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Mood Disorders: Some Additional Notes

Unipolar Disorder (Major Depression) Subtypes

 Postpartum experiences of
                mothers
  • "Baby Blues" or "maternity blues" for up to about 2 weeks after birth. Very frequent. Not a "disorder." New mother feels mild anxiety or depression, tearfulness, changeable mood feelings. Probably caused by hormonal changes following birth. In about 50% of new mothers.
  • Postpartum Psychosis: A very rare disorder appearing in 1-2 per 1000 births. Woman experiences hallucinations, thought disturbances, and disorganized speech or behavior. It seems to be highly related to an underlying bipolar disorder.

NEW: Persistent Depressive Disorder [PDD] (Dysthymic Disorder)

Bipolar Disorder Subtype

Cyclothymic Disorder



Schizophrenic Disorders

Schizophrenia (SCZ) literally means "split" ("schizo-") + "mind" ("phrenia). However, the split was originally thought to be between the thinking and the feelings of the person.

It DOES NOT mean that there are several people inside one person. That is a condition called "Dissociative Identity Disorder" (formerly, Multiple Personality Disorder).

= A class of disorders marked by delusions, hallucinations, disorganized speech, and deterioration in adaptive behaviors

Symptoms of Schizophrenia

Irrational Thinking

  • Delusions: false beliefs which are clearly out of touch with reality
    • Delusions of Grandeur: "I am Jesus Christ" "I am God"
        
  • Loosening of Associations: the train of thought of an individual is chaotic and does not make sense.
    • "I was going down to the store because it is October and the people near the street didn't tell me what was happening since I don't like to walk too fast. So, after the time when it was happening I decided that no one knew who I was and needed to buy some kind of bicycle or other type of train." (That paragraph doesn't make sense, but is an example of dissociated speech.)

Deterioration of Adaptive Behavior

  • Quality of functioning (a) in social relationships, (b) at work, or (c) in taking care of personal needs including health may become distinctly poorer

Beautiful Mind HallucinationsDistorted Perceptions

  • Hallucinations: sensory perceptions that occur in the absence of a real external stimulus or are gross distortions of perceptual input.
    • Most frequent hallucinations are auditory, especially hearing voices which are often insulting, commenting upon the person's behavior or telling the person what to do.
    • In the movie "A Beautiful Mind" John Nash, the character played by Russell Crowe, is schizophrenic and he hallucinates visually, that is, sees people and scenes which were not actually real. Visual hallucinations are unusual for schizophrenic

Disturbed Emotions

  • Inappropriate emotions, e.g., laughing at something sad or crying at something happy
  • Blunted or flat emotions, that is, the range of emotional responsiveness becomes narrow or even absent

Subtypes

Paranoid

  • Individual is dominated by delusions, especially of persecution and of grandeur.
  • Three most usual delusions: sex, government, religion
  • Hostility and suspicion of others and their motives
  • Believe they are being watched, manipulated, or otherwise the object of someone else's scrutiny

Catatonic

  • Marked by significant motor disturbances, e.g., muscular rigidity or random motor activity (hyperactive & incoherent)

Disorganized

  • Marked deterioration in adaptive behavior
  • Emotional restriction, incoherence in speech, social withdrawal
  • Sometimes bizarre delusions regarding bodily functions

Undifferentiated

  • Individuals who do not fit into any of the other three categories but who are clearly schizophrenic


Nancy Andreasen, MD
Negative Symptoms

= behavioral deficits

Do not tend to respond to medication; somewhat worse prognosis

Positive Symptoms

= behavioral excesses

Tend to respond to antipsychotic medications; somewhat better prognosis

  • Flattened emotions
  • Social withdrawal
  • Apathy
  • Impaired attention
  • Little speech
  • Hallucinations
  • Delusions
  • Flight of ideas
  • Bizarre behavior
  • Course and Outcome

    • Usually emerges during adolescence & young adulthood (75% of cases by 30 yo)
    • Prior to the full-fledged disorder, individuals often manifested strange and peculiar forms of thinking, acting, etc.
    • While it can emerge suddenly, SCZ usually follows a slower and more "insidious" course
    • Three types of outcomes
      • Milder forms of SCZ often comes with full recovery (for ca. 20% and up to 50% if given high-quality care)
      • Some will have partial recovery with periods of relapse for the rest of life
      • Chronic and deteriorating forms of SCZ which requires long-term treatment and, often, institutionalization (ca. 25% of cases)

    1. Genetic Vulnerability

    2. Neurochemical Abnormalities

    [SZ
                    Ventricles]3. Structural Abnormalities in the Brain

    4. Neurodevelopmental Hypothesis

    5. Expressed Emotion

    6. Stress

     


    This page was originally posted on 11/24/03 and last updated on December 6, 2016