Module 7: Mood Disorders PDF

# MODULE 7: MOOD DISORDERS ## Major Depressive Disorder - includes being in a "depressed mood most of the day, nearly every day" (feeling sad, empty, hopeless, or appearing tearful to others), and loss of interest and pleasure in usual activities. - believed to be a combination of genetic, environm...

# MODULE 7: MOOD DISORDERS ## Major Depressive Disorder - includes being in a "depressed mood most of the day, nearly every day" (feeling sad, empty, hopeless, or appearing tearful to others), and loss of interest and pleasure in usual activities. - believed to be a combination of genetic, environmental, and psychological factors. - risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse. - approximately 163 million people in 2017 (2% of the global population). - about twice as common in women as in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this. To receive a diagnosis of major depressive disorder, one must experience a total of five symptoms for at least a two-week period. These symptoms must cause significant distress or impair normal functioning, and they must not be caused by substances or a medical condition. Symptoms are: - significant weight loss (when not dieting) or weight gain and/or significant decrease or increase in appetite - difficulty falling asleep or sleeping too much - fatigue or loss of energy - feelings of worthlessness or guilt - difficulty concentrating and indecisiveness - thoughts of death (not just fear of dying) ## Depression Subtypes - The DSM-5 lists several different subtypes of depression. ### Depression with: - **Anxious Distress:** a person experiences anxiety in the form of tenseness, restlessness, lack of focus, fear, or of losing control - **Mixed Features:** a person experiences some manic symptoms such as elevated moods, increased energy, or talkativeness - **Melancholic Features:** a person experiences lack of interest or pleasure in activities - **Atypical Features:** a person may experience elevated moods for certain periods of time or around particular people, or may show weight gain, increased appetite, or excessive sleep - **Mood-congruent Psychotic Features:** a person may experience delusions or hallucinations - **Catatonia:** a person may show catatonic symptoms, such as staying still or immobilized for long periods of time - **Seasonal Pattern (formerly known as seasonal affective disorder):** a person experiences the symptoms of major depressive disorder only during a particular time of year (e.g., fall or winter). In everyday language, people often refer to this subtype as the winter blues. - **Peripartum Onset:** symptoms appear during pregnancy or in the weeks following birth ## Persistent depressive disorder - a person experiences mild to moderate depressed moods for most of the day nearly every day for at least two years, and displays at least two of the symptoms of major depressive disorder such as: - decreased or increased appetite - decreased or increased sleep (insomnia or hypersomnia) - fatigue or low energy - reduced self-esteem - decreased concentration or problems making decisions - feelings of hopelessness or pessimism ## Disruptive mood dysregulation disorder (DMDD) - is a childhood condition of extreme irritability, anger, and frequent, intense temper outbursts. - DMDD symptoms go beyond being a "moody" child—children with DMDD experience severe impairment that requires clinical attention. ## Premenstrual dysphoric disorder (PMDD) - is a health problem that is similar to premenstrual syndrome (PMS) but more serious. - PMDD causes severe irritability, depression, or anxiety in the week or two before your period starts. - PMDD causes severe and disabling form of premenstrual syndrome affecting 1.8-5.8% of menstruating women. ### Symptoms of PMDD include: - Lasting irritability or anger that may affect other people - Feelings of sadness or despair, or even thoughts of suicide - Feelings of tension or anxiety - Panic attacks - Mood swings or crying often - Lack of interest in daily activities and relationships - Trouble thinking or focusing - Tiredness or low energy - Food cravings or binge eating - Trouble sleeping - Feeling out of control - Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain # MODULE 8: EATING AND SLEEP DISORDERS ## Feeding and Eating Disorders ### Hunger and Eating Regulation - **Satiation:** fullness and satisfaction, and the eating behavior stops. - **Leptin:** a satiety hormone - **Metabolic rate:** the amount of energy that is expended in a given period of time. - **Set-point theory:** each individual has an ideal body weight, or set point, which is resistant to change. - Body mass index (BMI) between 25 and 29.9 is considered overweight. - An adult with a BMI of 