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Sir Christian Kreipke, PhD, FRSC . Introduction to Psychiatry . A disease manifested in the brain that causes deviation in behavior from a set of socially acceptable norms Distinct from psychological conditions in that a supposed somatic pathotrajectory exists
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Sir Christian Kreipke, PhD, FRSC Introduction to Psychiatry
A disease manifested in the brain that causes deviation in behavior from a set of socially acceptable norms Distinct from psychological conditions in that a supposed somatic pathotrajectory exists Can be induced by genetic conditions, damage to the brain, or environmental conditions What is a Psychiatric Condition?
Normal Abnormal
Psychiatric Criminal
Most societies have there own set of codes for “normal” and “abnormal” behavior • These closely defined norms may or may not overlap • Examples: • ADHD does not exist in Cuba • Infanticide is culturally acceptable in China • Cannibalism is still practiced in certain tribes of the South Pacific region • Female circumcision • Tattoos • Etc. Medical Anthropological perspective
Schizophrenia (10%) Turret's Syndrome (~1:10,000) Bipolar (~1:5,000) ADHD (~15-20%) Autism (~15%) Depression (~20%) Obsessive Compulsive disorder (~5%) Common Psychiatric Disorders
Characterized by a whole host of conditions • According to the DSM-IV, if the subject exhibits 2 or more of the following they have a probability of schizophrenia: • Auditory/visual hallucinations • Asocial behavior • Aggressive behaviors • Confusion • Negative affect • “split personality disorder” Schizophrenia
Possible biological cause • Abnormal development in striatum, medial temporal lobe, and/or corpus collosum • Hyperdopaminergic and hypoglutamatergic drive to the striatum • More generally, disrupted dopaminergic system Schizophrenia
Treatment: • Haldol (D2 antagonist) • Clorpromazine/clozapine (atypical antipsychotic which binds D3/4 system) • PROBLEM: • Patient’s behavior can be severely altered Schizophrenia
Characterized by multiple personality types (2 or more) and/or by severe shifts in mood (manic-depression) Bipolar
Possible biological cause: • Abnormal development of striatum, corpus collosum, and/or prefrontal cortex • Disrupted glutamatergic drive to the cortex Bipolar
Treatment: • Lithium (mood stabilizer) • Mode of action? UNKNOWN Bipolar
Characterized by lack of ability to focus on single task and/or hyperactivity associated with lack of focus ADHD
Possible biological causes: • Dysfunctional dopaminergic system particularly in the striatum ADHD
Treatment: • Dopaminergic drugs (amphetamine derivatives, psychostimulants) • How do they work? • Deplete the dopamine system quickly. Recovery time squelches dopamine drive and quiets overactive behaviors. Specifically they cause dopaminergic neurons to release dopamine and block reuptake via blocking the DAT ADHD
Characterized by chronic negative affect usually not correlated with a particular event. CAVEAT: clinical depression may be triggered by environmental cue. Emphasis on chronic!!! Depression
Possible biological cause: • Disrupted serotonergic drive to cortex Depression
Treatment: • SSRIs. Selectively prevent serotonin reuptake through the serotonin transporter, thus allowing more to remain in the synaptic cleft. Depression
Characterized by repetitive often self-injurous behaviors OCD
Possible biological cause • Recapitulates that of depression OCD
Treatment: • SSRIs most effective • Cognitive behavioral therapy OCD
Autism, turret’s and a host of other pathological conditions sadly have unknown biological pathotrajectories and hence treatment is often laborious and inconclusive Others