Understanding Psychopathology in Physiological Psychology

1. Proseminar in Physiological Psychology (PSY 627)

2. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

4. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

5. GENERAL SYMPTOMS OF SCHIZOPHRENIA Positive symptoms Hallucinations Delusions Dissociative thought disorders Negative symptoms Impoverished thought and speech Social withdrawal Blunted affect Cognitive symptoms Poor attention Deficits in learning Psychomotor slowing The term schizophrenia was coined by P. Eugen Bleuler (1857-1939)

6. DSM-IV-TR SUBTYPES OF SCHIZOPHRENIA Paranoid: delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening are absent. Disorganized: thought disorder and flat affect present together. Catatonic: immobility or agitated, purposeless movement. Symptoms can include catatonic stupor and waxy flexibility. Undifferentiated: Psychotic symptoms present but the criteria for paranoid, disorganized, or catatonic types have not been met. Residual: Positive symptoms are present at low intensity only. Developers of DSM-5 are recommending they be dropped from classification.

7. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

9. Gene X Environment Interactions • SERT allele x maternal influence = aggressivity • (Soumi and colleagues, 2005). • SERT allele x life stress = depression • (Caspi and Moffitt, 2002).

10. THEORIES OF SCHIZOPHRENIA Hypofrontality hypothesis Schizophrenics have less activity in frontal lobes Supported by PET studies showing less activity in frontal lobes of patients performing on “frontal task” such as Wisconsin Card Sort.

11. Males Females

12. THEORIES OF SCHIZOPHRENIA • Dopamine hypothesis • Schizophrenics have more activity in mesolimbic dopamine • system • Supported by several lines: • 1. Dopamine agonists mimic symptoms • 2. PET studies show patients have increased D2 dopamine receptors • 3. With antipsychotic drugs, there is a correlation between • affinity of the drug for the D2 dopamine receptor and • clinical potency

13. THEORIES OF SCHIZOPHRENIA Psychotogen hypothesis Schizophrenics have faulty metabolic process which leads to production of endogenous hallucinogens Supported by evidence of LSD and PCP effects

15. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

16. ANTIPSYCHOTIC MEDICATIONS (Pick your “poison”)

17. CLASSES OF ANTIPSYCHOTIC MEDICATIONS • 1. Phenothiazines- e.g., chlorpromazine (Thorazine) • Butryophenones- e.g., haloperidol (Haldol) • Thioxanthene derivatives- e.g., thiothixene (Navane) • Dibenzodiazepine derivatives- e.g., clozapine (Clozaril)

18. SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS • Antipsychotic medications generally have a high therapeutic index, but common side effects include: • 1. Anticholinergic effects- dry mouth, constipation. • Orthostatic hypotension- dizziness with movement • Sexual dysfunction- loss of libido, disrupted cyclicity in females • Disrupted thermoregulation- hyperthermia

19. SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS (con’t) 5. Extrapyramidal motor effects- a. Acute dystonic reaction - facial grimacing, torticollis, oculogyric crisis - most common in young males b. Akathisia - constant movement c. Tardive dyskinesia - stereotyped involuntary movements of lips, tongue and jaw - 10-20% of old patients 6. Neuroleptic malignant syndrome - fever, confusion - 1% occurrence, but can be fatal due to leukocytosis

20. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

21. SYMPTOMS OF DEPRESSION • Change in body weight and appetite • Change in normal sleep pattern • Loss of libido • Feelings of hopelessness • Thoughts of suicide • Internalizing of negative outcomes

22. SUBTYPES OF DEPRESSION Major Affective Unipolar Bipolar Dysthymia Lower grade, but long-lasting depression Atypical -Specific type of depression characterized by supersensitivity to social rejection and carbohydrate craving -Especially responsive to MAO inhibitors

23. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

24. THEORIES OF AFFECTIVE DISORDERS • Monoamine hypothesis • Depressed patients have less monoamine activity • Supported by evidence showing: • Reserpine-induced depletion of monoamine stores • leading to depression. • Clinical evidence showing efficacy of SSRIs (e.g., • setraline, Zoloft) and SNRIs (e.g., venlafaxine, Effexor).

25. COMORBID DEPRESSION AND ANXIETY

26. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

27. TREATMENT OF DEPRESSION • Antidepressant medication • Electroconvulsive therapy • Sleep deprivation • Light therapy • Psychotherapy

28. Trade NameGeneric Name Adapin doxepin Anafranil  clomipramine Asendin amoxapine Aventyl    nortriptyline Desyrel  trazodone Effexor venlafaxine Elavil amitriptyline Ludiomil maprotiline Luvox (SSRI)   fluvoxamine Marplan (MAOI) isocarboxazid Nardil (MAOI) phenelzine Norpramin desipramine Pamelor nortriptyline Parnate (MAOI) tranylcypromine Paxil (SSRI) paroxetine Pertofrane desipramine Prozac(SSRI) fluoxetine Remeron mirtazapine Serzone nefazodone Sinequan doxepin Surmontin trimipramine Tofranil imipramine Vivactil protriptyline Wellbutrin bupropion Zoloft (SSRI) sertraline

29. CLASSES OF ANTIDEPRESSANT MEDICATIONS

30. SIDE EFFECTS OF ANTIDEPRESSANT MEDICATIONS • Antidepressant medications generally have a high therapeutic index and they can be combined safely with other psychotropics (except MAO inhibitors). Some side effects include: • 1. Sedation • Insomnia • Anticholinergic side effects • Hypotension • Agranulocytosis • “Cheese effect” with MAO inhibitors

31. LITHIUM • First used by John Cade in Australia in 1949 • Complete absorption with no metabolism • Retention enhanced by low sodium diet • Blocks inositol monophosphate phosphatase, • thus reducing PI turnover • Low therapeutic index • Side effects include hypothyroidism, weight gain, • polydipsia, polyuria, increased leukocytes

32. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

33. Anxiety Disorders • 1. Phobia • a. specific irrational fear • b. responsive to behavioral treatment • 2. Obsessive-Compulsive disorder • a. repetitive intrusive thoughts or actions • b. SSRI treatment • 3. Panic disorder • a. episodes of intense anxiety • b. benzodiazepine treatment • 4. Generalized anxiety disorder • a. free-floating anxiety • b. benzodiazepine treatment

34. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

36. PSYCHOPATHOLOGY (Chapter 16) 1. Schizophrenia a. symptoms b. causes c. treatment 2. Affective Disorders a. symptoms b. causes c. treatment 3. Anxiety Disorders a. symptoms b. causes c. treatment

37. ANXYOLITICS Alprazolam Chlordiazepoxide Buspirone Diazepam Lorazepam Oxazepam Triazolam Phenobarbital Halazepam Prazepam HYPNOTICS Chloral hydrate Estazolam Flurazepam Pentobarbital Lorazepam Quazepam Triazolam Secobarbital Temazepam Zolpidem