30 or higher is considered obese. - Morbid obesity is defined as having a BMI over 40. ## Anorexia nervosa (AN) - is an eating disorder characterized by the maintenance of a bodyweight well below average through excessive starvation and/or exercise. ### Symptoms include: - Extremely restricted eating - Extreme thinness (emaciation) - A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight - Intense fear of gaining weight - Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight It is estimated that approximately between 0.32% of young women and 0.1 to 0.3 % of males will develop Anorexia. - Anorexia is a serious disease, especially given that people with anorexia aged 15 to 24 have 10 times the risk of dying compared to their similar age peers. ### Treatment for Anorexia is multi-dimensional and requires many different types of treatment including: - nutritional support - psychological counseling - behavioral modification ## Bulimia nervosa - is followed by an attempt to compensate for a large amount of consumed food. ### Symptoms include: - Chronically inflamed and sore throat - Swollen salivary glands in the neck and jaw area - Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid - Acid reflux disorder and other gastrointestinal problems* - Intestinal distress and irritation from laxative abuse - Severe dehydration from purging of fluids - Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack The lifetime prevalence rate for bulimia nervosa is estimated at around 1% for women and less than 0.5% for men ## Binge Eating Disorder - Binge eating is the core symptom of Binge Eating Disorder (BED); however, not everyone who binge eats has BED. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED. ### Potential symptoms: - Eating much faster than normal, perhaps in a short space of time - Eating a large amount when not hungry - Eating until feeling uncomfortably full - Subjective loss of control over how much or what is eaten - Binges may be planned in advance, involving the purchase of special binge foods, and the allocation of specific time for binging, sometimes at night - Eating alone or secretly due to embarrassment over the amount of food consumed - There may be a dazed mental state during the binge - Not being able to remember what was eaten after the binge - Feelings of guilt, shame or disgust following a food binge ## Avoidant/Restrictive Food Intake Disorder (ARFID) - is an eating or feeding disturbance associated with an apparent lack of interest in eating or food. - Disturbance in eating or feeding, is evidenced by one or more of the following: - Substantial weight loss (or, in children, absence of expected weight gain) - Nutritional deficiency - Dependence on a feeding tube or dietary supplements - Significant psychosocial interference ### Stages of Treatment for Children: - Record stage: children are encouraged to keep a log of their typical eating behaviors without attempting to change their habits as well as their cognitive feelings. - Reward stage: involves systematic desensitization. - Relaxation stage: is most important for those children that suffer severe anxiety when presented with unfavorable foods. - Review stage: is important to keep track of the child's progress. ## Rumination Disorder - Rumination is an eating disorder characterized by having the contents of the stomach regurgitated (drawn back up into the mouth), and either re-chewed, re-swallowed, or spit out. ### Signs and symptoms of rumination disorder include the backward flow of recently eaten food from the stomach to the mouth. - Occurs immediately 15-30 minutes after eating. - May also occur following a viral illness, emotional stress, or physical injury. - The main treatment of rumination disorder is behavioral therapy. - This may involve habitat reversal strategies, relaxation, diaphragmatic breathing, and biofeedback. ## Pica - a psychological disorder characterized by an appetite for substances that are largely non-nutritive, such as ice, soap, hair, paper, metal, soil, stones, glass, or chalk. - Eating must persist for more than one month at an age when eating such objects is considered developmentally inappropriate, not part of a culturally sanctioned practice, and sufficiently severe to warrant clinical attention. - Pica is most commonly seen in pregnant women, small children, iron and zinc-deficient children, malnourished children, and people with intellectual development disorders (intellectual disabilities). ## Sleep Disorders - Sleep is distinguished by low levels of physical activity and reduced sensory awareness. - Sleep-wake cycles seem to be controlled by multiple brain areas acting in conjunction with one another. Some of these areas include the thalamus, the hypothalamus, and the