Week 20 - Psychopathology II

Mood disorder

Extended periods of depressed, euphoric, or irritable moods that in combination with other symptoms cause the person significant distress and interfere with his or her daily life, often resulting in social and occupational difficulties.

Major depressive episode (MDE)

Symptoms that co-occur for at least two weeks and cause significant distress or impairment in functioning, such as interfering with work, school, or relationships. Core symptoms include feeling down or depressed or experiencing anhedonia

Anhedonia

Loss of interest or pleasure in activities one previously found enjoyable or rewarding.

Diagnosis criteria for MDE

Five or more of nine symptoms, including one/both of first two symptoms, for most of the day nearly every day

1. depressed mood

2. diminished interest or pleasure in almost all activities

3. significant weight loss or gain or an increase or decrease in appetite

4. insomnia or hypersomnia

5. psychomotor agitation or retardation

6. fatigue or loss of energy

7. feeling worthless or excessive or inappropriate guilt

8. diminished ability to concentrate or indecisiveness

9. recurrent thoughts of death, suicidal ideation, or a suicide attempt

Symptoms cannot be caused by physiological effects of a substance

Hypersomnia

Excessive daytime sleepiness, including difficulty staying awake or napping, or prolonged sleep episodes.

Psychomotor agitation

Increased motor activity associated with restlessness, including physical actions (e.g., fidgeting, pacing, feet tapping, handwringing).

Retardation

A slowing of physical activities in which routine activities (e.g., eating, brushing teeth) are performed in an unusually slow manner.

Manic or hypomanic episode

Distinct period of abnormally and persistently euphoric, expansive, or irritable mood and persistently increased goal-directed activity or energy. Manic episodes are one week and cause severe impairment, hypomanic are shorter and do not always impair

Diagnosis criteria for manic/hypomanic episode

present for one week or longer in mania (unless hospitalization is required) or four days or longer in hypomania, at least three of following:

1. inflated self-esteem or grandiosity

2. increased goal-directed activity or psychomotor agitation

3. reduced need for sleep

4. racing thoughts or flight of ideas

5. distractibility

6. increased talkativeness

7. excessive involvement in risky behaviors

Grandiosity

Inflated self-esteem or an exaggerated sense of self-importance and self-worth (e.g., believing one has special powers or superior abilities).

Unipolar mood disorders

Major depressive disorder and persistent depressive disorder. MDD is defined by one or more MDEs, but no history of hypomania or mania

PDD diagnosis criteria

At least two of the following:

1. poor appetite or overeating

2. insomnia or hypersomnia

3. low energy or fatigue

4. low self-esteem

5. poor concentration or difficulty making decisions

6. feelings of hopelessness

*need to cause significant distress or impairment for two months plus

Bipolar I disorder (BD I)

Characterized by a single (or recurrent) manic episode. A depressive episode is not necessary but commonly present for the diagnosis of BD I. Estimated 1% in America, 0.6% worldwide

Bipolar II Disorder (BD II)

Characterized by single (or recurrent) hypomanic episodes and depressive episodes.

Cyclothymic disorder

Characterized by numerous and alternating periods of hypomania and depression, lasting at least two years. Periods of depression cannot meet full diagnostic criteria for an MDE, symptoms at least half the time, <2 months free of symptoms, symptoms must cause significant distress or impairment.

Socioeconomic status

Inversely correlated with MDD, particularly for adults older than 65

Early adversity

Single or multiple acute or chronic stressful events, which may be biological or psychological in nature (e.g., poverty, abuse, childhood illness or injury), occurring during childhood and resulting in a biological and/or psychological stress response. Can increase risk for MDD

Chronic stress

Discrete or related problematic events and conditions which persist over time and result in prolonged activation of the biological and/or psychological stress response (e.g., unemployment, ongoing health difficulties, marital discord).

Attributional styles

The tendency by which a person infers the cause or meaning of behaviors or events.

Social zeitgeber theory

German for “time giver.” Environmental cues, such as meal times and interactions with other people, that entrain biological rhythms and thus sleep-wake cycle regularity.

Monoamine oxidase inhibitors (MAOIs)

Inhibit monoamine oxidase, an enzyme involved in deactivating dopamine, norepinephrine, and serotonin. Although effective in treating depression, can have serious side effects.

Tricylics

Second-oldest class of antidepressant medications, block the reabsorption of norepinephrine, serotonin, or dopamine at synapses, resulting in their increased availability. Most effective for treating vegetative and somatic symptoms of depression

Selective serotonin reuptake inhibitors (SSRIs)

Among most recently introduced antidepressant medication, most commonly prescribed antidepressant medication, blocks the reabsorption of serotonin. Fewer side effects, however can create difficulty having orgasms, gastrointestinal issues, and insomnia.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Block the reabsorption of serotonin and norepinephrine. Fewer side effects, however can create difficulty having orgasms, gastrointestinal issues, and insomnia.

Electroconvulsive therapy (ECT)

Involves inducing a seizure after a patient takes muscle relaxants and is under general anesthesia. Viable treatment for patients with severe depression or who show resistance to antidepressants although the mechanisms through which it works remain unknown. A common side effect is confusion and memory loss, usually short-term

Transcranial magnetic stimulation (TMS)

Noninvasive technique administered while a patient is awake. Brief pulsating magnetic fields are delivered to the cortex, inducing electrical activity. Fewer side effects than ECT, there is evidence that it is a promising treatment for patients with MDD who have shown resistance to other treatments

Deep brain stimulation

Recently being examined as a treatment option for patients who did not respond to more traditional treatments like those already described. Involves implanting an electrode in the brain. The electrode is connected to an implanted neurostimulator, which electrically stimulates that particular brain region.

