HD 3700 1st Edition Lecture 15 Outline of Last Lecture I Intro to mood disorders II The players arrive III Stimulating the depressed brain IV Approaching suicide V Mania hypomania and bipolar variants VI Treating and living with bi polarity Outline of Current Lecture I Bipolar Disorders II Hamlet associates to the players III Diagnostic criteria for Schizophrenia IV The Schizophrenic Spectrum V Case Study Jim Current Lecture I Bipolar Disorders Here is an example of a smart successful person in a hypomanic phase trying to inseminate his ideas into the public marketplace Bipolar people are famous for their grandiose ideas Conservation of feelings hypothesis must be an absolute balance of happy and sad emotions the writer of this is hypomanic he is writing about his experience Society is pushed forward by bipolar people they are visionaries but off base energy to push to believe it s true to get people s attention Bipolar people are very charismatic when they re up II Hamlet associates to the players Act II Scene II The players are coming the tragedians from the city A new fad in the city little boys doing songs and jigs and dances taking away from the great theater of the time When Hamlet is hypomanic Shakespeare lets the thin line between the play and his world fade Self is composed of mental associations at any given moment Hamlet is letting his mind wander he is thinking back to a speech he heard by these players and it comes to mind Shakespeare invented psychological drama Hamlet associates to play about Trojan wars and to the murder of a king with a wife who watches her husband be murdered Shakespeare is saying this is how our minds work if we have a trauma we associate to them Hamlet speaks to the audience His character is abusing himself screaming at himself then he has an idea he is going to put on a play a play within a play III Diagnostic Criteria for Schizophrenia Two or more of the following o Delusions o Hallucinations o Disorganized speech o Grossly disorganized or catatonic behavior o Negative symptoms diminished emotional expression SCZ is a failure of reality testing failure to distinguish between internal experience and external experience o Thought disorders such as Alzheimer s also have failures distinguishing between internal and external reality o Hallucinogenic drugs blur the boundary between internal and external reality o We can enter into artistic experiences and forget where we are Hamlet is having the opposite his artistic experience is taking him directly to where he is Acute Onset vs Prodromal o Acute Onset it seems to happen suddenly late teens early twenties for men a bit later for women Strikes 1 of the population often will isolate themselves when acute onset strikes o Prodromal Onset the person has always had odd characteristics often sociallyisolated and then slides into a schizophrenic episode Know there is something wrong Often the break is brought on by a trauma or even bad acid trips because they are vulnerable to SCZ Positive symptoms o Refer to the mental features which shouldn t be there o Delusions o Hallucinations auditory visual olfactory o Bizarre Speech Neologisms o Inappropriate Affect o Perseverations Clang Associations Clang associations rock shock lock o Violent or threatening behavior o Positive symptoms linked to excess dopamine Negative symptoms o Refer to the loss or absence of mental functioning o Flattened Affect o Paucity of thought o Catatonia restriction of movement o Lack of social awareness o Poor hygiene o Negative symptoms linked to low levels of dopamine IV Case Study Jim Michigan 25 years ago Since he was 14 he started having obsessive thoughts that bordered on delusions o Was terrified of germs would wash his shirt and pants separately and always wore the same clothes o Could not handle physical contact o Everyone in school smelled I smelled them in my mind o Preoccupied with end of the world scenarios building a shelter in his basement TAT a boy looking at a violin o Violin broke boy sad because grandmother might die before he can play for her o His father gets the violin fixed trying to think of what to play o Suffering from a thought disorder he feels broken feels like he can t do what he d like to do for his family his father trying to help TAT an elderly woman o Woman hears noises she hears rooms I mean noises o A ghostly image of her husband in her room tries to talk to him he doesn t listen realized ghost would not hurt her o Knew they were ghostly family members that lived in their house o The ghost doesn t know anything just rocks back and forth doesn t know why o Story about loss TAT dragon and castle o Dragon kills everyone but one man o He kills the dragon by poisoning bodies the dragon was going to eat o Man was sad because everyone was dead relieved that he stopped the dragon Symptoms o Anxiety about being touched o Need to touch things twice o Must wear same shirt and pants every day o Sees things moving on carpet o Thinks about nuclear war continuously o Doesn t want to walk in city for fear of nuclear attack o Socially isolated Consider antipsychotic medications for Jim o Put him on Prozac a mistake o Calls him I brought a gun to school with a plan to shoot over the heads of all of the students in his room to teach them of how dangerous the world is o Went home and smashed his gun with a hammer o Put on antipsychotic reduced his obsessive behavior by 70 o Hospitalized inpatient treatment antipsychotics