Thought, Mood and Anxiety Disorders

1
Thought, Mood and Anxiety Disorders
2
Psychiatric Disorders

• Characterized by changes in a persons thoughts,
  mood, or behaviors that interfere with ordinary
  functioning in one or more spheres of life

3
Causes

• Thought to have a biological basis in that many
  disorders appear due to abnormalities in brain
  structure and function
• Many conditions also have been shown through
  studies of monozygotic twins to have a genetic
  component
• Schizophrenia
• 45 concordance for twins, 15 for siblings
• Bipolar depression
• 80 concordance for twins, 10 for siblings

4
Causes continued

• Environmental factors are also important
• Fact that concordance is not 100 in twins
  suggests that environment plays a role in
  development of mental illness
• Overwhelming conclusion of research studies is
  that both genetic and environmental influences
  play a significant role
• Person with genetic vulnerability encounters
  specific environmental triggers

5
Anatomic Basis of BehaviorCerebral Cortex

• Frontal lobe
• JEM2
• Highly involved in memory and central to our
  sense of being a distinct self with a unique
  history
• Association Cortex in the frontal lobe
• Responsible for expression of personality
• Ability to complete abstract thinking
• Motivation and volition
• Making meaning of language
• Concentration

6
Temporal Lobe

• Integrates and interprets auditory and spatial
  information
• Accurate interpretation of emotions and ability
  to respond with a level of emotionality that is
  deemed socially congruent
• Impulse control, management of aggression and
  sexual expression
• Including expression of maleness and
  femininity
• Basic emotions originate in amygdala but are
  fine tuned by temporal lobe to an appropriate
  level
• Left temporal lobe in males
• Both lobes in females

7
Parietal Lobe

• Essential in integration and processing of
  sensory input
• Coordination of spatial awareness
• Ability to experience, claim and care for ones
  body
• Symptom denial
• Ability to associate with surrounding space
• Ability to filter out extraneous input

8
Limbic System

• Hippocampus, parahippocampal gyrus, cingulate
  gyrus, amygdala and the fornix (connects hippo
  with hypothalamus)
• Hypothalamus, although not a part of the limbic
  system, has extensive connections with limbic
  system and controls basic autonomic functions
• amgydala
• FARV
• Also sexual arousal

9
Integration of Thought, Mood, Learning and
Cognition

• Behavior is molded through learning and memory
• Experience a behavior and the result, remember
  the experience and gradually learn to modulate
  the behavior
• Psychiatric patients may experience impairment in
  pathways used for learning and memory

10
Information Processing

• First step in processing of behavior is the
  thalamus
• Thalamus determines whether sensory input is
  familiar or unfamiliar, safe or unsafe
• If safe, input is forwarded through the
  information processing pathways
• If unsafe, a sympathetic cascade is stimulated
  through the hypothalamic-pituitary-adrenal axis
  (HPA)
• Amygdala receives the input and generates a
  primitive response

11
Information Processing cont..

• Amygdala forwards input to the hippocampus
• Hippocampus prepares to encode it for memory
  storage
• Must separate out components
• If reading a book while listening to music, must
  separate words from the music and from the shirt
  youre wearing etc-otherwise memory would be a
  jumble of unrelated images
• Prefrontal associative cortex acts next
• Keeps tract of where information has been put in
  long term memory storage
• Integrates memories with sensory input

12
Information Processing cont

• Example of prefrontal association cortex
• Think about an apple
• Shape, color, texture, taste, smell, location
• Each sensory attribute is stored in a different
  location in memory
• Prefrontal assoc cortex retrieves those various
  attributes and brings them together so your apple
  is crunchy, juicy, delicious not gray, square and
  bitter

13
Information Processing

• Next stop is parietal lobe
• Filters out extraneous information
• Then forwards input onto frontal lobe
• Frontal lobe
• First become aware of thinking about the sensory
  input and formulating a cognitive behavioral
  response to it

