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.