pons. ### Stages of sleep: - Stage 1: a transitional phase that occurs between wakefulness and sleep, the period during which we drift off to sleep. - Stage 2: the body goes into a state of deep relaxation. Theta waves still dominate the activity of the brain, but they are interrupted by brief bursts of activity known as sleep spindles. - Stage 3: often referred to as deep sleep or slow-wave sleep. ## Narcolepsy - individuals experience extreme drowsiness and are unable to resist falling asleep at inopportune times. - These sleep episodes are often associated with cataplexy, which is a lack of muscle tone or muscle weakness, and in some cases involves complete paralysis of the voluntary muscles. - Narcolepsy with cataplexy is known as type 1 narcolepsy, while narcolepsy without cataplexy is known as type 2 narcolepsy. ### These factors include: - Autoimmune disorders: When cataplexy is present, the cause is most often the loss of brain cells that produce hypocretin. Although the reason for this cell loss is unknown, it appears to be linked to abnormalities in the immune system. - Family history: Most cases of narcolepsy are sporadic, meaning the disorder occurs in individuals with no known family history. However, clusters in families sometimes occur—up to 10 percent of individuals diagnosed with narcolepsy with cataplexy report having a close relative with similar symptoms. - Brain injuries: Rarely, narcolepsy results from traumatic injury to parts of the brain that regulate wakefulness and REM sleep or from tumors and other diseases in the same regions. Although there is no cure for narcolepsy, some of the symptoms can be treated with medicines and lifestyle changes. ## Hypersomnolence disorder - the patient in question must have no other symptoms or signs of narcolepsy (cataplexy, sleep paralysis, hypnagogic hallucinations, and no breathing-related sleep disorder like sleep apnea). - Sleep drunkenness: Patients report waking with disorientation, confusion, slowness and repeated returns to sleep. ### Treatment: - Stimulants, such as amphetamine, methylphenidate, and modafinil, may be prescribed. - Other drugs used to treat hypersomnia include clonidine, levodopa, bromocriptine, antidepressants, and monoamine oxidase inhibitors. ## NREM Sleep Arousal Disorders - **Sleepwalking:** the sleeper engages in relatively complex behaviors ranging from wandering about to driving an automobile. - During periods of sleepwalking, sleepers often have their eyes open, but they are not responsive to attempts to communicate with them. - **Night terrors:** result in a sense of panic in the sufferer and are often accompanied by screams and attempts to escape from the immediate environment. - **Nightmare disorder:** is a sleep disorder characterized by frequent nightmares, which often portray the individual in a situation that jeopardizes their life or personal safety. - Studies have reported that nightmare disorders were present in 50-70% of the cases for PTSD, in 17.5% for depression, in 18.3% for insomnia, in 16.7% for schizophrenia and in 49% for borderline personality disorder ## REM sleep behavior disorder (RBD) - occurs when the muscle paralysis associated with the REM sleep phase does not occur. - These behaviors vary widely, but they can include kicking, punching, scratching, yelling, and behaving like an animal that has been frightened or attacked. - The prevalence of RBD is approximately 0.5 to 1% in the general population and 2% in older adults. - **Restless leg syndrome:** experiencing uncomfortable sensations in the legs during periods of inactivity or when trying to fall asleep. - This discomfort is relieved by deliberately moving the legs, which, not surprisingly, contributes to difficulty in falling or staying asleep. ## Parasomnia Differences - A parasomnia is one of a group of sleep disorders in which unwanted, disruptive motor activity and/or experiences during sleep play a role. ### Parasomnias can occur in either REM or NREM phases of sleep. - **Parasomnias** include non-rapid eye movement sleep arousal disorders of sleepwalking and sleep terrors, nightmare disorder, rapid eye movement sleep behavior disorder, and restless leg syndrome. - **Sleep apnea** is defined by episodes during which a sleeper's breathing stops. - These episodes can last 10-20 seconds or longer and often are associated with brief periods of arousal. - **Obstructive sleep apnea (OSA)** occurs when an individual's airway becomes blocked during sleep, and air is prevented from entering the lungs. - **Central sleep apnea (CSA)** disrupts signals sent from the brain that regulate breathing cause periods of interrupted breathing - **Sudden infant death syndrome (SIDS):** an infant stops breathing during sleep and dies. - Infants