PSY 301 1st Edition Lecture 22Outline of Last Lecture I. Psychological DisorderII. Difficulties in Defining DisordersIII. Alternative Approaches to PsychopathologyIV. Classifying Mental IllnessesV. Goals of DSMVI. ComorbidityVII. SchizophreniaVIII. Social SymptomsIX. Acute SchizophreniaX. Chronic SchizophreniaOutline of Current Lecture I. GenesII. Dopamine HypothesisIII. Multiple NeurotransmittersIV. Prenatal InfluencesV. Physiological Reactions to StressVI. Mood DisordersVII. Clinical DepressionCurrent LectureGenetic InfluenceGenes play a primary role in the etiology of schizophrenia 1. several studies estimate the heritability at .832. the more genes two people share the higher their concordance ratesa. in discordant pairs of identical twins, the children of both twins are equally at risk3. 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 parentStarting to identify the genes involved:1. risk of schizo is much higher in people who have two specific DNA deletions2. a rare mutation of their DNA is seen 3-4 times as often in schizophrenics3. multiple genes contribute in subtle ways to expression of the disorderDopamine hypothesis: under and over supply of dopamine to the brain is implicated in differenttypes of symptoms1. 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 symptomsSchizophrenia seems to involve multiple NTs.1. excesses of serotonin and glutamate both seem to be involved2. effect multiple brain areas3. under the control of multiple genesStructural 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 timeb. present in siblings without the disorderc. not unique to schizophreniad. worse in temporal lobes, frontal lobes, connections of frontal lobes to emotion-processing circuits in the limbic system2. loss of gray matter in the prefrontal regions that support working memory; degree of tissue loss seems to be correlated with symptom severityPrenatal influences1. maternal malnutrition2. maternal illness: schizophrenia occurs more often in people whose mothers had a viral infection during the second trimester3. oxygen deprivation: may interfere with brain development in ways that increase the likelihood of expression of a genetic predispositionPrenatal factors suggest that schizophrenia is a neurodevelopmental disorder: a disorder that stems from early brain abnormalitiesAdult Schizophrenics showed symptoms in early childhood1. show less positive emotion and more negative emotion in their facial expressions2. 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 problemsPhysiological 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 schizophreniaFamily PatternsHigh levels of expressed negative emotions: family interactions characterized by criticism, hostile exchanges, and emotional over involvement or intrusiveness1. cross-culturally, much higher relapse rates for patients returning to such homes2. 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 patternClinical depressionLifetime prevalence rates: men 7-12%, women 20-25%1. prevalence rates are rising2. all cultural and ethnic groups, all economic levels, all ages3. in the workplace, it is the leading cause of absenteeism and underperformance4. about 2/3 who have one episode will have another episode5. often comorbid with anxiety Diagnosis requires two primary symptoms, present for at least two weeks, and any two of a set of possible symptoms1. 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 loss2. daily insomnia3. daily psychomotor agitation or retardation4. daily fatigue or loss of energy5. almost daily feelings of worthlessness or inappropriate or excessive guilt6. almost daily diminished ability to think or concentrate, or indecisiveness7. recurrent thoughts of death or suicide, with or without a plan ***most symptoms are culturally
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