Presentation is loading. Please wait.

Presentation is loading. Please wait.

Major Mental Illnesses

Similar presentations


Presentation on theme: "Major Mental Illnesses"— Presentation transcript:

1 Major Mental Illnesses
Thought Disorders Schizophrenia Mood Disorders Major Depressive Disorder Bipolar Disorder (Manic-depression) Focus today: disorders of thinking and mood Not to say that other mental illnesses are not important e.g. anxiety disorders (OCD, Panic D/O, PTSD); dementias (Alzheimer’s disease) Really two separate lectures CMH - severe and persistent mental illness Legal “Mental illness”: Substantial disorder of thought or mood that significantly impairs judgment, behavior, capacity to recognize reality, or ability to cope with the ordinary demands of life.

2 Characteristics of an Illness
Affect Individuals Across Populations Signs and Symptoms Course Heredity Diagnosis Causes Treatment When a mental health professional evaluates a patient, tries to formulate a diagnosis. Does this because helps to formulate a meaningful treatment plan. Diagnosis not just based on signs and sx. Sx - what person reports Signs - what observe Specific illnesses (DX) have different course, epi, FH, causes. Helps to gather hx about earlier life, the family to make dx. Also helps to think about frequency of illnesses in populations (Epi) Diagnoses can change over time as additional information is gathered. Not that Dr is confused, but as learn more about the hx, helps you refine the dx TODAY WILL COVER SIGNS/SX, DX, EPI, HEREDITY, CAUSES (NOT TREATMENT - NEXT WEEK)

3 Understanding Schizophrenia

4 Common Symptoms of Schizophrenia
Positive Symptoms Disturbances of thinking and perception Negative Symptoms Loss or decrease of normal functions Positive - symptoms that are there, that usually aren’t there Negative - lack of personality characteristics that are normally present.

5 Positive Symptoms of Schizophrenia
Disordered thinking Thoughts “jump” between completely unrelated topics or may be “blocked”. Delusions Fixed, false beliefs (not based in reality) Outside of cultural norms Hallucinations False perceptions Usually auditory Positive Disordered thinking - loosening of associations, blocking, overinclusiveness, inability to abstract Thought content - Delusions - beliefs outside of cultural experience. Hallucinations - false perceptions. Any sense (hearing, seeing, feeling, tasting, smelling). Actually do these things with our brain. Signals from sensory organs.

6 Delusions of Schizophrenia
Persecution Control Grandiose Reference Influence Religious Somatic Mind reading Thought broadcasting Thought insertion Thought withdrawal Guilt, sin

7 Hallucinations of Schizophrenia
Auditory % Voices commenting Voices conversing Voices commanding Visual % Somatic, tactile % Olfactory % Play tape of hallucinations.

8 Negative Symptoms of Schizophrenia
Affect blunted or flat Lacking emotional expression “Blank” face, little eye contact, few gestures Avolition Lacking energy, spontaneity, initiative Alogia Diminished amount of speech, or content Anhedonia Lack of interests, or lack of pleasure The new four “A’s” of schizophrenia.

9 Diagnosis: Schizophrenia
How is schizophrenia diagnosed? The diagnosis is made based on a thorough psychiatric interview of the person and family members. As yet, there are no medical tests for schizophrenia. Others diseases can cause psychosis as well rule out with tests. Diagnosis has changed over time. SEE NOTES FROM INTRO SLIDE

10 Schizophrenia: Diagnosis Across Time
Kraeplin - Dementia Praecox (1878) Simple Paranoid Hebephrenic Catatonic Bleuler - “Schizophrenia” (1911) Affect Associations Ambivalence Autism Schneider - First Rank Features (1959) Kraeplin Bleuler Schneider

11 Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)
Describes essential features of the syndrome Includes time course Must lead to impairment of functioning to be mental illness (relationships, work/school, self care) Must exclude other causes. Why is this manual important? Dx are VALIDATED by research (reproducible) Can COMMUNICATE with other clinicians and with families (otherwise one persons idea of schizophrenia may be different from another person’s idea) This is the way it used to be in psychiatry Led to problems Helps researchers to IDENTIFY CAUSES, FIND TREATMENTS (Need specifically defined population) Review history of DSM

