence 98 Anxiety Disorders Benzodiazepines ⊙ individuals who do, in fact, present a significant risk of abuse are people with a personal or family history of alcohol or other substance abuse. ○ with such individuals, benzodiazepines are not appropriate 99 Anxiety Disorders Benzodiazepines ⊙ benzodiazepine receptors are co-located with GABA receptors ○ have a high density in the limbic system ⊙ binding BZ at the BZ receptors enhances the effect of GABA 100 Anxiety Disorders Benzodiazepines Side Effects ⊙ sedation ⊙ ataxia (disruption of motor activity) ⊙ tremor ⊙ nausea ⊙ a withdrawal reaction that includes rebound anxiety 101 Anxiety Disorders Buspirone ⊙  19/11/2024 ⊙ atypical anxiolytic ⊙ serotonin agonist but not an SSRI ⊙ produces anxiolytic (antianxiety) effects without producing ataxia, muscle relaxation, and sedation, the common side effects of the benzodiazepines 102 Anxiety Disorders Buspirone Side Effects ⊙ dizziness ⊙ nausea ⊙ headache ⊙ insomnia 103 Anxiety Disorders Anti-Depressants ⊙ comorbidity of anxiety disorders and clinical depression is the observation that antidepressants are often effective against anxiety disorders ⊙ anxiolytic drugs (antianxiety drugs) are often effective against clinical depression 104 Thanks! Any questions? 105 Schizophrenia 106 hello! 1 Eugen Bleuler 2 He introduced the term ”schizophrenia” replacing ”dementia praecox” coined by Emil Kraeplin Schizophrenia means “split mind” 107 Schizophrenia  19/11/2024 SCHIZOPHRENIA SPECTRUM DISORDER 108 Schizophrenia Spectrum □ Brief psychotic disorder □ Schizophreniform disorder □ Schizophrenia □ Schizoaffective disorder □ Schizotypal personality disorder □ Delusional disorder 109 “The major difficulty in studying and treating schizophrenia is to accurately define it.” 110 Schizophrenia □ split between the emotional and intellectual aspects of experience □ emotional expression seems unconnected with current experiences □ positive & negative symptoms 111 Schizophrenia □ someone must have deteriorated in everyday functioning (work, interpersonal relations, self care, etc.) for at least 6 months for reasons not attributable to other disorders □ must also have at least two symptoms from the following list, including at least one from the first three: hallucinations delusions disorganized speech disorganized motor behavior 112 Positive Symptoms symptoms that seem to represent an excess of typical function 113 Positive Symptoms □ delusions □ hallucinations  19/11/2024 hallucinations □ inappropriate behavior □ disorganized speech 114 Positive Symptoms 1 Delusions fixed beliefs that are not amenable to change in light of conflicting evidence 2 Hallucinations perception-like experiences that occur without an external stimulus 115 Delusions Themes □ persecutory delusions (i.e., belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group) □ referential delusions (i.e., belief that certain gestures, comments, environmental cues, and so forth are directed at oneself) 116 Delusions Themes □ grandiose delusions (i.e., when an individual believes that he or she has exceptional abilities, wealth, or fame) □ erotomanic delusions (i.e., when an individual believes falsely that another person is in love with him or her) 117 Delusions Themes □ nihilistic delusions involve the conviction that a major catastrophe will occur □ somatic delusions focus on preoccupations regarding health and organ function 118 Positive Symptoms 1 Disorganized Thinking disorganized thinking (formal thought disorder) is typically inferred from the individual's speech 2 Disorganized Motor Behavior childlike "silliness" to unpredictable agitation  19/11/2024 difficulties in performing activities of daily living 119 Disorganized Speech □ derailment: switch from one topic to another □ incoherence: word salad 120 Disorganized Behavior □ catatonia: decrease in reactivity to the environment; psychomotor disturbance negativism: resistance to instructions stupor: lack of motor response mutism: lack of verbal response catatonic excitement: purposeless, excessive motor abilities 121 Negative Symptoms symptoms that seem to represent a reduction or loss of typical function 122 Negative Symptoms □ diminished emotional expression expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech □ avolition: decrease in motivated self-initiated purposeful activities 123 Negative Symptoms □ alogia: diminished speech output □ anhedonia: decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced □ asociality: apparent lack of interest in social interactions 124 Schizophrenia PREVALENCE 125 Prevalence  19/11/2024 □ attacks about 1% of individuals of all races and cultural groups, typically beginning in adolescence or early adulthood □ typically diagnosed in the late teens years to early thirties, and tends to emerge earlier in males (late adolescence – early 20s) than females (early twenties – early 30s) 126 Prevalence □ increased risk of premature mortality (death at a younger age than the general population) □ top brain disorder in the Philippines, affecting at least 42% of patients who seek psychological consult 127 Prevalence □ on average, it is also more severe in men and has an earlier onset—usually in the teens or early 20s for men, as compared to the mid- to late 20s for women 128 Schizophrenia CAUSAL FACTORS 129 Causal Factors □ occurring in a close biological relative – 10% probability □ higher in monozygotic twins (45– 50%) than in dizygotic twins (10–17%) □ some people inherit a potential for schizophrenia, which may or may not be activated by experience 130 Causal Factors □ many genes have been linked to the disorder but no single gene seems capable of causing schizophrenia by itself □ the genes act in combination with one another and with experience to produce the disorder 131 Schizophrenia NEURAL CAUSES 132 Neural Causes □ smaller anterior hippocampus □ enlargement of the lateral ventricles and widened cortical sulci □ decreased metabolic activity in the prefrontal cortex which correlates with the severity of negative symptoms 133 Neural  19/11/2024 Cause: Dopamine □ dopamine theory □ abnormal dopaminergic activity in the brain; caused by too much dopamine □ basal ganglia: DA neurons help to regulate motor functioning □ limbic & reticular systems: da neurons appear to play an important role in 134 Neural Cause: Dopamine □ excessive dopamine activity can lead to behavioral agitation, a failure to adequately screen stimuli, and disorganization of perception and thought 135 Schizophrenia PHARMACOLOGICAL TREATMENT 136 1ST Generation □ chlorpromazine (thorazine): accidental discovery; sedative □ phenothiazines: haloperidol, fluphenazine, loxapine, etc □ severe side effects extrapyramidal: parkinsonian, dystonia, akathisia anticholinergic antiadrenergic tardive dyskinesia 137 2nd Generation Atypicals □ effective for both positive and negative symptoms □ clozapine sedation lower seizure threshold hepatitis blood disorder  19/11/2024 □ olanzapine, quetiapine, risperidone 138 thanks! Any questions?