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Psychiatric Disorders

Psychiatric Disorders. June 29, 2011. Brainstorming: Psychiatric Disorders. PTSD Bipolar Disorder Psychopathology Asperger’s Schizophrenia OCD Depression Paranoia ADHD Anxiety Munchausen: Brad & Vivian. DSM & Psychiatric Disorders. Schizophrenia: Ime & Chloe

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Psychiatric Disorders

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  1. Psychiatric Disorders June 29, 2011

  2. Brainstorming: Psychiatric Disorders • PTSD • Bipolar Disorder • Psychopathology • Asperger’s • Schizophrenia • OCD • Depression • Paranoia • ADHD • Anxiety • Munchausen: Brad & Vivian

  3. DSM & Psychiatric Disorders • Schizophrenia: Ime & Chloe • Schizophreniform Disorder: Varun & William, Brad & Vivian • Schizoaffective Disorder: Karla & Leandra, , Ice & Hannah • Delusional Disorder : Ime & Chloe, Maria & Allie • Shared Psychotic Disorder: Stephanie & Krystal, Maria & Allie • Dissociative Amnesia: Juan & Paige, Melissa & Kyle • Dissociative Identity Disorder: Stephanie & Krystal, Varun & William, Brad & Vivian • Bipolar Disorder: Karla & Leandra, Ice & Hannah • Cyclothymia: Juan & Paige, Melissa & Kyle

  4. Neurobiology of Mental Illness Schizophrenia http://www.npr.org/programs/atc/features/2002/aug/schizophrenia/

  5. The Dopamine Hypothesis • Positive symptoms • Delusions • Hallucinations • Disorganized behavior • Dopamine hypothesis: • Overactivity of dopamine in mesolimbic pathway (VTA to nucleus accumbens and amygdala) 5 http://thebrain.mcgill.ca/flash/a/a_03/a_03_cl/a_03_cl_que/a_03_cl_que.html

  6. Dopamine Hypothesis • Mesolimbic system important for reinforcement of behavior • We all have irrational thoughts, but usually brush them aside • But if mesolimbic system was active when the thought occurred, we might take it more seriously, leading to delusions • Confirming piece of evidence: schizophrenics often report euphoria at onset of positive symptoms • Disordered thinking? • System so active that it does not discriminate between thoughts, making it hard to follow a logical sequence • Terrifying element of delusions? • Strong dopaminergic projection to amygdala 6

  7. Dopamine HypothesisEvidence for excessive dopamine 7

  8. Dopamine agonists (cocaine, amphetamine) produce symptoms of psychosis. Dopamine antagonists reduce psychotic behavior. Patients may have abnormalities involving dopamine autoreceptors. Dopamine and Schizophrenia 8

  9. Long-term Use of Typical Neuroleptics Often Produce Serious Side Effects • Chlorpromazine: • A “typical neuroleptic” • A dopamine receptor blocker for D2 receptors • Clozapine: • An “atypical neuroleptic” • An antipsychotic drug that blocks D4 receptors in the nucleus accumbens • Tardive dyskinesia involves tremors and involuntary movements. • Supersensitivity: increased sensitivity of neurotransmitter receptors (D2) to dopamine 9

  10. Dopamine HypothesisEvidence for increase in D3 receptors 10

  11. Problems With an Excessive Dopamine Hypothesis 25% of patients do not respond to dopamine antagonists. Atypical antipsychotic medications (clozapine) act primarily on neurotransmitters other than dopamine. Drugs change dopamine activity immediately, but patient may not improve for weeks. PCP produces symptoms similar to schizophrenia by blocking the NMDA glutamate receptor. 11

  12. Roll of The Dice http://science.education.nih.gov/supplements/nih5/mental/guide/nih_mental_masters.pdf

  13. PET Scanning: Normal vs. Schizophrenia

  14. PET Scanning Depression

  15. Stress

  16. How Does Stress Affect the Brain? • Stress causes the release of corticotropin releasing factor (CRF or CRH) from the hypothalamus. • This activates the anterior pituitary and causes the release of ACTH (adrenocorticotrophic hormone). • ACTH then activates the adrenal cortex and causes the release of glucocorticoids like cortisol. http://www.stanford.edu/group/hopes/treatmts/lifestyleandhd/an2.html

  17. Hippocampus Negative Feedback Loops • The body can sense high levels of cortisol or corticosterone in the blood. • To keep these levels from rising too high, it will take steps to help decrease the production of CRH in the brain, causing the whole cycle to slow. Joels M. (2008) Stress, the hippocampus, and epilepsy. Epilepsia 50 (4): 586-597.