younger than 12 months appear to be at the highest risk for SIDS, and boys have a greater risk than girls. # Perspectives on Eating and Sleep Disorders - Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. - Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. - Western society especially places a cultural emphasis on thinness which can influence how people view their bodies. - Other risk factors for developing eating disorders involve participating in some sports such as: - Aesthetic sports (dance, figure skating, gymnastics) - 35% - Weight dependent sports (judo, wrestling) – 29% - Endurance sports (cycling, swimming, running) – 20% - Technical sports (golf, high jumping) - 14% - Ball game sports (volleyball, soccer) - 12% The psychodynamic view on eating disorders focuses on understanding the unconscious forces and motives that influence the disorder. Humanistic approaches take a positive approach to help the individual see themselves as more than their disorder. ### Biological: - A genetic component related to a predisposition toward eating disorders and a genetic link has been found on chromosome 1 in multiple family members of an individual with anorexia nervosa. ### Cognitive: - Attentional bias is the preferential attention toward certain types of information in the environment while simultaneously ignoring others. ### Behavioral: - Eating disorders related to ways that behavior is learned and reinforced. For example, if someone who loses weight is praised or rewarded for their appearance but took extreme measures to look that way, this could contribute to the development or maintenance of an eating disorder. # Perspectives on Sleep Disorders - Sleep disorders consist of medical interventions that include surgical, non-surgical, and pharmacological, nonpharmacological treatments. - Treating sleep disorders focuses on reframing how people think about sleep and the act of sleeping to provoke change in their thoughts and sleeping habits. - Stimulus control helps to build an association between the bedroom and sleep by limiting the type of activities allowed in the bedroom. A systematic review found that traumatic childhood experiences (such as family conflict or sexual trauma) significantly increases the risk for a number of sleep disorders in adulthood, including sleep apnea, narcolepsy, and insomnia. # MODULE 9: Substance-Abuse and Addictive Disorders ## Diagnosis of Substance Abuse Disorders - Substance use disorder: when an individual uses more of the substance than they originally intended to and continue to use that substance despite experiencing significant adverse consequences. - There are two types of dependence: - Physical dependence involves changes in normal bodily functions—the user will experience withdrawal from the drug upon cessation of use. - Psychological dependence is an emotional, rather than physical, need for the drug and the drug is used to relieve psychological distress. - Tolerance is linked to physiological dependence, and it occurs when a person requires more and more drug to achieve effects previously experienced at lower doses. - Drug withdrawal includes a variety of negative symptoms experienced when drug use is discontinued. ## Depressants Impact on Central Nervous System - A depressant is a drug that tends to suppress central nervous system activity. ### Alcohol intoxication is measured for legal and medical uses in terms of Blood Alcohol Content (BAC). - A BAC of 0.10 (0.10% or one-tenth of one percent) means that there are 0.10 g of alcohol for every 100 ml of blood. - BAC levels above 0.40 are potentially fatal. ## Alcohol use disorder (AUD) - any drinking of alcohol that results in mental and/or physical health problems ranging anywhere from mild and imperceptible without special testing to severe and grossly overt. ## Alcohol intoxication - the recent ingestion of alcohol and clinically significant problematic behavioral or psychological changes that developed during, or shortly after, alcohol ingestion. - Alcohol use could be defined by one of the following: - Slurred speech. - Incoordination. - Unsteady guilt. - Nystagmus. - Impairment in attention or memory. - Stupor or coma. ## Alcohol withdrawal - a set of symptoms that can occur following a reduction in alcohol use after a period of excessive use. ## Stimulants - drugs that tend to increase overall levels of neural activity, such as cocaine. - Cocaine's most dangerous side effects include: - Increased body temperature (high fever) - Irregular heart rate or rapid heart rate - High Blood Pressure - Increased risk of heart attack - Strokes - Sudden death from cardiac arrest - Sudden aggression - Sudden, very bad paranoia - Feeling, seeing, or hearing things that are not really there, including