BD treatments

Typically treated with pharmacotherapy. Lithium is the first line treatment choice. This is because SSRIs and SNRIs have the potential to induce mania or hypomania in patients. Lithium acts on several neurotransmitter systems in the brain through complex mechanisms, including reduction of excitatory (dopamine and glutamate) neurotransmission, and increasing of inhibitory (GABA) neurotransmission

Adjunctive BD treatment options

Interpersonal and social rhythm therapy is a psychosocial intervention focused on addressing the mechanism of action posited in social zeitgeber theory to predispose patients who have BD to relapse, namely sleep disruption

Catatonia

Behaviors that seem to reflect a reduction in responsiveness to the external environment. This can include holding unusual postures for long periods of time, failing to respond to verbal or motor prompts from another person, or excessive and seemingly purposeless motor activity.

Anhedonia/amotivation

A reduction in the drive or ability to take the steps or engage in actions necessary to obtain the potentially positive outcome. Do not seem to reflect a lack of enjoyment in pleasurable activities or events but rather a reduced drive or ability to take the steps necessary to obtain the potentially positive outcomes

Delusions

False beliefs that are often fixed, hard to change even in the presence of conflicting information, and often culturally influenced in their content.

Persecutory delusions

Most common, involve the belief that individuals or groups are trying to hurt, harm, or plot against the person in some way.

Grandiose delusions

The person believes that they have some special power or ability (e.g., I am the new Buddha, I am a rock star)

Referential delusions

Where the person believes that events or objects in the environment have special meaning for them (e.g., that song on the radio is being played specifically for me)

Hallucinations

Perceptual experiences that occur even when there is no stimulus in the outside world generating the experiences. They can be auditory, visual, olfactory (smell), gustatory (taste), or somatic (touch).

Disorganized speech

Speech that is difficult to follow, either because answers do not clearly follow questions or because one sentence does not logically follow from another.

Disorganized behaviour

Behavior or dress that is outside the norm for almost all subcultures. This would include odd dress, odd makeup (e.g., lipstick outlining a mouth for 1 inch), or unusual rituals (e.g., repetitive hand gestures).

Abnormal motor behavior

Can include catatonia, can include holding unusual postures for long periods of time, failing to respond to verbal or motor prompts from another person, or excessive and seemingly purposeless motor activity.

Negative symptoms

The absence of certain things we typically expect most people to have. For example, anhedonia or amotivation reflect a lack of apparent interest in or drive to engage in social or recreational activities. These symptoms can manifest as a great amount of time spent in physical immobility.

Flat affect

A reduction in the display of emotions through facial expressions, gestures, and speech intonation.

Alogia

A reduction in the amount of speech and/or increased pausing before the initiation of speech.

Psychopathology

Illnesses or disorders that involve psychological or psychiatric symptoms.

Continuum of psychotic symptoms

Work by Jim van Os in the Netherlands has shown that a surprisingly large percentage of the general population (10%+) experience psychotic-like symptoms, though many fewer have multiple experiences and typically not long-term

Functional capacity

The ability to engage in self-care (cook, clean, bathe), work, attend school, and/or engage in social relationships.

Cognitive deficits as a result of schizophrenia

Problems with episodic memory, working memory, and other tasks requiring one to control/regulate behaviour. Problems with processing speed (The speed with which an individual can perceive auditory or visual information and respond to it.)

Social cognition deficits as a result of schizophrenia

Unclear if problems are separate from cognitive problems or result. Problems with recognition of emotional expressions on the faces of other individuals, inferring intentiosn of others (theory of mind).

Magnetic resonance imaging

Brain imaging noninvasive technique that uses magnetic energy to generate brain images

Positron emission tomography

An invasive procedure that captures brain images with positron emissions from the brain after the individual has been injected with radio-labeled isotopes.

Brain mechanisms of schizophrenia symptoms

delusions in psychosis may be associated with problems in “salience” detection mechanisms supported by the ventral striatum and the anterior prefrontal cortex. Misfiring of brain regions may make someone mistakenly attribute importance to irrelevant or unconnected events.

Brain region that relates to problems in working memory and cognitive control (schizophrenia)

Problems in the function of a region of the brain called the dorsolateral prefrontal cortex (DLPFC), include changes when doing working-memory or cognitive-control tasks, and problems with how this brain region is connected to other brain regions, including the posterior parietal cortex, anterior cingulate, and temporal cortex

Brain region that relates to problems in episodic memory (schizophrenia)

Medial temporal lobe deficits, specific focus on hippocampus, much data from humans and animals showing that the hippocampus is important for the creation of new memories. However, problems with the DLPFC also make important contributions, probably because this part of the brain is important for controlling our use of memory.

Risk factors for developing schizophrenia

some genetic influences, no one gene. Likely the summation of multiple genes. Additionally, schizophrenia presentation can be different in everyone, and schizophrenia genes are similar to other mental disorder genes. Environmental factors can effect.

Neurodevelopmental

Processes that influence how the brain develops either in utero or as the child is growing up.

“typical” antipsychotics

Help some forms of schizophrenia. All drugs that share a common feature of being a strong block of the D2 type dopamine receptor. Drugs can help reduce hallucinations, delusions, and disorganized speech, but do little to improve cognitive deficits or negative symptoms and can be associated with distressing motor side effects

“atypical” antipsychotics

More mixed mechanisms of action in terms of the receptor types that they influence. Not necessarily more helpful for schizophrenia but have fewer motor side effects. However, has side effects referred to as the “metabolic syndrome,” which includes weight gain and increased risk for cardiovascular illness, Type-2 diabetes, and mortality

Cognitive enhancement therapy (CET)

Has been shown to improve cognition, functional outcome, social cognition, and to protect against gray matter loss