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 tangentiality derailment neologisms clanging A.K.A. THOUGHT DISORDER

disorganization DISORGANIZED BEHAVIOR inappropriate affect bizarre behavior

negative symptoms alogia (few words) affective flattening avolition (lack of motivation) social withdrawal

age of onset stats 1% prevalence equal sex ratio course: better for women

medication ANTIPSYCHOTICS (A.K.A. neuroleptics) treats + symptoms side effect: tardive dyskinesia TYPICALATYPICAL treats + & - symptoms? less side effects? 10x price 74% noncompliance w/in 18 mo

major depressive episode 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) For 2 weeks, 5+:

manic episode 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 1 week of elevated, expansive, or irritable mood and 3+:

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

bipolar I disorder a manic episode bipolar II disorder hypomanic episode + major depressive episode the following are all chronic w/ poor prognosis

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 volts for half second produces seizure for 30 secs to few minutes. Applied 3x/week for 4 weeks.

generalized anxiety disorder 6 mo+ of uncontrollable worry to many issues 3+ of: restlessness, fatigue, poor concentration, irritable, muscle tension, sleep probs distress or impairment CRITERIA

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 obsessions repetitive, unwelcome thoughts compulsions repetitive, almost irresistible action germs something bad will happen symmetry religion #s 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