feeling like there are insects under the skin ## Methamphetamine - a type of amphetamine that can be made from ingredients that are readily available. ## Caffeine - another stimulant drug and the potency of this particular drug pales in comparison to the other stimulant drugs. ## Stimulant use disorder - a type of substance use disorder that involves the abuse of stimulants. ## Stimulant intoxication - marked by clinically significant problematic behavioral or psychological changes that developed during, or shortly after, use of a stimulant. ## Stimulant withdrawal - is marked by the following diagnostic criteria: - Cessation of (or reduction in) prolonged amphetamine-type substance, cocaine, or other stimulant use. - Dysphoric mood and two (or more) physiological changes, developing within a few hours to several days after Criterion A. - The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. - The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. ## Opioids - a category of drugs that decrease pain such as: heroin, morphine, methadone, and codeine. ### Humans have an endogenous opioid neurotransmitter system—the body makes small quantities of opioid compounds that bind to opioid receptors reducing pain and producing euphoria. - Opioid drugs, which mimic this endogenous pain killing mechanism, have an extremely high potential for abuse. - National Institutes of Drug Abuse has sponsored research that suggests the misuse and abuse of the prescription painkillers hydrocodone and oxycodone are significant public health concerns. - Methadone clinics help people who previously struggled with opioid addiction manage withdrawal symptoms through the use of methadone. ## Opioid use disorder (OUD) - a substance use disorder relating to the use of an opioid. ### Any such disorder causes significant impairment or distress. - Signs of the disorder include: - a strong desire to use opioids - increased tolerance to opioids - difficulty fulfilling obligations - trouble reducing use - withdrawal symptoms with discontinuation ### Opioid withdrawal symptoms may include: - nausea - muscle aches - diarrhea - trouble sleeping - agitation - low mood Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems at school, work, or home. ## Sedative, hypnotic, or anxiolytic use disorder: - **Hypnotic or soporific drugs,** commonly known as sleeping pills, are a class of psychoactive drugs whose primary function is to induce sleep and for the treatment of insomnia or for surgical anesthesia. - Hypnotic drugs are regularly prescribed for insomnia and other sleep disorders, with over 95% of insomnia patients being prescribed hypnotics in some countries. - **Sedatives:** drugs that serve to calm or relieve anxiety. - **Anxiolytics:** drugs used to reduce and treat anxiety, such as benzodiazepines like Xanax or Valium. ## Hallucinogen - a class of drugs that, when ingested, result in profound alterations in sensory and perceptual experiences. - Leo Hollister's criteria for hallucinogens are as follows: - in proportion to other effects, changes in thought, perception, and mood should predominate - intellectual or memory impairment should be minimal - stupor, narcosis, or excessive stimulation should not be an integral effect - autonomic nervous system side effects should be minimal - addictive craving should be absent. - Mescaline and LSD are serotonin agonists, and PCP (angel dust) and ketamine (an animal anesthetic) act as antagonists of the NMDA glutamate receptor. ## Phencyclidine or phenylcyclohexyl piperidine (PCP) - a drug used for its mind-altering effects. - Also known as “angel dust.” ## Hallucinogen persisting perception disorder (HPPD) - a chronic disorder in which a person has non-psychotic flashbacks of visual hallucinations or distortions from a previous hallucinogenic drug experience. ## Inhalants - a broad range of household and industrial chemicals whose volatile vapors or pressurized gases can be concentrated and breathed in via the nose or mouth to produce intoxication. ## Inhalant use disorder - is defined as a problematic pattern of use of a hydrocarbon-based inhalant substance leading to clinically significant impairment or distress. ## Inhalant intoxication - occurs frequently during inhalant use disorder but also may occur among individuals whose use does not meet criteria for inhalant use disorder. ## Cannabis - also known as marijuana, is a psychoactive drug from the Cannabis plant used primarily for medical or recreational purposes. - The main psychoactive component of cannabis is tetrahydrocannabinol (THC), which is one of the 483 known compounds in the plant, including at least 65 other cannabinoids, including cannabidiol (CBD). ### Cannabis Intoxication: - recent use of cannabis ### Cannabis Withdrawal: - cessation of cannabis use that has been heavy and prolonged ### Cannabis Use Disorder: - cannabis abuse and dependence were combined in the DSM-5 into a single entity capturing the behavioral disorder that can occur with chronic cannabis use ## Explanations of Addiction ### Biological: - Epigenetic genes and their products (e.g., proteins) are the key components through which environmental influences can affect the genes of an individual. - They also serve as the mechanism responsible for transgenerational epigenetic inheritance, a phenomenon in which environmental influences on the genes of a parent can affect the associated traits and behavioral phenotypes of their offspring ### Psychodynamic: - May explain addiction associated with unconscious factors from the past that could create something similar to a trauma response of negative coping by substances. ### Cognitive: - Expectancy theory may be a motivation for the high of the substance and the euphoric state that the drug brings to the body. ### Behavioral: - Withdrawal-based negative reinforcement accounts argue that although euphoric drug effects maintain initial use, growth in the adverse withdrawal syndrome drives persistent drug use. - Social learning theory may agree with the principles of modeling behaviors of those using substances that may onset use and promote addiction. ## Addiction treatment - must help the person do the following: - stop using drugs - stay drug-free - be productive in the family, at work, and in society ### There are many options that have been successful in treating drug addiction, including: - behavioral counseling - medication - medical devices and applications used to treat withdrawal symptoms or deliver skills training - evaluation and treatment for co-occurring mental health issues such as depression and anxiety - long-term follow-up to prevent relapse - About 11% of Americans with substance use disorder seek treatment, and 40-60% of those people relapse within a year. ## Cognitive and Behavioral Approaches ### Outpatient behavioral treatment - includes a wide variety of programs for patients who visit a behavioral health counselor on a regular schedule. ### CBT - used to help patients learn how their thought processes play a role in developing their behavior. ### Various forms of aversion therapy - have been used in the treatment of addiction to alcohol and other drugs. ### Covert conditioning - is an approach to mental health treatment that uses the principles of applied behavioral analysis, or cognitive-behavior therapy (CBTs) to assist people in making improvements in their behavior or inner experience. ### Inpatient or residential treatment - can also be very effective, especially for those with more severe problems. - Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention. ### A self-help support group - is fully organized and managed by its members, who are commonly volunteers and have personal experience in the subject of the group's focus. # MODULE 11: Schizophrenia Spectrum and Other Psychotic Disorders ## Schizophrenia - a devastating psychological disorder characterized by major disturbances in thought, perception, emotion, and behavior. - about 1% of the population experiences schizophrenia in their lifetime, and usually the disorder is first diagnosed during early adulthood (early to mid-20s). ### Delusions - beliefs that are contrary to reality and are firmly held even in the face of contradictory evidence. ### Disorganized thinking - refers to disjointed and incoherent thought processes—usually detected by what a person says ### Disorganized or abnormal motor behavior - refers to unusual behaviors and movements. ### Hallucination - a perceptual experience that occurs in the absence of external stimulation. In order to be diagnosed with schizophrenia, two (or more) of the following symptoms must be present for a significant portion of time during a 1-month period (or less if successfully treated): - delusions - hallucinations - disorganized speech (e.g., frequent derailment or incoherence) - grossly disorganized or catatonic behavior - negative symptoms (i.e., diminished emotional expression or avolition) ### Continuous signs of the disturbance persist for at least 6 months ### Positive symptoms of schizophrenia - are symptoms of commission, meaning they are something that individuals do or think. - Examples include the hallucinations, delusions, and bizarre or disorganized behavior described above. ### Negative symptoms - are those that reflect noticeable decreases and absences in certain behaviors, emotions, or drives. - Examples include: - Flat affect - Avolition is characterized by a lack of motivation to engage in self-initiated and meaningful activity, including