CID Anxiety, Depressive Disorders and Schizophrenia

What are the types of anxiety and depressive disorders?

• phobias

• separation anxiety disorder

• generalized anxiety disorder

• obsessive-compulsive disorder

• post-traumatic stress disorder

What are phobias?

an uncontrollable, irrational, and lasting fear of a certain object, situation, or activity

What is a specific phobia?

an extreme fear of an object or situation that typically isn’t harmful

What is social phobia?

An anxiety disorder in which a person has significant anxiety and discomfort related to a fear of being embarrassed, humiliated, or scorned by others in social or performance situations.

Separation Anxiety Disorder

disorder in which a child becomes excessively anxious when separated from parents

Generalized Anxiety Disorder

marked by excessive, exaggerated anxiety and worry about everyday life events for no obvious reason

Obsessive Compulsive Disorder

a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over

Post-traumatic Stress Disorder

a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it

Schizophrenia

• major disturbances in thought, emotion, and behavior

• disordered thinking

• lack of emotional expressiveness

• disturbances in movement or behavior

• can disrupt interpersonal relationships, diminish capacity to work or live independently

• significantly increased rates of suicide and death

DSM-5 Criteria for Schizophrenia

•Two or more of the following symptoms for at least 1 month; one symptom should be either 1, 2, or 3:

•(1) delusions

•(2) hallucinations

•(3) disorganized speech

•(4) disorganized (catatonic) behavior

•(5) negative symptoms (diminished motivation or emotional expression)

•Functioning in work, relationships, or self-care has declined since onset

•Signs of disorder for at least 6 months; if during a prodromal or residual phase, negative symptoms or two or more of symptoms 1-4 in less severe form

Diagnostic Process for Schizophrenia

•Physical and lab exams rule out psychotic disorder due to a medical condition and substance-induced psychosis

• Imaging (CT, MRI, PET) are seldom helpful in diagnosis

•The diagnosis is commonly made from history and the mental status exam

There are currently no reliable biomarkers for diagnosis or severity

Characteristic Psychotic Symptoms in Schizophrenia

•Audible thoughts

•Voices arguing or commenting

•Thought withdrawal or insertions by outside forces

•Thought broadcasting

•Impulses, volitional acts, or feelings imposed by outside forces

•Delusional perceptions

Positive Symptoms of Schizophrenia

• behavioral excesses and distortions

• delusions

• hallucinations

Negative Symptoms of Schizophrenia

• behavioral deficits

• lack of interest

• asociality

• blunted affect

• alogia—reduction in speech

• 2 groups—experience domain and expression domain

Epidemiology of Schizophrenia

•Lifetime prevalence of about 1%

•No differences related to culture or race

•Onset in men is usually earlier (15-24) than in women (25-34)

Etiology of Schizophrenia—genetic factors

• genetically heterogenous

• family studies—relatives

• twin studies

• adoption studies

• familial high-risk studies

Etiology of Schizophrenia—neurotransmitters

• dopamine theory

  • disorder due to excess levels of dopamine

• theory revised

  • excess numbers of dopamine receptors or oversensitive dopamine receptors

  • localized mainly in the mesolimbic pathway

Severity of Schizophrenia

•People with schizophrenia have different levels of disability varying form no disability to complete dependence on institutional care

•The amount and type of disability is related to the symptoms of the individual’s illness and how responsive these symptoms are to treatment

The severity of psychotic symptoms of schizophrenia are related to…

•How distracting

•Do they influence behavior—example: command hallucinations

•Do they cause suffering

•Do they impair social functioning—example: suspiciousness

The severity of negative symptoms of schizophrenia are related to…

•Social isolation

•Apathy

•Lack of expressiveness

The severity of cognitive impairments of schizophrenia are related to…

•Poor concentration

•Poor memory

•Inability to make simple decisions

•Inability to interpret social signals

•Slower pace

Pharmacological Treatment of Acute Schizophrenia

•Antipsychotic medications are effective for decreasing the severity of psychotic symptoms

•Nearly all patients on antipsychotic  medications will experience some burden from side effects

•Antipsychotics are relatively ineffective for negative  symptoms and cognitive impairment

Clinical Challenges to Schizophrenia

•Substance use disorders are common in people with schizophrenia

•Insight can be impaired leading  people with schizophrenia to refuse treatment

•Adherence to treatments can be irregular