Pathophysiology of Mania,depression and Schizophrenia

1. Mental IllnessMental Illness
Depression, Mania andDepression, Mania and
SchizophreniaSchizophrenia
Presented by: Prof.Mirza Anwar Baig
Anjuman-I-Islam's Kalsekar Technical Campus
School of Pharmacy,New Pavel,Navi
Mumbai,Maharashtra

2. What is a mental illness?What is a mental illness?
It is when someone lacks theIt is when someone lacks the
ability to manage day to dayability to manage day to day
events and/or control theirevents and/or control their
behavior so that basic physicalbehavior so that basic physical
and emotional needs are unmet.and emotional needs are unmet.

3. Mental illnesses are not the result of aMental illnesses are not the result of a
personal weakness, lack of character.personal weakness, lack of character.
These disorders can affect persons ofThese disorders can affect persons of
any age, race, religion, or income.any age, race, religion, or income.

4. What is mental illnessWhat is mental illness
like?like?
Mental illness is aMental illness is a
physical condition justphysical condition just
like asthma or arthritis.like asthma or arthritis.
But still society believesBut still society believes
that a person who isthat a person who is
mentally ill needs tomentally ill needs to
show more willpower -show more willpower -
to be able to pullto be able to pull
themselves out it.themselves out it.

5. ……....It is also likeIt is also like
telling a persontelling a person
who has anwho has an
amputated legamputated leg
to run across theto run across the
room.room.
But a person who has mental healthBut a person who has mental health
issue has aissue has a ““broken brainbroken brain””..

6. Mental IllnessesMental Illnesses
in our Communityin our Community
DepressionDepression
ManiaMania
SchizophreniaSchizophrenia

7. DepressionDepression

8. What is Depression?What is Depression?
Depression is a medical issue thatDepression is a medical issue that
affects a persons mood to be downaffects a persons mood to be down
and/or fed up.and/or fed up.
Depression is the most commonDepression is the most common
mood disorder, affectingmood disorder, affecting
approximately 20 million people eachapproximately 20 million people each
year.year.

9. Signs and Symptoms ofSigns and Symptoms of
DepressionDepression
§§ Persistent sad, anxiousPersistent sad, anxious
or empty moodor empty mood
§§ Sleeping too much orSleeping too much or
too little; odd time oftoo little; odd time of
wakingwaking
§§ Reduced or increasedReduced or increased
appetite which resultsappetite which results
in weight gain or loss.in weight gain or loss.
§§ Irritability orIrritability or
restlessnessrestlessness
§§ Fatigue or loss ofFatigue or loss of
energyenergy
§§ Thoughts of death orThoughts of death or
suicide, includingsuicide, including
suicide attemptssuicide attempts
§§ Feeling guilty,Feeling guilty,
hopeless or worthlesshopeless or worthless
§§ Difficulty inDifficulty in
concentrating,concentrating,
remembering orremembering or
making decisionsmaking decisions

10. What factors causesWhat factors causes
depression?depression?
There is no single cause of depression.There is no single cause of depression.
But here are some factors that mayBut here are some factors that may
contribute to itcontribute to it’’s development:s development:
§§ PsychologicalPsychological
§§ BiologicalBiological
§§ EnvironmentEnvironment

11. Evidence also suggests.Evidence also suggests.
Scientists have also found evidence which makes someScientists have also found evidence which makes some
people with apeople with a genetic predispositiongenetic predisposition to majorto major
depression vulnerable to the disorder. However notdepression vulnerable to the disorder. However not
everyone with a family history develops depression.everyone with a family history develops depression.
Some life event that may trigger episodes of depression:Some life event that may trigger episodes of depression:
§§ Death of a loved oneDeath of a loved one
§§ Major loss or changeMajor loss or change
§§ Chronic stressChronic stress
§§ Alcohol and drug abuseAlcohol and drug abuse
§§ Heart disease and cancerHeart disease and cancer
§§ medicationsmedications

12. How does depressionHow does depression
work?work?
The way we respond to situations (withThe way we respond to situations (with
thoughts of hopelessness, anxiety, anger,thoughts of hopelessness, anxiety, anger,
etc.) effects the emotions we feel, whichetc.) effects the emotions we feel, which
in turn, effects the chemicals that arein turn, effects the chemicals that are
released within our body.released within our body.
And all emotional responses have aAnd all emotional responses have a
chemical consequence.chemical consequence. SerotoninSerotonin, a, a
neurotransmitter (body chemical), is aneurotransmitter (body chemical), is a
major contributor in the depression cycle.major contributor in the depression cycle.

