In this Chapter…

• Anxiety Disorders

• Tourette Syndrome

• Major Depression

• Bipolar Disease

• Schizophrenia

Anxiety Disorders

• Anxiety disorders include:

  • OCD (Obsessive Compulsive Disorder)

  • Panic disorder

  • Phobias

    • acrophobia- fear of heights

    • agoraphobia- fear of open spaces)

  • Social anxiety disorder

  • Generalized anxiety disorder

  • PTSD (Post-traumatic stress disorder)

• Anxiety disorders often occur with depression

  • These individuals are at a high risk of suicide

OCD

• Individuals become trapped in repetitive thoughts and behaviors that don’t have a reason but cannot seem to stop

• Environmental factors and genetics probably play a role in the development of this disorder

• PET scans can reveal abnormalities in the cortical and deep brain

  • Shows that there are changes in the Central Nervous System that occur in those with OCD

• Dogs that develop acral lick syndrome respond to the serotonergic antidepressant clomipramine

  • Other serotonergic antidepressants are effective in treating OCD

    • “Serotonergic” refers to a substance that interacts with serotonin

• Behavioral intervention or exposure and response prevention is effective for many OCD patients

Panic Disorder and Phobias

• Phobia: intense, irrational fear of a particular object or situation

• Panic disorders and phobias have similar neurochemical underpinnings that come up as the result of a particular stressor

• Panic disorders and phobias usually start unexpectedly

• Individuals experience an overwhelming sense of impending doom

  • Other symptoms include:

    • Sweating

    • Weakness

    • Dizziness

    • Shortness of breath

• More attacks bring about more anxiety for the next panic attack

• People avoid public settings where attacks might occur

  • Individuals with panic disorders/phobias may develop agoraphobia if they are untreated

• Antidepressants (SSRIs) and cognitive behavioral therapy are effective treatments

Post-Traumatic Stress Disorder (PTSD)

• Extreme stressors can lead to the formation of stress that can last a lifetime

• PTSD is characterized by:

  • Intense fear

  • Helplessness

  • Horror

  • Intrusive recollections of the traumatic event

  • Avoidance and numbing

  • Hyperarousal

• PTSD is associated with:

  • Dysregulation of stress hormones

  • Disordered sleep

  • Major depressive disorder

• Very high levels of norepinephrine released in the brain during the traumatic event remain at those heightened levels

• The alpha-1 blocker prazosin that was used to lower blood pressure is now also used to treat nightmares experienced with PTSD

  • Beta-blockers such as propranolol are also being tested in individuals exposed to trauma

    • These must be administered shortly after the traumatic incident

• PTSD is generally treated with

  • Antidepressants

  • Atypical antipsychotic medication

  • Cognitive behavioral therapy

  • Eye movement desensitization

  • Reprocessing therapy

• Benzodiazepines can also be used to treat PTSD

  • Benzodiazepines bind to GABA receptors and enhance the responsiveness to endogenous GABA

Tourette Syndrome/Tourette’s

• Tourette’s is an inherited disorder

• Symptoms usually appear between the ages of 4 and 8

• Symptoms

  • Tics: a habitual spasmodic contraction of the muscles, most often in the face

    • These can either be motor or vocal

    • Types of tics may change and can increase or decrease in severity

  • Repetitive involuntary movements or utterances that are sudden and rapid and persist for 1 or more years

• Many people with Tourette's have associated conditions including:

  • Problems with learning

  • Difficulties paying attention

  • Obsessive thoughts

  • Compulsive rituals

  • These symptoms all seem to result from abnormal activity in the basal ganglia

• Genes and uterine or early environmental conditions can cause abnormalities in basal ganglia development or an excess of some chemicals

• The stimulants methylphenidate and dextroamphetamine are reported to improve attention and decrease tics in patients with Tourette syndrome

  • However, reactions to these medications can include:

    • Weight gain

    • Muscular rigidity

    • Fatigue

    • Motor restlessness

    • Social withdrawal

    • Depression

    • Cognitive impairment

• Other types of therapy include

  • Behavioral therapy

  • Psychotherapy

  • Counseling

Major Depression

• Symptoms of major depression include:

