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schizophrenia
1 month of at least two of the following:
• delusions
• hallucinations
• disorganized speech
• disorganized behavior
• negative symptoms
positive/psychosis
disorganized
negative
delusions
What types of schizophrenic delusions have
you heard of?
persecution
grandeur
control
reference
hallucinations
What kinds of schizophrenic hallucinations
have you heard of?
disorganized speech
A.K.A. THOUGHT DISORDER
• tangentiality
• derailment
• neologisms
• clanging
disorganization
DISORGANIZED BEHAVIOR
inappropriate affect
bizarre behavior
negative symptoms
alogia (few words)
affective flattening
avolition (lack of motivation)
social withdrawal
stats
• 1% prevalence
• equal sex ratio
• course: better for women
age of onset
medication
ANTIPSYCHOTICS (A.K.A. neuroleptics)
TYPICAL
ATYPICAL
treats + symptoms
treats + & - symptoms?
side effect:
tardive dyskinesia
less side effects?
10x price
• 74% noncompliance w/in 18 mo
major depressive episode
For 2 weeks, 5+:
• depressed mood or loss of interest/pleasure
• appetite or body weight change (5%+)
• sleep problems
• psychomotor agitation or retardation
• fatigue
• feelings of worthlessness or guilt
• poor concentration
• thoughts of death or suicide
(distress or impairment)
manic episode
1 week of elevated, expansive, or irritable mood and 3+:
• inflated self-esteem/grandiosity
• less need for sleep
• excessively talkative
• racing thoughts
• too easily distracted
• increased goal-directed activity/
psychomotor agitation
• excessive pleasurable but risky activities
mixed manic episode
Meets criteria for both major depressive episode &
manic episode.
hypomanic episode
Less severe than mania & does not cause impairment
(at least 4 days)
unipolar mood disorder
Major Depressive Disorder, single episode (rare!)
Major Depressive Disorder, recurrent
the following are all chronic w/ poor prognosis
bipolar I disorder
a manic episode
bipolar II disorder
hypomanic episode + major depressive episode
antidepressant meds
TRICYCLICS – monoamine reuptake inhibitor
MAO-Is – inhibits the enzyme that breaks down
monoamines (tyramine & the cheese effect)
SSRIs – selective serotonin reuptake inhibitor
mood stabilizers
LITHIUM (therapeutic vs. lethal dosage window)
-kidney dysfunction & seizures
ANTICONVULSANTS (valproate, carbamazepine)
- Less effective than lithium for suicide
ECT
65-140 volts for half second produces seizure for 30
secs to few minutes. Applied 3x/week for 4 weeks.
generalized anxiety disorder
CRITERIA
• 6 mo+ of uncontrollable worry to many issues
• 3+ of:
restlessness, fatigue, poor concentration,
irritable, muscle tension, sleep probs
• distress or impairment
benzodiazepines
Valium
Librium
Xanax
Also used for
sleeping pills &
anti-seizure meds
panic attack
inappropriate fear response
CRITERIA
4+ of:
heart palpitations, sweating, shaking, short
of breath, choking, chest pain, nausea,
dizzy, derealization/depersonalizaiton, fear
of losing control, fear of dying, chills/heat,
numbness/tingling
panic attack
cued – conditioned to external cues
uncued – conditioned to interoceptive cues
situationally predisposed
panic disorder
CRITERIA
• recurrent panic attacks
• 1+ for 1 mo+:
- concern about future attacks or
consequences
- sig behavioral change (avoidance of
external or internal cues)
panic disorder
• prevalence 3%
• 2:1 sex ratio
• onset teens-40 yrs
• rels 8x more likely concordant
TREATMENT
• medications
• cued: systematic desensitization
• uncued: induce interoceptive sensations +
cognitive restructuring of perceived control
agoraphobia
CRITERIA
anxiety about situations where:
- hard to access help
- escape difficult/embarrassing
specific phobia
CRITERIA
• 6+ mo persistent, excessive, irrational
fear of an object of situation
• anxiety/fear on exposure
• avoided or endured w/ intense anxiety
• insight that phobia is irrational
specific phobia
• 9% prevalence
• 4:1 sex ratio
• prognosis: chronic
CAUSE
direct or vicarious trauma exp or conditioning
from panic attack, information transmission
TREATMENT
systematic desensitization
social phobia
CRITERIA
• fear of social/performance situations
• anxiety/fear upon exposure
• insight that fear is irrational
• avoidance behavior impairs functioning
social phobia
• 7% prevalence
• 1: 1 sex ratio
• onset: adolescence
CAUSE
prepared learning of social disapproval or,
neuroticism/inhibition, conditioned direct exp
TREATMENT
MAO-Is, systematic desensitization, cognitive
therapy
OCD
CRITERIA
• recurrent & persistent thoughts/images
• associated behaviors compelled to perform
• insight to irrational “
• distress, consumes 1+ hr/day, or impairs functioning
ocd
• germs
obsessions
repetitive, unwelcome thoughts
• something bad will happen
• symmetry
• religion
• #s
compulsions
repetitive, almost irresistible action
• washing
• counting
• checking
• touching
• rituals
OCD
• 1% prevalence
• sex ratio?
• onset: childhood-30’s (earlier in males)
• prognosis: chronic
• thought-action fusion (belief that thought is
equivalent of the behavior)
TREATMENTS
• SSRIs, exposure & response prevention