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Thought, Mood and Anxiety Disorders

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... have been shown through studies of monozygotic twins to have a genetic component ... 45% concordance for twins, 15% for siblings. Bipolar depression ... – PowerPoint PPT presentation

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Title: Thought, Mood and Anxiety Disorders


1
Thought, Mood and Anxiety Disorders
2
Psychiatric Disorders
  • Characterized by changes in a persons thoughts,
    mood, or behaviors that interfere with ordinary
    functioning in one or more spheres of life

3
Causes
  • Thought to have a biological basis in that many
    disorders appear due to abnormalities in brain
    structure and function
  • Many conditions also have been shown through
    studies of monozygotic twins to have a genetic
    component
  • Schizophrenia
  • 45 concordance for twins, 15 for siblings
  • Bipolar depression
  • 80 concordance for twins, 10 for siblings

4
Causes continued
  • Environmental factors are also important
  • Fact that concordance is not 100 in twins
    suggests that environment plays a role in
    development of mental illness
  • Overwhelming conclusion of research studies is
    that both genetic and environmental influences
    play a significant role
  • Person with genetic vulnerability encounters
    specific environmental triggers

5
Anatomic Basis of BehaviorCerebral Cortex
  • Frontal lobe
  • JEM2
  • Highly involved in memory and central to our
    sense of being a distinct self with a unique
    history
  • Association Cortex in the frontal lobe
  • Responsible for expression of personality
  • Ability to complete abstract thinking
  • Motivation and volition
  • Making meaning of language
  • Concentration

6
Temporal Lobe
  • Integrates and interprets auditory and spatial
    information
  • Accurate interpretation of emotions and ability
    to respond with a level of emotionality that is
    deemed socially congruent
  • Impulse control, management of aggression and
    sexual expression
  • Including expression of maleness and
    femininity
  • Basic emotions originate in amygdala but are
    fine tuned by temporal lobe to an appropriate
    level
  • Left temporal lobe in males
  • Both lobes in females

7
Parietal Lobe
  • Essential in integration and processing of
    sensory input
  • Coordination of spatial awareness
  • Ability to experience, claim and care for ones
    body
  • Symptom denial
  • Ability to associate with surrounding space
  • Ability to filter out extraneous input

8
Limbic System
  • Hippocampus, parahippocampal gyrus, cingulate
    gyrus, amygdala and the fornix (connects hippo
    with hypothalamus)
  • Hypothalamus, although not a part of the limbic
    system, has extensive connections with limbic
    system and controls basic autonomic functions
  • amgydala
  • FARV
  • Also sexual arousal

9
Integration of Thought, Mood, Learning and
Cognition
  • Behavior is molded through learning and memory
  • Experience a behavior and the result, remember
    the experience and gradually learn to modulate
    the behavior
  • Psychiatric patients may experience impairment in
    pathways used for learning and memory

10
Information Processing
  • First step in processing of behavior is the
    thalamus
  • Thalamus determines whether sensory input is
    familiar or unfamiliar, safe or unsafe
  • If safe, input is forwarded through the
    information processing pathways
  • If unsafe, a sympathetic cascade is stimulated
    through the hypothalamic-pituitary-adrenal axis
    (HPA)
  • Amygdala receives the input and generates a
    primitive response

11
Information Processing cont..
  • Amygdala forwards input to the hippocampus
  • Hippocampus prepares to encode it for memory
    storage
  • Must separate out components
  • If reading a book while listening to music, must
    separate words from the music and from the shirt
    youre wearing etc-otherwise memory would be a
    jumble of unrelated images
  • Prefrontal associative cortex acts next
  • Keeps tract of where information has been put in
    long term memory storage
  • Integrates memories with sensory input

12
Information Processing cont
  • Example of prefrontal association cortex
  • Think about an apple
  • Shape, color, texture, taste, smell, location
  • Each sensory attribute is stored in a different
    location in memory
  • Prefrontal assoc cortex retrieves those various
    attributes and brings them together so your apple
    is crunchy, juicy, delicious not gray, square and
    bitter

13
Information Processing
  • Next stop is parietal lobe
  • Filters out extraneous information
  • Then forwards input onto frontal lobe
  • Frontal lobe
  • First become aware of thinking about the sensory
    input and formulating a cognitive behavioral
    response to it