14
Neuromediators

• Aka neurotransmitters
• Ensure that all of these areas of the brain
  communicate with each other
• Through synaptic transmission
• Have to be of the right type and amount and in
  the right location for normal processing to occur

15
Neuromediators Implicated in Mental Illness

• Acetylcholine
• Excitatory or inhibitory depending on area of
  brain
• Underactivity implicated in Alzheimers
• Dopamine
• Usually excitatory, involved in motivation,
  thought, and emotional regulation
• Overactivity implicated in schizophrenia

16

• Norepinephrine and epinephrine
• Excitatory or inhibitory depending on area of
  brain
• Underactivity implicated in some depressions
• Serotonin
• Regulation of attention and complex cognitive
  functions
• Underactivity implicated in some depressions and
  obsessive, compulsive disorder
• GABA, glutamate, aspartate, glycine
• GABA and glycine are inhibitory, glutamate is
  excitatory
• Implicated in anxiety disorders

17
Disorders of Thought and VolitionSchizophrenia

• Fairly common-about 1 of population
• Onset typically between 20-35
• Late onset between 66-77 is not uncommon
• Men and women affected equally
• Risk factors
• Having a close relative with the disease
• Winter/spring birth date
• Second trimester prenatal influenza infection
• Early history of attentional deficit

18
Schizophrenia cont

• Causes a disconnection between thought and
  language
• Disorganized speech
• Invented words
• Derailment (cant stay on subject)
• Incoherence
• Delusions
• Being controlled by an outside force
• Visual and auditory hallucinations
• Voices
• Unable to blunt sensory input leading to sensory
  overload
• Sounds are louder, colors brighter

19
Schizophrenia

• Absence of normal social and interpersonal
  behaviors
• Alogia-tendency to speak very little
• Avolition-lack of initiation
• Apathy
• Affective flattening (emotional blunting)
• Adhedonia-inability to experience pleasure

20
Schizophrenia

• Pathogenesis is unknown
• Abnormalities in brain structures are present
  suggesting prenatal involvement
• Enlarged ventricles
• Reduced thalamic and hippocampal size
• Smoother and smaller left hemisphere
• Reduced metabolic activity in frontal lobe
• Alterations in dopamine, serotonin, glutamate

21
Schizophrenia

• Treatment Goal
• Induce remission
• Prevent recurrence
• Restore behavioral, cognitive and psychosocial
  function
• Pharmacotherapy and psychotherapy both used
• Anti-psychotic drugs
• Individual and group therapy

22
Disorders of MoodDepression

• Common and highly under diagnosed
• Major depression affects approximately 20 of
  population
• Two types
• Unipolar
• Persistent unpleasant mood
• Bipolar
• Alternating periods of depression and mania

23
Depression

• Unipolar
• Affects approximately 5 of worlds pop
• Women double the rate of men
• Average onset mid 30s
• Bipolar
• Approximately 1.5 of world population
• Evenly distributed between sexes
• Average onset mid 20s
• Prevalence of both is higher in families with
  history of mood disorders

24
Depression cont.

• Classified as mood disorder characterized by
• Depressed mood
• Anhedonia
• Feelings of worthlessness or excessive guilt
• Decreased concentration
• Psychomotor agitation or retardation
• Insomnia or hyper-somnia
• Decreased libido
• Changes in weight or appetite
• Thoughts of death or suicidal ideation

25
Depression cont

• Can vary in intensity
• Often is recurrent
• First episode after 65 can be precursor to
  dementia
• Confusion is primary symptom

26
Uni-polar

• Three subtypes
• Melancholic
• Worse in the morning, insomnia, anorexia,
  agitation, mental pain, loss of interest in
  activity
• Atypical
• Worse as day progresses, hypersomnia, overeating
• Dysthymia
• Persistent but mild depression lasting more than
  2 years

27
Bi-polar

• Manic depressive disease
• Multiple subtypes
• Characterized by alternating episodes of elation
  and depression
• Mood change may begin abruptly or develop over a
  few weeks