13. Depression:
§ Types of depression:
a. Major depression: symptoms of depression that
last for more than two weeks.
b. Dysthymia: experiences episodes of depression
that alternate with periods of feeling normal.
c. Bipolar disorder, or manic-depressive illness:
recurrent episodes of depression and extreme
elation (mania).
d. Seasonal affective disorder (SAD):
depression during the winter months, when
daylength is short

14. Etiology & treatment:
Etiology:
Although the exact cause of depression is unknown.
Re-search suggests that depression is linked to an imbalance
of the neuro-transmitters serotonin, norepinephrine, and dopamine in
the brain.
Factors that may contribute to depression include heredity,
stress,chronic illnesses, certain personality traits (such as low self-
esteem),and hormonal changes.
Treatment:
Medication is the most common treatment for depression.
For example, selective serotonin reuptake inhibitors (SSRIs) are drugs
that provide relief from some forms of depression.
MOA:
By inhibiting reuptake of serotonin by serotonin transporters, SSRIs
pro-long the activity of this neurotransmitter at synapses in the brain.
SSRIs include fluoxetine (Prozac ® ), paroxetine (Paxil ® ), and sertraline
(Zoloft ® ).

15. SerotoninSerotonin
When a person is depressed, theirWhen a person is depressed, their
serotonin level is low, which causesserotonin level is low, which causes
several changes to the body:several changes to the body:
1.1. Pain Threshold LoweredPain Threshold Lowered:: A depressed personA depressed person
feels more pain from no apparent source.feels more pain from no apparent source.
(back pain is very common amongst sufferers)(back pain is very common amongst sufferers)
2.2. Sleep DisturbanceSleep Disturbance:: there are many spikes inthere are many spikes in
temperature throughout the night which causestemperature throughout the night which causes
a person to wake many times, resulting in nota person to wake many times, resulting in not
getting any REM sleep.getting any REM sleep.

16. The Cycle of DepressionThe Cycle of Depression

17. Treatment of DepressionTreatment of Depression
Be sensitive to their feelings, and validateBe sensitive to their feelings, and validate
those feelings.those feelings.
Teach emotion-coping skillsTeach emotion-coping skills::
§§ Acknowledge and express emotions.Acknowledge and express emotions.
§§ Remind the person to challenge irrational thoughts andRemind the person to challenge irrational thoughts and
write them down in a journal.write them down in a journal.
§§ Teach that for every one negative thought they need toTeach that for every one negative thought they need to
think of two positive thoughts.think of two positive thoughts.
Teach problem-solving skillTeach problem-solving skill::
§§ Help determine importance of problem while keepingHelp determine importance of problem while keeping
down their stress and anxietydown their stress and anxiety
§§ Break problem into small chunksBreak problem into small chunks
§§ Remind the person that it is ok to ask for helpRemind the person that it is ok to ask for help

18. Drug Treatment
Tricyclic Antidepressants (TCAs)
since the 1950s effective and cheap
limit compliance variable degrees of sedation
fatal in overdose (except Lofepramine)
dose-related anticholinergic side effects, postural
hypotension
Monoamine Oxidise Inhibitors (MAOI’s)
rare fatalities tyramine-free diet
Selective Serotonin Re-uptake Inhibitors (SSRI’s)
fluoxetine lack sedation - no anticholinergic effects
improved compliance less immediate benefit for
disturbed sleep
safe in overdose single or narrow range of doses
works

19. ManiaMania
(bipolar(bipolar
disorder)disorder)

20. What is Mania?What is Mania?
Mania is part of a condition called bipolarMania is part of a condition called bipolar
disorder, also known as manic-depression.disorder, also known as manic-depression.
Bipolar disorder usually causes a personBipolar disorder usually causes a person’’ss
mood to alternate between symptoms ofmood to alternate between symptoms of
depression and mania, a heighteneddepression and mania, a heightened
energetic state.energetic state.
This mood disorder affects more than twoThis mood disorder affects more than two
million Americans.million Americans.

