|PSY 101 Psychological Disorders III: Mood Disorders (2) & Schizophrenia|
Mood Disorders: Some Additional Notes
Unipolar Disorder (Major Depression) Subtypes
- Seasonal Affective Disorder
- Annual cycle which brings with it a depressive episode
- In the winter, associated with loss of light in daytime (in Northern Hemisphere)
- In the summer, associated with heat (much rarer)
- Postpartum Depression: Occurs to a mother within a month after the birth of a child (often appearing 2 weeks following birth). More severe than "baby blues" noted below. Mother feels quite down and sad, lack of energy, guilt, hopelessness, inability to feel pleasure and, often, feeling unable to take care of baby. May last for several months or more. Relatively frequently seen, i.e., in about 10% of new 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.
- Melancholic Depression: A form of major depression with strong physiological elements such as difficulty sleeping, lowered activity levels, and lack of appetite.
- Anaclitic Depression: A form of depression seen in young children (usually under 6 years old) following upon the death of a parent, usually a mother.
NEW: Persistent Depressive Disorder [PDD] (Dysthymic Disorder)
- In the DSM-5, this new diagnostic category combines two types of depression that had separate diagnoses in DSM-IV:
- Dysthymic Disorder: Individuals who have experienced depressed mood for a least two years in adults (1 year in children or adolescents), but do not have symptoms sufficient for a full diagnosis of Major Depressive Disorder
- Additionally, if an individual has experienced Major Depressive Disorder for at least two years, the diagnosis becomes PDD
Bipolar Disorder Subtype
- Rapid Cycling Bipolar Disorder: A form of the disorder in which the individual experiences 4 or more manic episodes within one year
- This is a DSM-5 disorder involving alternating periods of elevated (hypomanic) and depressed mood for at least two years in adults (1 year in children/adolescents) without sufficient other symptoms to justify a diagnosis of bipolar disorder
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
- Prevalence: Usual figure = 1% (to 1.5%) of the population (i.e. 3-4 million people in the USA); it is probably getting lower in recent years.
Symptoms of Schizophrenia
- 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
- 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
- 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
- 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
- Marked by significant motor disturbances, e.g., muscular rigidity or random motor activity (hyperactive & incoherent)
- Marked deterioration in adaptive behavior
- Emotional restriction, incoherence in speech, social withdrawal
- Sometimes bizarre delusions regarding bodily functions
- Individuals who do not fit into any of the other three categories but who are clearly schizophrenic
Nancy Andreasen, MD
= behavioral deficits
Do not tend to respond to medication; somewhat worse prognosis
= 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
- Concordance rate for identical twins = ca. 50% but for fraternal twins = ca. 15-20%
- Children born to two schizophrenic parents have a ca. 46% chance of developing the disorder (vs. 1% for general population)
- Hence, moderately high level of vulnerability due to genetics
2. Neurochemical Abnormalities
- Excessive dopamine (DA) may contribute (antipsychotic medications lower levels of DA)
- Possible interactive effect between two neural systems: DA and another neurotransmitter, serotonin: both of these affect glutamate receptors
- Adolescent use of marijuana in genetically-vulnerable individuals may precipitate SCZ
3. Structural Abnormalities in the Brain
- Enlarged ventricles are found with chronic SCZ
- Cause or effect of SCZ not clear; may be effect
4. Neurodevelopmental Hypothesis
- Insults to the brain during critical maturational periods (before or immediately after birth) may lead to subtle neurological damage; this damage leads to the eventual development of SCZ during adolescence or young adulthood.
- Insult may come from viral infections or malnutrition during prenatal period or obstetrical problems during delivery
- Evidence that higher levels of SCZ is associated with influenza in mother during 2nd trimester pregnancy
5. Expressed Emotion
- = high levels of critical comments and emotional overreaction toward SCZ patient by family
- In families with high expressed emotion, SCZ patient is 3-4 times more likely to relapse than in family with low expressed emotion.
- Varying levels of genetic/biological vulnerability may interact with varying levels of stress to precipitate SCZ. Thus, persons with low vulnerability may require high levels of stress but persons with high vulnerability may only need low levels of stress to become SCZ.
This page was originally posted on 11/24/03 and last updated on December 6, 2016