12 DSM-IV Schizophrenia Characteristic symptoms for one month
Impairment in functioning Continuous signs for 6 months Not do to a “look-alike” mood disorder substance abuse general medical condition autism Characteristic symptoms Delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms (blunted or flat affect, poverty of speech or content, lack of motivation/apathy, diminished interests) Continuous signs includes prodrome and residual Behavior - poor self care (food, clothing, shelter), silliness,aggressiveness Look alikes - many includes seizure disorder, brain trauma, other neurologic conditions, infections, tumors, medications, cocaine/LSD/PCP.

13 Types of Schizophrenia
Paranoid type Preoccupation with delusions or frequent auditory hallucinations Disorganized type Disorganized speech, disorganized behavior, flat or inappropriate affect Catatonic type Immobility, peculiar movements, purposeless and excessive activity Undifferentiated type Residual type

14 Who Gets Schizophrenia?
One of every one hundred people 2.5 million people in the United States All ethnicities Societies throughout the world Equal among men and women More prevalent in poorer communities “Downward drift” Equal opportunity illness.

15 The Course of Schizophrenia
Most commonly begins between ages 15-25 Usually begins later in women One, or multiple episodes Full or partial recovery between episodes Positive symptoms lessen with age Negative symptoms increase with age Tends to stabilize later in course

16 What Causes Schizophrenia?
Unclear Likely a complex group of brain illnesses with multiple causes Heredity Biochemical theory Brain anatomy Brain development

17 Causes of Schizophrenia
Heredity Genetic component to schizophrenia (runs in families) Adoption studies Inherit a vulnerability to schizophrenia Adoption studies - 50% in identical twins if one adopted away/healthy adopting parents. 1% chance if healthy bio parents, and adopting parent has the illness. Predisposition - An individual is not born with the actual illness, but is born with a vulnerability to it. Statistics cannot be used to predict the course of individual lives. Review population data. The closer the genetic relationship, the higher the incidence of schizophrenia. Roughly 90% of persons diagnosed with schizophrenia do not have a parent with the illness. There are many more relatives of persons with schizophrenia who do not show signs of the illness than those who do.

18 Lifetime Risk of Developing Schizophrenia
General population % Child of one parent with schizophrenia % Child of two parents with schizophrenia % Sibling with schizophrenia % Fraternal twins % Identical twins % Is a heritable illness. Susceptibility is passed down from generation to generation. But,majority of people who are diagnosed, do not know of any biologic relatives who have the illness (70). Identical twins “only 50%”. If all biologic, would be 100%. Therefore environment involved as well.

19 “For every complex problem there is a solution that is neat, simple and wrong.”
H. L. Menken

20 “It is better to be wrong than vague, if one is wrong in an interesting way.”
Bernard Carroll

21 Stress-Diathesis Model of Schizophrenia
Genetic Vulnerability (diathesis) “Second hit” Perinatal - pregnancy or birth injury Viral / Seasonality Other stresses - puberty, social stresses Leads to changes in the brain What can affect fetal brain development? Nutritional deficiencies, infections, injuries, toxins, abnormal hormones,autoimmune (IL2) Prenatal influenza increase in 1957 flu epidemic (midgestation) Dutch winter hunger Also neural tube defects (folate deficiency) Associated with schizophrenia winter-spring season of birth, prenatal exposure to influenza, obstetric complications

22 Brain Differences in Schizophrenia
Chemical Dopamine Hypothesis Anatomy / Activity Many sites Developmental Cell migration

23 Dopamine Hypothesis of Schizophrenia
Describes what is wrong in the brain but not how it got that way Dopamine system is hyperactive Too much dopamine Problem with the dopamine receptors Clues - amphetamines, Cocaine, L-DOPA

