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
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
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)
DSM-IV-TR SUBTYPES OF SCHIZOPHRENIA
1. Paranoid: delusions and hallucinations are present but thought
disorder, disorganized behavior, and affective flattening are absent.
2. Disorganized: thought disorder and flat affect present together.
3. Catatonic: immobility or agitated, purposeless movement.
Symptoms can include catatonic stupor and waxy flexibility.
4. Undifferentiated: Psychotic symptoms present but the criteria for
paranoid, disorganized, or catatonic types have not been met.
5. Residual: Positive symptoms are present at low intensity only.
Developers of DSM-5 are recommending they be dropped from classification.
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
Gene X Environment Interactions
•SERT allele x maternal influence = aggressivity
(Soumi and colleagues, 2005).
•SERT allele x life stress = depression
(Caspi and Moffitt, 2002).
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.
Males
Females
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
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
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
ANTIPSYCHOTIC MEDICATIONS
(Pick your “poison”)
TRADE NAME
Abilify
Clozaril
Geodon
Haldol
Lidone
Loxitane
Mellaril
Moban
Navane
Orap (for Tourette's syndrome)
Permitil
Prolixin
Risperdal
Serentil
Seroquel
Stelazine
Taractan
Thorazine
Trilafon
Vesprin
Zyprexa
GENERIC NAME
aripiprazole
clozapine
ziprasidone
haloperidol
molindone
loxapine
thioridazine
molindone
thiothixene
pimozide
fluphenazine
fluphenazine
risperidone
mesoridazine
quetiapine
trifluoperazine
chlorprothixene
chlorpromazine
perphenazine
trifluopromazine
olanzapine
CLASSES OF ANTIPSYCHOTIC MEDICATIONS
1.
Phenothiazines- e.g., chlorpromazine (Thorazine)
2. Butryophenones- e.g., haloperidol (Haldol)
3. Thioxanthene derivatives- e.g., thiothixene (Navane)
4. Dibenzodiazepine derivatives- e.g., clozapine (Clozaril)
SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS
Antipsychotic medications generally have a high therapeutic
index, but common side effects include:
1. Anticholinergic effects- dry mouth, constipation.
2. Orthostatic hypotension- dizziness with movement
3. Sexual dysfunction- loss of libido, disrupted cyclicity in
females
4. Disrupted thermoregulation- hyperthermia
SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS (con’t)
5. Extrapyramidal motor effectsa. 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
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
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
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
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
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).
COMORBID DEPRESSION AND ANXIETY
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
TREATMENT OF DEPRESSION





Antidepressant medication
Electroconvulsive therapy
Sleep deprivation
Light therapy
Psychotherapy
Trade Name
Generic Name
Adapin
Anafranil
Asendin
Aventyl
Desyrel
Effexor
Elavil
Ludiomil
Luvox (SSRI)
Marplan (MAOI)
Nardil (MAOI)
Norpramin
Pamelor
Parnate (MAOI)
Paxil (SSRI)
Pertofrane
Prozac(SSRI)
Remeron
Serzone
Sinequan
Surmontin
Tofranil
Vivactil
Wellbutrin
Zoloft (SSRI)
doxepin
clomipramine
amoxapine
nortriptyline
trazodone
venlafaxine
amitriptyline
maprotiline
fluvoxamine
isocarboxazid
phenelzine
desipramine
nortriptyline
tranylcypromine
paroxetine
desipramine
fluoxetine
mirtazapine
nefazodone
doxepin
trimipramine
imipramine
protriptyline
bupropion
sertraline
CLASSES OF ANTIDEPRESSANT MEDICATIONS
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.
2.
3.
4.
5.
6.
Sedation
Insomnia
Anticholinergic side effects
Hypotension
Agranulocytosis
“Cheese effect” with MAO inhibitors
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
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
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
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
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
ANXYOLITICS
HYPNOTICS
Alprazolam
Chlordiazepoxide
Buspirone
Diazepam
Lorazepam
Oxazepam
Triazolam
Phenobarbital
Halazepam
Prazepam
Chloral hydrate
Estazolam
Flurazepam
Pentobarbital
Lorazepam
Quazepam
Triazolam
Secobarbital
Temazepam
Zolpidem