21. Signs and Symptoms ofSigns and Symptoms of
ManiaMania
§§ Increased physical andIncreased physical and
mental activity &mental activity &
energyenergy
§§ Excessive irritability,Excessive irritability,
aggressive behavioraggressive behavior
§§ Decreased need forDecreased need for
sleep; withoutsleep; without
experiencing fatigueexperiencing fatigue
§§ Exaggerated optimismExaggerated optimism
and self-confidenceand self-confidence
§§ Racing speech andRacing speech and
thoughts; flight ofthoughts; flight of
ideasideas
§§ poor judgmentpoor judgment
§§ Reckless behavior:Reckless behavior:
erratic driving,erratic driving,

22. What Causes Mania?What Causes Mania?
§§ The neurotransmitters:The neurotransmitters: Norepinephrine,Norepinephrine,
dopamine, and serotonin,dopamine, and serotonin, have been studiedhave been studied
since the 1960s as factors in mania andsince the 1960s as factors in mania and
depression.depression.
§§ For example,For example, during a manic episode, clients withduring a manic episode, clients with
bipolar disorder have a significantly higherbipolar disorder have a significantly higher
Norepinephrine and epinephrineNorepinephrine and epinephrine levels than alevels than a
depressed or euthymic (normal mood) person.depressed or euthymic (normal mood) person.
§§ Norepinephrine and epinephrine are responsibleNorepinephrine and epinephrine are responsible
forfor ““fight or flightfight or flight”” responses.responses.
T

23. TreatmentsTreatments
§§ Those with bipolar disorder cannot depend onThose with bipolar disorder cannot depend on
medication alone as a treatment.medication alone as a treatment.
§§ TheThe antidepressantsantidepressants on their own can cause rapidon their own can cause rapid
mood changes which can make manic episodesmood changes which can make manic episodes
worse.worse.
§§ Lifestyle changes and social supportLifestyle changes and social support will helpwill help
someone suffering from bipolar live a normal lifesomeone suffering from bipolar live a normal life
including enjoying a successful career andincluding enjoying a successful career and
relationships.relationships.

24. SchizophreniaSchizophrenia

25. What is Schizophrenia?What is Schizophrenia?
Schizophrenia is a chronic and severe brainSchizophrenia is a chronic and severe brain
disorder.disorder.
It is a disease that makes it difficult for a person toIt is a disease that makes it difficult for a person to
tell the differencetell the difference between real and unrealbetween real and unreal
experiences,experiences, to think logically, to have appropriateto think logically, to have appropriate
emotional responses to others, aspects of memoryemotional responses to others, aspects of memory
and to act appropriately in social situations.and to act appropriately in social situations.
The World Health Organization (WHO) hasThe World Health Organization (WHO) has
identified schizophrenia asidentified schizophrenia as one of the ten mostone of the ten most
debilitating diseasesdebilitating diseases affecting all human beings.affecting all human beings.

26. Symptoms ofSymptoms of
SchizophreniaSchizophrenia
The severity ofThe severity of
symptoms variessymptoms varies
from one person tofrom one person to
another, andanother, and
typically symptomstypically symptoms
will decline andwill decline and
then reappear.then reappear.
Symptoms areSymptoms are
divided intodivided into
PositivePositive andand
NegativeNegative
symptoms.symptoms.

27. Positive SymptomsPositive Symptoms
Positive symptoms are characterized by abnormal thoughts,Positive symptoms are characterized by abnormal thoughts,
perceptions, language and behavior.perceptions, language and behavior.
§§ DelusionsDelusions:: False beliefs/thoughts win no basis in realityFalse beliefs/thoughts win no basis in reality
§§ HallucinationsHallucinations:: Disturbances of sensory perception (hearing,Disturbances of sensory perception (hearing,
seeing or feeling things not there)seeing or feeling things not there)
§§ Disorganized Thinking/SpeechDisorganized Thinking/Speech:: Jumping from topic to topic,Jumping from topic to topic,
responding to questions with unrelated answers or speakingresponding to questions with unrelated answers or speaking
incoherentlyincoherently
§§ Disorganized BehaviorDisorganized Behavior::Problems in performing directed dailyProblems in performing directed daily
activities.activities.
§§ Catatonic BehaviorCatatonic Behavior:: Lowered environmental awareness,Lowered environmental awareness,
unresponsiveness, rigid posture, resistance to movement orunresponsiveness, rigid posture, resistance to movement or
instructions and inappropriate postures.instructions and inappropriate postures.