24 Neuroanatomy of Schizophrenia
No single change is seen in all people with schizophrenia Enlarged ventricles Underactive frontal lobe planning, judgement, abstraction, expressing feelings Overactive temporal lobe preceptions and emotions No single change in all suggests perhaps multiple illnesses Ventricles - fluid filled spaces; suggests brain atrophy

25 Attention / Arousal Model of Schizophrenia
Stimulus flooding Lack of an effective filter Too much information from the environment Leads to withdrawal from social contact Stimulus overload Leads to frustration, poor concentration, nervousness PLAY TAPE OF AUDITORY HALLUCINATIONS

26 Examples of Stimulus Overload
“Everything seems to grip my attention although I am not particularly interested in anything. I am speaking to you just now, but I can hear noises going on next door and in the corridor. I find it difficult to shut these out, and it makes it more difficult for me to concentrate on what I am saying to you.” “My concentration is very poor. I jump from one thing to another. If I am talking to someone they only need to cross their legs or scratch their heads and I am distracted and forget what I was saying. I think I could concentrate better with my eyes shut.”

27 Schizophrenia IS IS NOT Biological disease of the brain
Disabling and emotionally devastating Relatively common Misunderstood and stigmatized Treatable IS NOT Caused by bad parenting A personal weakness Split personality We think of it as a disorder of thinking. But it is more than just that.

28 Understanding Mood Disorders
Major Depression Bipolar Disorder

29 Mood Disorders Signs and Symptoms Diagnosis The Biology Other Causes
The Course of Illness

30 Major Depression: Signs and Symptoms
Emotional Thought Somatic (body) Behavioral

31 Major Depression: Emotional Symptoms
Sad, irritable or empty mood Diurnal variation Diminished capacity for enjoyment Diminished interests

32 Major Depression: Thought (Cognitive) Symptoms
Difficulty concentrating Indecisiveness Memory problems Depressed content of thought Worthlessness Guilt Hopelessness Death and Suicide

33 Major Depression: Somatic Symptoms (Body Functions)
Sleep disturbances Appetite disturbances, weight changes Fatigue, low energy Upset stomach, constipation Physical pain

34 Major Depression: Behavioral Signs and Symptoms
Social withdrawal Increased dependency Poor frustration tolerance Suicide attempts Substance abuse Slow motion Slow speech Poor eye contact Tearfulness Agitation Poor self-care

35 Major Depression: Types of Episodes
Melancholia No pleasure or “reactivity” Weight loss Early morning awakening Worse in the morning Excessive Guilt Atypical Mood brightens to positive events Weight gain Over-sleeping Heavy feeling in arms and legs Interpersonal rejection sensitivity

36 “Masked Depression” May not complain of feeling depressed
Anxious, agitated Fatigue, insomnia Chronic pain, unrelieved by pain killers Confused, disoriented, poor memory Alcohol or drugs obscure symptoms

37 Major Depression: DSM-IV
Depressed mood, or loss of interest/ pleasure Other symptoms (total of 5) Increase or decrease in appetite/weight Insomnia or hypersomnia Agitation or slowing Fatigue or loss of energy Worthlessness or guilt Poor concentration or indecisiveness Recurrent thoughts of death or suicide

38 Major Depression: DSM-IV (continued)
Two week duration Impaired functioning in life roles Rule out “look alikes” Secondary depression

39 Secondary Depression Other treatable illnesses cause depression
Examples Endocrine problems (thyroid disease, diabetes) Infections (mononucleosis, influenza) Anemia Poor nutrition Neurologic illnesses (strokes, Parkinson’s disease, multiple sclerosis Tumors (lung, pancreas, brain)

40 Secondary Depression (continued)
Alcohol Drugs Medications Examples - steroids, high blood pressure medications, sleeping pills, oral contraceptives Toxins

41 Major Depression: The Causes
Limbic System Neurochemical Serotonin Norepinephrine Others Heredity Identical twins - 40% Environmental stresses