14
Neuromediators
  • Aka neurotransmitters
  • Ensure that all of these areas of the brain
    communicate with each other
  • Through synaptic transmission
  • Have to be of the right type and amount and in
    the right location for normal processing to occur

15
Neuromediators Implicated in Mental Illness
  • Acetylcholine
  • Excitatory or inhibitory depending on area of
    brain
  • Underactivity implicated in Alzheimers
  • Dopamine
  • Usually excitatory, involved in motivation,
    thought, and emotional regulation
  • Overactivity implicated in schizophrenia

16
  • Norepinephrine and epinephrine
  • Excitatory or inhibitory depending on area of
    brain
  • Underactivity implicated in some depressions
  • Serotonin
  • Regulation of attention and complex cognitive
    functions
  • Underactivity implicated in some depressions and
    obsessive, compulsive disorder
  • GABA, glutamate, aspartate, glycine
  • GABA and glycine are inhibitory, glutamate is
    excitatory
  • Implicated in anxiety disorders

17
Disorders of Thought and VolitionSchizophrenia
  • Fairly common-about 1 of population
  • Onset typically between 20-35
  • Late onset between 66-77 is not uncommon
  • Men and women affected equally
  • Risk factors
  • Having a close relative with the disease
  • Winter/spring birth date
  • Second trimester prenatal influenza infection
  • Early history of attentional deficit

18
Schizophrenia cont
  • Causes a disconnection between thought and
    language
  • Disorganized speech
  • Invented words
  • Derailment (cant stay on subject)
  • Incoherence
  • Delusions
  • Being controlled by an outside force
  • Visual and auditory hallucinations
  • Voices
  • Unable to blunt sensory input leading to sensory
    overload
  • Sounds are louder, colors brighter

19
Schizophrenia
  • Absence of normal social and interpersonal
    behaviors
  • Alogia-tendency to speak very little
  • Avolition-lack of initiation
  • Apathy
  • Affective flattening (emotional blunting)
  • Adhedonia-inability to experience pleasure

20
Schizophrenia
  • Pathogenesis is unknown
  • Abnormalities in brain structures are present
    suggesting prenatal involvement
  • Enlarged ventricles
  • Reduced thalamic and hippocampal size
  • Smoother and smaller left hemisphere
  • Reduced metabolic activity in frontal lobe
  • Alterations in dopamine, serotonin, glutamate

21
Schizophrenia
  • Treatment Goal
  • Induce remission
  • Prevent recurrence
  • Restore behavioral, cognitive and psychosocial
    function
  • Pharmacotherapy and psychotherapy both used
  • Anti-psychotic drugs
  • Individual and group therapy

22
Disorders of MoodDepression
  • Common and highly under diagnosed
  • Major depression affects approximately 20 of
    population
  • Two types
  • Unipolar
  • Persistent unpleasant mood
  • Bipolar
  • Alternating periods of depression and mania

23
Depression
  • Unipolar
  • Affects approximately 5 of worlds pop
  • Women double the rate of men
  • Average onset mid 30s
  • Bipolar
  • Approximately 1.5 of world population
  • Evenly distributed between sexes
  • Average onset mid 20s
  • Prevalence of both is higher in families with
    history of mood disorders

24
Depression cont.
  • Classified as mood disorder characterized by
  • Depressed mood
  • Anhedonia
  • Feelings of worthlessness or excessive guilt
  • Decreased concentration
  • Psychomotor agitation or retardation
  • Insomnia or hyper-somnia
  • Decreased libido
  • Changes in weight or appetite
  • Thoughts of death or suicidal ideation

25
Depression cont
  • Can vary in intensity
  • Often is recurrent
  • First episode after 65 can be precursor to
    dementia
  • Confusion is primary symptom

26
Uni-polar
  • Three subtypes
  • Melancholic
  • Worse in the morning, insomnia, anorexia,
    agitation, mental pain, loss of interest in
    activity
  • Atypical
  • Worse as day progresses, hypersomnia, overeating
  • Dysthymia
  • Persistent but mild depression lasting more than
    2 years

27
Bi-polar
  • Manic depressive disease
  • Multiple subtypes
  • Characterized by alternating episodes of elation
    and depression
  • Mood change may begin abruptly or develop over a
    few weeks

