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?

persecutiongrandeurcontrol

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

medicationANTIPSYCHOTICS (A.K.A. neuroleptics)

treats + symptoms

side effect:tardive dyskinesia

TYPICAL ATYPICAL

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 episodeLess 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 disordera manic episode

bipolar II disorderhypomanic 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

ECT65-140 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

ValiumLibriumXanax

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

obsessionsrepetitive, unwelcome thoughts

compulsionsrepetitive, 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