42 Major Depression: The Course
Can occur at any age Usual onset similar to schizophrenia, or later 10% have first episode after age 60 More common in women (2:1) Lifetime prevalence 17% Recurrent in 50-60% Later episodes: longer, deeper, more frequent, less of a trigger May be seasonal

43 Major Depression Severity
Mild to severe May include psychosis, poor self care, suicide Abraham Lincoln describing his own depression: “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever be better, I cannot tell. I awfully forebode I shall not. To remain as I am is impossible. I must die or be better, it appears to me.” Significant suicide risk. A biological illness No one’s fault Famous people with mental illnesses - Lincoln, Hemingway, Churchill, Tolstoy, many poets

44 Bipolar Disorder Signs and Symptoms of Mania Diagnosis Other Causes
The Biology The Course of Illness

45 Mania: Signs and Symptoms
Persistently elevated, expansive or irritable mood lasting at least one week Associated symptoms Inflated self -esteem or grandiosity Decreased need for sleep More talkative Racing thoughts or flight of ideas Distractibility Agitation or increase in activities Excessive involvement in pleasurable activities with a high risk for painful consequences Spending sprees, sexual indiscretions, foolish investments

46 Manic Episode: DSM-IV Elevated, expansive, or irritable mood for one week Three associated symptoms Significant impairment in life roles Not do to a “look-alike” Medical condition Medication Substance abuse Medical condition - hyperthyroidism, seizures, multiple sclerosis, infections, tumors Medications - steroids, l-dopa, thyroid meds drugs - cocaine, amphetamines (speed), LSD, PCP

47 Hypomania Episode similar to mania, but less severe
No impairment in functioning May actually be more productive, creative Bipolar II Disorder

48 Bipolar Disorder: The Course
1% of general population Equal in men and women Age of onset similar to schizophrenia Episodes can come on very fast (1-7 days) Later episodes longer, more severe, more frequent Substance abuse common Heredity plays a greater role than in depression Family members also at higher risk for major depression High suicide risk

49 Mood Disorders ARE ARE NOT Biological disease of the brain
Disabling and emotionally devastating for many Common Misunderstood and stigmatized Treatable ARE NOT The fault of the family A personal weakness We think of it as a disorder of thinking. But it is more than just that.

50 Characteristics of an Illness
Affect Individuals Across Populations Signs and Symptoms Course Heredity Diagnosis Causes Treatment When a mental health professional evaluates a patient, tries to formulate a diagnosis. Does this because helps to formulate a meaningful treatment plan. Diagnosis not just based on signs and sx. Sx - what person reports Signs - what observe Specific illnesses (DX) have different course, epi, FH, causes. Helps to gather hx about earlier life, the family to make dx. Also helps to think about frequency of illnesses in populations (Epi) Diagnoses can change over time as additional information is gathered. Not that Dr is confused, but as learn more about the hx, helps you refine the dx TODAY WILL COVER SIGNS/SX, DX, EPI, HEREDITY, CAUSES (NOT TREATMENT - NEXT WEEK)

51 Treatment of Schizophrenia and Other Psychotic Disorders

52 Long Acting Antipsychotics
Haldol Decanoate (Haloperidol) Prolixin Decanoate (Fluphenazine)

53 Clozapine Pros Gold standard for refractory schizophrenia
Effective for positive symptoms Does not produce EPS or TD May improve cognition Effective for mood symptoms

54 Clozapine Cons Agranulocytosis, blood draws, monitoring Seizure risk
Other side effects Titration Acquisition cost

55 Risperidone Pros Cons Effective for positive symptoms
Less EPS than with conventional agents May help cognitive and mood symptoms Cons Dose dependent EPS Dose dependent prolactin elevation

56 Olanzapine Pros Cons Effective for positive symptoms
Low EPS and TD liability FDA indication for mania May improve cognition Cons Weight gain Acquisition cost

57 Quetiapine Pros Cons Effective for positive symptoms
Very low EPS liability Limited data for mood symptoms, cognition Cons Titration, split dosing, sx break through Sedation, weight gain

