Transcript The Malfunctioning Mind

Mental Illness
Historical Views of Disorders
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Mental disorders have always been with us
but their treatment has varied:
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Hippocrates said mental illness arises in the
brain.
Arab physicians established humane asylums –
Moslems believed Allah speaks through the
mentally ill.
Middle ages -- demon possession requires
exorcism, madness was contagious.
Religious Views
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Medical diseases might affect the body but the
mind belongs to God.
Institutions for the mentally ill created.
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Imprisoned but not treated.
King George III motivated research to study
mental disorders.
Eventually asylums became more humane.
Modern Approaches
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After the 1850’s, neuroscientists studied
structural consequences of strokes, tumors
and brain trauma.
By the 1920’s-30’s, two diseases were
eliminated:
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Pellagra – niacin deficiency
General paresis (late stage syphillis)
Hope that more disorders would be organic
Disease vs Disorder
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Both are malfunctions.
Disease is a specific set of signs and
symptoms that are seen together frequently
enough to be diagnostic.
Disorder means something is wrong but there
is less consistency to its features.
Diseases are disorders but not all disorders are
diseases.
Research Approach
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Identify abnormalities of both biology and
behavior at stages in the progress of a
person’s illness.
See whether similar correlations exist in other
patients with the same symptoms.
Can people be categorized by their
symptoms?
Cellular Dysfunction
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Diseases of the brain arise from cellular
dysfunction.
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Pathology – study of such dysfunctions.
Organic problems: developmental
abnormality, inherited metabolic problems,
infection, allergy, tumor, inadequate blood
supply, injury, scars persisting after
recovery.
Functional Disorders
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No obvious organic pathology.
Symptoms may be non-physical:
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Changes in mood, thinking, social interaction.
Disruption of normal behavior.
Failure to find an organic cause does not
mean none exists.
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Tourette’s syndrome – once thought to be
psychological in origin, now organic.
Diagnostic Tests
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Verbal interview of patient or family.
Thorough physical exam testing sensory and
motor systems.
Additional tests depending upon the
findings of the physical exam.
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MRI, CAT, angiogram
Postmortem exam to confirm diagnosis.
Normal vs Abnormal
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Everyone experiences intrusions of strange
thoughts, peculiarities and eccentricities,
mood swings.
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These differ in quality and quantity from the
mentally ill.
Many patients are distressed by their own
behavior or thoughts and feelings.
Degenerative Diseases
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A disease in which the disease process is
progressive (becomes more severe).
Three of the most frequent and devastating
diseases:
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Parkinson’s
Huntington’s
Alzheimer’s
Functional Disorders
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Diagnostic and Statistical Manual, Fourth
Edition (DSM-IV).
Mental status exam – similar questions asked
of all patients.
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Results compared at different points in treatment.
Seven areas of functioning
Diagnostic batteries
Indicators of Abnormality
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Distress
Maladaptiveness – acts in ways that interfere with
accomplishing his or her own goals.
Irrationality – inability to communicate with others,
inappropriate affect.
Unpredictability – erratic behavior
Unconventionality – violations of social norms
Observer discomfort – threatening others
DSM-IV
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Diagnostic and Statistical Manual, Fourth
Edition (DSM-IV).
A standardized way to describe a person’s
problems:
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Research, statistical frequencies (epidemiology)
Insurance purposes
Communication with other professionals.
Depression Video
Mood Disorders (20% in Lifetime)
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Unipolar depression (5% in a year)
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“Common cold” of psychological problems.
Can be fatal if untreated, due to suicide – 30,000 deaths per
year.
Bipolar disorder (manic depression) (1-2%)
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Mania – excessive excitement and elation, gradiosity, flight
of ideas, distractability.
Hypomania – a milder form of mania that may be
associated with increased creativity and productivity.
Treatments of Mood Disorders
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ECT (electroconvulsive therapy) – current
passed between electrodes on the scalp
triggers seizure.
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Psychotherapy – talking treatments
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Highly effective, temporary memory disruption.
Highly effective, especially combined with drugs
Drug treatments – lithium, antidepressants
(tricyclics, SSRI’s, NE-selective reuptake
inhibitors, MAO inhibitors), CRH agonists
Anxiety Disorders (15%)
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Panic disorder – a feeling of panic that has no
connection with events (2% of population).
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Phobic disorders – irrational fear of a specific
object, activity or situation.
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Agoraphobia (5%)
Preparedness – easier to develop spider phobia
Obsessive-Compulsive Disorder (OCD) –
unwanted thoughts and behaviors or tics (2%).
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Compulsions – rituals that reduce anxiety.
Treatment of Anxiety Disorders
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Psychotherapy – addresses the learning
component.
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Success rates > 95%.
Anxiolytic medications:
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Benzodiazepine (e.g., valium) – increase GABA
effectiveness resulting in greater inhibition.
SSRI’s (prozac) – increase effectiveness of
serotonin.
Schizophrenia (1%)
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Personality disintegrates and perception is distorted,
affective symptoms.
Types:
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Catatonic – remain motionless and rigid, or becomes
agitated and hyperactive.
Paranoid – delusions and hallucinations.
Disorganized – incoherent speech, hallucinations, delusions,
bizarre behavior.
Undifferentiated – anything not classified above.
Schizophrenic Symptoms
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Positive symptoms:
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Negative symptoms:
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Delusions
Hallucinations
Bizarre behavior.
Social withdrawal
Impaired thought processes
Lack of affect or inappropriate affect
Positive symptoms controlled by drugs.
Treatment of Schizophrenia
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Neuroleptic drugs block dopamine receptors
and prevent positive symptoms.
Atypical neuroleptics – not clear how they
work – reduce negative symptoms.
PCP produces similar symptoms by reducing
NMDA receptors (inhibition), so dopamine is
not the whole story.
Psychosocial support important treatment.