Introduction to Psychiatric DiseaseImpactSlide 3EpidemiologySuicide riskEpidemiologyEconomic BurdenDiagnostic criteria for schizophreniaAmerican Description (DSMIV) Diagnostic CriteriaThree Classes of clinical features.Mood DisordersManiaManic psychosisSlide 14DSM IV Major DepressionDepressionManiaSlide 18SuicideEtiologySlide 21Much of mental life is unconscious.Slide 23Slide 24Slide 25Slide 26Slide 27Slide 28Slide 29Slide 30Neuropathology of schizophreniaSlide 32Slide 33Abnormal dendridic spines in prefrontal cortex- layer 3Slide 35Slide 36Slide 37Mood & PET StudiesSlide 39Slide 40Endogenous Drugs of ExperiencePlacebo Example Placebo from the Latin “I shall please.”Slide 43Slide 44Parkinson’s DiseaseSlide 46Placebo effectSlide 48Slide 49Slide 50Slide 51Slide 52Slide 53Slide 54Slide 55Slide 56Slide 57Slide 58Slide 59Slide 60Slide 61Slide 62Slide 63Slide 64Slide 65Slide 66Slide 67Coming up ShortHumans?Slide 7050% of Caucasian population carries one copy of sChild Maltreatment EffectsSlide 73Slide 74Slide 751Introduction to Psychiatric Diseaseand the Drugs of ExperienceJ. Michael McIntosh, M.D.University of Utah2Impact•Mental Illness extracts a enormous toll on the individual.•Mental Illness places huge burdens on society.•The study of neuroscience and how behavior influence CNS function will lead to the best treatments and cures.3Impact•The World Health Organization indicates that of the top 10 conditions that cause disability worldwide, 5 are mental disorders: •major depression; schizophrenia; bipolar disorder; alcohol abuse and obsessive compulsive disorder.•Depression is the leading cause of disability in the world as measured by Years Lived with Disability and the prevalence is increasing.4Epidemiology• Lifetime prevalence of schizophrenia is approximately 1% worldwide.•Schizophrenia is equally prevalent in men and women. •The onset is earlier in men, with peak onset at 15-25 years. For women peak onset is 25-35 years. Outcome for female schizophrenics is generally better.5Suicide risk•Suicide risk. About 50% of all patients with schizophrenia attempt suicide at least once. 10-15% of schizophrenic patients died by suicide in a 20 year follow-up period. •Major risk factors for suicide include the presence of depressive symptoms, young age and high levels of premorbid functioning (especially a college education).6Epidemiology•A disproportionate number of schizophrenic patients are in the low socio-economic groups. • Downward drift hypothesis suggests that schizophrenics move into or fail to rise out of a low socio-economic group. Social causation hypothesis proposes that stresses in low socio-economic groups contribute to the development of the disease.•It is estimated that 50% of homeless people are schizophrenic.7Economic Burden•Financial cost to society. About 1% of the national income goes toward the treatment of mental illness (excluding substance-related disorders). • Schizophrenia accounts for 2.5% of all health care expenditures. 75% of people with severe schizophrenia are unable to work.8Diagnostic criteria for schizophrenia•Different systems are used. DSM-IV (Diagnostic and Statistical Manual) most commonly used in the United States.• It is a clinical diagnosis. There are no diagnostic laboratory tests.9American Description (DSMIV) Diagnostic Criteria•Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): –delusions –hallucinations –disorganized speech (e.g., frequent derailment or incoherence) –grossly disorganized or catatonic behavior –negative symptoms, i.e., affective flattening, alogia, or avolition10Three Classes of clinical features.•Positive symptoms include delusions (false beliefs) hallucinations (false perceptions), and thought disorganization. • Negative symptoms refer to social withdrawal, diminished affect, poverty of speech, lack of energy, and the inability to experience pleasure.• Disturbances in basic cognitive functions, such as attention, verbal fluency, executive functions and memory (particularly working memory). In addition, many patients have co-existing mood symptoms including depression and anxiety.11Mood Disorders• Long recognized disorders. •Depression. Hippocrates (460-357 BC) -“black bile” a state of “aversion to food, despondency, sleeplessness, irritability and restlessness.”12Mania•Aretaeus of Cappadocia (ca. 150 AD) described “mania” “There are infinite forms of mania but the disease is one. If mania is associated with joy, the patient may laugh, play, dance night and day, and go to the market crowned as if victor in some contest of skill. The ideas the patients have are infinite. They believe they are experts in astronomy, philosophy, or poetry.”13Manic psychosis•“The patient may become excitable, suspicious, and irritable; hearing may become sharp…get noises and buzzing the ears; or may have visual hallucinations; bad dreams and his sexual desires may get uncontrollable; aroused to anger, he may become wholly mad and run unrestrainedly, roar aloud; kill his keepers and lay violent hands upon himself.”14•DSM-IV (Diagnostic and Statistical Manual) most commonly used in the United States.•Clinical diagnosis. There are no diagnostic laboratory tests.•Psychotic features may accompany major depression or bipolar disorder.15DSM IV Major Depression•A) Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure16Depression•1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.4) insomnia or hypersomnia nearly every day5) psychomotor agitation or