58 Psychosocial Treatments
Patient and family psychoeducation Vocational training Social Skills training Clubhouse model Schizophrenics Anonymous

59 Update on the Pharmacologic Treatment of Psychosis
Timothy Florence, MD Clinical Instructor University of Michigan Department of Psychiatry Making a diagnosis is a PROCESS - (review process today) 1. Can be FRUSTRATING for consumer and family 2. Can CHANGE over time 3. Based on interview and additional history from family. No test to do that will tell you for sure. 4. Get to see a SNAPSHOT of a person - but different illnesses can, at times, look exactly the same 5. Much SYMPTOM OVERLAP Today review the CLASSIC SYMPTOMS of two categories of illness, thought disorders and mood disorders. OTHER THINGS come into play when making a diagnosis as well - will talk about these also COURSE of illness (relapsing/remitting, continuous, prodrome) FAMILY HISTORY/ heredity Rule out LOOK ALIKES As gather more information, provisional diagnosis may change Also, need UNIVERSAL CRITERIA for diagosis; helps to make them valid, helps clinicians to communicate effectively with each other (DSM-IV) PLEASE ASK QUESTIONS/DIALOGUE

60 Psychosis Defined by impaired reality testing Characterized by:
thought content: delusions perception: hallucinations thought stream: grossly disorganized behavior: grossly disorganized Focus today: disorders of thinking and mood Not to say that other mental illnesses are not important e.g. anxiety disorders (OCD, Panic D/O, PTSD); dementias (Alzheimer’s disease) Really two separate lectures CMH - severe and persistent mental illness Legal “Mental illness”: Substantial disorder of thought or mood that significantly impairs judgment, behavior, capacity to recognize reality, or ability to cope with the ordinary demands of life.

61 Typical Psychoses Schizophrenia Psychotic mood disorders
Bipolar disorder Major depressive disorder with psychotic features Substance-induced psychotic disorder Psychotic disorder due to medical conditions

62 Mental Health: A Report of the Surgeon General
David Satcher, MD, PhD

63 Surgeon General’s Report: Key Messages
Mental illnesses are real illnesses and are biologically based Effective treatments are available

64 Surgeon General’s Report: Action Steps
Overcome STIGMA by disseminating accurate information Improve PUBLIC AWARENESS of effective treatments Improve access to treatment Individualize treatment Ensure delivery of state-of-the-art treatments Reduce financial barriers Continue to build the science base Ensure adequate supply of service providers

65 Characteristics of an Illness
Affect Individuals Across Populations Signs and Symptoms Course When a mental health professional evaluates a patient, tries to formulate a diagnosis. Does this because helps to formulate a meaningful treatment plan. Diagnosis not just based on signs and sx. Sx - what person reports Signs - what observe Specific illnesses (DX) have different course, epi, FH, causes. Helps to gather hx about earlier life, the family to make dx. Also helps to think about frequency of illnesses in populations (Epi) Diagnoses can change over time as additional information is gathered. Not that Dr is confused, but as learn more about the hx, helps you refine the dx TODAY WILL COVER SIGNS/SX, DX, EPI, HEREDITY, CAUSES (NOT TREATMENT - NEXT WEEK)

66 Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)
Describes essential features of the syndrome Includes time course Must lead to impairment of functioning to be mental illness (relationships, work/school, self care) Must exclude other causes. Why is this manual important? Dx are VALIDATED by research (reproducible) Can COMMUNICATE with other clinicians and with families (otherwise one persons idea of schizophrenia may be different from another person’s idea) This is the way it used to be in psychiatry Led to problems Helps researchers to IDENTIFY CAUSES, FIND TREATMENTS (Need specifically defined population) Review history of DSM

67 DSM-IV Schizophrenia Characteristic symptoms Delusions Hallucinations
Disorganized speech Disorganzied or catatonic behavior Negative symptoms

68 Negative Symptoms of Schizophrenia
Affect blunted or flat Lacking emotional expression “Blank” face, little eye contact, few gestures Avolition Lacking energy, spontaneity, initiative Alogia Diminished amount of speech, or content Anhedonia Lack of interests, or lack of pleasure The new four “A’s” of schizophrenia.