  18. The Fight or Flight Response sp.eths.k12.il.us/wilburnm/.../realfightor%20flight.ppt

  19. What is the “fight or flight response?” • The body’s response to immediate physical danger; the stress response. Energy is mobilized, either to mount an aggressive response against the danger, or to run away. • It is our body’s primitive automated, inborn response that prepares the body to “fight” or “flee” from perceived attack, harm or threat to our survival. sp.eths.k12.il.us/wilburnm/.../realfightor%20flight.ppt

  20. What happens to us when we are under excessive stress? • Internal and external stressors both trigger a bodily reaction, called the “fight or flight” response. • Hardwired into our brains and represents a genetic wisdom designed to protect us from bodily harm sp.eths.k12.il.us/wilburnm/.../realfightor%20flight.ppt

  21. Sympathetic Nervous System • Activated during stress to prepare your body for “fight or flight” • Connects the spinal cord to the peripheral organs through the sympathetic ganglia • Uses acetylcholine and norepinephrine to activate the body http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/PNS.html

  22. Sympathetic Activation • Chemicals such as adrenaline, noreadrenaline and cortisol are released into the blood stream. • Respiration increases, blood is forced away from digestion into our muscles and limbs, pupils dilate, awareness intensifies, sight sharpens, pain diminishes and the immune system mobilizes with increased activation. • We are focused on short-term survival sp.eths.k12.il.us/wilburnm/.../realfightor%20flight.ppt

  23. Can the fight or flight response become counterproductive? • Many of the major stressors today trigger full activation of the fight or flight response causing us to become aggressive and over-reactive (road rage) • Excessive stress leads to disorders of the ANS (autonomic nervous system), muscle tension, headache, upset stomach, racing heartbeat, shallow breathing, anxiety or depression. sp.eths.k12.il.us/wilburnm/.../realfightor%20flight.ppt

  24. How Do We Normally Calm Down? • Activation of the Parasympathetic Nervous System • “Rest and Digest” • Fibers from the peripheral organs synapse to the preganglionic fibers, which then pass through specific cranial nerves to enter the medulla and spinal cord. • Acetylcholine is important for the parasympathetic nervous system.

  25. What is our fight or flight system designed to protect us from? • When activated, the response causes a surge of adrenaline and stress hormones to pump through the body. • This surge can result in tremendous strength or heroism • When we are in real danger, the fight or flight response is invaluable. Today, however, most of our response is due to traffic, arguments, deadlines, parents, and teachers. So, stress hormones also flow into our bodies for events that cause no real danger. sp.eths.k12.il.us/wilburnm/.../realfightor%20flight.ppt

  26. Psychiatric Patient Experiences

  27. Awakenings • What did you notice about the mental hospital in Awakenings? Describe the tone and atmosphere. • How were the patients approached and treated? • How has mental illness been handled in our recent past?

  28. Mental Illness A brief history Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  29. 1908 • Clifford Beers publishes his autobiography, A Mind that Found Itself, describing his dehumanizing experiences in a Connecticut mental institution • Calls for reform, founds National Committee for Mental Hygiene—an education and advocacy group • This group later becomes the National Mental Health Association Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  30. 1930’s • Drugs, electro-convulsive therapy, insulin-induced comas, and surgery (lobotomy) used to treat people with schizophrenia Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  31. 1940’s • In 1946, President Harry Truman signs National Mental Health Act, establishing National Institute of Mental Health (1949) • In 1949, Australian psychiatrist, J. F. J. Cade introduces use of lithium to treat psychosis. Later this becomes a very useful drug in treating bi-polar disorder. Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  32. 1950’s • Anti-psychotic drugs introduced for treatment of psychosis. First anti-psychotic drug, chlorpromazine (Thorazine). • In 1955, there were 560,000 patients in state psychiatric hospitals. The advent of anti-psychotic drugs makes it possible for a dramatic reduction in state hospital populations. • Anti-psychotic drugs introduce new problem: sometimes serious side effects Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  33. Mid-1960’s • Deinstitutionalization: number of institutionalized mentally ill people in the US drops from 560,000 to 130,000 by 1980. • Deinstitutionalization possible because anti-psychotic drugs control symptoms, but long-term institutionalized people need ongoing mental health treatment and an array of social services that are not uniformly available. • Results: homelessness, “revolving door syndrome,” concern in the community about discharged patients Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  34. 1963 • Community Mental Health Centers Construction Act passes, providing federal money to develop a network of community mental health centers. • Note that this occurs after deinstitutionalization was well underway. Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  35. 1990 • New generation of anti-psychotic drugs introduced—clozapine, etc. • Drugs appear to be more effective and have fewer side effects Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  36. 1992 • Survey of American jails finds that 7% of inmates (100,000) are seriously mentally ill • Most of these individuals receive little, if any, treatment Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

  37. What Is a Mental Health Institution Like? Girl, Interrupted http://thegirlwiththebluebow.blogspot.com/2011/03/girl-interrupted-bcb-review.html

  38. http://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdfhttp://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdf

  39. http://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdfhttp://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdf

  40. http://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdfhttp://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdf

  41. http://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdfhttp://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdf

  42. One term of the sale was that Emory would accept the facility in its current state of disrepair. The central building, depicted in the photos above, was littered with medical equipment and signage from its active period. Outly-ing residency buildings arrayed around the central building were in worse condition: overgrown, broken. http://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdf

  43. http://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdfhttp://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdf

  44. Most rooms in the facility looked out onto the 42-acre estate. Although much of the view would be blocked by the building’s cladding, and much of the grounds immediately surrounding the building had been paved and developed, the land just beyond was still rolling manicured hills and scattered southern trees. http://readingon.library.emory.edu/issue1/articles/Miller/RO%20-%202006%20-%20Miller.pdf

  45. http://www.flickr.com/photos/nrbelex/2088995271/in/set-72157603376031618/http://www.flickr.com/photos/nrbelex/2088995271/in/set-72157603376031618/ • http://www.flickr.com/photos/judester/230742436/in/set-72157594262952659/

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