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Neurobiology of Schizophrenia, Mood Disorders, and Anxiety Disorders Chapter 18 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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2 Schizophrenia Schizophrenia is a term coined by Eugene Bleuler in 1911 to describe a collection of illnesses characterized by thought disorders
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Schizophrenia 1% of population (higher in twins, siblings) Emerges in young adults Slightly earlier onset in males than females Psychotic episode Genetic predisposition Monozygotic twins concordance rate 30% to 50% Dizygotic twins/siblings concordance rate 15%
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Schizophrenia Neuroanatomic alterations Enlargement of lateral and third ventricles; widening of frontal cortical fissures and sulci Neurotransmitter alterations Brain dopamine pathways altered Glutamate (acts on the N-methyl- D -aspartate [NMDA] receptor subtype) Implicated in learning and memory Implicated in learning and memory
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Schizophrenia
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6 Schizophrenia
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7 Schizophrenia Clinical manifestations Hallucinations Delusions Disorganized behavior Disorganized speech Disorganized speech Disorganized behavior Disorganized behavior Negative symptoms Affective flattening Affective flattening Anhedonia, alogia, and avolition Anhedonia, alogia, and avolition
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Mood Disorders Mood refers to a sustained emotional state Affective states are brief emotional feelings Euphoria, joy, surprise, fear, sadness, etc. Depression States such as sadness become prominent
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Mood Disorders Categories of mood disorder Unipolar Also called major depression, clinical depression Also called major depression, clinical depression Bipolar disorder Genetic predisposition Twin studies: concordance rates 40% monozygotic; dizygotic 11% 40% monozygotic; dizygotic 11% Environmental influences
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Mood Disorders Neurochemical dysregulation Neuroendocrine dysregulation Hypothalamic-pituitary-adrenal system dysregulation Hypothalamic-pituitary-thyroid (HPT) system dysregulation Neuroanatomic and functional abnormalities
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 11 HPT System Dysregulation and Mood 20% to 30% of persons with unipolar depression have an altered HPT system Increased CSF levels of thyrotropin-releasing hormone (TRH) Blunted thyrotropin-stimulating hormone (TSH) response to TRH challenge Decreased nocturnal rise in TSH
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Mood Disorders Clinical manifestations Depression Mania Treatment Antidepressants Psychotherapy Combination of both
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Mood Disorders
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Antidepressant Treatment Three major classes of antidepressant medications Monoamine oxidase inhibitors (MAOIs) Tricyclic antidepressants (TCAs) Selective serotonin reuptake inhibitors (SSRIs) All increase monoamine neurotransmitter levels within the synapse
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Mood Disorders
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Anxiety Disorders Panic disorder 80% respond to cognitive behavioral therapy (CBT) and/or antidepressant medication Generalized anxiety disorder Excessive and persistent worries Norepinephrine and serotonin abnormalities GABA-BZ receptor alterations
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Anxiety Disorders Posttraumatic stress disorder (PTSD) Exposure to terrifying, life-threatening trauma Lifetime prevalence rate 7% to 8% Adults: smaller hippocampus, brain structure susceptible to damaging effects of the stress hormone cortisol and excitatory amino acids Pediatric: studies reveal generalized effect of trauma on reducing total brain volume
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Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Anxiety Disorders Obsessive-compulsive disorder Repetitive, intrusive thoughts and/or compulsions Obsessions: involve a preoccupation with contamination, doubting, religious or sexual themes, or the belief that a negative outcome will occur if a specific act is not performed Compulsions: physical and mental ritualized acts
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