69 Negative Symptoms Caused by: Inherent deficit (deficit syndrome)
Positive symptoms Depression Medications Environmental deprivation

70 DSM-IV Schizophrenia Characteristic symptoms for one month
Impairment in functioning Continuous signs for 6 months Not do to a “look-alike” mood disorder substance abuse general medical condition autism Characteristic symptoms Delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms (blunted or flat affect, poverty of speech or content, lack of motivation/apathy, diminished interests) Continuous signs includes prodrome and residual Behavior - poor self care (food, clothing, shelter), silliness,aggressiveness Look alikes - many includes seizure disorder, brain trauma, other neurologic conditions, infections, tumors, medications, cocaine/LSD/PCP.

71 Positive Symptoms of Schizophrenia
Disordered thinking Thoughts “jump” between completely unrelated topics or may be “blocked”. Delusions Fixed, false beliefs (not based in reality) Outside of cultural norms Hallucinations False perceptions Usually auditory Positive Disordered thinking - loosening of associations, blocking, overinclusiveness, inability to abstract Thought content - Delusions - beliefs outside of cultural experience. Hallucinations - false perceptions. Any sense (hearing, seeing, feeling, tasting, smelling). Actually do these things with our brain. Signals from sensory organs.

72 Who Is At Risk For Schizophrenia?
Prevalence - 1% All ethnicities Societies throughout the world Equal among men and women More prevalent in poorer communities “Social drift” Equal opportunity illness.

73 Who Is At Risk? Predisposing factors: Season Perinatal Nutrition
pregnancy birth injury Nutrition Heredity Precipitating factors: Environment Stress Substance Abuse

74 The Course of Schizophrenia
Extremely variable Often chronic Onset Males: 15-25 Females: 25-35 Functional decline early Differential diagnosis of first episode challenging Recurrent episodes More difficult to treat Longer to remission

75 Dimensions of Functional Impairment
Occupational Social Instrumental Self-care Independent living

76 Predictors of Functional Status
Premorbid functioning Cognitive symptoms Negative symptoms

77 Severity of Functional Deficits in Schizophrenia
10% will work full-time 33% will work part-time Less than 10% of males will have a child Self-care deficits are reflected in high rates of medical comorbidity

78 Cognition and Outcome: Reasons for the Correlation
Cognitive deficits often make learning new skills difficult Job success requires the ability to learn and remember the demands of the position Deficits in organization make persons unable to perform the job responsibilities Deficits in concentration make performance unreliable

79 Schizophrenia PORT Treatment Recommendations
Choice of antipsychotic medication should be made based on: Patient acceptability Prior individual drug response Individual side effect profile Long-term treatment planning

80 What Is Schizophrenia? Heterogeneous
Likely a complex group of brain illnesses with multiple causes Genetic predisposition or vulnerability threshold Series of consequences resulting from brain dysfunction Requires a second “hit”

81 Lifetime Risk of Developing Schizophrenia
General population % Child of one parent with schizophrenia % Child of two parents with schizophrenia % Sibling with schizophrenia % Fraternal twins % Identical twins (adoption studies) % Is a heritable illness. Susceptibility is passed down from generation to generation. But,majority of people who are diagnosed, do not know of any biologic relatives who have the illness (70). Identical twins “only 50%”. If all biologic, would be 100%. Therefore environment involved as well.

82 Neuroanatomy of Schizophrenia
No single change is seen in all people with schizophrenia Enlarged ventricles Underactive frontal lobe planning, judgement, abstraction, expressing feelings Overactive temporal lobe preceptions and emotions No single change in all suggests perhaps multiple illnesses Ventricles - fluid filled spaces; suggests brain atrophy

83 Schizophrenia IS IS NOT Biological disease of the brain
Disabling and emotionally devastating Relatively common Misunderstood and stigmatized Treatable IS NOT Caused by bad parenting A personal weakness Split personality We think of it as a disorder of thinking. But it is more than just that.

