Psychiatric disorders

Psychiatric disorders
By: * Peter Liddle * Chris Rorden

Disorders of Mind & Brain
* Mind and brain are two sides of one coin; disorders of the mind are disorders of the brain.
* Particular clusters of symptoms (syndromes) tend to occur together in various different mental illnesses
* The ways in which symptoms cluster together tells us something about the structure of the human mind and brain

Anatomy of psychiatric disorders
* Contemporary psychiatry implicates neurotransmitters rather than anatomy.
o Schizophrenia :: dopamine
o Depression :: serotonin
* To some degree, this may reflect the popular treatments – neurotransmitters specific to brain regions.

Major symptom clusters
* Reality distortion
* Disorganization
* Psychomotor poverty
* Psychomotor excitation
* Depression
* Euphoria
* Anxiety

Reality distortion

* Mismatch between representation of reality in individual’s mind and representation supported by objective evidence
* Hallucinations and delusions
* Hallucination: perception with quality of a sensory perception but nor derived form stimulation of a sense organ
* Delusion: fixed belief derived by erroneous inference or unjustified assumption that cannot be accounted for by culture or religion

Delusions
* Delusions usually false but the key issue is lack of rational grounds and fixity.
* Ability to engage in logical deduction about other issues is usually intact; certain ideas seem exempted from the need for logic.
* Non-psychotic distortions of reality (eg in OCD or in non-psychotic depression) reflect biased thinking but are less resistant to debate

Psychotic Reality Distortion
* Can occur in schizophrenia, mania, psychotic depression, brain injury or degeneration
* Themes: persecution; alien control, religion, grandiosity, guilt
* Influenced by culture, but some themes are common across cultures

Reality distortion in schizophrenia
* Characteristic forms (but not present in every case)
* Less specific but common forms:

Affective psychosis
* Mood disorder with psychotic features is diagnosed if psychotic illness is dominated by mood symptoms unless there is reality distortion without substantial mood symptoms for at least two weeks
* Delusions and hallucinations are usually mood congruent (eg guilt, worthlessness, critical voices with depressed mood; grandiose delusions and self-reinforcing halluciations in mania)
* Reality distortion shows similar response to antipsychotic medication irrespective of diagnosis

Neuropsychological correlates of reality distortion
* Reality Distortion can occur in absence of general defect in reasoning.
* Defective internal monitoring of self-generated mental activity (Frith & Done 1989; Mlakar et al, 1994)
* Jumping to conclusions – the bead test (Huq et al, 1988)
* Patients with persecutory delusions tend to attribute negative outcomes to external causes (Bentall, 1994)

Regional cerebral activity and reality distortion
Neurochemistry and pharmacology of reality distortion
Pharmacology of reality distortion
Hypothesis for generation of reality distortion
Disorganization syndrome
Neuropsychological correlates of disorganization
Regional cerebral activity and disorganization
Psychomotor poverty and excitation
Neuropsychological correlates of psychomotor poverty
Psychomotor poverty and brain structure
Neurochemistry & pharmacology of psychomotor poverty
Neurochemistry & pharmacology of psychomotor excitation
Depression & Elation
Mood disorders
Neuropsychological correlates of depression
Brain structure and mood disorders
Regional cerebral activity and depression
Regional cerebral activity associated with elation
Regional cerebral metabolism in bipolar disorder
Neurochemistry and pharmacology of mood disorders
Bipolar affective disorder
Anxiety
Regional cerebral activity associated with anxiety
Pharmacology of anxiety
Concepts of schizophrenia
Reality distortion
Characteristic time course
ICD 10 diagnostic criteria
Aetiology : predisposing factors
Brain structure in schizophrenia
Cognitive deficits in schizophrenia
Pharmacology
Bipolar mood disorder
Genetics
Aetiology of bipolar disorder
Ventricular enlargement
Anatomy of bipolar disorder
Pharmacology of bipolar disorder
Psychopathy
Aetiology of psychopathy
Cognition and information processing in psychopathy

Psychiatric disorders.ppt