PSY 301 1st Edition Lecture 22 Outline of Last Lecture I Psychological Disorder II Difficulties in Defining Disorders III Alternative Approaches to Psychopathology IV Classifying Mental Illnesses V Goals of DSM VI Comorbidity VII Schizophrenia VIII Social Symptoms IX Acute Schizophrenia X Chronic Schizophrenia Outline of Current Lecture I Genes II Dopamine Hypothesis III Multiple Neurotransmitters IV Prenatal Influences V Physiological Reactions to Stress VI Mood Disorders VII Clinical Depression Current Lecture Genetic Influence Genes play a primary role in the etiology of schizophrenia 1 several studies estimate the heritability at 83 2 the more genes two people share the higher their concordance rates a in discordant pairs of identical twins the children of both twins are equally at risk 3 risks are moderate The likelihood of an individual suffering from schizophrenia is 50 if their identical twin has the disease A child adopted away from a schizophrenic parent at birth by adoptive parents who are not schizophrenic has the same probability of developing the disease as a child who stays with the schizophrenic biological parent Starting to identify the genes involved 1 risk of schizo is much higher in people who 2 a rare mutation of their DNA is seen 3 4 times have two specific DNA deletions as often in schizophrenics 3 multiple genes contribute in subtle ways to expression of the disorder Dopamine hypothesis under and over supply of dopamine to the brain is implicated in different types of symptoms 1 Positive symptoms too much in sub cortical circuits projecting from the midbrain to the limbic system and the basal ganglia produce positive symptoms 2 Negative symptoms too little in a circuit that projects from the midbrain to the prefrontal cortex produce negative symptoms Schizophrenia seems to involve multiple NTs 1 excesses of serotonin and glutamate both seem to be involved 2 effect multiple brain areas 3 under the control of multiple genes Structural brain abnormalities 1 swollen ventricles ventricles seem to become enlarged because there is not enough brain to fill the skull a present at first episode but worsens over time b present in siblings without the disorder c not unique to schizophrenia d worse in temporal lobes frontal lobes connections of frontal lobes to emotionprocessing circuits in the limbic system 2 loss of gray matter in the prefrontal regions that support working memory degree of tissue loss seems to be correlated with symptom severity Prenatal influences 1 maternal malnutrition 2 maternal illness schizophrenia occurs more a viral infection during the second trimester 3 oxygen deprivation may interfere with brain the likelihood of expression of a genetic predisposition often in people whose mothers had development in ways that increase Prenatal factors suggest that schizophrenia is a neurodevelopmental disorder a disorder that stems from early brain abnormalities Adult Schizophrenics showed symptoms in early childhood 1 show less positive emotion and more negative emotion in their facial expressions 2 unusual motor patterns including odd hand movements seen as early as 2 3 impairments in social behavior as kids and more likely to show childhood behavior problems Physiological reactions to stress at risk kids are more reactive to stress and have higher baseline levels of cortisol High levels of stress trigger the onset of schizophrenia Family Patterns High levels of expressed negative emotions family interactions characterized by criticism hostile exchanges and emotional over involvement or intrusiveness 1 cross culturally much higher relapse rates for patients returning to such homes 2 prevalence rates in similar cross culturally but illness is less severe and relapse less likely in cultures here this pattern is less likely non Western Mood disorders mental disorders that have mood disturbances as their predominant feature Major depressive disorder a disorder characterized by a severely depressed mood that lasts 2 wks or more and is accompanied by feelings of worthlessness and lack of pleasure lethargy and sleep and appetite disturbances Bipolar disorder an unstable emotional condition characterized by cycles of abnormal persistent high mood mania and low mood depression Dysthymia a disorder that involves the same symptoms as in depression only less severe but the symptoms last longer persisting for at least 2 yrs Double depression a moderately depressed mood that persists for at least 2 yrs and is punctuated by periods of major depression Seasonal affective disorder depression that involves recurrent depressive episodes in a seasonal pattern Clinical depression Lifetime prevalence rates men 7 12 women 20 25 1 prevalence rates are rising 2 all cultural and ethnic groups all economic 3 in the workplace it is the leading cause of 4 about 2 3 who have one episode will have 5 often comorbid with anxiety levels all ages absenteeism and underperformance another episode Diagnosis requires two primary symptoms present for at least two weeks and any two of a set of possible symptoms 1 primary symptoms a almost daily depressed mood most of the day b loss of interest or pleasure in most all activities anhedonia 2 secondary symptoms 1 significant weight loss 2 daily insomnia 3 daily psychomotor agitation or retardation 4 daily fatigue or loss of energy 5 almost daily feelings of worthlessness or inappropriate or 6 almost daily diminished ability to think or concentrate or excessive guilt indecisiveness 7 recurrent thoughts of death or suicide with most symptoms are culturally dependent or without a plan
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