28
Brain Changes in Depression
  • Reduction in activity in frontal and temporal
    lobes
  • Increased blood flow to amygdala
  • Alterations in serotonin, norepinephrine
  • Disturbances in regulation of cortisol through
    HPA axis

29
Depression cont
  • Treatment
  • Psychotherapy
  • Anitdepressnat drugs
  • Lithium
  • Anticonvulsants
  • Electroconvulsive therapy
  • 70-90 show improvement

30
Anxiety Disorders
  • Extremely common
  • 15 of population
  • Women more than men
  • Characterized by increased fearfulness
  • resulting from cascade effect through the HPA
    axis
  • Symptoms occur without a precipitating threat

31
Anxiety Disorders
  • Five types
  • Panic disorder
  • Post-traumatic stress disorder
  • Generalized anxiety disorder
  • Social phobia
  • Obsessive complusive disorder (OCD)

32
Panic Disorder
  • 1.5-3 prevalence
  • Characterized by
  • neurologic symptoms
  • Dizziness, lightheadedness, paresthesias,
    fainting
  • Cardiac symptoms
  • Tachycardia, chest pain, palpitations
  • Respiratory symptoms
  • Shortness of breath, feelings of smothering,
    choking
  • Psychological symptoms
  • Feelings of impending doom, fear of dying, sense
    of unreality

33
Panic Disorder
  • Attacks last 15-60 minutes
  • 50 also experience depression
  • Brain Changes
  • Lower levels of serotonin
  • Involvement of adrenergic system
  • Disruption of GABA
  • Substance abuse often accompanies disease
  • Treatment
  • Pharmocotherapy
  • Cognitive behavioral therapy

34
Post Traumatic Stress Disorder (PTSD)
  • Chronic activation of the stress response as
    result of experiencing a potentially life
    threatening event
  • Approximately 3.6 of adult population in US
    affected at any one time
  • Characterized by constellation of symptoms
    experienced as states of
  • Intrusion
  • Avoidance
  • hyerarousal

35
PTSD
  • Intrusion
  • Flashbacks, nightmares
  • Avoidance
  • Emotional numbing
  • Complicated by depression and survivor guilt
  • Hyperarousal
  • Increased irritability, exaggerated startle
    reflex
  • Also see memory problems, sleep disturbance,
    anxiety, substance abuse, depression

36
PTSD
  • Brain changes
  • Increased sympathetic activity
  • Decreased cortisol levels
  • Decreased hippocampal volume
  • Little is known about risk factors
  • Less than half of people exposed to traumatic
    events develop PTSD
  • Treatment
  • Psychotherapy
  • Pharmacotherapy
  • Antidepressants, and antianxiety medications

37
Generalized Anxiety
  • Recognized as separate disorder from panic attack
    in 1980s
  • Characteristics
  • Prolonged (6 mos) excessive worry that is not
    easily controlled by the person
  • Muscle tension
  • Autonomic hyperactivity
  • vigilance and scanning
  • Inability to concentrate
  • Treated with drugs that affect GABA uptake

38
Obsessive Complusive Disorder
  • Characterized by obsessions (repeated thoughts)
    and complusions (repeated acts) that are time
    consuming or distressing to the person
  • Person usually knows rituals are unreasonable
  • 2-3 of worlds population
  • Equal frequency in men and women
  • Average onset 20, although it may appear in
    children and confused with ADD

39
OCD continued
  • No evidence of anatomical abnormality in the
    brain
  • Increased activity in the anterior cingulate
  • Increased activity in the thalamus
  • Decreased serotonin activity
  • Treatment
  • Tricylic antidepressants
  • Cognitive behavioral therapy

40
Social Anxiety Disorder
  • Generalized or specific intense, irrational, and
    persistent fear of being scrutinized or
    negatively evaluated by others
  • Anxiety when exposed to the feared social
    situation
  • Recognition that the fear is irrational
  • Avoidance of the situation
  • Interference with persons normal routine
  • Must be present at least 6 months

41
Social Anxiety Disorder
  • Prevalence 3-13
  • Women more often than men
  • Onset 11-19 years of age
  • Side effects loss of earning power,
    socioeconomic status and substance abuse
  • Treatment
  • Pharmocotherapy
  • Cognitive behavioral therapy
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