28. Negative SymptomsNegative Symptoms
Negative symptoms are characterized by restrictionsNegative symptoms are characterized by restrictions
in range and intensity of emotional expression,in range and intensity of emotional expression,
communication, body language and interest incommunication, body language and interest in
normal activities.normal activities.
§§ Blunted (or flat) AffectBlunted (or flat) Affect:: Decreased emotionalDecreased emotional
expressiveness, unresponsive immobile facial appearance,expressiveness, unresponsive immobile facial appearance,
reduced eye contact and body language.reduced eye contact and body language.
§§ AlogiaAlogia:: Reduced speech. Responses are detached andReduced speech. Responses are detached and
speech is not fluid.speech is not fluid.
§§ AvolitionAvolition:: Lacking motivation, spontaneity, initiative.Lacking motivation, spontaneity, initiative.
Sitting for lengthy periods or ceasing to participate inSitting for lengthy periods or ceasing to participate in
work or daily activities.work or daily activities.
§§ AnhedoniaAnhedonia:: Lacking Pleasure or interest in activities thatLacking Pleasure or interest in activities that
were once enjoyable.were once enjoyable.
§§ Attention DeficitAttention Deficit:: Difficulty in concentratingDifficulty in concentrating

29. What CausesWhat Causes
Schizophrenia?Schizophrenia?
There is no one cause to thisThere is no one cause to this
complex and puzzling illness,complex and puzzling illness,
but it is believed that somebut it is believed that some
combination of genetic,combination of genetic,
biological (virus, bacteria, or anbiological (virus, bacteria, or an
infection) and environmentalinfection) and environmental
factorsfactors play a major role.play a major role.
There is currently no reliableThere is currently no reliable
way to predict whether away to predict whether a
person will develop the disease.person will develop the disease.
John Nash, a famous
Schizophrenic. His life
story made into a film,
A Beautiful Mind.

30. What Occurs in the Brain ofWhat Occurs in the Brain of
Someone with Schizophrenia?Someone with Schizophrenia?
Researchers believe anResearchers believe an imbalance ofimbalance of
neurotransmittersneurotransmitters may cause themay cause the
symptoms of schizophrenia. Twosymptoms of schizophrenia. Two
neurotransmitters that have most beenneurotransmitters that have most been
implicated as abnormal in schizophreniaimplicated as abnormal in schizophrenia
areare dopamine and serotonin.dopamine and serotonin.
TheThe ability to produce imagesability to produce images have helpedhave helped
in identifying structural and functionalin identifying structural and functional
differences in a schizophrenic brain versusdifferences in a schizophrenic brain versus
a normal brain.a normal brain.

31. From The Looks of ItFrom The Looks of It
Brian imaging has shown a difference in:Brian imaging has shown a difference in:
§§ Enlargement of the ventricleEnlargement of the ventricle
§§ Decrease in the hippocampusDecrease in the hippocampus (controls emotional and(controls emotional and
working memory)working memory)
§§ Decrease in overall sizeDecrease in overall size
§§ Abnormal development of pre-frontal cortexAbnormal development of pre-frontal cortex
(forehead region; controls information process, motivation,(forehead region; controls information process, motivation,
problem solving, decision making, and thinking speed)problem solving, decision making, and thinking speed)
Schizophrenic brain Normal brain
Ventricles

32. Treatment of SchizophreniaTreatment of Schizophrenia
§§ The acute psychotic schizophrenic patients willThe acute psychotic schizophrenic patients will
respond usually torespond usually to antipsychotic medication.antipsychotic medication.
§§ According to current consensus we use in the firstAccording to current consensus we use in the first
line therapy theline therapy the newer atypical antipsychotics,newer atypical antipsychotics,
because their use is not complicated by appearancebecause their use is not complicated by appearance
of extrapyramidal side-effects, or these are muchof extrapyramidal side-effects, or these are much
lower than with classical antipsychotics.lower than with classical antipsychotics.
conventional
antipsychotics
(classical
neuroleptics)
chlorpromazine, chlorprotixene, clopenthixole,
levopromazine, periciazine, thioridazine
droperidole, flupentixol, fluphenazine,
fluspirilene, haloperidol, melperone,
oxyprothepine, penfluridol, perphenazine,
pimozide, prochlorperazine, trifluoperazine
atypical
antipsychotics
amisulpiride, clozapine, olanzapine,
quetiapine, risperidone, sertindole, sulpiride

33. TreatmentTreatment
With all three of theseWith all three of these
illnesses, treatment, withillnesses, treatment, with
the right combination ofthe right combination of
medications and/ormedications and/or
therapy, can help stabilizetherapy, can help stabilize
the moods thatthe moods that
interfere withinterfere with
a productivea productive
life.life.

34. THANK YOU