the most basic of daily living tasks such as bathing and grooming. - Alogia refers to reduced speech output; in simple terms, patients do not speak or respond much. - Asociality or social withdrawal and lack of interest in engaging in social interactions with others. - Anhedonia, refers to an inability to experience pleasure. ### Genetics: - Schizophrenia sometimes has a genetic disposition. Like other mental illnesses, it does not mean that other members of the family will have it as well. ### Environment: - Scientists think that interactions between genetic risk and aspects of an individual’s environment may play a role in the development of schizophrenia. - Environmental factors that may be involved include living in poverty, stressful surroundings, and exposure to viruses or nutritional problems before birth. ### Brain Structure: - Scientists think that differences in brain structure, function, and interactions among neurotransmitters may contribute to the development of schizophrenia. ## Delusional disorder - occurs when a person has one or more non-bizarre delusional thoughts for one month or more, that has no explanation by another physiological, substance-induced, medical condition or any other mental health condition. - There are two main classifications of delusions: bizarre and non-bizarre. - **Bizarre delusions** include delusions involving a phenomenon that is impossible, not understandable, and unrelated to normal life. - **Non-bizarre delusions** involve situations that are possible, such as being manipulated or harmed, but remain fixed false beliefs even after proven false. ## Brief psychotic disorder - according to DSM-5, is the sudden onset of psychotic behavior that lasts less than 1 month followed by complete remission with possible future relapses. ### Marked by one or more of the following psychotic symptoms: - Delusions - Hallucinations - Disorganized speech - Grossly disorganized or catatonic behavior ## Schizophreniform disorder - is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time (at least a month), but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia. ### The main symptoms of both schizophreniform disorder and schizophrenia may include: - delusions - hallucinations - disorganized speech resulting from formal thought disorder - disorganized or catatonic behavior - negative symptoms such as: - an inability to feel a range of emotions (flat affect), - an inability to experience pleasure (anhedonia), - impaired or decreased speech (aphasia), - a lack of desire to form relationships (asociality), and - a lack of motivation (avolition). ## Schizoaffective disorder (SZA, SZD or SAD) - is a mental disorder characterized by abnormal thought processes and unstable moods. - Marked by at least one of the following symptoms: - Delusions - Hallucinations - Disorganized speech (e.g., frequent derailment or incoherence). - Grossly disorganized or catatonic behavior - Negative symptoms (i.e., diminished emotional expression or avolition.) ## Substance/Medication-induced psychotic disorder - involves the onset of the presence of psychotic features which have been catalyzed by the use of a substance or medication. ### Different substances that may onset the disorder are: - Alcohol - Cannabis and opioids - Sedatives and hypnotics such as benzodiazepines and barbiturates - Stimulants such as cocaine and amphetamines ### Medications such as: - Fluoroquinolone drugs and other prescription drugs such as antidepressants, L-dopa, Prednisone, and anticholinergic drugs - Illicit substances, or hallucinogenic or psychedelic substances ## Research on Schizophrenia Disorders ### Genetics: - The risk of developing schizophrenia is nearly six times greater if one has a parent with schizophrenia than if one does not. - Family members who are closely related (such as siblings) are more likely to share similar environments than family members who are less closely related (such as cousins). - Identical twins may be more likely to be treated similarly by others than might fraternal twins. - Such problems can be corrected by using adoption studies, in which children are separated from their parents at an early age. ### Biological: - Interest in the role of dopamine in schizophrenia was stimulated by two sets of findings: drugs that increase dopamine levels can produce schizophrenia-like symptoms, and medications that block dopamine activity reduce the symptoms. - The dopamine hypothesis of schizophrenia proposed that an overabundance of dopamine or too many dopamine receptors are responsible for the onset and maintenance of schizophrenia. - Brain imaging studies reveal that people with schizophrenia have enlarged ventricles, the cavities within the brain that contain cerebrospinal