  • Harrowing feelings of sadness

  • Fopelessness

  • Pessimism

  • Loss of interest in life

  • Reduced emotional well-being

• Major depression is also associated with:

  • Disturbances in sleep and appetite

  • Decreased energy levels

  • Cognitive disturbances, including difficulty concentrating and remembering

• Genes and environment play a role in one’s risk for depression

  • stress plays a role in triggering a depressive episode

• Physical symptoms may reflect disturbances in the hypothalamus

  • This results in excessive production of stress hormones

• PET scans show the anterior cingulate gyrus in the prefrontal cortex is affected in depression

• Current medications increase levels of norepinephrine or serotonin in synapses

  • Some also target dopamine

  • SSRIs (selective serotonin reuptake inhibitors) act on serotonin alone

  • Increased levels of neurotransmitters start changes in cells and circuits

  • Ketamine: a drug that blocks NMDA glutamate receptors

    • It has been shown to alleviate symptoms of depression

    • There are many side effects

• Cognitive-behavioral psychotherapies have shown to be effective for treating major depression

Bipolar Disorder

• Bipolar disorder was previously known as manic-depressive illness

• Individuals with Bipolar disorder have an increased risk of suicide

• Individuals usually experience episodes of deep depression and manic highs

  • Depressive episodes are indistinguishable from those of major depression

  • Manic episode symptoms include:

    • Increased energy

    • Decreased need for sleep

    • Marked interest in goal-directed activities

    • Poor judgement

    • Predominantly irritability but maybe euphoria as well

• Manic individuals are grandiose and may have hallucinations or delusions

  • Hypomania: a milder form of mania that can still be present in Bipolar disorder

• People with Bipolar disorder have recurrences of acute mania/depression throughout their life

• Bipolar disorder has a high genetic influence

• Lithium has a mood-stabilizing effect

  • Individuals may require additional treatments, especially in the depressive episodes

Schizophrenia

• Schizophrenia is marked by disturbances in

  • Thinking and cognition

  • Emotional reactions

  • Social behavior

• This results in chronic illness and personality change

• Schizophrenia is caused by disruption of neurodevelopment through genetic disposition

  • Maternal infections & direct brain trauma increase the severity of schizophrenia

• Brain scans and postmortems of those with schizophrenia show abnormalities in the brain

  • Enlarged ventricles and reduced size of certain brain regions

    • Ventricles: open areas deep within the brain that store cerebrospinal fluid

  • PETs and fMRIs taken when performing cognitive tasks show abnormal function in some brain areas

• Brain systems using dopamine, glutamate, and GABA appear to be involved in the development of schizophrenia

  • Genes involved in controlling neuron communication have been identified to increase the risk of schizophrenia

• Schizophrenia is usually diagnosed between the ages of 15 and 25

• Most patients continue to have moderate or severe symptoms that may be aggravated by life stressors

  • Deficits in cognition are frequent

  • There are lifelong manifestations of schizophrenia

    • Positive symptoms- symptoms that “add” something, including:

      • hallucinations

      • delusions

      • confused thinking

    • Negative symptoms- symptoms that “take away” something, including:

      • inability to experience pleasure

      • lack of motivation

  • Schizophrenia can make it difficult for people to lead productive lives

• Treatments

  • Chlorpromazine: the first antipsychotic drug discovered in the 1950’s by accident

    • It is more effective than a placebo or sedative

  • The first generation of antipsychotic drugs act by inhibiting certain dopamine receptors

    • However, this accounts for the high prevalence of side effects like Parkinson’s disease and tardive dyskinesia

      • Tardive dyskinesia: an irreversible movement disorder characterized by involuntary and abnormal movements in the jaw, lips, or tongue

  • The second generation of drugs treat positive symptoms but don’t have the same likelihood of causing side effects such as Parkinson’s disease

    • Side effects of these drugs include:

      • Lots of weight gain

      • Blood disorders

      • Muscle pain & dysfunction