84 Mania: Signs and Symptoms
Persistently elevated, expansive or irritable mood lasting at least one week Associated symptoms Inflated self -esteem or grandiosity Decreased need for sleep More talkative Racing thoughts or flight of ideas Distractibility Agitation or increase in activities Excessive involvement in pleasurable activities with a high risk for painful consequences Spending sprees, sexual indiscretions, foolish investments

85 Manic Episode: DSM-IV Elevated, expansive, or irritable mood for one week Three associated symptoms Significant impairment in life roles Not do to a “look-alike” Medical condition Medication Substance abuse Medical condition - hyperthyroidism, seizures, multiple sclerosis, infections, tumors Medications - steroids, l-dopa, thyroid meds drugs - cocaine, amphetamines (speed), LSD, PCP

86 Bipolar Disorder: The Course
1% of general population Equal in men and women Age of onset similar to schizophrenia Episodes can come on very fast (1-7 days) Later episodes longer, more severe, more frequent Substance abuse common Heredity plays a greater role than in depression Family members also at higher risk for major depression High suicide risk

87 The Use of Atypical Antipsychotics for Psychosis and Mood Stabilization
Timothy Florence, M.D. Clinical Instructor Department of Psychiatry University of Michigan

88 Theoretical Mood Stabilizing Mechanisms
Dopamine-Serotonin Interaction 5-HT inhibits DA release 5-HT antagonism enhances DA release GABA Hypothesis Inhibitory neurotransmitter system May mediate Valproate and Carbamazepine effects

89 Dopamine-Serotonin Hypothesis
DA Antagonism Mesolimbic Improves mania Mesocortical Worsens depression Nigrostriatal 5-HT Antagonism Mesolimbic Worsens mania Mesocortical Improves depression Nigrostriatal

90 GABA Hypothesis No change in GABA receptors with conventional neuroleptics GABA receptor down-regulation with chronic Clozapine and Olanzapine treatment Mood stabilizing effects may be related to effects on GABA neuro-transmission

91 Bipolar Disorder Mortality
At least 25% attempt suicide Suicide rate: 11-19% Suicidal ideation in mixed mania: 50%

92 Bipolar Disorder Morbidity
Recurrent illness for 90% of patients Fuctional recovery often lags behind symptomatic recovery Recurrent episodes may lead to progressive deterioration Number of episodes may affect subsequent treatment response and prognosis 6th leading cause of disability worldwide

93 Mood Stabilizing Agents
FDA Approved Lithium Valproate Other Anticonvulsants Carbamazepine Lamotrigine Gabapentin Topiramate Benzodiazepines Conventional Neuroleptics Atypical Antipsychotics Clozapine Risperidone Olanzapine

94 Novel Antipsychotic Agents
Clozapine Open - label studies Risperidone One study compared to Haloperidol and Lithium Olanzapine Two double-blind placebo controlled studies

95 Clozapine for Bipolar Disorder
Fifteen open trials in treatment-refractory illness suggest antipsychotic and mood stabilizing properties Pooled response rate = 70% May be used in conjunction with other mood stabilizers Exception - Carbamazepine

96 Risperidone in Acute Mania
Four week, double-blind, randomized study No placebo control Comparable and significant reductions in manic symptoms with Risperidone, Haloperidol, Lithium

97 Dopamine Rebound Syndrome
Euphoria / Dysphoria Hypomania / Mania Decrease in negative symptoms Agitation Psychosis Dyskinesias Withdrawal tardive dyskinesia

98 Cholinergic Rebound Syndrome
Insomnia Jitteriness Restlessness / Anxiety Somatic distress Gastrointestinal symptoms Sweating Drooling Increased urination Movement disorders Hypomania / Mania Delirium


Download ppt "Major Mental Illnesses"

Similar presentations


Ads by Google