fluid. ## Perspectives on Schizophrenia ### Cognitive: - Deficits that are present in schizophrenia are widespread and can include problems with episodic memory, working memory, and other tasks that require one to "control" or regulate one's behavior. ### Diathesis-stress model: - Debates nature versus nurture, as it explains how the two have a bidirectional relationship and a dual influence on the development of many mental health illnesses, especially schizophrenia. - Sociocultural: environmental factors may be during pregnancy, such as increased stress, infection, malnutrition, and/or diabetes have been associated with increased risk of schizophrenia. - Cross-Cultural: Culture plays a role in the way we view mental health disorders and their corresponding features. ## Antipsychotic Medications - There are two primary types of antipsychotic medications, referred to as "typical" and "atypical." - The fact that typical antipsychotics helped some symptoms of schizophrenia was discovered serendipitously more than 60 years ago. ### Typicals - can help reduce hallucinations, delusions, and disorganized speech, they do little to improve cognitive deficits or negative symptoms and can be associated with distressing motor side effects. ### Atypicals - The newer generation of antipsychotics is referred to as atypical antipsychotics. - Atypicals are not necessarily more helpful for schizophrenia but have fewer motor side effects. ### Extrapyramidal symptoms (EPS) - such as acute dystonia, akathisia, cogwheel rigidity, and tardive dyskinesia are some of the more prominent side effects to keep in mind within this drug class. ## Prosocial Therapy Effectiveness - Cognitive Enhancement Therapy (CET) has been shown to improve cognition, functional outcome, social cognition, and to protect against gray matter loss in young individuals with schizophrenia. - The development of new treatments such as Cognitive Enhancement Therapy provides some hope that we will be able to develop new and better approaches to improving the lives of individuals with this serious mental health condition and potentially even prevent it someday. ## Psych*o*therapeutic management - would involve medically informing the patient and his/her family about the condition and treatment modalities employed for the particular patient. # MODULE 12: Personality Disorders ## Personality disorders - differ markedly from the expectations of their culture, are pervasive and inflexible, and begin in adolescence or early adulthood, causing distress or impairment. ### Cluster A - the odd or eccentric types; paranoid, schizoid, and schizotypal personality disorders. ### Cluster B - the dramatic, emotional, or erratic types; antisocial, borderline, histrionic, and narcissistic personality disorders. ### Cluster C - the anxious or fearful types; the avoidant, dependent, and obsessive-compulsive personality disorders. ## Cluster A Personality Disorders ## Paranoid personality disorder (PPD) - is characterized by a general suspicion and distrust of others that presents with at least four or more of the following: - suspicion that others are exploiting or harming them - a preoccupation with doubting the loyalty of friends - a reluctance to share information with others for fear it will be used against them - views harmless comments or events as threatening or demeaning - holds grudges - quick to defend or attack perceived threats to their reputation or character - has recurrent suspicions about the infidelity of a partner ## Schizoid personality disorder (often abbreviated as SPD or SzPD) - is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy. - SPD is indicated by at least four of the following: - Neither desires nor enjoys close relationships, including being part of a family. - Almost always chooses solitary activities. - Has little, if any, interest in having sexual experiences with another person. - Takes pleasure in few, if any, activities. - Lacks close friends or confidants other than first-degree relatives. - Appears indifferent to the praise or criticism of others. - Shows emotional coldness, detachment, or flattened affectivity. ## Schizotypal personality disorder - is characterized by severe social anxiety, thought disorder, paranoid ideation, transient psychosis, and often unconventional beliefs. - At least five of the following symptoms must be present: - ideas of reference - strange beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms - abnormal perceptual experiences, including bodily illusions - strange thinking and speech - suspiciousness or paranoid ideation - inappropriate or constricted affect - strange behavior or appearance - lack of close friends - excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self ## Cluster B