28
Brain Changes in Depression

• Reduction in activity in frontal and temporal
  lobes
• Increased blood flow to amygdala
• Alterations in serotonin, norepinephrine
• Disturbances in regulation of cortisol through
  HPA axis

29
Depression cont

• Treatment
• Psychotherapy
• Anitdepressnat drugs
• Lithium
• Anticonvulsants
• Electroconvulsive therapy
• 70-90 show improvement

30
Anxiety Disorders

• Extremely common
• 15 of population
• Women more than men
• Characterized by increased fearfulness
• resulting from cascade effect through the HPA
  axis
• Symptoms occur without a precipitating threat

31
Anxiety Disorders

• Five types
• Panic disorder
• Post-traumatic stress disorder
• Generalized anxiety disorder
• Social phobia
• Obsessive complusive disorder (OCD)

32
Panic Disorder

• 1.5-3 prevalence
• Characterized by
• neurologic symptoms
• Dizziness, lightheadedness, paresthesias,
  fainting
• Cardiac symptoms
• Tachycardia, chest pain, palpitations
• Respiratory symptoms
• Shortness of breath, feelings of smothering,
  choking
• Psychological symptoms
• Feelings of impending doom, fear of dying, sense
  of unreality

33
Panic Disorder

• Attacks last 15-60 minutes
• 50 also experience depression
• Brain Changes
• Lower levels of serotonin
• Involvement of adrenergic system
• Disruption of GABA
• Substance abuse often accompanies disease
• Treatment
• Pharmocotherapy
• Cognitive behavioral therapy

34
Post Traumatic Stress Disorder (PTSD)

• Chronic activation of the stress response as
  result of experiencing a potentially life
  threatening event
• Approximately 3.6 of adult population in US
  affected at any one time
• Characterized by constellation of symptoms
  experienced as states of
• Intrusion
• Avoidance
• hyerarousal

35
PTSD

• Intrusion
• Flashbacks, nightmares
• Avoidance
• Emotional numbing
• Complicated by depression and survivor guilt
• Hyperarousal
• Increased irritability, exaggerated startle
  reflex
• Also see memory problems, sleep disturbance,
  anxiety, substance abuse, depression

36
PTSD

• Brain changes
• Increased sympathetic activity
• Decreased cortisol levels
• Decreased hippocampal volume
• Little is known about risk factors
• Less than half of people exposed to traumatic
  events develop PTSD
• Treatment
• Psychotherapy
• Pharmacotherapy
• Antidepressants, and antianxiety medications

37
Generalized Anxiety

• Recognized as separate disorder from panic attack
  in 1980s
• Characteristics
• Prolonged (6 mos) excessive worry that is not
  easily controlled by the person
• Muscle tension
• Autonomic hyperactivity
• vigilance and scanning
• Inability to concentrate
• Treated with drugs that affect GABA uptake

38
Obsessive Complusive Disorder

• Characterized by obsessions (repeated thoughts)
  and complusions (repeated acts) that are time
  consuming or distressing to the person
• Person usually knows rituals are unreasonable
• 2-3 of worlds population
• Equal frequency in men and women
• Average onset 20, although it may appear in
  children and confused with ADD

39
OCD continued

• No evidence of anatomical abnormality in the
  brain
• Increased activity in the anterior cingulate
• Increased activity in the thalamus
• Decreased serotonin activity
• Treatment
• Tricylic antidepressants
• Cognitive behavioral therapy

40
Social Anxiety Disorder

• Generalized or specific intense, irrational, and
  persistent fear of being scrutinized or
  negatively evaluated by others
• Anxiety when exposed to the feared social
  situation
• Recognition that the fear is irrational
• Avoidance of the situation
• Interference with persons normal routine
• Must be present at least 6 months

41
Social Anxiety Disorder

• Prevalence 3-13
• Women more often than men
• Onset 11-19 years of age
• Side effects loss of earning power,
  socioeconomic status and substance abuse
• Treatment
• Pharmocotherapy
• Cognitive behavioral therapy