Mental Illness

Historical Views of Disorders  Mental disorders have always been with us but their treatment has varied: 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  Medical diseases might affect the body but the mind belongs to God.  Institutions for the mentally ill created. Imprisoned but not treated.  King George III motivated research to study mental disorders.  Eventually asylums became more humane.

Modern Approaches  After the 1850’s, neuroscientists studied structural consequences of strokes, tumors and brain trauma.  By the 1920’s-30’s, two diseases were eliminated: Pellagra – niacin deficiency General paresis (late stage syphillis) Hope that more disorders would be organic

Disease vs Disorder  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  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  Diseases of the brain arise from cellular dysfunction. 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  No obvious organic pathology.  Symptoms may be non-physical: Changes in mood, thinking, social interaction. Disruption of normal behavior.  Failure to find an organic cause does not mean none exists. Tourette’s syndrome – once thought to be psychological in origin, now organic.

Diagnostic Tests  Verbal interview of patient or family.  Thorough physical exam testing sensory and motor systems.  Additional tests depending upon the findings of the physical exam. MRI, CAT, angiogram  Postmortem exam to confirm diagnosis.

Normal vs Abnormal  Everyone experiences intrusions of strange thoughts, peculiarities and eccentricities, mood swings. These differ in quality and quantity from the mentally ill.  Many patients are distressed by their own behavior or thoughts and feelings.

Degenerative Diseases  A disease in which the disease process is progressive (becomes more severe).  Three of the most frequent and devastating diseases: Parkinson’s Huntington’s Alzheimer’s

Functional Disorders  Diagnostic and Statistical Manual, Fourth Edition (DSM-IV).  Mental status exam – similar questions asked of all patients. Results compared at different points in treatment. Seven areas of functioning  Diagnostic batteries

Indicators of Abnormality  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  Diagnostic and Statistical Manual, Fourth Edition (DSM-IV).  A standardized way to describe a person’s problems: Research, statistical frequencies (epidemiology) Insurance purposes Communication with other professionals.

Depression Video

Mood Disorders (20% in Lifetime)  Unipolar depression (5% in a year) “Common cold” of psychological problems. Can be fatal if untreated, due to suicide – 30,000 deaths per year.  Bipolar disorder (manic depression) (1-2%) 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  ECT (electroconvulsive therapy) – current passed between electrodes on the scalp triggers seizure. Highly effective, temporary memory disruption.  Psychotherapy – talking treatments Highly effective, especially combined with drugs  Drug treatments – lithium, antidepressants (tricyclics, SSRI’s, NE-selective reuptake inhibitors, MAO inhibitors), CRH agonists

Anxiety Disorders (15%)  Panic disorder – a feeling of panic that has no connection with events (2% of population). Agoraphobia (5%)  Phobic disorders – irrational fear of a specific object, activity or situation. Preparedness – easier to develop spider phobia  Obsessive-Compulsive Disorder (OCD) – unwanted thoughts and behaviors or tics (2%). Compulsions – rituals that reduce anxiety.

Treatment of Anxiety Disorders  Psychotherapy – addresses the learning component. Success rates > 95%.  Anxiolytic medications: Benzodiazepine (e.g., valium) – increase GABA effectiveness resulting in greater inhibition. SSRI’s (prozac) – increase effectiveness of serotonin.

Schizophrenia (1%)  Personality disintegrates and perception is distorted, affective symptoms.  Types: 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  Positive symptoms: Delusions Hallucinations Bizarre behavior.  Negative symptoms: Social withdrawal Impaired thought processes Lack of affect or inappropriate affect  Positive symptoms controlled by drugs.

Treatment of Schizophrenia  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.